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….