what if... can i change the will of the GREAT ONE.....?

Not a quite night it was…I was “vrooming” here and there … the rescue call station had informed us a case of “penetrating injury” – well, that was it, the details were mostly blurred. We had get use of their style of reporting… I was seeing another patient, when the ambulance arrived. The way the EMT “rusheh” the trolley into the resuscitation area means – very very serious case.

When I placed my foot into the resus area – I saw this…

“Holy SXXT”, I grumbled and started my assessment and my question round. The EMT told me that the patient was a bike rider and skidded. A wood had penetrated his abdomen and he had removed it on site. It was a big wood judging from the size of the wound.

He was comatose when the EMT found him. In our ED the patient was unarousable and only carotid pulse can be felt. The night shift Head nurse had assisted my with the CVP insertion and I got 2 pack of O neg packed RBC stat. The resus was not pleasent as the ED nurses were doing nonsense act(despite of getting large bore in, someone was exposing the patient with her best effort(cutting the very thick jacket...)

Within 15 mins, I had flushed in 2000cc of fluid plus blood via the 1 large bore and CVP --  the patient regained conscious - good sign.... The BP was still unmeasurable and I rushed him to the CT room. I had called up the surgeon and Anesthetist. Well, I think he would make it, it was an risky act, because, the pt might collapsed again and unable to make it to OT, if so , the surgeon and anesthetist would not be happy as they had to rushed from KHH….and further more I had no family to sign the permit. But I thought I need to give him a chance….

Well, we finally got a SBP of 70 mmHg and all those needed were at scene. The pt was sent into OT. However 30 mins later, I saw the OT nurse coming down to the lab and asking for more blood… Well, should be a mess and deep shxt situation. I asked the OT nurse and she told me the IVC was injured, I heart sunk…he is definitely not going to make it….

3 hrs later my surgeon came down and told me what he saw… the wood had penetrated and torn the rectus muscle into pieces and went straight through until it was stopped by the spine – thence the IVC and SMA was ripped off. The intestine look pale as no blood supply was noted . He told me that he would be losing the patient….

I did my best the rest of the night pouring any fluid/blood I could get my hand on into the CVP line….

It was not up to us… the GREAT ONE had determined what is going to happen.. I did not feel well but I think I could closed my eyes tonight piecefully as I had tried . But sometimes I wandered if I should go for a surgical trauma training, so that I could do more. I am seriously thinking about it…..

end of tour...

I had completed my tour of vaccination yesterday.... these were the 2nd stage of the H1N1 vaccination(target were 1st -3rd grade students...). Well, as the wide spread of negative news around by the media, the vaccination rate had been so low (<20%....) The public had been so panic... the media had been so happy to comply with the hysteric act of the public...example of 3 suspected adverse reaction secondary to vaccination...  1. 16y/o high school student who was vaccinated 11/2009 and developed thrombocytopenia in 1/2010 ...unfornately the youth died despite of IVIG management...

2. 8y/o student who developed pethechia and blister over his limbs after 2wks of vaccination...

3. 7y/o boy who developed bil lower leg jerking movement(EPS like jerking) after 2 wks of vaccination...

4.Multiple intrauterine death was noted after mother being vaccinated... The opposition party had mobilized some van going around the rural area, broadcasting about negative effect of vaccination and asking the peoples not to be vaccinated... I could accept their act but there is this key person from the society of O+G who urged those in their first trimester not to be vaccinated and those in the 2nd and 3rd trimester to withold and consider their risk before being vaccinated...I despised his act as what he did was talking without evidence(talk X#$%@%%%)  - at least he did not quote any research.....

As a medicine man, I could only shake my head... The public had wanted an unreasonable guarentte from the govt - a 6 months or long lasting healthy life after vaccination or else ....The public had however forgotten their request of vaccine 4 months ago.

There was this high school student who died of H1N1 lately despite of tamiflu used. The family wanted to sue the hospital and the media report the news like don't know what...Negative negative news... No one appreciate what their was given, remind me of those student who never say thanks after their jab....

The public had fablized the medical profession... they thought if they follow the rules, take the medication they would be immortal..well, unfortantely, only the GREAT ONE could decide....all we can do is assist......condolence to those who had lost their love ones....

vaccine issue....

The issue of H1N1 vaccine was flaming as the local news station had tried their best effort to report single complaint by the public. First was the "needle vertigo" phenomena . One of the news reported had created the terms : it all started when bunch of school kids noted with giddiness and vertigo after the jab. The reporter had used the term and later all the media had started to massively report it ( newspaper and round the clock over the news channel). I had a bad tour of injection due to the report – there was this school with 2 handful of primary school student experiencing vertigo after the vaccination…the student was pre-hypnotized by the news that vertigo was expected after the jab.

Later more and more negative news came out. One of the most prominent was a child of a O+G specialist. The child had suffered from rashes 1 days after the injection and his condition had deteriorated later and gone into septic shock. The cause of death was sepsis. Specialist from the department of health had speculated that the child died of sepsis cause by immune defect. The father had called up some rep and held a few press conferences accusing the govt of releasing vaccine which was not fully tested. They had blamed the death of their beloved child on the vaccine. I pity the family however despised their act. The accuse they made was based on nothing. The vaccine was packed into 40 doses per ampule, that means another 39 students had taken the injection. If the vaccine itself is the cause, there must be some reaction noted among the rest of the students who received the same ampule of vaccine. That however brought the issue back to the processing of giving the injection – issue of aspirating and injecting(in my opinion, this was the most likely cause). However there would be no evidence to prove so….so back to the square zero --- sepsis . Anyone could get a sepsis just like that, a small wound or some unclean food…

After this incidence , patient who died or developed illness( stroke, weakness…sepsis…) few days(or maybe weeks later) after the injection started to complain to the media that they were also victim and wanted the govt to grant them an explaination(or maybe compensation )….

Is the vaccine safe ? All I could said was a local doggie team magazine had reported few months ago that some of the eggs used to produce the local vaccine were not up to the standard(not sterilized enough ….)

I felt relief as xian and yun did not have to undertake the vaccine as they was infected and cured….

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….