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.