We help each other... .

It was an easy going weekend shift. I was doing 10-10 shift. I had to wake up early, did my cycling round and sent the kids to school by 7am as it was schooling weekend for the kids.

I arrived at the ED on time and started my shift. A senior couple came in with a mid-aged male. The patient was an elderly male assigned to my colleague L. He presented with SOB and later was diagnosed as congestive heart failure with possible acute coronary syndrome. The accent of the couple had raised my attention. It was Malaysian mandarin they were using. I glanced through the patient address and found the keyword Johor.

The consultation was a smooth one and after diagnosed as Acute coronary syndrome. The loca tour guide had asked for a referral to K city. The local tour guide left the scenario and an elderly female[who later identified herself as the Malaysia tour guide] joined the couple for further management. Later the lady tour guide came to me for help. She asked me if I could help her to contact the local tour guide as her phone was not working properly.

I assisted her on the calling with our phone.

The referral was done promptly but during the payment session. The lady tour guide came to me again asking me what to do as she had not enough NTD. The fee was NT19993 and she had only NTD 12000. The wife of the patient had joined the conversation and told me that  she had only SGD and asked me if the hospital accept SGD. Well…of coz we accept but at a very bad rate…I remember once there was this foreigner who paid the bill with USD; the rate offer by the management was as low as the hotel rate…

I told the ladies that I would help them with the exchange. The wife asked me what was the rate I want. I googled and shown it to her for fairness. She agreed with the rate and I went to the ATM at the 7-11 next door and drawn 7000NT. I gave her 6700 for SGD 300(It was supposed to be 6650 according to google).

They had then proceeded to the counter for payment. After a good 30min, while I walked pass the counter, the ladies were still at the counter. I approached them and found that they were still short of NTD 1000+ as the lady tour guide was reluctant to help out on the sum. Finally the lady tour guide gave in but was still short of NTD 293. I took the NTD300 from the leftover of NTD7000 and given it to our counter staff and settled the scene.

The wife asked me why did I help them? I told her,” Malaysian helps each other…especially when we are not in Malaysia…” We had a short chat, the wife had asked me where did I reside in Malaysia. I told her that my parents live in Johor. I told her that her husband should undergo the angiography here as it would be cheaper here than in Malaysia.

Well, the elderly was about the age of my parents and I could imagine their feeling of being stranded in a foreign place. Their offspring were supposed to manage this kinda of troublesome matter for them but yet they were helplessly facing the situation here. A hand was what they need….

Later the nurse who escorted the referral came back and told me that everything was fine….

the code, the oath.....

I still recalled the day I took my oath, even though I could not remember what I had recited but could still remember the rule of do no harm….

Well, few months ago, an O+G specialist had posted in a line group regarding a case. A 34 weeker in labor had presented to ED and he was consulted. The Os was fully opened and the O+G specialist had decided to transfer the case under the ground of preterm.

The case was initially referred to a hospital nearby with 24hrs labor capability that is 30 mins away from the ED. The referral was denied on enroute as the on call pediatrician refuse to accept the case. The ambulance had however detoured to another tertiary facility further up north.

The specialist had later shared in the line group:

The driver had competently driving the ambulance fast and steadily.

The accompanied nurse had done her job of pacifying the patients…

Most important, the patient had done her best withholding the delivery…..the baby just popped out minutes after their arrival in the receiving ED….

I grinned and mumbled, “WTXXXk”…..well, should have delivered the baby rather than took the chance doing a transfer. What if the child decided to come out on the ambulance and really had need a resus and intubation…

Another orthopedic surgeon I knew had involved in a fight with his local neighbor after a “you should let my car pass through first” incident. He was walloped by a few residents and later he told the ED that He would not see any referral patient from the neighborhood. Totally unacceptable situation…

I presumed they had forgotten the oath and the rule of DO NOT HARM…. Violation of the code of conduct and knowledge we had taught, it is still a Noble profession ? well, I had recently read the blog of Dr Pagavalan….he had quoted what the founding dean of UM, Tan Sri T J Danarj, said “ The day the medical education is commercialized and medical practice is commercialized, that’s the day prostitution of medicine starts”.

Can’t agree with him no more, I had quotas , KPI and other indexes to meet apart from providing care to my patients….

As for the prostitute part, I had always told my nursing colleagues,” I am nothing better than those ladies standing beside the wall( a Taiwan synonyms of prostitute), at least they got to finish their meal before seeing their client….. I can’t, I need to put down my spoon and fork whenever you girls called me, or else you would keep ringing the phone every 20 seconds….”

mal-lanka trip part 2

As I was unable to proceed with the long trip to east cost of Sri Lanka; I would need to split up from the group and headed back home after 5 days. The children with be accompanied me on the return trip as they would have to return for the school opening.

After the Colombo tour, Ving’s cough had worsen. Yun had noted with diarrhea complicated with low grade fever. Ving’s worsening cough had raised the issue if she was able to proceed to the east coast. She was worried about the expenses but I told her not to worry as I had bought the frequent flyer option and could change the flight as I wish. The final straw came on D-2 days of return when Ving’s artificial crown of her right lower molar came off. I told her that this was the sign for her to back off. I changed the flight and apologized to the east coast group that Ving was unable to join the trip.

On the day of departure, Yun had developed high grade fever and I had barely enough antipyretic to get the temperature down.

We were fortunately to get onto the plane and have a safe passage transiting in KLIA2.

After arriving back to our home, everyone had developed fever. I started tamiflu for all of the patients(including me) early and the fever had subsided on D2…..

It was a daring trip initially; starting from the ticket booking. I had done 5 bookings with different date and destination. The cross checking of passenger details had worn me off. The anxiety of making sure everything is in order is truly an agony for me. Ving’ cough however did not get better. She had told me that she had realized that no one in the family is comparable to my level of tolerance. She had given up the feeling of travelling with me to the more secluded part of the world….. Some trip, I would need to go alone in the future. 

mal-lanka trip , part 1

After the Osaka trip….we were supposed to gear up for another trip to south Asia. I was reluctant to leave my house after the new year trip. Ving had however got an invitation to have a trip to the east coast part of Sri Lanka. The trip was 2 weeks in length and I was unable to apply for such a long leave. After some negotiation and compromise, we had reached an agreement to materialize the plan.
The trip had separated into 3 stage, 1st stage was to visit my in law in Malaysia; as my mother in law condition had deteriorated over times. The 2ndstage was to join the church group in KLIA for a flight to Sri Lanka. The 3rd stage was to return with Xian and Yun before the 2 days early of the group Sri Lanka trip.
The prep stage was a tedious one for me. I had to book numerous tickets with different travel dates for 9 persons. The input of personal details had really haunted me for few days. As it was Air Asia we are flying with and any error will lead to a long and tiring emailing event and possible extra payment.
I had tried to book a car with the HAWK late as I was tied up with some hazardous shift. However HAWK was out of Innova when I logged on to their website 1 month prior to the travelling. I had no choice but to try my luck with AVIS. As a VISA holder, the AVIS provided a good discount price for car rental over the world. I had tried to book it before but unfortunately the discounted price was still more expensive than the HAWK. I was lucky this time, the price was cheaper and later when I arrived at KLIA2, the pick up process was smoother than the HAWK. I took me less than 20 minutes to buckled up and drive out from the parking.
The travel was not smooth as everyone was confident and attempted to do last minutes packing. We were almost late for the flight on the travel date. I had come back from a streak of consecutive night shifts and have to assist and supervised their packing. I hit dream land prior to the take off and woke up 40mintues before the arrival.
This time, I was able to use the autogate and passed without difficulty with my new passport. All of our baggages had arrived safely and we met my in law in less than 40 minutes on arrival.
Surprisingly, we were given a new generation Innova. Bigger space and more pickup.
After picking up the car, we had proceeded to picked up a friend from Taiwan in Putrajaya. She is a church member and also an investor who bought some property in Nilai. She had come to Malaysia few days before the Sri Lanka trip.
The route to Putra Jaya was a little packed and we had arrived at Setia Aman by 9:00pm for a late dinner in a local Sri Melur Mamak Store. I found that those people staying around Putrajaya were the lucky one, the google map had led a route which does not need to pay up any TOL!!!
I had good night sleep that night after walloping a bunch of Mamak store food….
I visited Lem on D2 at his new clinic near Dataran Sunway. His clinic is readied to go pending for license. I admired his guts to set up his clinic in this hazardous period of GP flooding. I would have opted to work under supervision for specialist gazettement.
We had done a few shopping rounds and visited my father in law shrine in Klang.
Living expenses around Klang valley had shot sky high. A decent breakfast cost RM8-10 (drinks and meals).
After 2 days of wandering around Klang valley, we were readied for our Sri Lanka trip….
It really disturbed me as we would be heading to KLIA during rush hours. We would joining a group church members in KLIA. They however were on a very rush scheduled. AirAsia does not offer a fly-thru from KHH to CMB. They would need to check out on arrival and check in again. The window was barely 2.5hrs….
With grace, even with the delay of flight from KHH, we were still able to get the 25 members dropped their baggage in time and enjoyed a smooth trip.

Nipponbashi apartment....

The service apartment we stayed in Osaka was just opposite Dotonbori. There is a MRT station just 10 seconds away from the front door. There is no service counter in the apartment. All communication is done with e-mail!!!. Imaging if you are trapped in the lift and you would need to email the hotel management to help you!

It is a one room one dining + kitchen unit. There are two double queen beds in the room. 1 dining room with a fully equipped kitchen. The bathroom is even equipped with a washing machine (you don’t need to buy any washing powder, provided!…).

During our stay there we had bought some food from the 7-11 and we were able to re-heat it and boil some water. It also comes with a compliment mobile wifi.

Very strategic location and good bargain price….

a short trip to O city

Although Xian had fully recovered but I was still nervous when he coughed….However few days after his recovery. I had gotten an undeniable offer. A friend working in a travel agency had told me that she had some very cheap air ticket to Osaka. A few tourists had backed out last minute prior to the journey and there were a few tickets to spare. The price was extremely low after communicating with Xian and Yun about their leave…I had taken the offer.

It was a short journey as Xian and Yun was still schooling despite of the summer holiday. Luckily Monday and Friday is half day and they felt that it was acceptable to absence for the class.

Choice of lodging was limited as the journey starts in less than 1 week. 4 persons room, nearby MRT had truly restricted my selection. I had however got a 1 star rated lodging which had 8-9/10 rating on booking.com. Since it was a short trip, I had crossed out Universal studio on my list.

Everything was in havoc as I had a very short time to prepare for the trip. I had gotten a mobile wifi machine and some MRT and airport transport ticket via the net. Not much time to think and I just grabbed whatever I could.

We were able to hit the airport on time and arrived at the Osaka airport. It was a low cost carrier and it had landed at the T2 and we would need to travel to T1 for to pick up the ticket and the airport rail.

The arrival was late in the evening and we had grabbed some chinese bao( penglai bao store) at the airport. It was tasty temporary pacified our hunger. I had planned to have our dinner at YiLan Ramen near the hotel we stayed. The service apartment I had rented was just a street across Dotonburi. We started our journey at 8:40pm. We had eaten our dinner at the YiLan Ramen. It was one of its kind but not really my type of food. We had roved around Dotonburi and SinShaibashi before we retreated to our room.

Ving was not feeling well on D2 morning and three of us had gone to breakfast by ourselves. We had visited a UCC breakfast around the corner for breakfast. The initial plan was to visit Tensogaku(premier castle) on D2 but Xian wanted to see if we could get a Nintendo Switch from the local store. We had found that there was a lucky draw for purchasing at the Big Camera store on that day. The registration started at 10 and draw done at 11. We had taken a slow tour around the area and joined the queue at 9:30am. It was a long queue roughly about 600 peoples turned up to draw for 10 machines.

After the draw, Ving was still not feeling well. We had changed our plan and headed toward the Tsutenkaku and Tianwang temple. It was a long hike for us. Xian and Yuan had enjoyed the trip as I allowed them to try their luck on gacha machine along our journey.

We had tried various food shops which recommended by Takagi Naoko in her book during our walk. It was a long walk of 3km before we could get onto the MRT. With our sore leg, we had to take rest for 2 hrs before we go for our dinner at 7pm. Ving was much better that night and we had a good shopping tour along Dotonbori and Shinshibashi.  

Xian was a little bit upset as our name was not listed on the Big Camera lucky draw.

D3 was a shopping tour day for Ving. We had also gone to a few gaming shop trying to get a Switch.

The night ended late even though we need to get up early for a noon flight back home.

There are lots of smoker in Japan and most of the Izakaya allow smoking. We had wanted to try out some Izakaya food but were unable to do so.

It was a new experience for all of us, short trip which was very compact. Tasty food and walk till you cramp road trip. Everyone had returned with loads of stuffs…except me.

Well, we are looking forward to another trip in the future.

attending physician vs patient family - the rest of the stay......

It was one of the toughest and agony night for me…I woke up on hourly basis , auscultated his breathing sound and checking his pulse rate. By 5am on the nurse morning round, his HR had dropped to 100/min with SpO2 of 94%,  but his BP was at an uncomfortable reading of 88/60mmHg despite of his improvement clinically. The second check was 1 + hrs later after Xian inhalation and antibiotic medication; his SpO2 was better at 95%, and BP had increase to 94/56mmHg. I was still feeling discomfort about the reading but yet he was in better shape.

Boss did his Sunday round at 9:30am and we had a brief discussion, Xian SBP was over 100mmHg by then. Both of us agreed the Xian was in bad condition on arrival but improvement was noted. He agreed with the admission ordered and thought that we were at the right track of management. Xian had improved later that day with no fever but yet his tachycardic was stationary. Ving had visited us later that evening and brought us some supplement for our stay. I had a better sleep as Xian condition was better though his SpO2 was still at 95%. His cough was better less sputum was noted.

D3 and D4 was a challenge to both of us as I had to do morning shift. Ving was only able to visit us later in the afternoon after Yun returned from school.

I left Xian alone in the room at 7:50am. After 2 days of living with the drip he was able to go to toilet with it and managed his own routine. His condition had improved greatly with heart rate down to 80/min(his average was 70/min). SpO2 was stationary at 97% and his breathing sound had greatly improved. It was a busy day and when I grabbed a chance to check on Xian at 10am, I found him by himself at the basement waiting for his turn for sonography. He was cool and confident about his condition. He mixed his medication (syrup and powder) and took it by himself after his meal. The feeling of seeing your own child handling his own task is beyond words..

I fetched Xian lunch at noon and Ving had brought us dinner later in the evening. The ED was busy and I could only returned to Xian room at 8:30pm. Xian breathing sound was still noisy but limited only to the base of his lung. The struggle at that time was to complete a 5 days or 7 days parenteral antibiotic. I was too tired and slept throughout the night. I woke up at 5am and Xian reading was almost normal. His heart rate had returned to baseline and breathing sound was much better. The struggle began as his venocath was due and need to be replaced. This time, the struggle was less.

 I prepared his breakfast and left him for ED at 8am. He was very comfortable with the environment than; he had wanted badly to get discharge and go back to school. I had a short discussion later that morning with boss and agreed that to discharge him tomorrow morning. It was a busy day in ED and I rejoined him later that night. Ving had come again later in the evening to bring us dinner. Xian was happy with our decision to discharge him on D5. He had slept more than 12 hrs per day during his admission; he had a very severe condition and I thank the great one for his speedy recovery…We had a great chat and I told him that my fear during this period. He finally realized why I brought my surface pro with me when we leaved home 5 days ago; I had expected the worst….

On D5, after the final rocephine drip, I had brought him home at noon…..

I slept through the afternoon when we reached home. This was life of a patient’s family. It was not my first one and I knew it will not be the last…..

I continued Xian on 2 more days of oral antibiotic and was very anxious whenever he had a slight cough. He had recovered well after the medication……