A busy day in the emergency room

I had a great time in the emergency rooms around Vancouver when I went through my third year rotations. I guess I liked the variety of cases that come through the door, and doing what I think is one of the most fun parts of medicine: diagnosing and stabilizing all sorts of patients until the right experts can take over.

But my 4 weeks of emergency in Vancouver was nothing compared to what I did in a rural rotation during my fourth year. In a small town emergency manned by just one doctor, I suddenly became a useful member on the team. The nurses look to me to take on patients so that I can help with the workflow, seek me out to do procedures “because the student should learn this”, and the doctor place me up front and center for my first cardiac arrest code…

During the day, I sutured a few lacerated fingers (I love suturing no matter how many times I do it… I think it has to do with liking to do small arts and crafts that are fun but not overwhelming), examined a few patients with various ailments, pushed the shock button and zapped a patient out of her multifocal atrial tachycardia, all in a day’s work.

But in the evening, things got more interesting. While I was talking to the ER doc about anaphylaxis, a family member suddenly called out: “we need some help!” I jumped up and rushed to the bedside; I interviewed the frail lady just several minutes ago and thought she just had a partial bowel obstruction, and ordered the standard set of workup.

She looked very different now. Her eyes rolled back, and her muscles started to spasm. Her false teeth came loose and was about to fall into the back of the throat when I threw on a pair of gloves and grabbed it.

“Open her airway,” the ER doc said. “Start bagging her. Call a code!” He turned and called out to the nurses.

I grabbed the bag-valve-mask and the thing fell apart. I clumsily put it back together and starting bagging (providing artificial respiration by pressing air into the lungs with the bag) the patient. I was so focused on my task that when I finally looked up, the family member has been gone, a team is already around the patient, and an ECG was showing ventricular tachycardia (and she is pulseless)- one of the most deadly heart rhythms that means certain death if not corrected in minutes.

“All clear!”

The patient jerked while the shock was delivered. I resumed bagging the patient right away, but almost immediately she started showing signs of life, moving her limbs and spitting out her oral airway. I pulled out the airway and the doctor told me to keep bagging her. After a minute or two, she started breathing on her own and I just held the mask delivering 15L/minute of oxygen over her face, and took in the scene.

A nurse was having difficulty with placing the oxygen pulsimeter, another nurse is placing a large-bore IV, and someone else is fitting a bag of fluids into a pressure cuff. The ER doc was giving orders for interventions and investigations. The patient continued to stabilize, and things finally settled. She was saved from death, for now, but we haven’t figured out what she was dying from.

As a part of tests to find out, we ordered an arterial blood gas. This requires puncturing the artery with a needle to draw arterial blood, to find out about the gases and pH values of blood that the body sees. I had practiced on a classmate more than a year ago, so I was poking my head over a nurse’s shoulder to get a look.

She suddenly asked, “where’s the student?”

“I’m right here behind you.” I said.

“You should be doing this.” She said, matter-of-factly.

“I was thinking ‘I wish I could be doing this'”, I said, which was the truth.

So we switched spots. I struggled at first, but another nurse holding the patient’s hand was steady and patient, and the ER doc gave me some directions, and I got a steady stream of arterial blood from the radial artery. First ABG, success.

The ABG later showed that the patient had plenty of oxygen in her blood, and no other abnormalities. “You bagged her well,” the ER doc said. First time bagging a coding patient, success.

Later on that evening, just as everyone felt they’ve put in a good day, a call came in notifying us that there’s a cardiac arrest patient being rushed in by ambulance.

A team of nurses that make up the trauma team got ready in the trauma bay, and I volunteered to do chest compressions. But the ER doc had something else in mind.

“You will intubate the patient.” He said.

“Alright!” I said, excited.

“Have you intubated before?”

“Only in very controlled settings (in the operating room).” I said

“Well, there will be nothing controlled about this,” he said.

We checked the intubation equipment, and someone pulled up the glidescope. The guidescope is basically a camera that shows the patient’s airway on a screen, which often helps visualizing the trachea into which the tube has to be inserted.

After a few minutes of calm when the whole team waited, the ambulance arrived. A nurse closest to the door took a look, and said quietly: “god, he is 400lb.”

The ambulance crew flew in with the morbidly obese patient, and somehow managed to drag him over to our stretcher. The continued to pound away on his chest until our nurses took over. The team got to work, placing IV’s, defibrillator pads, and I pulled over the glidescope.

“Go?” I asked.

“Go.” The ER doc said. “And 1mg of epinephrine!” He said to the medication nurse.

I opened the man’s mouth. His neck is massive, and his tongue seemed as big as my palm. I couldn’t even fit the glidescope into his mouth, and I think it is at least 2 inches too short for him.

“Let’s use the traditional way,” the ER doc said after he couldn’t get a view either.

I pulled up the laryngoscope, and naturally used my right hand to put his head (which must weigh 8kg) into the sniffing position. I saw the epiglottis, and it was impossible to see the vocal cords.

Thankfully I learned how to use a flick motion with the tube in this suboptimal situation, and I got it in one go.

Unfortunately, despite our best efforts, the patient was too far gone. The ambulance crew has been doing CPR for about 30 minutes before arriving to the emergency, and he was in asystole on arrival. The most likely cause of death is a massive MI, and there is little CPR can do in this situation.

The ER doc called it, and commended on everyone’s efforts. He was especially impressed with my intubation.

“Truly a great job. Things were chaotic, the nurses were doing chest compressions, the man is so obese that even anesthetists would have to try hard.” He said. “You won’t have to do a harder intubation in your life.”

Although the outcome of my first case of cardiac arrest was not successful, I left the emergency room at 2am knowing that I have done as well as what anyone in my situation could have, and that was a good feeling for a medical newbie like me.

And I realized: the more I do in the emergency, the more I like it.


Resume revamped

How do you write your resume?

Most people I know use MS Word and try to maintain the look of a template that they like. I used to use Word as well, and I have a template that I thought was reasonably pleasing to look at.

My old resumes are done in Word. Some lines are starting to get misaligned. With careful adjustment, this can become presentable.

However, there are some obvious problems with using a word processor to edit resumes, due to some inherent characteristics in a resume. Namely, resumes:

  1. Need a moderately complex but highly stable layout to look good. Resumes usually have section headings, job titles, time frame, location, company name, and job description, among other things. They are usually laid out using left, right, and center alignments, bold or italic fonts, and/or varying font sizes. But to look good, the entire resume should have a consistent format. Even if a date is offset by 0.5cm, the resume will start to look sloppy. You can do so by copying and pasting sections to try to preserve a consistent format, but when you edit the text, there is a good chance that the format will be thrown off, leaving you to struggle for ages to make the dates aligned on the right hand side again.
  2. Are constantly updated. You need to add new job items, new volunteer experiences, update the time frames on previous job descriptions, etc. to your resume. You may find yourself in the situation where the delicately designed resumes on Word that you built a few summers ago fall apart like a weathered antique that cannot be tempered with.
  3. Should be tailored. Every time you apply to a job, you should tailor a version of your resume. With Word, you may have to cut and paste items suitable for a specific job from any number of previous resumes, thus creating a mess of slightly different versions that gets more and more cumbersome to keep track.

So I wanted to switch to a system where I can achieve the above with maximal ease. I want to deal with formatting less, and focus on content more. I want to be able to update any section I want without worrying which word should be bolded and which word should have a 11pt font rather than 12pt. I also want to be able to “comment out” unwanted items for any particular job without removing it from my resume, so that while it won’t show up on the finished product, it is still easily accessible on the if I need it in the future. In fact, I want a “Master Resume” where everything I could put on a resume lives, and I just need to pick and choose which items to show up for a particular version and click print.

I explored two options: first is XML/HTML + CSS, which is an improvement over Word but still a bit messy on the content side with all the HTML tags, and the output is a webpage, not an easily printable copy.

So I settled on my old friend: LaTeX.

After a few iterations, I designed a new resume system that I feel very proud of.

1. Content backend. All of my job titles, descriptions, dates, etc, live on an easily readable spreadsheet, on which I can make edits effortlessly. And since this is LaTeX, I can comment out any job item by simply putting “%” in a left column, and that item will not show up in the finished product but it is still available for future use. In fact, I can create a different column of %’s for each version of resume, so that I take one glance and know which job items have been shown in which application.

The columns with content are interlaced with minimal LaTeX syntax, made possible by item 2 below.

For added awesomeness, do this part on Google Docs and edit your resume anywhere!

2. Centralized formatting. I pulled all the formatting up into a method, which means there is only 1 line of code determining which words should be on the left, which ones on the right, and which ones to be indented by how much space. If I want to make all the job titles italic instead of bolded, I only need to change one word. I built on top of the format template found here.

This part I don’t have to edit often, but if I wanted to change how each job item looks, I just need to edit this piece of code and the changes will apply to all resumes.

3. Integration. Now, I just need to copy the spreadsheet with the appropriate selector %’s, paste it onto LaTeX in the appropriate location, and click on generate PDF.

Copied and pasted from the spreadsheet. The coloring is automatic syntax coloring, to help visualize the code.

And then check out the final product for any final touches.

Finished product looks so awesome that I can’t wait to show it to people. Good start for any job application if you ask me.

I would be happy to share the code and spreadsheet I shared the TeX code and spreadsheet in this follow-up post, although this is a highly breakable system because there are countless ways to break it. You just need to miss one tag on the spreadsheet to be entirely stuck.

And of course there is the intimidation factor. All these code-looking things can make those with faint of heart hesitate.

Therefore, if there is market, I think it would be wise to make a more robust and less flexible software that allows the user to enter values in a spreadsheet, and spits out PDF files on the other end, and save everyone from the code.

You said there are lots of software like that?

Well, not exactly the way I made it, I’d bet 🙂


移民加拿大10年, 我的朋友圈應該還有一半的人看得懂中文, 而看得懂中文的朋友裡, 十之八九都會關心台灣的事。所以這則標題為「清大畢業生 為何淪為澳洲屠夫?」的新聞, 值得一提。

文中大意, 是一名清大的畢業生在台灣工作兩年, 賺不到錢, 就到澳洲從事勞力工作。目標是在澳洲賣命賺兩年錢 (大概跟在台灣賺10年一樣多), 然後再回台灣。他在肉品工廠裡, 發現很多勞工都是台灣的年輕人, 進而體會到: 泰國人到台灣當泰勞 (人均GDP1/3), 而台灣人到澳洲當台勞 (人均GDP 1/3), 完全是一樣的道理。

讀完我有個體會: 泰勞應該集體出走, 去澳洲賺 1/9的GDP差異才爽嘛! 😄 (大誤)

看完上一篇文章, 再回來看嚴長壽嚴董最近說的: 年輕人缺乏熱忱使命感, 正好成為把清大哥逼去澳洲當屠夫的壓榨者的代表。

嚴董認為, 台灣的年輕人因為薪水低, 寧可待業也不要低薪工作, 跟他底下 “公益平台文化基金會” 裡面, 願意當半年無薪志工的有為青年來比實在太差, 太草莓了。

能夠花一年半載當無薪志工, 食衣住行都不愁花費的人會是多數嗎? 能夠拿他們來跟沒錢會挨餓的一般人比嗎? 老闆這樣的心態, “我給你當廉價勞工的機會, 不, 我給你當無薪勞工的機會, 幫你「拓展格局」, 還不知感恩。跟我們當年拼命的樣子差太多了!”, 看到越來越多的台灣人出門另找生路, 應該沒有意外吧?

我倒是很想看看, 說台灣年輕人沒有熱忱, 沒有幹勁, 不肯吃苦的老闆們, 看到清大哥的故事以後, 他們會說什麼。 他們會說 “清大哥短視近利, 賺到兩百萬又怎樣, 又不能在澳洲當一輩子的勞工, 還不如在我的公司底下乖乖的給我罷凌, 10年後至少不會餓肚子” 嗎? 還是會承認他們看低了台灣的年輕人, 其實很多人願意吃的苦不輸當年工業起飛的台灣。 只要給他們足夠的待遇, 再艱難的環境 (去澳洲當二等公民遊民)、再辛苦的工作 (用類固醇止痛去劈8小時的肉) 都有人會做的。

當然, 不能以偏概全。清大哥的例子雖然不少, 但是也有很多人抱持著不同的人生目標。 在出國去打工的族群裡,就有另一個族群和發狂賺錢的清大哥形成對比。一位名叫Rex Huang的同學, 在他的臉書上寫得很具代表性。他說:

來澳洲半年 我剛好工作了三個月度假了三個月
我已經經過三個州 五個大城 開了六七千公里路 更不要提途中所有的美景讓人難以忘懷
我過得不是很奢華 但是也不至於餓肚子 我過得很快樂


在澳洲工作一週五天 朝九晚五準時下班 一個星期就有22K
假日上班還有加倍的薪資 穩定工作一個月可以存到五六萬塊
認真工作老闆還會肯定你 鼓勵你
說穿了 花更少的精力換更大的利益誰都想要
台灣政府與資方 憑甚麼要我們回去領22k?
只在乎草莓不草莓 真的有在乎過年輕人的付出與所得成比例嗎?


讓自己去看沒看過的風景 嘗試在台灣沒做過的事情

24小時隨時可得的美食 頂級的服務業精神


“在小事上忠心 在大事上也忠心”
我想我們背包客不只是更加努力讓更多人認識 看見台灣 
也都會在各個位置上認真盡責 因為我們每個人都代表台灣
請讓我們擁有應該有的尊重跟待遇 讓我們在國際有生存與發聲的空間

其他的佳句太多, 大夥可以去他那裏看全文。

Rex (以下暱稱暴龍) 同學體會到的, 除了澳洲錢好賺以外, 其實比清大哥還要多出很多。他看見了澳洲人 “work to live” 的態度, 和華人 “live to work” 的差別。(其實暴龍同學的翻譯不夠好, 應該是 “為了快樂生活而工作” 和 “為了拼命工作而活著”。) 更重要的, 是他能夠融入這種生活心態, 和澳洲人進行有意義的交流, 充實自己也介紹台灣。台灣政府沒辦法和大陸抗衡, 在國際上永遠會是落水狗, 但是越多和暴龍同學一樣的國人在國際舞台上當台灣的大使, 就越多人會認識台灣, 欣賞台灣。雖然他回台灣的時候, 荷包大概比不上清大哥, 但是他學到的、做到的一定不會少。

其實暴龍同學和清大哥, 一樣到澳洲打工卻有如此兩極化的經驗, 一方面也許是機緣, 一方面肯定是兩人在價值觀上原本就不同。一個要賺錢, 一個要賺經驗, 兩人都有自己的想法, 不能評論高低。也許暴龍同學在澳洲露營交友爽了半年, 回台灣抱著熱血繼續忍耐煎熬, 而清大哥抱著一桶金,  回台灣有了別人十年才賺得到的資金, 在人生起跑點大大加速。又也許暴龍同學繼續保持他 “work to live”, 工作是為了讓生活更好的樂天態度, 生活小康卻知足而樂。無論如何, 兩人不同的價值觀大家可以討論, 但是到頭來, 還是要看自己的人生目標, 而不能斷論誰是對的。

比起暴龍和清大哥的差異, 更值得大家探討的, 是如何從這些故事裡, 發掘台灣的問題。因為讀到這裡, 大家可以發現: 台灣的年輕人要賺錢的應該出國賺錢, 要拓展視野的應該出國拓展視野。澳洲簽證到期了, 來加拿大啊, 去美國啊! 那還有誰要留在國內啊?

這問題還不嚴重嗎? 嚴董還要繼續說: 「你們怎麼這麼弱, 餓肚子半年就受不了!」 嗎?