G.I. Hoe: Rise of the VIPER

Lately, there are too much of workplace politics, to my likings. I am not a political person per se, but things do come to your face when you least expect it.

First, My MO forms two battalions, one called themselves as the ‘Shift Workers Union Team’. The SWUT army consist of those who work in shifts, not confined to the usual 8 to 5 and those who need to do night shifts. Its members is about 10 persons. The other side is also known as the ‘Office Hour Liaison’ (OHL). OHL has smaller number of people. In fact they have only 3 members to speak of. However, don’t judge the OHL by sheer number, as all the member are high ranking officers. The battle line between the SWUT and OHL is clearly drawn. OHL accused the SWUT for working less hours and not allowing them to take their day off. SWUT blame the OHL for not doing any oncall at all despite the number of MO is minimal. If you think the SWUT and OHL is like cats and dogs from the start, you are wrong.

Going back to history, They were not like this. They were loving each other, complementing others work. They OHL wouldn’t mind helping out night duty. The SWUT wouldn’t mind the extra calls and all those weekend shifts. It was due to a OHL chief that is able to find harmony between the 2 teams. The peace was not forever. With time, the chief promoted to other post and came the new leader of OHL. Within the week of taking the throne, she had made new rules and changes that favours OHL. She blame SWUT for not working enough. She pushed the SWUTs to work extra. Many SWUTs that can’t take the new ruling resigned. There are also some SWUTs that stay on and put up a good fight with this OHL.

Out of nowhere, came a swarm of General Infantry (G.I.), sent by the Higher OrdEr (G.I. Hoe). These are G.I. Hoe. When all else fails, they don’t. They can work 24/7. When the Order call, they can work without food or rest. They know no fear. They have the tolerance of getting 60 rounds of automatic machineguns per second to their head without breakdown (I mean the scolding).

So the new chief of OHL saw an opportunity, and she snapped it! The swarming of G.I Hoe is seen as the solution for the uprising battle between the SWUT and OHL. Then she fully utilized the G.I.’s and put them is many calls and rotations that they don’t belong to, for example in the fever screening zone. Everyday, she do rounds in resus and green zone and shunt away all G.I. to this fever screening zone despite no patient in the fever zone! With these, she can shut some of the SWUT’s mouth and the OHL especially her do not need to be on call at night at all. What a brilliant solution! Pity the G.I. Hoe, working day and night in the fever zone. They are supposed to learn something in the resus and green, but all they get is only seeing the fever cases…

One day, the VIPER (Very Important Person in Emergency Room) will rise, and the chief shall fall. I am longing for the day to come…

Birthday Blues

Dear Mom,

It is your birthday today. I did not bring you any present. I am sorry. I just want to wish you happy birthday. Deep down in my heart, I wish you enjoy every moments you lived now. Your life journeys marked heavily on your face. Each line is a passing of a past that turns into nothing but memory. Each dots speaks for itself for a legend that you make.

There are few things that I regretted in this life. I am sorry for not spending more time with you. Its all the work, stress, love, and sidelines that keep us apart. I know you are lonely. The vast amount of time that you spent on the couch crunching away the stupid Taiwan Hokkien TV series is to filled the emptiness of this house, more of the emptiness of your heart. The nonsense that you joined, to give back life to the ex drug addicts, says it all. I know. I can see it in your eyes.

I am sorry that I behave like a jerk. I raised my voice to you. I turn a deaf ear to you. I shut myself from you. I lied to you. I am trying to shake loose this connection. All because one day, I am ready to fly. I will be going away, sooner or later. You stories ends here, but my life starts from here. There is endless possibilities out there. I will be back, as the new me.

Don’t cry, mama. Your agenda is not my agenda; your life is not my life; to you is good but to me, maybe it’s bad. Alas! we are two different people. I read from a book once: you know your child only as much as when both of you are connected via the umbilical cord. After the cord is cut, the child is a person by himself. You don’t know what he thinks, why he behave like this. You have to admit, the child is a totally new person, and you will not understand him/her fully. 

I don’t want to break your heart, mama. Sorry for all the things that I did, things that I ought to do but I didn’t. Sorry for the big gap in between us. Sorry for the words that I said but didn’t mean it, and the words that I should have said but didn’t. I still love you the same. Till then.

 

With love,

Son

The Pan(dem)ic Flu

At the time of this writings, the author is suffering one of the worst post call syndrome in his whole career.

I am recovering from one of my worse call ever. Since the escalation of H1N1 cases on top of new mortality reported on daily basis, my emergency department had faced its hardest time. On the usual daily basis, I am seeing about 100 cases per night shift. Yesterday alone, there is a whooping jump to 380 cases! The card stretched 3 times than our table can accommodate and the waiting time is up to 4 hours. If you take a walk outside my clinic, you might think you had walked into Puduraya or Bazaar Ramadhan. There are seas of people, with all seats occupied and the ‘standing’ seat also taken. People lying on the floor, on the trolley, on wheelchair, in toilet and into the open road outside. During the past 20 years of its service, this is the worst ever ever faced by Emergency department. We had declared a state of ‘disaster’, and channeled doctors, nurses and paramedics from all over hospital to come to aid.

It is safe to say 99% of the case came to hospital for sole reason: to ascertain whether they contracted H1N1.

People are in panic. They fear of H1N1. They want to be sure that what they are having is not this strain. I can’t blame them. The propaganda for this disease is very extensive. I will take time to explain to them and make some facts right. I hope it would help the people who read this article. Yes, it’s you.

While it is true that the Director General (DG) of Health said we should not be less vigilance on this disease, there is a general rule of the thumb that one should adhere before coming to hospital:

1. Please COME to hospital/health facilities if you failed self treatment after 3 days. AH1N1 is a new strain of Influenza virus. Means there is no herd immunity. Means it can and will spread like wild fire. But flu is always self-limiting, that is to say it will resolve within few days of onset. We take a rule of 3 days. So to say, if you are having underlying risk factors such as obesity, pregnancy, underlying heart of lung disease, or any condition that renders your immunity less than ordinary people, you are welcomed to see us earlier.
2. Take adequate water and rest. Yes, it is important but often overlooked steps. Take vitamin C. Take 2 large bottles (3L) of water unless you are told not to. Don’t take too much of carbonated isotonic drink if you are having vomiting as the gas will make you bloat and nauseous.
3. Bring your medications to follow up. It will definitely help us a lot if you can remember what medication you took, but most of the people will describe to me “the white pill” “small yellow tablets”. This is like describing Adam Lambert by telling me he wear a blue jeans.
4. The Throat Swab. I know this is a very controversial issue. Majority of the referral cases from private healthcare to us request us for a throat swab for confirmatory test. This is also a confusing issue. At the early part of the disease, the government requires all patient that came from affected area to be screened from AH1N1 by doing the throat swabs. With time, the disease burden increases to a level that National Lab unable to cope with the amount of throat swabs analysis with the escalating amount of patient. New circulars are out by the minute to limit the screening to high risk patients i.e. pregnant mother, heart disease patient or with other co-morbids. In outbreak cases, for example in a closed compound like a school facility, only a random sample of 10 throat swabs will be taken. So you understand why we as the staff of Emergency department do not take anymore throat swabs; this responsibility is passed to Medical Department specialist and medical officer to decide which cases are severe enough for a confirmatory test. In shorts the throat swabs is a limited test now and NOT done for mild flu cases.
5. Help us to help you. This is my personal opinion. We are seeing at least a 400% to 500% increase in patient a day. My clinic usual closed with 100 patients during a night shift; but in this hard times, the numbers jumped to 400 patients at night time only. The number of doctors are very limited at night, and we are recruiting ‘cold’ department Medical Officers to aid in seeing patients but still average waiting time increase to 4 hours. It does help a lot if the patients behave less hostiles towards the doctors. It is a testing times. No one like it either. Tolerance is the key.
6. Please adhere to home quarantine order. I have few cases in hand that came to us. She was supposed to be in home quarantine as the school closed for a week. Out of her sympathy, she went to visit a sick friend and got fever instead. At this time, the cinema, shopping complexes is full of youngsters that feel that home quarantine is nothing but a scam. Home quarantine is meant for reducing the disease spreading rate. As a general rule, any viral fever should settles within 7 days and by separating the affected and unaffecting, we are hoping to limit its spread till it dies down. There is always a reason for things to be done.

This is both a testing time for us, the healthcare provider and the people out there. H1N1 is hard to control. But we still have to do something. The number of cases is increasing and the mortality increase. However, the rate of mortality remains fairly low. There is no reason to panic. Mostly recovers from H1N1 as a self limiting viral flu. At the same time, we should take precautions as listed in ministry of health guidelines, cheerful and above all: constant vigilance.