Nothing is fair

The ED and Out patient clinic is actually 2 very depending unit in our hospital. The clinic would “pushed” some patient to ED if the illness is severe or complicated enough to be managed in ED. Sometimes, some hot shot doctors with loads of patient would referred patient for admission via ED as they don’t have the luxury 10 min to sign an admission. I usually would not reject such request as we worked as a team. The existence of the OPD in the evening had lessen my work load and I appreciate that.

As for K, even though the management had agreed that the ward on call doctor would assist during the ED evening session on Saturday night, K was still very unsatisfied with the arrangement of patient distribution. He had insisted on an equal basis that each doctor should see equal amount of patient rather than the ED doctor seeing triage grade I-III and the ward on call doctor seeing the grade IV-V. He had done some compliant toward the nurses triaging skill (triaging too many patient into grade I-III) and holding back examination as much as possible lately.

Lem had a discussion with me and I had told him that K intention of drawing attention of the management was so obvious. However it is not a right way to do so….but our conclusion is nothing could be done….We shall wait and see how long would it take for the management to discover the fact….

There would be a final showdown on the arrival of the new ED physician later in August…

I just hope that my shift is not affected after that….

Playing safe....

I had this traumatic case during my last shift. A middle-aged male who had rammed his car onto a bridge pier was sent over by the EMT. He was in comatose state when the EMT recovered him. The patient was un-arousable when I saw him and gasping for air. The initial resuscitation was intubation and follow by IV infusion. The BP was ok with bradycardia of 60/min. I did a FAST (Focus Assessment with Sonography for Trauma) and there was no fluid in the abdomen. The possible diagnosis was possible intracranial bleeding. However I had also ordered chest and abdomen CT just in case I am wrong.
The head and neck CT was clear but the abdomen CT revealed a intraabdominal bleeding with hematoma at the intestine. I was wrong and luckily I did everything.....

The patient crushed and resuscitation was done and with fluid/blood infusion we were managed to get the SBP back to 80mmHg. I could do nothing and further more in the ED and sent the patient to ICU.

Minutes later a lady came and asked about the patient condition. She had indentified herself as a friend and I told her that I need authorization from family for the surgery as it was a high risk surgery and most probably the patient would not survive. The lady had asked me if we could proceed with the surgery before anyone could be contacted. I told her that surgery might not save the patient life and I need consent and fully communication before

I proceed with anything. The lady had requested to see the patient and told me that she would tried to do something and I had to sent the patient to ICU pending decision.

The patient had passed away hours later just after the family arrived.

Unlike the bigger hospital, the place I worked in does not have a 24 hrs in house consultation. I had to call the physician/surgeon and they had to take a 1 hr drive from their home for the consultation after office hour. Imaging that I had called the surgeon/anesthetist for surgery and the family had refused the ops when they arrived; it would be another 1 hr drive back home…..I had to decide if the patient need surgery instead of calling the surgeon to come over and decide further management.

At one moment, I had struggled if to call my surgeon to come and do the surgery and give the patient a chance but as the patient BP had crushed and gone into arrest once in ED, I doubt that the patient would make it through the anesthesia. Unlike the other surgeon I knew, our surgeon CJ is an aggressive person who would do laparotomy straight then guessing in front of the CT scan whether to observe to see if the patient could improve. The decision is cruel as I had just signed the death warrant for the patient… but yet in Taiwan, doing surgery without family consent could ended up with a medico-legal suit that last many years..CJ is that kind of person that would go for it and I just don’t bare to drag him down with the possible risk. Well, I am too old for those hanky panky and tried to play by the rules for the shake of my family….

coconut grater

During my schooling day back in Malaysia, there was this pasar malam(night market) in the Saturday and Wednesday night near our neighbourhood. My mother would take a rest and we would scout our dinner cum supper in the night market. There was this stall that sells coconut juice and sugar cane juice. It was one of my favorite stall, coconut juice was a must buy during those days.

The local coconut juice was however not that tasty compare to the one sell in Malaysia and the price is higher here. The most expensive coconut juice I had drunk was the one in Club Med Cherating, it was RM20 per coconut….

My mom used to asked me or my brother to go to the local Indian grocery shop to buy dried coconut. The shop keeper would chopped the coconut in half and later grated it with a electric grater. The grater coconut would be juiced for santan later to cook curry. Occasionally my mom would make some onde-onde for us…

Ving would cook curry for us from time to time as there is no shop here selling any grated coconut, we had to used canned santan. The santan is more creamy and thick and I felt that there must be chemical inside and I had decided to seek for a new source of santan.

The southern part of Taiwan had a good supply of coconut thanks to the weather. I had tried to buy some dried coconut in the past but unfortunately I was unable to grate the coconut and produce santan as I don’t have the proper grater.

I do not have the luxury to keep a electric grater due to it’s size and price. So I had started to survey for the “appropriate” tools for grating.

I remembered many years ago, my dad had use a wooden grater similar to the tools below to grate some coconut for santan in my nanny coffee shop.

very simple grater 

A very primitive tools but effective as I recalled it. I had sought to the net trying to find a plan and I came up with some design.

With the help of my power tools, I had build this coconut grater.



a box-style stool c an iron grater



 The key to the tools is that sharp iron piece. During our last trip back to Malaysia for my passport, I had managed to get two of those in one Chinese hardware shop.

After our return, I had started the building project…

Looks fine but still need some improvement..

However the result is still good though the grated coconut is not as fine as the electric grated one back in Malaysia, but still, it is a good start…

the indon working in the shop had peel off the outer skin for me...

poor chopping half technique.....

The final product - whole wheat coconut bun....

Next try would be santan.... 

Wood work....

Ving is a big fan of wooden stuff. More than half of our cabinets are made up of wood. Since few years ago , she had persuaded me to start doing some wood craft and I had purchased  some tools…

I had an electric jigsaw, sander, drill and router initially. The tools were placed aside after I build my 2 gun rack ( 1 for the BB hand gun and 1 for the Nerf Long gun).

Few months ago, I had decided to build myself a book rack as my bookshelves were being taken over by the kids gradually. To save place, I decided to build mobile book rack like those use in the library so that I could store them under my big table.

All begin from a search over the net for plan and I managed to get one and after adjusted the measurement, I stared the build.

I had bought my wood material from B&Q. The adjustment of measurement was done so that I could do the least sawing and cutting as I had difficulty to cut straight line with the jigsaw(of coz, it can't as jigsaw is not mean to cut straight line).

The screwing and trimming of the edge took about 3 hrs and I had 2 mobile book racks build.

The result was stunning and I started my second project.

During the period, I had bought some useful book and done some reading over the net. I had created some assisting device to enable me to cut straight line with the jigsaw.

I had decided to build a small cabinet to store up my wireless router(not the power tool router), modem, linkstation, slingbox and those wires which create the most trouble for the irobot, as I had spread the above gadget over the floor along the wall..…

With the assist block, I am able to cut straight line with the jigsaw and I had started the build on one of a Wednesday afternoon.

The process was a tedious one and it took me about 10 working hours to complete the project. The key for the delay was the tools I am using. I need to spend lots of time placing clamp and block before a cut thence I had spent a great time cutting the wood.

the 3 antenna....with the chongkak

 

everything in order....

 

the opening...

After this project, I decided to build a working table upside down hanging a circular saw and router. A daring project and I had partially completed it….

New gadget for the floor

There had been quite some changes since Chinese new year. I got a small bonus (same as last year) and had added some gadgets into the house.

Ving had finally agreed that we should have a robot for floor cleaning. I had suggested irobot to Ving few years ago did not get any approval. Since then, there are many similar product emerged on the market but still irobot is still the highly recommended over the market. Lots of people had dumped the other product and gone for an irobot in the final run.I had surveyed over the net and found that there are 3-4 dealers over the market. The authorized dealer had marked up the price severely compare to the other importers. The price is 2x difference and the importers provide similar warranty over the products. The irobot is a mature product and it is broken up into many modules you can just replace the problematic part easily by itself and the importers could easily repair one locally.

I had obtained a 7 series and a scooba initially. And the effect was stunning… floor was cleaner then ever. After few weeks of using the product, we had decided to buy another 5 series for use in the garage to tackle the harey hairy problem.

A great product indeed….

GE XIII

Finally the GE13 is on its way….

After 20+ year of gaining the voting right, I had never cast down any vote…. During my 4 years of service with MOH there was no GE. When I was a child, I was told a lot of unfair events regarding the govt. by the seniors in the family. One of my uncles was even a political secretary to a minister at that time. At that time, Chinese was shouting unfair ,unfair and unfair but it seems that they are the only races who had the feelings…

There were 5 GEs held during my schooling day and the opposition had performed poorly. The govt. had actually taken care most of the citizens properly.

In the past most of the “earth prince” are cool – they had nothing to worry, govt. had taken care their of their children education fund – there is always a place for them to study without worrying about the expenses so that the financial hardship is not there like the other races. Top scorer go to overseas and the middle range one go to the top U -> false impression that the “earth prince” is academically lower , but in fact their best of the best is getting the best share abroad….

Malaysia had been developed like don’t know what in the past few years… salary increase and so do the cost of living… however there are many who felt that earning a living is difficult.

I would hear stories regarding corrupted politician on my visit back to Malaysia. A gardener who joined the “balance scale” for just 6 months could spend hundred of thousand renovating his house. A district officer who had brought a bag full of cash to Australia during an official visit organized by the district office and so and so and so…

The unfair part– the govt. should have look after the minority instead of keep stressing that the majority should enjoyed the most interest – the minority is neglected ( the African American [make up of 14% of the total population] are being look after and given more privilege than the white)

The strategic work until recent few years when the “being look after” found that a small part of them enjoy more “privilege” and they wanted a change.

I had follow up the thread of a bunch of Malaysian residing in UK filing a suit against the EC for voting as absent voter since 1+ year ago. The plea was rejected but later the EC had announced that it would allow Malaysian residing oversea to cast their votes…. Both Ving and I had sent in our application via email 1+ month ago.

I was expecting load of overseas voter but yet the result was disappointing. I was expecting load of Malaysian residing/studying in Taiwan to apply for the voting but yet I am wrong, my explanation is simple – bad habit from the ancestor: remember how our ancestor sold our right out during the formation of Malaya -> now we had the chance and yet they given it up… failure of Chinese independent school education ? I wish I knew the answer….

It would be an expensive voting for us as we would have to take the high speed rail up north (360km x 2) ….yet it is still worth every penny as both of us had never voted.

I would be looking forward for a change of sky….

losing backup, the terror

I was told by the EDP department staff that I need to add new floor to the pharmacy slip conversion program 1+ weeks ago. The hospital billing program is based on Oracle database and the system had nothing much to do with my program initially. But later I had requested the company to provide me with a “view” to read in the in patient data(bedno, chartno, name, sex…etc..) and the linkage had started since then. “View” after “view” were provided and linkage was only limited at the my program reading the “view”level. Upon the completion of ED triage program, the management had requested the computer company to read from the access database used by my program and after couple of months of effort, it was materialized.

At the end of last year, the hospital decided to upgrade the pharmacy dispensing system(enabling a 200k+/month payoff from the insurance company). The work load of the pharmacy had increased and they had refused to proceed with the billing process. The billing process required a staff to enter the drug prescribed in the ward into the billing system. To avoid error of data entry resulting in dispensing error, the staff will need a good knowledge of drug.

I usually do my programming work on the ED physician’s desk computer. My work was mostly done in between consultation/waiting for data, thence it was not my personal computer and I had to share it with some other guys. It is a Celeron 2.4GHz with 2GB ram running XP. I started with VB 2005 express then shifted to VB2008…I had the 2010 version install but did not imported my program. With this fossil type of equipment and software, I am still able to maintain the system…

After few years of doing the job, I had set up a backup procedure… I use to backup the whole project folder to a folder (which can be seen by me only over the intranet).

I had started this procedure about 14 months ago when I had lost the ED triage project file. I had just accidentally copy an earlier version over the latest working folder…. The published version was ver.18 but I had only the ver.13 project folder with me… It took me 2 weeks to rebuild the whole project and updated it to ver.18… I hack and hack and hack during the rebuild. The worst part was that, I had no idea what I had done between the upgrade…

When I called up the program and I found that I was in the same crisis 14 months ago. Well, my mistake and I had to re-do the program again but thank to grace of the LORD, I knew what I had done and it was “up to date “ again in few hours…

It was a warning and I think I had to write a auto backup program....