backlogging....and conclusion of 2017

Appreciation was what I learnt during my last trip. Life was getting harder as the working environment became more hazardous. Interference was noted after Lem left. As the senior staff in our department, I was harassed less. A couple near misses that merely dragged me to medico-legal suit due to some reckless and unethical acts. I had tolerated such events and decided to do nothing…

A trip back to Malaysia was planned and it was a complicated one for me. I had not been having reunion dinner for over 10+ years with my parents and my brother. As our working force expended, this is the 1^st time in 10 years, I could be able to stay over Chinese new year eve.

The fly thru option was available for K city to Senai airport; it was my first choice but I had something to settle before I made the reservation – the overnight stay in sama-sama KLIA2. Unfortunately, it was not available at the time I did the search. Well, I had to give up the idea of getting fly thru but to do 3 separate purchases. KHH->Senai(fly thru), Senai->KUL, KUL->KHH. The interesting part was the price was NT10k less than purchasing a to-fro fly thru. I had noticed it sometimes ago and found that, the price of round trip from KUL to KHH vs KHH to KUL is different. You get a cheaper price if the initial departure city is KUL.

Well, I secured a room with the Plaza Premium lounge at KLIA2 gateway at the price of 1/3 of sama-sama (breakfast also included !!!).     

Despite of being disturbed on my job, I was struggling to learn JAVA; a tough task for a person with 70% of white hair….

the mission ...... impact beyond imagination...

The trip was a stunning one for me. Handful of team members, limited supply of drug. Poor lodging and the worst part, restriction of food, we were told that not to eat any food outside any food shop and only drink from bottled liquid. I had to refrained myself badly to laid my hand on whatever street food being sold. One of the team members was a lady pastor who had been there for more than 4 times, she told us that she had once eaten those food sold by seller along the roadside and she ended up sitting on the toilet for 2 days…… I had a mission to complete and I have no room for error so I told the local pastor that I would try those foods later when I go back to the homeland.

I had seen over 160 patients at the small village over the 2 days of stay. We had stalked the pharmacy around that area and grabbing whatever supply that they could provide us.

It was an amazing tour….I had learnt to appreciate what I have.

I left the team on D5, I travelled 140km to the local airport, took a domestic flight to N city and later hopped onto a flight back to HKG. While transiting, I had a deep thought about my journey and my future plan about serving the great one….

I picked 2 boxes of moon cake[black bean sand….my favorite] during my transit at HKG; the only prize that I got during the whole journey. I bought some gift for Xian and Yun on the plane. 

the mission.....A passage to .....

Unlike the previous few trip, I had lack the driving force to do drug preparation. The drug list proposed by me was being discounted and discounted….well, truly speaking, I don’t know what I could do with the limited stock..

I brought some of my stock and prepared for the impact when I arrived at my destination.

Malaria was one of the threats I am facing and since I am heading to the more secluded country side, I presumed I needed some prophylaxis. The choice from expensive Malarone to the cheapest doxycycline. Well, I opted for the later. I knew we definitely needed a lot of ointment but reluctant to do so as I was not sure if I would be stuck at the custom.

There were so many uncertainties waiting ahead and I was helplessly holding on with prayer. The day had come and I woke up early as I had an early flight to catch. It was not a smooth start. I discovered that I left out my phone after 1km away from my house. I driven back recovered the phone and noticed that my priority pass card was missing from my passport holder….

Well, everything was in chaos on my start. I left home 30mins late from my schedule after picking my phone with an eventful search for the card. Arriving at the airport and found that my PP card was in my wallet hidden slot, a relief but not good enough for a comfortable trip. The PP card would be a great tool on return trip as the transit time was more than 8 hrs.

The stopover at the HKG airport was a short one and I met my team 1+ hour prior to the departure….

the mission ..... pre flight

After 1+ years of burying my head like an ostrich, I finally decided to hit the road again for mission….

There had been invitation from time to time but I had denied them with lousy excuses. The decision was actually a conflicting one as Ving did not fully support my involvement.

After the Lanka, Ving had given me a go and an offer came in not long after that.

The offer came from the NGO which I had worked with few years ago in Satun.

It would be difficult for me to join the group on departure as they always use CKS as their departure airport. The departure time is always in early in the morning and arrival is late in the night. It would take me two more travelling day to complete the mission.

Luckily on this trip, they need to get a transit in HKG. I told the pastor I would get the flight ticket myself and I would meet them in HKG. The ticket was far more cheaper compare to the quotation from the travel agent. The visa part was a difficult part as I am not comfortable handing my passport to the travel agent and “mail” it up north for application. I did it over the net. The process was a tedious one, with all the detail to complete. I manage to do a full upload after a few attempts. The approval came few days later and I was all set to go….well, almost all set….

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.