Battle of the matron....

struggle to survive........the winner  gets the post....

The post of nursing director had been vacated since early this year. The nursing director was promoted as Dep. Supt. Of administration. Well, she is the relative of the boss family and the most senior admin personnel available.

The candidate for the post nursing director was vacant as there were 2 persons available for the post. The 2 matrons were the top listed persons…however the choice was difficult…

There was only 1 matron in the past until 6 months ago. Lai was the matron overseeing everything in the past. 6 months ago, when the community service portion was highly urged by the government, the admin had intake another matron – Liu. Liu had been head nurse in a medical center and later took up a job as matron in a hospital nearby. She was demoted  in a power shifts(rare rare scenario, the new hospital superintendent had brought in his own person….) and later she took up a job with my ex-boss as patient safety officer.

She was also actively involved in the local nursing association. On job seniority wise, Liu was more senior with more experience.

 

The vacancy of nursing director was not filled up immediately, but the management had consulted both of them and none of them took the offer…

Lai was closed to the ED as she was head nurse of ED prior to her promotion. She is a hard working person with good discipline. However things had changed over the years. Powers make a person rot....

 

There were bunch of senior nurses who become her followers – both in job and in personal life. I personally dislike those people as they were not only short-sighted but also forming a gang and trying to bully who ever does not belong to their group.

 

Lai was in charge of the critical unit and Liu in charge of the community service and ward. The resignation of all three respiratory therapists had left a very bad stained over Lai records as most of the staff thought she is behind the plot. Lai and gang had actually did some really ugly things on the job especially on human resource management.

Well, let us just see what would happen…..

i care about their pain...

 

I took glance over the narcotic prescription sheet while I signed my name…. my signatures were all over the sheet, for the past 3 days, I was the only one who prescript pethidine..

ketorolac for peptic ulcer pain ???? no pain killer given for trauma patient with fracture ????? -- not my style...

I grinned and told the nurses, I would be definitely blacklisted by the narcotic bureau on their next visit…

One had to be a patient than to know how they feel…I remembered Mark Green( ED physician – ER series) always ordered pethidine injection to trauma patient after his primary survey… Strangely, I learnt part of my practice from the ER series, being a patient in the past , I felt the pain and discomfort…

Feel what the patient feel, treat everyone of them as someone you love  - is an essential factor to be a good doctor…as a no one in this field , I am in no position to tell anyone to do so…but I hope someday when I am in pain, I am in good care...

Rival....

this is the rival base... a building just across the railway cross....

During our morning meeting, our Dep. Supt. Of Admin had told us that it is confirmed that a new hemodialysis clinic would be opened shortly in the town. There was this doctor from KS city who rented GF – 3F of a local insurance building. There were rumors initially stating that my ex-boss is behind that scene. However when confronted, he had denied of such act. But still, many believe that he is one of the investors….but denied or not, he definitely would act as backup for the clinic.

As predicted by one of our colleague – an internal medicine clinic initially and later physiotherapy and O+G & paeds and finally a small hospital….

Our plan ? apart from advising our physician and surgeon to start their clinic promptly there is nothing more than sit and wait…

there is no paeds clinic in the area and if we could start one with a good service , it would be a great investment…but no one seems interested….

There is some problem about this weekend shift – Ong had gone for his green card interview back home. My mother in law had come over for a biopsy and I intended to take her around. So I am not available. The new emergency physician was left to covered the weekend. He had to do night shift on Thr and Fri and after that from Sat night to Mon morning ( yea, yea it 38 hrs…). He told Lem it would not be a problem but later regretted – he did not go to Lem but go straight to boss. Boss said he does not want to do anymore shift…. So he is stuck with it. Boss did not dare to ask me as he knew I am quite unhappy with the current scheme…. The management did not wanted to compensate my 4 days Chinese new year leave, neither with cash nor actual leave…. I told Lem, no more extra calls… I would do what ever that is set down and don’t ask me for favor or what ever in the future….

However the final verdict - boss would covered for Sunday morning --- K would get a rest 10 hrs...and it is just NOB(none of my bussiness) to me....

settling down as health and medical officer....

 

I got my MO posting letter few weeks after I was posted to casualty department. It was just a state away from Selangor. I was reluctant to leave my house and filed my appealed. I had tried to pull some strings but was unable to get those “big chain” graded one. I had asked around and someone had told me that working at the health side (govt. health clinic) is better – no calls and I could focus on my study. I decided to called up the clerk in charge of the posting of the Jabatan Kesihatan Negeri Perak(Perak Health Department). She told me that there is a vacant in Slim river – 120 km from my house and I thought it was acceptable. We made an agreement, I withdraw the appeal and she would post me to the spot. Few days after the conversation, she had called me up again and asked me if I wanted to be posted to Tanjong malim which was closer to Selangor. I told her I gladly accept the offer…

I got my posting letter 3 weeks later and finally started my job as a health and medical officer….

One of my colleagues during the house officer days was posted to there as well and she brief me about the condition….

Me and my father had driven up north and tried to find a house. A single storey terrace house was around RM300-400 and I was lucky to find a new house with the price of RM400 /months….

I still remembered the first day I reported to duty. ……I presented early to the JKN Perak. I waited for a long time as the new Director was busied as she was new to her job as well. I did not met her but was brief by the deputy director (health). I left the office by 11:30pm. I took a drive to Tapah health office when I got my first bombardment from my new boss. The 1^st thing he asked me was – why did I reported late? He had asked me as if I had wandered around ……I explained that I was discharged later from the JKN Perak…..the briefing was brief and he had told me not to “curi tulang” as he would monitor us from time to time….

I drove back to Tg Malim and seen the Medical officer in charge, the next day, I had started my work……it was an easy life , I spent 2 year 8 months at the clinic….

eh-ventilator crisis, aka bagged till you drop....

  da so called "rice cooker" - simple home care ventilator

Our hospital had been facing ventilator shortage since few months ago. I am not sure about the cause… boss had told us during the morning meeting that the hospital is currently under the subsidiary scheme of the health department and every purchase over a certain amount would need to go tender…the tender process would take times… and it had been sometimes after the meeting and the condition had become worse during the Chinese new year…there was this 15+ years old Drager Evita ventilator posted in our ED. However due to shortages, the ventilator was moved to the ICU.

I had did a few resuscitation with the aid of ED. In a small hospital, we had limited staff to manage the CPR scenario. 1D2N in the night and with 1 person on the chest compression and 1 person on the BVM, the other would have to act as runner for the drug administrating and charting.

No one seems to care and whenever I saw there the Drager Evita was not in the resuscitation area, I prayed very hard. The LORD is indeed full of mercy as I had escaped and had enough sleep on most of my shift. However I finally hit the rock few shift ago. It was a bad night – the ward was calling and patients kept coming to ED as if it was free of charge. The ICU had informed that a patient had been experiencing shortness of breath. I ordered an ABG and it revealed a mix respiratory and metabolic acidosis. The respiratory therapist had told me no ventilator was available not even a “rice cooker”. I ordered some sodium bicarbonate and told the nurses to review the patient later. By 3am, the nurses had told me that the patient had again noted with dyspnea and this time, stridor was heard. I told myself – what the heck...I had to intubate him. I passed on a tube without difficulty and told the nurses that we would take turns bagging the patient. Each of us bagged for 15 mins. It was 2 hrs later when the patient was stable enough to be hooked onto a T-piece…

Sarcastic episode – during the early 2000, when I was doing house officer call in my home town general hospital, I had intubated a COPD patient who went into failure. I remembered the medical officer yielded at me telling me that there was no ventilator available and I should have “ask around” before I passed on the tube. That night, the staff nurse and attendant bagged the patient with me until morning…

Yet, I had recreated the scenario ….some had come to me and asked me why I joined the bagging – I told them that I make the decision for intubation and I should be responsible for the consequences…..Another yet – the management still pretend their “so far so good” attitude….until last week…

The was this 80+ years old male who was sent to us by the local ambulance, noted with a forehead laceration. He was unable to tell me how he had fallen despite being asked specifically about the event. I ordered a brain CT and a large subdural hemorrhage was noted. I called up the neurosurgeon as usual and after informed him about the case, I told him no ventilator was available. He asked me to try to “squeezed” one out for him. As usual, nothing can be “squeezed”…. The only option was transferred the case out and I told our surgeon about the result and he had wanted me to talk to boss again – boss was informed prior to my call. When I called up boss- he told me no problemo, 2 ventilator is coming in by noon….really need some kicking from the cash cow….

That ended the ventilator crisis…

cat feces coffee... ( not luwak)

actual kopi luwak bean....RM100 / cup ..

the management had held a few coffee meeting with some staff just before the Chinese new year… Workers and nurses from various departments were invited. The aim of these meetings was to inform the staff about their poor performance and indirectly telling them that their bonuses would be reduced.

 

The coffee meeting reminds me of a film – “Corrupts all Cops”, directed by Wong Jing. It stars Tony Leung Ka Fai (Lak, chief of sergeant major HK police force) and Anthony Wong Chau Sang(Tang , senior ICAC agent). It was one of the non-comedy film done by Wong Jing recent few year. The role played by Tony Leung was actually a projection of a legend of HK police back in the 50s[another similiar film was starred by Andy Lau]. Tang(starred by Anthony Wong) was a corrupted cops which later recruited by another ICAC agent in charge (starred by Bowie Lam). On the first day of his job, he had asked the junior ICAC agents to buy what ever coffee they could get. One of the young agent choices of coffee was selected as it had a taste of cat feces.(not kopi luwak of coz, as the agent claimed that he used it to fertilized his plant) - Tang vomiting on the spot when he drank it....

Indeed the coffee offered during the meeting does not have such taste of cat fxxxx, but it as hard to swallow as the cat fxxxx taste stuff….

No one had seen their own “prestatievorm”(borang prestasi, performance form). No one knew who did their evaluation. One of the therapist had voiced out – “I was never late for work, never reported for any accident/fault during my job, never absent from my job and why was I being rated as underperformed….”.  The reply from the key person(newly appointed you know who…) had replied her that, “ you know, you are attending a course that distracted your focus from you job, that was why you are rated so low….”. The therapist had asked the management regarding her part time schooling during her intake interview and the management claimed that it would not be any problem … and now the management had used it as an excuses. And the worst part was no one had come out and admitted that he/she was the evaluator regarding the poor rating.

The result was a save of money (both bonuses and salary) as some of the staff had opted to resign. Some had opted to play rot on their job – the surgical aides had started to do everything in a very slow tempo (all 3 of them were summoned for the coffee meeting)….

I did not make it to the list and got the bonus cheque as I expected....

License run.....

I had just came back from a trip to Malaysia…

Not really a holiday trip – I had to re-apply for my driving license. My Malaysia driving license had expired a long time ago (back in 2004). I lost the original copy during a trip to the KL tower and I did nothing – stupid and lazy of me…Later I learnt that the only way I could get it back is to re-sit the examination. I could be exempted from the paper test by writing to the Director General of the Road transport department... Who got the luxury time to do that….It had been bothering me for the past few years.... the only place I could drive is Taiwan as I had no international driving license...

I finally found that I could get back my Malaysia Driving License by converting my current Taiwan Driving license. The Malaysia govt. allow such conversion (non-automatic of coz...) by writing to the DG of RTD. 

I need to translate my Taiwan Driving License into English. This was the trickiest part – The translation would need to be certified by the representative office of Taiwan in Malaysia and I need to go down personally to do it (there was alternative way by getting a authorized letter from the local court house/notory public…but I still need someone to ran for the errant of certification for me in Malaysia ….).

The 1^st part was getting a good translation example of the Taiwan driving license. I glanced to the net for months and finally got a good translation for me to use…

http://roc-taiwan.org/public/Attachment/09281393071.doc

It really took me sometimes to get this document….

The rest of the procedure was simple – 2 trip to the Taipei representative office in KL – submission and retrieving the copy, 1 trip to the Putrajaya RTD office.

The process went smooth and there would be a 3 weeks waiting before I got my approval letter for the re-application of my driving license from the DG office.

Apart from applying for the driving license, I would apply for an international driving license….a voice told me that I would need it in the near future….