death of a medical student....

I was parking my car outside the lion govt. clinic and heard the news from the radio regarding a Malaysian intern from my alma mater who committed suicide after assaulting another staff and burning down a locker room….

After I settle down in the clinic, I had glanced through the net and got a small piece of information.

My last encounter with intern was 8 years ago when I did my medical posting of haemato-oncology posting in my alma mater university hospital. Unlike internship in my old days when the intern had to trace data and prepare for rounds, the intern’s life was free and easy. During one of the night calls, the nurse had called me at 3 am and said, “ Sorry, Dr L, I could not locate the intern and could you please manage this feverish patient for me…”. Absconded from night shift ? well, that was an easy life…

Internship had changed a lot as they had no license and there is nothing such as a provisional registration here in Taiwan, as to avoid medico-legal problem, they are excused from many duty since then. Thence the govt. had changed the rule and modified the structure of medical education. They had change d the 7 years med school (incl. 1 year of internship) to 6 years of med school only. And the 1 year PGY training would be extended to 2 years. The total years of studying + training prior to 1^st year resident training is unchanged. But a medical graduate had to pass his part 2 license examination before entering the PGY1 training.

According to one of the report, the victim, our junior L, is currently at his last few day of internship however due to his poor performance, he was unable to receive his diploma as he had failed his internship and had to re-do it next year. He had been troubled by adaption and financial problem in the past and taken 1 year leave from his study few years ago. Some are lucky to graduate and change his carrier path but some….

Condolence to his family…..

I had never wanted my kids to follow my path, I had told many of my friend, “ One person in the family suffered is enough……..”

bravo 600 -> lattitude hp

I had finally replaced Fefe’s tire last Saturday. I had tolerated the slipping from time to time while driving through wet surface for the past few months, and the tire noise is definitely in compatible with the car price. The original tires of Fefe were Maxxis Bravo 600 (Korean made). According to most of the user in the SantaFe club, the tires were durable but noisy. Some of the tire lasted for 60000km before replacing it. However as I hardly parked my car in the garage and mostly left it under the sun, slipping was noted at about 47000km. During this rainy season, I had slipped few times driving in the rain and finally decided to replace it. Compare to my last 2 cars which lasted only 35000km+, it is considered as long lasting.

As the 235/65 R17 is not common spec here in Taiwan(only XC60 and less than a handful of car use it), there are limited selection. As most of the club members recommended Michelin, I had decided to give the Lattitude HP a try.

I called up a chain tire shop which located near my house and check out the price. The price was average compare to the shop up north. The change took about 1.5 hrs and the noise reduction effect was remarkable….

Well, it a cost RM2300 and I hope it would last at least 2 years….

crab XXXX.....

My alma mater university hospital has called a press conference and told the reporters that the hospital did not have any stretcher which height is adjustable so that the on side rescue was not done by the ED staff  for the old man...
There is something called the long spine board and scoop stretcher and most of the ED had one of those...
Presume that there is someone who had fallen in the hospital from height and get hurt and guess what according to the statement, the hospital would have to call the rescue ambulance to come in to the hospital and carry the patient to its own ED....a logic which is not logical...

see death don't rescue....

This incident happened in front of the hospital of my alma mater. There was this old man who was rammed down by a car. A good hearted guy had run to the emergency department 30m away and asked the medical staff for help.

The medical staff had refused to go out to have a look at the patient and told the guy that “we don’t have the stretcher and it is raining out there…” the ambulance had arrived 3 min. later(the rescue service was not far away) and the patient was sent into the ED in 10+ mins…

The news hit the front page with severe critics from all, so have pro the staff and most of the other had knocked severely....

What would my medical staffs do ? We had had various similar events in the past and what we did was a quick assessment with scoop and run strategy after ruling out spinal injury.

According to the law, the hospital act within its capacity but in the actual world, it create a very bad impression for the public… sending a medical staff to the victim and do a quick assessment and first aid is definitely a must to avoid accusation and finger pointing event…

Well, big shop and arrogant staff, bashing is needed to make them humble…

USP chemical and "DRUG"

During my first few years of work, it would take 15-20 minutes for a brain scan and 40+ minutes for an abdominal scan. The duration and length of the examination is a pain in the ass for the medical staff. I had seen senior physician, utilizing chloral hydrate for pediatric sedation during the examination. It does not work always but yet, I knew it is quite safe for use in the setting.

Later in my practice, I had never had the chance to use the drug, partial due to improvement of the scan machine which reduce the exmination time to less than 2 minutes for brain.

Lately, my boss had told me that the chloral hydrate is available in our pharmacy and in case I need it, I could call the pharmacy.

Last night I had this 2 years old boy who presented with seizure for the 1^st time. I had ordered a brain CT but the child was quite irritable and the parents and I shared the same opinion that the child would not be able to hold still for the needed 2 minutes. Thence I ordered a chloral hydrate and later the pharmacy had called me up for a discussion.

I had visited the pharmacy and the pharmacist had shown me that bottle. He had told me that this might not be “pharmacy grade” chloral hydrate and asked me to reconsider my order. I complied with his call and later did a check over the net.

Well, there is currently no approved chloral hydrate in the market. All the 3 suppliers did not renew the drug license few years ago and there is no approved “chloral hydrate” to be use on human currently in Taiwan. According to the label, the chemical was manufactured by WS Simpson Ltd and I ran a check over the net and found that the company produced dye and reagent. Although the label did revealed the word “USP” but there was no such chemical in the online catalog.

If the drug is USP grade, that means it is suitable to be use in human however since the chemical is not approved by the local FDA, thence it would be a violation to use it as a drug and if any side effect was noted, the prescript physician would be held fully responsible for the event.

I am still thinking of how to bring this issue to  boss…..

supposed to be like this....

There was this shooting incidence leading to a death of a sailor recently. The incidence had become an international issue and the government had expressed great concern over the matter.

The sailor’s daughter had however shown some attitude which I felt very improper. The daughter had initially expressed disgrace about the coast guard for not sending its chopper to fetch her father which was pronounced death. She claimed that it might had saved the victim’s life if he was fetched back early. The victim was noted with no sign of life with multiple gun shot wound over vital part. The captain informed the coast guard that the victim was dead when found.

Later when the victim was sent back by the convoy, the family had refused post mortem as they don’t want their relative to suffer anymore. But yet they demand the relevant government to responsible for the act. How could a coroner issued a death certificate without post mortem ? without the post mortem report how could the government proceed with the protest procedure…

I had seen lots of “it is supposed to be like this as we are the victim” attitude here, they think they are above the law if they are the victim…well, reminds me to be careful when I roved around…

We shall see....

The air hostess had gone home after 3 nights of stay, Dengue count is now 19 and I am post call sitting at the dining table, waiting for the water to boil and enjoy my earl grey tea...

A further disappointment after the defeat is to read about the untrue accusation… a winner with only less then 50% support should be more humble than aggressive.

Well, Yun is asking me if we are going back during the summer holiday as she is eyeing on the freeeeeeeee computer…. I returned her request with a grin and said, “We shall see…”

darkest day and it is just the beginning...

The D day was filled with anxiety - sleep cannot deep, eat cannot full...I had tried 505.my, ubah.my, cari and kept switching and reloading webpages...
at 11:20pm, the spr website is publishing result faster then any other webpage(a very weird event as most of the time, the official result should be the latest to publish...)
I had followed the result until 12:50am where the "Scale" hit the mark of 112 with the "people" still behind with 50+...
The was this uneasy feeling during the counting even though good news was noted from the ubah.my at the early hours... The rocket had done a great job but sadly the "fair" and the moon did not strike their target.
I kept asking myself, why the 1/2 of the peoples chose to tolerate inflation, chose to buy expensive car with no safety feature, chose to torelate corruption ? the is only 1 answer -> cooking frog with cold water.... they had get use to it.......
There were frauds here and there, dark skin with a valid IC but cannot sing negaraku (I taught the kids how to sing it many year ago...), but yet , we had to accept the result as we agree to play the game..
The chinese had decided to take the greatest gamble in the history, it was a dare daring move but what the heck, we had nothing to lose, those protected by the constitution is still there and we had been threatened from time to time, further more we had been given small pieces of crap goodies for the past 50+ years and yet we still survive
Well, lain kali lah....

GE13....the long wait starts...

I took a good nap in the afternoon and found that everything is static during my sleep... few updates was noted over the internet...
I had tried my luck scouting for a streaming live TV of Malaysia and finally came up with the Astro Awani over the play store...
Just installed it and I felt that I am not the "blind" at the moment...
it is slightly over 5 and the long wait begins...
Read an article about the possible defeat of PR and my hearts sunk with it and all I could do is cross my finger and pray very very very hard....

GE13 - D day

I had spent almost half of my life living overseas but yet, I am passionate to the land. There was this conversation that taken place few years ago.

There was this English teacher in our church that had a brief chat with me in English. She told me that most of the Malaysian and Singaporean she met dislike their country and I replied her that I am one of the exceptions… I considered myself as a patriot, I served my country before even though I am staying overseas, I still love my country. I taught her the Malay phrase - > tempat tumpah darahku -> “the land that I spill my blood”, I learnt this phrase during my high school and had the passion toward the land, even though, I received no aid from the govt for my study, yet I still served my duty as a lowly paid(at the time la, not now of coz) medical officer in the rural area. There was once, I had a second thought of leaving Malaysia for good but yet, the feeling toward the land could not be overcomed so easily… I am here, proudly as a Malaysian ; whenever other people asked me if I am a “Hua Qiao”(chinese who reside outside Taiwan/China), I would told them that, nope, I am a foreigner, a Malaysian…

I had been checking up the malaysiakini website every 20mins for update…hoping to grasp the feeling of being there.

6 more hours to go before the count…

I regretted for voting as a postal voter, should have gone back and vote and be part of the historical event…

GE13... ini kalilah...

In less than 24 hours, the counting will begin...
Apart from gathering info from the net, I had called up my in laws for some first hand info. The conclusion is still the same, folks in the urban sided the PR but yet it is hard to say for the kampungs...
Unlike in the past, many had made up their mind early and I doubt any act would change one decision at this crucial moment.
Chinese would be the bashing target if the BN would reign again as the MCA would be suffering the heaviest defeat of the history. Chinese should be very cautious of lending their support to BN as even if BN won, with the <5 % of parliamentary seat in hand, MCA would be marginalized.
I read the statement issued by Datuk Bolly Lapok and hopefully it could spread fast enough and the Christian in Sabah and Sarawak would vote wisely.
Cross my finger and pray.

I had done my part last week and frankly, I had voted emotionally and not wisely…..

My last concern is -> how to get first hand information regarding the ballot result…..it would be long night for me....

Occupied....

The weather had changed abruptly and it was raining heavily with the temperature lowered about 5 degree since Tuesday.
The shift in the Wednesday night was hazard as patient had started to pour in after the rain stopped.
While I was prepared to retreat to 175 for a rest, I saw this tricycle sliding in from the entrance of ED slowly....OMG and not again.... the air hostess have decided to pay us a visit. She had had couple of visits to the ED in the middle of the night during my calls asking for wound dressing. She had requested some NSAID ointment and my refusal for complying to her request had ended up with word of threat.

She had however told me that she is having chillness and suspected fever after she sat down. She was afebrile though and I had complied to her request for a drip and hopefully she would go away after the drip.

However I was wrong, she was still sleeping with her second bottle of drip when I pass over to Lem.

Lem had told me that he would "referred" her to our financial adviser( controller post was taken over by bosses' son ) and hopefully she would be out by noon...

Today morning when I came for a stopover before heading to the govt clinic. I had seen her bike still parking along the bedside... Darn, all the attempt(including summoning the  police for help..) to chase her out had failed and she is still "occupying" one of the bed with her tricycle parking around..she had warned us that her tricycle was not to be touched or else...

I had told Lem that I would be back on Monday night for my next shift and hopefully she would be out by then...

It was so easy to chase her out with some "extreme" measure but it is none of my bussiness till Monday...

dengue outbreak...

The infection controller (nurse train in infection control) of the hospital had hailed me at the car park and informed me that there is a load of dengue cases noted around the JR area (I used to visit to the govt special clinic until last month) which is 5 km from our hospital . There were 8 cases notified and most of them had admitted to our hospital.

I told her that I would watch out for the case. I had seen this young chap which was noted with fever with mild flu like symptom in the night. He was seen in our ED 2 days ago and a negative rapid influenza test was noted during the consultation. He was still febrile despite the medication and I had put him on the drip and the result was thrombocytopenia and leucopenia. He had c/o mild headache and eye pain was noted on D1 of fever. I had further inquired about his history and found that his grand father was one of the confirmed dengue case admitted to our hospital. I admitted him but later found out that there is no mosquito net in the hospital.

It seems that we are not ready for this ....

 I had spoken to the infection controller today and told her that patients would be pouring in recent few weeks as the JR area is a small village at the border of forest. I remembered the UiTM in Shah Alam which is located beside the forest. The health office had done their best to sprayed the insecticide but yet new case kept evolving and the condition had lasted for months, with the coming raining season, we would be struggling in the deep muddy hole...

Nothing much can be done for such cases as what we could offer is hydration and antipyretic, the more severe hemorrhagic one would be transferred out as we had not infectionist and hematologist...

The ED is filled with influenza A cases since 1 + weeks ago and now dengue patients have joined the line up….