2 in 1 out...

It is almost the end of the month of the ghost… well, it had been a cool month, the bed occupancy rate is about 70% only and admin had asked us to admit as many as we could from time to time…

The great thing for me was less patient in the night, Chinese are so superstitious about the month of the ghost, the chance of encountering “dirty” stuff is  way higher than the other month.

I had this patient who gave me the creep few weeks earlier.

It was a quiet night when the ambulance ferried over a patient covered with mud to us. The patient was a middle-aged male who was confused. He was moaning in the bed. The EMTs told me that he had rammed his bike into a big “pothole”. The electricity company had dug a big pothole few km away from our hospital. The EMT told me that someone had seen the victim rammed his bike into the “pothole”. I did the routine and tried to dig up some story from the patient. He was obviously drunk but yet was still able to answer some of my question. He had kept telling me that someone had abducted him and dumped him elsewhere. He had later moaned and cried while repeating his story.

Later the police had arrived and asked about the patient condition. The patient sustained multiple wound over his face and no intracranial hemorrhage was noted. I had chatted with the police about the accident later.

The police told me that the patient bikes had overtaken a young girl bike and headed straight toward the pothole ignoring the barricade set around the pothole. The pothole was few meters high and the pothole was filled with water and mud. The police had said that the patient had swum and climbed to the surface after the crash. The rescue department had however summoned a excavator to the site trying to locate if there is any other victim. I felt strange and asked the police why ? the answer of the police gave me a creep as he told me that the young lady who witness the crash was not sure that if there is 2 or 1 rider on the bike. She thought she saw 2 riders ….. however there was only 1 person who climbed out from the pothole….

Well… I felt chills over my back as the lady story was correlated to the patient account that he was abducted and dumped….

Well… it is ghost story of the year I presume…

lie to save ?

I had a dog bite case last week. There was this auntie who was bitten by a house breed dog nearby her house. Although, house breed, the dog was not tie up and allow to wander around the area. The treatment was uneventful but I think it is unsafe to let the lady go without the vaccination. I filled up the form and I had put down a special note in the form regarding the dog condition.

According to the guideline, one bitten by house breed dog without symptom, does not require any vaccination. As for roving animal, injection is needed. The CDC later returned our call and told me that the lady does not required any injection. I told the lady officer that dog should be considered as roving animal as it is not tie up nor kept in door and it would be difficult to be sure it would be fine for the next 10 days as such animal might go AWOL from time to time. But lady officer told me that if I ticked house breed on the form, they would not give a green light for the request. I sighed and asked her if she could tear the form and I email her a new one and stating the dog as roving animal ,and she said yes..…

Darn… office bureaucrat that drawn up unreasonable guideline causing me to lie for the sake of my patient…..

dating, accident, relationship......

The Sunday shift was a calm one until 8pm when a pair of casualty was sent to our ED. The male was sitting on the chair when I approached my desk. The male had told me that the girl have ridden his bike speeding and they had skidded while negotiating a curve. Another vehicle had however run over the female casualty after the fall. 

 

At that point, I realized that there was another female patient who is more series. I did a quick assessment on the young male casualty and proceeded to the resuscitation room. 

The male barely knew the female casualty... they had gone out for a inter-school dating session. (bunch of guys from a school ask bunch of gals from another school for matching date by bike key lucky draw...)

The young female was confused and my nursing staffs had almost ripped all her clothes off. The deformed right thigh had caught my attention immediately. She was mumbling that she had chest pain and she felt like dying [not again] however I dared not promise her that she is not going to die today – she is going to die today [I shouted in my heart]….. My staff had failed to secure a line and I had decided to put in a central vein. There was multiple wound over the trunk and body and she was stained with rubble and sand. I did a FAST echo but did not found any ascites nor organ rupture. I had noticed that the girl had a very prominent superior iliac crest but it was bilaterally symmetry and I did not pay any attention[ok, I missed the pelvic stability check, guilty …] . Before we moved her, I found that there was this stain of blood over her panties. I asked that patient if she was menstruating and she said ”yes”. As the stain was too massive, I did a speculum check and found that the blood was pouring out from os like stream. Blood pack was hung and she was pushed to the x-ray department for imaging.

I was busy managing the usual Sunday crowd and I heard our head nurse shout echoing from the imaging department, “ Dr Lau, ON ENDO…”, followed by the “hong rong hong rong” sound of the trolley wheel..

The patient was comatose and gasping for air when I tried to insert the blade. Some struggle, but yet I overpowered her and the tube was inserted within seconds. The BP was 60/30 mmHg and her heart rate was 130/min. She looked paler and I asked my staff to squeeze the pRBC bag hard, even though I knew the effort would most probably be wasted....

Asystole was noted minutes later and the automated CPR machine was installed….. I certified her 20 minutes later….

The imaging came in later and revealed that she had multiple ribs fracture bilaterally with pulmonary contusion but no hemorrhage was noted in her abdomen and brain CT . 

open book fracture ( 3D CT...)

Her cause of death was hypovolemic shock which cause by rt femur shaft fracture ( 2000cc) and pelvic fracture(3000cc)……well, with our capacity, nothing much could be done….

The shocking part was not the process but the reaction of the parents. I called up the mother during the resuscitation updating her with the progress. When I broke the news that she had collapsed and we might lose her; the reaction of the mother was shockingly calm….

The mother came few hours later(she resided up north and the patient studying down south) and I overheard part of her conversation with the other friends of the patient…. The mother had complaint that she had worked very hard up north and the daughter had bla bla bla bla(bad ear of my but I got the story figure out....)

Well, reminds me of Yun and hoping that our relation won’t end up like that….

And NEVER NEVER buy a motorbike for your kids…..

Chinese Movie....

Yun and Xian had been tracking the movie Karaking lately over the net. Director cum actor, Namewee had been one of our favorite recent 2 years. I remembered he had made the headlines during his college days in Taiwan. He was summoned to the Bukit Aman and later some MP from the Chinese association had bailed him out.

I thought he would be quiet since then but yet, he had aggressively involved in film shooting stepping on the red tape and causing some issue.

Indeed, the way Malaysian Chinese speak is very different from what I encountered in my daily routine here. There are so many terms which are localized to the Malaysia Chinese community.

Apart from Namewee’s movie, the Ah Beng series is Yun and Xian favorite. They would ask me to hunt around for the relevant DVDs…

The latest film we viewed was the “Ah Boys to Men” by Jack Neo. I thought it was just another comedy by Jack Neo, but yet, I was wrong. It was a propaganda film instead…

We had a good laugh and saw the part I 4 times within 3 days.  We had seen the part II last night and it really gave us a good time...

As an ex-warrant officer of SJAM, it reminded me of our foot drill session in the brigade; Our Area Sergeant Major then, Encik Eng KC was not a military man but yet, the way he conducted the foot drill training is just like what we had in the Army camp….nowadays, the training in the army is more “senang” than those we had in the past….

Well, it was a good film to expose Yun and Xian to what I been through in the past….

exciting month.....

I logged into my bank account and saw the figure wired into my account. The amount wired into my account was a recorded high.... 
I had worked 240+ hrs last months, 60+ extra from the average 180, yet, I had gone for a camping trip, an offshore island trip and a mountain reserve forest trip....
However, I had only gone to my farm once, cycled 40 kms last month.
I had a good time with my parents, a good communication episode with Yun and Xian...
The most important part is the support from my beloved soul mate .... nothing could be done without her...
Life is hard and with the blessing from da LORD....me and my family shall move on and serve HIM...

charting c imaging....

2 months ago, one of the nursing specialists had asked me that if I could upgrade my e-charting system so they could add imaging in the progress note section. The claim department had “requested” the nursing specialist to draw imaging in the chart for a more detail presentation.

I told her that I would give it a try…..I had thought about the idea but reluctant to do it – it would include :screen copying, edit and select and finally printing it out. All the skill I know not…. A back to square one learning path and I felt lazy about doing so.

I had surfed the web and found some code capturing and selecting picture from a picturebox…I given up the part and went to the final part of printing. I took me a few nights before I found that printing picture was quite simple. The rest of the task was putting the fragmented code together…

Well, it works ……

I got an applause after I presented the new function during the combined meeting last week….some motivation for me to continue...