Registrar , senior registrar .....or maybe consultant

I had this SMS lately from my colleague cum senior Han. It was about recognition of KMUH degree by the Singapore Medical Council. They are calling for a dinner conference next Thursday. The SMC is inviting those with qualification of 3^rd year resident and above to attend the conference. I did a search over google and got a good picture of the plot...

When I went back to Malaysia, the SMC had only conditionally recognized those from NTU but now they had recognized 2 universities – the NTU and CGU.

 

The SMC is inviting those with specialist qualification to fill the post as registrar(working under supervision as our specialist qualification is not recognized.) Registrar is sort of like a chief resident - consult, supervision of junior medical officer and also NIGHT CALLS !… well, a simple conclusion is:  they want to find KULI(hard labor).

 

A very attracting offer if I am still single. But if I take up such offer, I would have to stay in an apartment instead of a terrace , and my children have to study together and compete with those singlish speaking kids….. well, I could not accept both…although working back in a English speaking environment is so attractive……but still, I think I would attend the dinner….

never enough....staff

 

Located 100+km from the southern tip of Taiwan, it is not easy for us to hire staff. I spent around 2+ yrs to get a full time general surgeon. As for nursing staff, the situation is no where better. Most of the wards short of 1-2 staff averagely.

The key to the shortage of nursing staff is the pay. Our pay is considered as par around this part of the county.

 A par means we could only get whatever other people reject. Indeed most of the new staff was either 1^st timer to the job or basically under average. The time for them to have proper attitude and proper working skill was so long that it is intolerable, and so of them never evovled....

 

Imaging that there was one time we had 3 ICU nurses who was over 100kg. I am fat myself but for ICU nurse with that kind of size, it would be difficult for them to move about. Well, both 3 of them were transferred to ward after 3 months.

 

Recently the ED nurses were so short that Lem started to grumbled. He is rather a nice guy and to get to his nerve it would really take a good effort. 1/3 of our staffs were below average either in attitude or skill. I would directly point out their fault when I noticed it but Lem does not act like me. As the head of dept. he is consider a nice person.

Once, the deputy supt had had a discussion with me and we agree that the nursing staff would really need a raise and we should start to kick out whoever that is unfit. A raise would attract more applicant and we could choose. According to our observation, the plan is definitely gonna work as there were so many mistake/violation of SOP done in the past. Some of the mistake was so non-forgivable from my point of view. But what can we do, you pay what you get what.

 

However it would be a hard move as the nurse dept had been a welfare dept for quite a long time. The tolerance was so high that no one was fired/demoted due to mistake in the past.

Recently 2 head nurses was demoted – 1 due to some “black mail” attacking her being unfair , the other due to poor performance leading to failure during an evaluation. It is a good start, but still a long long way to go.

 

chane again....and ? how long

Since CM joined us, I was able to spend more time in the ICU. I was very frustrated with the nursing staff. Their performances were really out of my expectation. The nurses do not know amikacin is an aminoglycoside and have no idea that it would worsen the renal function. Only a hand full of them knew how fast you could drip the dilantin into a patient, and no one knew EKG monitoring was needed during the drip.

 I had told the head nurse that it was intolerable. The deputy head nurse had even questioned my order for not inserting a Foley catheter for a patient with urine retention(I did a drainage instead). The deputy head nurse had used the word “pig head” to describe me and I was very unpleased with it.

Head nurse JL was a nice person. She is good at preparing document and running admin but is not good at managing her staff. Due to salary reason we are facing shortage of senior nurses. The head nurse had agreed that we start a training program and retrained the staff.

Loading had become more but we really see some improvement.Unfortunately I was called by boss and deputy supt (admin), they had asked me politely if I could take back Monday night shift. I had expected the request and was not surprise when they asked me. I gladly complied but was not happy when they told me I need to do 6pm to 6pm(mon->tue). I was not happy with the decision as I had told them earlier that I don’t want to do any more evening to evening 24 hrs shift. I usually wake up by 6am and take a nap of 1-2 hrs during the afternoon. It would be more stress for me if the shift start by evening. After all I don’t get use to prep myself for night shift by sleeping the whole afternoon.

 When Lem told me that he would be taking the shift arrangement, I told him that I don’t want any 6-6 shift and asked him to see what he can do. He gladly complied with my request and I got  8am-8am shift instead. I got a small break during the mid-week as I am off from Tue 8am till Wed 6pm. I was happy again but wander how long would it last.

CM had lost 40-50k as the Monday night shifts were stripped off. I wandered how long he would tolerate as his pay was 100k lower than he was expected.

lost .....

I spend the whole day outside…govt specialist clinic (darn good one with only 1patient/3hrs) then the lube - > tyre change and finally home. My mobile phone’s battery was drained dry and when I got a plug to recharged it , I got this SMS from my brother - --- “granny had passed away and dad and mom is going back Malaysia tomorrow..”

Not a shock for me , my granny(mother side) was so old. She was in a dementia state and regressed greatly for the past few years. Last year, I had chosen to put up a night in my uncle’s house and had a good look at her. I thought I could see her a few more times before the time arrive.....

She was a nice lady, manned a coffee shop with my granfather . The coffee shop was located in Chuah;small town near Bukit Pelanduk, Negeri Sembilan. Yeap, the origin of Nipah virus (however they had shifted out from the shop many years earlier before the outbreak).

After my grandfather had passed away, my aunts had started to bring her around the world. I remembered she had gone to Europe and various place until her knee osteoarthritis worsen. She could only walk for a short distance since then.

She doesn’t speak Chinese but we could communicate with Cantonese. Me and few of my cousind had often played card game(name 4 colour, UNO like game) with her during my younger days.

Our financial situation was bad and from time to time, she would tugged RM50 to me and brother during our visit to her house. Not much but still it was a great help.

When her bil knee OA worsen, I had suggested to my parents that she might need a total knee replacement so that she could work properly again. However, my parents had asked me not to interfere with the medical condition of my granny as my uncle had shown “concern” about if she might be wheel chair bound after the ops. I kept silence and did not fight that for her.

However one of my uncle(with the help of his wife of coz), did a great job of looking after her. She was taken care properly when I saw her last year.

She was a tradition lady and a cheering person as far as I recall.

I called up my dad last night and asked him to informed me about the date of funeral services when he got back to Malaysia . Although, I am the “outer rim” grandson(inner rim means father side), I would like to attend her funeral service if time allow….a little sad I am…but still LIFE GOES ON….

from ER300 to CPC2

 

I went for 75000km maintenance yesterday… the foreman told me that 3 of the tyres’ thread lug had reach the wear bar(very technical way of saying so -- > your tyre had worn off…).. They asked me if I wanted to replace them. I asked them what kind of tyre did they offered and got the answer : Bridgestone.  I politely rejected their offer and told them that I wanted to replace them outside.

My Z came with Bridgestone Turanza ER 300. 2 of them lasted for about 3500km, and after another 5000, another 2 worn out. The life spam was short compare to others who had reported the tyre lasted >40000km. Another issue that bothered me was the noise. The ER 300 was quite noisy, almost the same quality as the AT tyres my Kembara had.

I had read quite a lot about tyre replacement for the past few months. I decided to switch to Continental CPC2. Some of the club members had highly recommended it. I called up the KHH dealer and asked for a quotation. The H grade was 4200 and V grade was 500 extra. Compare to 4000 of ER300 , I thought it is still acceptable.

From the net, I knew that the different between V grade and H grade was the speed limit – H 210km/h, V = 260km/h. Well, both was way far beyond from my upper limits. So I was thinking of getting H is enough.

 

 I reached the shop at 4:40pm after the lube. The manager had shown me 3 types of the type( H,V,W). Well, indeed, the W is much more thicker and the H is the thinnest. But I am not a speedy dude and I decided to take the V grade. Hopefully more protection...

The price was 4700 each. I waited for 2 hrs before I got my car back. The process include a wheel balancing and alignment. Well, a single alignment would cost about 2000 - > so it is worth the price.

 Although I am expecting the different, but still I was surprise about the “silence” performance. It was great - > worth every penny of it…..no pain(in the ass pocket) no gain….

the relation between fall and stupid...

 

I had seen this 4 years girl 2 weeks ago. She had presented with vomiting x1 and quite sleepy after a fall incident. She had fallen from a table while playing. No sign of concussion noted but I had always be cautious with kids. I offered a brain CT and the parent gave me a green light. Nothing was notable on the scan but pending to her sleepiness, I had admitted her. She was discharged a few days later.

During my last call, the mother had brought the girl to me again. She said, “ she did not get better, you see, her head had swollen again.” She had shown me that big bum over the girls’ left parietal scalp. It was a true bum. I always took such accusation seriously any misspoken word or question might end up a legal suit. I did a very cautious history taking.

1.  When was the bum noted – yesterday night

2.  Was it so “big” when it was noticed ?

Nope – it was small initially ..

3.  Did she have a fall ?

Nope – she did not sustained any fall

4.  Was she within you eyesight all the time ?\

Nope, I went to work and the granny look after her…

5.  So how can you sure, she did not fall when you are not around ?

She did not tell me so I presume she did not have a fall…

 

Well…5 questions lead me to answer : negligence. I told the parents (tolerating their alcohol scent breath..) that definitely a new lesion – the brain CT was ok during her last admission…

I unwilling ordered another scan ( the bum was big…so big that I could not feel the skull bone)

The scan result had made me to call up X (our neuro-surgeon). She had had  left parietal subdural hematoma ( small one <2cc). X came down personally and gave the parent a very serious bombardment about child caring…The child was admitted to ICU later…. I had to rearrange the bed so that I could clear a separate cubicle for the child…..

Well, kids were so fragile – I quote what X said that day – “fall and fall, made you child stupid…” parents please please take a good care of them....

Old games .... new feel...

I am not good at arcade game- I had thought I had poor reflex during my high school days….Those financial constraining days did not allow both of us to venture around in the arcade store. Most of the time, I am a watcher…I had own a PS, Xbox and later the Wii.

   The Wii had let me had a taste of real arcade gamer. The controller was so realistic… I am very into shooting game in fact. I got my self a zapper( 2 in fact… ) and the infamous Ghost squad.. Mission 1 was ok… Taking out the chopper was easy , Mission 2 is a little bit hard, but still with a pillow under my left elbow, I could still get a clear shot.. but Mission 3 was a nightmare…initially I could even get pass the armored boat. I put the game aside after I got Mission 1 13 , Mission 2 12 and mission 3 2 (rank of major, darn my brother gained the rank of major general a long long time ago)….

A little bit upset but still I would pick up the zapper and gave it a try from time to time…. Lately I picked up the zapper again and try my luck again. Surprisingly, I got Mission 3 with my 1st trial. Well, I started to play it on a daily basis…and I found that I am really not a bad player with poor reflex.

 Later I saw a game introducing program airing during a bad night call and I saw a familiar game : Street fighter IV – another drooled….I remembered those college days when I stand beside Lem and watched him tackled all the opponent. Another there were so many version of Street fighter published for other platform – I had never set my hand on it…I admit I am not good at swinging the stuff.. But this Street fighter IV was introduced on the iphone…that mean I could play it on ipod touch as well. … The next day after I got off from my shift. I downloaded the game from istore…. Well, I got the nostalgic feel again – holiuken move… I shared the games with Xian –guest what, his favorite character is Blanca.

just cant imaging why a handsome chap like Xian would fav. the "green giant"....

and for Yun --- Chun li was her choice

had a great time with them – demonstrating those special move and looking at the astonishing face…. they never realized I was a “meat leg” during my younger days…