difficult airway....

The patient had presented with an unusual complaint – throat pain which radiated to neck base. A young age male in his early 20s who noted with sudden onset of discomfort. The initial review had shown enlarge tonsil with some pus.

I had given him some pain killer and a parenteral dose of Augmentin. He had become better and discharged with oral medication.

He had returned to ED 5 hrs later in the morning c/o SOB and unable to swallow. I had a very bad feeling about it and started him on epinephrine inhalation. I had proceeded with a neck CT which revealed swelling over the epiglottis region.

A very unusual case as acute epiglottis is very rare in adult…. I am aware of the difficulty of intubating such patient and does not want to risk it even if it is an elective one. Since it is early in the morning, I had decided to hand him over to an expert for intubation.

I had called up our anesthesiologist CZ and he had gladly complied with my referral. He had come and seen my patient within minutes.

I thought he was going to take the patient up elsewhere for the intubation. However he said he would bring down his tools and do it in the ED.

He ordered large doses of diprivan (a full ampule ) with an ampule of succinylcholine. ( I would only use 1/4 of those most of the time). Before he started with the routine, I joked to him,” don’t treat here as yours house”…indeed, the equipment in the ED might not be as complete as it was in the OT.

After the fibrillation of muscle, he had started the insertion which ended into the oesophagus. The O2 sat had fallen to 50% then. Prior to the second attempt, the O2 sat had fallen to 30% and CZ had told me to relax as the patient is young….

The second attempt was successful and the SpO2 risen to a comfortable level within seconds and it was a real relief for me when I confirmed the position of the tube.

For me, anything which go wrong would be my responsibility as I was the patient’s attending physician.

CZ had told me that the epiglottis was actually ok but there was this large swelling at the tongue base which actually acted as the culprit. Well, a review of the history which was compatible to the diagnosis -> no barking cough but difficulty of speaking ( tongue base problem c normal epiglottis vs swollen epiglottis).

What ever is the diagnosis, I am happy with the outcome as the patient had improved after admission to the ICU….

sit down and think for a second...

Democracy = majority ruled with protection of the minority right….no violent shall be involved….

Scenario :
bunch of youngsters who are mostly financially dependent [non-taxpayer]  

came forwarding and claiming that

they represent the people voice (without being elected/entrusted)

utilized violence force to trespass a building (thus violating the law)

while their occupation of the building (illegally), they had asked for provision of air-conditioning supplement (their human right !!!)

damaging properties in the building (paid by taxpayer)

demanding a change of govt. policy (refusing negotiation)

under the name of justice and righteous

there are so many ways to express themselves….and yet they chose to break the law and acted like bunch of  mob...

a treat for an old dog.....

It was noon , I was on my way home after my govt clinic rounds (Tuesday was not my usual clinic, I covered for our family med specialist who is on her maternity leave).... I called up Ving and ask her what was our plan for lunch; she told me that why not try out the instant "curry mee"(cannot mention the 5 letter word start with L as Yun is going to yell unfair...)  which her brother given to us during our trip back in Malaysia 2 months ago...(world ranked instant noodle from malaysia)
My eye shined and told her that I would step on it...

what I saw when I reached home.... I was drooling and waiting impatiently in the kitchen for the next 20 mins...

"Ka Liu" (extra material)
 hit the table after the long wait...

took me 15min to whacked the whole bowl...




Well, nice and I would definitely get a full carton on my next visit home...(RM2 per packet, over lelong.net...)

mystery and should me know earlier...

Since the disappearance of MH370, we had had some serious discussion in the family. We had discussed about some technical detail which leading to some mystery; such as the mobile phone of some passenger was still able to be called....

We had car GPS tracker but why didn’t the plane had a tracker as well ?

There were so many why…

I remembered during my college days, there was this watch by Breitling (model EMERGENCY) that could send a distress signal that enables rescue team to locate the bearer. 

The model was phased out later and the MK2 was introduced last year which integrated satellite technology. The price is RM45000…. Well, seems expensive but when disaster hit, it is worth every penny…I just wander why the airliner company issued one to every captain ?  

At the moment, we could just pray…..

Reality...

As a foreigner with a working permit, it would be darn difficult to apply for loan and credit card, even with the job in the medical field.

Most of the bank required a guarantor (local with IC). Most means there was exceptional one, and I got my first card from CT bank which didn’t require any guarantor.

The additional benefit provided by the bank had been degraded over the years and lately, CT bank had lost its contract with the chain retailer Costco and the co-branded credit card was terminated last year.

The local Costco has however teamed up with the CBK bank which is notorious for its foreigner unfriendly in the past. I was reluctant to try but later gave in as I thought the rebate was truly attracting to give it a shot.

The bank had called me up 10 days later and told me that my application was in-complete and they would send me the relevant document to complete my application. My instant reflex was OMG -> would it be the guarantor form ?

I did not hesitate to ask the lady officer what was the missing part -> should her answer be the “guarantor form”, I would tell her that don’t bother, I give up…. Out of surprise, she told me that my application was accepted but I missed one of the signatures on the application form and she would sent the form back to me and all I need to do is just signed it and mail it back. Well, a smooth process after all.

I got my card 2 weeks later…..and I would be cutting my TC bank credit card very soon(after I redeemed all my bonus point)....

The bank was not notorious in the end....

I finally experienced one of the classic phrase from the movie “Money not enough”(by Jack Neo) -> the bank only help those are rich, if you are poor, the bank won’t help you….

Well, life is truly cruel….

service provider...competent

I had a conversation with K today morning before I headed to the land of lion. K had told me that the there is complaint made by a patient lately involving 2 of our attending physicians.

The patient was first seen by Lem, he had presented with “chronic” headache and dizziness. During the review, patient had told Lem that he had black stool and Lem had decided that it was tarry in nature and admitted him to GI ward. The patient however was not that satisfied regarding the arrangement as he thought his headache and dizziness was his main concern and tarry stool was nothing to be worried about.

After the admission, he had made our gastroenterologist who had given a face when he had refused panendoscope examination. He had later asked for a change of service and posted under the care of neurologist. Our neurologist had however told the patient that his condition would not improve if he does not quit smoking nor betel nut. He was irritated by the comment and later complaint to our superintendent. After his discharge, he had written to the health department and complaint of his unpleasant during the treatment process.

The case was review during the meeting....

I agreed with K that there is nothing to shout but just mis-communication. We were lucky as there is less VIP to entertained here than elsewhere, but this industry had become less authorized in the past as the patient would decide what they want and as the service provider, we need to comply as long as no life threatening situation is noted.

I had a few encounter with sales rep(non-medical) lately and found that some of them tried very hard to please their customer. Some of the them were very young who apparently not well prepare with what they are selling(when a buyer can tell more detail about the product than the sales reps….or maybe I do much of homework), I felt their pressure and I had tried my best to act dumb and patiently hear the not that satisfy explanation during the process and completed the purchase, I had seen a guy in a decent attire that asked very harsh question regarding what was the number of filter paper during a purchase of a hand made coffee at an outlet, the guy "lagak" like he is the master and cross his arm watching the worker prepared his coffee...

Leave no one behind.

A 32 weeker (G2 I presumed) had gone to Korea for a tour with her hubby. Unfortunately, she had gone into premature labor and the baby was intubated and placed in the NICU.

The couple had freaked out when the hospital informed them about the total medical fee which might summed up to RM300k at the end of the treatment. They had gone to the representative office and asked for help and they were however not satisfied with the help provided. A bombardment over the FB was done regarding negligence of the Foreign Affair and they had gone to media…

Most of the feedback over the net was negative regarding their act.

The most shocking act was coming back to Taiwan with their baby  still admitted in the NICU... it would be difficult for a dog to abandoned its puppy and I am looking at human doing so and dare to face the media...

The couple had left their first child with their relative for their tour in Korea and now they left their 2^nd new born child in Korea…. As a believer of “Leave no one behind”, I just couldn’t understand their thinking logic.