ass covering with their head....

I was stunned when I heard that the transplantation of HIV infected donor organ to 5 recipients by 2 of the local prestige university hospitals…

The surgeons (more than a handful ) had discovered the facts that their donor was HIV positive 48 hrs after the transplantation…

The 1^st action response to the incident after it hit the news desk was to push the responsibility to the organ transplant coordinator…

The team had blamed that the coordinator and the respective lab technician who had a miss communication when the lab technician reported the “infection” status of the patient via phone to the team. (the lab technician said reactive and the coordinator took it as negative)

 It was very sarcastic as the health authority and the hospital evaluation group had stress over the patient focus care issue over the past few years. The top rated surgeon had forgotten their duty as an “attending” surgeon in this case. They allowed their job to be done by resident and other staff. I don't think they had glanced through the medical chart and talk to the family's of both donor and recipient properlly prior to the surgery. All they wants is to perform surgery and gather as many case for their research material and published as many article as they could.

The team had been touring all over the island doing transplantation...where was the basic core of good medical care ? should the doctor done a thorough history taking (the patient’s mother knew that he was a gay) someone would be alert enough to seriously ruled out the possible HIV status…

Flash back the incident -> a 37 y/o male alleged fallen from 2 storey height. He had sustained a severe head injury and treated in a hospital in Hsin Zhu. He was pronounced brain death later and the family had informed the university hospital that they agreed for a organ donation. Both the hospital was 60 km apart. A 1.5 hrs drive…. How long would it take for an urgent check of HIV and other “infection” status ? 2 hours max in an urgent situation. The data would be readied by the time the team arrived. The surgeon had proceeded boldly instead of waiting -> a decision endangering the whole team…. Didn’t the surgeon read the medical chart before they proceeded with the surgery ? Should they had read the chart properly they would definitely found out that the lab data was missing….

The worst part was – no one claimed responsible – the hospital tried to blame the coordinator over the incident. They management had even regard the coordinator as employee from the DOH instead of the hospital (so it was the DOH employee who did the mistake and it had nothing to do with our hospital…)[the DOH granted a sum of NT 20 million to all the hospitals which operate the transplant surgery, the university hospital had use part of the money to hire the relevant coordinator…] the hosptial superintedent(currently president of internal medicine society) had come out to apologized few days later....no attending surgeon had come up to admit their negligence (I hope they could sleep properly in the night and walk in piece during a stormy day...)

Crap SHXT story which can fool the public but not some insider like us…I hope the investigation is done properly and someone dearly pay the price (so I could be pacified as I am going to one of tax payer paying up the anti-retrovirus drug for the recipients..)

Fefe...

Having Fefe for almost 3 months… Everyone is happy about her….There is no more problem after the initial “adjusting” here and there. We took a drive to east coast – Hua Lian. A 220km drive which took us 4+ hrs.

No one wasted their lunch during our drive through the southern reversing road, thanks to the modified suspension of 4wd version. The suspension for the 2wd was softer instead. Unlike the Z with excellent maneuver ability, Fefe is a SUV with great view unsuitable for high speed maneuver.

 There were a lot of modification option around -> chip tuning, HID lamp etc…but this time, I would save the money, the original version had offered a lot of fun …..with the extra width0cm wider than the Z) it offered a better riding experience for the back seater. During a drive, I told Ving, I missed our Kembara -> we were so close then sitting in the Kembara. Maybe we would get the Terios to replace Ving’s Sirion later … but it would be a long long time….

PGYs.......

 The fresh medical graduate of the Taiwan would be experiencing a new training scheme starting from this year…

The story goes all the way back to the SARS period (2002-2003)…. A few hospitals was “contaminated” and quarantine were ordered by the department of health. There were a few doctors (govt. servant) who refuse to enter the hospital for work -> their excuses, I am not specialist in medicine and I lack of ??? skill to care for such patients. Their unethical act had led to a call for reforming the post graduate medical training. Some so called experts and professors had thought that if young doctor was given proper ethical education and basic/general skills training during their first year – then they would not have any excuse to “abscond” from their duty when needed. They were partially right....

The initial training program was set in a rush and the training was set for only 3 months -> 1 month in surgery, 1 month in medical and 1 months in community medicine. During the 3 months period, a series lectures concerning ethical issue and practicing environment were given. The secondary objective was aim at setting up a training which last for 1 years comprising basic training in major scope of medical (surgery, medicine, OBGYN, paediatrics) - > so called Post Graduate Year 1 training. The primary objective was abolishing the internship training by shortening the medical school from 7 years to 6 years and introducing a 2 years Post Graduate Year training for medical graduate.

I was unfortunately to be accepted into the initial phase of the PGY1 training. However although the training was 3 months, the DOH had promised that the certificate awarded would be valid and good for the rest of my life no matter how the training would change in the future. I considered the 3 months as a waste of time as I had gone through the solid training of Malaysia MOH few years ago.

The general medical wards and general surgical wards set up for the training were a crap as there is no true internist and surgeon around. Most of the staff specialists were sub specialty holder who know everything about their field and would referred their patient to another sub specialist about other problems. Most of the medical center had created post of attending physician/surgeon in these training ward, however -> most of the post was filled up by junior physician/surgeon who just finished their subspecialty training….

The training was so limited…..but the lectures were good…

After 8 years of effort, the PGY1 had extended from 3 months to 6 months and now 1 year. A good start, but situation did not change.

There was still lack of physician focusing in general internal medicine or general surgeon. Some had suggested setting a sub-specialist known as general internal medicine but it was never materialized.

It would be a very difficult situation for Malaysian to stay back to work here after medical school. Unlike the housemanship nor 1^st year resident training, the PGY candidate would be dispatched by the DOH. The salary was fixed at RM2300, no matter where you are posted.

However for a foreigner to obtain a working permit which lead to resident certificate, one would need to get a job with salary of RM5200. If the labor department refused to revise the current law and regulations, Malaysian graduate from medical school in Taiwan would be forced to return to Malaysia for practice.

 

Not sure if I would go for a sub specialty training at the moment as I am enjoying life of growing my own food - 2 night shift + 2 half day shift/week enable me to enjoy such life....but becoming an attending physician a sub specialty would led me back to day shift work and I would not have the luxury to spend time in the farm....

 

A painful visit....

I had seen a church member in one of the famous medical center yesterday. He was diagnosed with adenocarcinoma of lung 1+ years ago and currently staying in a hospice ward.

His initial symptom was weakness of right hand ->unable to write properly. The first doctor who saw him could not differentiate a peripheral neuropathy from a central one and referred him for cervical and thoracic spine CT. A 3cm nodule and some infiltration was seen over the CT and he was suspected to have pulmonary tuberculosis which leading to isolation of his family and workup for his family. However the were no suitable explanation for his weakness and a brain CT was done where multiple brain metastasis was noted. He was then referred to a chest physician where he was diagnosed as lung adenocarnimoa with distant metastasis.

He had come to our church after someone introducing him to us. He had undergone a course of chemotherapy and radiotherapy for his brain metastasis. His wife had chatted with me and I had fed her with some proper introduction. The chest physician had misled her that they would get Iressa would be provided by insurance after they had undergone chemotherapy. I had told her that Iressa had limited effect on brain metastasis and if the medical insurance would not cover the expanses as the lung nodule was relative small. He had suffered from multiple seizure attack due to the brain lesion and they had chosen to be treated in the famous medical center which was 35 km away(40-50 mins drive as there is no freeway…). Every time he suffered from an attack he would be sent to my ex-hospital and after some stabilization in ED, they would spent RM500 on ambulance transferred sending him back to the medical center.

He suffered from less attack some times and his condition become worsen as weakness was more prominent. He was admitted again 3 weeks ago and later referred to the hospice ward.

I had spent sometimes in the ward during the visit…and was so sad that the so call hospice care was almost the same as an ordinary ward apart from the huge narcotic dose.

His port A was clogged as phenytoin was given through it. The IV insertion site was noted with erythema and a new line was needed today. He was edematous after a long term use of steroid and poor nutrition. It would be better for him to insert a central line however I wander any resident (junior or senior) have the guts to do it on a patient which could barely show his neck…..As for the attending staff -> no way, aggressive management had seen to be contradicted to the principle of hospice care and after practicing such principle for sometimes, one skill would be reverted to an apprentice level after a short while….

 

Patient was having swallowing difficulty and aspiration pneumonia was likely as he had a lot of phlegm and low grade fever, however he was still fed orally and his wife was reluctant to insert a NGT for him worrying that NGT would irritate him more. No one ever tell her that feeding orally in such situation might ended up in aspiration pneumonia.

The wife kept awaking him from his sleep however patient was so drowsy owing to the heavy dose of morphine and sedative. Her wife was so worried about his constipation despite of heavy laxative use – no one had told her that after such a heavy dose of narcotic use, ileus is likely to happen….

His wife looks so helpless, trying to do something that she things would get him better which in some instance causing the patient to suffer more….A sub standard care as I think the hospice care team would have explain properly to the family about the management strategic and the final process…..

Everyone is hoping for a miracle that he would get out from his bed and returning home well…. I felt so sad during the prayer…During the 1^st meeting, I had told his wife that the best way for him to return to the hug of LORD is a sudden onset of intracranial hemorrhage cause by the metastatic tumor. But I knew, no one would pray for that…..

I had seen miracle – there was this female lung cancer patient, she was rushed into our ED for dyspnea and fever. She was also a stage IV lung cancer patient. I had done a short discussion with her family prior to the intubation. Her family was so dedicated for intensive management as her daughter was getting married in 3 weeks. I intubated her and after aggressive management, she had managed to get out from the ICU and later attended her daughter wedding. She continue to live for another year…I received a thank you card from her husband after she passed away…..I considered it as a miracle as we managed to let her gone through so many great event during that year….

I felt great pain – to know more about the process but just don’t know how to help them as I was not the attending physician of the patient…..

2nd great weekend....

 

This would be the 2^nd great weekend for me…. I had taken a great trip to the east coast last week.... This week, I am going to spent the weekend in the pool(swimming pool of coz, not the poker pool...) and the farm…

Lem would be going back to Malaysia next week, and I need to do some extra hours, but still, the great weekend hold. We had a short discussion and next months would be almost the same..Almost means, I need to do 1 Sunday night shift – requested by boss of coz…. A cut of working hours ( 180->142)..a salary cut of coz, but I can live with it…

Lem would likely to stay till Chinese New Year and my happy weekend would most probably last until then….