eh-ventilator crisis, aka bagged till you drop....

  da so called "rice cooker" - simple home care ventilator

Our hospital had been facing ventilator shortage since few months ago. I am not sure about the cause… boss had told us during the morning meeting that the hospital is currently under the subsidiary scheme of the health department and every purchase over a certain amount would need to go tender…the tender process would take times… and it had been sometimes after the meeting and the condition had become worse during the Chinese new year…there was this 15+ years old Drager Evita ventilator posted in our ED. However due to shortages, the ventilator was moved to the ICU.

I had did a few resuscitation with the aid of ED. In a small hospital, we had limited staff to manage the CPR scenario. 1D2N in the night and with 1 person on the chest compression and 1 person on the BVM, the other would have to act as runner for the drug administrating and charting.

No one seems to care and whenever I saw there the Drager Evita was not in the resuscitation area, I prayed very hard. The LORD is indeed full of mercy as I had escaped and had enough sleep on most of my shift. However I finally hit the rock few shift ago. It was a bad night – the ward was calling and patients kept coming to ED as if it was free of charge. The ICU had informed that a patient had been experiencing shortness of breath. I ordered an ABG and it revealed a mix respiratory and metabolic acidosis. The respiratory therapist had told me no ventilator was available not even a “rice cooker”. I ordered some sodium bicarbonate and told the nurses to review the patient later. By 3am, the nurses had told me that the patient had again noted with dyspnea and this time, stridor was heard. I told myself – what the heck...I had to intubate him. I passed on a tube without difficulty and told the nurses that we would take turns bagging the patient. Each of us bagged for 15 mins. It was 2 hrs later when the patient was stable enough to be hooked onto a T-piece…

Sarcastic episode – during the early 2000, when I was doing house officer call in my home town general hospital, I had intubated a COPD patient who went into failure. I remembered the medical officer yielded at me telling me that there was no ventilator available and I should have “ask around” before I passed on the tube. That night, the staff nurse and attendant bagged the patient with me until morning…

Yet, I had recreated the scenario ….some had come to me and asked me why I joined the bagging – I told them that I make the decision for intubation and I should be responsible for the consequences…..Another yet – the management still pretend their “so far so good” attitude….until last week…

The was this 80+ years old male who was sent to us by the local ambulance, noted with a forehead laceration. He was unable to tell me how he had fallen despite being asked specifically about the event. I ordered a brain CT and a large subdural hemorrhage was noted. I called up the neurosurgeon as usual and after informed him about the case, I told him no ventilator was available. He asked me to try to “squeezed” one out for him. As usual, nothing can be “squeezed”…. The only option was transferred the case out and I told our surgeon about the result and he had wanted me to talk to boss again – boss was informed prior to my call. When I called up boss- he told me no problemo, 2 ventilator is coming in by noon….really need some kicking from the cash cow….

That ended the ventilator crisis…

cat feces coffee... ( not luwak)

actual kopi luwak bean....RM100 / cup ..

the management had held a few coffee meeting with some staff just before the Chinese new year… Workers and nurses from various departments were invited. The aim of these meetings was to inform the staff about their poor performance and indirectly telling them that their bonuses would be reduced.

 

The coffee meeting reminds me of a film – “Corrupts all Cops”, directed by Wong Jing. It stars Tony Leung Ka Fai (Lak, chief of sergeant major HK police force) and Anthony Wong Chau Sang(Tang , senior ICAC agent). It was one of the non-comedy film done by Wong Jing recent few year. The role played by Tony Leung was actually a projection of a legend of HK police back in the 50s[another similiar film was starred by Andy Lau]. Tang(starred by Anthony Wong) was a corrupted cops which later recruited by another ICAC agent in charge (starred by Bowie Lam). On the first day of his job, he had asked the junior ICAC agents to buy what ever coffee they could get. One of the young agent choices of coffee was selected as it had a taste of cat feces.(not kopi luwak of coz, as the agent claimed that he used it to fertilized his plant) - Tang vomiting on the spot when he drank it....

Indeed the coffee offered during the meeting does not have such taste of cat fxxxx, but it as hard to swallow as the cat fxxxx taste stuff….

No one had seen their own “prestatievorm”(borang prestasi, performance form). No one knew who did their evaluation. One of the therapist had voiced out – “I was never late for work, never reported for any accident/fault during my job, never absent from my job and why was I being rated as underperformed….”.  The reply from the key person(newly appointed you know who…) had replied her that, “ you know, you are attending a course that distracted your focus from you job, that was why you are rated so low….”. The therapist had asked the management regarding her part time schooling during her intake interview and the management claimed that it would not be any problem … and now the management had used it as an excuses. And the worst part was no one had come out and admitted that he/she was the evaluator regarding the poor rating.

The result was a save of money (both bonuses and salary) as some of the staff had opted to resign. Some had opted to play rot on their job – the surgical aides had started to do everything in a very slow tempo (all 3 of them were summoned for the coffee meeting)….

I did not make it to the list and got the bonus cheque as I expected....

License run.....

I had just came back from a trip to Malaysia…

Not really a holiday trip – I had to re-apply for my driving license. My Malaysia driving license had expired a long time ago (back in 2004). I lost the original copy during a trip to the KL tower and I did nothing – stupid and lazy of me…Later I learnt that the only way I could get it back is to re-sit the examination. I could be exempted from the paper test by writing to the Director General of the Road transport department... Who got the luxury time to do that….It had been bothering me for the past few years.... the only place I could drive is Taiwan as I had no international driving license...

I finally found that I could get back my Malaysia Driving License by converting my current Taiwan Driving license. The Malaysia govt. allow such conversion (non-automatic of coz...) by writing to the DG of RTD. 

I need to translate my Taiwan Driving License into English. This was the trickiest part – The translation would need to be certified by the representative office of Taiwan in Malaysia and I need to go down personally to do it (there was alternative way by getting a authorized letter from the local court house/notory public…but I still need someone to ran for the errant of certification for me in Malaysia ….).

The 1^st part was getting a good translation example of the Taiwan driving license. I glanced to the net for months and finally got a good translation for me to use…

http://roc-taiwan.org/public/Attachment/09281393071.doc

It really took me sometimes to get this document….

The rest of the procedure was simple – 2 trip to the Taipei representative office in KL – submission and retrieving the copy, 1 trip to the Putrajaya RTD office.

The process went smooth and there would be a 3 weeks waiting before I got my approval letter for the re-application of my driving license from the DG office.

Apart from applying for the driving license, I would apply for an international driving license….a voice told me that I would need it in the near future….

1a2b....

A = arrow, B = bird


I went to this annual lunch meet organized by the local govt. clinic. I was reluctant to attend the lunch as it was held on Thursday noon.  I did the Wed night shift and went off by 9am after the morning meeting; reached home by 9:30am. If I would attend the lunch meet, I would have to leave home by 11:00am. The lunch was held in a secluded mountain side – restaurant run by a local aborigine chief, 40mins drive from my house and I don’t like to be late.
The former Dep. Supt. Had told me that I “must” present just to make the scene look nice – as I was the only specialist supporting the program available; Lem was attending the ED, Voon’s chest OPD would usually ran late to 1pm.
Boss had reminded me again after the morning meeting and I could not escape the invitation.
I arrived early and meet others during the lunch. The food was nice and Boss arrived late. After a few rounds of glass tossing, Boss had told me that he had something to discuss with me. I thought it was about the salary review…however I was surprised when boss offered me a day time job(no night shift…). He told me that he would reassign me to the ICU and work only day shift. I did not cheer up instantly as I knew the offer would come with a “BUT”. Yep, I was right, about the “BUT” : I would need to covered for Ong night shift when Ong is not around( Ong took a leave of 2-3 weeks every 6 weeks of work. )
Boss had told me that he had found someone “well trained” and this guy worked only 180 hrs in ED per months. He would “take over” my shift and I would only need to covered part of Ong night shift when he is not around.
His word irritated me – the usage of “well trained” means that I am not well trained so I need to make way for him….I told him, I would considered his offered and I asked him what if Ong retired (Ong had talked about it for a long time) – Does it means, I had to come down to take over his shift(Tue,Thrs, Sun night shift) which were worst that I had (Mon, Wed night shift and alternate Sat night shift) I told him that I had no intention to grab a rock and crushed my own foot, Boss had reassured me that this would not happen, but he did not raised any plan to resolve my question.
He told me the ICU would be covered by T(CV man) and me if I agree with the arrangement.
I rejected his offer few days later stating that I would remain in ED .
I had a chat few weeks later with T and he told me that the management had wanted him to do full time in ICU. He had been holding the title as ICU director for years. He had however recommended me to boss. It was an arrow for 2 birds strategic should I have taken the offer. My paid would definitely be cut as I don’t do night shift most of the time. I could be a valuable asset to ED as I could covered for any night shift with no problem (and the pay is less…) – I would have no excuse to reject any request for ED night shift as I would be the only one without any fixed night shift….
I later found out the well trained guy mentioned is a urologist working in ED somewhere nearby… he was just probing around asking here and there and boss took it for real….however I thanked him for letting me to see the scenario in depth…..

tidal wave....the beginning...

 

Ong had finally decided to leave….his daughter had filed an application of PR for him in the States. He had told me few months ago and finally he had opted for retirement. Well, Boss had asked Lem about roster problem and told Lem that he would sought the problem out.

The incoming of the board certified emergency physician had caused some ripple effect in the department. Prior to the new year holiday, I had had an encounter c the newly appointed dept. Supt. Of admin regarding the roster of govt. clinic. I had raised the question about the readjustment of my salary scale. The Dept. Supt. Showed me a “??” look and told me, “ I thought your all had settled with it, the roster seem fine to me…”. I asked her to exam the document regarding our last discussion; it clearly stated that my salary would be reviewed once an ED physician joined us. She clearly rejected my request while holding the “black and white”, she told me I should sympathized the situation of the management…. Really pissed me off, I told her that I am the only doctor who present on everyday of the Chinese new year holiday. We decided to settle the roster doesn’t mean that I forfeited the right for salary revision. After all, there is > 10k RM different between me and the ED physician. There is no hospital I knew that had such different.... It was 10 months ago, when the first crisis noted in ED – both of the locum guys left and Boss had padded our shoulder and told us that the different of the ED license would not exceed 3k RM, max is 4k RM and now, we should sympathize and tolerate ?

Well, the doctor number had reduced to a critical level with the leaving of Ong, another further reduction of doctor would made the hospital reduction of 10 beds/doctor. There is a rumor that our orthopedic surgeon is leaving in May……Things would be very ugly by then….

Lem told me that he would arrange a meeting with boss....I am not the optimistic regarding the discussion but would see how thing go and decide my future....

Injustice....

I had not been blogging for sometimes….domestic disturbance mainly and later interlacing with some formal business….

So many events had occurred during this period…The dep. Supt. of admin had finally resigned. He had been objecting many “event” regarding the new building. There were some under counter stuff going on (violation of the construction act), which he did not approve, however such hanky panky stuff were pushed through by the maintenance manager (he was a real veteran to the hospital). The dept supt did not want to loss his pension and opted for a “Demotion”. Initially he was told he would be in charging part of the supervision new building but later his was designated as head of medical service. He had faced many of difficulty starting with finding a desk. He finally settled down in the registration officer.

The new dep. Supt. of admin(promoted from the position of nursing director) had asked him about what was his expectation about his salary. His formula was simple – ex salary minus the dept supt subsidy. However the amount was 1/2 less when he saw the figure….

He had decided to quit later on walking off with part of his pension….

 

Sad to see a man of justice leave….  And this only part of the injustice occurred within this 6 months….