1a2b....

A = arrow, B = bird


I went to this annual lunch meet organized by the local govt. clinic. I was reluctant to attend the lunch as it was held on Thursday noon.  I did the Wed night shift and went off by 9am after the morning meeting; reached home by 9:30am. If I would attend the lunch meet, I would have to leave home by 11:00am. The lunch was held in a secluded mountain side – restaurant run by a local aborigine chief, 40mins drive from my house and I don’t like to be late.
The former Dep. Supt. Had told me that I “must” present just to make the scene look nice – as I was the only specialist supporting the program available; Lem was attending the ED, Voon’s chest OPD would usually ran late to 1pm.
Boss had reminded me again after the morning meeting and I could not escape the invitation.
I arrived early and meet others during the lunch. The food was nice and Boss arrived late. After a few rounds of glass tossing, Boss had told me that he had something to discuss with me. I thought it was about the salary review…however I was surprised when boss offered me a day time job(no night shift…). He told me that he would reassign me to the ICU and work only day shift. I did not cheer up instantly as I knew the offer would come with a “BUT”. Yep, I was right, about the “BUT” : I would need to covered for Ong night shift when Ong is not around( Ong took a leave of 2-3 weeks every 6 weeks of work. )
Boss had told me that he had found someone “well trained” and this guy worked only 180 hrs in ED per months. He would “take over” my shift and I would only need to covered part of Ong night shift when he is not around.
His word irritated me – the usage of “well trained” means that I am not well trained so I need to make way for him….I told him, I would considered his offered and I asked him what if Ong retired (Ong had talked about it for a long time) – Does it means, I had to come down to take over his shift(Tue,Thrs, Sun night shift) which were worst that I had (Mon, Wed night shift and alternate Sat night shift) I told him that I had no intention to grab a rock and crushed my own foot, Boss had reassured me that this would not happen, but he did not raised any plan to resolve my question.
He told me the ICU would be covered by T(CV man) and me if I agree with the arrangement.
I rejected his offer few days later stating that I would remain in ED .
I had a chat few weeks later with T and he told me that the management had wanted him to do full time in ICU. He had been holding the title as ICU director for years. He had however recommended me to boss. It was an arrow for 2 birds strategic should I have taken the offer. My paid would definitely be cut as I don’t do night shift most of the time. I could be a valuable asset to ED as I could covered for any night shift with no problem (and the pay is less…) – I would have no excuse to reject any request for ED night shift as I would be the only one without any fixed night shift….
I later found out the well trained guy mentioned is a urologist working in ED somewhere nearby… he was just probing around asking here and there and boss took it for real….however I thanked him for letting me to see the scenario in depth…..

tidal wave....the beginning...

 

Ong had finally decided to leave….his daughter had filed an application of PR for him in the States. He had told me few months ago and finally he had opted for retirement. Well, Boss had asked Lem about roster problem and told Lem that he would sought the problem out.

The incoming of the board certified emergency physician had caused some ripple effect in the department. Prior to the new year holiday, I had had an encounter c the newly appointed dept. Supt. Of admin regarding the roster of govt. clinic. I had raised the question about the readjustment of my salary scale. The Dept. Supt. Showed me a “??” look and told me, “ I thought your all had settled with it, the roster seem fine to me…”. I asked her to exam the document regarding our last discussion; it clearly stated that my salary would be reviewed once an ED physician joined us. She clearly rejected my request while holding the “black and white”, she told me I should sympathized the situation of the management…. Really pissed me off, I told her that I am the only doctor who present on everyday of the Chinese new year holiday. We decided to settle the roster doesn’t mean that I forfeited the right for salary revision. After all, there is > 10k RM different between me and the ED physician. There is no hospital I knew that had such different.... It was 10 months ago, when the first crisis noted in ED – both of the locum guys left and Boss had padded our shoulder and told us that the different of the ED license would not exceed 3k RM, max is 4k RM and now, we should sympathize and tolerate ?

Well, the doctor number had reduced to a critical level with the leaving of Ong, another further reduction of doctor would made the hospital reduction of 10 beds/doctor. There is a rumor that our orthopedic surgeon is leaving in May……Things would be very ugly by then….

Lem told me that he would arrange a meeting with boss....I am not the optimistic regarding the discussion but would see how thing go and decide my future....

Injustice....

I had not been blogging for sometimes….domestic disturbance mainly and later interlacing with some formal business….

So many events had occurred during this period…The dep. Supt. of admin had finally resigned. He had been objecting many “event” regarding the new building. There were some under counter stuff going on (violation of the construction act), which he did not approve, however such hanky panky stuff were pushed through by the maintenance manager (he was a real veteran to the hospital). The dept supt did not want to loss his pension and opted for a “Demotion”. Initially he was told he would be in charging part of the supervision new building but later his was designated as head of medical service. He had faced many of difficulty starting with finding a desk. He finally settled down in the registration officer.

The new dep. Supt. of admin(promoted from the position of nursing director) had asked him about what was his expectation about his salary. His formula was simple – ex salary minus the dept supt subsidy. However the amount was 1/2 less when he saw the figure….

He had decided to quit later on walking off with part of his pension….

 

Sad to see a man of justice leave….  And this only part of the injustice occurred within this 6 months….

Grudge

There was this incident 2 days ago…. I overheard the conversation while I was called to the ward. I decided to dig the story and finally get a good picture.

There was this patient admitted by LEM 1+ weeks ago. A bed-ridden patient admitted for fever. No obvious infection focus was noted and the patient was admitted to the chest physician. Antibiotic was shifted from parenteral to oral as no obvious focus was noted. However the fever persisted and later parenteral antibiotic was restarted. About 1 week after the admission a swelling over the pustule was noted over a swelling at the right inguinal region and the testes appeared to be swollen. The surgeon was consulted and testes incarceration was impressed. However the family had declined surgery.

After the consultation the surgeon had however commented (the nurses had used the word “bombard” instead) in a very loud tone with his nursing specialist at another nursing counter regarding the consultation[?delay of noticing the infection focus]. The conversation was of course overheard by the chest physician. Later that day, the nurses had described that the chest physician had shown a very long face….

The comment was done purposely in a very high tone – the surgeon had apparently wanted the chest physician to hear it.

I had shared the story with Lem and he told me that their grudge had started many months ago. The chest physician had not only once commented about the management of the surgeon over medical condition, however the main insult started over a referral patient. The chest physician had a patient referred for surgery but did not transfer the patient to the service of the surgeon after the surgery. The surgeon had told his nursing specialist to ask about the transfer of the patient. However upon request, the chest physician had told her in a sarcastic way (by using Taiwanese) – “ you can clasp the patient over [with chop stick] as your side dishes”. This was an impolite way to say it…

No wander the surgeon wanted to humiliate him publicly at the nursing station.

Indeed, the chest physician is overloaded with patient – he had too many patients under his service. From time to time, he would have patients(especially nursing home resident) re-admitted after 1-2 days of discharge. One of my senior(Malaysian current head of internal medicine dept in another hospital) who had worked with him had warned me about him prior to his arrival – a calculative person who tends to avoid anything which is not profitable to him…. I had stopped to admit irrelevant patient to him months ago after re-admitting those patient and wiping his ass in the midnight ( inserting CVP to patient who was in shock since afternoon as the only thing he does was hydrating without CVP).

During yesterday morning meeting, the chest physician was still in a low mode –

I would be very upset seeing a patient died slowly with his scrotum gangrene slowly...

I hope their paying back game ends here....

struggle of the ro(o)ster

After a week of struggle, the rosters(Jan and Feb) was finally out. Lem had did a lot of discussion with me…. The situation was kinda complicated. The were so many restriction. 4 persons with 4 different scheme…

 

I had agreed with Lem that we settled the roster than negotiate with boss about the pay. Actually I am the only one who is going to get adjusted as Lem and Ong had their special request.

I am reluctant to do so as I had planned to leave mid at next year. But I would have to experience a cut of my working hour later as we need to squeeze enough work time for our new colleague.

The extra cash would help us in the future as I would be experiencing a great cut during my training…..

I would be planning a short break after the Chinese New years- a week vacation in Malaysia….

Well, I had put my faith in GOD…Let the LORD laid the pave and I shall trace it....

Mercy...

 

It was supposed to be a good call – the cold front hit us few days ago. Most of the locals would stay at home, no one is gonna get drunk and ride their bike recklessly ending up in ED. But I was wrong – the 1^st OHCA( out of hospital cardiac arrest) came by 3am. Resident in a local nursing home, one of our Chronic Obstructive Pulmonary disease patient who had just discharged from our ward few days ago. He was found unresponsive by the nursing aide and sent over to us for help. I saw the blanket – so thin , core body temperature was 33C…negligence leading to freezing to dXXth… Well, the family came 20+ mins later and asked me to stop…

The next OHCA came by 5+am, another no sign of life for don’t know how long…. I did the routine and certified the patient…

Life was so fragile and sometimes we live at the mercy of the LORD. Few days ago, Yun and Xian had slipped a ruler into the piano…. We called up the piano tuner(who is also the dealer who sold the piano to us) and shockingly found that he had passed away. I later checked the tuning record and found that he had missed his regular tuning few months ago and we were not aware of it.

His son came for the tuning and I asked him what had happened to his dad – he grinned and told me that he met an accident, I saw the peacefulness in his eyes……

Our life is at the mercy of the LORD…. No one could defy the faith – I had learnt something – to value life and value whatever I had at the moment. I knew I had to be humble and love giving. I had to try my best to be an example and leave a good memory to my children…

Reshuffling ?

It was a great leap for us…We finally got someone to join us… he was my ex-colleague. He is a trained plastic surgeon turned ED physician. He was a man of night shift and locum.

Virtually he could do as many shifts as we can provide. However as our present scheme of 10-14(day shift 10 hrs, night shfit 14 hrs), he was unable to do consecutive daily night shift – he lives up north and the buses had been his main transport in the past. He had wanted a shift to 12 -12 but both Lem and Ong had against the idea and I support the 12-12 only if everything is fair and square.

So at the moment he had to settle with it. Boss had asked us to adjust the shift and we are gladly to do so. Ong and Lem will be taking their vacation next 2 months and there are lots of empty shift to fill in.

Boss had offered him with 35% more of what I got. I did not feel upset as my term is to re-discuss my pay scheme if anyone comes in and shift change….

I am still waiting and currently I would comply and tried to sort out what ever empty shifts there are present.

With 6 months left, I am not sure if I would want to fight for a big increment…

Shift was tough in the January as I would be doing 270 hrs ….

The discussion of shift did not go well initially as most of us did not want a change – however our colleague would be settled with our view at the moment.

I had prayed hard as I am really at the junction and the temptation of money is so great.... to stay and grab big cash or to train...

I praying very hard....