the mission ...... impact beyond imagination...

The trip was a stunning one for me. Handful of team members, limited supply of drug. Poor lodging and the worst part, restriction of food, we were told that not to eat any food outside any food shop and only drink from bottled liquid. I had to refrained myself badly to laid my hand on whatever street food being sold. One of the team members was a lady pastor who had been there for more than 4 times, she told us that she had once eaten those food sold by seller along the roadside and she ended up sitting on the toilet for 2 days…… I had a mission to complete and I have no room for error so I told the local pastor that I would try those foods later when I go back to the homeland.

I had seen over 160 patients at the small village over the 2 days of stay. We had stalked the pharmacy around that area and grabbing whatever supply that they could provide us.

It was an amazing tour….I had learnt to appreciate what I have.

I left the team on D5, I travelled 140km to the local airport, took a domestic flight to N city and later hopped onto a flight back to HKG. While transiting, I had a deep thought about my journey and my future plan about serving the great one….

I picked 2 boxes of moon cake[black bean sand….my favorite] during my transit at HKG; the only prize that I got during the whole journey. I bought some gift for Xian and Yun on the plane. 

the mission.....A passage to .....

Unlike the previous few trip, I had lack the driving force to do drug preparation. The drug list proposed by me was being discounted and discounted….well, truly speaking, I don’t know what I could do with the limited stock..

I brought some of my stock and prepared for the impact when I arrived at my destination.

Malaria was one of the threats I am facing and since I am heading to the more secluded country side, I presumed I needed some prophylaxis. The choice from expensive Malarone to the cheapest doxycycline. Well, I opted for the later. I knew we definitely needed a lot of ointment but reluctant to do so as I was not sure if I would be stuck at the custom.

There were so many uncertainties waiting ahead and I was helplessly holding on with prayer. The day had come and I woke up early as I had an early flight to catch. It was not a smooth start. I discovered that I left out my phone after 1km away from my house. I driven back recovered the phone and noticed that my priority pass card was missing from my passport holder….

Well, everything was in chaos on my start. I left home 30mins late from my schedule after picking my phone with an eventful search for the card. Arriving at the airport and found that my PP card was in my wallet hidden slot, a relief but not good enough for a comfortable trip. The PP card would be a great tool on return trip as the transit time was more than 8 hrs.

The stopover at the HKG airport was a short one and I met my team 1+ hour prior to the departure….

the mission ..... pre flight

After 1+ years of burying my head like an ostrich, I finally decided to hit the road again for mission….

There had been invitation from time to time but I had denied them with lousy excuses. The decision was actually a conflicting one as Ving did not fully support my involvement.

After the Lanka, Ving had given me a go and an offer came in not long after that.

The offer came from the NGO which I had worked with few years ago in Satun.

It would be difficult for me to join the group on departure as they always use CKS as their departure airport. The departure time is always in early in the morning and arrival is late in the night. It would take me two more travelling day to complete the mission.

Luckily on this trip, they need to get a transit in HKG. I told the pastor I would get the flight ticket myself and I would meet them in HKG. The ticket was far more cheaper compare to the quotation from the travel agent. The visa part was a difficult part as I am not comfortable handing my passport to the travel agent and “mail” it up north for application. I did it over the net. The process was a tedious one, with all the detail to complete. I manage to do a full upload after a few attempts. The approval came few days later and I was all set to go….well, almost all set….

We help each other... .

It was an easy going weekend shift. I was doing 10-10 shift. I had to wake up early, did my cycling round and sent the kids to school by 7am as it was schooling weekend for the kids.

I arrived at the ED on time and started my shift. A senior couple came in with a mid-aged male. The patient was an elderly male assigned to my colleague L. He presented with SOB and later was diagnosed as congestive heart failure with possible acute coronary syndrome. The accent of the couple had raised my attention. It was Malaysian mandarin they were using. I glanced through the patient address and found the keyword Johor.

The consultation was a smooth one and after diagnosed as Acute coronary syndrome. The loca tour guide had asked for a referral to K city. The local tour guide left the scenario and an elderly female[who later identified herself as the Malaysia tour guide] joined the couple for further management. Later the lady tour guide came to me for help. She asked me if I could help her to contact the local tour guide as her phone was not working properly.

I assisted her on the calling with our phone.

The referral was done promptly but during the payment session. The lady tour guide came to me again asking me what to do as she had not enough NTD. The fee was NT19993 and she had only NTD 12000. The wife of the patient had joined the conversation and told me that  she had only SGD and asked me if the hospital accept SGD. Well…of coz we accept but at a very bad rate…I remember once there was this foreigner who paid the bill with USD; the rate offer by the management was as low as the hotel rate…

I told the ladies that I would help them with the exchange. The wife asked me what was the rate I want. I googled and shown it to her for fairness. She agreed with the rate and I went to the ATM at the 7-11 next door and drawn 7000NT. I gave her 6700 for SGD 300(It was supposed to be 6650 according to google).

They had then proceeded to the counter for payment. After a good 30min, while I walked pass the counter, the ladies were still at the counter. I approached them and found that they were still short of NTD 1000+ as the lady tour guide was reluctant to help out on the sum. Finally the lady tour guide gave in but was still short of NTD 293. I took the NTD300 from the leftover of NTD7000 and given it to our counter staff and settled the scene.

The wife asked me why did I help them? I told her,” Malaysian helps each other…especially when we are not in Malaysia…” We had a short chat, the wife had asked me where did I reside in Malaysia. I told her that my parents live in Johor. I told her that her husband should undergo the angiography here as it would be cheaper here than in Malaysia.

Well, the elderly was about the age of my parents and I could imagine their feeling of being stranded in a foreign place. Their offspring were supposed to manage this kinda of troublesome matter for them but yet they were helplessly facing the situation here. A hand was what they need….

Later the nurse who escorted the referral came back and told me that everything was fine….

the code, the oath.....

I still recalled the day I took my oath, even though I could not remember what I had recited but could still remember the rule of do no harm….

Well, few months ago, an O+G specialist had posted in a line group regarding a case. A 34 weeker in labor had presented to ED and he was consulted. The Os was fully opened and the O+G specialist had decided to transfer the case under the ground of preterm.

The case was initially referred to a hospital nearby with 24hrs labor capability that is 30 mins away from the ED. The referral was denied on enroute as the on call pediatrician refuse to accept the case. The ambulance had however detoured to another tertiary facility further up north.

The specialist had later shared in the line group:

The driver had competently driving the ambulance fast and steadily.

The accompanied nurse had done her job of pacifying the patients…

Most important, the patient had done her best withholding the delivery…..the baby just popped out minutes after their arrival in the receiving ED….

I grinned and mumbled, “WTXXXk”…..well, should have delivered the baby rather than took the chance doing a transfer. What if the child decided to come out on the ambulance and really had need a resus and intubation…

Another orthopedic surgeon I knew had involved in a fight with his local neighbor after a “you should let my car pass through first” incident. He was walloped by a few residents and later he told the ED that He would not see any referral patient from the neighborhood. Totally unacceptable situation…

I presumed they had forgotten the oath and the rule of DO NOT HARM…. Violation of the code of conduct and knowledge we had taught, it is still a Noble profession ? well, I had recently read the blog of Dr Pagavalan….he had quoted what the founding dean of UM, Tan Sri T J Danarj, said “ The day the medical education is commercialized and medical practice is commercialized, that’s the day prostitution of medicine starts”.

Can’t agree with him no more, I had quotas , KPI and other indexes to meet apart from providing care to my patients….

As for the prostitute part, I had always told my nursing colleagues,” I am nothing better than those ladies standing beside the wall( a Taiwan synonyms of prostitute), at least they got to finish their meal before seeing their client….. I can’t, I need to put down my spoon and fork whenever you girls called me, or else you would keep ringing the phone every 20 seconds….”

mal-lanka trip part 2

As I was unable to proceed with the long trip to east cost of Sri Lanka; I would need to split up from the group and headed back home after 5 days. The children with be accompanied me on the return trip as they would have to return for the school opening.

After the Colombo tour, Ving’s cough had worsen. Yun had noted with diarrhea complicated with low grade fever. Ving’s worsening cough had raised the issue if she was able to proceed to the east coast. She was worried about the expenses but I told her not to worry as I had bought the frequent flyer option and could change the flight as I wish. The final straw came on D-2 days of return when Ving’s artificial crown of her right lower molar came off. I told her that this was the sign for her to back off. I changed the flight and apologized to the east coast group that Ving was unable to join the trip.

On the day of departure, Yun had developed high grade fever and I had barely enough antipyretic to get the temperature down.

We were fortunately to get onto the plane and have a safe passage transiting in KLIA2.

After arriving back to our home, everyone had developed fever. I started tamiflu for all of the patients(including me) early and the fever had subsided on D2…..

It was a daring trip initially; starting from the ticket booking. I had done 5 bookings with different date and destination. The cross checking of passenger details had worn me off. The anxiety of making sure everything is in order is truly an agony for me. Ving’ cough however did not get better. She had told me that she had realized that no one in the family is comparable to my level of tolerance. She had given up the feeling of travelling with me to the more secluded part of the world….. Some trip, I would need to go alone in the future. 

mal-lanka trip , part 1

After the Osaka trip….we were supposed to gear up for another trip to south Asia. I was reluctant to leave my house after the new year trip. Ving had however got an invitation to have a trip to the east coast part of Sri Lanka. The trip was 2 weeks in length and I was unable to apply for such a long leave. After some negotiation and compromise, we had reached an agreement to materialize the plan.
The trip had separated into 3 stage, 1st stage was to visit my in law in Malaysia; as my mother in law condition had deteriorated over times. The 2ndstage was to join the church group in KLIA for a flight to Sri Lanka. The 3rd stage was to return with Xian and Yun before the 2 days early of the group Sri Lanka trip.
The prep stage was a tedious one for me. I had to book numerous tickets with different travel dates for 9 persons. The input of personal details had really haunted me for few days. As it was Air Asia we are flying with and any error will lead to a long and tiring emailing event and possible extra payment.
I had tried to book a car with the HAWK late as I was tied up with some hazardous shift. However HAWK was out of Innova when I logged on to their website 1 month prior to the travelling. I had no choice but to try my luck with AVIS. As a VISA holder, the AVIS provided a good discount price for car rental over the world. I had tried to book it before but unfortunately the discounted price was still more expensive than the HAWK. I was lucky this time, the price was cheaper and later when I arrived at KLIA2, the pick up process was smoother than the HAWK. I took me less than 20 minutes to buckled up and drive out from the parking.
The travel was not smooth as everyone was confident and attempted to do last minutes packing. We were almost late for the flight on the travel date. I had come back from a streak of consecutive night shifts and have to assist and supervised their packing. I hit dream land prior to the take off and woke up 40mintues before the arrival.
This time, I was able to use the autogate and passed without difficulty with my new passport. All of our baggages had arrived safely and we met my in law in less than 40 minutes on arrival.
Surprisingly, we were given a new generation Innova. Bigger space and more pickup.
After picking up the car, we had proceeded to picked up a friend from Taiwan in Putrajaya. She is a church member and also an investor who bought some property in Nilai. She had come to Malaysia few days before the Sri Lanka trip.
The route to Putra Jaya was a little packed and we had arrived at Setia Aman by 9:00pm for a late dinner in a local Sri Melur Mamak Store. I found that those people staying around Putrajaya were the lucky one, the google map had led a route which does not need to pay up any TOL!!!
I had good night sleep that night after walloping a bunch of Mamak store food….
I visited Lem on D2 at his new clinic near Dataran Sunway. His clinic is readied to go pending for license. I admired his guts to set up his clinic in this hazardous period of GP flooding. I would have opted to work under supervision for specialist gazettement.
We had done a few shopping rounds and visited my father in law shrine in Klang.
Living expenses around Klang valley had shot sky high. A decent breakfast cost RM8-10 (drinks and meals).
After 2 days of wandering around Klang valley, we were readied for our Sri Lanka trip….
It really disturbed me as we would be heading to KLIA during rush hours. We would joining a group church members in KLIA. They however were on a very rush scheduled. AirAsia does not offer a fly-thru from KHH to CMB. They would need to check out on arrival and check in again. The window was barely 2.5hrs….
With grace, even with the delay of flight from KHH, we were still able to get the 25 members dropped their baggage in time and enjoyed a smooth trip.

Nipponbashi apartment....

The service apartment we stayed in Osaka was just opposite Dotonbori. There is a MRT station just 10 seconds away from the front door. There is no service counter in the apartment. All communication is done with e-mail!!!. Imaging if you are trapped in the lift and you would need to email the hotel management to help you!

It is a one room one dining + kitchen unit. There are two double queen beds in the room. 1 dining room with a fully equipped kitchen. The bathroom is even equipped with a washing machine (you don’t need to buy any washing powder, provided!…).

During our stay there we had bought some food from the 7-11 and we were able to re-heat it and boil some water. It also comes with a compliment mobile wifi.

Very strategic location and good bargain price….

a short trip to O city

Although Xian had fully recovered but I was still nervous when he coughed….However few days after his recovery. I had gotten an undeniable offer. A friend working in a travel agency had told me that she had some very cheap air ticket to Osaka. A few tourists had backed out last minute prior to the journey and there were a few tickets to spare. The price was extremely low after communicating with Xian and Yun about their leave…I had taken the offer.

It was a short journey as Xian and Yun was still schooling despite of the summer holiday. Luckily Monday and Friday is half day and they felt that it was acceptable to absence for the class.

Choice of lodging was limited as the journey starts in less than 1 week. 4 persons room, nearby MRT had truly restricted my selection. I had however got a 1 star rated lodging which had 8-9/10 rating on booking.com. Since it was a short trip, I had crossed out Universal studio on my list.

Everything was in havoc as I had a very short time to prepare for the trip. I had gotten a mobile wifi machine and some MRT and airport transport ticket via the net. Not much time to think and I just grabbed whatever I could.

We were able to hit the airport on time and arrived at the Osaka airport. It was a low cost carrier and it had landed at the T2 and we would need to travel to T1 for to pick up the ticket and the airport rail.

The arrival was late in the evening and we had grabbed some chinese bao( penglai bao store) at the airport. It was tasty temporary pacified our hunger. I had planned to have our dinner at YiLan Ramen near the hotel we stayed. The service apartment I had rented was just a street across Dotonburi. We started our journey at 8:40pm. We had eaten our dinner at the YiLan Ramen. It was one of its kind but not really my type of food. We had roved around Dotonburi and SinShaibashi before we retreated to our room.

Ving was not feeling well on D2 morning and three of us had gone to breakfast by ourselves. We had visited a UCC breakfast around the corner for breakfast. The initial plan was to visit Tensogaku(premier castle) on D2 but Xian wanted to see if we could get a Nintendo Switch from the local store. We had found that there was a lucky draw for purchasing at the Big Camera store on that day. The registration started at 10 and draw done at 11. We had taken a slow tour around the area and joined the queue at 9:30am. It was a long queue roughly about 600 peoples turned up to draw for 10 machines.

After the draw, Ving was still not feeling well. We had changed our plan and headed toward the Tsutenkaku and Tianwang temple. It was a long hike for us. Xian and Yuan had enjoyed the trip as I allowed them to try their luck on gacha machine along our journey.

We had tried various food shops which recommended by Takagi Naoko in her book during our walk. It was a long walk of 3km before we could get onto the MRT. With our sore leg, we had to take rest for 2 hrs before we go for our dinner at 7pm. Ving was much better that night and we had a good shopping tour along Dotonbori and Shinshibashi.  

Xian was a little bit upset as our name was not listed on the Big Camera lucky draw.

D3 was a shopping tour day for Ving. We had also gone to a few gaming shop trying to get a Switch.

The night ended late even though we need to get up early for a noon flight back home.

There are lots of smoker in Japan and most of the Izakaya allow smoking. We had wanted to try out some Izakaya food but were unable to do so.

It was a new experience for all of us, short trip which was very compact. Tasty food and walk till you cramp road trip. Everyone had returned with loads of stuffs…except me.

Well, we are looking forward to another trip in the future.

attending physician vs patient family - the rest of the stay......

It was one of the toughest and agony night for me…I woke up on hourly basis , auscultated his breathing sound and checking his pulse rate. By 5am on the nurse morning round, his HR had dropped to 100/min with SpO2 of 94%,  but his BP was at an uncomfortable reading of 88/60mmHg despite of his improvement clinically. The second check was 1 + hrs later after Xian inhalation and antibiotic medication; his SpO2 was better at 95%, and BP had increase to 94/56mmHg. I was still feeling discomfort about the reading but yet he was in better shape.

Boss did his Sunday round at 9:30am and we had a brief discussion, Xian SBP was over 100mmHg by then. Both of us agreed the Xian was in bad condition on arrival but improvement was noted. He agreed with the admission ordered and thought that we were at the right track of management. Xian had improved later that day with no fever but yet his tachycardic was stationary. Ving had visited us later that evening and brought us some supplement for our stay. I had a better sleep as Xian condition was better though his SpO2 was still at 95%. His cough was better less sputum was noted.

D3 and D4 was a challenge to both of us as I had to do morning shift. Ving was only able to visit us later in the afternoon after Yun returned from school.

I left Xian alone in the room at 7:50am. After 2 days of living with the drip he was able to go to toilet with it and managed his own routine. His condition had improved greatly with heart rate down to 80/min(his average was 70/min). SpO2 was stationary at 97% and his breathing sound had greatly improved. It was a busy day and when I grabbed a chance to check on Xian at 10am, I found him by himself at the basement waiting for his turn for sonography. He was cool and confident about his condition. He mixed his medication (syrup and powder) and took it by himself after his meal. The feeling of seeing your own child handling his own task is beyond words..

I fetched Xian lunch at noon and Ving had brought us dinner later in the evening. The ED was busy and I could only returned to Xian room at 8:30pm. Xian breathing sound was still noisy but limited only to the base of his lung. The struggle at that time was to complete a 5 days or 7 days parenteral antibiotic. I was too tired and slept throughout the night. I woke up at 5am and Xian reading was almost normal. His heart rate had returned to baseline and breathing sound was much better. The struggle began as his venocath was due and need to be replaced. This time, the struggle was less.

 I prepared his breakfast and left him for ED at 8am. He was very comfortable with the environment than; he had wanted badly to get discharge and go back to school. I had a short discussion later that morning with boss and agreed that to discharge him tomorrow morning. It was a busy day in ED and I rejoined him later that night. Ving had come again later in the evening to bring us dinner. Xian was happy with our decision to discharge him on D5. He had slept more than 12 hrs per day during his admission; he had a very severe condition and I thank the great one for his speedy recovery…We had a great chat and I told him that my fear during this period. He finally realized why I brought my surface pro with me when we leaved home 5 days ago; I had expected the worst….

On D5, after the final rocephine drip, I had brought him home at noon…..

I slept through the afternoon when we reached home. This was life of a patient’s family. It was not my first one and I knew it will not be the last…..

I continued Xian on 2 more days of oral antibiotic and was very anxious whenever he had a slight cough. He had recovered well after the medication……

attending physician vs family D1

It started 2 weeks ago when Xian had started to experience cough. It was mild initially and later the cough become bursting in nature. No fever was noted and he had noted with no sign of life influenza. I had given him some cough syrup and the cough was better later on. The cough was still non-productive but had been disturbing in the night.

D-5 days before the incident, Xian’s cough character had changed – episode become longer and the sound quality was different from before. I had started him on Augmentin syrup and after the completion of the 3 days course, the cough was stationary and I stopped the antibiotic. On D-1 days, he was noted with low grade fever. I had gone for my night shift and felt very uneasy about his fever. His spirit was ok but yet the cough did not improve.

When I arrived home, I did an auscultation again and found that Xian condition had worsen; there were bilateral basal crepitation with mild wheezing. He was also tachycardia which made me more uncomfortable. I had started him on azithromycin, antipyretics and and some cough syrup before I gone to sleep. I hoped that when I woke up with the fever subsiding, his heart rate would become better…and I was wrong.

After 4 hours of sleep, I woke up and found that Xian’s fever had subsided. He was still tachycardic. I hesitated for a few minutes and decided to take him to the hospital. Tachycardic was not a good sign. Baring in mind that he would be admitted, I grabbed all my gadget and took him to the hospital.

ED was crowded and I seen him myself. The initial vital sign was unsatisfactory, tachycardic, hypoxic(SpO2 93% on room air). The CXR was better than I excepted, some infiltration over rt lower lobe instead of a very large patch. Another struggle….but there is no alternative, to risky to do home care therapy as I don’t have an oximeter in the house. I signed the admission form and praised the great one that there was still a single room available. Single room had been hot cake and very difficult to get one nowadays.

I started him on rocephine and azithromycin as he was an ICU candidate; not much choice for me.

Although with all of the “I am in very bad condition” findings, Xian was still comfortable which worried me. This is the sign of "I could deteriorated fast anytime" without any sign of warning...

The most difficult part was inserting the branula; Xian is definitely a super needle phobia compare to my needle phobia. It took 4 persons to perform the task, he is now 168cm and 63kg instead of the kiddo few years back.

In less than a hour, I had managed to take him into the room. SpO2 had increase to 95% after inhalation but yet he was still tachycardic.

I was unable to sleep that night due to anxiety; I was there as an attending physician, nursing aide and also a family. Xian’s life was in my hand and at the mercy of the great one….

I had questioned myself many times if I made the right decision...should I referred him to a better setting and under care by a pediatrician or should I use another regimen of antibiotic. Questions which I was unable to answer...

So long.....

It was a sorrow week for me….Lem is leaving Malaysia for good. After years of planning, he had finally acted; he had decided to gone back to the Boleh Land and open up his own practice.

Parents and kids are the main factor that motivated him to perform the daring move.

Setting up a practice is easy nowadays in Malaysia; there are companies to assist one to open up their own practice. However the market is currently flooded with GP. I remembered I had passed by a clinic opened by a Taiwan medical grad back in Kuching during my dinner tour. Within the 2 hours around that area, I had seen no patient in the clinic.

Lem had opted not to seek any specialist recognition as the process will be lengthy; a certain period of attachment will be required to attain such accreditation.

Setting up a clinic, getting a car and a house will need at least a million RM. It is a true gamble as the expenses of car and clinic is non-retrievable and devalued on the day of its existence.

I am in no position to do so as I need to save up for the kid’s education fund. 

Lem had been my classmate since we were studying in med school. We had come to this hospital after our graduation. He had completed his training and serve as attending physician in the ward and later work in ED. We have been very close and share lots of thing at work and about the life back in Boleh Land. 

So long Lem, best of luck….. 

forgotten the birthday of their father .....

Communicating over the phone is considered risky in my business. The code of practice required us to protect confidentiality of the patient. So it is our duty to confirm the identity of the respective speaker over the phone.

There is multiple ways of doing the job, from asking addresses, ID no to birthday. One of my favorite is birthday. However recently, I had found that it had lost its Mojo. I had come across, many siblings who were unable to recall the birth date of their parents. It is considered absurd to an old fashioned person like me….

It made me remember the famous phrase by gunslinger ROLAND from the DARK TOWER –

I do not shoot with my hand; he who shoots with his hand has forgotten the face of his father.
I shoot with my mind.

I do not kill with my gun; he who kills with his gun has forgotten the face of his father.
I kill with my heart.”

I am looking forward to the release of the Dark Tower movie later this year. Although the story was heavily modified but yet the revolver loading screen from the trailer had truly attract me….

well met.......

brew of freedom.....

I was a coffee freak for quite a long time until I developed esophagus reflux. I had stopped coffee craving after it worsen and affected my life. After a long time from my miraculous recovery. I had gone back to the coffee sipping life. Carefully monitoring my intake, I was able to maintain a symptomatic free life.

During our shopping tour at the Kuching Airport, I came across a shop selling Liberica bean. I had given up the thought of buying the pack not because of its price; but due to its mixing with Robusta. I was curious about the taste but was aware that the Robusta might succumb the flavor of Liberica. I held back the thought and vowed that I would give it a try later.

During my trip to Malacca, I had visited the old shop of Aik Chong at Jonker street. I was surprised when I found out that they are selling Liberica bean. Light to medium roast and not mixed with any Robusta. The price was surprisingly low and I bought it.

This was my second brew and the taste was one of its kind; berry like flavor with acceptable sourness. The aroma of coffee was light and refreshing.

I had bought some expensive beans recent few years and had almost laid my hand on the Exotica Kopi Luwak bean; the phrase “roasted in Malaysia” had pulled me back to reality. I would give it a try when I visit Indonesia next year…..

Well, my second brew, nel drip..

solo trip - the return

A day after we came back from Malacca, I had taken another long journey way home. My brother and parents had sent me to Senai Airport after dinner. It was sorrow parting from them; I wished I could stay longer but yet I can’t.

The flight was smooth and I arrived at KLIA2 on time. I proceeded to the transit counter and had my passport stamped and baggage checked. It was a late flight and I faced some difficulty finding the Sama Sama transit hotel; I was tired and could not read the map properly. The price was cheaper than Tune hotel and I could save the time re-checking in.

It was a small room with no window; unlike the room shown on the webpage. But for a 5 hrs rest, it was good enough for an old hog like me. I did not sleep properly and checkout at 6am. I am always anxious about catching a plane and afraid that I will miss it. As the flight was scheduled at 8:30am, I proceeded to the Air Asia Red lounge for breakfast. The lounge was small but has every element a lounge should have (except for the toilet). Food was above average(chef cooked noodle/porridge with malay kuih). The seat was comfortable and I had a short nap before my alarm woke me up for the boarding.

It was an eventful flight back to K City. I had brought back a load of items which Ving and the kids looking forward to…

A short trip it was and I had accomplished quite a few tasks which I had regretted that I have not done it earlier.

solo trip 2

I had a day rest after the flight. My bro had also arrived late that night. He had flown back from Shanghai via the Singapore route. We had a good chat and he had given me lots of technical advice regarding my EMR program. He had done well in his career. I am far from a retire life and he had achieved it…

Well, it was nice seeing him after all those silence year.

On D3, I had begun my 500km drive up north. We planned to pay a visit to the columbarium where my grandfather rest. The columbarium was situated at a temple near the Sg Besi airfield. I had visited it multiple times before I left the homeland. We pushed out early and at 7am, we were on the highway after our breakfast at a small coffee shop. Typical Malaysia breakfast of wantan mee and cham. The Sportage which my bro bought for my father was in tip top condition. We stopped a few times for refreshment before we arrived at the temple at 10:30am. My parents completed the ritual and we were off at 11:30am.

We stopped by Empayar Siew Paw restaurant for a crab meal (which is still as good as what I had tasted few years back) and then proceeded to Malacca to visit my aunt.

I had taken my parents to Jonker Street for a quick tour before stopping at my aunt’s place.

I had met my cousins who are working in Malaysia. We exchanged some view and I learnt more about the situation in the homeland. The salary had risen over years and so did the living cost. The deprivation of ringgit had made thing worst. We had a dinner at a newly opened restaurant at the out skirt of the town. We were lucky to secure a seat despite of not making an early reservation. Surprisingly the food was way below standard. Pork was not prep properly and shrimp was not fresh. But yet it was filled with customer. The only reason was it location. It was outside the town and the jam in the town had lured people to it.

We headed back to Makhota hotel after the dinner. I had paid a visit to the night market across the street while retrieving my GPS from the car.

It was a night market for Malay; as usual, I was the few Chinese wandering around and I bought some Sate and Apam Balik from the hawker around. Food was average but I had a good time wandering around.

I had taken my parents to a BKT shop around the town before we headed back to Kulai. The BKT is Klang style although it is not as good as what I had tasted in the past but I could settled with the no fish shrimp is also ok situation.

We took a slow drive back to Kulai and had our lunch at Yun Lai Dim Sum shop.

It should be routine for me next year to accompany my parents to KL for the ritual; travelling up north has becoming a stress for them.  

solo trip....

I had a solo trip back to the homeland after my daring trip in CNY. Ving had suggested I pay my parent a visit as we did not visit them during the CNY. Both of us agreed that we need to show Xian and Yun what filial is – one of act was to please your parents….

I had arranged a 6 days leave for the trip. I had booked a fly thru flight from KHH to JHB ( the fly thru was available after my parent booked the non-connecting route last year).

The departure was smooth until I arrived at KLIA2. There is not much information about the fly thru procedure. After I departed from gate, I had followed the sign board and arrive at the transit area. It was a long march…and nothing to stop by to waste any time(which I wanted to do so as the transit time was 2 hrs).
The transit area consists of a baggage check security counter and immigration counter.

I got passed the area without difficulty and headed to the gate. Well, it was as simple as it should be….2 food joints were located at the pier and the food did not catch my attention.

The departure was delayed but yet still arrived at Senai airport on time….

My parents were waiting for me at the arrival hall. My dad health deteriorated over this few years after the stroke episode. I was happy to see him moving around freely.

We stopped by a mamak stall near my brother house for a late dinner. The nasi lemak was so so but yet it was great for an old hag like me who had been too far away from home….

Overall it was a good start, I had a good rest on board, viewed a few episode of “midnight canteen” on Netflix(pre-download ofcoz” during the flight. The in-flight mee goreng which I ordered was substandard. But able to reach the land of spilling blood again felt really good….

when the birthday present is not only an item.....

It is easy when your kids want something, a book, a toy and even a mobile phone. As a father, you just need to reach for your wallet and volla...

After many years of easy give and take, things had gone a little complicated during Xian’s recent birthday…

During a dinner season, Xian had told us that he envies those who build his own computer and he would like to learn the skill and do so in the future. Ving however had told him that he doesn’t have to wait; there is someone in this house who can teach him to do so. Xian had shown an astonishing look and told me that he wanted to build his own computer as a birthday present.

I picked up the skill during my college days but I had opted to buy built up unit later when I returned for my training. As I figured the training might be quite hectic and I would have no time for gaming. I had acquired 2 units in the past 10 years and all of them had failed recent 2 years

Xian's request had pushed me to the difficult part, to build and not to buy….

Well, he had actually wanted something more than a simple desktop. He wanted something that can powered 3 monitors – inspired by the scene in Rogue Nation where Benji played Halo at work….

So we are not talking about an entry level i3 with all in one mother board; it is something at the high end with i7 and GTX10x0.

Well, I had started to read up since then. There was a lot to learn from even though the concept did not change but lots of technical details were updated since then. Over clocking was definitely out of my plan as it requires a good liquid cooling system and the risk of leaking would haunt me everyday. I had some struggle making up the list. Some decisions were easily made and some were not. But the principle was to get components sub par to the best in the market.

After our trip from Malaysia, I had a discussion with Xian again and he had shown determination to build his own unit. I had caught a window between my shifts few days prior to his birthday to do the shopping round. I visited a whole-seller in Kaohsiung and grabbed everything on the list.

During the purchase session, I had asked Xian again “Why don’t we let the seller to help us to assemble the unit, after all it is free of charge”

Well, he had firmly told that he wanted to proceed with our plan.

Handling a few hundred RM component is one thing, assembling a few 1+K RM components together is another story. Anything could happen and I just can’t bear to think about it...

The assembling process was complicated. The casing was mATX and the mother board I bought was ATX; we had to wait for one more day for the replacement. It took us 3 nights to get the mother board LED light to turn on. A further 3 more days to get all three monitor working in surround mode.

Xian did most of the assembled job under my instruction, minus the insertion of CPU and graphic card of course (you should see me shake while inserting both of the devices).

Triple monitor with surround mode is a something new to Xian and me. Not many games support the mode but yet it is an extraordinary experience.

The triple monitor setup requires a table with decent depth to unable a good view; thence I had modified my working desk by adding a keyboard drawer. It extended my desk depth for about 30cm.

While Xian is roving in the world of watchdog2 (Which gave me a severe vertigo even watching him played).; I had added a thrustmaster hotas x and rudder to my gadgets recent few days.

I did a night airfield traffic pattern flight at Kaohsiung airport on FSX today morning prior to my shift and it was amazing…

It was truly an adventure for me; without Xian request and enthusiasm, I would not have the motivation to perform such task.   

Thanz to the birthday boy...

2017CNY trip - the return

D9 was the most challenging day; I would need to drive from Batu Ferringi to Bayan Lepas airport. I would have to pass through the Bayan Lepas industrial area during rush hour. 2 routes were available – the balik pulau route and the Jalan Sultan Azlan Shah route. I had tried out the Balik Pulau curvy mountain route and considered it as more risky to drive early in the morning. I decided to do an early start and go through the Jalan Sultan Azlan Shah route. Everything was smooth until I took a wrong turn at a junction along Jalan Macalister; I had stumbled myself into a route near an Indian temple. The next day was Thaipusam and the route was filled with followers. It took me a good 20min to make a U-turn back to the main road.  

I was lucky to make it to Bayan Lepas Airport and made the key drop for the Innova in time.

The flight back to KLIA2 was smooth however I had had a hard time picking up the car. The staff had messed up with the booking and it took us a good 1hr before we hit the road. We took a quick tour around Putrajaya and we later proceeded to the local church at the Jalan Air Panas. The local church there had kept a very very low profile to avoid unnecessary attention from the locals.

We managed to get back to Klang before the rush hour and had a “luxurious” dinner at a restaurant located in Klang Parade.

I had my second Yu Shang dish. Yu Shang was one of my favorite dishes in the past, however the taste had changed. I still remembered during those old days, a master chef would be responsible for the preparation and there was always a red and green packet of spice in the dish. Nowadays, you can get a pack of Yu Shang from the supermarket and DIY in the house. 

I was a little worn off after the dinner….while Ving and my friends preparing for the final packing that night, I had thanked the great one to allow me to execute this daring journey without any major mistake.

We had left my brother in law’s house at 5am and reached KLIA2 before 6…the rest of the flight was unremarkable….

2017CNY trip D7,8 - Penang

I would do whatever to avoid hotel breakfast whenever I travel back to Malaysia. I would rather tried BKT and whatever noodle outside rather than the standard continental breakfast plus nasi lemak. Well, on D7, we had our only hotel breakfast. Simple 3 star hotel breakfast, toast bread, fried bee hoon, fried egg… Nothing to shout but yet a nice one.

We reached the airport 2 hour before the take off. We did our last minute pepper buying tour. GSW had told me that the white pepper is produced by soaking ripen pepper in water until the skin break up(another words is until it is rotten). So he recommended black pepper over white pepper.

The flight was on scheduled and we reached Penang at 11am. I checked out and get our car from rental. After a few meal of food court, we decided to try out some restaurant food. I found a Chinese restaurant near Bayan Lepas. The food was up to the standard. The lady owner had recommended that we took the balik pulau road to enjoy another kind of view. I followed her advice and we had a great view of Teluk Bahang Dam. We stopped over the Batik factory and grabbed some load.

We reached Holiday Inn Batu Ferringi at about 3:30pm. We were given an upgrade by the hotel, instead of the crossing the road Ferringi wing, we were given room at the main building. The environment was great with the beach and lobby.

When the sunset, we had driven to the town for dinner. Penang had changed a lot and most of the major road had become one way. Komtar was no longer the highest building around Penang. Lots of Condos were being built and the price is fairly expensive.

After dinner at the new lane food court, we had stopped by the local shop for some shopping. There was a durian seller nearby the food court and Ving decided to try out the Musang King….Well, a hole in my pocket but still worth every penny; it would be a memorable taste that would last for a long time. (we did it once many years ago; my bro-in law, took me to a roundabout around PJ ..)

I had a dipped in the sea and enjoyed a short relax time on the recline chair along the beach side. I wished we had spent more time in the hotel.

We had done a city tour around George town on D8. Penang is indeed a good place to live; it is definite a good place to enjoy retire life.

We visited Penand Hill and stopped by penang road for a batik sweeping round. The chendol is nice but nothing to shout about. A must visit for anyone that like batik as Ving does are the Sams Batik and Asia co.

Both shop were located at the Penang road. The Asia co is manned by a friendly old Chinese couple; batik is local price and the souvenir is cheap as well. They sell traditional batik.

The Sams is an Indian shop and batik price is 1/2 of the Batik factory. Only thing to shout is the parking fee….We had stopped for 1hr 40mins and the fee was RM20….the most expensive I had paid over the last 10 years….

Gurney drive was one of my favorite spot during my childhood; it had changed over the year and the hawker had relocated to the food court…Food was still ok but I missed the feel of walking along the jetty and enjoying the breeze from the sea.

I hit dreamland early as we had to move out early the next day;the hotel staff had told me that it would be rush hour in the morning along the bayan lepas route….

2017CNY - Sri Aman D5,D6

I woke up and found out that all my ip cams were back online. The only explanation was my router in the 3^rd floor had been touched by the great one…

GSW had tugged six of us into his good old UNSER early in the morning. We had stopped by the orang utan rehabilitation center and crocodile farm before we proceed to Sri Aman.

The ride was a pleasant one through the pan-Borneo highway. We had made multiple stop along the way and we reached Sri Aman late in the afternoon.

We had stayed in GSW bungalow. It was a great night with all the sharing and laughing. Both of us share the experience of doing housemanship during the doctor shortage era. Housemen were trained to become all rounded medical officer and later distributed throughout Malaysia. Medical officers were the core for the medical service. The story is different nowadays; 20% of the houseman quit and many of them got extended.  

We had enjoyed a good city tour on D6 and left Sri Aman after the Sunday church gathering. GSW is current the elders for the local church.

We left Sri Aman at 3pm; a church senior had sent us back to Kuching.  

We had put up in the Jinhold Service Apartment which is nearer to the Airport. There is a shop lot nearby with a few food court. We had ordered a load of food from various hawker store...

2017CNY trip - D4 Cat city cont....

D4 was a relaxing day, we had an early start. Breakfast was average; “Kolok Mee”(as is Gan Lao Mian->dried noodle) and Sarawak Laksa. The Laksa was curry base with shrimp as it main ingredient. Indeed the taste was different from what we have in the west.

GSW had taken us to the Sarawak cultural village after the breakfast. The village is well maintained and a good source for understanding the traditional living style of the Sarawakian.

We left at noon and enjoyed a grand seafood meal at a restaurant (Teo Seafood), near the village. Standard Ye Har Hai (Fish, Shrimp, Crab) dishes supplement with drink to you drop coconut juice.

The rest of the afternoon was spent in the forest museum and cat museum. During the tour, I had called up CTBO airasia and the staff told me that Xian’s baggage is still in limbo.

The dinner was a memorable one; GSW had taken us to “the.Dyak”; a restaurant famous for Iban’s food. GSW told us that the Jani Kasam pork was actually pork buried under ground for 1 week before it was taken out and made into dishes. The dishes had a particular smell....acceptable but I won't give it a second try...

Luckily tempuyuk was not available at that time (not durian season). the.Dyak is a good restaurant if you ever drop by Kuching.

We had a quick tour at the supermarket next to the imperial hotel and found that food price had gone up significantly compare to 2 years ago.

It was an easy day for me….thanks to GSW and his brother in law, they had given us a good tour around Kuching.

2017CNY trip - D3: Cat City

I got up at 4 and wake up the rest of the team. There was a couple who served in our church that participated in our trip. The trip become complicated as I had to charter a 7-seater rather than a sedan. I managed to get an Innova from Hawk and surprisingly the drive was smooth with acceptable pick-up. We arrived at KLIA in time and there was a 30 minutes window for us to have breakfast at the mamak store around the gate.

The flight was smooth and I grabbed a good nap on the flight. I had pre-informed GSW about my plan of getting passport renewal at Kuching.

GSW is my classmate in medical school. He is a Sarawakian who completed his housemanship in Kuching and proceeded to Sri Aman for his medical officer service. He had later opened his own practice in Sri Aman. His wife is a dentist and they shared the same building for their private practice. I had met him during our graduation anniversary and he had invited all of us to pay him a visit at the calm town of peace. I however decided to be the first to do so….Frankly said, I had never been to Sarawak. It was a good time to do so as GSW promised to give me a good tour.

In the past, the west Malaysian would need a passport to enter Sarawak and nowadays, you just need the IC. However, I was curious when I saw many passengers queuing in front of me at the immigration that taken out their passport. I got my answer when the immigration officer took my IC and started to fill up a form. Those who shown their passport had a more express entry; the officer just scanned it and let them passed. It was like 10 secs vs 3 minutes….

GSW and a serving brother were waiting for us at the exit. He had borrowed a 13-seater minibus from the church to take us around the city. After a quick lunch at the local food shop. We were taken to the local UTC for the passport renewal.

The process was really fast and we got our passport in 40 minutes (not from the time that we paid up, but from the time we entered). Grace from the great one….We proceeded to Sarawak Museum and small city tour before dinner.

We had dinner at a local steak house and enjoyed a good time with some local church members (most of them were GSW relative…).

I had booked a 3-room service apartment at Imperial Hotel. It was a good bargain (those who are interested can search for A-10 Imperial Apartment) for a group of 6. It is well furnished and maintained with 3 room + 3 bathroom. It even had a washing machine.

Everyone was worn off after the 2 days intensive trip. It was a relief for me as I had settled the passport issue. The rest of trip was planned and I don’t ha

2017CNY trip - Day 2: Passport run

The second day of the trip was the most disturbing for me…I had to deal with the immigration department. It is a real pain in the past when dealing with passport matter. I recalled that we had to spend a whole day getting my passport done and pick it up few days later during my childhood. Getting to the department early was essential to secure a number; there was a big chance you would be turned down and ask to return tomorrow if you arrive late as there was limited quota/number per day in the past.

Things became better later and I almost get it done on the same day on my recent few renewal. However it is different this time as we were going at the peri-CNY period. Well, I have no choice, Xian, Yun an Ving’s passports expired in less than 3 months and I have a packed schedule to follow during our trip.

My brother in law advised me to go early, get a number and enjoyed our bakuteh as brunch. I complied with his advice and we arrived at the Port Klang Immigration department at 7:40am. My heart sunk when I saw the queue; the queue was long enough to encompass the whole building 1 round. Ok, I decided to have my BKT first and came back later. My bro-in law took me to the famous Teluk Pulai BKT shop and we have a great bite. I knew it would be my only BKT meal during this trip. During the breakfast, I called up immigration department at Kuching and confirmed that the west Malaysian can renew and get their passport within the same day. We returned to Port Klang immigration department at 9am and found that the queue had shortened and decided to join the lineup. After 20mins of waiting, a security came out and started to counting head. Xian was first in our group and the last who received the head count; 3 of us was left out. We decided to forfeit the queue and proceed with the plan of getting the passport done at Kuching. Tough decision for me as we were in more trouble if we can’t get it done there; the final location would be Penang which I definitely resist.

We had proceeded with our trip up to KL, visited Muzim Negara, Jalan Petaling and Central Market.

As in the past, Jalan Petaling is no more China Town, but Bangala Street. However the Kun Kei Wantan Mee at Jalan Petaling is still manned by the original owner and I considered it as one of the best in Klang Valley. Although the environment was considered as very unpleasant but it is worth to give it a try. We headed back to Klang after a shopping tour at the central market.

We reached Klang by 5pm(no Jam as it was FT day). Enjoyed a greartvariety of food in the local food court. That night was an unpleasant night for me; I had to worry about the passport renewal and also the trip to KLIA2. Our flight to Kuching was scheduled at 9am and we need to arrive early. I decided to leave Setia Alam at 5:30am so that we would be able to arrive at KLIA2 at 6:30am and proceed with check in. This is not the first time I regret about my planning of the trip. To many place to visit and the schedule was very tight with no room of mistake.

2017CNY trip.....the journey begin

The drive back home was a smooth one and I was able to do my final packing. The rest of the members were actually partially ready and I had to do the whipping job. We were a little late on schedule but were still able to hit the airport on time. It was a long queue waiting for the airasia counter to open. We were lucky as we are eligible for the premium counter check-in. A middle age lady had asked me to not to jump queue when I squeezed my way to the counter. I was too tired to argue and flashed my travel itinerary and make my way through the crowd. She was unpleased but some of her friend had stopped her further from approached us. Paying more getting better service seems fair and unfair…..

We completed the check in and proceeded to the immigration clearance and passed with no difficulty. While having my lunch in the food stall around the gate, I found that I was unable to connect to 4 of my dlink ip cams. Those cams were connected to my 3^rd floor router via wifi and I had lost connection to them. I was confused as I had done a final check before leaving and everything was in order….Well, nothing could be done and I had to live with it as we were 1 hr away from boarding. Not a good start and the worst await me later….

I had encountered some rude senior citizens during the boarding stage; 2 elderly Malaysian couple had tried to barred me from loading my luggage to the upper compartment as they wanted to reserved it for some friends who were late behind the queue. I was too tired and ignored their request; others passenger had done the same….

I entered dreamland on the flight and awaken 30min before touchdown.

The immigration was crowded and I had waited a good 30min before we passed the autogate.

We met our worst nightmare at the baggage claimed. Xian luggage was not seen after the last baggage arrived. The local lost of found staff were helpful and we had made a report...

Luckily the luggage was filled with Xian’s cloth only…

The event had made us 90min behind our schedule. Xian was very depressed about the incident….We had our dinner at the mamak store beside the Setia Alam Tesco as we had to do some shopping for Xian.

Food was up to the standard; it was one of the great event of the day.

We managed to grab some Cloths for Xian. My bro-in law had also given him a load of goodies; You lost some and you gain some.

I had a sense of uneasiness….bad start with bad ending for that day…

I knew the Great One is preparing something for me during this journey but I was not prepared.

CNY trip D-0....

1 hrs till the end of the shift….I had struggled for the past 4 days; the shifts were stressful during the last 3 days. I had slept less than 30 minutes during those 3 shifts and preparing for the trip had taken up most of my alert time in the house…

The last call was better as I had a total amount of  4 +hours of sleep (minor interruption of coz).

 It would have to be a smooth process after my shift as I had to drive back start the final check, pack all my 3C (cell phone, camera, surface, note8…) into my back pack, load the luggage and hit the road. Any delay means a disastrous rush during the process.

The airport should be crowded and I have to do counter check in as the passport expire date is less than 6 months for Ving and the children.

I had read my blog again and found that I had not been home for over 2 years instead of 1….Well, I really missed the land, hopefully I could enjoy some Maggi Mee Goreng + teh ais by 9pm today at a mamak store near my in laws house…

CNY call , D-4

CNY is a nightmare for the ED staff. All the outpatient departments are close and everyone rush to the ED. You would see a lot of GI upset, flu and trauma. The ED would be crowded and patients and family staring at you hoping that you would speed up and see them ASAP.

I have to do 4 consecutive night shifts starting from CNY eve as I would be leaving from homeland for 10 days. The ED roster is always you gain some and lose some basis; most of us will comply to others request if there is no other event.

Well, the ED was packed as expected when I walk passed the triage desk. At 10+pm, a 21y/o lady had presented to ED complaining of abdominal pain since morning. She claimed that she was pregnant. She confirmed her pregnancy with a pregnancy kits. She was wearing a tight jean with plumy look. It was difficult to tell if she is truly pregnant. I had bad feeling when I saw her. I took her to the bedside and did a bed side sono. Fetal heart beat was noted and I was unable to locate the head…bad sign, should be in labour and the station was definitely low.

I rushed her into the resus area and asked the nurses to alert boss (I saw him wandering around earlier). A quick VE confirmed my fear; fully open os and fetal station is +2… I “interrogated” her further and found out that she was G1 and unable to recall her last menstruation cycle. She claimed that she had only one pre-natal follow up and unable to recall the due date. The contraction was not prominent as she was plumy. I had 2 choice at that moment, one to deliver the baby and two to transferred the lady. Option two was applicable as she was G1; but it might also jeopardize the fetal as it might be premature and might be complicated with prolong labor. I made a decision to deliver her as boss had agreed to come. It was risky but worth the effort to save the baby as boss was well trained in neonatology (his record was 800g premature in our hospital ).

Boss arrived about 10 mins later and he joined the team. We had a hard time as she was a primigravida. The baby was delivered after 30mins of effort. The baby was well taken care by boss and was in good condition. I had a hard time repairing the vagina tear but was able to manage it with the aid of surgical assistant.

Well, my nurse had later asked the girl that who was the father…. Her answer was not surprise –“ex-boy friend”. She said that she don’t want to kill her baby. My nurses pointed out to her that the way she managed her prenatal was incorrect and might hurt her baby.

I came out from the scenario with more than 10 patients waiting for consultation and I managed to clear them. 2 of the local regional grade hospital and denied my referral as the gestation age was uncertain even though the Apgar score was satisfactory.

I finally got a referral up north at a medical center. 2 hours later, the EMT who escorted the duo called me up stating that the lady had given a false identity during the consultation…. She was actually 17 instead of 21. I sigh and surprisingly I did not curse even though I need to re-enter the “#%#@#” medical note again. Truly an unforgettable CNY eve….

CNY....

The only period that I enjoyed CNY after I start working was those day with MOH. The Chinese colleague was given priority for leave and with some manipulation I enjoyed a 4-5 days rest. My parent’s house was near my in law and I don’t get trapped on the highway. After I left Malaysia, life had become different. Although the holiday was much longer but we need to split it into half; the workload was triple during the working days. CNY eve is the splitting point and each of us enjoyed a 3 days off instead of 6 days.

For the locals, 3 days is enough, but I would need at least 8 days for a trip back home. In the past, it was simple but nowadays, I would need to adapt to the schedule of Yun and Xian; they have tuitions classes during the winter holiday. Secondary school is different from primary school…..

Yun and Xian had lost the feeling of CNY. They had never expecting any new cloth as we don’t buy new cloth for them prior to CNY. They have no chance of eating a reunion dinner as we are the only family around and I worked most of the CNY eve. No relative means no Ang Paw but they are definitely not looking forward to the extra reward. For them , CNY is just another trapped in the house holiday as I preferred house detention as everywhere is packed with people. The conclusion : CNY is nothing to cheer about for them.

But CNY was a grace for a poor kid like me. I don’t have the luxury to retain all my red packets, but yet I got to keep the one from my grand parent.

From time to time, Ving and I had tried to introduce the CNY feel to them, however we had failed. This year, despite the struggle of going back during CNY, we are not enjoying the trip with our family…..a trip to Sarawak and Penang would consume most of our time in Malaysia.

walk in and straight and exit laying...

After the joining of our 5^th staff, life was better but however the quality of night shift had gone down. We were being harassed q10-15min most of the time by nurses. The fee of RM 50(all in, no partial burden) is considered cheap to the locals as it is just walk in and seen by doctor without extra waiting(especially in the night). Of cause the health insurance covered an additional RM140 medical fee to the hospital (simple flu, stomach upset with no examination done).

Most of the ED physicians are not afraid of those critically ill cases as when they stepped into the ED, you could tell everyone related that the patient is so ill that he would die. The most horrifying patient is those that walked in and deteriorated out of your expectation.

Lem had left me a patient yesterday. An old lady with mild abdomen pain for few days. Lem had told me that she is case of diabetic nephropathy and had undergone a partial hysterectomy with bilateral opphrectomy 2 weeks ago at a big hospital at the K city outskirt. An KUB was obtained which revealed markedly distended colon. Lem had ordered a CT before he left. I took over the case and review the CT later. The CT did not reveal any significant finding apart from the colon distension. Her white count was rocking high at 19000 and Creatinine had worsened from 2.0mg/dl to 6.0 mg/dl. Despite of her status of afebrile, everything pointed to the direction of septicemia. I told the family about the result but the patient had opted to return to the “big hospital” up north for further treatment. I told the family that although she looked stable, she is at the risk of sudden death. The patient had however decided to transfer despite of my explanation. The final check vital sign before her transfer had shown a BP of 55/30mmHg. We approached her and she was fitting. We rushed her to the resuscitation area, I had a moment of hesitation to intubate her as she was still breathing but drowsy. She was bradycardic on the monitor. I ordered 2 epinephrine but no obvious improvement was noted. I ordered 2 vials of sodium bicarbonate and her heart rate was stabilized and regained conscious. After the event, the family had decided to stay back and patient was sent to ICU. She passed away later that night….

Family had accepted the situation as there was time for the family to accept her condition.