new year again...

1/1 and I am sitting in front of the ED desk, sharing patient with Lem…

Our 5^th staff is joining and some of the shifts will have 2 physicians treating patients… The actual number should be 6 according to the rule but 5 is enough to pacify the committee. Night shift is reduced from 10 to 8. I am reducing my govt clinic round to 2…

Last year was an exciting year for me; my health was at a verge of failing and with grace, I was able to recover. If I had not been to Sri Lanka, I would not have found the way which not only cure myself but also revived my dad from his stroke. As a western medicine practitioner, I become aware that there is something beyond the evidence-based medicine which I had believed for almost 20 years. The participation in the 3 “missio-dei” was a milestone in my life, I would be going back to Sri Lanka and Thailand next year to conclude what I had started….

It was a year of disastrous for my homeland, from plane crash to flood, I hope next year would be better…

I am looking forward toward this year as my course with the seminary would be wrapping up in April and still praying what would be my path in the future…

frus...

I got a text message when I woke up in the morning... it was sent from the auto sms system to alert me regarding some major abnormality of the imaging I have order.

The message was a “suspect neoplasm/malignancy” alert regarding a 19 y/o female who had presented to ED for acute gastroenteritis. She had a intra-uterine device implanted (which made me remembered her…) and I had discharged her with oral medication yesterday.

As a physician serving as first liner in a small hospital; I do not enjoy the luxury of having a 24hrs radiologist support. We would get our report hours or maybe days later.

The message confused me as what kind of information could one gathered from a KUB film to reach a diagnosis of neoplasm.

I was a little bothered by the message and when I gone to work the next day and saw the report:

“… Moderate enlargement of the uterus is seen, myoma should be R/O….

I was a relief….well, fine at least I did not miss anything…

It was hours later when I got a similar text message which alert me of a patient whom I had just admitted to ward for pneumonia minutes ago.

The reports :

“  Abnormal opacity is seen in Rt middle lung field…”

No impression was noted but he classified the report as possible neoplasm…

This time, I am a little frus as I had noted in the application form that the patient was febrile and cough was noted.

There was a film which was taken 1 months ago and it was completely normal…

Well, nothing was mentioned about the pneumonia though…

It had been only 1 month and all the emergency medical staff was irritated by this new radiologist…

Radiologist is usually our last resort and if the radiologist is unable to give us a definite diagnosis(I am not asking 100% of the time but at least most of the time), it would be difficult for us... 

but the worst part was not giving a definite diagnosis for the situation but to raise some out of cosmo possible neoplasm diagnosis to further complicate the condition....

blessed...

Back to the desk after my tour to Sri Lanka..

I did not intend to join the medical tour initially, however after I could not resist the invitation and I agreed to come back for the medical mission later in December.

For me, vacation is not a problem as I could arrange my 15 days off according to my needs, but for the children, it would be a pain as they would need to take leave from school. However not much struggle for me after praying; I knew that I would have to bring them along.

Unlike the Satun tour which consist of less than a handful of member. The team consisted of 7 doctors and 7 nurses and other supporting staffs (including 2 professors of basic medical science, chef and kiddo[Yun and Xian]).

The tour was complicated in the beginning. When the registration started, my family was turned down as the organizer related that it would be a medical mission and kids were barred from joining. I did not complain but was approached later by another elder that they would remove the restriction as my services would aid the team.

I missed the 1st pre-tour meeting as Ving did not check on her email regularly. Not much was discussed on the second meeting and I was in a mist of what to prepare.

My pre-tour night shift of 10 shifts in 13 days had increased to 13 shifts over 15 days (due to my trip back to Malaysia).

On the 1^st day of the journey, I had left out a few detail..

1. Left out some Lankan Rupee and 1/5 of the USD I supposed to bring in the vault

2. Did not properly place one of my surveillance cam..

3. Place one of the wireless phone charging on the deck...

The above detail does trouble me but I had to live with it…

Later during the transit in Hong Kong, Ving had a very bad gastric pain….

Xian started to cough when we landed in Bandaranaike Airport…

D2 -> Yun broke the lens of my NEX-3 (luckily it was the lens of the protecting filter)

D3 -> Ving had diarrhea and fever with bodyache and joint pain

D4 -> Yun had fever with fatigue (no diarrhea)

Years ago, when Ving first mentioned about going to a medical mission; I told her that medical mission is not mean for any family -> Don’t be a burden to the team as we might be the one that other people need to look after during the mission… Definitely due to my crow mouth and I did not “touch wood” after saying that..

Ving and Yun recovered after 3 days without complication but it started to rain and the northern and central part of Sri Lanka were flooded; we had to detour a few times before we reached Colombo again for our flight

The medical mission was smooth though....

Everyone gained something during the trip; a trip blessed by the great one indeed….

I was completing my chart when the OHCA patient came in. An obese female noted with sudden onset loss of conscious. She was noted with no sign of life when the rescue ambulance arrived. My heart sunk when I entered the resuscitation room. She was 150cm and almost 150kg… “A case of difficult airway”, I mumbled while getting the laryngoscope. I could barely open her mouth and not to mention about inserting the blade. I gave up the direct method and requested a laryngo-mask intubation kit. I could barely insert the mask and failed to insert the guide wire…

Well, I asked my nurse to call OR and asked if the anesthetist could help me with the intubation and before she walked out from the door, I changed my mind and told her to come back.

No point of calling for the anesthetist as the mouth was too small to pass in a blade…

The process was not satisfied at the beginning. There was no tracheostomy set when I ordered. Someone passed me a scalpel and open up a normal dressing set while I cleansed the neck; I asked for a pair of retractor and Kelly forceps. Definitely would be a chaotic situation I thought when I completed the cleansing, however with grace, I had a good surgical assistant and I managed to poke a hole through the trachea while is located 3cm from the skin within minutes.

Well, ROSC was noted but still I lost her later…

Well, I did not screw up and secured the airway within a reasonable period, my team was quite shock and had a good talk about my decision…..

Training and exposure are what the Taiwan emergency staff lack; lucky that I picked up the skill elsewhere….

trip back home....

I had had a brief journey back to Malaysia few days ago.

I got a call from my dad while I was catching a nap hours before the end of my night shift. He told me he was unable to stand properly and numbness over his limbs and probably had a stroke. I confirmed his presumption and told him that I would fly back to Malaysia. During the conversation, I had taken a quick glance over my roster, and found out that if I could change 2 of shift with L, I would have a 3d2n window to go back to Malaysia. L had complied with my plead and I proceeded with the flight booking.

The choice of flight was limited as LCCT was not an option since my parents lived in Johor. I booked a flight over the net and proceeded with my journey back home.

The journey was a tedious one, home->high speed rail -> TY airport->Changi airport ->JB….

With grace from the Lord, I was able to reach the puteri specialist hospital 12 hours later…

It was a closed one, both for my dad and me….No involvement of the brain stem and hopefully a good recovery with proper rehab. I nearly missed the flight but was able to catch it on time…

I wished I could stay longer but I couldn’t...

it was a tiresome return flight for me and I reached home 12 hrs after I left JB…

It would not be the last one …..I knew…

different view.....

Boss came down to Lem with a complaint letter last week; the letter was about a pubis fracture. An elderly female had presented to ED for pain over multiple site after fall. K had seen her and later told the family that there is possible fracture over left pubic bone and she was discharged later for orthopedic follow-up

On follow up, our young orthopedic had told the family that there is no definite fracture and refuse to comply to state that it is possible fracture over the pubic bond despite the pain over the relevant area.

The patient was brought elsewhere and later the fracture was confirmed. The family had written the letter asking us politely that what should they do in the future if 2 doctors in the same hospital had different diagnosis on the same patient….

Nothing to shout, we do make mistake from time to time, but yet sometimes, don’t be over confident….

trip back to college

I had always been adventurous but yet as I grew older, I had been more cautious as I need to think about the 3 persons that rely on me…

Adventure is all about exploring and learning, which I considered as learning one limits is also a kind of adventure.

Last Thursday, while travelling up north on the high speed rail, I had a called from the seminary staff. The lady had asked me if I could make it to the college next week from Mon to Wed to replace the class which I missed in June. The 3 Days seminar could substitute the 2 credits which I left out due to Ving’s pneumonia. A very tempting offer but I had a morning shift on Monday and a night shift on Tuesday…. I told the staff that I am able to reach the seminary late in the night and the lady told me that as long as I report to the seminary by 9 on Tuesday I would be fine. I told that I would attend the course and started my call out to K and Lem about shuffling my Tuesday night shift. It took me about 20 mins to settle the shuffling. I started to regret after I completed the task; I need to drive 5 hours to the east coast after my strenuous 12 hours day shift. The road to east coast is not like the west as there is no high way, I need to drive through the notorious winding “southern loop” route to cross the central mountain range from west to east coast. I am not unfamiliar with the path as the land of lion is located at the beginning of the route, the peripheral clinic which is situated at the highest point of the route is also a frequent site which I visited from time to time. The distance is about 300km and with more than 20 speed trap spread along the route, the average speed would be a pity 70km/h and it would take 4+ hours to reach the college.

I was lucky that one of my classmates had decided to join me on the journey. Well, still, I was a little anxious about the drive, I am not sure if I could complete the perilous journey.

It was not an uneventful shift as I could only caught a short nap in the afternoon. At the beginning of the drive I felt a little bit worn off and have doubt that I could complete the drive. I am not afraid of driving along the curvy mountain road as the light of opposite car’s lamp offered a pre-warning sign at each cornering. My dad who is a veteran at night driving taught me about this fact when I was very young…

I completed the 300 km drive after 5hrs under the grace of the Great One. It was a smooth drive as most of the traffic light was shut off and there were only a handful of truck/car moving around.

I woke up after 5hrs of deep sleep and enjoyed the spectacular view around the college.

The credit fee of RM350 was waived as a local church had sponsored the course.

The drive back home took a little bit longer than expected as the traffic was pack in the daytime.

I praised the Great One for this uneventful trip, 12 more credit to go….