CNY call , D-4

CNY is a nightmare for the ED staff. All the outpatient departments are close and everyone rush to the ED. You would see a lot of GI upset, flu and trauma. The ED would be crowded and patients and family staring at you hoping that you would speed up and see them ASAP.

I have to do 4 consecutive night shifts starting from CNY eve as I would be leaving from homeland for 10 days. The ED roster is always you gain some and lose some basis; most of us will comply to others request if there is no other event.

Well, the ED was packed as expected when I walk passed the triage desk. At 10+pm, a 21y/o lady had presented to ED complaining of abdominal pain since morning. She claimed that she was pregnant. She confirmed her pregnancy with a pregnancy kits. She was wearing a tight jean with plumy look. It was difficult to tell if she is truly pregnant. I had bad feeling when I saw her. I took her to the bedside and did a bed side sono. Fetal heart beat was noted and I was unable to locate the head…bad sign, should be in labour and the station was definitely low.

I rushed her into the resus area and asked the nurses to alert boss (I saw him wandering around earlier). A quick VE confirmed my fear; fully open os and fetal station is +2… I “interrogated” her further and found out that she was G1 and unable to recall her last menstruation cycle. She claimed that she had only one pre-natal follow up and unable to recall the due date. The contraction was not prominent as she was plumy. I had 2 choice at that moment, one to deliver the baby and two to transferred the lady. Option two was applicable as she was G1; but it might also jeopardize the fetal as it might be premature and might be complicated with prolong labor. I made a decision to deliver her as boss had agreed to come. It was risky but worth the effort to save the baby as boss was well trained in neonatology (his record was 800g premature in our hospital ).

Boss arrived about 10 mins later and he joined the team. We had a hard time as she was a primigravida. The baby was delivered after 30mins of effort. The baby was well taken care by boss and was in good condition. I had a hard time repairing the vagina tear but was able to manage it with the aid of surgical assistant.

Well, my nurse had later asked the girl that who was the father…. Her answer was not surprise –“ex-boy friend”. She said that she don’t want to kill her baby. My nurses pointed out to her that the way she managed her prenatal was incorrect and might hurt her baby.

I came out from the scenario with more than 10 patients waiting for consultation and I managed to clear them. 2 of the local regional grade hospital and denied my referral as the gestation age was uncertain even though the Apgar score was satisfactory.

I finally got a referral up north at a medical center. 2 hours later, the EMT who escorted the duo called me up stating that the lady had given a false identity during the consultation…. She was actually 17 instead of 21. I sigh and surprisingly I did not curse even though I need to re-enter the “#%#@#” medical note again. Truly an unforgettable CNY eve….

CNY....

The only period that I enjoyed CNY after I start working was those day with MOH. The Chinese colleague was given priority for leave and with some manipulation I enjoyed a 4-5 days rest. My parent’s house was near my in law and I don’t get trapped on the highway. After I left Malaysia, life had become different. Although the holiday was much longer but we need to split it into half; the workload was triple during the working days. CNY eve is the splitting point and each of us enjoyed a 3 days off instead of 6 days.

For the locals, 3 days is enough, but I would need at least 8 days for a trip back home. In the past, it was simple but nowadays, I would need to adapt to the schedule of Yun and Xian; they have tuitions classes during the winter holiday. Secondary school is different from primary school…..

Yun and Xian had lost the feeling of CNY. They had never expecting any new cloth as we don’t buy new cloth for them prior to CNY. They have no chance of eating a reunion dinner as we are the only family around and I worked most of the CNY eve. No relative means no Ang Paw but they are definitely not looking forward to the extra reward. For them , CNY is just another trapped in the house holiday as I preferred house detention as everywhere is packed with people. The conclusion : CNY is nothing to cheer about for them.

But CNY was a grace for a poor kid like me. I don’t have the luxury to retain all my red packets, but yet I got to keep the one from my grand parent.

From time to time, Ving and I had tried to introduce the CNY feel to them, however we had failed. This year, despite the struggle of going back during CNY, we are not enjoying the trip with our family…..a trip to Sarawak and Penang would consume most of our time in Malaysia.

walk in and straight and exit laying...

After the joining of our 5^th staff, life was better but however the quality of night shift had gone down. We were being harassed q10-15min most of the time by nurses. The fee of RM 50(all in, no partial burden) is considered cheap to the locals as it is just walk in and seen by doctor without extra waiting(especially in the night). Of cause the health insurance covered an additional RM140 medical fee to the hospital (simple flu, stomach upset with no examination done).

Most of the ED physicians are not afraid of those critically ill cases as when they stepped into the ED, you could tell everyone related that the patient is so ill that he would die. The most horrifying patient is those that walked in and deteriorated out of your expectation.

Lem had left me a patient yesterday. An old lady with mild abdomen pain for few days. Lem had told me that she is case of diabetic nephropathy and had undergone a partial hysterectomy with bilateral opphrectomy 2 weeks ago at a big hospital at the K city outskirt. An KUB was obtained which revealed markedly distended colon. Lem had ordered a CT before he left. I took over the case and review the CT later. The CT did not reveal any significant finding apart from the colon distension. Her white count was rocking high at 19000 and Creatinine had worsened from 2.0mg/dl to 6.0 mg/dl. Despite of her status of afebrile, everything pointed to the direction of septicemia. I told the family about the result but the patient had opted to return to the “big hospital” up north for further treatment. I told the family that although she looked stable, she is at the risk of sudden death. The patient had however decided to transfer despite of my explanation. The final check vital sign before her transfer had shown a BP of 55/30mmHg. We approached her and she was fitting. We rushed her to the resuscitation area, I had a moment of hesitation to intubate her as she was still breathing but drowsy. She was bradycardic on the monitor. I ordered 2 epinephrine but no obvious improvement was noted. I ordered 2 vials of sodium bicarbonate and her heart rate was stabilized and regained conscious. After the event, the family had decided to stay back and patient was sent to ICU. She passed away later that night….

Family had accepted the situation as there was time for the family to accept her condition.

Good bye 2016

It is a “nothing to shout” year for me, nothing much had been accomplished but yet it was an exciting year for me. I had done a few road trips which were considered as perilous for me. Thanks to the great one, I had escaped from a few possible medico-legal suits. I had become older but and maybe a little bit wiser…..

The most notable part is that I had not visit the Boleh land for over 1 year. Being home sick and I had been grabbing every opportunity to lay my hand on Dim Sum, Cha Sao Bao and curry. I had even made some Sri Muka few months ago….

I had been lucky as life was tough for most of the people. The extreme weather this year had disturbed the life of many locals, but yet I am freed from the harassment.

I had been home-bound this year, trying not to leave my house. I felt anxious leaving my house. Our 4^th floor had become a secret retreat for me and Xian. We shared a good time playing nerf war, challenging each other on SF5, Mortal combat X.

Last month, Ving and I decided to invest on a massage chair and we were amazed by its effect.

However, I know hiding in the house is not my destiny….

20 mins till the end of my shift and I would be joining my family for the countdown after I struggle with the traffic…. 

5th staff

Our department was joined by another staff 1+ month ago. It was struggle for us having our 5^th colleague.

The new staff G is someone I knew. He was a trainee resident (not registered, pending examination) during my days in AT hospital. He had passed his exam and later shifted to north where he completed his training in emergency medicine.

We were desperate to have a 5^th staff joining since earlier this year as we could barely cover the 3 person shift during weekend.

The management had a problem with our shifts arrangement after G agreed to join us . They had only approved a 3 person/d setting on only weekend; thence 5 of us will be facing a deficit of 1-2 shifts per month. The management told us to accumulate the deficit and pay the hospital back in February during the Chinese new year period. In other sense, we need to do more shift during the CNY; paying back each shift as holiday shift.

None of us agree with the decision. After a few round of negotiation, the management had finally agreed with our proposal.

The pros ->less night shift(2-3 less/month). The cons, more holiday shift(1-2more/month). But as holiday shifts will be 3 ED/d, the work load will be less.

It had been 1 months since G joined, and I enjoyed the luxury of doing less night calls. But It won't last for long....

padan muka (match their face)

It was a bad call, patient coming in on 15min basis. The sleepy bug was chased away by the 2 female patients sent in by the ambulance at 3am. They had ridden a bike and rammed onto a tree along the roadside. The rider was confused and the back seat passenger was alert. The back seat passenger suffered from multiple contusion and abrasion. The rider was however noted swelling of her face with epistaxis and rt ear bleeding. A sign of skull base fracture and I had proceeded with the essential CT scan and other imaging examination. Both of them were nursing student on their way down south for a holiday.

The imaging had revealed a rt maxilla bone fracture with pneumocranium. She was lucky as there was no intracranial hemorrhage.

Unlike the backseat passenger’s parents who came within an hour; the rider’s parent came late. I had presented the backseat passenger (BP) condition to her parent on their arrival. Since they are not residing around our area, they had requested a referral to a medical facility near their residence.

The father had asked my opinion and I told him it would not make any difference as the on call surgeon would review her and make the proper arrangement. The couple had a further discussion and told me that they wish to refer to YT hospital. I overheard their discussion and apparently the father had proudly told the mother that he knew the special assistant to the chairman of the board of the YT group.

YT group was initially a property developer and later venture into education and medical field. They had secured a land near the outskirt of K city. Theme park with shopping facility, university and hospital were built over the area. They had wanted to start a medical faculty but however restricted by the government as the quota of medical student was used up. As the chairman of the board had a good relation with the former president, the university was allowed to set up a special medical class for African student – training them to become qualified doctor. The condition was that the graduates from the class were barred from practicing in Taiwan upon completion of their course.

The “connection-relation” culture is a rooted deeply in the local community; If you have connection with big gun than you should be in good hand. From time to time, there is always some patient/ patient’s relative came to the desk and asked our staff if “who or who/aka Big gun of the hospital ” is around. They is showing off that they know the “big gun”, and they deserve better service. If the big gun is around, they would request the big gun to approach the medical team asking for “special treatment”. Frankly speaking, I hate this kinda of culture; one of the reasons I left my ex-employer.

The girl was sent over to YT hospital later and I had dragged myself to the govt clinic in the land of lion after the hazardous call.

At around 9:30am while I was taking a nap…. My head nurse had called me up and told me that the parents of BP had called up and wanted to speak to me….My heart sunk as I thought I must had missed something; the parents had demanded an explanation.

I called back and the voice of the anxiety mother over the phone pacified my soul; it was nothing to do with me. Apparently the ED physician had referred the case to the plastic surgeon instead of the neurosurgeon. The plastic surgeon on call had told the parents that if they agreed for ops later, the girl would be admitted to his service. If they are not willing to do any surgery for the facial bone, then they should discharge straight from the ED. The parent was in a dilemma and hesitated to do an early surgical decision. They called me to ask me for a second opinion. Well, sometimes the pulling string magic failed, I guess.

Few weeks later, a group was tree was sent to ED in a busy afternoon. The reckless youngster had rammed onto a small van; none of them had fastened their safety belt. The front seat passenger was noted with severe depressed skull bone fracture(closed). But luckily there was no intracranial hemorrhage. The father of the victim was gangster’s honcho type of person. He used strong language and had raised his tone from time to time during the conversation with me. I had called up our neurosurgeon and during the explanation session, the father had expressed his in-confident with our judgment and suggestion. He had asked for a transferred and our neurosurgeon had gladly complied with his decision. After a long period of working together, we had developed a mutual consent about such patient – transfer as the patient wish to avoid further medico-legal issue if the patient’s condition deteriorate.

The father had then raised his tone while telling the other family member that he had known a big gun at the related hospital.

When I told the father that the relevant hospital’s NsICU was full and refused our referral. The father had tried to make some calls and failed to secure a bed. He had then called up another neurosurgeon and passed the phone to me for further explanation. The neurosurgeon after hearing my presentation had however suggested the father to stay back at our hospital for ops as our neurosurgeon was his senior and in his opinion is a well trained and reputable surgeon.

Our of my expectation the father had changed his attitude and acted like a bug wagging his tail and begged our neurosurgeon in his clinic for further management. However, his begging was in vain and later the patient was forced to transfer out to another setting.

The patients and their family’s attitude decide what they get. Somehow, they deserved it…

Summer trip 3/3 ....2

The camping trip at the Wu Ling Farm was disturbed by on and off shower of rain. As we had arrived late in the afternoon and the sky was covered with heavy cloud. We were lucky to set up our tent before the rain poured. We had a simple dinner- Penne mixed with tomato ketchup and Thai chili sauce. 

I entered dream land after I complete a few rounds of MPQ.

The next day was a hiking trip around the farm. The view was spectacular and hiking at 2500m was still a stress for a plain lander like me.

We had a buffet dinner at the hotel in the farm after the hiking trip. The night was  noisy as it was Friday night and the camp site was flooded with campers. We had a neighbor of campers who had to speak out loudly to declare their presence. I presumed they were city dwellers who were so excited at looking at the green view. I had a good sleep despite of the disturbance but yet had to wake up early to pack our gear as we had to reach YiLan by 2pm. We managed to dry up our tent and hit the road at 10am.  

The rest of the journey and the conference were uneventful. Staying at the Shangri-La hotel for 2 days was considered luxury compare to the camping in the mountain area.

The drive through the snow mountain tunnel was smoother than I thought. I had purposely avoided the overcrowded weekend.

We had stopped at Taipei and paid a visit to a restaurant selling mamak store food. Overall speaking, nothing is up to the standard but for an old dog who is away from home too long…. It is acceptable.

This trip concluded my summer trip.  

I had been camping for the past 5 years and felt that I would cut by the frequency of camping in the future. Like my dad always said, you shouldn't save up on thy lodging, sleep is important during travelling.....