The renewal run....part 1

The renewal of passport was one of the crucial events for me every 4 years. I need to properly plan the trip so that it would not be too early or too close to the expiration date. My earliest renewal was 8 months prior to the expiration date and ended up being questioned by the officer for the reason we chosen to renew it early. The officer had told me later that they had flipped through our passport carefully just to see if I have any specific reason that I did so and they found nothing; the process had taken them more than 2 hours to do so. Those who had come later than me had picked up their passports and we were still waiting. The officer let us passed when he knew that we had planned for a travel 3 months later and was unable to return to homeland for passport renewal as the kids were schooling.

When the pandemic started, my passport was far beyond its expiration death. However as the pandemic dragged on for more than one year, I had begun to worry about my passport renewal.

Returning home and comply to the quarantine rule would take at least 30 days [14days quarantine x 2 plus 2 days for passport renewal] provided that we are lucky enough not to contract the disease during the travelling. It would not be feasible for Yun,Xian and me. I had been closely following information about how the renewal could be done at the representative office up north.

The renewal process is easier at the homeland; you just need to present yourself, relevant documents and money. Photo would be taken by the officer and woo la .. it is over. My last renewal of passport at UTC Kuching was smooth. Even in the past where photo had to be prepared by the applicant; it was simple and all you need is walk into any photo joint and tell the uncle what you want. However the photographer here was unfamiliar with the standard of photo needed for the passport renewal. I was so anxious as there would be no margin for error as there would not be any photographer around the office trying to take instant photo making fast money out of those mischief who presented with unqualified photo.

I had to coordinate between Yun, Xian and me so that we could head to the mission and settle the problem in one shot. I started the planning two months prior to the action.

I had e-mailed the mission as suggested by most of the fellow homelanders from the web with no news for over a week. I had to call up and the call was answered by a female officer. When she knew that we were coming from the south; she had squeezed me into the appointment list even though the date I asked for was full at the time I called.

An order of “no event” was given to Yun and Xian around the date I picked; I had pre-arranged my leave and everything was set. However a small disagreement had altered my plan. Yun wanted to travel up north on the day of action. I wanted to put a night at T city and proceed to the mission without rush. I had to compromise and put up a night near Yun’s place one night before the date.

So it would be home ->HSR to TC city –stay a night->HSR to TP city early in the morning. Hotel and ticket was booked after everything was finalized.

The tricky part came later….

I download the sample photo from the website and gone to the local photo studio where I been patronized for years. I had to wear a deep color shirt which was not plain in color as it was my only deep color shirt I had. The studio owner had tried to be nice and made our photo look nicer…I was quite terrified when I saw the photo; a noticeable grin was noted on the photo. It would not be feasible to retake the photo and I had to cross my finger and live with it. Ving was actually happy with it as the photo looked nice…

I photocopied all the document needed and downloaded the form from the internet. The checklist however did specifically state that the form had to be filled AT the office….

Everything seems fine and fully prepare.....  

Double tap....

 

The work in ED is always a team work and as the lead in the team, you would surely want a group of staffs with good skills and proper attitude.

I had encountered a few taps lately…

It was a busy morning when I took over the shift. A car accident with multiple victims; a few youngster rammed their car onto a big drain along the road down south.

Two were considered severe among those victims. A 18 years old girl with T- spine fracture with another young chap sustained a brain concussion.

K told me everything was done and awaiting the family to picked them up.

I took a quick glance at the CT and confirmed the T-spine fracture(yeap it was my fault for taking a QUICK GLANCE). The two victims were surrounded by other and was chit chatting while waiting for the pick-up.

I got a call 1 hrs later by the radiologist.

“Dr L, I think I saw something in the uterus of the pt chart no 123456. I think it might be a fetus”, said the radiologist. I thanked him and cursed while I reviewed the CT again. It was truly a fetal like object in it. I pushed the sonography machine to the bed-side and asked the patient again….She missed her period 2 months ago and did not tell our staff as no one had asked her. WXF, I cursed again; no one even bother to ask the menstrual period! The EP, the nurses, the radiographer; the girl had gotten pass those 3 layers of defense and got hit by a large doses of radiation…Catastrophic incident and my most fear was being walloped by the family when I broke the news to them…

The sonography confirmed my fear, shinning spine with a heart beat was shown over the screen.

I called up our gynecologist for a consult and reported the incident to the superintendent. The social worker was called for further counseling.

One of the youngster around the girl appeared to be her boyfriend. 8+9 type of youngster.

8+9 is a synonym for “eight house general”. There are youngster involved in temple activity as dancer portraying as warrior from sky. Some of the temple had served as branches for triad and these youngster would be adsorbed as minion.

I was a little bit restless while waiting for the parents to come; hopefully they don’t appear with betel nut stained tongue and tattoo.

The father came in his working suit, he appeared like a good old man with good manner. And he was what he look like...

I explained to him about the injury and told him that the CT was done under an emergency circumstances. Father was worried with his daughter injury from his look as I explained the condition to him.

I was relieved when he mumbled that even if the child is ok, they could not afford the child. I arranged referral to a medical center where a further high risk pregnancy assessment would be done. 

The social worker chatted with me later and told me that the family was financially restraint and she had left home early to work. The father claimed that they could not afford to raise the grandson. I was not happy with the ending however it was best for all including fetus…

I had followed up the case 2 months later and found that D+C was done.

It looked like a very happy ending, parents saves RM1k for the abortion, everything was taken care of; girls and boys can go back to their life.....

How the hack did it happn? It was near passing over time, everyone rushing to complete their task and no one bother to ask seems like the only explaination and yet I think it is all act of the Great One....

It was a double tap for me as my staff had sent an elderly female with renal insufficiency for enhance CT without waiting the Cr result(her condition was not ok for that); I had gotten a narrow escape without a scratch with grace from the Great One...And this double tap had made me believed more about his grace...

However the third tap was waiting for me...

U path for XX

 

The path for Xian to University was a major struggle for me. He was not sure of what he wanted to study and lagging on his preparation plan. 2 months prior to the application, he had decided he wanted to dip into show biz. It was way beyond my imagination and all I could do was support his decision.

Only handful of school could be chosen from and Xian grade had limited his choice to only a handful of selection. Good news and bad news. Good news was we don’t have to travel a lot for interview. Bad news was he had gotten only one of it as favorite. He had opted for a University at the central part of the island. We had once passed through it when we visited Yun. It was situated on a mountain and very secluded. The hostel are mostly situated down the mountain and it was a short trip uphill on a winding road. Definitely not my cuppa of tea as a father…but it was not my choice and not my course…However we had however recommended few more school to Xian and persuaded him that not to put all egg in a basket.

The preparation stage was short as Xian was left only with 2 months before the submission. He had had to enter a photography competition and made a short movie. From time to time, I had asked him about his progression and for once, he had told me not to disturb him. I had told him, it was my duty to bother him as he had claimed that he did not wanted to sit for the designated exam (aka best result enter the best school exam) which will make him suffered for another 4 months. My job was to ensure that his wish come true. We were good after the conversation and I stopped my harassment as he promised he would keep to the schedule.

When his ability exam result came one early Feb, his choices had down from 4 to 3. He did not make it to the required grade for his favorite school. I thanked the Great One for answering to my prayer.

Xian was not very upset as he had three options left. The submission was smooth as he had completed everything; from the movie to the photo competition. With grace he had made it to the interview stage for all three of his submission. The most worrying part was the interviews as Xian was not that good as Yun. He had undergone a few simulated interviews at school and there was nothing we could do but prayed.

YSU was situated on a small mountain and it is a Genting like tourism spot with a big mall, theme park, luxurious housing project. SZU was located in a secluded area where the town was 20min drive away. CJCU is a Christian university located just beside a train station and located in a small township.

CJCU was the best choice at the time as it had a vast varieties of hostels to choose from and assessable plus convenient. Xian was looking forward to attend the school as he will be staying out campus and a bike will be provided to him just like what we had offered Yun. The thought worried us as riding around was considered dangerous to every Malaysian parents. However as the local church was situated just outside the school and it even had a society inside the school, we were still looking forward that he could enter the school and enjoy church’s life.

All of the interview had gone uneventfully and the final moment came months later. Xian was accepted to YSU and on backup list for the other 2 schools. Xian was not disappointed as he was very excited when he was given a short tour at YSU during the interview. Just like what I had told him when I persuaded him to apply for YSU; a loaded university with good equipment. He told me that he wanted to accept the YSU offer and not wait for CJCU 2^nd intake even though he would not get a bike during his college years.

It did not go down the road as we had imagined but yet it was a good start.

 

 

late flashback

 

I considered 2021 as the year of trapped. The terror caused by Covid rampage had restricted our movement. The local people had enjoyed more freedom than the rest of world; however the restriction of travelling abroad had really depressed me.

However I did encountered some matters that cheered me up despite of the depression that weaken my soul. Xian had made it to University. Yun was doing well on her first year with some struggle on her second. I had gone back to airsoft life where I set up my workshop and small range on the 4^th floor; I had shot a few IDPA matches and take a few tactical courses.

A few hazard was noted during my practice but I was able to retreat myself properly without any scratch. Entering into the field of long term care was a new milestone for me. The ride was rough from time to time and with grace I managed to surf to it.

I believed everyone will still be trapped under the current pandemic for the next few months. Some had considered the rise of the omnicron as a possible solution to the current condition but I am not optimistic about the situation. Travelling back to homeland might not be possible for another year and when the barricade was removed, the travelling expenses will be high.

post crisis

 

We were like a burnt child dreads the fire since then, we took rapid test for every patient entering our ED. The reason was simple, the local county government had kept sending patient relevant with the event for PCR test on daily basis; which indicated that the local community was not safe. Thence we started to treat patient outside the ED. For patient who needed to enter the hospital building for examination, they would need to clear rapid test for covid. The practice was adopted for almost 2 weeks when boss came to ask us about the situation. An inquiry was made to the local health authority and we were told that all related persons were cleared and the screening would be stopped in a few more days.

Despite of their promises; residents were still brought to our screening station by police. We felt uncomfortable with it but yet were unable to raise any question to the local authority. Our ‘clear to enter’ policy had gone for another one weeks before most of us loosen our grip.

There were no more active cases since then. Most of the cases diagnosed were residing in the north; some of them had traces down south but did not lead to any local infection.

The Hypoman visited us 2 months later and noted with hypoglycemia again. The Taximan suffered from shortness of breath and numbess over limbs from time to time and I had seen him lately in ED. The Mangoman’s wife had unfortunately passed away during her stay in the ward.

The Delta crisis had drawn an end after 1+ months of struggle. 2 months later the country daily Covid cases had hit zero again. Happiness did not last very long; another Delta cluster was noted in a kindergarten days after the zero emerged.

The rest of the story...

 

The event had led to an intensive contact tracing and isolation. After one week of effort, the local county health authority had found that the Hypoman had been a passenger of the Taximan. The Hypoman had chartered the service of Taximan three times before the Taximan was diagnosed. Meanwhile, the Hypoman’s wife was also confirmed as a Covid victim. The Hypoman’s house was just beside the Peru grandma’s house and his wife was relative to the Peru grandma. All of them was confirmed as Delta variant carrier;the link was apparent at that moment. The Peru grandma was the source, the Hypoman and his wife; although denied of any direct contact with the Peru grandma; had contracted the disease.

A few more positive cases were noted from the quarantine group; the Hypoman’s wife who was working at a 7-11 as shop manager, a few farmer who had a chat with the Hypoman and….

The Hypoman’s PCR came back positive after 8 days from the day I saw the Hypoman. I was lucky enough to escape from the quarantine list as they only backdate 7 days for possible contact.

It was almost 2 weeks from the first case when the final rock hit us.

While driving to my ward shift, I had gotten a call from my colleague telling me that there was a positive case from OPD who had passed by the ED. The ED will be shutting down for few hours for sanitization. The case was an elderly male (Mangoman) who was scheduled for a knee replacement surgery. He had undergone a PCR test as pre surgery evaluation and it had come back positive. He had walked pass by the ED before the swab test.

He was isolated and a wild goose chase of origin had begun. Few days later, his was proved as a Delta variant victim. His wife was also confirmed having similar infection.

After few days of contact tracing, the local authority had announced that the Mangoman had contracted the disease from the Hypoman’s wife.

It was noted that the Hypoman’s wife had presented to our OPD while the Hypoman was receiving treatment in our ED. Both the Mangoman and the Hypoman’s wife were in the same OPD waiting area on that specific day. According to their investigation, this was the only overlap trace and it was the only explanation that would explained the infection route. Our hospital was designated as the infection source and thence we would need to shut down for precaution.

Based on the above speculation the local authority had however decided to shut us down even though the southern command center of Covid prevention had against their decision.

The ED and OPD was closed down under and those patients admitted in the ward was barred from discharge. The hospital was still functioning without its OPD and ED thence no admission was noted. All the hospital staffs were put under self monitoring status and some of the closed contacts from the OPD were quarantined.

We were in a mist as the local authority did not state clearly the duration of shut down. According to internal source, the local authority had decided that we could only re-open when all of our staffs were fully vaccinated with the last vaccine taken at least 14 days ago. That was deemed impossible as we had only 1/3 of staff meeting the above requirement and it would be impossible for us to comply as the vaccine shortage was still haunting the country.

It was an agony while waiting for the re-opening announcement. Most of us had commitment and the management is not going to pay us as we were not working at that time. We were the designated primary PCI center and neurosurgical referral center of the southern tip of the island. Without our present, those relevant cases would have to refer further up north for management.

According to the national health insurance bureau, lost of income of a medical facility due to shutdown in the event of Covid will be compensated. The bureau would pay the similar amount of claim to the facility according to the figure submitted last year during the same month.

That period was definitely an anxiety period for me, everyone was waiting for the reopening order but yet everyday it ended in disappointment.

We did not believe with the contact tracing report. If the Hypoman’s wife had infected the Mangoman, why the other in the OPD area was not infected?

A massive screening was done during that period. Few thousand of people had undergone PCR test and none of them was found positive from this massive screening. All the persons who presented to the OPD at that day were summoned and screened and yet none of the result was positive. There were a few rumors later spreading around the community stating that the Mangoman had actually in contact with the Hypoman elsewhere. Those rumors were unable to be confirmed. The hospital had given up appealing early in the struggle as fighting the local health authority would lead us nowhere in the future. The local authority had contracted the part of the massive screening to us and we had received a great grant of material including two negative pressure chambers for further isolation.

The order for restarting service was finally signed 15 days later after our shut down. We were able to start our operation and everything went smooth.

The management had offered us to fill up our shift deficit by doing ward calls. Not a bad offer as it cut our wages loss to the least. The nursing staffs were offered a compensation scheme by deducting some of their outstanding working hours. Only a handful of peoples were left with a salary cut.

I had a long rest without a sense of insecurity; the mental stress noted was beyond imagine as I had to worry about the wages and also the afraid of contracting the disease even though I was fully vaccinated.

The Delta crisis drawn a red line since then and no cases of was noted.

The county government had been propagandizing their prompt action of management the Delta crisis during the period; however for me, it was a violent move of acting against advice of professional medical expert. They had stepped over our sweat and dignity by stigmatizing us as source of infection. The order of ceasing operation was the final blow and yet all the credit had gone to those bureaucrats.

The first 4....

During mid of June, we had received a call from the county health office informing us about a quarantine case would be sent over to us for treatment..

A senior lady who was undergoing home quarantine after returning from Peru had developed diarrhea and fever. I was doing day shift with my colleague G at that time. The ambulance came hours later with the ambulance team in full gear. Two patients came instead of one, the lady had brought her 10 years old asymptomatic grandson who was undergoing home quarantine with her as no one is looking after him.

G took the case and taken proper precaution while doing the consultation. A PCR swab test was done and xray was taken. The xray had revealed bilateral lung infiltration and we agreed that she was probably a covid victim judging from her xray and history. A swab test was also taken for the child even though he was asymptomatic. After 2hours of waiting, both the test result came back positive and a second confirmation test was done. We had informed the local health authority and as we had only one negative isolation ward and we had to referred both the case to another hospital.

The process was a smooth despite of the late transferring process. The case was placed all the time in our isolation room outside the hospital premises. The patients were transferred out after 6 hours of retention in the isolation room.  

The lady with her daughter in law and grandson had migrated to Peru a year before. Due to uprising of Covid cases in Peru and lack of vaccine; she and her grandson had returned for vaccination. They had travelled from Peru to Panama and later transit via Turkey, Hongkong and arrived in Taiwan. A long journey and they had caught the disease during transit.

The first rubble hit us 1 week later after our first Covid case.

About 10 days later , while I was on leave, the ED line chat group had announced our ED will be closing for 8 hours for sanitization as a positive case Covid case had entered our ED early in the morning.

A middle-aged male had presented to our ED at 5am for fever. He claimed that he was a delivery man and no significant travel nor contact history was noted. As no active case was noted around our county, the attending emergency physician had allowed him to enter our ER and he was put on a drip and antipyretics. A Covid PCR swab test was later done and patient was discharged without waiting the result.

By 7am, a positive result came back and our ED was shut down for sanitization. The patient was admitted to another hospital for care. Our colleague had apparently broken the rule and allow febrile patient to enter our ED. A swab was done without any proper precaution measure. The event had led to quarantine of 1 physician, 1 radiographer, 2 nurses, 1 attendant and 1 counter clerk.

Contact tracing was done and it had revealed that he did not give the whole story. He claimed that he was a delivery man but he only delivered human; he was actually a “taxi sapu” driver (illegal taxi operator). The contact tracing had led to a dozen of patient being isolated and checked. One of them was an elderly male who was seen by me few days ago. The elderly male  had presented to our ED for hypoglycemia and was discharged 3 hours later after his sugar stabilized. I had asked if he wanted any admission but he denied even though he was still feeling giddiness on his discharge.

The elderly male (Hypoman) was tested positive few days later. Now we had 4 cases, the granny (Peru grandma), the grandson (Peru grandson) and the taxi driver(Taximan)

So the connection between them was still unclear at that point…The common part was all of them lived around the same area……