Card game...

Since K arrival 2 years ago, K had gradually taken over the duty of making up the roster…

Well, as most of the shift was fixed, there is nothing much could be done to manipulate the roster. However K could do his best to kept the roster fully fill. Boss had told Lem specifically that he is not going to do anymore shift and all 3 of us should do our best to fill up all the holes….

K would do the best to do so and he had to persuade me from to time to time to take up some grave yard shift…

However 2 weeks ago there was this news that the we had been graded as secluded region and the govt would start to dispatch govt sponsor doctor (Scholarship holder) to our setting. There is one to come to our setting in Q2-Q3 this year. Nothing much would change as I am doing merely 170-180 hrs per months. However it would be a shocking cut form K. A cut of 120 hrs summing up to > 180k loss in his pocket.

The struggle had come early though. Boss had approached Lem that he would be taking up Tue and Fri nightshift, leaving K with 1 weekday night shift. When Lem broke the news to me, I shook my head and said that it would not be possible. But later Lem told me that Boss is serious and the struggled had started.

As K had put up the roster earlier and Lem had altered the roster and shown it to Boss and K. Lem was cautious and instead of stripping 2 weekday shift per week; he had taken away one shift. Less impact for K…

K had strike back without showing rage. He had complied with the alteration but declared that he would not be doing anymore Sunday night shift. Leaving 2 big hole in the Sunday night shifts….

2 “lubang” in the roster and I told Lem that I am not going to volunteer…..

The game of poker had started and we don’t know what card Boss has at the moment….. time would tell….

CNY case 1 - "transfer also die and no transfer also die"

I had this 2 “extra-ordinary” cases during the Chinese new year.

The 1^st case was a 60+ years old female who had fallen into a drain about 1+ meter high. She had opened the backdoor of the kitchen and miss stepped into the drain. She was sent over by the ambulance with full immobilization gear. The patient had complaint of bilateral hand numbness. She was however unable to lift her lower limbs and drop wrist was noted. She was alert and denied of any loss of conscious. It was a spot diagnosis and I told the family that she had this cervical injury with spinal cord involvement. I told them this is a life threatening injury and the patient’s younger brother had told me straight that they want a referral. I told them I would referred her once the examination is completed.

The initial management and CT took about 35 mins and it was a C7-T1 fracture with subluxation. I called up a medical center up north and they accepted the case. I told the family again that I couldn’t managed her here as our neurosurgeon is not around. I The BP was fine on arrival and started to sloop down just before we moved her. I ordered a dopamine drip and flush in 1L of saline. I had also given her a mega dose of hydrocortisone. The patient had left the hospital after lightly 1 hour on arrival. The nurse had however called me up 15 mins later telling me that patient had gone into hypotension and loss of conscious on the way. They had stopped a nearby hospital and resus was done. The patient was intubated but however did not make it through the resus. The family had asked some sharp question and queried about the decision of referral made by us at the nearby hospital and the doctor over there was kind enough to tell the family that the patient condition is destined and referral is a must as it is the only hope for the patient.

The younger brother who was residing in our area and came to me the next day and asked me again about the referral detail and I told him that if my neurosurgeon was around, I would have objected the referral request and would do everything possible to keep her as ops is the only hope for her to survive. The brother had seem to do some asking around and agreed with my explanation. They had thanked me on the way out and appreciated what we had done.

I was lucky as it might end up as a medical legal suit as cardiac arrest on en-route would be the referred doctor responsibility….well, ass save and reminds me to do my usual “transfer also die and no transfer also die” speech(I was too busy during the period and didn’t told the family about this --- my fault…), I hated this speech as it make the family panic and very disturbed while making referral decision, but still I won’t have to clean my butt (and prepare for jail house…) if I do so...

post CNY call.....

I had made it to 4pm yesterday evening, ending the 3 hazardous night shift of the Chinese new year. I entered dreamland at 5pm after a smooth drive back home. The sleep was a comatose one and I was later awakened by some noises made by Yun and Xian. The kiddo had planned for a movie in Pintung ( da “Tranzavania”) however, it was fully booked and I was able to sunk into our aging sofa for a good movie after dinner.

I would enjoyed a 2 day off after tomorrow day shift…. Planning for a bicycle ride elsewhere, however Xian had gathered enough fund to buy his ultimate “angry bird” toy and wish to go to Kaohsiung......Struggling decision for me to make.

 

CNY night shift -1

 My 2^nd call was a good 24 hrs call last night and I managed to catch some sleep. I hit home in time as the traffic was not crowded. I had a short sleep before Xian awaken me from my sleep... he told me that the 2 disc was stuck in the Blu-ray player… WTH, I had to climb out from the bed. I pressed the ON button and found that the machine is as dead as a fish. The kids were at my side before I called for their help. Yun had to me that she had unplugged the player as the machine was making a very horrible noise. I told her to re-plugged the player and after the grueling horrible noise, I pressed the eject button while praying the almighty one. Alas, a miracle and the eject tray came up with no problem…

Both of the kiddo had a short bombardment before Ving chased them for a afternoon nap.

I did not get back to sleep and have a small chat with Ving.. Well, sometimes you just get too tired to sleep and I struggled myself to the job at 5pm. It would be another hard night and my last night shift for the new year. I would enjoy an of starting from Friday evening….

CNY shift 1....

I had done a 26 hr shift yesterday…

The shift had a bad start as I was trapped in front for a traffic light for a good 20 minutes. Unlike last year, there is only a handful of police working instead of a load… Well, I still get to the job on time to relieve K.

There is 1 patient every 5-10 minutes… I was still able to take a intermittent “eye-closing” rest.

The ED was crowded with case of acute gastroenteritis in which most of them had to put on a drip. Our superintendent had helped me out during the night but still the speed limiting factor for a consultation is the nursing manpower, a fact that is in-correctable due to shortage of manpower….

In the night, the incoming rate had fallen from 5-10min to 10-15min which is still very sleep disrupting…

The pacing had caught up later in the morning and from time to time, I had to tell the nurses that all the mosquito were dead due to my beating( a Chinese saying – beating mosquito means one had nothing to do)…

The shift ended 26 hrs later but I was still able to dragged myself to the car. The drive was a smooth one, I was so afraid that I fall asleep during the drive but still, I was cool....and I hit the bed at 3pm....

New year eve trip....

I had gone for the hot spring trip after my govt clinic round on Friday. I left the clinic on time and reach home and found that everyone was still in their final packing stage. It was a 30min delay and we hit the rood at about 1 at noon. I cruised at about 110km and get off the highway at 1:00 reaching our first destination – a restaurant for lunch.

The lunch was a satisfying one. The restaurant was the earliest shop around that region selling “bucket chicken”. An above average lunch and we headed to the mountain side where the hot spring hotel is located. The hotel is not the luxurious one in the area, but it can with a moderate swimming pool and spa facilities. We had visited the area a few time and most of the time we put up at the hotel. It had a moderate pool c activities room. I had a dipped into the pool with the kids on arrival. The water was darn cool and we managed to swim for a while before we dipped into the hot spring pool. The dip was a relaxing one chasing away my fatigue for the past few weeks. After the dip, we had dinner at a local shop and the food was acceptable. We retreated to the room after the kids did their shopping round in the local convenient store.

We had another dip in the pool next day and the water in the swimming pool was darn cool. However all 3 of us were managed to take a good swim in the swimming pool before we had a dip in the hot spring. The dip was another relaxing one. We left the hotel at noon and eat the famous mango ice on the way back. It was indeed a suitable day for ice as the temperature was around 28 degree in the afternoon.

The next stop was Kaohsiung for our annual reunion dinner. I had booked the same restaurant as last year as I had booked late and failed to secure a “Good seat” in another buffet vegetarian restaurant. The buffet restaurant had allocated a seat at the entrance which was away from the food serving table.

The dinner was average and we had taken a round in the new year night market around our house. The night market had been very successful for the past few years and had been a tourist attracting spot. We had tried our luck at the doll extracting machine and Yun and Xian had their load...

A new start by tomorrow and as a working man on the new year, I had no joy at all…

dispensing righ....

 

Experiencing is one of best way to learn.....I am a lucky person as I was granted the chance to experience some extraordinary event…

Unlike the doctor in Malaysia, doctors in Taiwan had limited dispensing right – only in emergency or in secluded area where pharmacist is limited. Every clinic had to hire a pharmacist to dispense medicine and some of the doctors just opened up a pharmacy next door to his clinic….

However serving in the specialist clinic, I had the privileges to exercise my dispensing right..

The govt. clinic I am serving now had only 1 pharmacist and she had to follow the mobile medical unit to the mountain area from time to time. Unlike the govt. clinic in Malaysia, the govt clinic here serves as the local health office and it is allocated with lots of staff managing the health matter. The clinic had to cut down an admin staff to vacant for the pharmacist. The job left over would be distributed among other admin staff and the govt. clinic is reluctant to let go another staff. Thence most of the time, I had to dispense the drugs. Playing with the dispensing machine is some fun and luckily the clinic is not crowded as I could still run between the pharmacy and the clinic and not keeping my patient from waiting too long.

CNY eve....

The dinner/lunch on the 30^th of December of Chinese Year is a important day for Chinese. I remembered during my childhood day, the usual routine would be eating lunch at our house and dinner at my mother side grand parent’s house around Chuah( small town near Sg Nipah – famous for the Nipah Virus) . My father side grand father would joined us for lunch and later we would stay in Chuah for 1-2 days and proceed to Seremban(my uncle’s house) for another 1-2 days.

My mother side relatives would gather together and celebrate. One of the exciting parts was the gambling session, the elder cousin and my uncle would start 1-2 tables of black jack / 3 pieces (a modified version of Baccarat, in which everyone received 2 cards instead of the original banker vs. player)

My parents would usually join a game of mahjong and the rounds would last to late night. As for the younger ones there are endless foods , videos , movies and games… A great memory for me minus the angpow part. As the angpow was very small….

I had booked a table in a vegetarian restaurant in the D mall at K City this year, food is rather cheap and nice..(be frank, I had booked it late and it is the only available option that I have….)

land of lion govt clinic rounds...

 The dep supt of admin had come to me during my last shift and asked me if I could go to the “land of lion” govt health clinic from March. I told her that it would not be a problem. The drive is longer as it is about 20 min more down south. An extra NT1k for the 40km to and fro, and the extra mileage cost about NT350. It was a fun for me to drive to the clinic as the road is straight mixed with S curve. You can sprint to mark 14 on the speedometer and later decelerate at the right timing to negotiate the multi-S curves at the final approach. For a sinner, it was fun driving with the the Zs, but now, I stick to the speed limit most of the time…

The dept supt had hinted me during weeks ago that about the re-assignment. I had wanted to quit initially but later complied to the management due to lack of man power. Some extra cash to grab and it serve as my pocket money…

Another benefit is I got to buy some fresh onion on the journey. The southern part of our county had been famous for its onion plantation and this are a few variety to choose from.

offence and malpractice.... WTH.....

 There was this old lady who come to ED last night showing her wound that she had sustained few days ago from an accident. However she did not want to have a consultation. In fact, she asked me to see her dog. It was an old dog who was knocked down by car 1 +weeks ago. It had sustained injury over it’s left hip and crippling since then. According to the lady, it had lost it’s appetite and lost 3 kg since then. The dog had been moaning due to pain and she had asked me to help the dog. She had placed that dog in a morning market trolley and came to our ED. I had hesitated for a second and told her that I would see the dog. It is against the law for a physician to treat animal but what the heck….

The lady told me that her son is admitted and no one could take the dog to a vet clinic with xray, I had always been a fan of “Emergency Vet”……
The poor dog was placed in the floor and I examined her hip. Definitely a dislocation/or fracture as frank deformity was noted. She had requested an injection just to comfort the dog for tonight. I told her I would help the poor dog and I proceeded to google…
I had this high school classmate who is a vet. She had studied in NTU and proceeded to UK for her master(yeap, she was the one who was detained by the UK immigration for hours..). On a meeting years ago, she had told me that the medication animal use is just like human but just to be careful with the dose.

I had googled up and find that I could use tramtor and paracetamol.
I calculated the dosage and gave the dog an injection and the lady was unfortunately bitten during the restraining as she was not strong enough to hold the dog. I give a  bottle of paracetamol syrup and told her the proper dosage. ( proper pain killer should be aspirin but I just don’t have any syrup for it…)

After the treatment, she offered a payment but I told her that I had never seen her nor the dog and she had never been to our setting...
Well, I told her she must take the dog to a vet clinic and surgery intervention is warranted….
Hope the dog made it…

The beginning of CNY .....

Lem had gone back for his Holiday and it is up to K and I who would be covering up all the ED shifts. As K is unable to work 24 hrs ( he had to minus the travelling time back to his house), I would have to do 26hrs shift instead just to ease the roster.

I had requested a 2 days off per 5 -6 days. The shifts would be tough during the new year period and the worst part will be the traffic. The drive back home is so far away as there are certain blocks which are definitely going to be jammed, but thanks to the local traffic police which had worked out a great scheme, jam was better for the past few years….

There would be no problem for food unlike in the past as most of the restaurant would be opened during the period. A good time to grab cash as many family which don’t cook in the house.

There were tons of patient with acute gastroenteritis and as the Norovirus is hitting badly at the moment, I think there would giga tons of AGE patients pouring into the ED. There would be never enough bed in the ED and hopefully we could coup with it this year…