the p and the t....

I had a small chat with one of my colleague while inserting a pigtail for his patient…. He told me that my ex-boss is quite unhappy with our new ED physician. The new comer had worked with my ex-boss for over 10+ years…. He had left and my ex-boss is left with a big hole in his roster…. He is currently manning 2 hospital – very short of ED staff. So it would be a tough competition in the future…

I am looking forward to it as I am going to had a discussion with boss about my salary. I had thought it over and written a memo to boss. It was Sunday and I put it in Lem overall jacket. He however did not pass the letter to boss. He told me Boss was not in a good mood as one of the family is unpleased with the outcome of a patient….. Lem to me to speak properly to boss and when I told Ving last night, she told me she had a feeling that I should hold that matter for a while…after all I had waited so long….What the HXCK…just another week or two, pray really hard to the LORD and see what path he would be leading me....it is not just only patience but also tolerance....

ass wiping...

One of my senior colleagues had described our job as ass wiping… I am not proud of  nor ashamed of the job. In the past, when I was so junior, senior physician and surgeon “ordered” us to do some procedure for them – to them, there are providing chance for us to practice so that we could get the “hang” of such procedure and later mastered them. However, it was only partially true, most of the senior had actually lost the feeling to do so…..some of the them didn’t even mastered the skill at all…..

 I saw something like this in the Berjaya Time Square hotel
well, not wiping but just wash... but franklly said I found it difficult to aim properly...

As we become more senior in the field, colleagues started to ask for favor instead of giving order. They ask us politely and we complied. However, I knew that some of our colleagues considered it as part of the resident job. I am not irritated with it. I am glad I still had the chance to do so. There was this incident years ago when I did my hemato-oncology posting in the university hospital. The nurses had prepared the CVP insertion kit for me and left, she told me to call her when I was done. The patient next to us called her and asked her some question. The patient was thin and it was an easy penetration. As usual I did it under 2 minutes. I remembered her looks and mumbling while she hooked the CVP onto the monitor….most of the resident would take a long time…but I was too senior then (although I was designated as 3^rd year resident…). I am not proud of it but perfecting the skill make the patient suffered less. And that is all what I wanted to do…..

I never turned down any referral and was glad to do it as I still enjoy doing most of the procedure. There is a few occasion that I would "murmur" - e.g. patient was put on dopamine drip without a prior CVP guided fluid challange as no CVP was inserted.

 

The policies had changed over the years. I spent more time on explaining to the family/patient than doing the procedure. It took 5-10 minutes for the explanation and Q & A. for a procedure. In a smooth case, it took less than 5 minutes to complete the task.

A doctor would only sympathize his patient only if he had undergone what he is doing to his patient. I was sick before….cut and stitched up by someone, saw my children being treated. I was lucky as the pain and agony was so less, as everything was in good hand and I intend to act as a good hand for someone else….

 

I hope I never ended up like this….

 

 

 

 

 

 

 

 

 

 

 

 

Instinct...

Instinct... .  something gifted from the almighty....

There was this case brought up for discussion yesterday…. A medico-legal to be case as a perforated peptic ulcer was left for hours before someone decided to take the case to the theatre.

 

Well, I had a brief discussion with Lem and both of us agreed that we would have done a CT scan much earlier and might dug the shxt out earlier. One might said it is just bombardment from the rear side of the horse [ Chinese proverb : meaning to give negative comment to a event after it had happened] , but after years of doing this off office hour job – a.k.a ass wiping job, I had just the instinct to sense problems, allowing me to escape much of the deep shit situation......

 

I remembered the movie “BODYGUARD”, Kevin Costner (acting as the ex-secret service agent for the white house ) said, “…not on my watch…”

 I really like the song....and the movie too....

I deeply pray to the LORD that I kept such instinct as long as I could and nothing happen on my watch...

 

Well, da family was unpleased with the condition of course….

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….