survival the night shift......

I still remembered the 1^st night I did my shift as a houseman. The thrill and excitement was handling patient was a new experience for me…After years of working, managing patient’s complaint in the night had been a reflex for me. Use the shortest time to get to the key point, managed the complaint and get back to sleep ASAP was the key to survive. Once, a senior had shared with me a cue to good sleep with me. He told me there was this resident who would do a night rounds in the ward around 11pm and after ensuring everything was managed he retired to his call room and  he would get a good sleep most of the time.

I never practice what he had said but I still think that it should be practicable. Last week, Lem told me about what the ward night shift physician done. All three of them had left respective note in the nursing station. The note was if BP more than ??? and give drug so and so , if Fever more than ??? then give drug so and so and much much more other “IF..THEN” order. A good move and they would be less disturbed by the nurses. Individualized of management according to various doctor but not according to the patient's condition....

The nursing director had later complaint to the boss and boss had stopped the action. I shook my head and told Lem after all this of year of doing night shift, I dare not do so as it is clearly violate the law.

I told Lem, those guys will not stay for the nightshift as the night shift ward job is stressful as well….I had a bad feeling about this and preparing to go back to the past life of covering the ward.

age of maturity and age eligible for driving license...

 I had this 18 years old young chap who fell from his bike with a gal as the backseater. Both of them had minor abrasion wound over their left limbs. It was 6:00am in the morning and I had good sleep thanz to the night shift attending physician covering the ward.

I had asked the phone number of his parents and called up.

“Good morning, sorry for disturbing in such an early morning… are you Mr A, father of A jr.?

“Yeah…what is the business…?”

“I am Dr lywuu of F hospital and your child had fallen from his bike on his way from KD to KHH….. he had sustained bla bla bla…”

“What on earth, ain’t he suppose to have ? class today morning…..”

Typical slipped out from hostel and brought she-classmate for an over night in the famous KD beach 50 km down south of our hospital… Most of the chaps will spent the whole night there and rode their bike in a “not enough sleep” zombie mode back to KH city early in the morning…some unlucky one would rammed their bike while day dreaming in limbo or too tired to react to some emergency condition and landed in my shift….



One of the crucial element of ED management is communication. Proper communication with the family and patient is always a key to avoid medico-legal problem. For an adult, the ED physician just need to well explained the medical condition to the patient, and then discharged the patient. But for youngster like the chap, communication with the guardian is vital. Imaging you had a 18 years old patient with traumatic knee injury who can still walk, after clearing him from any knee fracture, you just dischaged the patient. Unfortunately, the patient collapsed hours later in his house and a traumatic intracranial bleeding was diagnosed in another hospital. The family would definitely stick to your axx like a no head fly - why didn’t you examine his head and do some thorough studies before you discharge him? . For youngster who had not attained the age of majority it is crucial to speak to the family either face to face or talk via the phone.

In actual fact, half of the youngsters are reluctant to let guardian acknowledge about their condition. And many of them just couldn’t understand why the law allows them to get a motorbike license at the age of 18 but the age of majority is 20. Sometimes I would insist the parents to come over and fetch their children in person if the youngster had difficulty of walking or other risk who required further observation or admission....

There was a few times I had to threaten the youngster to surrender them to the police just to get their parents phone no….Most of the parents was polite and I could feel their worried and disappointment when their children met such accident…

I remember one of my lecturers had taught us that a child of age 3-5 would think that he is the king of the world and he is capable of everything…. But nowadays, lots of youngster thinks the same, they never know their limitation….

separation of ward and the ED

Call had become better nowadays… We had no longer had to cover for the wards complaints. The management had gotten a locumer initially. An internist with his own clinic down south, he had come for interview months ago and had retracted last minutes before he comes to work. He had however changed his minds probably due to temptation of cash.

He had done a few calls and complaint to K that the pay was too low. We were quite surprise when K told us his price. It was only 1/4 of our pay… queer feeling when I heard the figure; I wandered if I had to earn those hard earn money years later….well, keep up the faith as experience is the real asset that was gifted by the LORD…

K had gone to the management few times regarding night shift attending for the ward. Complaint from the ward had truly disturbed us as from time to time there are these “emergencies must visit patient” condition took place simultaneously in the ward and ED. Any of delay of management would lead to a life disturbing medico-legal case( multi-million medico-suit rarely occurred here in Taiwan, but the court running is very tiresome and torturing). I had nothing to say as I am definitely support the change.

Calls were better since then as I got to sleep the “morning call hours”. The “morning calls hours” is around 4-6 am as the patient started to wake up and nurse started to take vital signs. Lots of complaint is noted and it is the worst hours as one would be very tired after the long night shift.

But still, we had to covered for procedure and other critical condition in the ward…

night shift of the ward..

After few weeks of struggling about going for the training, I had finally settled down for another 10 months of works. Well, I had adapted well lately and more time to spent with the family.

More and more doctors are hired and we had a load of specialty to consult but I did not benefit much from it…most of the doctor are around in the daytime and as night shift attending physician, I could rely on my own most of the time.

K had complaint about covering the ward during night shift. According to his contract, his job is limited to the ED however since his arrival 2 years ago, we had been covering the ward. However the in patient had increase about 2x and the loading had become worse and worse lately. K had threaten the management that his contract ends in December and if we are still require to cover the ward, he would…..

The hospital had managed to get a clinic internist down south to cover the ward. He had come a few times and was reluctant to continue. K had chatted with him and found that he was paid less then 1/4 of our pay per night. He requested a higher fee (and still it was about 1/3).

The boss is still negotiating with the other attending physician and surgeon about doing the calls as the locumer could only cover part of the shifts.

All I want is fair and square…

The truth

It was a dull shift… I had glanced through the web and found something which I don’t usually read from theStar. Indeed, my in laws had told me that theStar, the Chinese newspaper over the net is unreliable as most of them “write” for the government. I had come across some article over Malaysia Chronicles and Free Malaysia Today. Wow, it is truly interesting.

The 4 letter word started with F had almost burst out from my mouth when I saw the “Malay first, Malaysian seconds” phrase. Indeed the Red-white Kris Party had decided not to rely on the non-Malay voter. They had wanted to lure the rest of the Malay to support them and aim for the victory in GE13.

I had heard a story from my uncle during my stay in Malaysia. There was this consultant who worked for one of the racists in the past. There was this state development plan designed by the consultant, the consultant had submitted a plan with a budget. The racist was not satisfied with the figure and given the consultant a handsome figure to lay him off. The racist hired another consultant and the figure was 30x the amount…well, gods know where the extra money had gone…

It is eye aching when I saw the 1Malaysia slogan and more irritating and blood rising when I saw the 1 Malay phrase….

It is time…. Too bad I couldn’t join the group to flip the table as we had decided to go back early in January for Yun’s IC instead of the GE13. 

Yun is darn worry about her IC as this is a symbolic of growing up for her and Xian is very disappointed as he would be the only one without IC in the family…..

 

3000m above....

We had taken another trip to the National Park here in Taiwan during this summer holiday. It was a camping trip, 5d4n. The longest camping trip ever and one of the camp site had no electricity supply.

We had traveled to the highest road in Taiwan. During the trip, I had climbed the 2 peaks of the He Huan Mountain. Both of them were above 3000m. The air was so thin and I had to rest on every few steps.

The 1^st peak was a challenging one as we need to climbs stairs like road to ascend to the top. All of us made it to the tops…. Our 1^st experience of climbing mountain of more than 3000m. It was a special experience for everyone of us; the climb was complicated by the thin air above 3000m. We had to stop every few steps to gasp for air. I had seen many film regarding mountain climbing and I finally realized the feeling of shortness of breath on every steps…..

The next day, I climbed the 2^nd peak alone due to the rain; Ving and kids waited me in Fefe. I donned the rain coat and ascend to the peak , praising the LORD all the way up. During the ascend, I was so afraid that I suffered from a heart attack but still with the grace of LORD, I made it….

Each of us learns something from the trip. I am truly happy as I could take my children to experience something which couldn’t be bought by money – although money is still a must for these trips…..I am glad I am still energetic enough to take them up to the top….

Quality of care...

I had always considered the diagnosis and management of acute appendicitis as a index for an competent ED doctor...careful hx and PE would lead one to the diagnosis...

I had a cousin who is very much older than me… my granny and my mother’s eldest sister got pregnant almost the same period… My cousin was 20+ years older than me, a story regarding of him was shared amount us during our childhood.

We were warned not to do any sport after meals as one would get appendicitis (which is not true…). My eldest cousin had a big vertical scar across his belly. The story goes like this; he had suffered from abdominal pain and later seen at various clinics and he was only sent for ops after generalized peritoneal sign was noted. The ops was a major one as appendix had ruptured….

I had read over the net about this poor Indian chap who suffered from abdominal pain lately…

http://www.freemalaysiatoday.com/category/nation/2012/09/24/ibu-kesal-dengan-layanan-buruk-hospital/
9/5 pt noted with diarrhea, abd pain, vomiting

9/7    9am seen in Klinik kesihatan - discharge

9/7 8pm seen in ED Seremban GH – discharge

9/8 ?   seen in private clinic

9/9 8pm seen in ED Seremban GH admitted to ? medical ward

9/10 9am diagnosed as ? appendicitis

9/10 4pm transferred to ? surgical ward and sent to OR…

It is queer that no doctor had ever mentioned the possibilities of peritoneal sign during the consultation. The Medical officers in Klinik Kesihatan ,ED Seremban GH and the private clinic doctor had discharged the patient despite of noted the pain and symptom for over 2-3 days. The 4^th visit to ED and the medical officer still admitted a patient with peritoneal sign to medical ward is a beyond standard medical care.

Could just shock my head…. Is it because those medical officers did not receive any specialist training making them incompetent or was the patient pain so non-specific.

There is still a lot of improvement for the health care in Malaysian..

Provider course re-visited....

 

I still felt depress over the failing of the instructor course… My ACLS provider cert had expired 1 months after the instructor course and I did not take up any course later… It was a must for medical staff working in the critical unit to hold a valid ACLS provider certificate – requirement for the hospital evaluation association. I had finally decided to take up one recently(the university’s hospital requested a valid cert if I wanted to work as a research fellow there)

I took a course organized by an education group in Kaohsiung. 1.5 days course. A small class consist of 1 lecturer (yeap, 1 man show) and 15 students. I am the only physician and the rest of them were 1 nurses (13 female and 1 male). The lecturer is one of the emergency physician in a local medical center. The course was solely designed for nurses and it was very bored for me especially for a person who been through the hellish instructor course….

Well, to make the things worse was I had to do my night shift at the end of the 1^st day course. I make it in time to the hospital and told Lem to relieve me 1 hr earlier the next day.

I was lucky as the call was darn good… I had a full 3 hours sleep…

Despite of the sleep, I was still sleepy during the morning. Nodding and wandering.. an impolite act, but I was too tire…

The was a long strip of food shop near the class. I got into a Ramen Shop and regretted my choice 15 mins later as it taste just like one of the instant noodle and it cost 80NTs....

The paper test was simple and I completed it in 20 mins. The skill station was even more simple and I left the class by 1:30pm.

I went to JK lane and tried to get a red HTC J for Ving. The initial visit at the famour SH 3C wholesale was unsuccessful, they had 1 red and 1 black but the red one was pre-ordered by someone. I turned to another HTC shop and got Ving the android phone…

The drive back home was tiresome but I still manage to make it…. After the test, I am quite sure that I would go for the instructor course selection progrem next year in Taipei....

Gain and loss....

Everything was smooth until the gastroenterologist department informed me that I had to report by 1^st of October and unfortunately due to the processing time of the university’s hospital, I could only report for duty on the 15^th of October. The conclusion was: I am not going to be eligible for the board examination 2 years later ….

After some communication and string pulling, I decided to give up and delay the training for another year.

I had no time to feel sad nor moan as

the second round of negotiation begun immediately ; the management wanted me to stay. They offered me a 3 year contract. Same salary of course…. With the frustration feeling, I was brave enough to asked for a 8% raise and after some unfruitful bargaining, I got what I want…I did not compromise this time . the hospital is at the verge of success and failure as the management was unable to hire any one recent few years…. I knew they are desperate and nothing much could be done…

Well, life was never fair but still, I got something. I thank GOD for looking after me and preparing me for the training. With the new increment, I could save up a handsome amount and looking forward for the training next year….

At the current dark age of economic regression, it is mercy from the lord that I still got my raise….

Money or fame ?

 

I had read the news about this young chap name Winson Seow over the net lately…. A young man who done some medical relief work in some war zone. He had shown some photograph of himself, donning a surgical suit performing surgery over the net. The news was spread and massively reported by local newspaper in Malaysia. He had even attended several television interviews. He had published a book regarding his work and fund was raise for his act. During his interview, he had claimed that he had graduated from the prestige Peking University Faculty of medicine and he held UK qualification of trauma surgeon and emergency physician plus a degree in psychology….However he is only 26 year old… At least 6 years of post graduate medical training to obtain such qualification and provided that he held a GMC recognized medical degree(Peking University is not on the list…) and secure a training post in UK. That means he graduated from medical school at the age of 20, and he entered medical school at the age of 15. That would make him a genius….such genius in Malaysia should have been reported by the local newspaper at the time he enter medical school….

I remembered the 1^st Malaysian genius – Z, he had entered MIT at the age of 12. Chinese entrepreneur had sponsored a large amount of money for him to complete his course. At the age of 15 he was accepted into Cornell University for his PhD, he received his doctorate at the age of 21. He returned to Malaysia 4 years later, however he had suffered from depression since then. 5 years later, he was admitted to a local government hospital and passed away on the next days…Such genius would be reported and never forgotten.

Some of the friends and ex-classmate had seen enough of his “lagak” and had started a anti-Winson Seow FB page over the net. His qualification was dug up and he had submerged from the surface of the earth. His father had instead shown up to apologize for his son’s act. 1+ months ago, his father a(Chinese medicine practitioner ) had defended his son that Winson is not opening a clinic nor charging anyone medical fee, he joined the medical relief work under contract of a company which would later sponsor his study as a medical doctor later on and such allegation who damage his reputation and affecting his contract and sponsorship later.

Well, sound just like another irresponsible parents I met in ED- just riding a bike in Kampung, need a license ka ? Father supporting lies of his son -à wrong kind of love….

The young chap had attended multiple interviews, talk and enjoying people calling him doctor and yet he claimed that he doesn't pursue fame nor money.....the donation was wired into his own account instead of a public account....

I had a junior who didn't practice medicine, he graduated from med school and further his study in Life and Death Issue and obtained a master degree. He had used his medical background giving talk back in Malaysia regarding the issue of life and death. In my point of view, that was crap..as he had never practice medicine and never struggle within his subconsicous regarding patient's life and death. But lately, I had read his news and he had omitted his background and use the title of Dharma Lecturer instead... well, a person with a doctorate is more convincing....  

Still couldn’t understand why bright student wanted to become doctor ? is it for the job satisfaction or the money ?

To be truth, I knew a doctor could earn a handsome income and that was one of the factors which influence my choice. To provide a better life for my parents and my family…

did you best ?

 

I had this OHCA[Out of hospital cardiac arrest] case today… In the past, we use to classified it as DOA (death on arrival), however after multiple incidents and events the terms had changed and "DEATH" is no more mentioned. I remembered there was this medical bill which was complained by a family – the patient was tagged with the  diagnosis of death on arrival and the family had queried that since the patient is death why a long list of examination was performed… they refused to pay the bill…

I hate OHCA in the past – an exercise session for all the staff as we had to take turn performing chest compression. A tiring act especially late in the night, sleepy after many hours of stress. With the help of CPR machine, half of the time was staring over the monitor; a real boring act but more man power to spare for covering other patients in the ED.

The OHCA case was a severely obese male which had collapsed in front of his wife. We did the routine but no ROSC (return of spontaneous circulation ) was noted. 2 ventricular fibrillation episode was noted and two defibrillations were done. Most probable diagnosis was acute myocardial infarction and I knew nothing much could be done at the middle of the session though, I had to do my parts. After 35 mins of effort, I broke the news to the family and continued with the charting.

The wife had summoned me later and asked me what was the cause and I told her what I knew but she had asked one more question which made me felt uneasy – “ did you all did your best ? “

I answered, “of coz, we had used everything we could, you can see we had even used CPR machine which cost NT 400k….”, yet I knew the machine was the culprit which made the wife raised such question...

The was this slit at the automated door of our resuscitation room, the wife was peeking through the slit during the resuscitation. Well, with the introduction of automated chest compression machine, less man power is needed and scenario is less chaotic compare to the pass. Could understand the feeling of family, seeing less and less staff remained in the resuscitation room, from 4-5 initially to only 2 prior to the “CALL”.

Well, yet there is nothing could be done as it is the will of GOD and I could do nothing… It is a very impolite act to ask such question – questioning our team effort especially when we had really done the job to our limit.

I went to the nursing department personally later in the afternoon and requested for a folding screen in the resuscitation room, less peeking, less trouble…

flat tire and dad's teaching....

We were going to Kaohsiung to buy the Igloo maxcold 40q cooler 3 weeks ago; The 5d4n camping trip was a challenge to us and after hesitating and struggling about a cooler or not, I had decided to invest in one of them. The choice was simple but yet to decide which item to buy was difficult. One can get a cheap Igloo Maxcold series cooler from the local Costco store easily however they only sell the 58q version instead of the 40q which was way to big for us. The Coleman was a good choice however it is darn expensive – NT 4k…The Igloo 40q is only sold in one of the chain mart and I called up the store but the lady who answered the call was unable to tell me exactly which model they had. So I decided to pay a visit. I took a nap after returning from my long night shift and took of in the evening.

Ving halted me from getting into the car as the one of the neighbor told Ving that we had a flat tire.

The rear wheel over the left side was flat and I decided to pump up the tire and drove to the nearest tire shop for help. I took out the jack and managed to jack it up and tried to pump it with the Michelin electrical pump. According to some user over the net, the pump could easily filled a flat tire within 3 minutes provided that the car was jacked; 4 minutes past and I could get only 25 PSI instead of 32 ….. And Yun told me that there was a puncture over the tire. I saw a nail protruding from the tire and decide to give up. Ok…I had to switch to plan B -> replace the flat one with the spare tire.

I had never done it by myself although I had a couple experience with my dad. But still I manage to remember some of the details. It took me a good 30 minutes to get the spare tire into the proper position as the spare tire of Fefe is not a shrinkage iron version but a proper rim as other rims were, darn heavy and I had difficulty mounting it onto the car….

I remembered one of the key my dad told me – you need to stand on the L-shape bar to tighten or loosen the wheel lug. I did it in front of Yun and told her that, that was what my dad taught me, it would take a brute force to loosen the lug unless you use you body weight and the gravity.... I told her that she need to remember it by heart and hopefully it would come in handy later in her life….

I drove to a nearby tire shop and got the tire patched in a few minutes.

It was a lucky day and I got the Igloo maxcold 40q as planned; we had a good dinner in one of the restaurant nearby…

Yun had tried to help me lowered the jack after the replacement and she quit after a while as she found that it was so tiring to lowered the jack, nothing much to expect as Yun is a GIRL……. Lot of young chap out there that never saw a spare tire is mounted; they just call the tow car when they encounter it. I hope Yun would remember the steps and keys later in her life just like what I had done….

The path of training....

I had decided to go for sub-specialty training during my Malaysia tour. Well, I had been thinking about it for a long time. 6 years since I passed my internal medicine board examination. Most of the resident dipped into subspecialty training stat and I had waited a long time. I would be renewing my internal medicine diplomat this year and I think it is time for a step further.

The 1^st step was not simple as I had to find a teaching hospital to train. I had to secure a research fellow post or 4^th year resident post. Pay is definitely way below I got at the moment. I called up a medical center a little bit up north(50km from my house) and the pay was way lower than my expectation(30% of what I earned at the moment). There are 2 posts available, nephrology and infectious disease. My 1^st choice of Gastroenterology…

I called up my ex-college hospital. I had done 2 tour there. Called up the department secretary and I got an encouraging answer. A lot of discussion and negotiation were done since then. I finally came up with a working cum training schedule. I met the head of department of digestive medicine 2 weeks later and I got all my answer.

I would be doing ED night shift on Monday in my hospital with 2 weekend 30hrs shift. Monday, Wednesday, Thursday, Friday, I would be undergoing training in University hospital. I had to cover for 2 night shift and 1 Holiday shift for the university’s hospital. I would be getting pay about 70% and I think I could survive the next 2 year without problem….

The final negotiation is pending on Lem return as I had shift I gave up had to pass over to locumer.

It would be different for me later…and I am preparing to my route for returning to Malaysia….

post taman negara....

The taman negara tour was an amazing amazing one for all of us…. Every one gain something but unfortunately, we had to give up the tour up north. We postponed the tour to Betong and east west highway. We headed back to Klang to have a thorough check of my dad’s car.

The drive was a strenuous one as I dare not sprint. The radiator was fixed but not properly installed. The rubber pad the axed the radiator to the car was no where seen and the vibration of at low engine rev make a great noise when the car stopped. It took me a good 6 hrs to complete the 240+km drive. We had ended up at my in law’s house later that evening.

I took my car to one of my dad’s old colleague. He opened up a tire shop in Taman Goodwood. Their family’s shop was at the Jalan Tengku Kelana beside the old Hockkien Association of Klang. My dad’s had worked in the Singer shop next door during my primary school day until he was transferred to Ipoh (a very agony process for everyone of us in the family as the transfer was preceded with debt and my dad’s lost a handsome income after the transfer). The Jalan Tengku Kelana had however later turned into little India where all the Chinese merchant was “expelled” from the street as the Indian businessman had offered irresistible rental to shop owner just to secure a shop there. There was a shop I missed most – a Wantan mee shop (their specialty was abalone mee RM 30+ per bowl, out of our budget and I never try anyone of it, but still, their Wantan mee was one of my favorite.).

A rubber piece was inserted and the radiator was temporary fixed to where it supposed to be.

I had surprised the Sri Shamugum Mamak store around the Berkeley roundabout was still around as they were forced to shift earlier this year. The land was bought by the 99 group (chain grocery store) and a HQ building of ?20 floor height was planned to be erected. Later I found out that the land was too soft and unable to build building of that height.

The teh tarik was good as ever and the rest of the roti canai and nasi lemak tasted as usual; except for the price which went up like rocket…

I had decided at that moment that I would be back and worked in Malaysia…..

D3 taman negara...

The D3 was a challenge for everyone of us… after the wet and tiresome D2, everyone was truly exhausted and 1/3 of the adult fell sick. The water splashing and the breeze in the evening during the “shooting” was a killing factor.

I took 1 cap of Acemet early in the morning and was cold sweating during breakfast. For a second, I wanted to back out from the hiking trip, but still, I felt it was my responsibility to watch over my family and I continue with the trip in stead.

The trip was a different challenge compare to what we had in D2. The trail was smaller and there were a load of leeches waiting for us along the hike. Well, the cream I made was effective but still, after sweat and wear, the effect went off and I need to reapply the cream from time to time. We did not make it to Abai waterfall as the trail became very hazardous when we arrived at the downstream of Abai waterfall.

We headed back and take a nice dip at one of the river crossing. It was a truly amazing experience as I had once more stepped on the soil of the mountain area of my homeland. My last tour was 20+ years ago when I took a hike to Gunung Ledang. Everything was so familiar as if I had never leave Malaysia to work in a foreign country. I had made a decision then while enjoying the beautiful scene sitting on a rock in the middle of the river.

Well, the afternoon rapid shooting was less exciting and we had taken a comfortable ride drifting along the river.

I was finally there – It reminded me of my visit to Disney Land Hong Kong … one by one of my dream came true and I wander would it be the end of my life in the near future…. Indeed what my parents told me was true – study hard and you could go where ever you dream of…..

I joined the night safari walk with Ving while all other of the team had forfeited the tour. Nothing much was seen despite of some frog and insect. But the highlight of the hike was the glowing moss in the jungle. A sad one as we were unable to take any photo as our tour guide AZAK told us – you just can’t snap it, all you can do is to remember it….

Yun and Xian had a good time with the other kids and they become braver….Xian was always leading the team and unlike the usual “master” lau he portrait in the family – slow and peace life seeking . He showed me what he could do and Yun had acted maturely in the group.

A great experience which could be bought by money …. But still, I wanted to give them more….It was the last day in the national park but sadly we would not be proceeding to Betong as planned and we are going back to Klang to have good check over the car...

 

Taman Negara D2

The night jungle walk was postponed due to rain on the 1^st night. We had a good sleep... and woke late in the morning.

The breakfast was simple though but on a eat till you drop basis.

 

The 2^nd day began with a mountain climbing to “bukit indah”. The 5 kids had no problem as the guide over watched their climb, but for rest of the adult the climb is still a stress. I had to look after Ving as she was still unfamiliar with the trekking stuff.

The climb was smooth but the trekking to the canopy walk was slow as most of us had worn off after the climb. Water was really an issue as the preparation as not sufficient. A good lesson as the kids learnt how precious water is. He finally arrived at the canopy walk and the 1^st thing was buying drinks…. The refreshment kept us going and the walk was exciting even though we got to walk half of the trail. The other half was undergoing renovation but still it was a very stunning experience for all of us…

Lunch was darn simple, nasi goring kampong with fried egg. We had a nap and later proceeded for the rapid shooting….

A wet experience but with the temperature of 22C, it was a chilling when the breeze streamed through our wet suits….

Dinner was better with 3 dishes and fruit plus cold air syrup. Air syrup was one of my favorite; during my childhood, my mom would buy a big bottle of condensed juice - add water and ice , woola,a nice and chilling experience in a hot day...

The first day ended and I was wandering if I would make it to D3 as my lower leg and thigh had begun to soar, just wandered if I could complete the walk to Abai waterfall..

Tour D' Taman Negara - 3 Plans, 2 options and 2 choices...

It was a rough start…. We were supposed to pre-pack our luggage 2 weeks ago, nothing was done until 2 days of our flight. We managed to pack it just before our long drive from Pingtung. We drove out at 3pm, stopped at the famous Ching Shui R & R for dinner and reached Tao Yuan at 3 8:20pm. Parked our car at the car park and reach the airport at 8:40pm. The queue at the airasia counter was long. I did not web check-in as I did not pre-book our seat. I thought the flight would be quite empty and we could get there early and ask the counter crew for some seat arrangement. We waited for 20 min and managed to get seat on the same row. I save RM120 for 4 of us by waiting the 20min...could have web-check in but our seats might be scatter all over the flight....

We wandered around the airport and got onto the flight on time.

We opted for night flight for 2 reasons, first – it was darn cheap less than rm250 per person for the single trip. Second, we could go straight and pick up my dad's car early in the morning, saving the money for 1 night hotel.

The flight was however not suitable for sleeping(the seat is definitely very un-ergonomic and not suitable even for sitting). The light in the cabin was not turn off until 1:30am; the crew served the food and sold the duty free stuff before everything went to peace. I had a bad sleep indeed, but still it is considered enough for a guy like me who did night shift. The flight hit the ground 20 mins earlier than expected.

The imigration crossing was simple and fast ...

We took a very easy time getting past the immigration and picking our luggage.

We had a good breakfast at Old town Coffee, RM 40+ for a breakfast…well, money well spent, we had nasi lemak, dry kueh teow, lum mee, kaya toast, butter puff and drinks. After the luxurious breakfast, I went to pick up my Tunetalk prepaid card. I found the booth just outside the departure entrance. I told her my booking number and she told me that I had to show her my flight itinerary which I didn’t have. The webpage of airasia did mention that I had to present to the check in counter with the booking number but never mention about the printout. She directed me to the sales counter at the departure hall and I got a stamped paper. I got my hand phone working minutes later….

At 6am, we took a taxi…Why 6, because, a surcharge of 50% is imposed for taxi called before 6am. From LCCT to Port Dickson, the fare is 90+RM…saving almost 50 RM….

We managed to reach my uncle’s house to pick up my dad’s Sirion at 7+am…

There was one act the made me uneasy but I did not pay enough attention to it – my uncle opened up the water tank and added some water into it before he handed over the car to me… I did not ask anything as I presumed the car should be in good shape as my dad had called my uncle 2 weeks ago to prepare the car….

The car was 15+ years old and I don’t expect much. My brother had warned me about the drive as the car was equiped with drum brake only and the braking ability was very poor.

The drive was smooth as I did not sprint …. Before I pass one of the toll house picking up a ticket, one number caught my sight – the number of PLUS line rescue, bad bad sign but still I was not aware of it.

The drive beame rougher as we reached the notorious Karak Highway. I was trying very hard to negotiate the curve and suddenly the air con become warmer than it should be….I take a glimpse at the temperature meter and spotted the pointer pointing at the peak of the meter…. Darn “tanki” and water problem, I cried in my heart… I was lucky as no steam was steaming out from the bonnet yet…the car was at the tunnel now and I slide the car slowly through the tunnel and drove into the R & R of Genting Sempah….

I parked the car at the parking zone and open the bonnet, and I sighed. I was lucky as there is some steam coming out from the water tank hose and the radiator looked intact. But the tank was empty and I knew that I had a leaked radiator. Same event occurred twice…. I told myself this is faith of a twins, I usually got same event twice; radius fracture in 1 shift (1 left, 1 right), 2 CPR in 1 shift, 2 snake bite in one shift and so on…..My last radiator leakage was about 10 years ago with my Kembara. It ended up with a radiator change and some engine part replacement costing almost 1k….

 

The next step was to call up my uncle, and I got the number of the AAM(Association of Automobile Malaysia). However my hand phone could not reach the toll free number ( it is usual as most toll free line barred hand phone from calling.) as expected.

With the help of God, I opened the front storing case and found an envelop of AAM. There was this KL number and I called up. The lady on the line told me that I am out of the AAM coverage and they would sent a panel tow truck to me….

It was another wait of 30 minutes before the tow truck driver called me. By this time, I knew that I was unable to reach Jerantut in time to meet T and his families. T is my senior in College, a gastroenterologist, former colleague of mine. We had met up for dinner months ago and after knowing my plan of going to Taman Negara, he had decided to join me. Later he had persuaded his mother and sister to join the trip and the group had expanded to 11 person in total.

I told him that I am unable to meet him for lunch in Jerantut and asked him to proceed to the jetty of Kuala Tahan; I would try to catch the last boat at 6:20pm. It was 11:30 am when I made the call.

I had come up with several plan by that time.

Plan A: tow to nearest Perodua Service center(Perodua =loca assembled Daihatsu), and left the car there until next week(it was Saturday and I doubt they are working).

Plan B, towed to the nearest workshop and left the car there. the workshop would sent the radiator to someone for mending and it would take a day to mend and another to get it back and installed it.

Plan C, towed back to Klang, (no difference as I had to pay up the tow truck anyway) and find a workshop and get another transport to Taman negara or forfeit the trip...

With both plan A and B, I had to hired a cab to sent me to Kuala Tahan Jetty. The main problem is that I had a big luggage which I intended to leave it in my car booth while enjoying the 4D3N trip initially. It would be a big in-convenient bringing the baggage. However it seems to be the only solution at that time as we would not be able to reach the jetty in time – the distance was about 200km and with the rough condition of the road, it would take about 3 hrs to reach the jetty. So the dead line for us to move on is 3pm. With plan C, it would be a different story as we would have to get a car to drive to the jetty(which is very unlikely to happen) or we would catch the midnight train and reach Jerantut at 3am the next day.

The tow truck called me again before he came and told me that I had 2 options.

Option 1: he sent his foreman over and sees what he can do, he said, no matter how big is the tanki, they can fixed it

Option 2: tow to whatever destination I wish…

I opted for option 1 as I wanted to give it a shot before forfeiting the trip, came a long way and waited for a long time for this trip….

The foreman came with 2 of his colleague. He had a look at the engine and told me that the radiator had leaked and he would need to take it out to see if they could mend it…as I had expected and I knew it would not be cheap as these rover rogue foreman would cost a hand and a leg if I let them laid their hand on my car… but I had no choice – 7 peoples are waiting me to join their tour… I had to beg on it….

I let them took out the radiator and rested at the R&R. We were lucky as the weather was cool; I had a reading of 22°C from my Mudman, we took a nap and I called up the foreman at 1:30pm and asked him about the progress. As expected, he told me that the radiator is in very bad shape and couldn’t be fixed. I concurred and asked him to replace the staff with a new one. I told me that he would try to find one. I told him that if he can’t put the thing back into my car he would have to call me back by 2pm. I would have to go for plan C. By 1:50pm, he told me that he had gotten an expert to mend the thing back and he is on his way to the R&R. By this time, both my dad and Ving had given me another choice – if the things is barely fixed then we should drive back to Klang and tried to get to the jetty by tomorrow….I crossed my finger and decided to see how was the condition of the radiator when it was returned.

The foreman and his “budak-budak” came and I saw the radiator is in good shape, cleaned and painted….they put the thing back and started their “Show”. They kept telling me that very difficult to get a replacement and it took a great effort for them to mend it, one of the fan’s carbon had worn off and needed to be replaced…After a 5 min bull shitting, I told them to get down to the point – how much. The foreman sit aside and let one of his “budak” performed the show. The “budak” was in a trance, raising his voice and waving his arm into the air and mumbling the price while writing it down. The fan cost 480RM, the rest of the radiator mending cost 870RM, summing up to RM1350. RM 500 more than I had expected…. I told him frankly that I am doctor working overseas and I could only pay him RM1000. I told me that I could get cash from the ATM at the R&R and I told him that I am not residing in Malaysia and I don’t own a ATM card. I took up RM500 and NT5000… and passed over to the foreman. I told him I would wired the money into the account by Wednesday when I came back from Taman Negara. He had no choice and written down his name at the back of the receipt… I left those blood suckers behind by 2:45pm….

It was a very rush drive as I had to complete 70km of highway, 130 km of kampong road (70 of it is very rough…) within 3 hours. I had no confident at all even though I was satisfied with the appearance of the radiator after the repair. I carefully monitored the thermometer while cruising at 90km/h on the highway. I dare not push the car to its limit…

When I get off the highway, I was sure that the car would make it to the Jetty as the temperature did not rise more than half of the meter. I had another thing to worry by then, will I make it to the Jetty on time.

I had 2+ hrs to complete the rest of the 130km. The drive from the highway exit to Jerantut was still ok as I could make 70-80km/h most of the time. But I knew the challenge was the last 60km. I had seen some photo taken from the internet and knew that the road was narrow and it goes up and down like roller coaster rail. The next thing that worried me was my fatigue, I had been going on for more than 30+ hrs, thanks to my usual routine as a night shift attending physician – I could still hang on to it….

I parked my car at the parking of Jetty at 5:50pm(30 mins before the last boat), paid up RM20 for 4 days…. I reached the nusa station floating restaurant by 6:10pm and catch my breath while watching the beautiful view of the riverside…We managed to hop on the boat on time. The ride was longer than expected, 15 mins from the Kuala tahan Jetty.

T was at the jetty of Nusa Holiday Village waiting for our arrival...

Finally we make it to destination after a long journey. This was the longest duration for me for not changing my cloth outside my job- almost 27 hrs ( the working suit I wore during my weekend lasted for 30 hrs…)

While enjoying my dinner with the group, I stared at the river while enjoying the water flowing sound – finally I am at my dreamland, after all those year of dreaming since my high school, I am finally at the beginning of my adventure….

 

 

past but still....

“Malam Sial Untuk Adam. Membunuh, Dibunuh atau Bunuh Dir”

The above was found on a mirror in a Hotel where Private Adam Jaafar assembled his gun. A few version of different story was found over the net:

This is the worst version…

http://webcache.googleusercontent.com/search?q=cache:sYd2BiQ6_jYJ:jemaribebas.blogspot.com/2009/07/prebet-adam.html+Prebet+Adam+Jaafar&cd=4&hl=zh-TW&ct=clnk&gl=tw

I had belived the version for many years….and until recently, I found that his interview article of Datuk Muhammad Shafee Abdullah by the STAR 2009 – a high profile lawyer in Malaysia; He was the defending counsel for Private Adam Jaafar. I believe this is the real story…

http://thestar.com.my/news/story.asp?file=/2009/9/27/focus/20090926195907&sec=focus

 

Adam Jaafar was at least confined in Tanjung Rambutan for 5 years…I knew this in the past when I joined the Perak Health officer course held in Kuala Gula. The senior medical officer, had told us that she was working in Tanjung Rambutan then and there was this Petronas Executive(?engineer) who slaughter his wife. He was using drug(Ectasy or so ) at the time and he was claimed as temporary insane at the time of murder. But unlike the STATES, murder who was proved temporary insane at the time of the crime is to be confined to Tanjung Rambutan for at least 5 years for Justice purporses, even though he is sane after the incident…

PKM...

2 more weeks before I hit the airport… anxiety I am as this tour would be different from before. We would be taking the so call “red eye” flight as the plane is getting off at 2330 and arrive at LCCT at 0410…. A 40 min to clear the immigration and luggage and we should be enjoying “Old town” coffee at 5am… Another wait till 6am then we can hop onto the taxi and head to Port Dickson... a 50% surcharge would be charge for trip before 6am. That is why we need to wait till 6am. We would pick up my dad’s car at my uncle’s house just located beside the health office of Port Dickson. A compact sedan>15yrs Daihatsu Sirion….

We should be off by 8am heading to Jerantut and later to Kuala Tahan….a 300+km drive and I would be resting at the riverbank of Sungai Tahan, looking at the stars, sipping my root bear…

Finally I got my Kuala Tahan Trip after 20+ years…Both Xian and Yun are actually reluctant for the trip as they are afraid of the arthropod and the reptile. I got a full 4d3n package and would be heading up north to Betong….I am going to the peace village to see the left over of the Malaysia Communist Party. I remembered my dad told me, my grand dad was one of the supporter in the new village. I had told Yun about the story and she was fascinated with the history and it would be a good education trip for her...JUST if we make it.....

Worst Case Scenario....

The worst case scenario had occurred…. W (the locumer) had told Lem that he is going for a vacation in August, the whole month… That means 4 big lubang during the weekend. I told Lem that I could cover 2 of the Lubang … that means 2 more holes to be filled up…. It would not be a problem if Lem could cover for 2 day shift during the Sunday… but still, with the current pay scale, no commitment…We shall see…..

Worry....

I had written about a young chap with renal failure and received help from some charity body raising a quarter million RM enabling him to go up north so that some poor guy could sell his kidney for money…

After a struggle with the charity committee for a gene therapy rather than the transplant, his plea was rejected, he had gone to the north and received his new kidney. He had come back and returned to his study. He had written in one of his recent blog regarding his medication fee. He needs 2-3k RM per month for the immunosuppressive medication. He is wandering about his job in the future…he need a job with 2x of salary than a normal people, that is if he could secure a job with RM2-3k… he is dreaming of working part time and getting a double amount of salary with 2 jobs… but with his attitude, I think it would be very difficult…

Things would be smooth after your further study, that was what I was told during my high school days… yeap my parents were right, but nowadays, the society is different and graduation means nothing – this is one of the great article , a must read for youngling and parents

http://mag.chinatimes.com/mag-cnt.aspx?artid=10913

the urge of buying a land and setting up a farm had become stronger and stronger ….. a sanctuary of tranquility for the kids if they need it in the future….

Mona and his father.....

Yun was studying for her final last week. The social science subject had taught about the famous WeShe incident… A epic saga of an aborigine tribe fighting against the Japanese army. The tribe leader Mona Ludo was one of the warrior of the Seediq tribe. He had led his men fighting till their last breath for honor instead of living like slave. We bough the BD version and I saw the movie with the both of the kiddo … Hell of the film, I remembered at one of the preview interview, the director Wei TS had said that when they went to John Wo(one of my favorite director)to invite him as producer, John had told them that they could only shot 1 fighting scene with their Budget…..Indeed the movie making is an agony process..Yet the presentation was so fascinating

 The money well spent for the blu-ray version worth every penny. No regret of spending it....

Mona was a great warrior, However most of the tribe men could barely follow his step…. It reminds me about me and my kids….I had come so far but unfortunately I do know how to teach what I know to them. I hope they would be someone better than me, but I am not confident…they can’t trace my foot step as the way I raise them is different from what I gone through.

 I rather be the father of Mona seeing his son growing up as a proud person than being Mona himself. But the only thing I could do is to follow the way of THE BOOK hoping they would concur and learn……

oh i forgot....

There was this old man who come to ED c/o gastric pain. He claimed that he had eaten some contaminated food during dinner and pain had awakened him from sleep. He had however pointed to right upper quadrant of abdomen instead of the usual epigastric region.

I asked him what he had for dinner and he said as usual. I am not satisfied with this of answer most of the time. I don’t live with the patient and I don’t know what does the usual mean. I usually would dig the story and he told me he had some chicken soup. Should get the spot diagnosis by this time and I had asked him if he had any history of stone (that include urinary and gall bladder). He gave me a negative answer.

I proceeded with the physical examination and a positive Murphy’s sign was noted. I proceeded with the ultrasound and show the 3cm stone to him and told him about the diagnosis.

He then told me, “ yeah yeah I had gall bladder stone…” I asked him,” but you had told me that you had no stone in the past…”. The patient grinned and answered me, “ Oh I forgot…” Well, just another never trust your patient scenario….

It was  pain in the ass during those resident/medical officer days… clerked the patient like dog and during the specialist round, the patient gave another story – some of the time, one would get this unfriendly “you are lazy” stare from the specialist….time had passed but still, the same scenario happens again and again but this times, I am the one who give the “stare”-----to the patient of coz….

 

lou hang....

I had this lady who met an accident few days ago. She was involved in a bike vs bike accident. I had a chat with her while waiting for her wound to be cleaned up. She told me that the accident occurred at a traffic light junction. I told her that it would be a 50-50 case as the both the rider would claimed that the opposite party is the offender….Well, indeed the young chap turned up and told the police the story later…

Well the parents of the young chap came and after the police investigation. I told the lady the xray did not revealed any bony fracture and the young chap’s father asked me would it be better if an xray is being ordered. I told him serious that I would not be standing there telling the lady that her bone is ok if no x ray was taken.

Later on discharge, the father against asked me in front of the lady that would it be better to give a tetanus toxoid jab. The act frus me and I told him,” I won’t be discharging my patient if I had not done my job”. The father told me,” no lah, just do reminding of each other..” this really irritated me, “ do you thing that I am a first day on my job fresh graduate who need reminding on such basic job…?” I told him in a firm voice while looking into his eyes and walk off after a few seconds… Could have stay back and humiliate him further by telling him that this is not the way to act in real life, but still he is like 20+ years senior than me in life… well, just cut it..but while walking to my desk, the word, "lou hang" [cantonese] (老坑) came into my thought and I just grinned for a good 5 minutes.

The word "lou hang" is just another way of saying "lou hon"(老漢) in cantonese in a disrespectful way.... an old guy with no proper manner....nice term for the old chap even though he wore a proper attire...

I had met lots of people who came to ED ordering the medical team for this and that acting like they are so concerned about the victim…most of them had a little knowledge about medical but this make them look more like a fool…

ye how nga gan ji hang....

It had been raining for the past few weeks, not surprise during this plum raining season. The weather is affected by the southwest monsoon… with the 2 typhoon Talim and Guchol surrounding the Taiwan, it was speculated to be the worst raining session ever. The local govt. had declared a holiday on 6/20 and the kids were happy. I did not enjoy the leave as I had to go to work anyway.

Driving to work is a challenging task even though the road is not expected to be flooded but the water pooling along the roadside cause a splash from time to time proved to be some fun driving across it. Z was a good car but still it shortcoming was the height, it is just a wagon but with Fefe, I lost the fun of maneuvering but gain the confident of driving through minor flood, I always remembered my dad’s advice – [ye how nga gan ji hang[Cantonese] ]drive through with 2^nd gear, never stops or else – if water enter your exhaust pipe, you are done…

….I had a smooth drive as the was only a handful of car during the drive. It was raining intermittently with no heavy down pour.

The rain had become smaller in the midnight and I had a hard call….

I had encountered a tough drive during a heavy rainy day back in Malaysia. The rain was so heavy that I could barely see the road with my wiper at its maximum speed. However I had multiple similar encounter here in Taiwan and getting used to it...

It is one of the worst year, rain and earth quake here and there, I really missed Malaysia which is relatively disaster free….

filial ....(1st time I use this word...)

Lem passed over this patient to me….a 70 y/o male which was found sitting at the crematorium nearby our hospital. The worker had found him unresponsive and he was sent over to us by local rescue ambulance. Lem saw him at noon and he was alert (hand to face test was done and his hand did not land on his face…). He had however refuse to response /answer all our question. I took over the case at six and he refused to answer my question. Later in the night, he started to talk but was able to give us only a phone number.

We had managed to contact one of his son and he said he would communicate with his brother and decide who would come to get him; it was 10+pm then.

He is also a case of uremia on hemodialysis. He was supposed to get his dialysis on that day. I had planned to get him hemodialyses in the morning if he is still around.

I called up the hemodialysis center he was receiving his regular hemodialysis to get some basis data. The nurse told me that he had two sons and 1 daughter. The daughter stay up north and he took turns staying in his sons house. The 2 sons did not call up and the patient decided he wanted to take a train back to his house….I let him do so as he was alert and was able to move around with good appetite...

One of our nurses called up his son at 7am that morning and the son told the nurse that we are harassing him….

Well….where is the fundamental family value…I felt pity for the old man….at leaving, he had told our staff he had gone to crematorium because he wanted to be cremated and get some peace…indeed with this kinda of sons....

I had seen many off spring who is not filial to their parents. It always serves as a reminder to me. If you treat your old folks badly, than that is what you will get from you children, but still, if you treat them good, it doesn’t guarantee you child would do it to you. Seems like a losing investment but still just can't be calculative about everything....at least I could sleep comfortly in the night...

 

GE13..

The thought of going back for the voting still haunt my soul…. The GE12 was a stunning one for me… For sometimes, I had given up hope that the opposition would perform, especially those days of working with the MOH; I just can’t figure up people would like to settle with the situation. I had heard voice but still didn’t see any changes. I been to the Health officer introduction course conducted by the state health office – specially for Medical officer working in the health side(klinik kesihatan). The course was held in a very secluded resort – Kuala Gula, I drove a few hundred km to reach there. There was 2 non-Malay MO among the 10+ who joined the courses. During the course a senior medical officer had shared her opinion with us- > she actually talked about the privileges of the Malays and “advice” the Malays MO to stand up strong and not to satisfy with the right but to build a life of themselves with pride. She quoted that Chinese had to save up since young for their children education fund but most of the Malays don’t…..

But still BN swept during the GE11….

At the night of GE12, I went to a company dinner with my family. I came back at about 11:00pm and logon to the net. There was only a handful of result..and at 3am, I woke up and saw that Selangor and Penang were taken by the Pakatan. It was a stunning one.

I am still looking for a change, and I wanted to be there if that should occur. The election would mostly held during the school holidays at the end of the year… The reason is simple, it will be a close fight and a chaotic rally leading to curfew might just happen. It would be relative safe for the children if school is closed, no Monday shutting down of school is needed in the worst case scenario…

Most of the citizen (with whatever right or not) did not benefit from the current government, only some that share a piece of the pie…most are struggling with a moderate salary – trying to buy a house and car with a forever lasting installment….

I don’t mind our minister is being paid a million/year provided the country is progressing and every citizen is paid some dividend (just like our neighbor country) every year. But what I saw was a Minister who don’t have the guts to take out his own RM24200 for a car license plate – what he is afraid of ? a check from the MACC or he is too stingy?

Still 6 more months to go…. Lets see what kinda of joke they would perform…..

money not in my pocket.....

It had been 2 months since we joined the new insurance payment scheme….the 1^st batch of revision was supposed to be declared 2 weeks ago, the management had estimated a 30% reduction on the 1^st pass…. but we had not heard a word from the claim department….

I went to the nursing department for some errand and stopped by the claim department. I met the person in charge and asked her about the result….she told me the deduction rate was 12.8%...WTH, a very good result indeed, a 10% increase of amount of bed, 20% increase of bed occupancy rate and 15% increase of investigation rate….the is a boost of 30+%....well, maybe a good bonus increment next year for us…..

Negotiation....

Pt had become more, complaint from the ward had become more… admission become more, but our pay remain the same, unlike the other attending doctor in the hospital – when pt amounts increase ,their ppf(proportional physician fee) become more….the financial controller had not show up in the ED hinting us about empty bed in the ward for quit some time. The locals had made our hospital first choice after the use of new building….

Lem was called up by the dept supt of admin and he was told that he would have to give up his govt clinic visit. The notice had not only affected his pay but also affect 2 of us. K and me… During the Tuesday, Lem would spent his morning in the govt clinic and on alternate week, he would visit the local nursing home down south. I covered for the morning session(4hrs x 4 ) and K covered for the afternoon session(6hrs x 2). The admin had told Lem that he would remain in the ED and K and I would have to do weekend shift to cover for the lost of working hours. I had been working 140-150 hrs instead of 180 for the past few months and further down cut would definitely affect my pay…

Apparently the govt clinic and nursing home is passed over to the new family physician. The initial negotiation was not smooth as all of us resisted the change and there was once an agreement that it would remain the same for a short while. But yesterday, Lem was called up again and told him that it was a go and we would have to settle the issue ourselves.

I had given up the Tuesday morning 4hrs and a Sunday night shift and go for a 27 hrs call. (I am still -3…) but 1 long call for a change of 4 tiresome mornings ED shift…. Not good but acceptable

The act had irritated us but still the admin is alarmed by our reaction.

W(the weekend locumer) would be reconsidering his locum after August as the Respiratory ward he is covering in K City is phasing out him. He had planned to get a job in slightly up north. The hospital is considering to hire him as night shift duty physician covering for ward during weekdays and continuing his weekend call….

Another round of negotiation….I hope it would be smooth….

corporate's life....

The ED had become very busy lately….our pt amount had increased 30% since 1+ months ago… still able to coup with the situation but still, the calls from the ward is another stress.Not sure what would happen and calls would be worse than ever.

The doctor’soffice is situated in between the 1^st and 2^nd floor… adimension which not supposed to exist in the building plan. It looks just likean office in a company. There is a reception hall with sofa at the entrance. Adining area with ? coffee maker and some drinks. 2 call rooms with 2 beds each.
A large area which separated into 20+ cubicles, each cubicle has a desk 2 cupboards … Boss had told Lem to pick a spot and both of us had picked a seat beside the window…. Nice view with larger space.

Not sure if Iwould stay forever but it is the first time, I had an office seat….anothermilestone for me…

The hospital even issued a discount card…. bigger and bigger it grows and become more complicated on the job....

Mourn....Fatty....

The alarm of my hand phone rang at 5:00am, I woke up and did the routine before I woke up the kids…. Fatty past away last night….Fatty was Yun’s pet hamster… Fatty(a she) was passed over to us from a church member. The man of the house was severely ill (lung cancer with brain metastasis) and the family had to split up as the lady of the house had to look after the master in the hospital. The pet owner, a girl of Yun’s age had to stay in her granny house. Fatty had to be place at the  “kaki lima” besides a dog during that periods. The family had decided to “let” Fatty go later on and we thought it was a bad move and took over Fatty.

Fatty was about 2 yrs of age when we took her in. She was quite aggressive trying to attack every object that approached her initially. After months spending times with her, she became more friendly and tamer…

We had done some reading and knew that Fatty is at her last period of her life as most of the hamster live about 1 1/2 years…. At the age of 2, she is considered very old… I knew that day would come initially. It was another year since Yun started to look after her...

Fatty had become very thin when we came back from Malaysia, We had placed her again to her old master for a period of 2 weeks during the trips. Fatty was very weak and refuse to eat during that period. I had had a check on her and found that she might be emotional disturbed by the change of environment. In the mercy of LORD, she had regained her vitality 1+ weeks later and started to eat well, but she become less active and slept more than she does….a sign of aging....

Last night, when I was feeding the Titi and Dragon Cat (the 2 hares); I found that Fatty did not came out from her strawberry cave(we bought it for her during a trip up north)…. She usually come out and sniff for food and I would feed her some vegetable… I had bad feeling about it; I took a glance at the strawberry cave and she was not moving… I took her out and found that she is not breathing. I summoned Ving and the kids…. The kids were very sad and bursting in tears….Fatty was in her sleeping posture and food was noted in her paws….

It is time, I had expected it but still....

Today, I took everyone of the house to a ground in front of our church. Conducted my first funeral service and let Fatty rest in piece… I was tearing when I said the prayers….It is a loss for everyone in the family…it was a lesson for all of us regarding life, with pain and mercy from our LORD….

Fatty, may you rest in piece , we would remember you for ever…

Attitude ... it does matter...

We had an ex colleague rejoining us few weeks back…W is Burmish who graduated from top medical school here in Taiwan. He had failed to pass the board and later ended up working in some construction site down south. He was introduced to our boss many years ago, I had just returned from Malaysia then. He was posted to ICU and ward to freshen up his skill and knowledge. He had shown poor skill and knowledge and lack of working passion then. Posted to ICU and he had placed himself in the discussion/resting/office of ICU after the morning rounds instead of busying with order and charting. The skill parts were worst as he had no idea of sterile technique… Well, Boss had asked him to leave after few months of effort. Lem had given him some ref. material for the board examination on his leaving.

Few years later, boss had told us that he had passed the board and currently undergoing training in orthopedic. Good for him, a shame seeing a medical grad earning a living on hard labour.

Well, aprox. 1 + month ago, boss had introduced him to both of us while Lem and I was doing the morning Passover.

The introduction was a little bit weird,

Boss had told us that

1.W would be standing by for trauma case in the night
2.our senior orthopedic surgeon would be covering for him /going in with him for ops in OT.

3.We can call W for large/contaminated wd which need to be done in ED

W had told us that,

1.He is good at ankle – his mentor is an ankle expert

2.He can do trauma and nerve repair is not a problem

3.He is keen to learn everything – even medical management

Boss impression – he is under probation,

W impression – he is good….

Few days later, Lem told me that he had overheard a conversation between W and the management – it seems that W is still staying in a motel rather than a unit rented by the hospital. The management had never treated a doctor in such way - > rooms/house would be ready / almost ready on arrival…Lem told me that W might be still having attitude problem…

1.W is always playing with his Ipad – whenever he sits down, no matter where he is, no matter how busy is the environment

2.A case was send up to the OR and he had sit in the ED (With his Ipad of coz)  for 30-40 mins after the patient was sent up.

Another few days later, Lem had told me that Boss is going to let him go…. And Lem told me the incident that happen for the past few weeks..

1. 1.    OR (boss doesn’t know about this…)

He had done a few ops. He had done a Total hip replacement, which had taken him a long time to decide how to make the 1^st incision, and later the procedure was completed by the surgical aide and the prosthesis sales rep.

He had done a plating which later re-ops by the senior surgeon, the plating took him 4 hrs to complete…

1. 2.    Pharmacy

He had called up the pharmacy on his OPD session asking for drug info(mainly the use, QID or TID , AC or PC) for most of the drug (Except acetaminophene and some antacid). The pharmacists were irritated by his act…

1. 3.    Ward and OPD

The nurse had complaint about his attitude and prescription…

He was in a fuss when the management asked him to leave…. He had threatened to let the hospital suffered in the future after the meeting….

This was the 2^nd orthopedic surgeon I encountered who cannot operate properly… There was this urban legend about surgical training – the senior surgeon would bar those incompetence and attitude problem training resident from entering the OT. These residents would still pass their board but eventually ended up as one who cannot operate….I think I had seen one again….

Boss might had heard some rumor in prior to hire him and that was why he had no hostel to stay in…..

Well, it is not the knowledge nor skill, it is the attitude that matters… 

ACLSI - see u next year...

I did not make it to the list…..I did bad in one station, below average on another and the rest of the 2 was ok….well, I did not get the approval of 7 examiner and thus, again I was struck off the list…

 

Well, depress I was but still, those who passed include

- one who teaches no pulse than Chest compression for child pass(shoule be no pulse and <60/min c poor perfusion) : best candidate in our group....

- shock: volume ->rate>pump (wrong sequence)

- spent lot of time on intro than on hand skill

And much much more which violate the examiner introduction of what not to be done...

Well, the chief examiner had told us that it is an evaluation which based on "luck"...don't be depress if you fail....WTF.....

 

 I felt it was my destiny, time is not up yet and next year I would give it another try….

Well, nothing much to cried about and life goes on…. 

ACLSI .... revisited...

It had been 3 years since my last entry to the ACLS instructor course – failing the final part was really a stress to me… I gone to the pretest 1 years later in Taipei but again with minimal preparation and of course I did not make it into the course.

I forfeited the pretest in Taichung, but this year I had managed to step out from the shadow and trying to gain ground from where I had fallen….

I had managed to register my name on the closing date – a close one. I decided to buy a Chinese version book with guideline 2010. I had the 2010 guideline downloaded to my kindle but never got the feeling to read it….

I had picked it up but found that I need something more condense and picked one over the net.

The book arrived 1 day later and I got it from the 7-11 nearby. I had started my reading and completed all the MCQ few days ago. I did a thorough reading and ran through the scenario provided.

Not very confident as the preparation time was too short – only 1 week. But still, unlike the past, I handed my faith to the LORD…

The pretest was held in a teaching hospital 60km from my house and it was just at the exit of the highway. I left home 1.5 hrs before the pretest start.

I managed to get there without difficulty.

The written test was easier then I thought but still I was a little bit worried. I had my lunch and returned to the building and found that there were candidate walking out from the main door – the result was out.

I did not rush and took my time up to 7F where the pretest was held. I saw my name being highlighted and thank god that I had passed… however more to come next as I had to face the skill station. BLS, megacode and Airway. I had no problem with the BLS and airway, but still the megacode post a challenge to me.

I was assigned to the megacode group and I had waited a while before I was called. My heart sunk when I walked out from the room. I did badly…. It was a trauma case (rare to have it in ACLS scenario) and it was supposed to be a hypovolemic or pneumothorax scenario. However I had spent to much time and the time was up before I got the the needle aspiration part. A bad start and I waited for another hour before I was called to the BLS station. I did fair at it and the airway station was good as I completed it under 30 seconds.

We were led back to the class room when the introduction speech was given by the tutor. The introduction was better than the last one I heard, a simulation of the scenario was given.

I praised LORD when I saw my name highlighted again, RM970 poorer and I had to stress for another 3 weeks. I had to prepare 20 topics for the course. 4 topic would be chosen 10 min before the presentation.

I am back to the ground where I collapsed and trying to get on my feet again……

Hope I would make it to the list this time....