no where

I was summoned by the dept supt of admin 4 days ago and we had talk about my job review…

She had prepared a memo, comparing my paid per hour with Lem. It revealed that the different was 100+ different. I got paid more than Lem. I told her that it is truly unfair as Lem only day shift and he got 4 week end off and I work mostly night shift and I had to cover for 2 weekend.

Truly unacceptable… She then told me that the pay of board certified ED physician had risen to a sky high level as someone had manipulated it. I told her that is true but that is the market price. I told her if the hospital think my pay is a fair price compare to the market, then the hospital would easily hired a handful of people like me…I said I would gladly place my resignation if the hospital could hire someone with the price they paying me…

I told her during the 1^st negotiation, I had told the management that if they agreed with the figure I requested. I would not care whatever they pay others in the future. However they had bargained a 15% less figure and told me that revision would be done if any new ED physician is recruited. The dep. Supt asked me if I would accept the previous figure, I told her “definitely not”… I had waited and I request a fair wages….

The discussion ended up no where as she could not make any decision… further discussion to be done next week....

not prepared...

 

The quake and tsunami of Japan had truly shattered the world….The ED staff had a small discussion on it…It is not the quake that frightened us, it was the nuclear reactor crisis. We had always been the 2^nd level rescue hospital however the equipment and training we had is far away to manage a true disaster. What we had gone true focus on managing 2 patients – yes, 2 patients at a time. We were always allocated with 2 patients…we had never given the scenario with a massive suspected contamination. Even though the no 3 plant is 60km away, but we never prepare for a true disaster. We had drilled to duel with incident only.

Everything we had are merely on the paper…there was this massive food poisoning incident happened in KH county(now part of the KH metropolitan), the responsible hospital where the famous KXXMH and the handling was bombarded severely during the post mortem…

The final conclusion is we are not prepared…..

Some columnist had commented vigorously on the subject but most of the them were only partially right – still, everything is think and then said, no where better than a paper drill….

The hospital had not discussed it as the area is relatively safe from any immerse disaster. But there was this report that caught my attention.

The manila trench is currently a real threat to the southern part of Taiwan. If there is any earth quake occurred in that region, there would only be minutes before the tsunami would hit the southern part of Taiwan. The place I stay is relatively safe – 10+km from the nearest coast line. The Japan Tsunami wave had stormed 6km into the inland. However the hospital I worked in is just along the beach….

Hopefully the hospital building is strong enough to survive the wave…

UXO

UXO , aka - UneXploded Ordnance

It was a queer period in the past…. Boss seldom talk to me nor discuss with me...I presumed it was due to the shift….

A discussion was done today... I dropped the BOMB...

 

 He was not surprise when I told him that I wanted an a review for my salary and shift…

I told him I had been 3x tumor terror( the latest one was a mass over rt parotid area…)… I was lucky that I slipped through…

I told boss that I am willing to have a cut on working hour if we could get another ED man to come in. I would “tie up” my working hour with Lem – both of us would work only 360 hrs (so 360- his working hour would be mine). In such case, the rest of 360 ED hour would be shared by the rest of the 2 ED guy.

Boss had told me that recently they had approached a doctor but did not successfully recruited him… I could understand the reason – most of the shift offered was night shift – (a usual ED man work 7d8n or 8d7n per months), but with Lem on most of the day shift, we had only 8-10 days shift to split among the rest of us… The other reasons was the working hour – with lem working 220+, there would be only 140 to be allocated to the new comer.

My suggestion help boss sought out this 2 issue as I told boss that I am willing to do all night shift with a working hours of 140 only. BUT I want an adjustment…

I told boss I got paid 30% less and it is unacceptable as the most of the hospital difference was only 10-15% less.

Boss mumbled a little bit about the current situation…he had hinted me that there is problem with the shift at the moment and I told him in a polite way that I need some weekend as I need to go the church and currently I am getting 4 solid days off only…

He told me that he would get back to me later on…

I knew his strategic and he would definitely try to talk me into sharing all the weekend with K.

I would not walk into the trap, my last move would be resign…

The hospital is in no situation to loss any one further as 2 doctor would be leaving by the mid of May. The hospital was unable to get anyone new coming in. The radiologist from centre of Taiwan had rejected the offer after some friendly dinner and lunch meet….

 I am not trying to push the limit of the management and squeeze whatever I could. I seek only fairness and a cut off working hour.

If the negotiation comes to a good end , I would be getting another 15% raise or a cut of working hour by 30%...either both I gain. But I am prepared if the LORD is sending me on a training path earlier that it should be…. I had to wait and be patience….

 

Wild goose chase...

I  had submitted the application of my foreign driving license conversion(non-automatic) to the JPJ at Putrajaya about 30 days ago… a dreadful wait for me...as far as I knew no one had ever been rejected, but still, the waiting was real pain.

I finally decided to called up the JPJ office yesterday morning. An friendly officer took up the phone and she told me that my approval letter was sent the day before.

I called up my brother in law and he told me he had just received the letter and heis going to the local JPJ office to summit the application…

Well, I got a call from him hour later and he told me that everything had been settled but I would need to supply him with a passport size photo for the international driving license. AND the cost was RM 150….PERRRR YEARRRRR…

I logged on to the JPJ website and saw this page that really make me tears...

Well, I look up the Taiwan transport department and found that the International driving license of Taiwan is only RM25 and valid to the date of current driving license…and anyone (including foreigner) with a Taiwan driving license is eligible…

What the HXXK…  a wild goose chase for me, but at least I got back my Malaysia driving license…….

 

the p and the t....

I had a small chat with one of my colleague while inserting a pigtail for his patient…. He told me that my ex-boss is quite unhappy with our new ED physician. The new comer had worked with my ex-boss for over 10+ years…. He had left and my ex-boss is left with a big hole in his roster…. He is currently manning 2 hospital – very short of ED staff. So it would be a tough competition in the future…

I am looking forward to it as I am going to had a discussion with boss about my salary. I had thought it over and written a memo to boss. It was Sunday and I put it in Lem overall jacket. He however did not pass the letter to boss. He told me Boss was not in a good mood as one of the family is unpleased with the outcome of a patient….. Lem to me to speak properly to boss and when I told Ving last night, she told me she had a feeling that I should hold that matter for a while…after all I had waited so long….What the HXCK…just another week or two, pray really hard to the LORD and see what path he would be leading me....it is not just only patience but also tolerance....

ass wiping...

One of my senior colleagues had described our job as ass wiping… I am not proud of  nor ashamed of the job. In the past, when I was so junior, senior physician and surgeon “ordered” us to do some procedure for them – to them, there are providing chance for us to practice so that we could get the “hang” of such procedure and later mastered them. However, it was only partially true, most of the senior had actually lost the feeling to do so…..some of the them didn’t even mastered the skill at all…..

 I saw something like this in the Berjaya Time Square hotel
well, not wiping but just wash... but franklly said I found it difficult to aim properly...

As we become more senior in the field, colleagues started to ask for favor instead of giving order. They ask us politely and we complied. However, I knew that some of our colleagues considered it as part of the resident job. I am not irritated with it. I am glad I still had the chance to do so. There was this incident years ago when I did my hemato-oncology posting in the university hospital. The nurses had prepared the CVP insertion kit for me and left, she told me to call her when I was done. The patient next to us called her and asked her some question. The patient was thin and it was an easy penetration. As usual I did it under 2 minutes. I remembered her looks and mumbling while she hooked the CVP onto the monitor….most of the resident would take a long time…but I was too senior then (although I was designated as 3^rd year resident…). I am not proud of it but perfecting the skill make the patient suffered less. And that is all what I wanted to do…..

I never turned down any referral and was glad to do it as I still enjoy doing most of the procedure. There is a few occasion that I would "murmur" - e.g. patient was put on dopamine drip without a prior CVP guided fluid challange as no CVP was inserted.

 

The policies had changed over the years. I spent more time on explaining to the family/patient than doing the procedure. It took 5-10 minutes for the explanation and Q & A. for a procedure. In a smooth case, it took less than 5 minutes to complete the task.

A doctor would only sympathize his patient only if he had undergone what he is doing to his patient. I was sick before….cut and stitched up by someone, saw my children being treated. I was lucky as the pain and agony was so less, as everything was in good hand and I intend to act as a good hand for someone else….

 

I hope I never ended up like this….

 

 

 

 

 

 

 

 

 

 

 

 

Instinct...

Instinct... .  something gifted from the almighty....

There was this case brought up for discussion yesterday…. A medico-legal to be case as a perforated peptic ulcer was left for hours before someone decided to take the case to the theatre.

 

Well, I had a brief discussion with Lem and both of us agreed that we would have done a CT scan much earlier and might dug the shxt out earlier. One might said it is just bombardment from the rear side of the horse [ Chinese proverb : meaning to give negative comment to a event after it had happened] , but after years of doing this off office hour job – a.k.a ass wiping job, I had just the instinct to sense problems, allowing me to escape much of the deep shit situation......

 

I remembered the movie “BODYGUARD”, Kevin Costner (acting as the ex-secret service agent for the white house ) said, “…not on my watch…”

 I really like the song....and the movie too....

I deeply pray to the LORD that I kept such instinct as long as I could and nothing happen on my watch...

 

Well, da family was unpleased with the condition of course….

Battle of the matron....

struggle to survive........the winner  gets the post....

The post of nursing director had been vacated since early this year. The nursing director was promoted as Dep. Supt. Of administration. Well, she is the relative of the boss family and the most senior admin personnel available.

The candidate for the post nursing director was vacant as there were 2 persons available for the post. The 2 matrons were the top listed persons…however the choice was difficult…

There was only 1 matron in the past until 6 months ago. Lai was the matron overseeing everything in the past. 6 months ago, when the community service portion was highly urged by the government, the admin had intake another matron – Liu. Liu had been head nurse in a medical center and later took up a job as matron in a hospital nearby. She was demoted  in a power shifts(rare rare scenario, the new hospital superintendent had brought in his own person….) and later she took up a job with my ex-boss as patient safety officer.

She was also actively involved in the local nursing association. On job seniority wise, Liu was more senior with more experience.

 

The vacancy of nursing director was not filled up immediately, but the management had consulted both of them and none of them took the offer…

Lai was closed to the ED as she was head nurse of ED prior to her promotion. She is a hard working person with good discipline. However things had changed over the years. Powers make a person rot....

 

There were bunch of senior nurses who become her followers – both in job and in personal life. I personally dislike those people as they were not only short-sighted but also forming a gang and trying to bully who ever does not belong to their group.

 

Lai was in charge of the critical unit and Liu in charge of the community service and ward. The resignation of all three respiratory therapists had left a very bad stained over Lai records as most of the staff thought she is behind the plot. Lai and gang had actually did some really ugly things on the job especially on human resource management.

Well, let us just see what would happen…..

i care about their pain...

 

I took glance over the narcotic prescription sheet while I signed my name…. my signatures were all over the sheet, for the past 3 days, I was the only one who prescript pethidine..

ketorolac for peptic ulcer pain ???? no pain killer given for trauma patient with fracture ????? -- not my style...

I grinned and told the nurses, I would be definitely blacklisted by the narcotic bureau on their next visit…

One had to be a patient than to know how they feel…I remembered Mark Green( ED physician – ER series) always ordered pethidine injection to trauma patient after his primary survey… Strangely, I learnt part of my practice from the ER series, being a patient in the past , I felt the pain and discomfort…

Feel what the patient feel, treat everyone of them as someone you love  - is an essential factor to be a good doctor…as a no one in this field , I am in no position to tell anyone to do so…but I hope someday when I am in pain, I am in good care...

Rival....

this is the rival base... a building just across the railway cross....

During our morning meeting, our Dep. Supt. Of Admin had told us that it is confirmed that a new hemodialysis clinic would be opened shortly in the town. There was this doctor from KS city who rented GF – 3F of a local insurance building. There were rumors initially stating that my ex-boss is behind that scene. However when confronted, he had denied of such act. But still, many believe that he is one of the investors….but denied or not, he definitely would act as backup for the clinic.

As predicted by one of our colleague – an internal medicine clinic initially and later physiotherapy and O+G & paeds and finally a small hospital….

Our plan ? apart from advising our physician and surgeon to start their clinic promptly there is nothing more than sit and wait…

there is no paeds clinic in the area and if we could start one with a good service , it would be a great investment…but no one seems interested….

There is some problem about this weekend shift – Ong had gone for his green card interview back home. My mother in law had come over for a biopsy and I intended to take her around. So I am not available. The new emergency physician was left to covered the weekend. He had to do night shift on Thr and Fri and after that from Sat night to Mon morning ( yea, yea it 38 hrs…). He told Lem it would not be a problem but later regretted – he did not go to Lem but go straight to boss. Boss said he does not want to do anymore shift…. So he is stuck with it. Boss did not dare to ask me as he knew I am quite unhappy with the current scheme…. The management did not wanted to compensate my 4 days Chinese new year leave, neither with cash nor actual leave…. I told Lem, no more extra calls… I would do what ever that is set down and don’t ask me for favor or what ever in the future….

However the final verdict - boss would covered for Sunday morning --- K would get a rest 10 hrs...and it is just NOB(none of my bussiness) to me....

settling down as health and medical officer....

 

I got my MO posting letter few weeks after I was posted to casualty department. It was just a state away from Selangor. I was reluctant to leave my house and filed my appealed. I had tried to pull some strings but was unable to get those “big chain” graded one. I had asked around and someone had told me that working at the health side (govt. health clinic) is better – no calls and I could focus on my study. I decided to called up the clerk in charge of the posting of the Jabatan Kesihatan Negeri Perak(Perak Health Department). She told me that there is a vacant in Slim river – 120 km from my house and I thought it was acceptable. We made an agreement, I withdraw the appeal and she would post me to the spot. Few days after the conversation, she had called me up again and asked me if I wanted to be posted to Tanjong malim which was closer to Selangor. I told her I gladly accept the offer…

I got my posting letter 3 weeks later and finally started my job as a health and medical officer….

One of my colleagues during the house officer days was posted to there as well and she brief me about the condition….

Me and my father had driven up north and tried to find a house. A single storey terrace house was around RM300-400 and I was lucky to find a new house with the price of RM400 /months….

I still remembered the first day I reported to duty. ……I presented early to the JKN Perak. I waited for a long time as the new Director was busied as she was new to her job as well. I did not met her but was brief by the deputy director (health). I left the office by 11:30pm. I took a drive to Tapah health office when I got my first bombardment from my new boss. The 1^st thing he asked me was – why did I reported late? He had asked me as if I had wandered around ……I explained that I was discharged later from the JKN Perak…..the briefing was brief and he had told me not to “curi tulang” as he would monitor us from time to time….

I drove back to Tg Malim and seen the Medical officer in charge, the next day, I had started my work……it was an easy life , I spent 2 year 8 months at the clinic….