CNY case 2 - from med to surgery....

It was in the middle of the Chinese new year holiday. I was doing the endless shift which I had a feeling that it would never end…

I am alert but yet the body is darn tired, with years of training, I was able to see patient with reflex but sometimes, the banshee of tiredness would confuse one and eventually leading to a case like the below…

It was late in the night, a middle-aged severe obese lady had presented to ED with her husband. She had complaint of left flank pain. She had noted with stable BP and denied of any past attack nor trauma history. However she had presented with an unusual sign – cold sweating.

I had ordered some routine test and given her some analgesic. The study revealed pyuria and no mild leukocytosis. During the 2 hours in which I attended to wave after wave of patient, I had given her NSAID, Stin, Pethidine as the preliminary diagnosis was left urinary stone. After the result came out, I had diagnosed her as pyelonephritis and told her that she should be admitted. She was still cold sweating ..... I was confuse and unable to find a proper explaination... I did ruled out acute coronary syndrome and hypoglycemia as nothing could be done, I had admitted her to the ward...

I went off on the morning and came back later in the night….. I logged into the system and saw that the patient was admitted to ICU under the dx of renal hematoma.

I was stunned by the record and called up Han for latest update. Han told me that the lady had experienced a BP drop later in the morning. On further inquiry, she had admitted that she was pushed during an argument with her husband and knocked over a closet on her back. She was embarrassed to tell us about the family violence event….

She was lucky as her shock stage was promptly reverted after proper management. As it was subcapsular renal hematoma and no surgery was needed.

If I had done a quick look abd sonography as usual in the ED, the case could have been diagnosed earlier. However I was too tired(frankly said, bad excuse… but my judgment was affected…)

But the weird part was that even with the severe subcapsular hematoma, her urine was still clear and no hematuria was noted.

A missed and I learnt something…

I recalled that was this case many years ago when a male withe head injury later admitted for pneumonia....Just had to more cafeful in the future....

 

Stateless Junior....

The local parliament is currently in session and one focus is the amendment of immigration law. I had read across the news that one Malaysian doctor Y had given up and his citizenship and yet his application of local citizenship was rejected. He had become a “human ball” – stateless person.

I presumed that he had held a Taiwan alien resident certificate (presumably a permanent one). The reason of the rejection was that he was involved in a court case with the national health bureau. According to the procedure of getting the local nationality, one would submit an application (incl. local criminal record) to the home ministry. If the application was approved, the ministry would issue a cert of quasi ROC naturalization certificate to the applicant stating that he/she is eligible for citizenship. By then, the application would submit the certificate to the MFTC (Malaysia Friendship and Trade Center) and fill in the Borang K(form K) to renounce your Malaysian citizenship. The official would allow one to sign the Borang K if you had shown proof that you had citizenship of another country or a quasi naturalization certificate.

Apparently something had gone wrong during his application and he was stranded…. I had done a research over the net and found that Y was possible one of our junior(3 years junior than me). He had changed his name from ZP to XF…. Y had opened up a small clinic in the secluded area at the central part of Taichung. With the help of another Malaysian doctor G who had dual citizenship (our senior who is 4 years senior than me ) that had travelled back to Malaysia to practice, he had set up a clinic by placing G as the clinic in charge as Y had no IC here in Taiwan. G had a brother that opened up a successful medical center in my home town and he had joined the practice.

The National health bureau had found out the fact later and had filed a case against Y… I think the case would be finally over and Y would eventually get his IC here in Taiwan. It was a mistake for the home ministry to issue a quasi naturalization certificate to him enabling him to renounce his Malaysian citizenship. The parliament is currently trying to amend the act so that a foreigner would be granted citizenship first and later renounce his other citizenship within a reasonable time frame. There are also other amendment being carried to the discussion – dual citizenship is allow… although the chance is slim for the amendment to pass, but I would closely follow up the progression….

car battery....

I had not been a lucky car owner. Since my 1^st car Kembara( Daihatsu Terios), I had experienced problem after problem. First was the radiator, then the gear box. The car had noted with 3 gear instead of 4 when I sold it… My second care- Serena was noted with generator problem and I was stuck on my way back, almost trapped on a road without light at 9pm. My 3^rd car, Zafira was troubled with the famous gear box problem.

The car fan club had been a good resource for owner and I had joined relevant fan club since few years ago. The rule of thumb is the more electric gadget the more problem you get.

After of almost 2 years of driving Fefe safely, I had encountered a problem during our passport trip back to Malaysia. I had left our car in the airport parking for 1 week. It was darn cool at that time with the temperature fluctuating at 14-20C. On the day returning from Malaysia, the temperature was 14C and 3 warning light was lighted after ignition – the ABS, ESP and diesel warming light. I told Ving that we had fried as our car is having problem. It was 400km from house and I had to do day shift the next day. Such a disaster and I just couldn’t drive 400km with the warning light on. I took a deep breath and turned the engine off. I restarted the car 30seconds later and found that the warning light had gone off… What the hack, it was better to drive home with no warning light than with 3….Thank god and it was a very smooth drive.

I brought my car to the service center few days later and the mechanic had told me that no error code was noted from the computer nothing to insist and I drove back with a very bad feeling. I sought help from the fan club forum and found that some of the car was noted with faulty sensor which may cause the above problems.

I continued to drive for another 3 weeks and the incidence had occurred few times and the warning light went off after restarting the engine. However the interval was closer and closer;

1->2 = 3 weeks

2->3 = 2 weeks

3->4 = 1 weeks

4 -> few days once….and most of it happened in the morning/after a long hour of parking….

About 1 month ago, I was driving to the K City health office for the Oral Cancer screening course. The 3 warning lights were noted again and I restarted the car with no problem. However half way on en route, the ABS and ESP lights had suddenly lighted. I was shocked with the condition and stopped the car along the road side. I restarted the car and the light went off. It was an intolerable condition and I had decided to defaulted the course and drove to the service center. I reached the center by 8:30pm and found that the center was closed on Sunday. I met a Sale Rep who was not very helpful and tried my luck at another service center in K city.

The mechanic had noted my condition and told met hat he would replace the relevant sensor and check my car thoroughly on Tuesday when the parts arrived.

It was the end of the story as I had noted with same 3 lights problem and the service center had advised me to left my car for 1-2 days for further checking. I had left he car and took a train to work. The next day, the mechanic had told me that it was 4 light instead of 3 and he had found the problem – gear sensor and he had replaced the part for me and he told me that it should not be any problem…

4 days later, the 4 lights problem recurred. I had called up the center and the chief mechanic had told me that it might be the battery and although the reading was ok. I am not satisfied with the answer. I did another search over the net to see if any other model of car had similar problem and found that Ford Mondeo had similar problem.

Unlike the normal petrol car, the diesel vehicle requires battery with higher capacity. When battery of a diesel car weaken, one could not jump start easily from an average car (<3000cc). There are 2 signs which shown a weaken battery - > difficulty to ignite the engine or/and abnormal warning light showing on ignition and disappeared after restarting it. If only the problem with warning light happened, the battery might just went dead suddenly without going through the process of difficult ignition.

I was confident with the finding and decided to change the battery. I had scouted around the net and set my eye on Kawasaki battery 95D31L, which had a cold cranking amp of 620CCA and 80AH.

During the battery change, I asked the mechanic to check my old battery, the result was as I expected, the voltage was ok at around 12+V(so, the ignition was smooth) but the CCA is only merely 420CCA.

The warning light did not go on since then….

Happy that I had solved the problem and learnt something during the process….

Doctor jobless ?

I had read from a blogger who is an active member of the MMA regarding posting of medical officer. The medical officer post of KKM if almost filled up last year. That means, houseman might have to wait for their MO posting if there is no post available. As GP clinic flourishing and the pay of GP would become lesser.

GP get pay less + MO pay rise - > less MO go to private -> less MO go to private= less post available -> HO had to wait for MO posting (in the house) and eventually HO is jobless indefinitely as there is no MO post available.

In the future doctor would be jobless like self trained pilot in Malaysia nowadays…. I just can’t bare thinking of it…..

Camping....

We made a trip up north last weekend…. There was this Doraemon exhibition in Taipei. All of us in the family are fan of Doraemon and Xian had been begging us to take him to the exhibition since months ago.

As usual, we had planned for a camping trip. I had called up our usual camping ground in Taipei and was told that a fair is going on this month and there is closed for campers. I did a survey over the net and found a camping ground in XinZhu. Cheap price – NT 600 per night( the Taipei ground was cheaper -NT 500). Hotel room is pretty expensive nowadays, especially for a room for 4…

However the drive was a hazard one, 320km up north. We took off at 4pm (Yun left school at 3pm).

There is 2 options to go north. The no 1 and no 3 highway. The no1 is packed but shorter and the no3 is 30km longer but less crowded. I had opted to do the no3 ->no1 ->no3->no1 route which is shorter but I had a rough time negotiating with the heavy traffic.

We finally reached the camping ground at 9pm. With 2 stops at the service areas and 1 stop at the grocery store , the average cruising speed is around 80km. I sworn that I would never take the no1 highway again.

The ground was empty and we are the only campers. Great atmosphere and the toilet was clean as recommended by other campers. With the light provided by the 2 LED lamp stripe and the Coleman Northstar gas lamp, we were able to cook some supper and enjoying it under the cloudy sky. It was cold and the sweat potato soup and instant noodle were just a perfect match for the night.

The experience is priceless (rather cheap compare to the pricy hotel) and I am glad that I had learnt the skill of camping during my high school days. Taiwan is rather peace and safe compare to Malaysia, in Malaysia, camping in the outdoor means exposing one to a wide range of threat, however here in Taiwan it is a heaven for campers – security is better and there are lots of camping ground.

However camping itself is not cheap, the initial investment is low (RM300-500 for a decent tent). The rest of the purchase would depend on one needs and affordability.

The kids is getting use to the life style and hopefully they would learnt what my knew……

the air hostess....

 

When I took over the Monday night shift, there was this tricycle parking beside Bed no.1.

 

not this.....	but this.....

 

I am not shattered by the scene as the new ED is spacious. From time to time, you would see some uncles or aunties riding their electric car/tricycle passing along the hallway.

While I am walking back to the call room, the notorious “air hostess” walk by ED and warned me not to move her staff while pointing at the fully loaded tricycle. I finally realized that the tricycle belong to her.

The “air hostess” got her name because she had wandered around the town with her “air hostess” luggage bag. In the bag, according to someone who had seen it was filled with petition and summons. She had filled complaint and sued quite a number of unit/persons in the town. She had been a regular patient in our surgical OPD – consultation for a poor-healing heel wound which cause by her poor caring.

I had a few encounter with her and she was rude and bashing type of person. She would start to relate her story about someone had sexually assaulted her and the police station had mistreated her case. She was persecuted by the locals and someone had scalded her… (all bxxsxxt as she burn while setting a fire to burn down her husband’s car repair shop.) She would proceed to accusing the hospital of mistreating her and demand a good treatment and threaten to sue/complain if she is not satisfied with the service. As usual, I would treat her without prejudice rejecting any inappropriate order.

I had asked around and the nurses had told me that she had been “occupying” bed 1 since Friday ( that means she had slept there for 4d3n)….

She had warned the ED staff that if her things to be move, she would sue for trespassing… I did not bother about her as the ED was not crowded at the time. Later, our financial controller came (Boss’s wife) bringing “air hostess” son along. The air hostess had grumbled for sometimes and later left the ED. Our financial controller had told us that she was just being notified about the incident and told us that if she comes again to call her to settle the problem…Our financial controller is a dedicated and stiff iron lady…thanks to her, I was not bother again.

I was told by the staff, the police was summoned during the 4d3n stay, however no one dares to chase her out from the ED.

On my Wednesday shift, nurses had told me that she had come again to seek for K as K had complied to her order during the stays. I grinned….

card game - final showdown

After 10+days of turmoil, the card game was over…not bloody nor messy but still a little it shattered the relationships…

K had complied throughout he process and kept claiming that he was ok with the arrangement. He had dumped the reshuffled roster to the dept supt of admin. The management was hearty enough to let him took over the Tuesday ward shift which in fact is very unwise. The paid was 2/3 lesser and by “converting” the ED shift to ward shift means an indirect salary deduction. 3-4 days after passing the roster, K had told Lem that he would ditch the 2 Sunday night shift as he wanted more rest… The makes 2 major hole in the rosters and Lem and K is definitely not going to fill it….

Lem had gone for a final discussion with the management and told them that K was actually very care about the shift as the income loss was considerably great.

A final discussion was done 2 days later and all the shifts were back to K hands.

The management had specifically told Lem to inform us that when the 4^th ED physician joins us, there would be no excuse/struggle/small movement under table to maintain our current working hours – each would be 180hrs up and down….

Peacefully on top the table but black current under the table …. Feeling hurts with broken relationship…..

I pray that the current situation to last till summer holiday -> planning to bring the kids to Outward bound school for 2 weeks…..