bitten

It was a last day of the "cold front" night - supposed to be a peaceful night - at least the "small night" shift(4pm-12MN) was... I had a 999(a.k.a code blue) and I managed to get a ROSC after 15min of effort...A CVP was inserted as hypotension was noted. After the CVP, I went back into the blanket and wished for a good night shift the rest of the night. But by wish lasted for only 10 min - > "ETT cuff leak noted with bed I X, might need a re-intubation...". I gladly complied and went back to ICU. The patient was struggling as the nurse tried to remove the ETT - no a good sign : "S n R" (struggle and resistance)...
I ordered a propofol - if muscle relaxant was ordered, the nurse would have to take a long time(ran to ED ... it was the hospital policy to keep it in ED and OR only) and  propofol seem to be a  good choice at the moment - and I was wrong....

  I waited for the patient to calm and introduced the blade... the patient suddenly awaken and started his "S n R" tour. He had caries and lost half of the tooth and the blade had sunken into one of the gap and my right index finger was bitten following the sink.... Luckly no wound was done but I had a bruise over my index finger's nail bed....

darn ... 3rd time since I got my license, reminded me to insist for muscle relaxant next time....

Best employee award again...

It had been 1 year and the election was on…Unlike the other hospital I work in. The best employee award was generated by election. The staffs vote for the best nursing personnel and the best employee…
Well, as the last year award holder, I was barred from being voted for the next 2 years. The nursing list was not surprised as the winner came from big unit(means unit with more than 10 staffs). These unit can “request” their member to vote for specific person in the unit….
The best employee winners went to some ‘rover’ … those who roved around the hospital…
The polite rover would attract enough vote as other staff would have a good impression on them...(I am a rover as well, I roved around in the night...)

well, a little bit unfair and much more to be improved, But I still felt that every winner deserved the award as they really work hard..

bone problem...

I had tried very hard to keep myself update on my job, however sometimes, I had doubt…. Thank god, someone had invented something called the internet.

We had this osteomyelitis case who was referred to a medical center for further management. There was a great chance for the patient to get the disease as she had rammed her bike into a drain and the bone was soaked in the drain for sometimes before she was dragged out. A simple trauma case who undergone surgery in our setting...

It should have been ok eventhough osteomyelitis developed. However we had pushed ourselves to the current ground. Proper communication was not done pre-ops - no one had explained the risk to the family. When the wound broke down and pus was pouring out from it the family was still hoping for a forever remedy - the family was polite : I just don't care how you all fix the problem, just healed the pt.... 

 The implant was removed and however a plate was re-planted on the second debridement. And weeks after discharge, pus was noted from the scar again...Well, this time, the patient was referred to a bigger hospital up north ... and more shoking news came later -osteolytic lesion was noted (so rapid...) . We reviewed our film and found that no xray was repeated on the latest admission...well, the worst is not another suit as one of the close relative of the patient was a ex-convict ( man-slaughter....)...

For a moment I was a little bit shock when I heard the whole story as it was not the 1^st time for the attending doctor to do so…(the last pt expired after a severe noscosmial infection) .

I had a discussion with Lem and we had re-confirmed over the net that the concept of removing the implant in an osteomyelitis situation was appropriate.

It is impolite to criticize our colleague…but I still felt someone should talk to him…..

Pain in the ear...

The H1N1 immune injection is available to the school kids since mid of November , I had my jab earlier this months – darn painful one, my arm sore for about 3 days. My heart sunk when I saw the milky fluid in the syringe. Must be a painful one, I grumbled as the needle penetrated my skin…But the govt provided the medical personnel with the Novartis product instead of the local made GG biomedical co….

Rumors had said due to the lack of the egg, the factory had utilized ordinary egg instead of customized egg for immunization injection production.

However as all the school children are scheduled for the injection. Each hospital was “allocated”(force should be the appropriate word)

A few schools for the injection. I was part of the injection team …

For the past 2 weeks, I had gone participated in 4 session and seen over 1300 students(primary and secondary school). The hospital was paid RM5 per student…The money did not slip into my pocket…I had observed a few interesting point during the needle pricking session..

1.   The student got the pain in the arm and I got pain in the ear – I had to put my stet on and off 300+ times each session…almost otitis externa…

2.   No student appreciate you service… only less than two hand full of the students say thank you to me.. I think those kids saw as “BULLY”…

3.   Kids gave every excuse just to escape the injection. The worst lies came from secondary school student – they often give you some story that was so inconsistent ( “I saw the doctor 1 wks + ago for flu and I am currently still eating his medication ::: taking my ass -> clinic usually give 3 days medication…)

4.   The kampong boy are braver …

Another few thousand awaiting me….

Zafira - salt eating experience....

My Z have undergone a major repair lately…

It all started around the 60000km service…. 60k km is one of the major hallmark of service for the Z -> the change of the timing belt. Unlike the Jap car, the timing belt replacement came in a set : the change cost around RM 1600… And it was the start of the catastrophe – the change required 1 full working day and I had to left my car in the workshop. During the service,  I was informed that 2 more replacement –

1.   brake lining shoe – fair enough after 60k km …

2.   Clutch pieces of the easytronic gearbox had worn off (the distant was 8.85 instead of the minimum 9 )…

The brake lining cost about RM500 and the clutch piece was about RM2600….

Well..as the Cantonese said – “when you wanted to eat salt, make sure you can tolerate thirsty..” so be it..I had to concurred with the changes…

The clutch replacement was a major one as the engine need to be lifted…it was a 3 days work : so my Z lay in the workshop for another 3 days…

During the replacement, they found that 2 balance beam had loosen and replacement was needed as well – the goes another RM360…

Well, the total cost was around RM6000….

But I got my Z like a new car – no more lililala sound here and there – and the sprint was darn smooth…better than ever driving experience….2 more years and hopefully the Zafira C is out by then and Opel is still available in Taiwan...

clever patient...

It was 6am in the morning....I had a good night sleep, 3 patients seen (and they all came within the same 30 mins) and no call from the ward after 2am. The patient was a 60+ y/o male sent into ED by the local 911 ambulance. The nurse had told me that the patient claimed that he had an intestine rupture. I looked at the patient behind my desk when the nurse told me that complaint. The patient is bed-ridden and he doesn't look like a "medicine man". "Another clever patient..." I grumbled as I walked toward him.
The history taking was long and unpleasent as the patient is a case of old stroke, bed-ridden and suffered from dysarthria. It tooke me a while before I get a incomplete image of what had happened. He claimed that he had constipation problem and use to enema himself. During the enema he had heard a "pop" sound and severe pain was noted over his lower abdomen. Indeed, he had an distended abdomen c rebound. But I also notieced he had a over filled bladder(up till the umblicus). I ordered a urinary catherization and gave him an NSAID jab. The catherization produced around 500cc of urine and his pain was not relieved. I ordered an abdominal cat scan and managed to get the full story this time. He did not use a glycerine ball nor evac enema(bottle of 118cc of glycerine) for enema instead he slided a hose(yes water hose) connected to a tap and inserted the other end into his anus. "Holy XXX" , he is right,  definitely a rupture in the colon. What amazed me was he had left side weakness and his left upperarm was contracted.

 I gave him 50mg of pethidine and called the surgeon. No free air was seen on the CT scan as I expected. The surgeon came and concurred with my decision. He was sent to OT and Hartman procedure was done.

 
Well, you don't need a scan sometimes - proper history and physical examination concluded your diagnosis. Sometimes I would tell my patient and their family - I take the image because I want to let you see the lesion....most of the time it was waste of money and time but it protect my ass  ....

Uninvited...

It was a quiet night until 2am.. I had been disturbed by call from the wards and the ED. Around 3:30am , there was this family wanted an explaination and I walked out from my call room. The explaination was short and I walked back to the office minutes later. When I opened the door, I had seen a shadow moved inside the toilet. The toilet just at the right end of the room from the room, I could see the toilet door just when I stepped into the office.

The ED office sketch.....

 

I was stunt and waited for a second, before I asked "who is there?" A voice anwser from the toilet and "I came for a pee". "PEE" my ass I grumble. A voice means he is definitely human and not any being that belong to another word. I walked into toward a toile and slice the pie. I saw a person about 175cm tall wearing a cap and blue jacket. He saw me and told me that he couldnt find any toilet and so he came here. I was a little annoyed, "WTF" I grumble. I chased him away in a unhappy tone. He quickly zipped his pants and I walked him out from the room. I sat down and had a quick thought that he might be a thief - but I was too tired. The next day, I shared the incident with Lem, and Lem told me that he was definitely a thief. I went to our engineer department and told the manager what had happened. We traced the surveillance camera. Yes, he is definitely a thief. He had entered the hospital 20 minutes before he walked into the office. He had wandered around and took the lift to 7 floors. The nurse was sitting in the station but did not ask him what he wants when he walked into the ward. Then he wandered around the registration desk and waited for me to come out and see my patient. Fortunately I did not take too long to do so and I walked back in heavy paces. If I had not make any sound when I walked back I might had caught him red handed searching for something -then a fight and someone may get hurt....well, I was lucky, nothing was lost. I had a couple of hundred laying on the table along with my laptop, mobile phone....... well, I was lucky I don't have to confrant him ... or else someone might get hurt....

We had actually hired a security guard 3 months ago. However he was sitting in the ED instead of sitting where he should be. If he had sitted at the security desk and questioned someone who had entered the hospital but did not seek help in th ED, the thief might had walked out straight. But it is not the time to make a big issue about this neglect of duty - boss might think it is useless to hire them and we would be back to dark age again.