back to 9...

Well, our plan to intake a newcomer had failed. The offer was rejected and we were back to square one. The problem had become worst new months as the other locum doctor had quit. We would had to cover the weekend night shift by ourself...

I was "allocated" with 1 shift and next months, one of our ED colleague will be taking his routine 3 wks break. That would make my night shift count back to 9....

I am not sure what would happen later but I am prepared for the worst....Would I resign and get a new job ? Most probably not. I dont want to move again... 20+km upnorth is Kaohsiung and the hospital is 20km downsouth from my house. I am happy with the current living environment. Lots of peoples had told me (not my colleague, but the locals)that the education resource in the suburb is definitely uncomparable in the big city. Well,  I tend to denied it and I think self effort and parents role is important than tuition.

Deep in the heart, I am still worry that my child would be handicapped at the starting point as I did not provid her with the best school. But as I look at her performance, I think we were on the right track.

Sometimes I still dream of getting back to work with the MOH...but the dream is drifting away slowly...

illegal and misconduct

The typhoon had badly hit the northen and central part of Taiwan earlier this week. However the southern part was spared. Building collapsed , bridge sunked.. 20+ peoples lost their life...

I was not surprised but such news... 20+ yrs ago when I first arrived here. There were this busses which were called "wild chicken bus".  At that time, the only legal long distance bus service was manned by govt. However there were bussiness man who run the illegal bus service. They uses 40+ passengers big bus ferrying passengers from south to north and vice versa. The police could have stopped them easily but no action was taken as people reps such as legislator had involved in the activities. This country had been well known for favor....

The hotel which was washed away by flood in the hot spring region had been built without a license and did not have proper infrastructure of steel /cement. And later in the TV, those illegel operator had condemned the authority for asking them to take down there illegal building. They plead that the act may make dampen their income. All I could say is "WTF!!!".  There were 20 hotel/ L &B operator in that area and only 4 of them were legal. The rest of illegal and due to their irresponsible act of building without any environmental evaluation - the flood had taken away life.....

There were also a also a fire and rescue officer who had fallen into the flood while doing a search and rescue. Everything was recorded by the TV. 5 officers had used a rubber boat and tried to row in themself to nowhere in a flooded river. Part of the brigde was collaped and 3 cars had fallen. Only 1 body was found and 5 still missing. The families of the victims had condemned the search party that not enough effort was done. So I think the F and R department had tried to show their effort over air. The drift of current was so strong in the water and I don't think motorized boat could sail properly. Luckily the officer was saved 5 hrs later. I saw a scene of family "ordering" the party to search here and there just becoz they the fortune telling clamp had shown a 3 positive result. (One would pray and throw the fortune telling clamp , if the clamp

Xian's school...

Xian had gone to school and doing well....

We had tried in the past when Yun was still in the senior class. However he was unable to concentrate and willing to go into any class. He had become familiarized with the school and we think that sending him back to the same school would not make him learn properly. We sent him to another school instead. It was not far away from Yun's previous school. The teacher there was friendly and the senior teacher had tried to couch him on 1 by 1 basis starting from learning daily rules. He learnt fast and was able to coup with the stress of being restricted from doing this and that. The restriction was less intially and later the net was tightened. Our conversation had become more interesting. In the past, I am always the one who intiate the talk and it went like 1 ask and 1 answer. But now, he would come to me and start a topic, he asked and expecting answer from me. He would told me what to do and wished to join what I am doing... He had gone into the classroom and joined the others. He would finished his homework after class.

Well, I am not sure if he would be ready 1 year later for the primary school. But he had progressed so far. I am glad as I had expected the worst .

Ving got all the credits as she is the one who had looked after and care for Xian in the past....many peoples had told us that it is difficult to bring up such child, but we are considered lucky as Xian had progressed so much....

massive casualties scenario

  It was 8pm and I had just seen a pt with traumatic SAH and sending the patient up to ICU. When I placed my foot steps in the ED, the nurse told that the Emergency Dispatch Channel had just called and told us that there had been an MVA and unknown amount of patients are coming in…I did a curse and knew that the “unknown” meant a lot, uncountable, unable to estimate… the next few seconds the ED door just slide open and 2 patient was brought in a truck. I get out from the ED and walk toward the counter and instead of seeing the patient – I told the counter clerk  to intiate  “ code 333” ( that means massive casualties scenario)…

This is not my first real massive casualties scenario – and I had my surgeon around….I walked back to the ED and started to see the patient.

Everything was wrong. The ED medical sheet, the staff management, the admin – things should not have gone like that. Everything done in during the drill was not follow properly. But we were still able to managed the scenario….

There were total 23 patients – 2 were transferred under my request : a 6y/o girl with pulmonary contusion (> 50% pul hemorrhage noted) plus minimal pneumothorax. Another 24wker G1P0 with pelvic fracture. Without MRI , O+G, Paeds Surgeon, we just can’t take this 2…

The incident : there was a local temple which held prayer. After the prayer a gathering dinner was held along the roadside. A tent was set up and few tables were arranged in it. A lady had rammed her VIOS toward the tent and those peoples in the tent were injured.

Well, I think we can do better next time - smoother and patient could be managed more promoptly...a post mortem would be done recently...

massive casualties scenario

 

It was 8pm and I had just seen a pt with traumatic SAH and sending the patient up to ICU. When I placed my foot steps in the ED, the nurse told that the Emergency Dispatch Channel had just called and told us that there had been an MVA and unknown amount of patients are coming in…I did a curse and knew that the “unknown” meant a lot, uncountable, unable to estimate… the next few seconds the ED door just slide open and 2 patient was brought in a truck. I get out from the ED and walk toward the counter and instead of seeing the patient – I told the counter clerk  to intiate  “ code 333” ( that means massive casualties scenario)…

This is not my first real massive casualties scenario – and I had my surgeon around….I walked back to the ED and started to see the patient.

Everything was wrong. The ED medical sheet, the staff management, the admin – things should not have gone like that. Everything done in during the drill was not follow properly. But we were still able to managed the scenario….

There were total 23 patients – 2 were transferred under my request : a 6y/o girl with pulmonary contusion (> 50% pul hemorrhage noted) plus minimal pneumothorax. Another 24wker G1P0 with pelvic fracture. Without MRI , O+G, Paeds Surgeon, we just can’t take this 2…

The incident : there was a local temple which held prayer. After the prayer a gathering dinner was held along the roadside. A tent was set up and few tables were arranged in it. A lady had rammed her VIOS toward the tent and those peoples in the tent were injured.

A post-mortem regarding the response plan is definitely needed.....

Meeting , meeting, meeting and meeting....

I had attended 4 meetings yesterday... it was my post call day and  I went off by noon. It eaten up all my time and I had only a short time for my rounds...

The 1st one was the ICU review - weekly routine to review appropriateness of ICU admission and day of stay. The 2nd one was ED personnel meeting - an unusal one. Boss wanted to get someone considered unfit to our hospital. His intention is to train him and make him "fit". This doctor is currently doing locum in our ED - many thing could be mentioned regarding his "mis-"... I don't want to point any finger as everything I knew was hear-say. But life would be a great change if this appointment truely happen. Night shift would be less, I would need to take up some Weekend call, pay would be less as well...the key point is - no one is sure if he is interested as he gave different answer to the top people. I am sure if he join us, then my life would be better (minus the cut of pay of coz...)

the 3rd one was the pharmacy operation meeting. I am not officially in it but as the "electronic order system" I am responsible at the moment has some relation to the daily UD(unit dose distribution) operation. The order system generate a prescription whenever a drug is enter in the ordering sheet. The head of the pharmacy can be described as a person reluctant for change. He objected every options or changes we proposed.. "This cannot and that would be problem , their loading would be increase"....We had 2 meetings in the past and this is the final one before fully implementation could be done. I had a bad start as most of the problems complaint by the pharmacy were due to incompetent of nurses... I had to live with it as the ward chosen for the test ground were "problematic" unit... I agreed with the choice intially as the daily operation of the relevant ward was less but their out of shape conduct had complicated the process. The nurse didn't even look at the prescription before sending the prescription down...

The 4th one was the infection-control committee and again I am not on the list but I would need to seek a approval of extending the antibiotic review period from 3 to 7days. The current review system was set to control the use of antibiotic and currently we would need to order renew the antibiotic in a very frequent fashion. Nurse would have to go around asking doctors for prescription. It involved regarding the system I am working on as well....

I left the hospital by 1pm...so tired after a bad call...I had 3 more committee meeting coming up - the ICU, the medical ethic and the patient safety....

I hope to make some changes.....

Kam Dou Tak ? (like this also can ?)

It is a typhoon day... I don't know why, I had my shift during most of the typhoon days... well, had to live with it...

however the gusting wind did not depress me, but the news of the 3 new ISA detainee shocked me...

2 journalist( I considered blogging as journal writing...), 1 senior  state Exco member(I thinked she ranked as deputy menteri besar), I think one had been left out  - the true racist...... well, I sincerely hope for their early release......

where is the wind of change ?