Master

We had gone to this half day trip last Sunday. A small recreation park 30+km from our house. I loaded all our bicycled ( Strida, F20W, 2 kid's BMX) into the back trunk. 
I took the highway and 2km after we got down from the highway. I noticed the red "flat tyre" lamp was on. Darn, I grumbled. We were at the country side. Although the manual said the Z could do 80km with the speed of under 80km/h, I was still worried about getting to the nearest tyre shop. I took a quick glance and saw a tyre shop 50m away. I drove toward it and the gate was closed. I drove further and saw a tyre shop with it's gate half open. I approach the shop and a 60+ yrs(or maybe 70) old lady came out. I asked her if she could get me someone to check my tyre. She gave me a strange look while looking at my car. Yes, no flat tyre... I told her that the car alarmed me that one of the tyre had a leak. She was still confuse about the technology - if I knew one of the tyre had leaked than I should know which one. Unfortunately the Z did not have such high tech - its detect only the balancing of the suspension system. A leak means imbalance cause by one of the tyre (or maybe 3...). She finally took the pump cum gauge and checked my tyre. The left front(driver side) was 28psi compared to the others(33psi). A possible leak and I asked her if she wanted to call the SIFU(master or the expert) - my 1st stupid move..... She told me if patch is needed, she would call for the SIFU. I had a big "?" in my brain for a moment until I saw her pushing the car jack towards my car.

same kinda of jack she used

She jacked my car up and I was in an embarass situation then - to help or not to help her ?. But within second the car was lifted. She then used the air-powered drill and got all the nut out. While she was getting the nut out, I told her that my tyre was tubeless( Bridgestone Turanza ER 300) - another stupid move by me... she told me she knew that in a polite way. By the time I should have known that she was the expert, but I still wanted to play smart by feeding her with such information....

The rest of the drill was routine: she checked the tyre with some soap water and located a small puncture hole. No nail was noted and she called her son. While leaving the scenario to her son, she told me that the tyre need to be patched from inside and the cost was higher. Her son took over the job and removed the nail. A long and tiny one. My wheel was back onto my Z after 15 mins. The charge was NT 200( darn cheap, tyre patch from inside and filled with N2).

2 stupid move in a day, never judge a person (especially old lady) from her look.....the old lady was Yoda type of person.....

Caged

 I was sunk in the 175 sofa when I saw the news showing a photocopy of the medical degree of one of my senior. The news was about a locum syndicate composed of non-licensed doctor roving around center and southern part of Taiwan. 5 were arrested and detained by Tainan Prosecutor Office. I called Lem and notified him about the news.

Most of the Malaysian graduated here passed our board examination and got our license within 1 year of our graduation. A few got it within 2-3 years and a handful of them are still trying their luck. My senior W is one of them. He was 2 years senior than me, he was deputy president Malaysia student association at the time I entered med school. Although he was not an outstanding student but he was a nice guy. I had not heard from him for a long time since my graduation. He was one of the unlucky one who did not passed his board examination. He managed to stay back in Taiwan by marrying a local girl.  

I had not heard from him for a long time. But lately, while I was surfing the net, I logged onto the medical registry website and entered the name of those unlucky Malaysian who are still trying their luck. Sadly – none of them made it.

The board examination was not an easy one for those who had graduated for years as it covered some of the ‘ basic’ subjects – biochem, physiology…. The examination was divided into 2 parts and later combined into 1 and recently separate into 2 parts again.

For those who did not pass, one of the main reasons was job. Most of them still secure a job elsewhere working ‘under-supervision’ or without- license. Working and studying at the same time is the major stress – especially doing night shift.(Specialty board examination is another story as what you are being tested are what you do daily)

It would be difficult for a guy to lead a life without job – especially when you are married and you don’t have a rich daddy.

In the past, there were quite a number of medical graduates without license working in hospital and clinic as they are some secluded places in Taiwan (my hospital is one of them) which have difficulty hiring doctor.

At the time I graduated (10+ yrs  ago), doctor without license could get a job in any department provided you are willing to work night shift (pay less of coz) and weekend. Later, some hospital had started to restrict the presence of such doctor in ED/OPD fearing of any medico-legal dispute. Although working in the ward, such doctors could still get a pay of more than RM 10+k(night shift ++ of coz.).

There are also a group peoples who are not medical graduate but work as doctors – most of them are ex-surgical assistants (no medical assistant here) who had worked for years in the OT and ED , they knew something in and out about medicine.

They were pay less nowadays – RM 300-500 per night shift. One could earn RM 5-7k per month doing night shift/weekend shift. They usually operate in group – few of them had license and they were the one who interviewed locum jobs. But later, the person who turned up during the shift was another one without license  -that was how some of them still got to work in some regional hospital or even govt. hospital. But this syndicate was fierce – they used fake licenses and certificates. That was the main reasons, they were detained by the prosecution.

 

But still, some hospital still hired them as resident doctors working in the ward and ICU. Well, after this incidence, I doubt any hospital would hire them…

But contrary to most of the public opinions, doctor never get jailed for malpractice (even someone life’s was involved) here in Taiwan. Most of them being convicted (for malpractice) were sentenced but usually put on probation with fine. However lately, one of my ex colleague (psychiatrist) was sentenced and jailed due to fraud (issuing false certificate for insanity).

Hope my senior won’t get something hard…

Addicts

I had seen lots of drug addict during my service with the MOH. But not in Taiwan, most of my colleagues do not have the awareness of such dangerous patient presented to us. Whenever I saw one, I would advised my staff to don double glove. Most of the drug addict cum HIV user would revealed themself without fear back in Malaysia. But in Taiwan, these group of peoples would try to hide the facts - deny deny and deny....

Most of the addicts around our area are also stilnox(zolpidem) abuser. They came to our clinic and asked for large supply of stilnox. They were given 2wks to 1 months supply but many of them returned before the time was due. They had many reasons - drug lost, I gave it to who and who.... Lately the narcotic drug control bureau had instructed us not to prescribed extra medication to those before their drug ran out.

I had this young man presented to ED for epigastric pain earlier this week. After the routine Q&A, I had concluded that he had acute gastritis and asked him how would the treatment to be ( you had to... some would not get healed if your treatment doesn't meet their expectation. eg - some like a jab, some want a IV....) He said he wanted an injection. Just when I was entering my order, the patient told met that the normal pain killer doesn't work on him as he had undergone "80+" times of surgery before(he is 23). I then asked him what kinda of pain killer he preferred - as I expected :narcotics. I told me I could help him and would give him a H2 blokcer parenterally as he had received 2 injection ( 1 is a prohibited drug - avapyra, the other as ketoprofen ) prior to his visit[he showed me a prescription during the Q&A. ]
Another drug addict trying to crave narcotic from us.

Later that night, a couple came by and the nurse had pulled me out from my bad dream. I saw the girl before , she was young, thin with tattoo. She showed me a few ampules of drugs( diphenhydramine and solaxin) and said that she could not inject her self. She had wanted us to put in a veno-cath for her as she couldn't get any vein by herself. Her vein was bad....another drug addict...I asked her for prescription and she told me she get the medication from a clinic(drug addict rehab clinic). I politely turned her down and told her that without any prescription we couldn't help her. They walked off and try their luck elsewhere. Most of the drug addicts use insulin needle and sometimes with the insulin needle it is hard to get the femoral vein. So "highway" user become less.

I still remembered back in my kiddi days the RTM would aired those documentary regarding dadah (malay term for narcotics drug) - those addicts would add lime juice to heroin powder and heat the mixture over candle/lantern. Recent I googled and found out that the lime juice would kept the heroin in the liquor form during the process. The liqour is then aspirated to a needle and injected to the vein.

sponge and syringe

Nowadays -those addicts had a new toy : zolpidem. There is no parenteral form of zolpidem, but some of our nurses had seen them crushing zolpidem pills and mixed it with normal saline then inject it into they veins. Those addicts had 'used' everyone they could to come to hospital and get zolpidem and buy it from them.

 

Mourn

 2 days ago… I got a call from my father – my cousin had passed away in Tibet Lassa. He had participated in a survey tour to Tibet organized by the Malaysia Tourism Association. He was feeling unwell few days before the departure – cough and some flu like symptom. However after some Chinese herb medication, he was better. He suffered from diarrhea when they reached Lassa. He was left alone in the hotel as he was feeling unwell. Later the tour returned to the hotel in the evening and they found him in a very ill state. He was admitted to local hospital and passed away that night.

I felt sorry about the incident. He most probably had acute mountain sickness and was not properly treated, he had had fever and might be treated as pneumonia (if he is suspected for pneumonia, I don’t think any doctor would gave him any viagra, decadron …..)

My uncle(his father) was closed to my parents. They are wealthy as my grandfather left a load of fortune for his sons( not daughter or else I might not ended here…). My cousin was sent to Canada for pre-U and he quit his study later as he suffered from stress. He came back to Malaysia and rested for a few years. He later worked in my uncle’s company( 1^st china tour organizer in Malaysia). He had led a quite life and never got marry. We played together during my young days but never get close. After my study here in Taiwan, our relation was merely head nodding….

I think my uncle and aunty suffered the most…...That’s life…..

 always in our memory.....

Wildfire ?

 

Shock I was when the news I have read (delirum I have)….A confirm case of H1N1 in Malaysia…

Oh… I was more shock reading this comment on the star http://thestar.com.my/news/story.asp?file=/2009/5/16/nation/3921825&sec=nation

“Entry and exit points in the country are being monitored. Designated hospitals are primed to treat patients suspected of having contracted the flu.

Quarantine procedures are in place. We have anti-virals to treat those confirmed to have A (H1N1).”

Entry and exit points in the country are not being monitored… or else the govt would have traced down all the passengers who sat within 3 rows of the patients instead of calling all those on the flight to report themselves…. The govt had not monitored them – those passengers should have filled up a form stating where they are residing in Malaysia…

No prophylaxis medication for those who are highly expose (sitting beside him) ?  I wander does the Govt have enough Tamiflu supply ?

Well.. 1 + months before I make my trip back to Malaysia..Darn, I just grabbed the NT 888 offered by Air Asia (TPE-KUL) 2 wks ago… Got to buy more tamiflu…might have to take it all the way during the stay back in Malaysia….

failed fan

When someone asked my opinion about buying a laptop, notebook… I would recommend a Thinkpad(no more IBM, now it is own by china base Lenovo…). Still, it is something very solid – Xian had not only once, stand on the laptop and still it still work fine.

My R40 was bought 5+ yrs ago and it is still working fine. 1+ months ago, I got this fan error message and hanged. I seek my answer out with GOOGLE and finally know that the CPU fan had failed.

I went to this Thinkpad service center in Kaohsiung and the engineer told me everything was fine, just the fan, the axial rod had broken BUT no replacement, its part had ceased production….. I had a bang over my head… I had asked around the other service center and found that the CPU is something unique.

I asked my brother for help and he said he can get some supply from some of the supplier. However during the waiting period, I found a ebay seller who sold such fan , a new one would cost me around RM280… Really sucks – quit a figure and I decided to buy it. While waiting for the seller for confirmation of stock. I came across another seller who sold a used one… just RM 50.. I bought it – anyway , if it failed, I could still buy a new one….

I got the fan

And started my work in our kitchen…

I had to read the guide from the net to open up my R40...the ASUS came in handy ...

as the engineer at the thinkpad center said - the inside was very clean...

I recomposed the R40 and Presto.. my R40 is running again...

Would I recommended anyone for a thinkpad again - definitely.... the feeling is still rock solid...well, maybe next time I would buy a harddisk and replace it...

some photo...

I finally got my USB bluetooth adapter and uploaded this photo... it was a nightmere but still I learnt something from it...

This was the swelling prepruce I mentioned weeks ago...

still shattered by the incident...

Dont Scroll down if you don't like any medical photo ( which part of it would cause your appetite...) 

 

 

 

well...3 days....many of us were lucky, no gangrene noted	only pressure ulcer noted ....after the reduction