Cry fahter clan....

It was a rainy day, there was this sudden storm who had hit the southern region hard. Wet and chilling but I was not affected as I was under the shed in the ED for the whole 24 hrs.

The ambulance had sent over this 12 y/o kid with left thigh deformity after he was hit by a car. A spot diagnosis of left femur fracture could be made from the shortening of left lower limbs and swelling. Accompany the youngster was his granny and 2 young chap in their early 20s.

The 2 had expressed that they were passengers in the vehicle which had knocked down the child. The accident took place in the mountain area of Lion land(a small village which I visit few times in a month during my govt. clinic rounds).

The local county councilor had come moments later and told me that the council speaker had asked him to show concern over the case as the driver’s father is a close acquaintance of the speaker. The local councilor is a friendly nice guy and he had socialized with the tribe members of the child (the child is an aborigine). The imaging was done and confirmed my spot diagnosis. As our orthopedic surgeon does not operate in the night, I had told the nanny that they would need a referral. The referral was done smoothly and the driver had come during the referral. A tall and stout looking young chap and a few young men had accompanied him to the ED. When the counter informed the crowd that the ambulance fee was rm 800+; the tribe’s pastor (who was currently admitted and come down to have a look) had asked the driver that if he could cover for the payment. In such case, the responsible person would normally pay for the fee to show his gratitude…. However the young chap had told that the pastor that they would have to wait for his father to come down and settled the payment, the kid’s referral was delayed by 30min waiting for the father … There were 5-6 young chap and they look like they had just come back from a trip from the east coast. I had grumbled in my heart, WTF, no one in the crowd had a ATM card which can withdraw a couple “piece” of NT ? delay = more pain for the kid...

I shocked my head, just another few piece of crap who belong to the “cry father” (哭爸[Taiwanese pls] , a.k.a 靠爸…..) clans….  Well, still need to shout even though I seen them from time to time....

Trip after trip.....

After the ride, it would be a camping trip for me... a middle size camping trip with 40+ church members that are new to camping. We had planned for a trip to the mountain area at the out skirt of K city.I would have to take a pre-camp tour this Saturday to survey the site and peripheral location.
After the camping trip, my parents would be coming over to see us and there would be trip to Peng Hu Island..... another challenge as we would be driving Fefe (into the freighter and ferry over) to the island for 3D2N...
prior to that it would be some strenuous night shifts as Lem is going for a good 2 weeks vacation back in Malaysia...
I just hope I could keep my cycling program going .....

None of my business ....

We had never had a full time urologist serving in our hospital until 1+ year ago. He had resigned with unknown reason prior to the setting up of our ESWL room. We had a new urologist who had joined us about 2 months ago. He had issued a circular to the ED and it was "planted" at the notice board.
The content of the circulars could be summarized into 3 parts:
1.Admission
- admission to urologist could only be done after consultation by the urologist on call upon his consent
- admission could be done in the day time only
2.Management of acute urinary colicky pain 
- Demerel( this is the word he type ...)
- morphine + atropin drip
- Buscopan iv drip....

I had no intention to comply with any of his "suggestion" as there are so many contra-indications with atropine and buscopan use; I prefer something that I feel comfortable with. The Department of Health had however issued a circular warning doctors not to utilized pethidine for 1st line pain control few year back and most of us had shifted from pethidine to tramator since then...

Lem  had however had a final conflict with the new urologist few days ago. There was this old man with bladder cancer s/p TURP who came for backache and referred to him later for acute renal failure with bilateral hydronephrosis. He had however referred the patient to ED and "instructed" Lem to admit the patient to nephro department under the impression of obstructive uropathy. He had also "written" down a referral order for him to see the patient again in the ward...
It was like a General surgeon admit a patient with ileus to Gastrointestinal department for admission and referred to see the surgeon in the ward for possible surgical intervention.
The conclusion is simple - he does not want to care any patient in the ward....
Both of the head of department ( ED and Uro) had exchanged call which had ended in hostile atmosphere.... and Han (nephrologist ) was not that please with the arrangement as well...
The new urologist had previously held the post of hospital superintendent down south at the christian hospital and I felt a smell of bureaucracy during his talk at the official opening of ESWL room. Not a friendly guy to work with and most probably won't last long...
Well, I told Lem that I would not have any encounter with him in the near future... but yet would kept an eye on the issue....

da 100 ride ->72km..

 Yun had a late wake up and we were late at the breakfast gathering. We arrived at the school at about 7:30am.

The opening was rather short compare to the few events in the past. The last few events were organized by the school however this event was organized by the local cycling association. The school merely played an assist role. We were at dispatched to group one together with Yun 5 other classmates. The event was actually targeted for the junior high student but allow 6 grader to take part.

The pushing out was smooth and we were cruising at about 17-18 km/h. We had reached checkpoint 1 at about 1:08 hr. I was a little bit surprise to find out that the organizer only supply plain water. In the past event, there would be “cold” water plus plum, not as good as sport drink but at least provide some salty replenishment for the rider. There were also snack and banana at the check point and there was nothing there… I walloped my 700cc of diluted sport drink and urged the kids to drink and refill… 

The weather was darn hot and it was about 33 degree Celsius. The push out was delayed for about 30mins and it was 10am before we started pedaling for the second checkpoint (we had completed about 17+km only). I had actually run a check over google map and found that the max riding distance was about 80+km instead of 100km….the distant between each check point are supposed to be 20km(5 check points).

The 2^nd checkpoint was about 12+km away and it took us about 40min to complete. The supply at check point 2 was better with a low amount of banana and Chinese cake. I managed to grabbed some for the kids and refilled my bottle with plain warm water.

The ride to the 3^rd checkpoint was more dangerous as we had to ride through a main road instead of the less crowded country road. By the time we reached check point 3, I had found that the “collection truck” was filled up with bicycles. There were 10+ participants who quit and get onto the bus and their bicycle were collected by the “collection truck”.

I had gone over to the “betel nut” store opposite check point 3 to buy some sport drinks for Yun and her classmates. There collection truck was doing its second run by now. The ride to lunch(check point 4) was more tedious but safer as there was this cycling lane to ride.

up bridege push....

We hit lunch point by 1:15pm and the total ride distance was 55km only. 5 hrs had passed since the start and salted plum had finally appeared beside the water supply machine. 

lunch box...

 

Yun and her gang...

The ride started again at around 2pm and Yun and her buddy ZQ were exhausted. We had dropped off the team and was able to cruise at 11-12 km /hr only. At a point, both of them had kept asking me how far it was to the endpoint(School) and I had feared that they could not make it as they not only look fatigue but could hardly pedal and kept up the speed. The bus and collection truck had traced behind of our trail for a good 30min before they had lost their patience and asked us if the kids wanted to take a joy ride back. The kids had given a negative answer and I had promised the drivers that I would take them back to the endpoint; the bus and truck had left us and we had, with the grace of god, completed the ride.

 

exhausted ......end of ride

The total distance was 71.9km and it was a great experience for me and for the kids. I recalled the 72km I had done with Xian, he was grade 2 then, and we had arrived as the last one despite of cramp and fatigue. As for this time, both of the kid had a great experience of pushing themselves to limit testing their skill of “mind” over matter…..

da burn....

the ride....

today is the big day but most of the thing did not go the way I had planned...
Yesterday supposed to be a rest day however we had ended up with a half day( true half day of 12 hours) in K city... a hit and run tour ended up like a shop till u your drop adventure....
Well, still managed to hit bed by 9:30 pm but yet had to get up early today for the preparation; minor adjustment of the bikes and packing of bags. I decided to ride the T2 instead of the F20W and without the back sled support, items I could bring is reduce by 40%...
The event is scheduled to take off by 8:15pm but Yun had a breakfast meeting with her friends at 6:30am and I had to coup with it....
Well, everything is set apart from my body...need to pray hard this ride....

patient's happiness...

Although most of the holidays here were “adjusted” to coup with the 5 days week working scheme here, there are still some festive holiday date which is “unadjustable”. The rice dumpling holiday fell on Wednesday and that means that there would be no night clinic for that night. It was quite a busy night when da patient came in. The patient was seen in the OPD in the morning for his routine hypertension follow-up. He had complaint of palpitation when he came back again in the evening. I glanced through his medication and found that he was given ventolin and Xanthium due to his dry cough. He told me that the chest physician had told him that one of the drug (he is put on Atenolol, Zestril, Ismo) he was taking could cause cough. \However the physician had DC the atenolol instead and kept the Zestril. I dragged him to the resus room and asked him if he had any impotence problem and he said yes. I then proceeded to explain the side effect of all the drugs he is taken and told him that I would readjust the medication and advice him to follow again in the CV department instead…

I do not want to point any finger but yet it is negligence  definitely. He had seen the relevant physician for the past 6 months and the issue of impotence was never raise (for god sake, he is only 53 and put on beta blocker…). The dry cough had been going for months and no one had ever wanted to DC the zestril….

Well, our chest physician had some problems since his promotion to head of department of internal medicine. He had an argument with the imaging department (a case of pneumomediastinum in which he had inserted a chest tube for a skin fold line which he thought was a pneumothorax line…) in the morning discussion session, the imaging department had since then absent from our meeting or turn out very late. He had also some opinion with the ED “admitting” skill …..

Or maybe he is just too tired….well, either way, patient “happy” life is our main concern….

da 100km... preparation...

I had been preparing for the ride on Sunday… Well, frankly said, I am not confident I am going to complete the ride last week. After some intensive training event, I saw improvement and completing the ride might be possible at this moment.

I had done 6 rides since I bought the edge 800 and with the Garmin Training Center installed, I was able to see my improvement and frankly said, my dream of entering the Randonneur might be materialized at the end of the year, provided that I get a road bike (preferably GIANT defy 3…, something that I could afford at the moment…)…

2 more ride before Sunday….well, have to keep my faith….

attitude problem...

 

I had a short discussion with Lem over the case of our junior who committed suicide. The conclusion was the whole story is very irrational, as failing as an intern is a very difficult event.

According to the news, our junior LW, had failed 1/2 of the subject during his internship. The fact had indicate that at least 2 head of the departments and chief residents need to summit their report stating that why the intern had failed in the relevant department. 

In the past, no matter how bad was the performance, the only failing reason is attitude problem…..LW must had lost in action many times and pissed not only one Chief resident (there are at least 8 chief resident each in Surgery and Medicine) during his work as intern.  Intern are responsible for 2-3 charting per day and covering some of the EKG, NG tube, Foley cath insertion....was that so difficult ? intern rotate in group and tends to cover each other in the day time and his attitude problem had reflected to be true as some of the news had reported that he had shown his blade to the night shift nurse when being called to attend patient....

Even though he passed the internship and receive his degree, he could not practice here as a PGY1 as he had not passed his step 1 license examination. The only path for him is to go back to Malaysia and serve as a house officer but would be extended and extended by his Head of department….

Attitude problem is one of the major obstacles during the training of a medical doctor. Think positively, tolerate the pressure and work hard is the key to roll from one posting to another…In the end of the day, some had become worst that than the worst he had met during his training but some would set a standard as a good mentor….

Pre-ride....

 

Ving had gone up north on a tour organized by the local church 2 weeks ago. Xian had initially agreed to follow her but later changed his mind. I was left with the 2 children during the weekend. I had taken them for a bicycle ride along the beach side in Kaohsiung then a tour at the book store. During the tour I had felt throat discomfort but did not pay any attention. On D2 we had a short stop at the HSR station and the shopping mall beside it. The kids had a good time and I had found my sorethroat become worsen.

The next day, I had a bad cough and mild wheezing with chest pain noted on waking up. The initial impression was pneumonia and I had taken 2 tab of zithromycin. I was lucky as the call was good and I become better on D2. I was lucky that I had taken the antibiotic early and no fever nor worsening of s/s was noted. I had a test ride on Wednesday and the result was bad, I could barely finish the 20km….

I did another ride yesterday and could hit the 30km mark in 1.5hrs…but still, far beyond the need to complete 100km….

Well, 2 weeks to go before the ride…