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...