death of a medical student....

I was parking my car outside the lion govt. clinic and heard the news from the radio regarding a Malaysian intern from my alma mater who committed suicide after assaulting another staff and burning down a locker room….

After I settle down in the clinic, I had glanced through the net and got a small piece of information.

My last encounter with intern was 8 years ago when I did my medical posting of haemato-oncology posting in my alma mater university hospital. Unlike internship in my old days when the intern had to trace data and prepare for rounds, the intern’s life was free and easy. During one of the night calls, the nurse had called me at 3 am and said, “ Sorry, Dr L, I could not locate the intern and could you please manage this feverish patient for me…”. Absconded from night shift ? well, that was an easy life…

Internship had changed a lot as they had no license and there is nothing such as a provisional registration here in Taiwan, as to avoid medico-legal problem, they are excused from many duty since then. Thence the govt. had changed the rule and modified the structure of medical education. They had change d the 7 years med school (incl. 1 year of internship) to 6 years of med school only. And the 1 year PGY training would be extended to 2 years. The total years of studying + training prior to 1^st year resident training is unchanged. But a medical graduate had to pass his part 2 license examination before entering the PGY1 training.

According to one of the report, the victim, our junior L, is currently at his last few day of internship however due to his poor performance, he was unable to receive his diploma as he had failed his internship and had to re-do it next year. He had been troubled by adaption and financial problem in the past and taken 1 year leave from his study few years ago. Some are lucky to graduate and change his carrier path but some….

Condolence to his family…..

I had never wanted my kids to follow my path, I had told many of my friend, “ One person in the family suffered is enough……..”

bravo 600 -> lattitude hp

I had finally replaced Fefe’s tire last Saturday. I had tolerated the slipping from time to time while driving through wet surface for the past few months, and the tire noise is definitely in compatible with the car price. The original tires of Fefe were Maxxis Bravo 600 (Korean made). According to most of the user in the SantaFe club, the tires were durable but noisy. Some of the tire lasted for 60000km before replacing it. However as I hardly parked my car in the garage and mostly left it under the sun, slipping was noted at about 47000km. During this rainy season, I had slipped few times driving in the rain and finally decided to replace it. Compare to my last 2 cars which lasted only 35000km+, it is considered as long lasting.

As the 235/65 R17 is not common spec here in Taiwan(only XC60 and less than a handful of car use it), there are limited selection. As most of the club members recommended Michelin, I had decided to give the Lattitude HP a try.

I called up a chain tire shop which located near my house and check out the price. The price was average compare to the shop up north. The change took about 1.5 hrs and the noise reduction effect was remarkable….

Well, it a cost RM2300 and I hope it would last at least 2 years….

crab XXXX.....

My alma mater university hospital has called a press conference and told the reporters that the hospital did not have any stretcher which height is adjustable so that the on side rescue was not done by the ED staff  for the old man...
There is something called the long spine board and scoop stretcher and most of the ED had one of those...
Presume that there is someone who had fallen in the hospital from height and get hurt and guess what according to the statement, the hospital would have to call the rescue ambulance to come in to the hospital and carry the patient to its own ED....a logic which is not logical...

see death don't rescue....

This incident happened in front of the hospital of my alma mater. There was this old man who was rammed down by a car. A good hearted guy had run to the emergency department 30m away and asked the medical staff for help.

The medical staff had refused to go out to have a look at the patient and told the guy that “we don’t have the stretcher and it is raining out there…” the ambulance had arrived 3 min. later(the rescue service was not far away) and the patient was sent into the ED in 10+ mins…

The news hit the front page with severe critics from all, so have pro the staff and most of the other had knocked severely....

What would my medical staffs do ? We had had various similar events in the past and what we did was a quick assessment with scoop and run strategy after ruling out spinal injury.

According to the law, the hospital act within its capacity but in the actual world, it create a very bad impression for the public… sending a medical staff to the victim and do a quick assessment and first aid is definitely a must to avoid accusation and finger pointing event…

Well, big shop and arrogant staff, bashing is needed to make them humble…

USP chemical and "DRUG"

During my first few years of work, it would take 15-20 minutes for a brain scan and 40+ minutes for an abdominal scan. The duration and length of the examination is a pain in the ass for the medical staff. I had seen senior physician, utilizing chloral hydrate for pediatric sedation during the examination. It does not work always but yet, I knew it is quite safe for use in the setting.

Later in my practice, I had never had the chance to use the drug, partial due to improvement of the scan machine which reduce the exmination time to less than 2 minutes for brain.

Lately, my boss had told me that the chloral hydrate is available in our pharmacy and in case I need it, I could call the pharmacy.

Last night I had this 2 years old boy who presented with seizure for the 1^st time. I had ordered a brain CT but the child was quite irritable and the parents and I shared the same opinion that the child would not be able to hold still for the needed 2 minutes. Thence I ordered a chloral hydrate and later the pharmacy had called me up for a discussion.

I had visited the pharmacy and the pharmacist had shown me that bottle. He had told me that this might not be “pharmacy grade” chloral hydrate and asked me to reconsider my order. I complied with his call and later did a check over the net.

Well, there is currently no approved chloral hydrate in the market. All the 3 suppliers did not renew the drug license few years ago and there is no approved “chloral hydrate” to be use on human currently in Taiwan. According to the label, the chemical was manufactured by WS Simpson Ltd and I ran a check over the net and found that the company produced dye and reagent. Although the label did revealed the word “USP” but there was no such chemical in the online catalog.

If the drug is USP grade, that means it is suitable to be use in human however since the chemical is not approved by the local FDA, thence it would be a violation to use it as a drug and if any side effect was noted, the prescript physician would be held fully responsible for the event.

I am still thinking of how to bring this issue to  boss…..

supposed to be like this....

There was this shooting incidence leading to a death of a sailor recently. The incidence had become an international issue and the government had expressed great concern over the matter.

The sailor’s daughter had however shown some attitude which I felt very improper. The daughter had initially expressed disgrace about the coast guard for not sending its chopper to fetch her father which was pronounced death. She claimed that it might had saved the victim’s life if he was fetched back early. The victim was noted with no sign of life with multiple gun shot wound over vital part. The captain informed the coast guard that the victim was dead when found.

Later when the victim was sent back by the convoy, the family had refused post mortem as they don’t want their relative to suffer anymore. But yet they demand the relevant government to responsible for the act. How could a coroner issued a death certificate without post mortem ? without the post mortem report how could the government proceed with the protest procedure…

I had seen lots of “it is supposed to be like this as we are the victim” attitude here, they think they are above the law if they are the victim…well, reminds me to be careful when I roved around…

We shall see....

The air hostess had gone home after 3 nights of stay, Dengue count is now 19 and I am post call sitting at the dining table, waiting for the water to boil and enjoy my earl grey tea...

A further disappointment after the defeat is to read about the untrue accusation… a winner with only less then 50% support should be more humble than aggressive.

Well, Yun is asking me if we are going back during the summer holiday as she is eyeing on the freeeeeeeee computer…. I returned her request with a grin and said, “We shall see…”