Grudge

There was this incident 2 days ago…. I overheard the conversation while I was called to the ward. I decided to dig the story and finally get a good picture.

There was this patient admitted by LEM 1+ weeks ago. A bed-ridden patient admitted for fever. No obvious infection focus was noted and the patient was admitted to the chest physician. Antibiotic was shifted from parenteral to oral as no obvious focus was noted. However the fever persisted and later parenteral antibiotic was restarted. About 1 week after the admission a swelling over the pustule was noted over a swelling at the right inguinal region and the testes appeared to be swollen. The surgeon was consulted and testes incarceration was impressed. However the family had declined surgery.

After the consultation the surgeon had however commented (the nurses had used the word “bombard” instead) in a very loud tone with his nursing specialist at another nursing counter regarding the consultation[?delay of noticing the infection focus]. The conversation was of course overheard by the chest physician. Later that day, the nurses had described that the chest physician had shown a very long face….

The comment was done purposely in a very high tone – the surgeon had apparently wanted the chest physician to hear it.

I had shared the story with Lem and he told me that their grudge had started many months ago. The chest physician had not only once commented about the management of the surgeon over medical condition, however the main insult started over a referral patient. The chest physician had a patient referred for surgery but did not transfer the patient to the service of the surgeon after the surgery. The surgeon had told his nursing specialist to ask about the transfer of the patient. However upon request, the chest physician had told her in a sarcastic way (by using Taiwanese) – “ you can clasp the patient over [with chop stick] as your side dishes”. This was an impolite way to say it…

No wander the surgeon wanted to humiliate him publicly at the nursing station.

Indeed, the chest physician is overloaded with patient – he had too many patients under his service. From time to time, he would have patients(especially nursing home resident) re-admitted after 1-2 days of discharge. One of my senior(Malaysian current head of internal medicine dept in another hospital) who had worked with him had warned me about him prior to his arrival – a calculative person who tends to avoid anything which is not profitable to him…. I had stopped to admit irrelevant patient to him months ago after re-admitting those patient and wiping his ass in the midnight ( inserting CVP to patient who was in shock since afternoon as the only thing he does was hydrating without CVP).

During yesterday morning meeting, the chest physician was still in a low mode –

I would be very upset seeing a patient died slowly with his scrotum gangrene slowly...

I hope their paying back game ends here....

struggle of the ro(o)ster

After a week of struggle, the rosters(Jan and Feb) was finally out. Lem had did a lot of discussion with me…. The situation was kinda complicated. The were so many restriction. 4 persons with 4 different scheme…

 

I had agreed with Lem that we settled the roster than negotiate with boss about the pay. Actually I am the only one who is going to get adjusted as Lem and Ong had their special request.

I am reluctant to do so as I had planned to leave mid at next year. But I would have to experience a cut of my working hour later as we need to squeeze enough work time for our new colleague.

The extra cash would help us in the future as I would be experiencing a great cut during my training…..

I would be planning a short break after the Chinese New years- a week vacation in Malaysia….

Well, I had put my faith in GOD…Let the LORD laid the pave and I shall trace it....

Mercy...

 

It was supposed to be a good call – the cold front hit us few days ago. Most of the locals would stay at home, no one is gonna get drunk and ride their bike recklessly ending up in ED. But I was wrong – the 1^st OHCA( out of hospital cardiac arrest) came by 3am. Resident in a local nursing home, one of our Chronic Obstructive Pulmonary disease patient who had just discharged from our ward few days ago. He was found unresponsive by the nursing aide and sent over to us for help. I saw the blanket – so thin , core body temperature was 33C…negligence leading to freezing to dXXth… Well, the family came 20+ mins later and asked me to stop…

The next OHCA came by 5+am, another no sign of life for don’t know how long…. I did the routine and certified the patient…

Life was so fragile and sometimes we live at the mercy of the LORD. Few days ago, Yun and Xian had slipped a ruler into the piano…. We called up the piano tuner(who is also the dealer who sold the piano to us) and shockingly found that he had passed away. I later checked the tuning record and found that he had missed his regular tuning few months ago and we were not aware of it.

His son came for the tuning and I asked him what had happened to his dad – he grinned and told me that he met an accident, I saw the peacefulness in his eyes……

Our life is at the mercy of the LORD…. No one could defy the faith – I had learnt something – to value life and value whatever I had at the moment. I knew I had to be humble and love giving. I had to try my best to be an example and leave a good memory to my children…

Reshuffling ?

It was a great leap for us…We finally got someone to join us… he was my ex-colleague. He is a trained plastic surgeon turned ED physician. He was a man of night shift and locum.

Virtually he could do as many shifts as we can provide. However as our present scheme of 10-14(day shift 10 hrs, night shfit 14 hrs), he was unable to do consecutive daily night shift – he lives up north and the buses had been his main transport in the past. He had wanted a shift to 12 -12 but both Lem and Ong had against the idea and I support the 12-12 only if everything is fair and square.

So at the moment he had to settle with it. Boss had asked us to adjust the shift and we are gladly to do so. Ong and Lem will be taking their vacation next 2 months and there are lots of empty shift to fill in.

Boss had offered him with 35% more of what I got. I did not feel upset as my term is to re-discuss my pay scheme if anyone comes in and shift change….

I am still waiting and currently I would comply and tried to sort out what ever empty shifts there are present.

With 6 months left, I am not sure if I would want to fight for a big increment…

Shift was tough in the January as I would be doing 270 hrs ….

The discussion of shift did not go well initially as most of us did not want a change – however our colleague would be settled with our view at the moment.

I had prayed hard as I am really at the junction and the temptation of money is so great.... to stay and grab big cash or to train...

I praying very hard....

Resus and SHXT

A CPR/resuscitation scenario is always a thrill in most of the TV series/ movie, but in actual life, it isn’t. One of the main concern is SHXT and PXE ( feces and urine)… In about 1/4 of the case, patients(either with sign of life or not) are incontinence. You just have to tolerate the smell. The nurses wouldn’t try to clean up the mass if no sign of life was noted. The 30 mins scenario is sometimes a smell tolerance game.

Well, I had this middle-aged psychiatric patient sent over by the local asylum after she collapsed. A lady with BMI of >40…as usual she was intubated but I told my nurses that prep the ETT anyway, I said there is a 50/50 chance the tube is in the stomach.(but in fact, their record is 100% esophagus intubation…).

The patient arrived and as I had predicted – I had to re-intubate her…The nurse who came with the patient told me –she was seen in a hospital nearby for Acute gastroenteritis earlier that day. She was soaked in her own feces…I had to do my job…I certified her after 15mins later…

I remembered the film “silence of the lambs”, when Jodie Foster and Scott Glenn entered a Autopsy scene – they had applied some whitish cream over their upperlips to barricade the smell of the degraded corpse….Just wander where I could get those….(tiger balm won’t work…I tried it during my days in the casualty department as coroner)

the next wave....

one of my favorite movie....

I had finally finished the coding of drug… 450+ of them (it is really small amount compare to the 10000+ items of the National Taiwan University Hospital). The interface for the drug data managing and nurses drug dispensing are also readied. The nurse could just click the mouse and all the photos of drug for the patient would be shown on the monitor. The program is time specific, if the current time is 6:00pm , only the drug given on the time would be shown. The nurses won’t have to double check the drug with the pharmacist if they were unsure about the appearance of the drug.

However there are still 3 great challenges lying in front of the project. The 1^st is the photo, I got about 200 drugs with photo and the quality was unacceptable. I had coordinated with the art supervisor of the hospital and she agreed that she would get a desktop copy stand and take the photo for me. But I had to communicate with the pharmacist and get all the sample labeled and pass it over to her. Communicating with the head pharmacist is a problem as he had always been a stone head.

The 2^nd challenge is setting up the testing ground. I had did a preliminary discussion with both the matrons(we had 2 now- 1 for he critical unit and the new one is focusing on the ward)- the ICU would be the 1^st to run. But I would have to communicate with the attending physician and surgeon that all prescription would have to computerized –no more hand writing. Someone would definitely grumble….

The 3^rd challenge is to introduce the scanner and modify the dispensing trolley. Scanner and bar-coding are simple technical issue but the dispensing trolley is more complicated. Batteries, wireless LAN should be included and the MIS dept is currently still in limbo. They are still busy upgrading some of the window 2000 terminal to window 7 as I had upgraded my develop platform from VB 2005 to VB 2008…

An amateur trying to create a user friendly interface for an existing system .... I am alone and I felt like sailing into a series of giant waves – this would be the most gigantic wave ever, there are so many things that are new to me….

I hope I could make it through with FAITH…

 

 

we pay for them...

I had been trouble by those stimin seekers lately. I do not consider this bunch of suckers as addict as no craving is noted. They used stimin as “interlude” drug- to sedate themselves whenever they had no money to buy heroin. The benzodiazepam group of hypnotic had no effect on them (one of the reasons – almost everyone of them are heavy drinker and).

The oral route had is not adequate for them – they crushed and grinded it into find powder and injected it into their vein.

Some of them with history of pancreatitis would come in to ED complaining of epigastric pain and minutes after the injection given(I usually start with cimetidine), they would start to request for “Demerol”. I would usually told them to be patient and wait for the amylase level. If the level is elevated, I would admit him and give whatever to ease his pain. But unfortunately, 1/10 chance I would get a normal value. I would then politely told them, no one would ordered me to give any narcotic drug. After a few time, they would not come in if they saw me at the desk.

However lately, I had covered the Ortho OPD(surgeon gone for ops) and met his scum bag. He had still 6 pcs of stimin left and he came for asking more. I told him that the computer prohibit me to prescribe such drug to him as he had still medication left(I had to lie…). The scum bag had told me that he would bring his kids and asked to prescribed for the boy after he had spend 15mins begging, threatening and cursing in the clinic.

I was lucky the surgeon came back and I handed over the clinic back to him. The surgeon did not prescribed stimin for his child (thank god…)...

A stimin worth less than 20 NT but  it’s hypnotic effect which could get the addict through the craving stage make it priceless….and the health insurance paid for it( so sarcastic….)