I was completing my chart when the OHCA patient came in. An obese female noted with sudden onset loss of conscious. She was noted with no sign of life when the rescue ambulance arrived. My heart sunk when I entered the resuscitation room. She was 150cm and almost 150kg… “A case of difficult airway”, I mumbled while getting the laryngoscope. I could barely open her mouth and not to mention about inserting the blade. I gave up the direct method and requested a laryngo-mask intubation kit. I could barely insert the mask and failed to insert the guide wire…

Well, I asked my nurse to call OR and asked if the anesthetist could help me with the intubation and before she walked out from the door, I changed my mind and told her to come back.

No point of calling for the anesthetist as the mouth was too small to pass in a blade…

The process was not satisfied at the beginning. There was no tracheostomy set when I ordered. Someone passed me a scalpel and open up a normal dressing set while I cleansed the neck; I asked for a pair of retractor and Kelly forceps. Definitely would be a chaotic situation I thought when I completed the cleansing, however with grace, I had a good surgical assistant and I managed to poke a hole through the trachea while is located 3cm from the skin within minutes.

Well, ROSC was noted but still I lost her later…

Well, I did not screw up and secured the airway within a reasonable period, my team was quite shock and had a good talk about my decision…..

Training and exposure are what the Taiwan emergency staff lack; lucky that I picked up the skill elsewhere….

trip back home....

I had had a brief journey back to Malaysia few days ago.

I got a call from my dad while I was catching a nap hours before the end of my night shift. He told me he was unable to stand properly and numbness over his limbs and probably had a stroke. I confirmed his presumption and told him that I would fly back to Malaysia. During the conversation, I had taken a quick glance over my roster, and found out that if I could change 2 of shift with L, I would have a 3d2n window to go back to Malaysia. L had complied with my plead and I proceeded with the flight booking.

The choice of flight was limited as LCCT was not an option since my parents lived in Johor. I booked a flight over the net and proceeded with my journey back home.

The journey was a tedious one, home->high speed rail -> TY airport->Changi airport ->JB….

With grace from the Lord, I was able to reach the puteri specialist hospital 12 hours later…

It was a closed one, both for my dad and me….No involvement of the brain stem and hopefully a good recovery with proper rehab. I nearly missed the flight but was able to catch it on time…

I wished I could stay longer but I couldn’t...

it was a tiresome return flight for me and I reached home 12 hrs after I left JB…

It would not be the last one …..I knew…

different view.....

Boss came down to Lem with a complaint letter last week; the letter was about a pubis fracture. An elderly female had presented to ED for pain over multiple site after fall. K had seen her and later told the family that there is possible fracture over left pubic bone and she was discharged later for orthopedic follow-up

On follow up, our young orthopedic had told the family that there is no definite fracture and refuse to comply to state that it is possible fracture over the pubic bond despite the pain over the relevant area.

The patient was brought elsewhere and later the fracture was confirmed. The family had written the letter asking us politely that what should they do in the future if 2 doctors in the same hospital had different diagnosis on the same patient….

Nothing to shout, we do make mistake from time to time, but yet sometimes, don’t be over confident….

trip back to college

I had always been adventurous but yet as I grew older, I had been more cautious as I need to think about the 3 persons that rely on me…

Adventure is all about exploring and learning, which I considered as learning one limits is also a kind of adventure.

Last Thursday, while travelling up north on the high speed rail, I had a called from the seminary staff. The lady had asked me if I could make it to the college next week from Mon to Wed to replace the class which I missed in June. The 3 Days seminar could substitute the 2 credits which I left out due to Ving’s pneumonia. A very tempting offer but I had a morning shift on Monday and a night shift on Tuesday…. I told the staff that I am able to reach the seminary late in the night and the lady told me that as long as I report to the seminary by 9 on Tuesday I would be fine. I told that I would attend the course and started my call out to K and Lem about shuffling my Tuesday night shift. It took me about 20 mins to settle the shuffling. I started to regret after I completed the task; I need to drive 5 hours to the east coast after my strenuous 12 hours day shift. The road to east coast is not like the west as there is no high way, I need to drive through the notorious winding “southern loop” route to cross the central mountain range from west to east coast. I am not unfamiliar with the path as the land of lion is located at the beginning of the route, the peripheral clinic which is situated at the highest point of the route is also a frequent site which I visited from time to time. The distance is about 300km and with more than 20 speed trap spread along the route, the average speed would be a pity 70km/h and it would take 4+ hours to reach the college.

I was lucky that one of my classmates had decided to join me on the journey. Well, still, I was a little anxious about the drive, I am not sure if I could complete the perilous journey.

It was not an uneventful shift as I could only caught a short nap in the afternoon. At the beginning of the drive I felt a little bit worn off and have doubt that I could complete the drive. I am not afraid of driving along the curvy mountain road as the light of opposite car’s lamp offered a pre-warning sign at each cornering. My dad who is a veteran at night driving taught me about this fact when I was very young…

I completed the 300 km drive after 5hrs under the grace of the Great One. It was a smooth drive as most of the traffic light was shut off and there were only a handful of truck/car moving around.

I woke up after 5hrs of deep sleep and enjoyed the spectacular view around the college.

The credit fee of RM350 was waived as a local church had sponsored the course.

The drive back home took a little bit longer than expected as the traffic was pack in the daytime.

I praised the Great One for this uneventful trip, 12 more credit to go….

unexpected experience...

It was a Saturday morning, Ving had gone to a conference up north and I was enjoying my time with the two kiddo. After sending Yun to school, Xian had suggested a swimming trip as he would be facing his swimming test few weeks later. I complied with Xian’s request and headed to the nearest swimming pool but found out that it was closed for service. We decided to go to another swimming pool  nearby and we had noticed an accident at a T junction during the drive. A lady was laying at the middle of the junction and a few bystander were standing around. Normally I won’t stopped as most of the time, there would be a lot of bystander willing to help but this was different as the victim was laying without movement. I told Xian that we would stop and offered some help. I parked the car along the roadside and told Xian to grab an umbrella to shed the patient as it is still hot during daytime.

The scenario was a bloody one as the lady suffered from an open jaw fracture and skull base fracture. After securing the airway and c-spine(that was what I could do, as I did not bring my bag and was driving Ving’s car instead of mine) and packing the wound, I called out the ED at A-hospital(my employer) as it is the nearest facility with neurosurgery capability. The nurse whom I knew told me that their computer was downed and I told them that they are the only hope for the patient and we would be coming over.

The ambulance arrived 10+ mins later and the patient went into arrest. I commenced CPR and have no choice to accompany the patient to A hospital as only one EMT-B would not be enough to manage the patient during the ride. Xian had come along and taken a seat at the front seat passenger seat of the ambulance. I managed to insert the LMA into the patient and continued the CPR session until our arrival in ED 10+ mins later.

The pass-over was a crap as the attending ED physician did not bother for a pass-over. I brief the triage nurse and walked out from the ED. The morale is low at that department as most of the ED physicians there are asking around for job lately. 

Xian had acted bravely during the scenario but freaked out during the ambulance ride. The local drivers have no driving ethic as no one is giving way for the ambulance; the ambulance had to drive like snake crawl during the journey. 

Well, the ambulance was kindly enough to give us a drive back to the scene to pick up our car. It was a perilous and educational journey for us. Xian had finally taken a look at what I am doing and I had a good workout…it was 2+ years since I did a long duration of CPR(we had a auto-CPR machine since then).   

It is my 1st time to involved in CPR on board an ambulance...not a pleasant one but yet a memorable one...

For Xian , it was another trilling experience on a speeding vehicle ( the first one was the TUK TUK ride in Sri Lanka months ago...)

As for the victim, sadly she did not make it even though ROSC was noted after she arrived at the hospital....

serve....

I had a small chat with Han during the insertion of double lumen catheter few days ago. One of my classmate had gone back to Malaysia to practice recently. He is cardiothoracic surgeon by training and is currently posted to Penang… he is satisfied with the 10+K RM salary and I envy him. 

There had been many occasions I had been asked if I wanted to go home to practice and I told them that I wanted to serve the public instead of the affordable. Indeed, the only way to serve the public in Malaysia is to work with the govt. It would be a chop waist cutting of salary for me….and if I open a clinic or work with a private hospital, I could not do what I am doing now….

The only regret I have is that I could not be my parents attending physician whenever they need me.

It is always a trading game, just like MPQ, one would need to determine the priority and go for it and never look back.
6 more year before Xian hit college and hopefully it would be a turning point for me...

Kukaracha...

It is Annual Nuke Disaster Exercise day again. As usual, Lem is the decon team leader and I acted as the ED in charge…Well, the case was a nuclear power plant worker with traumatic head injury and vomiting. He had exposed to unknown substance and vomited 2 hrs post trauma. Lucid interval was noted

The key to the exercise was DD of intracranial lesion vs Acute radiation syndrome...

I had read up at 6am, refreshing my knowledge, and downloaded the latest REMM mobile app...
 The outcome was great…..the Q&A was flawless and one of my staff had told me that no question could electrified me and I answered, “yeah... just like cockroach..”
indeed it feels good when you are invincible during such Q&A. Yun is getting the hang of it and frequent shared her experiences about her recent exams, but i knew she could do better...