age of maturity and age eligible for driving license...

 I had this 18 years old young chap who fell from his bike with a gal as the backseater. Both of them had minor abrasion wound over their left limbs. It was 6:00am in the morning and I had good sleep thanz to the night shift attending physician covering the ward.

I had asked the phone number of his parents and called up.

“Good morning, sorry for disturbing in such an early morning… are you Mr A, father of A jr.?

“Yeah…what is the business…?”

“I am Dr lywuu of F hospital and your child had fallen from his bike on his way from KD to KHH….. he had sustained bla bla bla…”

“What on earth, ain’t he suppose to have ? class today morning…..”

Typical slipped out from hostel and brought she-classmate for an over night in the famous KD beach 50 km down south of our hospital… Most of the chaps will spent the whole night there and rode their bike in a “not enough sleep” zombie mode back to KH city early in the morning…some unlucky one would rammed their bike while day dreaming in limbo or too tired to react to some emergency condition and landed in my shift….



One of the crucial element of ED management is communication. Proper communication with the family and patient is always a key to avoid medico-legal problem. For an adult, the ED physician just need to well explained the medical condition to the patient, and then discharged the patient. But for youngster like the chap, communication with the guardian is vital. Imaging you had a 18 years old patient with traumatic knee injury who can still walk, after clearing him from any knee fracture, you just dischaged the patient. Unfortunately, the patient collapsed hours later in his house and a traumatic intracranial bleeding was diagnosed in another hospital. The family would definitely stick to your axx like a no head fly - why didn’t you examine his head and do some thorough studies before you discharge him? . For youngster who had not attained the age of majority it is crucial to speak to the family either face to face or talk via the phone.

In actual fact, half of the youngsters are reluctant to let guardian acknowledge about their condition. And many of them just couldn’t understand why the law allows them to get a motorbike license at the age of 18 but the age of majority is 20. Sometimes I would insist the parents to come over and fetch their children in person if the youngster had difficulty of walking or other risk who required further observation or admission....

There was a few times I had to threaten the youngster to surrender them to the police just to get their parents phone no….Most of the parents was polite and I could feel their worried and disappointment when their children met such accident…

I remember one of my lecturers had taught us that a child of age 3-5 would think that he is the king of the world and he is capable of everything…. But nowadays, lots of youngster thinks the same, they never know their limitation….

separation of ward and the ED

Call had become better nowadays… We had no longer had to cover for the wards complaints. The management had gotten a locumer initially. An internist with his own clinic down south, he had come for interview months ago and had retracted last minutes before he comes to work. He had however changed his minds probably due to temptation of cash.

He had done a few calls and complaint to K that the pay was too low. We were quite surprise when K told us his price. It was only 1/4 of our pay… queer feeling when I heard the figure; I wandered if I had to earn those hard earn money years later….well, keep up the faith as experience is the real asset that was gifted by the LORD…

K had gone to the management few times regarding night shift attending for the ward. Complaint from the ward had truly disturbed us as from time to time there are these “emergencies must visit patient” condition took place simultaneously in the ward and ED. Any of delay of management would lead to a life disturbing medico-legal case( multi-million medico-suit rarely occurred here in Taiwan, but the court running is very tiresome and torturing). I had nothing to say as I am definitely support the change.

Calls were better since then as I got to sleep the “morning call hours”. The “morning calls hours” is around 4-6 am as the patient started to wake up and nurse started to take vital signs. Lots of complaint is noted and it is the worst hours as one would be very tired after the long night shift.

But still, we had to covered for procedure and other critical condition in the ward…

night shift of the ward..

After few weeks of struggling about going for the training, I had finally settled down for another 10 months of works. Well, I had adapted well lately and more time to spent with the family.

More and more doctors are hired and we had a load of specialty to consult but I did not benefit much from it…most of the doctor are around in the daytime and as night shift attending physician, I could rely on my own most of the time.

K had complaint about covering the ward during night shift. According to his contract, his job is limited to the ED however since his arrival 2 years ago, we had been covering the ward. However the in patient had increase about 2x and the loading had become worse and worse lately. K had threaten the management that his contract ends in December and if we are still require to cover the ward, he would…..

The hospital had managed to get a clinic internist down south to cover the ward. He had come a few times and was reluctant to continue. K had chatted with him and found that he was paid less then 1/4 of our pay per night. He requested a higher fee (and still it was about 1/3).

The boss is still negotiating with the other attending physician and surgeon about doing the calls as the locumer could only cover part of the shifts.

All I want is fair and square…

The truth

It was a dull shift… I had glanced through the web and found something which I don’t usually read from theStar. Indeed, my in laws had told me that theStar, the Chinese newspaper over the net is unreliable as most of them “write” for the government. I had come across some article over Malaysia Chronicles and Free Malaysia Today. Wow, it is truly interesting.

The 4 letter word started with F had almost burst out from my mouth when I saw the “Malay first, Malaysian seconds” phrase. Indeed the Red-white Kris Party had decided not to rely on the non-Malay voter. They had wanted to lure the rest of the Malay to support them and aim for the victory in GE13.

I had heard a story from my uncle during my stay in Malaysia. There was this consultant who worked for one of the racists in the past. There was this state development plan designed by the consultant, the consultant had submitted a plan with a budget. The racist was not satisfied with the figure and given the consultant a handsome figure to lay him off. The racist hired another consultant and the figure was 30x the amount…well, gods know where the extra money had gone…

It is eye aching when I saw the 1Malaysia slogan and more irritating and blood rising when I saw the 1 Malay phrase….

It is time…. Too bad I couldn’t join the group to flip the table as we had decided to go back early in January for Yun’s IC instead of the GE13. 

Yun is darn worry about her IC as this is a symbolic of growing up for her and Xian is very disappointed as he would be the only one without IC in the family…..

 

3000m above....

We had taken another trip to the National Park here in Taiwan during this summer holiday. It was a camping trip, 5d4n. The longest camping trip ever and one of the camp site had no electricity supply.

We had traveled to the highest road in Taiwan. During the trip, I had climbed the 2 peaks of the He Huan Mountain. Both of them were above 3000m. The air was so thin and I had to rest on every few steps.

The 1^st peak was a challenging one as we need to climbs stairs like road to ascend to the top. All of us made it to the tops…. Our 1^st experience of climbing mountain of more than 3000m. It was a special experience for everyone of us; the climb was complicated by the thin air above 3000m. We had to stop every few steps to gasp for air. I had seen many film regarding mountain climbing and I finally realized the feeling of shortness of breath on every steps…..

The next day, I climbed the 2^nd peak alone due to the rain; Ving and kids waited me in Fefe. I donned the rain coat and ascend to the peak , praising the LORD all the way up. During the ascend, I was so afraid that I suffered from a heart attack but still with the grace of LORD, I made it….

Each of us learns something from the trip. I am truly happy as I could take my children to experience something which couldn’t be bought by money – although money is still a must for these trips…..I am glad I am still energetic enough to take them up to the top….

Quality of care...

I had always considered the diagnosis and management of acute appendicitis as a index for an competent ED doctor...careful hx and PE would lead one to the diagnosis...

I had a cousin who is very much older than me… my granny and my mother’s eldest sister got pregnant almost the same period… My cousin was 20+ years older than me, a story regarding of him was shared amount us during our childhood.

We were warned not to do any sport after meals as one would get appendicitis (which is not true…). My eldest cousin had a big vertical scar across his belly. The story goes like this; he had suffered from abdominal pain and later seen at various clinics and he was only sent for ops after generalized peritoneal sign was noted. The ops was a major one as appendix had ruptured….

I had read over the net about this poor Indian chap who suffered from abdominal pain lately…

http://www.freemalaysiatoday.com/category/nation/2012/09/24/ibu-kesal-dengan-layanan-buruk-hospital/
9/5 pt noted with diarrhea, abd pain, vomiting

9/7    9am seen in Klinik kesihatan - discharge

9/7 8pm seen in ED Seremban GH – discharge

9/8 ?   seen in private clinic

9/9 8pm seen in ED Seremban GH admitted to ? medical ward

9/10 9am diagnosed as ? appendicitis

9/10 4pm transferred to ? surgical ward and sent to OR…

It is queer that no doctor had ever mentioned the possibilities of peritoneal sign during the consultation. The Medical officers in Klinik Kesihatan ,ED Seremban GH and the private clinic doctor had discharged the patient despite of noted the pain and symptom for over 2-3 days. The 4^th visit to ED and the medical officer still admitted a patient with peritoneal sign to medical ward is a beyond standard medical care.

Could just shock my head…. Is it because those medical officers did not receive any specialist training making them incompetent or was the patient pain so non-specific.

There is still a lot of improvement for the health care in Malaysian..

Provider course re-visited....

 

I still felt depress over the failing of the instructor course… My ACLS provider cert had expired 1 months after the instructor course and I did not take up any course later… It was a must for medical staff working in the critical unit to hold a valid ACLS provider certificate – requirement for the hospital evaluation association. I had finally decided to take up one recently(the university’s hospital requested a valid cert if I wanted to work as a research fellow there)

I took a course organized by an education group in Kaohsiung. 1.5 days course. A small class consist of 1 lecturer (yeap, 1 man show) and 15 students. I am the only physician and the rest of them were 1 nurses (13 female and 1 male). The lecturer is one of the emergency physician in a local medical center. The course was solely designed for nurses and it was very bored for me especially for a person who been through the hellish instructor course….

Well, to make the things worse was I had to do my night shift at the end of the 1^st day course. I make it in time to the hospital and told Lem to relieve me 1 hr earlier the next day.

I was lucky as the call was darn good… I had a full 3 hours sleep…

Despite of the sleep, I was still sleepy during the morning. Nodding and wandering.. an impolite act, but I was too tire…

The was a long strip of food shop near the class. I got into a Ramen Shop and regretted my choice 15 mins later as it taste just like one of the instant noodle and it cost 80NTs....

The paper test was simple and I completed it in 20 mins. The skill station was even more simple and I left the class by 1:30pm.

I went to JK lane and tried to get a red HTC J for Ving. The initial visit at the famour SH 3C wholesale was unsuccessful, they had 1 red and 1 black but the red one was pre-ordered by someone. I turned to another HTC shop and got Ving the android phone…

The drive back home was tiresome but I still manage to make it…. After the test, I am quite sure that I would go for the instructor course selection progrem next year in Taipei....