Tony’s Anatomy-#9: AAD, against advice discharge?

Patients come to a hospital in order to relieve their pain or cure their disease. But as patient right rises,  the more often patients refused to take the advice from medical staff(doctor, nurse…..). The term “AAD” means “Against advice discharge”.

It’s weid that people come here to seek helps from doctors and they refused the advice when diagnosis is made. This week, there’s a patient who was diagnosed as acute myocardial infarction (AMI) and admited to our ward. It’s really high risk of

deaths if not taking treatment emergently.In order to monitor the progress of AMI, it’s necessary to check cardiac enzyme and electrocardiograph(ECG,EKG) every 6 hours. After I finished the ECG and the nurse drawed the blood for cardiac enzyme tests at the midnight,

the patient’s wife ran out to the medical station and queried why we often interrupted the patient’s sleep and draw so much blood. She reported many unrelated medical storied to us and showed her angery.After repeat-and-repeat explantation, she turned back to the bedside. Then there’s a “click” sound poped out. She locked the door of the ward in order to prevent doctors and nurses to see the patient ANY MORE!  Fortunately, there’s a backup key of this ward. Unfortunately, we’ve to find a key to open his wife’s heart. To protect our medical staff from lawsuit, it’s common to discharge patiens when they decide to against advice.

 

In this story, I found we should take “AAD”as Anxiety, Agitation and Delirium  rather than against advice discharge. The family reported this woman(therir mom) didn’t have such weired response before and I was guessing it’s a delirium attack on this woman. Fortunately, there’re many

medications for delirium. Unfortunately, she is the family member and not the AMI patient who was admitted to our ward an lying on the bed now! Can we prescibe a medcation for her  ?? If we can’t control her temper and mood, the AMI patient may lose his life because she refused all of our treatement recommendation.

Well, I had to treat the couple , not only this old AMI man. It’s a tough on-duty night since I had to cope with the delirium and AMI simutaneously. When the sunlights shined into the ward from the window, this woman abruptly changed her attitute and responses ! She showed good manners to us and agreed any of our medications. What a delirium nihgt and the power of sunshine!

 

Tony

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Without Facebook-#3. New drug

This is a candy with drug function and it's made in German. The drug can fix and make up your hurted and broken relationship. And the most important is you don't need a doctor'prescription. A pill a day keeps the broken heart away.

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Without Facebook-#2 Merry Christmas

Being a volunteer really lights my passion!

In December, we are assigned to help the community in a rural area. We dissipate meals to self-living elders and help them measure blood pressure. In every Wednesday, we accompany children reading books and help them to correct their homeworks.These children come from poor family and the church help to take care of them in order to keep them not to become a ganster or have a bad behavior.When I  accompany children, I found them quite easily satisfied. Maybe just a candy or a game playing can fulfill their desire.In contrast, I found I was not a easily satisfied person. My mind is easily affected by the advertisement, TV show or others’ suggestions. Like Christmas, there’re many promotions and naturally you would like to have a better dinner or an expansive gift. It’s not a shame to have luxury stuff but it’d be better if we can adovocate ourselft or donate some money to help the world. I really found I became more easily satisfied and treasure what I already have after being a volunteer.

 

 

The mobile free bookstore

 

 

 

There’re many story and picture books.

 

 

A game playing between children

 

 

I planned to go home this weekend but my mother already went to a camp for young people. My mother doesn’t have a high education, high salary or reputation. But she does volunteering nearly everyday! More surprising, she refused my monthly money support and asked me to turn it to help poor family. As her wish, I donated much money every month.I think I gave up the chance to have a good watch, clothes or car (No doubt!, I donated more than a car’s price). As my mother, I am not looking for being memorized or having a good reputation. Except this diary, I don’t  ever talk or mention my donation with anyone.

It’s Christmas now and it’s time to make a wish.

Wish I can become more smart and have more power to help others.

 

Tony@2010 Christmas

 

 

 

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Without Facebook-#1

People say if God closes a door, he will open another door for you.  It’s the same reason why I choose to quit Facebook until my birthday of 2011.

There’re 6 months to go. Facebook is really useful and interesting tool for communication and sharing photos.But it takes me much time everyday. Some connections on Facebook are real and some are virtual. Although I already “unfriend”some people from list, there’s still someone you would press “like” on his photos or say “Happy birthday” but never hang out with. The longer I spend on Facebook and the lesser I spend on real connections with “real friends”. And as you see, it’s my first blog diary since I became a resident doctor. In the following 6 months, I will transform the time I spent on Facebook into working on my dream, making a real call to friends/family, updating blogs and travel.

 

Tony @ the era without Facebook

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Tony’s Anatomy-#8: Intern concerto!

Finally, the end of internship is coming. In review of this year as an intern doctor, it’s like a concerto, composed of 3 parts (fast, slow, and fast).  The first 4 months was like  a “Allergro”. Everything around you was fast! We came to a whole new medical center and tried to fit to new enviroment. Try to learn medical procedures we didn’t do befoe. Try to ask medical history of new patients who you never met before. And then at the same peroid, we were preparing for apply of next year’s resident doctors’ positions. Even you know you just came to a new beautiful city, no one had a mood to travel or fool around. Near December, most people will know where they would work as a resident doctor next year. Then the 5-8th months was like a “Lento”. Everything became slow!  As you know where you will go next year,  you’re starting to think when to leave and how long you have to wait especially if you were not in a hospital which you got a postion. And since you got adapted and familiar with mediccal procedures, every time you insert a Foley catheter you feel like doing a repetitive boring work. In the last 4 months, most people choose easy courses for their internship. However, life became very very fast as “Presto”!  Although our burden became less and easy, we felt we’re leaving in soon. We want to grasp more things like medical knowledge or procedure practice before we leave! We want to enjoy more happy moments with friends we meet here. We start to travel or gather together. Sometimes we even tried to talk with someone we never talk before. How do you feel if someone you just meet and found adorable and interesting is leaving soon ?   Quite sad, isn’t it? Iris shared a good movie story, “Harold and Maude”, to me. The 19-year-old boy loved and had dating with a 79-year-old woman in the story. When the woman’s life came to the end and the boy was panic of how to live without her, the woman said “ To love more!”.  Huge thanks to every friend and coleage ! Really hope our path will cross again in the furture.    

 

Tony @ Taichung

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Tony’s Anatomy-#7.Seeing is not believing!

Finally,my internship program came to the end course,Pediatic medicine.I pick up hematolgy department for my 1st rotation.In the grand round by all the staff,me included, I saw a little young girl who looks like 6 years old. However,her real age is 12 years old.How come? There must be something wrong! To everyone’s surprise, her family abandon her in the hospital and we can’t get contact with her family members to know any information about her disease history.Her kidney is going down due to the tumor obstruction. What a pity it is ! Finally we arranged a tube into her body to relieve the kidney obstruction and she was now transfered to ICU.We still don’t know why she had retarded growth.Through this true story, you can know the difference of the accompany between adults and childs. Without accompany or wife, we,doctors, still can take history of patients’ disease process. But in pediatric patients, it’s obvious that we can’t.Patients’ role is very important.  There’re some news about adoption and discard in recent days. I truely hope that every child will be well cared and accompanied.Children are so cute that many people like them.But you will know how much you love them until you have to face the problems and difficulty they made.Children are not toys that you can’t discard when you don’t need them. They are truely alive persons. Don’t discard any child,please.

Tony

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Tony’s Anatomy-#6:Unforced error and ACE

It’s at the last day of my internal medicine program. The emergency department(ER) transfered a man presented acute progressive back pain to our pulmonary medicine ward.Initialy,he was diagnosed as pnuomonia(lung infection) by ER doctors.However, after detail analysis, we suspected he may have a internal bleeding.We arrange a CT image scan for him which showed internal bleeding and colon PERFORATION! Oh~~~my god! Comparing to ER’s impression,it’s totatly different impression. This man was dyeing! Then we arranged endotracheal tube insertion and intra-venous(IV) line on the man. However, until one anesthesia doctor came , we found we forgot to insert a larger diameter IV tube(CVP) on this patient. Without this large IV tube, it’s quite impossible to infuse sufficient blood to compensate acute server internal bleeding.Thanks god.We did it before acute internal bleeding happened and arranged emergent surgery immediately. However, when I was writing medical summary note, I found my team member,the decision marker, was crying. Why? She felt guilty for making a unforced error( a term from Tennis). I told her it’s really a mistake but we also made an ACE  ball that we found the most life threatenng disease he got and fix the problem in time.A great docot bears strong resemblance to the great Tennis player like Roger Federer that they rarely makes double fault and learn from experience. I am not a great doctor yet.Hope I can make many ACE balls in the furture.

 

Tony

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Tony’s Anatomy-#5:100 meter running!

When did you ever try so hard to run 100 meter again after senior high school? I got a call asking me to Emergency department in one afternoon.When I arrove,the patient got trauma injury by falling from four-story-high building's roof was lying on the bed and had no consciousness.Hemothorax(much blood in lung space) was highly suspected and blood pressure was gradually decreasing.Vital signs were obviously worsing.We decided to sent this patient into operation room for emergency surgery.There're three people for this mission.One senior doctor for keeping ventilation and checking vital sign, and one nurse and me for driving and CPR if necessary.Then we started to take this patient to receive surgery.We ran veryyyyyyyyyyyyy quickly!But unfortunately,in the process of delivery,the oxygen saturation was decreasing sharply and we adjusted oxygen volume immediatly.Then we speeded UPPPPPPP as possible as we can!Finaly through 100 meter running,we arrove the operation room.But the story did not end yet!In the operation room,when anesthesia doctors were preparing,the pulse of this patient was lost! Damnnn it! Without any doubt,I immediately did cardiopulmonary resuscitation by delivering chest compressions with rate of 100 times per minute.Thanks God! Few minutes later,his pulse and blood pressure came back.Then after sugery,his vital signs became stable.The 100-meter-running on that day was not a race with any athlete or friend but with THE GRIM REAPER!I didn't record how fast I really ran but I tried my best to run for sure.

Tony

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Tony’s Anatomy-#4:Resistance helps light bulb shine!

 

 

 

 

The story happened when I rotated to neurosurgery department.One day,a patient was sent into the operation room due to intracranial hemorrhage(bleeding inside the brain).I was paged to assist in this emergency surgery.To my surprise,I finished my first experience  of drilling a hole on the skull bone by other two doctors’s assistance.After then the chief resident doctor started to talk about what kind of peosons he wants to be his assitant.He needs someone who will be assistant rather than resistant.Well….it’s common sense ,right?Since I’m quite new to sugical medicine,I was thinking whether I assist the surgery or become a obstuace of others.Then I got a warming answer from another resident doctor who was also assisting in this surgery.Dr.Yeh said to the chief resident doctor:”A light bulb need resistance(R) to shine or radiate light.” I guess whenever I meet diffiuclties, I’ll thnik of these words.

Tony

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Tony’s Anatomy-#3:If placebo is also effective in clinical trial

This week,our main training course is evidence base medicine(EBM).In EBM,all we often to do is to find and study associate research and studies.Usually,new drug is expensive.What will you do if placebo is also effective in the clinical trial about  your patient's disease? Money really matters especialy for poor family.Can doctors just precirbe a placebo drug for them if placebo drugs are also effective in evidense based medicine research?

Anyone have good idea about this question,welcome to mail me or even just drop me a line.

 

Tony

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Tony’s Anatomy-#2:Cooking Labs & World Games in Kaohsiung

Since my internship,I am very very busy but trying to cook is really fun and always in my mind. I arranged a quite easy course in these 2  weeks.I am runing Family Medicine now.TGIF! I cooked curry rice this week.....not really good appearance but it tastes good at least.

 

The World Games 2009 Kaohsiung is starting now.It's Taiwan's first time to host international multiple sports games.Can't wait to see the sport dancing competitions in World Games next week.

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Tony’s Anatomy-#1:As days go on,my libido goes down

I started my internship from 1st June 2009.My first program is Obstetrics and Gynecology (OBGYN) deparment.I have to touch and examinate lots of female patients every day but as days go on,my libido is actually going down.One day,there’s a pretty woman with Louis Vuitton bag came to out-patient clinic.I can’t quiet believe my ears and my eyes since she got a fungal infection at women’s private part!OK,pretty  appearance doesn’t grantee any thing inside.

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No one defines who you are!

This title is from Season 3 Episode 4 of Grey Anatomy TV series.

To live for myself is a very important thing and philosophy for me. A excellent advertisement or marketing makes people follow.When I notice a new current event or idea people are chasing after,like LOHAS , I'd try to see whether this idea is really good enough or just an idea published out by marketing in order to promote something.Hope one day I can make others follow rather than I follow someone's step. There're only one month still for me to stay in Kaohsiung and I am trying to grip the last few great moment here.Last week, I went to Kengting with my Austria friend,Judith, and my German guest ,Johannes.Although Kengting Spring Scream or Spring Wave festival is the most famoust event in Taiwan,it's really my first time to join it.We didn't preserve any room or teny even when we arrived there.Who needs sleep at that night? LOL!It's realy like a vacation journey.After enjoying the music concert,we laid on the beach,seeing stars,and talking and some friends are dancing.When it was near the morning,there's a foreigner running naked along the beach with a girl,quite crazy ,isn't it?

 

Judith and me!

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Valentine's Day

My classmate,Chmo, was planing to propose to his girl friend on Valentine's Day.He invited me to write "Recommendation of  him" when I was still working and wearing white coat. After writeing my words on the small blackboard, Chmo took the photo of me and my words. Translation of my words in English: "Feel easy to marry Chmo. How happiness it is !".

 

On Valentine's Day, after his proposal with knee down and showing photo collections from all our group members ,his girl friend immediately started crying! It was a heart touching moment,wasn't it? As a student as I am now, there're no so many resources behind my classmate,Chmo, and they knew each other before entering medical school. They attract and love each other by their own personality rather than fortune or the doctor title.

 

Wish their love lasts forever!

 

As the financial status is geting worse and worse, many engineers are fired or their salaries become much less than before.And it's irony that the ranking of women's favorite job of their date men is also changing.Engineer is not the first place any more and it's replaced by doctor.It's very ridiculous that many years ago as IT industry was sharply growing ,engineer replaced the first ranking rather than doctor which used to be.

Job,title and fortune really affect most women and of course,men either. Taking a bag of Louis Vuitton doesn't mean you have a excellent taste also.

 

Show me the taste! Not show me the money!

 

Tony

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Human soul is the only organ you can't see in the operation room.

Rotate to General surgery department yesterday.We have a woman patient with colon cancer today. During surgical operation , due to doctor's privilege, I can see any organ even if viewing from inside out.But there's only one organ I can't see.

 

 

That is SOUL! And maybe that's why I am so interested in meeting friendds.

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Paris-My Euro Trip @ August 2008

Thanks for Summer offer tickets of Thalys train,it's my first time to enjoy the 1st class seat.Finally,I arrived the city I want to visit most.Yes,it's Paris and I was coming!

Before arriving Euro,I read many books about Art History.I can't believe I can see these real paintings and arts in so close distance.As a chocolate fan,Paris is also the most important city.There're many 3-star chocolate stores in Paris.

 

Musee d'Orsay

In Musee d'Orsay,the painting "Dance in the City" highly attracts me. It maked me want to dance at that moment,and reminded me "Vienna Waltz".If available,I'd like to dance Waltz.

Dance in the City,

Pierre Auguste Renoir

 

I meet Cynthia Nixon in Paris!

At last day in Paris,i can't believe that it just happened.I love to watch America TV series "Sex and City". The character  I love best is Miranda Hobbes. In Paris,it's rare to hear someone speaking English. After visiting Jean-Paul Hévin Chocolatier,I was causely looking around near the Jardin du Luxembourg.Suddenly,I hear a very familiar voice and it's American language.I saw a pretty woman with a classic hat was talking to her child.It really catched my attention because it's the accent as the same as Miranda Hobbes on screen.But I am thinking it's impossible to meet an American star in Paris especially the one I like best.Then I followed her into a pharmacy store, and took my courage to talk to her.I asked her " Are you celebrity?" ,then she replied "yes, how are you?". Wow,very amazing!.

 

 

Jean-Paul Hévin Chocolatier

 

 

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Netherland-My Euro Trip @ August 2008

There's no night train at Taiwan and I really want to take night train in Euro.There're 2 choices ,choose Prague or Munich after Vienna tour.All low price tickets of Munich-Amsterdam were sold out so that I decided to visit Prague.

CNL night train is very comfortable.You can lie on the bed , listen music, and see the scenery through window at the same time.Listening my favorite song "Meaning of Travel", I was also thinking the meaning of my Euro travel.

 

 On CNL night train

Finally,I arrived Amsterdam after passing by Berlin.There're many canals and buildings with different gables in Amsterdam.You can tell when the building was builded by observing it's gable.I walked around randomly and then I saw a "Purple cow".There're many street artists in sight-seeing places.But this one was very different.He costumed as if he was the Sith Lord Darth Vader. Every child ,even any adult, will love to take picture with him,right?

 

Purple Cow

After  first day in Amsterdam,I took a train to Haarlem. Anouk drove me to the beach and we walked her dogs together.Wind is very very strong and there're only wind-surfers on the beach!One day I and Tommy walked on the street in Leiden,we meet Tommy's friend.

Tommy asked his friend "Why did your long hair become crew cut now?"

He answered "Because of Netherland's wind".

It's funny ,isn't it?

 

Anouk

After visiting Van Gouh museum,I saw this family stoped at traffic light. The woman agreed with my photo request.What a wonderful bicycle it is!You can drive your little babies and it's rain-proof. I told her there're no such bicycles in Taiwan,and she said there will be in Taiwan,soon.

 

Special bicyle

My friend, Sanne, gave me her hand-made Lonely Planet Book about Leiden. If you visit Leiden,don't forget Rapenburg and BLT sandwhich.

 

Key to Heaven

BLT sandwhich

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Prague-My Euro Trip @ August 2008

During my first 2 days in Prague,it was raining and raining. I was afraid that the photo race holded by Prague CS group on the 3rd day will be canceled. Very lucky,sun came out and it didn't rain any more on the 3rd day.But the CS photo race oraganiser canceled the race by posting a canceling messege on messege board at 30 mins later than the time for deal  and he also did not open his mobile phone . Except I and Irina, there are no other persons who arrive BeerGarden in time.

 

The cancel reason was not because of the weather!
It's ridiculous that they canceled it because most people were still sleeping near noon !

 

Anyway,I and Irina won the photo-race ,didn't we?

 

Then we went boating on the Vltava river.We had a relaxing time on the boat, and almost forgot the time we've spend.We rowed near 2 hours.Except sightseeing, I really recommend boating on the river.

 

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Vienna-My Euro Trip @ August 2008

Guess where I took the header picture "Kiss and Ride" from ?

It's taken at Vienna Praterstern Train Station.

It's my first time of  Euro travel and couchsurfing experience.

Courchsurfing really made my trip become very awesome and fantastic.

If you want to join it, click "About Me" or "Couchsurfing" link,and you can understand what it is.

 

Due to flight transfer problem I got in Paris CDG airport,I arrived Vienna later than oridinary plan.

After asking direction,I finallly found Theresa's office and meet her there.

Guess what happened later?

Like the key St Peter has,I also get a key to heaven from Theresa.

It's really amazing because it's our first meet and we didn't have a long talk yet.

I saw the beauty of humanity in this experience.

 

 

Theresa

 

On Wednesday's night, I meet Susi at Wiener Staatsoper.Then we walked to the Donaukanal and had nice talk at a restaurant there.I really enjoyed the moment of going out with her. Her company has a branch office in Kaohsiung , maybe we can meet each other in the furture. :)

Susi

 

At the last day in Vienna, I saw a rainbow in the spring of Belvedere.Wow......it should be in the sky ,right?

I have more words about Vienna,it is a beautiful city full of  many nice people and interesting festivals .

I'd love to visit it again in the future.

Rainbow in Belvedere

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My Cusine 0726-2008

It's a relaxing day.No reason for going out.So I decide try to cook PASTA in my flat!

I choose penne for noodles , and add some Brasil leaves to let my cusine have more flavors.

Maybe it's because I cooked this cusine by myself ,I try to figure out what it tastes like so eat very very slowly.

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