21,180 and 13,120 ...

It was a hot night - yes, at this time of the year, you could still get 23 in the night at the southern tip of Taiwan. I had this couple with MVA. A young man and a girl  - I considered 21 y/o as a man and a female below 16 as a girl. The girl was only 13 y/o. They was riding a bike and fallen. I had this young man admitted 1+ months ago for UGI bleeding. Gastric ulcer due to alcohol... alcoholic at the age of 20+ : not surprise if he is an aborigine but nope he is a local. I was not sure with the relationship when I examined them both. When I sent the young man to radiology for imaging, I asked the girl what was their relationship ? The girl said friends - when a male and female is not relative that means they are couple. The nurses and I looked at each other with a queer look.... well, the girl definitely look like a girl - she is merely 120cm and the guy was 180+ cm. Well, I grumbled with the usual cantonese proverb - "Kam Tou Tak ?!!"(like this also can ? ) and hoping they are not having the relationship that I thought ( sexual relationship of coz, what do you expect from this kind of couple ? puppy love ?)
I insisted the girl to give us her parents phone. She had resisted once when the registration asked for her details - "I forget"(how could you forget where you stay and your house phone no ?) . I threated her that if she refuse, I would have to handed her over to the police (by law yes - but I doubt the police would comply with the law and dance along..). She gave in fast and I called her house the next minutes. I called the house and a very young voice picked up the phone - I asked if that is XXX house and I got a positive feedback. I told the kiddo that I am from FL hospital ED and asked her if any elder person is around. She told me that no one is around  - and asked me about the detail - I told her the situation and strangely she told me to hang on.  Seconds later - a male picked up a phone and identified that he is the father. I told him the detail and he said he would rush over and asked me to keep the young man.
The police came to  ED later - the police had a link with the ambulance service - they would come over for investigation. They police asked around and requested an alcohol breath test and the young man refused. You could refuse a breath test provided you agree with a blood test and the police love blood test - no arguement. The police equipment was not properly maintain and there was a case in the past which went to court as someone had found out the breath test machine was not sent for recalibration for a very very long time.
The young man absconded after he went to toilet. The police had to issue him a fine of NT 60000. Another maroon who think he is smart - NT 60000 is the highest fine and he doesn't look that drunk.... he might get a less fine if he took the test.
The girl family came and the father was quite pissed off. After some Q&A about her medical condition. I chatted with the granny. The girl had been with the young man for sometime and the girl's family had went to the young man's house and proposed a lawsuit. ( the girl was under 14 and it is a crime to have sex , consent or no consent). The grandmother(I knew her as she brought the young man over for UGI bleeding last month) had kneed down and begged for pardon. The girl's granny told me that the young man was very spoiled.
I thinked of Yun after the girl went home ... I need to spend more time with her - I am those kind of dad who would break those young maroon's leg  who dare to hurt Yun....

New year's joke and jokers...

There was this female patient admitted to a local regional hospital for facial cellulitis. She is a k/c of diabetes mellitus and hypertension. On D2 of admission, a computer tomography was done and the doctor (? infectionist) had told the family that a great amount of pus /a.k.a abscess was noted in the face and debridement was needed. Unfortunately no plastic surgeon was around and a referral was needed. 2 place was offered - another regional hospital and a medical center(medical center > regional hospital > area hospital) . The family opted for regional hospital as there was bed available. The patient was seen in ED and later admitted to ward. In the ward, the atteneding physician/?surgeon saw the CT and told the family that massive pus is also noted and debridement is urgent and warranted but again they were unable to perform it. So the patient was again referred to the medical center. As no bed was available - the patient was placed in the observation ward in ED. However in the observation ward, the oncall CR told them that only a samll amount of pus was noted and no surgery was needed...

Facts of the day -
1.Physician/ Surgeon cannot read CT without the radiologist - the medical center had 24 hrs coverage of radiologist and the smaller hospital did not...

2.General surgeon trainning is not sufficient - I+D of face could not be done by a board certified surgeon(general)

3.The doctor cannot differential diagnose an abscess from a cellulitis -( or maybe too cold this few days - the doctor thought that the abscess will be iced and stoney hard on palpation...?)

well - there is still someone who earn something in this case - the ambulance driver... 2 referral cost the family at least NT 5k....

this happened to a friend's mother......last night.....

anyway  - happy new year....

Taiwan Medical Grad in Malaysia....

 

I met with one of my old classmate 2 days ago. GSW had been my classmate since med school. He is a Sarawakian. Unlike most of us who get into med school after high school. He was from govt school stream- completed form6 and work as a temporary teacher with the Ministry of Education. He had then come to Taiwan and study in the pre-U course . He gained his seat 1 ys later and I met him the first time in KMUH North Hostel. KMUH(Kaohsiung Medical College then....) North hostel still stand today,eventhough KMC had become KMU and many old building had been demolised and new one established....... He is much elder than me... A nice person , Christian who really care. He is just like a big brother to us. He was elected as North Hostel in charge during the old days... a nice person who helped the Malaysian to secure a place to stay...

After we completed med school. He worked in Pingtung Christian Hospital for a year and went back to serve the MOH. He was posted in Kuching GH then Sri Aman District Hospital. He served his time and open up a clinic there. His wife is a Taiwan Dentistry Grad and both of them shared the same building and practice. I met him once in Malaysia during my service. He had come to KL and I gave him a small tour around KL in my Kembara .... It was 6 yrs back....

He is a all rounded GP who served the Sri Aman Area. He had a successful practice ... I envy him really - if I had gone into private practice instead of coming back for my specialistship  - I might lead a life like him...... well, nothing much to regret....of 9 Malaysian in my class - 3 went back to served the mother land and I swayed away from what once I believed just to pursue my personal achievement....

 But Syabas GSW ..... keep up the good job....

 

the end of the year....

This is the end of the year....

I had spent less time on blogging for the last few months.... Domestic disturbance mainly but now I am better and hopefully would improved more...

I had done a lot this year... passed some exam and failed some - but more confident now... I am turning 39 next year and the learning process is still going on.... I am planning to swtich field next year - maybe joinning a resident program  but still the economic situation is so bad and my current hospital is doing well and stable. We had achieved most of our target(health insurance agency)  and gained some extra budget next year. Well, not a bad performance in this economic storm.... hopefully the bonus is big this year(we get our bonus on the chinese new year eve....)

My job is secured - we had a new locum ED doctor (Emergency medicine certified) . He was quite ambitious initially. Trying to ask as many shift as he could - the deputy superintendent even asked me if I could spare my Wed night shift to him. I gladly concurred and looking forward to enjoy life in 1-2009. However, my dream was blasted out lately. This locum doctor had done a few hanky-panky act and nurses from ED and ICU had complained vigorously... he had also stepped on my foot - moxifloxacin was prescribed for UTI ( my patient !!!!)... Well, one can be lacked of knowledge but most of the complaint was about his attitude. He is still on our locum list but definitely would the first to be stripped off....
Well... I would stick to my current schedule and grab as many cash as I could....

Farewell 2008....

1 arrow 2 hawks plan....

 

It was a hard mission for me…

I had 2 objectives to accomplished and hope to complete them in 1 shot…

The first objective was to attend the exam of Health Information Manager certification exam. The exam was organized by the Medical Informatics Society. The exam was fixed on the mid of the November. I had an advantage for the exam – 20 % of the examination was about medical term and another 20% about medical ethic and health insurance. I thought I need something to justify my position as a programmer in the hospital – I am not a computer science/engineering grad  , really inappropriate for me to such job...

On the same day the internal medicine society(SIM) was having it’s annual conference. I am still 2 credits short from my practicing license renewal. This 2 credits was specific credits that means only I needed to attend specific courses to get them – the sex and infection control credits. The sex credits was required as too many of sexual harassment occurred in the medical field recent few years. The infection control credits was required due to the avian influenza and SARS outbreak. The SIM annual conference had organized such course during the 2 days conference.

The challenge – the courses was held during the morning session. The sex issue in the morning(8:30am) and the infection control in the afternoon(3:30pm) in the National Taiwan University Hospital.(NTUH) The HIM exam was set at 2pm at the other end of Taipei City(Taipei Medical University). I made a call to the SIM and the SIM had claimed that they are not very strict about the entrée and exit time for the courses(we need to sign in and out during the course to make sure we actually sit in the classroom…). So I decided to rush and see if I could get the attend the examination and still collect the 2 credits. I came out with the 1 arrow 2 hawks plan…

I took the 1^st high speed train up north – it was the biggest Build-Operation-Transfer plan of Taiwan and the dream of 1 days traveling for North and South came true. The 6:36am train would arrived in Taipei by 8:15pm. The 1^st course started by 8:30am. The Taipei main station is a joined station of train , HSR rain, LRT. The NTU is LRT station away from the Taipei main station. I arrived at the station on time and hopped onto the train. I did some reading and the was shocked as I heard the train announcement. I was on the wrong train – the announcement said it would be stopping at all station and would arrived in Taipei by 8:30am… Definitely no my train. I jumped off the train and found that my train was actually at the other dock. I ran up the stairs and cross to the other dock and managed to get on the proper train 2 mins before it departed. Not a good start definitely and “I had a bad feeling about it”…

I slept during the journey and the train arrived on time. I found the LRT dock and get on the LRT and arrived at NTUH by 8:25am. I went to the registration and went to the class room at level 5. The next 2 hours was not that boring as I imagined. When I went off by 10:30am. I found that we did not need to sign out…good news. I could go back earlier. I collected some free gift – a VISA electron card from a local bank, a blood sugar machine(free of coz….)…I took the LRT again to the closest station near National Taipei University. I took a bus instead of a cab. Lots of time for me to spare.

I had lunch at one of the shop outside the university – there are always lots of restaurant/food stalls outside a university…. I had an hour to go through everything again…

A 50 questions MCQ paper. I did a count before I passed up my papers – 70+ .. The passmark was 70 and I think I could do it.. at 30mins, I handed out the paper and rushed back to NTUH… I managed to get to NTUH by 3:40pm and signed in.. I left the NTUH by 4:10pm and got to the HSR station by 4:20 pm. There was a long queue in front of the automated ticket selling machine and even a longer queue in front of the ticketing counter. I quickly glanced through the train timetable and I thought I should take the 4:45 train. There were 3 machines in front of the queue. A female worker was standing around it and trying to help out those with difficulty of operating the machines. There was this man in proper suit(coat with ties) who tried to buy a ticket with credit card and kept having error and retrying. He had however turned down the offer when the lady tried to help him…He had stand there for almost 10 mins and finally gave up…I observed the buying process and found that the credit card route took the longest time. I decided to use the ATM card instead but then I would lost the credit card insurance coverage – but what the hack ,time is gold ( I need to go back and look after my 2 kiddo)… I managed to get my ticket by 7 mins before the train departed.

The course was smooth – I got home in time…

 

I accomplished all my objectives….I got the 2 credits and I passed my examination(got my cert last week…)

Well what a day…next year I need to go for the analysist examination....

hopefully someone "repair" him elsewhere...

It was a bad night - I managed to get a few hrs of sleep and was darn tired. When I got the call it was 6:00am. I went to the bathroom, brused my teeth and walked toward the ED. The patient was a male who looked familiar. When I sat down, I did the usual routine of asking his name. It was a strenous agony being a patient in Taiwan. A patient would need to said out his/her name few times during his visit to the hospital. The nurse, the doctor, the lab technician, the pharmacist would ask the patient's name before performing their duty. The hospital evaluation committee had stressed on this topic and it is a major field concerning patient safety.
The patient replied me, " I forgot" when I asked him the routine question. I had a bad feeling when I got the answer - the patient was either suffering from amnesia, a mxrxn or a trouble seeking A-hole. I asked him again politely and explained that I did so because the regulation required me to do so. He still answered " I don't know" and asked me why it took me so long to get to the ED. Another FxCxxxG A who thought he is the big daddy after paying up 250NT at the front desk.

 I was not in the mood of starting a fight. I apologized to him and told him that I need to brushed my teeth as I didn't want my bad breath to affect my patient.  I apologized again and told him that I respect his decision of unwilling to saying his name if he didn't want to do so....He than showed me his left thumb which suffered from a penetrating injury. After the examination I told him that he needed a tetanus injection. He asked me if he really needed it. I told him yes but he could refuse if he didn't want to do so. He accepted the jab and dressing. I was too tired but still wrote a "FxxK" word at the allergy hx column on the front page of the patient chart. ( This ritual was started by one of my ex-colleauge in our hospital, a very prestige orthopedic surgeon (Korean, who is also a FACS and FICS - he got the honor while working in our small and humble hospital, contributed a good amount of papers and he is currently semi retired. One of the good all rounded surgeon who could repair nerve, vessel and do some plastic job .....), but he wrote FK usually and I like to complete the 4 letters word instead.)

That guy was not drunk eventhough I could smell some alcohol scent from his breath.  Later the nurses told me he was nice during the waiting period and suddenly turn violence when I started the consultation. The nurses told me that he was a private ambulance driver and came to do some transfer in our hospital.  He had quit recently. Most of the private ambulances were operated by funeral home and most of them have relation with the mob. But it was not the reason I did want to give him a good lesson. I would be at his level if I do so and I did not want to make dirty my hand....

I just hate this kind of trouble seeking jester and would really like to give them a good whacking ( in my imagination of coz...)  Anyway - hope he is "repaired" by someone elsewhere at some point of his life....

ass in the hole.....

Another surprise....

well... It had been a year since my return to this hospital.... well, I think I consider my self lucky (despite the worsen astham...). I got an additional cash reward (my annual leave converted ..). I had another surprise 2 days ago.... I am the employee of the year .... well, still don't know about the benifit I could gain from it(definitely uncomparable as the cermelang award of the MOH...) but I am happy. Nothing to do with performance - the employee of the year were elected....won't happen next year - the electee would not be entitled the following year...

This is my 12th year since I joined the employee line up - never been nominated or choosen before. I remembered back in those days when I was still serving the MOH - my district medical officer had told us during a talk that don't even think about cermelang if you have not work under him for 5 years. And if any staff have wanted the award badly - please talk to him. In my memory - the cermelang award come with a 1 months basic pay and 1 wks leave( correct me if I am wrong....). I heard other workers in the office told me that the cermelang award are given out on rotation basis - everyone would have the chance to get the award if you worked long enough....

well, it reminds me to keep up the good job... Nope ..good attitude towards my colleague....