new year again...

1/1 and I am sitting in front of the ED desk, sharing patient with Lem…

Our 5^th staff is joining and some of the shifts will have 2 physicians treating patients… The actual number should be 6 according to the rule but 5 is enough to pacify the committee. Night shift is reduced from 10 to 8. I am reducing my govt clinic round to 2…

Last year was an exciting year for me; my health was at a verge of failing and with grace, I was able to recover. If I had not been to Sri Lanka, I would not have found the way which not only cure myself but also revived my dad from his stroke. As a western medicine practitioner, I become aware that there is something beyond the evidence-based medicine which I had believed for almost 20 years. The participation in the 3 “missio-dei” was a milestone in my life, I would be going back to Sri Lanka and Thailand next year to conclude what I had started….

It was a year of disastrous for my homeland, from plane crash to flood, I hope next year would be better…

I am looking forward toward this year as my course with the seminary would be wrapping up in April and still praying what would be my path in the future…

frus...

I got a text message when I woke up in the morning... it was sent from the auto sms system to alert me regarding some major abnormality of the imaging I have order.

The message was a “suspect neoplasm/malignancy” alert regarding a 19 y/o female who had presented to ED for acute gastroenteritis. She had a intra-uterine device implanted (which made me remembered her…) and I had discharged her with oral medication yesterday.

As a physician serving as first liner in a small hospital; I do not enjoy the luxury of having a 24hrs radiologist support. We would get our report hours or maybe days later.

The message confused me as what kind of information could one gathered from a KUB film to reach a diagnosis of neoplasm.

I was a little bothered by the message and when I gone to work the next day and saw the report:

“… Moderate enlargement of the uterus is seen, myoma should be R/O….

I was a relief….well, fine at least I did not miss anything…

It was hours later when I got a similar text message which alert me of a patient whom I had just admitted to ward for pneumonia minutes ago.

The reports :

“  Abnormal opacity is seen in Rt middle lung field…”

No impression was noted but he classified the report as possible neoplasm…

This time, I am a little frus as I had noted in the application form that the patient was febrile and cough was noted.

There was a film which was taken 1 months ago and it was completely normal…

Well, nothing was mentioned about the pneumonia though…

It had been only 1 month and all the emergency medical staff was irritated by this new radiologist…

Radiologist is usually our last resort and if the radiologist is unable to give us a definite diagnosis(I am not asking 100% of the time but at least most of the time), it would be difficult for us... 

but the worst part was not giving a definite diagnosis for the situation but to raise some out of cosmo possible neoplasm diagnosis to further complicate the condition....

blessed...

Back to the desk after my tour to Sri Lanka..

I did not intend to join the medical tour initially, however after I could not resist the invitation and I agreed to come back for the medical mission later in December.

For me, vacation is not a problem as I could arrange my 15 days off according to my needs, but for the children, it would be a pain as they would need to take leave from school. However not much struggle for me after praying; I knew that I would have to bring them along.

Unlike the Satun tour which consist of less than a handful of member. The team consisted of 7 doctors and 7 nurses and other supporting staffs (including 2 professors of basic medical science, chef and kiddo[Yun and Xian]).

The tour was complicated in the beginning. When the registration started, my family was turned down as the organizer related that it would be a medical mission and kids were barred from joining. I did not complain but was approached later by another elder that they would remove the restriction as my services would aid the team.

I missed the 1st pre-tour meeting as Ving did not check on her email regularly. Not much was discussed on the second meeting and I was in a mist of what to prepare.

My pre-tour night shift of 10 shifts in 13 days had increased to 13 shifts over 15 days (due to my trip back to Malaysia).

On the 1^st day of the journey, I had left out a few detail..

1. Left out some Lankan Rupee and 1/5 of the USD I supposed to bring in the vault

2. Did not properly place one of my surveillance cam..

3. Place one of the wireless phone charging on the deck...

The above detail does trouble me but I had to live with it…

Later during the transit in Hong Kong, Ving had a very bad gastric pain….

Xian started to cough when we landed in Bandaranaike Airport…

D2 -> Yun broke the lens of my NEX-3 (luckily it was the lens of the protecting filter)

D3 -> Ving had diarrhea and fever with bodyache and joint pain

D4 -> Yun had fever with fatigue (no diarrhea)

Years ago, when Ving first mentioned about going to a medical mission; I told her that medical mission is not mean for any family -> Don’t be a burden to the team as we might be the one that other people need to look after during the mission… Definitely due to my crow mouth and I did not “touch wood” after saying that..

Ving and Yun recovered after 3 days without complication but it started to rain and the northern and central part of Sri Lanka were flooded; we had to detour a few times before we reached Colombo again for our flight

The medical mission was smooth though....

Everyone gained something during the trip; a trip blessed by the great one indeed….

I was completing my chart when the OHCA patient came in. An obese female noted with sudden onset loss of conscious. She was noted with no sign of life when the rescue ambulance arrived. My heart sunk when I entered the resuscitation room. She was 150cm and almost 150kg… “A case of difficult airway”, I mumbled while getting the laryngoscope. I could barely open her mouth and not to mention about inserting the blade. I gave up the direct method and requested a laryngo-mask intubation kit. I could barely insert the mask and failed to insert the guide wire…

Well, I asked my nurse to call OR and asked if the anesthetist could help me with the intubation and before she walked out from the door, I changed my mind and told her to come back.

No point of calling for the anesthetist as the mouth was too small to pass in a blade…

The process was not satisfied at the beginning. There was no tracheostomy set when I ordered. Someone passed me a scalpel and open up a normal dressing set while I cleansed the neck; I asked for a pair of retractor and Kelly forceps. Definitely would be a chaotic situation I thought when I completed the cleansing, however with grace, I had a good surgical assistant and I managed to poke a hole through the trachea while is located 3cm from the skin within minutes.

Well, ROSC was noted but still I lost her later…

Well, I did not screw up and secured the airway within a reasonable period, my team was quite shock and had a good talk about my decision…..

Training and exposure are what the Taiwan emergency staff lack; lucky that I picked up the skill elsewhere….

trip back home....

I had had a brief journey back to Malaysia few days ago.

I got a call from my dad while I was catching a nap hours before the end of my night shift. He told me he was unable to stand properly and numbness over his limbs and probably had a stroke. I confirmed his presumption and told him that I would fly back to Malaysia. During the conversation, I had taken a quick glance over my roster, and found out that if I could change 2 of shift with L, I would have a 3d2n window to go back to Malaysia. L had complied with my plead and I proceeded with the flight booking.

The choice of flight was limited as LCCT was not an option since my parents lived in Johor. I booked a flight over the net and proceeded with my journey back home.

The journey was a tedious one, home->high speed rail -> TY airport->Changi airport ->JB….

With grace from the Lord, I was able to reach the puteri specialist hospital 12 hours later…

It was a closed one, both for my dad and me….No involvement of the brain stem and hopefully a good recovery with proper rehab. I nearly missed the flight but was able to catch it on time…

I wished I could stay longer but I couldn’t...

it was a tiresome return flight for me and I reached home 12 hrs after I left JB…

It would not be the last one …..I knew…

different view.....

Boss came down to Lem with a complaint letter last week; the letter was about a pubis fracture. An elderly female had presented to ED for pain over multiple site after fall. K had seen her and later told the family that there is possible fracture over left pubic bone and she was discharged later for orthopedic follow-up

On follow up, our young orthopedic had told the family that there is no definite fracture and refuse to comply to state that it is possible fracture over the pubic bond despite the pain over the relevant area.

The patient was brought elsewhere and later the fracture was confirmed. The family had written the letter asking us politely that what should they do in the future if 2 doctors in the same hospital had different diagnosis on the same patient….

Nothing to shout, we do make mistake from time to time, but yet sometimes, don’t be over confident….

trip back to college

I had always been adventurous but yet as I grew older, I had been more cautious as I need to think about the 3 persons that rely on me…

Adventure is all about exploring and learning, which I considered as learning one limits is also a kind of adventure.

Last Thursday, while travelling up north on the high speed rail, I had a called from the seminary staff. The lady had asked me if I could make it to the college next week from Mon to Wed to replace the class which I missed in June. The 3 Days seminar could substitute the 2 credits which I left out due to Ving’s pneumonia. A very tempting offer but I had a morning shift on Monday and a night shift on Tuesday…. I told the staff that I am able to reach the seminary late in the night and the lady told me that as long as I report to the seminary by 9 on Tuesday I would be fine. I told that I would attend the course and started my call out to K and Lem about shuffling my Tuesday night shift. It took me about 20 mins to settle the shuffling. I started to regret after I completed the task; I need to drive 5 hours to the east coast after my strenuous 12 hours day shift. The road to east coast is not like the west as there is no high way, I need to drive through the notorious winding “southern loop” route to cross the central mountain range from west to east coast. I am not unfamiliar with the path as the land of lion is located at the beginning of the route, the peripheral clinic which is situated at the highest point of the route is also a frequent site which I visited from time to time. The distance is about 300km and with more than 20 speed trap spread along the route, the average speed would be a pity 70km/h and it would take 4+ hours to reach the college.

I was lucky that one of my classmates had decided to join me on the journey. Well, still, I was a little anxious about the drive, I am not sure if I could complete the perilous journey.

It was not an uneventful shift as I could only caught a short nap in the afternoon. At the beginning of the drive I felt a little bit worn off and have doubt that I could complete the drive. I am not afraid of driving along the curvy mountain road as the light of opposite car’s lamp offered a pre-warning sign at each cornering. My dad who is a veteran at night driving taught me about this fact when I was very young…

I completed the 300 km drive after 5hrs under the grace of the Great One. It was a smooth drive as most of the traffic light was shut off and there were only a handful of truck/car moving around.

I woke up after 5hrs of deep sleep and enjoyed the spectacular view around the college.

The credit fee of RM350 was waived as a local church had sponsored the course.

The drive back home took a little bit longer than expected as the traffic was pack in the daytime.

I praised the Great One for this uneventful trip, 12 more credit to go….

unexpected experience...

It was a Saturday morning, Ving had gone to a conference up north and I was enjoying my time with the two kiddo. After sending Yun to school, Xian had suggested a swimming trip as he would be facing his swimming test few weeks later. I complied with Xian’s request and headed to the nearest swimming pool but found out that it was closed for service. We decided to go to another swimming pool  nearby and we had noticed an accident at a T junction during the drive. A lady was laying at the middle of the junction and a few bystander were standing around. Normally I won’t stopped as most of the time, there would be a lot of bystander willing to help but this was different as the victim was laying without movement. I told Xian that we would stop and offered some help. I parked the car along the roadside and told Xian to grab an umbrella to shed the patient as it is still hot during daytime.

The scenario was a bloody one as the lady suffered from an open jaw fracture and skull base fracture. After securing the airway and c-spine(that was what I could do, as I did not bring my bag and was driving Ving’s car instead of mine) and packing the wound, I called out the ED at A-hospital(my employer) as it is the nearest facility with neurosurgery capability. The nurse whom I knew told me that their computer was downed and I told them that they are the only hope for the patient and we would be coming over.

The ambulance arrived 10+ mins later and the patient went into arrest. I commenced CPR and have no choice to accompany the patient to A hospital as only one EMT-B would not be enough to manage the patient during the ride. Xian had come along and taken a seat at the front seat passenger seat of the ambulance. I managed to insert the LMA into the patient and continued the CPR session until our arrival in ED 10+ mins later.

The pass-over was a crap as the attending ED physician did not bother for a pass-over. I brief the triage nurse and walked out from the ED. The morale is low at that department as most of the ED physicians there are asking around for job lately. 

Xian had acted bravely during the scenario but freaked out during the ambulance ride. The local drivers have no driving ethic as no one is giving way for the ambulance; the ambulance had to drive like snake crawl during the journey. 

Well, the ambulance was kindly enough to give us a drive back to the scene to pick up our car. It was a perilous and educational journey for us. Xian had finally taken a look at what I am doing and I had a good workout…it was 2+ years since I did a long duration of CPR(we had a auto-CPR machine since then).   

It is my 1st time to involved in CPR on board an ambulance...not a pleasant one but yet a memorable one...

For Xian , it was another trilling experience on a speeding vehicle ( the first one was the TUK TUK ride in Sri Lanka months ago...)

As for the victim, sadly she did not make it even though ROSC was noted after she arrived at the hospital....

serve....

I had a small chat with Han during the insertion of double lumen catheter few days ago. One of my classmate had gone back to Malaysia to practice recently. He is cardiothoracic surgeon by training and is currently posted to Penang… he is satisfied with the 10+K RM salary and I envy him. 

There had been many occasions I had been asked if I wanted to go home to practice and I told them that I wanted to serve the public instead of the affordable. Indeed, the only way to serve the public in Malaysia is to work with the govt. It would be a chop waist cutting of salary for me….and if I open a clinic or work with a private hospital, I could not do what I am doing now….

The only regret I have is that I could not be my parents attending physician whenever they need me.

It is always a trading game, just like MPQ, one would need to determine the priority and go for it and never look back.
6 more year before Xian hit college and hopefully it would be a turning point for me...

Kukaracha...

It is Annual Nuke Disaster Exercise day again. As usual, Lem is the decon team leader and I acted as the ED in charge…Well, the case was a nuclear power plant worker with traumatic head injury and vomiting. He had exposed to unknown substance and vomited 2 hrs post trauma. Lucid interval was noted

The key to the exercise was DD of intracranial lesion vs Acute radiation syndrome...

I had read up at 6am, refreshing my knowledge, and downloaded the latest REMM mobile app...
 The outcome was great…..the Q&A was flawless and one of my staff had told me that no question could electrified me and I answered, “yeah... just like cockroach..”
indeed it feels good when you are invincible during such Q&A. Yun is getting the hang of it and frequent shared her experiences about her recent exams, but i knew she could do better...

the reward...

 Our last stop was a tour in Hatyai. Hatyai was a place that I had known for over 30+ years but never set my foot on. My neighbor, auntie and many whom I known had gone there, it is a shopping paradise for many. The 1D1N tour pushed out in the night and reached Hatyai in the morning. After a day tour, they would hop back to the bus headed home. No stay in hotel and they often come back loaded with stock.

The bombing might have shadowed some foreigner but yet Hatyai is still flourished with its tourism. The streets around Lee Garden Plaza are very similar to the Petaling Street. There are varieties of shops around the area. We had put up at the Tune Hotel which is very closed to the main shopping area. I did not spend a fortune but my suitcase was still filled up (with Pocky (banana, strawberry ....)).

 Despite of the tense atmosphere, I told myself, I would bring my family here next year….

I woke up early on the final day and I viewed the life ceremony of the returning of fellow Malaysian from Armsterdam. The kawad kaki was darn lousy, if I were the sergeant major, I would have their axx....

The returning journey was a stressful one for me after the break..

Although I had asked, requested, begged to change the flight returning from Thailand, the organizing party did not comply my pledge. The returning flight would arrive at 10:30pm…and it is 4+ hrs drive from CKS tom my house…although I had tried my best by providing the flight no. I preferred but yet my pleading was not heard.

The flight was eventually delayed for 30mins and I was lucky to get into my car at 11:20pm…The drive was uneventful and I reached home by 3:45am….

By 8am, I was back to my ED desk….

It was a journey which brought some surprise for the local staff; after many years of struggling and servicing the local people, the local staff had the opportunity for the 1^st time to spread gospel during their visit to a family….Indeed the mission is not only a personal feeling to sacrifices and acted but yet, it is the mission of the great one, known as “mission dei” (I learnt it during my last subject…indeed this was a practical session for me..).

There would be another tour in December and this time all of us are going….

Lead by the light

The stay in Satun and Langu were a great experience for me…

The local staffs were friendly people and dedicated to their job, they were experience at reception of foreign short term mission, they had a few mission visits per month and they would bring them around while executing their daily routine. Even though they are new to this medical relief mission (only 1 last year) but yet their passion to their job had eased our tour.

On D3, we had two clinics and one of them was held in the local govt health clinic. The office in charge had given a lunch which consisted of fish, prawn and crab (which would cost you a arm and a leg if you go to some sea food shop which you are not familiar). The cooking style was simple but the materials were very fresh.

After 2 days of bread and packet drink as breakfast, I was bored and I had walked over to the store opposite, even though the local had told me that the food they serve was very sweet.

After I tried out their teh kurang manis and bought a pack of onde-onde , I decided to eat breakfast at store instead of buying it 1 night before.

We left Langu the on D4 and proceeded down south and back to Satun.

The last 3 clinics we run were smooth and the last clinic was held in a small town where 90% of the patients speak Malay. The 1^st patient was a teacher who has surprised me with her good command of English. The local peoples were friendly as those Malay I had served during my medical officer day…

It was a life risking journey though, as we had utilized small truck as our transportation tool. We had also travel to a swamp area crossing a wooden bridge that look unstable ( the returning path was more perilous as it was raining heavily).

God had blessed us and every one of us had gained something during this journey….
The final debriefing with the local staff was a touching one and although we were warned about not to promise anything, but I told them that I would be back again next year....

am I doing the right thing ?

We were sent to Langu (means Laut in Malay) the next days as there was this HK mission of 16 coming to Satun.

Our 1^st clinic started in a secluded small village in Langu…

I met few local peoples that could speak Malay; they had surprised me as they speak Malay Baku instead of the Malay pattani.

The local missionary in charge is a Taiwanese lady. She had brought us to the local beach and we had some snack at the small pasar malam. We had our dinner at a local restaurant around the beach side and retreated to the local office for rest.

As usual, we were dropped by the local 7-11 where we could buy our dinner.

I had started to question my strategic of seeing patient ? did I really help them ? I got my answer later when I reached home… the local people had started to ask when is the fatty doctor coming back?

Not to worry when you work for the great one...

I did not sleep well as “trafficking” the medication was actually illegal. Well, I woke up at 4:10am and starting the final checking and packing. Leaving the hotel by 5am and dropping the car at the carpark. I was ferried over to the airport by the car park operator as usual.

I met my team members later at the airport. The check-in was smooth and I took a nap on board.

The plan arrived at Bangkok airport on time…I missed my lunch as I was too worried about the “load”…The short intro clip about the departing x-ray scan was quite disturbing.(this is the only country that I knew that wanted an xray scan of luggage before departing airport ).

However with the grace of god, the custom officer did not ask us to open the box of medication and we had slipped through the scan without any obstacle…I praise the great one and almost kneed down when we walk out from the airport.

The atmosphere around the airport is tense; heavy armed arm forces securing the perimeter….

We were picked up by the director of the foundation and we headed to Satun.

After a brief introduction by the local staff; we were told that we would be sleeping in the office instead of posting to the other missionary’s house.

The 2 nurses took the room and I slept at the conference room.

We were lead to the local TESCO and had dinner there. I had a plate of fried Kwaitiao -> Singapore fried beehon flavor… food was nice but very small plate; although the rock which hung on my heart was thrown to limbo but yet I was worried about the clinic tomorrow, the small plate of Kwaitiao was enough. 

The medication had entered with blessing but yet I was still worried about the amount - > is it enough for the 6 clinics we planned ?

We picked up some bread and packet drinks before we left TESCO.

I hit dreamland just after 10….

struggling week..

After 2 weeks of struggling with the preparation of medical relief trip, I am finally on my way...
The trip was not simple as I think; just present myself and volla, I am seeing patient at the other end of the world. I had become the tour lead member and the part that trouble me most was the medical supply.
I had tried any possible way to secure the drug locally but was a frustration wild goose chase. Finally, BCH had replied me and they had gladly offered us help with a heavy price. The quoting was 5 times over our budget and I had to chop and two leg and an arm to get the figure closed but yet still 0.5x over. The struggle was not over as we had difficultly obtained the drug from BKK. I had tried to pull string but came out zero. As the day are closing, We had decided to ferry over the medication...
A challenging task as it would be a great problem should we are stopped by the custom. My sleep was disturbed so was my appetite. 
At the moment, the box of medication (>thousand tab ) passed the xray scanning machine( yeah, this is the  only airport where baggage need to clear xray machine after you claimed it from the baggage claim) and we are not stopped. I almost knee down and thank the great one...
We had passed the most heart sinking challenge and finally the mark the beginning of the mission.
Here I am, sitting at the foundation office writing down the beyond imaging nightmare the haunted my night for the past 2 week....it is a learning process; for me to adjust my way of thinking process and task completing..
Praise the Great one....

Sri Lanka food...

The Sri Lanka streets view has given me a nostalgia about my childhood. The streets almost look alike the old klang road about 30 years ago...
The foods are my favorite - spicy food: sambal, samboi and curry...but the meat was stony hard. I become almost vegetarian since D4...yet, the Basmati steam rice is still a fatal attraction for me. 
I finally got a taste of Farloda on the last day, acceptable but not surprising. 
The final surprise was on the last day when we visited a chinese restaurant - one of the highly recommended over the net. During the food ordering process, I noticed that the owner have a cantonese accent and I approached and asked him if he is a Malaysian...and He said he came from Ipoh...We had a short chat and found out that he had been in Sri Lanka for over 20 years...
The food was a satisfying one....Yi Min, Gou Lou Yok....

the Lord is fair full of grace; we had chosen to go for this mission trip instead of going back to Malaysia and at the end of the the tour, I was still rewarded with this graceful feast...

lost...

I was a little bit confuse when I came back from Sri Lanka. I had the feeling that part of me was in the limbo (definitely not in Sri Lanka). The straight night shift has further crumbled my sensation. I felt numb, not physically but emotionally. I was unable to tell the feeling and later on I was bothered by the medical relief trip.
It was like 4 weeks before the green light but yet everything was not finalized yet. The Satun trip I intended to go was cancelled as I was the sole volunteer. The pastor asked me if I would like to join the Dhaaka group and I complied. But Later, the Dhaaka group was packed up and the group has to be splitted into 2. 4 were redirected to the Satun group and one of them pulled out with another kiv to join....
The pastor asked me if I could lead the team if there is only 2 persons...and I gladly complied.
The kiv person later agreed to join and now it is a team of 3.
The worst part was the application to the local medical council was still pending as we need to be covered by a local hospital, which was still n/a....
Well, I think everything is in the hand of GOD, and all I need to do is prayed..

honorable face

Seri muka has been one of my favorite kuih since my childhood... I never miss it if I ever visit the night market. The best one I had tried was from my  neighbour - auntie ahmad. My mom would buy some durian and asked her to do the seri muka durain for us... the smoothness of the upper layer was splendid...
After missing the bengawan solo trip few weeks ago, I am a bit loss and eager to seek the taste of it..
I glanced thru the net and found out that I might be able to make some in the house...
I finally acted today...I bought some nasi pulut on my way back and soaked. After I woke up at 7 pm in the night, I proceeded with my plan..

the pandan I planted last year had been growing well...key ingredient!

I didn't bother about the appearance and I use the rice cooker to steam it...

this is the final verdict... not the best I have ever tasted but it should be the only one I could get at that moment in this foreign land...yummy but I dare not wallop the whole bowl, those santan in it would cost me a heart attack tonight....

I shared some with my neighbors and this is the left over...

The hike

I woke up at 4:00am, do my routine and woke up the kiddo. We were at the lobby by 5:20am and the driver came on time.

Horton’s plain was 33 km away from Nuwaraeliya and it would be a 1 hrs drive. There was only a handful of information over the net regarding the pricing of hiring a vehicle to the plain. Most of the price quoted over the net was around LKR 8000 for 4 persons. However during the search I had come across an ad over FB with contact no and email. I contacted the person and he had quoted me the price of LKR 4000 for the chartered. Frankly I was a little bit worried about the quotation but yet he was the only one that I could contact.

The driver DK was a nice young chap and the vehicle (Nissan Homy) was well maintained with good pickup. We managed to get to the entrance at 0645H. It was 13C and freezing cold when we started the hike.

\

I had decided to take the left route which leading to the world’s end instead of the right route which leads to Baker’s fall first.

The pros -> we would enjoy a good view at world’s end (mist would be up after 10)

The cons -> should be very hot on the return path.

I reached the world’s end before 9pm and enjoyed our breakfast along with the great scenery.

The returned path was quite stressful as the trail covered various kind of terrain, from plain to muddy mountain route.

While walking along the stream with my family, I could feel the loneliness; leading my family walking the path of salvation.

We had made it to the entrance at 11am and back to Nuwaraeliya at 12+noon. We had our lunch at the famous De Silva Food centre. The kids had burger(too much spicy food and they had tend to loss appetite) and I ordered a plate of fried rice.

As noted by Tripadviser:

1. The service is darn slow ->waiting time >45min

2. The burger is nice and up to standard

3. The milk shake taste superb

My personal experience:

1. The fried rice is darn big-> enough for 3 person

2. pre-cooked meal is fast

Well, I joined the group later in the afternoon and the day was uneventful, however I had slept through the meeting as the 9km hiking above 2000m was a stressful one for me.

Pre-trekking day....

We had arrived in Nuwaraeliya late in the evening as one of the members had suffered from severe nausea and vomiting during the trip. We were brought to a local food store and had our dinner upon our arrival.

I have contacted our driver during the dinner and reconfirmed about the pickup time…

I was worried about the trip tomorrow as the price was too cheap compare to what I had known from the net…

The hotel looked nice but the yet the bathroom was quite out of shape. The hot water supply was in-consistence; it was either too hot or too cold…

I had arranged the hotel to provide us with the breakfast box early in the morning before we go to sleep as suggested by other traveler to the Horton’s plain. We had to leave the hotel at 5:30am to get a good view at the world’s end.

It was a tiring day as we had been travelling most of the time for the past 2 days, I begun to question my decision for the trip but yet it was the only time that we could plan for private trip.

sluggish winding trip...

We pushed off at about eleven, at 4 pm, we could manage to cover 110km...the ascending route was filled with vehicle, tuk tuk and truck snaking around...well, 68km till our destination, reminding me about the our honeymoon trip to Cameron Highlands, it took me 3 hours to drove to Equitorial hotel from tapah...I was new to driving then, with the good old kembara I dare not negotiate the curve like I do now...

Rush start...

We reached hotel by 2am and drop to dream land before three....as usual i got up by 6 and after a simple repacking, we have our breakfast by 9....
The day begun by getting a sim card...it took us one plus hour...i got three card with one passport...and we are on our way to nuwara eliya via kandy....

Last leg..

Finally we are at the T1, unfortunately we are requested to the next gate after we leave the flight for security check..and there goes my serimuka...flight is delayed almost one hour and we world boarding anytime from now....

Complicated flight...

The flight was delayed for thirty min but when the plane taxied into the runway, the capt had declared that hkg airport was closed due to heavy rain and strong gust. We were towed back to the gate, and lunch was served on the ground...
50 min later, we were airborned and arrived in the hkg .
As the bad.weather continued, the flight to Cmb was delayed and I doubt that we could make it to t1 bengawan solo....

Bad. Weather.....

The weather is still bad, but we managed to make it to the departure area....it was not the worst driving in the rain experience but yet it is still a stress when you have a schedule to catch.
The flight is 1 HR away and I hope it would not be rough ride....10 plus years ago, I have boarded a russian made propeller flight from taichung to khh during a typhoon, that was one of the time I thought of seeing god.

The final run

After fighting with the heavy rain, we are finally at the airport...marking the beginning of the long flight...

greet by the rainbow

nothing better than a good start...1st of the last 3 shift before the tour...

the prep...

Less than 10 days before the trip, everyone are excited and the task list is narrowed down to 3 tasks : money changing, packing and drug preparation.

There is no direct money changing for LKR(ruppe) at the local bank; thence a interchanging to USD is needed (darn, forex loss x2 noted…). I had bought USD last week at the lowest rate and I would need to cash it this week.

Luggage packing would be challenge as we might not be able to our laundry during the visit. Most of the time, we would be lodging in Nurwara Eliya where the humidity is 80%...and the temperature was 12-28C. My plan is simple - > to buy a box fan (average RM60) at the airport shop and blow it 24hrs over the washed cloth…

Drug preparation is a challenge as the tour comprised of 22 persons and the focus would be acute gastroenteritis- > rule 1 -> no iced drink from the roadside, but frankly said, I am eager to try out the cendol-like farluda….

It was a good night sleep for me after a strenuous “fill with event” post call day. My sleepy bug was chased away when I read the news about the gas explosion in K city.

It was a tragic event which taken away many lives…it is really unbelievable that the local peoples did not realize that their house is sitting on a load of flammable gas transferring pipelines. 

The fire department had taken too long to search for the source and did not shut down relevant pipeline during the search. 

Someone is definitely going to bear the responsibility and hopefully it does not drag down the mayor (it is election time at the end of the year).

month of the GXXXX

I am back after 7 days of leave…. A little bit confuse as I felt I am more comfortable sitting in front of the desk.

Today is the beginning of the 7^th month aka – month of ghost. We would be expecting a great fall of patient amount. I presumed we would be experiencing a better night shift this month as peoples are reluctant to come out in the night. I still remember those nights when my brother and I rode to school for our SPM tuition during the 7^th Chinese month…there were no LED light then and we relied on the dynamo for light -> the harder and faster you pedal the brighter the light. Those nights were quite scary indeed for a 16+ years old kiddo, luckily I had my brother riding with me along the thrilling path….

Holiday?

It is the beginning of my 7 days leave...but yet it seems that there is an event waiting for me every day. Well, a lucky person i considered myself, able to enjoy such experience under the grace of god.

MH again....

I was doing my night shift when I read the news from internet...
My colleague had asked me if I take MH whenever I flown back to boleh land, and I told her that I seldom fly with MH nowadays.
The MAS started its KHH-BKI-KL route since my freshman year...it was so convenient then, I don't need to travel up north for the return. Few years ago just after a bird hit the windshield of MH087 during a flight (which later ended up 2 MH087 flight landed in KHH the next day), MAS had decided to cancel the flight. The reason -> holiday very pack, non-holiday very empty... money losing line and the MH087 was history..
Condolence to those who has lost their love ones....

off day that fill with event....

As lem was going off, the shifts were shared between 3 of us. L and I had down over 11 shifts over the past 15 days.

I was supposed to get a 2 days ago break but was occupied by some event.

I had cut my morning farming session to one hour as Dragon Cat(our rabbit ) had caught a dermatitis (pus noted with hair lost -> bacteria infection with no doubt). I had asked for an appointment in the morning at the university vet hospital but was informed that there was this specialist clinic (for small animal) in the afternoon. The consultation was thence extended to the afternoon. We were lucky as when the teaching clinic started, we were the 1^st one to be seen (the no1 and no2 of the appointment list did not show up). I learnt something new from the vet about the use of antibiotic in rabbit; cautious with the use of oral antibiotic in rabbit as the bacteria in the blind loop might be killed and ended up in toxic colon syndrome….

We left the clinic at 2:30 and headed back home.

The day before my shift ended in Kaohsiung where we have our dinner after sending Yun to the summer camp.

The dinner was a special one - > bah kut teh shop in Kaohsiung. There was a big crowd waiting in front of the shop when we arrived as the shop was due to open in 8 mins.

Well, the taste of the soup – “ a class less” (zhang seng guo ban - >Cantonese) from what we have back in Malaysia, totally different herb use, but the thickness of soup was there. Still and enjoyable one….

thunder god

The LUI SHEN aka thunder god ( not THOR, one of my fav MQP character) has been a hot product since months ago. 

The kitkat-like chocolate originated from Japan has swept through the local market. The product was instant as soon as it hit the rack. The selling price over the net was 3-4 fold….

I had bought some for Xian months ago and he enjoyed it and asked me from time to time if I could buy more for him. The price was rocking then and I told him that I would buy him more when the price cooled down later. The Taiwanese had swept the market and the producer had announced that they had to limit the supply to the sole retailer (that is 7-11) only for the next few months.

Today while driving to work with Xian (yeh, Ving would be fetching Yun and her gang later in the evening in Kaohsiung ->car fully seated and there is no place for Xian …). We had stopped at the 7-11 nearby. Xian had noticed a load of it at the counter and I fulfilled my promise….

MMLE...

I had been following the news of MMLE and found that a committee was formed and it would definitely be a go in the near future…

How to conduct the MMLE would be a challenge for the council. I doubt that the exam would be limited to written and that would be definitely a practical session. At least 1500+ would be scrubbed off per year and the pool of MMLE taker would be growing like a rolling snowball even with the limitation of attempts.

But the biggest problems would be-> where would be the houseman heading after their housmanship ? similar event has happened years ago when a load of youngster pursing their dream of flying by going for a private pilot course and was unable to work as a pilot...The days of taxi driver holding a medical degree would be coming soon....

The govt. KK had become more and more accessible and the private clinic had no room of survival, GP get around 7k/month (lower than a senior MO...why get out from the service ?)

Recently, I had told Ving that we were lucky we did not accept the offer to buy a clinic from a local doctor in Tg. Malim….

it is holiday...

Lem had gone back for his holiday and the ED would be manned by 3 of us… although I did not request a long break, I was still given a long break (8 days) on the roster….According to the evaluation standard, we should be getting a fifth physician on our roster as our patient had struck a recorded high last year, however, we doubt that it would be materialized in the near future..

Well, a camping was called at the end of my long break and it should be a relaxing one...

 

Tin Kosong.....

As our hospital is located beside one of the major road leading to east coast, I would encounter foreign tourist from time to time.

There was this tour bus which lost control yesterday. 5 patients were sent to our setting. One of the middle-aged patient had immediately caught my attention while I was busy wrapping up my admission order for another patient. He had talked in a loud tone asking the EMT who was completing the transfer note, “ Does this hospital has MRI, if there is no MRI, why is the “fart” meaning of send me over ?.”

While Mr G talking in a loud tone, the triage nurse directed me to another lady passenger who looked more “severe”.  I did a quite look as the EMT told me that there would be 3-4 passengers coming in later. The lady produced an US passport and apparently the group came from US.

As expected, when Mr G(MRI asking guy) sat in front of me, he had asked me if our hospital have an MRI, for he wanted a MRI scan to confirmed his injuries. I had confirmed with him that we do have a 1.5 T MRI and it could be done stat. He raised a question that what does a  1.5 T means and on the spot, I knew that his is  “Tin Kosong” type of patient (Tin kosong -> malay proverb = empty can; nothing in it and produced a loud sound when being hit). After explaining the meaning of 1.5 T, I proceeded to tell him that as he is not a local with health insurance, he would need to pay up for the scan.

He was quite agitated and interrupted the consultation as he wished to call up the tour guide to confirm about the payment as he claimed that he have no money. I had grinned, as the answer was out of my expectation as I thought, he would be clapping his chest and said, “ never fear, money is not a problem….”

I proceeded to the other patients who flooded the unseen patient list. After minutes later, he had come back and told me that the tour guide had promised that the company would handle the expenses. I had then told him that the MRI report would took a few hours as the imaging would need to be reconstructed and the radiologist would take a few hours to give me an urgent report. He had shown me a queer look and I had proceeded to tell him, “if he had been to a medical center for MRI check up, it would take weeks for an appointment and another 1 week for the report.” He then showed me a “Yes ah? I had never gone through that” look…..

I told him that in ED, most of the time CAT scan would be enough and I would arranged one for him under his request. He agreed with my offer as he seemed to have run out of suggestion/request.

The rest of the consultation was uneventful as Mr G become more polite since then.

Few months ago, I had met this Chinese tour involving in a bus accident. The ED was packed with 10+ elderly mainlanders; most of them suffered from minor contusion. All of them were polite and asked intelligent question during the consultations; it took me quite a while for me to explain their condition, they were “good” patients indeed….

Another thing that had surprised me was that none of the tourist knew where they would be putting up later that night....

sales reps...

There was this notice which is pinned onto the message board in the 175… It was the amount of patient each attending EP had admitted last month.

I saw the list and told Lem that it was really irritating being treated like salesman…

The job is really a pain working as counter service provider and now the management treat us like sales rep….

Unlike other ED which was a money losing department, our ED is actually making profit.

Well, just focus on the job- > distracting is the key to err…

Multiple role playing session.....

t was supposed to be a smooth trip to east while I enjoyed a long break…but my LORD has plan for me….

Well, Ving has noted with chillness while we were enjoying our Mongolian BBQ( invented by the Taiwanese and not originated from Mongol) in the evening of Saturday. She was noted with low grade fever when we reached home.

I had started her on antipyretic initially but the next day, typical sign of influenza was noted. I had started her on Tamiflu stat and the fever was better on Monday morning. I was confident that I could make it to Ministry for my course but later in the afternoon, Ving’s fever had worsen and she was coughing badly. Another Déjà Vu and I prayed that the lightning doesn’t strike twice, by then I was having a bad feeling that my trip is going to soak in soup…I started her on a drip as she had not been drinking well.

I was supposed to push off at 6am on Tuesday. Ving was getting better then, even though the cough was stationary but the auscultation related a different story – I had a bad feeling despite of the improvement of her fever. 

I decided to take Ving to the ED for a Chest Xray after sending Xian to school on Tuesday morning ….and the result confirmed my physical findings- > rt lower lobe pneumonia...

Well, at that point, admit and not admit was a struggle for me…. Admission would be pain and strain for me as the kids schooling would be a major problem, house/school is 20km from the hospital. It took me a brief moment to make the decision – outpatient treatment as it would unlikely to affect the family except me.

Although the lab test had indicated it was viral ( just like Xian have), I did not hesitate to start her on Moxifloxacin, I dare not gamble...

Ving’s low grade fever had spiked to 40 during our drive home and the fever had persisted the rest of the day despite the application of drip and aggressive antipyretic.

I had brought a load of normal saline + venocath + drip set with me. Even though I believe the sanitation in the house is better than the hospital, I dare not keep the venocath in situ for 3 days. I changed site on a 24hrs basis to avoid phleblitis

As I need to prep food for Ving, I tried to cook for the rest of us and the help from the kiddo was well appreciated.

The 1^st 24 hrs was quite a drain of physical strength and mental tolerance. As a family, one can raised so many questions and the anxiety could be eased by the medical staff. But I am all alone, I almost lost faith in my judgment but the feedback from the Ving’s physical findings was quite reassuring despite of the stagnant condition of fever.

There was always some errand waiting for me at the corner every 2 hourly and I was at the verge of collapsed at the mid of second 24hrs.

With grace, Ving’s condition had greatly improved after D3 and I was able to catch some sleep and regained my vitality.

By D4, Ving’s was able to get out from bed and the fever had totally subsided.

Well, it was a strenuous effort for me but yet the daily routine of the family was not affected.

The multi-role playing session was over finally and I was back to work as scheduled after the long break. Well, seemed to be a waste of vacation but yet I am truly appreciated for the chance given for me by the Great one. I had experienced the anxiety of family, stress of a foreign maid (nursing aide), act as a one-man medical staff providing in-patient care and finally working as a full time house maker.

For the past 20 days, everyone in the family had gone through a febrile session (with 2 pneumonia ) except me, a truly pain for a Malaysian family living abroad – no support (Just couldn’t ask any help from any church members/friends as the disease might be contagious …..sigh) and the loneliness and helplessness was beyond imagination…

Keeping up....

I had a great time with the kids lately. We had spent time together, chatting and sharing…

Not sure how long I could hold on to the current situation; keeping up with the pace of their growing up process. A tough work for an aging guy like me, but yet the process is filled with fun. 

There was this pearl moment during our stay in the Avillion resort; 3 of us sitting in the balcony chatting and sharing Shandy.....hope to have more memory like this in the future.

right guess....

Xian has a remarkable recovery. His fever subsided after the augmentin drip...

Well, the lab test had suggested that it is not bacteria infection - WBC 7300 , Procalcitonin <0.05...apart from the xray and course of the disease..

well, the antibiotic did help and Xian had returned to school today...

it is still a long way for machine to replace physician....

dejavu...

Xian fever had subsided for just 1 days and it had recurred yesterday morning. His cough had worsen since then. He had lots of sputum and I had started to give him chest percussion but yet the effect was limited. I had been there before, I told myself; few years ago, Yun had suffered from similar event. She had noted with 5 days of URI and mild fever but later the fever worsen and pneumonia was noted, she ended with in ward for 5 days.

I was more cautious this time and at 4am today morning, I had brought Xian to the ED.

The X-ray had shown:

Well, left lower lobar pneumonia- most probably a secondary bacteria infection. I had given him an adult dose of Augmentin drip and prescribed zithromax for him for out patient use, lets hope my strategy works…….

Gone with the wind....

The weather had been darn hot lately, even though the north have been raining cat and dog, our side remains calm.

The night has been intolerably hot and air con is needed as a good induction factor for a good night sleep.

Life was simple back in Malaysia. I remembered those days when 3 of us staying in the single story terrace house back in Tg. Malim….no air con, no big screen TV, no Tidafor for me to sunk into…

but there was this big padang(field) for us to take an evening walk, hawker who sold hand-made yummy red bean bao….

but yet it had gone with the wind..

I really missed it…..

first trial....

I harvested some pineapple and some beet root...
I have no idea what to do with it and finally one idea flashed across my mind - fruit vineger...
Did some reading over the net and finally decided to give it a shot.....

fever and school

I had always advised parents that don't sent their child to school if they are feverish. Sometimes, the parents would ask me why, and I would give them a standard answer ,"would you be happy if some sick kids infected you child in school ?"
Well, Ving had felt that Xian was "warm" in the middle of the night. We had a temperature check and he was 37.5°C. I shut off the aircon and within minutes, his temperature had risen to 37.9°C. Well, although he had no cough nor sorethroat. I think he is sick. That evening, he was complaining of fatigue during his piano class and I did not pay any attention....
As Wednesday school was half day and his temperature was 37.2°C in the next morning, we had allowed him to go to school the next day.
After he came back from school, Xian's temperature had risen to 38.5°C... By then, he is noted with mild cough.
He was barred from school the next day and he had been anxiously asking me how to chase the fever away.... he was so keen to attend school today morning. Unfortunately, he was still febrile and he was tearing in his bed and asking me if I could let him attend school, he is actually worried about his computer project and very keen to complete it....
Well, I turned down his petition and told him that not everyone is lucky as he is; he doesn't need to wait in the clinic/hospital when he got a cold, the rest of his classmate need to wait for their turn in the clinic.
Well, it is a 3d weekend and hope he recoverd by then....

land of query

 Few weeks ago, a car had accidentally rushed into a flooded tunnel; a mother and 2 children were trapped. The rescue department had successfully rescued the children but not the mother. Family members of the victim did not show any gratitude but yet queried the rescue was faulty.

Months ago , there was this young NCO who was sent to disciplinary confinement prior to his discharge from service. The procedure was noted with fraud. Some had concluded that the superior officer was to give him a “code red”(as in a FEW GOOD MEN).

He had later suffered from heat stroke and rhabdomyolysis complicated with acute renal failure after heavy physical exercise during the confinement. He collapsed in his cell and later passed away. His family demanded that the accused superior officer to be charge in the criminal court instead of the military court as the military court might rule in favor of the senior officer. The event had lead to a major demonstration and the legislators had listened and the law was altered; the military court would only function during wartime and all criminal case involving arm forces would be trialed in the criminal court. The family demand was accepted but when the court ruled that the patient mishap was due to his physical condition the family had yet again queried about the verdict…

Query had become a norm for the locals, they queried about everything when the result is not in their favor…..

As a service provider, I had encountered similar incident but with grace, I was able to pull myself out without lesion…need to be very careful in the future…