One....

1.... 

I had read about this 1Malaysia concept proposed by our YAB PM. I think it is not even a concept yet but just a slogan…I remembered back in my college days. There were few of us who were Dr M follower. Yeah, we didn’t like the ‘scale’ but we think that Dr M was a man with vision - but due to reality he was unable to execute out what he believed in….We considered ourselves as patriot, but I was the only one who really served my motherland(I dare not call myself a patriot now. During my first posting in Malaysia, a senior consultant of OBGYN had told me – “with that kinda of pay and training environment, I don’t know why you want to come back”, I dare not reply her as my houseman duration was at her mercy then, but in my heart my answer was “Bcoz, I love my motherland…)...I was in the civil service and could understand the helpless situation..

In a developed country, minorities are well taken care of, they are provided with scholarship, advantages in joining higher education, aides financially etc….it was vice versa in my motherland… from time to time, some important person would come forward and ‘remind’ us – the right of majorities should not be challenged. I just wanted to say – no one wants the so called ‘right’… but please look after the minorities…..until the country is mature enough – there is NO ONE------- for everyone….

I really wanted to serve the land again, but I don't know how ? so many negative remarks from my relative .

Going back to have a good look in less than 30 days...

Losing....

 It was still a very hot afternoon… 18 hrs had passed and I was still hanging around 175 trying to catch some sleep.  A call from our asst head nurse , “OHCA, 15 mins”. In the past, we had used DOA(death on arrival) but now the term had replaced with “Out of hospital cardiac arrest”. Confusion had arisen in the past when we used DOA. We had had a case in the past – a family had question about the medical bills when they saw the diagnosis of DOA. The itinerary included CT, sonography and lots of medication. The family had asked us ,"since the patient was death and why so many procedures and medications were provided. ?"

It had been lots of dispute here and there and the department of health had decided to have a shift.

Even though I had tried  the path of ACLS instructor, I am not a faithful follower of the guideline. I always intubate first – an average of 10 sec. ( no kidding, I actually timed my performance…, but so what, those are chosen are still chosen….). I hate those standard procedure – bagged, medication , trial…Especially when a code 999 was called. Other doctors(anaes, boss…) would come and “demonstrate” their standard procedure. Normally I don’t called the code and if could I would ‘tube’ in before they come down,

The patient was a case of liver cirrhosis. I had admitted once for cellulites. She had been drowsy and sleepy since morning. In the afternoon, her husband was unable to wake her up and the rescue ambulance was summoned. No sign of life was noted at scene. On arrival, the body temperature was 40C...a case of sepsis(severe one definitely). The EKG wave was flat after 30 mins of effort, I decided to give as call. I talked to her hubby and he looked at me with a confuse look. I knew the question he wanted to ask me, “ is that it ?”. I led her to his wife and told him that nothing more could be done. I dare not look into his eyes again when he started stared at her(not cold one, she was still 39.7C when I gave it a call.). I tapped on his shoulder and told him that my nurses would help him with the rest. This was my standard practice, a way to escape from such a scene…Life was very very cruel and I had to face the families who had lost their love one and I am not good at it, the worst part – I don’t know where to learnt…..

From the movie “Fireproof” I learnt something – you can’t give what you don’t have. I have never lost someone close, the closet were pets ( Mimi(wifey cat), Lasy(a mixed breed K9, we used to have during my schooling day…)). The sensation was weird....

When I shared it with Ving, that was her answer :” a pets where something you used it as spiritual bailment but someone close maybe a person that you relay or entrust.., and it is totally different thing…” She had always given me some alternate thoughts, and I agreed with her most of the time… she is an emotional and perceptual person…facing life and death in my daily works (lucky I don’t work everyday…), I tried to hide it but I still seek a balance between job and my daily life – trying not to be so cold hearted….

 

 

shimofuri meat in the hospital...

shimofuri human flesh....

I couldn't recognized the patient when he was brought to our ED...Chief complaint - intermittent bleeding of wound. He was a patient with epilepsy and presented to ED for conscious disturbance. He was found drowsy in his house and his family had sent him over. No proper history was obtained as he was intubated and never regain his conscious. The attending neurosurgeon had speculated many causes but nothing was confirmed.

He was bed-ridden and the local Penghulu(chief of village) had got some fund and sent him over to a local nursing home for care. The money was less and the care was poor of coz....

He had developed some pressure sore when staying in our hospital during his multiple admission for pneumonia and others problem. But now the wound was intolerable....

quality of Life = ?????

Well... just admit him and see what he can do --- we owed it to him...(some ward had worsen his pressure sore during his admission...)

 

- Ward job

I met the hospital superintendent few weeks ago. He told me that he had sometime to go through with me the day after. However I never got the chance to speak to him. I was in a mist and anxious about the meeting - either a cut of wages or adjustment of working hour....
I finally met him during a pass over - he told me that I would be concentrating my job in the ICU and ED. No more patient would be placed under my service as the hospital evaluation was on its way. I was happy though..... finally I could start my teaching session again in the ICU. It had been > 9 months since my adjustment of duty and I was unable to give any teaching to the ICU staff. ICU was packed with 1/3 of new nurses and their knowledge were way below average.
The relevent head nurse had been telling others that I did not see my patient in the ward on a routine basis after the prepruce incident... truely, covering the ED was tiring and I had an agreement with the hospital that I would see my patient from Mon to Thr - the rest would be covered by someone else. I did not get extra pay for such additional work and it was supposed to be a combined care and when incident happens, I had to be part of the blame....
Well... nothing much to explain anyone.... the consultating firm had considered me as ED physician instead of ward attending physician and I had not been playing a good part squeezing between the two roles. Lots of paper works to be completed in the coming few months...hope I could able to survive it...

Square one and the half ...

Our new orthopedic surgeon reporting in on Monday. He is currnetly staying nearby the hospital. The hospital had arranged an apartment ( owned by our hospital superintendent) along the sea side for him. He was considered lucky as the apartment was well renovated ( price of renovation = price of the apartment, long long story ...).
Some had said he is a nice guy(info from his previous colleague of coz.). My major concern is - nerve/vessal repair capable. The old fashioned one were mostly trained with such skill thus they would take any case up( hand, possible nerve and vessel...) to OT. But those trained nowadays are reluctant do so - either not trained or afraid of medical legal or any other reasons.  Working in ED, sometimes we were stuck with those equivocal case and some of the ortho would ask if any nerve/vessel injury present - if yes, they don't even come to see the consult and ask you transfer the case stat.

My question was answer during my last call - we need to transfer such case...
well, at least I could call someone to reduced hip dislocation in the night...

Master of the trade

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.  Amazing a 4.4m wagon could hold such a load.
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). 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.

similiar 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 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 in a polite way. By the time I should have known that she was the expert, still I played smart and embarass myself.

The rest of the drill was routine: she checked the tyre with some soap water and got the 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 looks.....the old lady was Yoda type of person.....

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.....