D minus to home....

 

I left the ED at 5:40pm as K came early…. It was a tiresome drive and I was lucky as the traffic was reasonable. I managed to hit home before 7. I had a good shower and dinner and had a co-op game with Yun on the “Gunstringer” game – awesome experience with great and humorous dialog during the game play….. the control of kinect is a whole new experience for me…

Well after 8 hrs of a good sleep I hit the road by 7 today… a 25 minutes drive took me 50 mins due to heavy traffic…

I am now D-33 hrs on my 34 hrs shift….to be frank I had done worst but still it is new year and I had to expect the unexpected…

I had 2 OHCA(out of hospital cardiac arrest) and 1 EDCA(ED cardiac arrest) with 4 fracture and 1 shoulder dislocation on the previous call..

Thanks to the lords for giving me a chance to push my limits….

The worst would be the drive of going home….

long shift.... of da CNY

I had been doing calls on 1st and 2nd days of Chinese new year for the past few months… One of the reasons is I don’t have a mother in law house to go for …. Most of the new year calls are bad one – all the clinic closed c limited OPD …. The average patient in the ED increase from 50+ to 120+ per days… However the rate limiting factor for consultation in ED is the nurses and not doctor. The appropriate ratio for nurses : doctor is about 5:1…but still capable nurse was the key factor…

The ED was busy last night but still I caught some sleep. Well, the calls end at 6:pm today and the hazardous part was driving home. Today is the 2nd day of CNY and I had to join the long queue of “in-law returner” or take a long detour…I hope I could make it home in 1 piece…. The next shift would be a seem impossible calls – 8 to 6 , 34 hrs call…. Long long story which I had to compromise ……

of election...

 

The presidential election of Taiwan had finally come to an end after a 4 months fight. The green had lost over a 5+ % of votes… I had disliked “da green” dating back to my college days. I had met people/fellow student that demand me – to speak in Taiwanese as they claimed the southern part of Taiwan is their reign…..I was stunned by their language and they almost barbaric act towards those “pig from outside the province”(people that is not originated from Taiwan- including those who moved to Taiwan during the war).

I had focused on the political talk show during the last few weeks of election and saw speakers who were pro- “da green” misleading the folks with false viewpoint.

After the election, they had claimed that the public were misled and threatened by the ‘da blue” and “da red”, some even claimed that the democratic spirit had died in Taiwan.

During my college days, at the time when the ex-president turn inmate was serving as legislator, a bill was passed by the ex-president regarding foreign doctor working in Taiwan: For the purpose of protecting local doctor working right – foreign medical graduates are required to return to their homeland for 2 years to entitle for a working permit. The restriction was lifted 2 years after my graduation….During the “da green” ruling period, the alien residential control was very strict – we were treated as outsider who came here to eat up their resource…..

My next focus would be the general election of Malaysia…I am looking forward for a bigger change this time..and hopefully I would go back and fulfill my duty as a voter…

liar

It was my once per months Sunday night call…. I saw this old-aged male walking down from the ambulance…

 

Our locum doctor had seen him and he passed over the case to me after I change into my walking suit…

The male had joined a hiking trip and collapsed during the tea break session. He had regained conscious en-route.

I had asked a detailed history as usual. The patient had specifically denied trauma nor knocked over his head during the Q-A session. He had told me he was still alert but was unable to open his eyes and move his limbs. I ordered a brain CT and after the CT session. Another lady from the team had asked me if I could give them a medical report with the diagnosis of head injury. I told her that there is no head injury and I could not write it down in my report and the patient and the team of the folks had started to overturn their story – yeah, the old man had slipped and bla bla bla …. I told him that then I need to change the dx to brain concussion and advice for admission. He had wanted a referred to K city hospital where he stayed. Another Insurance claim craving liar – how much can they get ?
I had a bad feeling being force to do some “I know is lie, but what can I do “ stuff. Maybe I would buy a pen recorder and next time…

Under fire

 

It was a bad days… On the passing over the day before, Lem had told me that tomorrow meeting would revealed our effort of work… I stared at him and told him that nothing much to shout as we definitely would be the target of cross fire….our effort would not be seen !

I explained to Lem that, the figure presented to the meeting is unfair to ED.

In most of the hospital, ED would have been a money losing department. Why ? The National health insurance had divided the medical fee into 2 portions. The OPD(ED included) and the In-patient. A fee generated by an ED patient admitted to ward would be counted fully into In-patient claim instead of ED. So whenever a patient is admitted, that particular revenue would be off-hooked from the ED income. Unlike the other hospital, 70% of the admission came from ED (other hospital range from 20-40 instead.

I told Lem, don’t expect any increment as most of our effort would not be notable in the presentation. In actual fact ; more admission from ED = less ED income….

The presentation by the director of hospital affair was as I predicted. The figure generated from OPD and ED was slight increased compare to last year… why, we had admitted a load of patient in the past 2 weeks – keeping the in patient rate to 90% for the past 2 weeks…but still, that part of the effort was compromised by a mass discharge of patient ( almost 50 beds in one day)….

Some of the staff had come out and bombarded the ED for admitting not enough patient….and that pissed Lem off, the ED patients is 1/5 of the total patient /days but still we are taken for granted to be the major admitting window….

We had a short discussion in the morning and agreed to fight back on the next meeting… we would be demanding a new way of presenting the figure, a presentation which could show we are working very hard….