cut throat...

a boys and men dream item...nevery knew when it  will come in handy...

It was tiresome day…. Ong had gone back for his routine escape , I had a rest of 17 hrs before I returned to desk of ED. I did not had a good rest after the 30hrs shift: the shift was considered moderate with a sleep of 3 hrs. However I had to prepared for a talk in the school. It was not mine actually. Ving had planned for sharing experience regarding the hunger 30 activity organized by the worldvision with the children in the school. Initially the talk was limited to Xian and Yun class. Yun had invited the supervisor of the local worldvision office to present some film and talk to the children. My only part was to edit a short clip of DVD for them to present(extracted from the 2009 hunger 30 special). However Ving told me that she made a mistake and she was supposed to attend the “Rainbow mother education class” in another school. She was unable to make it to the morning session…..so I had to replace her for the talk.

I had to say yes as everyone was prepared for it….

6 hrs before I went off on Tuesday. Ving told me that the talk had expanded from 1 class/talk x 2…The whole second grade is coming …I was only 1/2 prepared….it was hell night as I had gone to sleep as 2:30 am and wake up by 6:am…

The talk was a success but I was over stressed…

I was hoping for a easy call…

The patient came in about 7pm – terminal stage esophagus cancer patient , complaining of shortness of breath and coughing blood. Cachetic and hypoxic, a taxi driver brought him in. No family around. I decided to tuck him into the ICU. I ordered some blood for transfusion and after a 20min trial, the nurses finally gave up and asked me to insert a central line. He was quite dyspneic but I was reluctant to intubate him. I inserted the internal jugular line at a sitting position(yeah, with me standing on a stoll!!!).

He seems ok when I sent him off, but 5 mins later, the ICU informed me that he had gone into arrest.

I rushed to the ICU and took over the resuscitation scene. The ABG was readied when I resumed the intubation position – darn, a mix respiratory and metabolic acidosis. I ordered a large dose of sodium bicarbonate. The intubation was smooth until I tried to pass the tube. There was a big clot of blood over the opening of larynx and I had a real bad feeling about it – blood clot or tumor????? I got the answer seconds later. I failed to push the tube through.

I hesitated for 2 seconds before I told the nurses to prepare a suture set and a scalpel. One of the nurse asked me , “?why ?”… the respiratory therapist answered for me- “we are going to do a tracheostomy”…yeap... did not want to do a cricothyroidectomy…there would be no one to sign a tracheostomy and the patient would stuck with the supposed temporary cricothyroidectomy for the rest of his time, if he is “unlucky” to make it….

It was another 2 minutes(seems for ever to me…it is my no 6….) before someone had scrubbed the patient and I placed my incision…the tracheostomy tube was inserted in less than 10 seconds….he was hooked onto the ventilator – within minutes, we got a pulse.

This is the first time, my tracheostomy patient survive through the CPR...

I saw him today – laying on the bed breathing smoothly…..

it was a milestone for me.....

 

out of the jam but stranded.....

 

Lem was in a good mood when I stepped in to the 175….That could only mean one thing – he had a good call last night. He had bad call most of the time being called every 15-30 minutes. I took a detour and was lucky that did not strand in the jam; I arrived 20 mins earlier. I had a good chat with Lem.

He broke out the bad news…of the 4 ED physician called up – none of them is coming. The senior one told boss that his wife disagreed because our hospital was too far away from Kaohsiung. The rest of the 3 junior ones said, they don’t want to cover the wards. Our dept supt had told Lem that the management had no plan of hiring any night shift locum at the moment… no plan my ass –even if there is any plan, they won’t be able to get anyone. Two larger hospitals up north had been advertizing for the past 5 years and not even an interview was done. One of it had been head hunting me for the past 3 years- the initial pay offered to me had increased 30% since the first approach.

I had been looking forward to the arrival of the new colleague and new roster but it seems that I am stranded...

karma.....

It was my third encounter with the so called principle minded obstetricians.

I had this 19 years old girl who presented to ED with massive per-vaginal bleeding. She was using a towel instead of a pad. Blood stain was noted from the pants…

I did a quick assessment – she was in early shock stage with stable BP but her heart rate was 110/min. A G1P0 at 9 weeks. She was not married and another young chap came in with her. She told me that the chap was not the father and the “real McCoy” was somewhere up north. As she was at this grey area of 19. I told her that I need to contact her parents.

In Taiwan, one is considered adult at the age of 20(civil law)  but would be responsible for his act(Criminal offense) at the age of 18 (as stated in the criminal law). So 19 is consider as minor and I need to do my job. She is aborigine and her guardian was the nanny. Nanny usually can't make any decision as most of them are not educated or japanese educated....I asked her if any other senior relatives was available and she gave me detail of her aunty.

While the nurse was busy proceeding with my resuscitation orders, I called up the aunty and she told me that she would come over to sort things out. As we don’t have any O+G specialist at the moment, I had to transfer her. I called up my ex-hospital and one of the senior nurse took the call. She asked me to call her back 5 mins later. A question mark popped up above my vertex but I complied. Minutes later, I called up again and she told me that their obstetrician rejected the case stating that it is against his religious. I thanked her but cursed as I called up another hospital nearby. I finally sent the girl out before her vital sign crushed beyond my resuscitation abilities.

  
3rd encounters of such kind and I questioned about ethic of these so called “religious orientated principle upheld obstetrician”…. I believe most of these obstetricians are devoted to Buddhism, but their practices of “no-do” of any D&C is really way against the ethic of a doctor. In a case of incomplete abortion, the embryo is deemed to be aborted and the D&C(for the incomplete abortion) in a sense is a life saving measure. By not doing such procedure, such devoted doctor was actually endangering the lady’s life…endangering other people life – so that one would not create any karma ?  a queer concept….but my future O+G colleague is one of this kinda of person(my 2nd encounter….), I am lucky as the nearest O+G facilities are 20km away…

G-shocker....

I had been a G-shocker since my college days – inspired by my brother---- a truly techie(currently serving as  managing director of an European Firm in China) on his job and life. He had taught me a lot….

I was attracted with G-shock (durability and looks) since then. My first 2 G-shock watches had plastic belt. I lost my first one during my Malaysia housemanship and bought another one. However the plastic case started to wear off and piece by piece slogged off…. A disappointment as I thought it was very durable, I told me myself, next time, maybe a G-shock with metal case.

Years later, I saw interestring an ad over the net featuring a football player with mud and a Gentlemen in suit…both of them wearing the MTG tough solar series. I was attracted by the ad - everything I need, metal case G-shock with solar ….

I started to eye for one and it cost 8k…Later I picked up one in the Costco with the tag of 6+k…

worn off... but still look great....

The MTG series is just inferior to the highest grade MRG series… My watch was unfortunately the 1^st batches and later the battery become to degrade. I had the battery replace years later(during my Z EDS upgrade). It is currently still in service and running well… But the stainless belt made it appeared a little awkward when I wore it during my bicycle ride.

I had no idea at all initially as I recalled the problem with the resin/cloth watch band – smelly residual after you sweat heavily… The metal band was the only solution and “all” the metal bands are stainless steel/gold/alloy band are mostly silver or gold in color... Until lately I came across the Protrek series – The was this black titanium band (metal band which is black in color). It was easy to decide which feature I need : A double LCD model was my call as the compass would be simulate on the LCD. That left me the choice of PRG 80 and PRG 200…the differences : thickness 1.4cm vs 1.1cm … the 0.3cm cost about NT3k… I had struggled a bit initially but decided to take the PRG 80 YT.

the case is bigger then the MTG the black color give a false appearance that it is a resin band...

I had thought of buying a good mechanical watch and later pass it along the line, but watches are not for ever –what the heck let them buy the one they wish when they could afford….I still keep the Orient Quartz watch given by my father when I came over here for medical school – it is still running and I wear it whenever there is a formal function(MTG is just too “Tough”…), an nostalgic feel whenever I wear it...

East coast tour - the journey

The trip started late and according to the google map – the 120km drive would take about 3:30 hrs… well, the Z is definitely a good car to drive over the curvy mountain road. I managed to got there by 3 hrs. Could have done it by 2:30 but was a delay but a long queue during the journey.

We got to the hotel and hit the pool – the was the hot spring (41°C) pool and small swimming pool. Yun and Xian was darn happy with the 1+ hr dipping. We did not have dinner around the hotel area but took a ride to the train station not far away. There was this night market going on… we had some budget steak and hot plate noodle – very cheap but tasty one…

The D1 ended early as all of us were tired after the "dipping"…A hot spring spa really relax one nerve and muscle.

We got up early the next morning – the breakfast was awesome in contrast to the price.

xian with his toast.....

However I was worried that it would be a waste as the boat ride might be very rough.

It was an exciting day for me… everything needs to be on schedule… We had a boat at 9:30 to catch and I had to rely on the GPS to get there.

at the quay...

We arrived in time and the boat ride was bloody rough(just like the pirate ship ride in the fair park). Yun had vomited x 3 but Xian and Ving went through it.

before the ride turn ugly...

The rest of the journey was smooth and we reached the ocean hot spring by 4:30pm.

taking a rest and sips...

We had another “dip” again – hell of a experience….salty hot spring spa. We left the spa by 6:00pm and the sky was getting darker. The evening ride was so beautiful with the sun setting just beside us. There was where the torch light came in handy.

The 8km ride took us 1+hrs and we finally got had our mutton hot pot dinner…

waiting for the dinner....

The sea weed ice was another unforgettable treat….

ice..ice ...ais...ais....

By 10pm everyone had sunk into the bed….

East coast tour - gadget

 

I recalled my old high school days – my mother had a good old Raleigh bicycle.

similar model -when I rode it , it was 20+ years old...

It had night lamp powered by dynamo. A dynamo shaped like a small bottle and it make a loud ‘WoWoWo’ when it was engaged to the tire. It really slow one down…..The light was darn dim even the street lamp was brighter. However when it is a useful gadget when one go through a dark alley. During my form 5(senior middle 2) year, the dynamo generated lamp had guided me during the journey to and fro from my house to the school for the night SPM class.

However to ride on a mountain road of an island, I need sometime brighter…

	the LED was truly brighter than the traditional lamp.... the front torch was powered with 3 AAA and the back lamp was powered by CR2032 button battery..

The experience was truly fascinating…. Ving was leading the team followed by Yun and Xian. I had to be last rider overseeing the team. Few more islands to ride and they would definitely be handy in the future….

unsure path...

I had chatted with few of the medical college undergrad months ago. The govt. has planned to shortened the medical school tenure from 7 years to 6 years. The 1^st stage of the project is to lengthen the training of current Post Graduate Year(PGY) program from 6 months to 1 years. I was the 1^st batch of PGY trainee – the initial training was 3 months (1 months posting in Medicine, Surgery and Community Medicine eacg). The training was not that solid as there was no general medicine and general surgery ward at the time. However I felt the medical ethic part was good. I got a certificate which stated that I had passed the PGY training. According to the Dept. of Health, if the PGY training length had changed in the future my training would be valid though.

 

The training was later lengthen… the worst part was it was incorporated into the specialty training – there were a lot of resident training program that lengthen from 3 years to 4 years due to the PGY training. However start from next year the training would be different. There 2011 batch of medical graduate would be enrolled into the PGY training for 1 year and they would start their resident training 1 year later. The juniors had told me that their salary would be fixed at 40k – 50k during the PGY period. A very bad news for the foreign student – the entry salary for a foreigner(white collar) should be 54k at least! So if no modified criteria are added, our junior would be unable to secure a job. If the training of ED is shortened from 4 years to 3 years, I would considere taking up a training post instead of a medical sub-specialty….

Actually the training environment is the most important part of the program – appropriate ward should be set up – proper exposure is warranted. Doctor’s eye were flooded with money: ENT surgeon claiming that they could handle myocarditis and meningitis and influenza with complication. (How many months did they rotate to peds wards? Murmur ? assessing pulse volume ? ) ED physician who had conducted limited delivery and I guess most of them won't have the guts to come forward facing a lady in labour on a public transport….well, on the paper the training seems to be advance but the basic skill is tracing backwards….a pity….

 

 

inbound ....

 

3 weekend call starting from now… 30hrs shift is considered as in-humane but still have to coup with it.

A few board certified ED physician had called up and the hospital is planning to get 2-3 of them. I am not shattered nor worry as life would become better. 2 more months to go before one of them reported in and the other would be coming in after the Chinese new year(CNY). CNY is definitely an important date as the annual bonus would be distributed before the eve. Most of the working people would leave after picking up the extra cash. Anyway, I would be getting an adjustment (increment to be exact) and shift would become less....

A little bit tired for me as I am riding quite a lot lately…..

Milestone...the 10th

It was one of the memorable week – a new member to the family tree line….My brother got his second child….Congratulation ….

Well, my parents would be happy … there is less than a handful of living member in the family – the number had increased to 10….a real milestone in the family log…

 

Slides

It was lecture week for me…I had done 2 lectures, one for the EMTs and one for the high school teachers. It is an extent of my first aid teaching life…back in SJAM I had tried very hard to fulfill the duty as a medical officer. The slide part was the hardest however after you complete one, it would be simple for me to present it. I found that picture and photo is one of the key to the success of lecture. As most of the students would fall asleep if the slide is fill with words(my very own experience). Back in those days where the google was not the “shrine of search”, I had had to scan the photo myself. However nowadays, most of the photo were “googleed” Only a few amount of the photo was taken(yeap with my SE cybershot). Life was more easier than however the photo searching task still took up most of my time… I had prepared 6 pcs of slide back in for the EMTs(it was a whole day course). I like to put in some “ bloody” photo as it could truly attract the audiences.

The slide preparation is really a technique that needed to build up. The background actually is the hardest part – choosing the background would depends on the lecture place. Use a white base if the room couldn’t be shaded. If a dark room is there than a blue base/dark color base is suitable. One of my college’s lecturer had taught us this basic concept (of using dark/blue base slide in the dark room), later I knew that dark/blue base slide could not be use in a brighter room (very blurrrrr).

I had learnt a lot all the way and trying to help Yun to build up the skill as well(that was school teaches a 4th grader...)

East coast tour - prelude

After the rearrangement of my shift – I would have 2 weekends to enjoy per months. I had always been a outdoor person and I want Yun and Xian to be so… Yun had changed a lot, I remembered few years back, whenever we go on a trip, she would ask me what kind of hotel(how many stars !!1) we would be staying in (in fact she still does, but she would omit the stars part). She had learnt the path of humble life slowly. There is 5 weekends this month and I was scheduled to do the 1st, 3rd and 5th weekend. I was planning for a bicycle trip, but I was greedier than ever- I planned for a Jin Men Island trip – one of the airlines had offered bicycle transportation. I was interested and “google” whatever info I got. It was a frustrated one as the the YJ 256s was 130cm long- 20cm longer that the upper limits.

Giant YJ 256(currently in service)

However I had the feeling of doing another round the island trip – so I switch my focus, there was this island just outside the east coast: GREEN ISLAND. It was a good choice the island is small- round trip was 20km. A boat trip from the pier takes about 50min. Everything seems fine so I planned a 3d2n trip. We would take off in the afternoon and put up a night in the famous east coast hot spring area. On D2 we would take the boat at noon and start our round the island trip. The planning phase was smooth; I got a 4 person room in the hot spring area with the price of 2880.

the Tong Mao Hotel.... chain	hot spring pool - swimming pool like...

I got a non-package room in the Green island, it cost 1600 with a great view.

great view.....

The most important part is – CLEAN(review from the net by some backpacker said so…). A package in Green Island would include a motor bike, snorkeling and meals. The hot spring stay was an excitement for Xian as he was looking forward to a play in the swimming pool… There was another challenge was us – night ride … There was this ocean water hot spring on the Green Island – only 11 countries in the world had such hot spring. We had planned to dip in it and the most suitable time to do so was in the evening. My plan was to reach the hot spring by 4-5pm and enjoyed the natural gift. However the hot spring is 8 km from the place we would be staying. That means we would have to ride in the dark. A good opportunity to expose the 3 young riders(have to count Ving in) to the night riding environment. The preparation was expensive – I had bought 4 LED torch light (650 each minus the rechargeable batteries). Back light was also neede(440 each). The results are astonishing as the brightness was truly amazing.($$$$$ of coz...) We took off as planned.....