Saturday, December 18, 2010


I was totally shocked upon hearing the news of the death of a good friend, Mas Afzal Masaruddin. Not that I was one of the closest person to him, but him and my other good friends; we surely are bonded by one tie that is strong enough to say that yes, indeed we are good friends who walk the same path.

I first met him at KMYS, the college where I did my A Level. We were never in the same groups but I remember going for the bronze award of D.O.E which involved climbing up to Cameron Highland. He was one of those few who joined - he was so nice he carried my 10kg rucksack when I was too tired to push my body up with the heavy rucksack on (which made it probably more than 20kg total of rucksacks he was carrying).

I was despatched to Newcastle whereas he went to Sheffield. I met him every now and then back in the UK. He was constantly giving good words, inviting people to what he believes in, Islam. He was then diagnosed to have Hodgkin's Lymphoma - but I was not that close to him, to personally say how sorry I was to hear his condition.

Yet, he was a true fighter. He never failed to amaze me. Having been diagnosed with such cancer, with bouts of coughing and side effects of chemotherapy that he had to succumbed to, he still passed his final year medicine and graduated as a doctor. The last time I read his blog was quite a few months ago, then I never really heard of him and how he was doing again.... until today. I feel ashamed and speechless, to have been so busy with my own life and nonsense worries, when he was fighting endlessly in his own world - and never did I try to contact him.

Truly, he was indeed a fighter. He fought to the end. My deepest condolences to all close to him. His presence once will be remembered. May all his doings bring him to the Paradise.

Innalillahi wa inna ilaihi raji'un.

Sunday, November 21, 2010


I was planning for at least a decent day off during the 'week off' for raya haji, but due to shortage of H.O. that was not made possible. But my wish was finally granted, after I got this horrible self diagnosed AGE (acute gastroenteritis).

I actually went to hospital for my morning shift on Friday, only to find out that I was too dizzy to stand up (I even get my brother to send me to the hospital), probably due to the loss of fluid via vomiting and diarrhoea. I hesitated before decided to finally take the two days of MC that the Big Boss offered me. My hydration was actually fair (a very bias judgement I have to say, as I was assessing myself), so I refused IV drip in the first place, but after two bouts of vomiting I succumbed to the correct decision of having a cannula inside my vein - and it did feel painful when the Hartmann solution ran through the small pink cannula into my left radial vein (is there?) to compensate for my loss.

Diarrhoea became worse when I got home that I literally did nothing just because I was incapable of doing things or to think, because I was too tired and dizzy running from bed to toilet, and vice versa. The next morning I woke up, pulse rate was still tachycardic, but I was feeling much better - then only I could think up straight - I was probably already in second stage of hypovolaemic shock. I called my friend, and let her brought me in anohter couple of IV drips. Today I feel much better, and ready for works, and surely in a much more empathic mode.

*Left - modified IV drip stand at home; Right - adik Aqil my doctor*

The Big Boss asked me why did I refuse admission, which I didn't because on Friday morning there was exactly no indication for admission (Friday night's condition was a good enough inditation though) - but so true, the worse patients to serve are the staff, simply because we know how it works.

I might as well sign an A.O.R anyway should I require admission, why should I be warded when the rest of the family is at home? Still the granted two days off at home was not that meaningful because all I did was sleeping and sleeping, all day long. And I miss a day out with friends who came around from Kelantan, as well as a friend's wedding. The least bit that made it worth it was that I managed to read almost five chapters of Harry Potter and The Deathly Hallows after feeling a bit better, after completing those IVD and tolerating orally.

The sad thing is, I am left with only 6 days off for another 3months in this posting, and that is only if it is permitted. Yes, for us H.O, MC is deducted. Counted in. Exactly why we bother so much about getting ones. Explains the reason why we still work despite having a one week suffering of unresolved fever, seeing those who came with a few hours fever without taking antipyretics.

The good thing is, now it reminds me how bad an IV line could torture your nerves, I will try to be more empathy as I used to once upon a time when I was a medical student.

Wednesday, November 17, 2010

Sunday, November 14, 2010


Some people missing in action in working time, is not a peculiar subject for me anymore. People coming in late for the ward rounds in the morning, or go back so early and leave the burden of the ward works to the others, also sounds so familiar. I can go on and put in complaints, and the list will be endless. Including things about my own self, like how I feel how slow I can be at times. But complaining alone won't achieve anything. Feedback like those in today's handovers is more likely to cause improvements, complaints won't.

I like my Big Boss, he is so far the most responsible H.O.D. I have met. He has this weird 'flight of ideas' speech when we were presenting cases or during the handover sessions, but he is very thoughtful and he does take good care of the staffs and the department; about things that should be in its right place. No one is allowed to come late. Which is good. I dislike punctuality too, even though I have always been rushing to work - but to my defense, that is only so that I arrive on time. I can list up ten reasons how coming in late for ward rounds will cause your punctual colleague to suffer. Of course, there are exceptions to being a few minutes late, but if it is a habit, it is something that hardly changes.

Back to the Big Boss. He knows what is going on in the department. Absconded staffs, nonfunctioning computer system that delay things, absconded patients, issues with other departments...etc. People who were missing in action and those staffs who weren't helpful were also warned today, so hopefully things will get easier and quicker for me. I love those nurses who were so helpful and not just bossing around, scolding doctors (read: housemen) because they have to do jobs. I love the former I would bake cakes for them. If I have the time and energy =)

Anyway, feedbacks like these, discussed in today's handovers are more likely to cause improvements, complaints won't. When I said feedback, I mean complaints made to and done by people who are able to do the changes for the better, and not just merely complaint to friends, who are at the lowest position like yours.

Attempt to get help from the supervisor was to no avail the last time, and even when we ran out of the lab forms yesterday, nothing very helpful was done about it. If the Big Boss is not in his current position right now, I wonder if adrenaline will always be enough in the emergency department.

Malaysia and good feedback system, is still a long way to go. The last time I put in suggestion in a suggestion box, a few weeks (or months) later, the box was gone. When my medical boss lodged an incident reporting to improve some systems, which I seconded, he got an incident reporting attack as if he was doing that out of arrogance.

Reminds me to how Newcastle University library answers NICELY to all the suggestions sent, oh how good the system is.

Same goes with the politics. But not going into that topic tonight, too tired I need some good sleep right now. And the conclusion is I like my Big Boss. Taraa...

Saturday, November 13, 2010


I feel I lack that feel that I used to have
I don't exactly know how to describe it
Maybe one day I will be able to
But for now
It is just upsetting
I want my old self back
And the gratitude I used to show
I miss my old life
This working life is just.... not working
As how I wanted it to be
As how I imagined it to be
The soul feels empty
That surely needs a refill
And all traced back to the One

Friday, November 12, 2010


I was working at green zone this morning, and most of the cases I have seen today were those with fever. Here goes some conversations:


Me: Bakpe mari?
Patient: Demam doktor
Me: Bile start demam?
Patient: Bangun tidur tadi
Me: (glancing at the watch which showed 1030am) Ooo...baru 4jam laa lebih kurang?
Patient: Lebih kurang gitu aa
Me: Amik panadol doh ke?
Patient: Dok pon. Buleh ke gitu?
Me: ????


Me: Mokcik, bakpe mari hari ni?
Patient: Demam doktor
Me: Ooo, berape hari doh?
Patient: Lima hari doh
Me: Lagi ade masalah lain ke?
Patient: Ade...batuk-batuk doktor
Me: Ooo, berape lame doh batuk?
Patient: Lame doh doktor
Me: Ye la, berape lame?
Patient: Lame sangat doh doktor
Me: Mokcik, (again, with all the patience) lame tu, berapa lame? Seminggu, sebulan, setahun?
Patient: (sengih) Lame doh, mokcik dok pindoh rumoh anok mokcik lagi mase tuh
Me: ?????? (and how on earth would she expect me to know when did she move to other house?)


Me: Bakpe mari hari ni?
Patient: Rase pening aa doktor. Hawe2 nok demam ade gok. Tadi daroh saye tinggi
Me: Ooo...kad takdok lagi ni, doktahu lok tekanan daroh awok berape (assuming it was the BP he was talking about). Saya panggil je dulu sebab takut ramai lok beratur kekgi. Berape tekanan daroh awok td?
Patient: 146 gitu aa
Me: Hok atas ke bowoh?
Patient: Hok mule2
Me: Ooo dokla tinggi sangat
Patient: Tapi memang tinggi tadi doktor!
Me: Dakpe, kekgi sapa kad kite tengok

(after noted his diastolic BP was more than 90 for four times, and him having symptoms of hypertension with a high haematocrite and viral illness symptoms, he was advised for admission)

Me: Awok kene masuk ward ni, tekanan daroh memang tinggi, apstu kite takut denggi jugok
Patient: Hah? Dok payoh la doktor, saya rehat kat rumoh je laa. Doktor wi ubat je ke saya
Me: Doh awok siap kelabu mate lagi, tu tanda2 tekanan daroh tinggi. Dohla mude lagi dapat doh. Kene cek betul2 ni. Lagi daroh awok dok comel sgt, takut denggi. Ade due sebab doh ni saye nok suruh awok masuk ward
Patient: Dok payoh laa doktor. Bagi ubat je laa
Me: ??? (tadi die jugok yg beriye kate tekanan daroh tinggi, pening dok berenti)
Lucky he finally took the advice for admission, if not I myself would go hypertensive.


Me: Ye dik, bakpe mari ari ni?
Patient: Sakit perut doktor
Me: Sakit kat mane...bla2
Patient: Sakit kat beloh ni...bla2
Me: Ade demam dok?
Patient: Semalam rase macam ye, tapi tadi misi kat depan tu kate saye takdok demam pon
Me: Tuh hok die cek, die dokleh rase awok demam ke dok. Awok sendiri rasa hawe2 demam dok, dik?
Patient: Doktau laa saye. Takdok la kot
Me: (susoh nguh ikut ke misi pulok doh)

How I wish history taking can be much easier...

Saturday, November 06, 2010


This is not the exact reason why I am giving my thought to having an iPhone, more specific the iphone 4. Should I, or should I not?

But seriously, the Talking Tom is so cute and funny it made me laugh.

ps: I practically did part of a chest tube insertion today, I was only assisting, but did actually managed to put a finger on top of somebody's parietal pleura. How exciting is that? Just joking =) At least next time I will have to do it on my own, I have some ideas about it.

Friday, November 05, 2010


For those who would like to know our working time as houseman, this posting will enlighten you in general of how it works. It might be different with different hospitals or postings.

I am working pm shift today. We have three shifts per day at casualty. Morning or AM shift starts at 0800 and finishes at 1530. Afternoon/evening or PM shift from 1530 to 2230 and night or ON shift from 2230 until 0800 next morning. But every weekdays' morning starts at 0730 with the handovers, and usually the morning people will start the shift at 0730 then.

In general , everyday we are entitled to work for at least one shift. There are days where we will be working double shift, which means we work in the AM and ON shift. And the next day, those who worked the night shift at the red or yellow zones MAY be entitled for a night off - meaning they don't have to go to work the next day, but those in green zone, still has to come for a PM shift the next day. This is how it works here.

Even if we have a night off, we will still be coming for CME (continuous medical education) presentations for our learning purposes on the night off day, and every weekdays, regardless of us in the PM shift, still has to come sharp at 0730 just for the handovers. I don't mind that seriously, as it forces me not to prolonged my sleep too much, like today (because it's a weekend, and hence no handovers). Plus, sometimes there are so much to learn at the handovers. The HOD (head of department) really likes to ask questions, and I think that is how I learn much. Even though most of the time, I was not even close to answering the questions.

I think I'd prefer the oncall system better, but maybe it won't work well in casualty because the patients are non-stop, and you will most likely be exhausted after the formal working hours. At least with double shifts, you get to go back for a while before continue with the night shift. But still, so tiring.

For those who had no idea how oncalls work in other departments, this is how it works - your working hours starts as usual from 8am to 5pm, but you come as early as 7am or earlier for your morning rounds. If you are not oncall, you go back after 5pm only if you finish your job that are not supposed to be burdened on the oncall people. Say you have too many jobs in the ward, you might only goback after 10pm. If you are oncall, then your oncall time starts at 5pm until 8am the next day. Then you continue working, until 5pm the next day, or later if too many tasks need to be done, as mentioned before.

Let me give you the example of one of my tiring schedules with the oncall system. It was when I was in medical posting, at times where the total medical housemen was 17 and we have four main wards to cover, not to mention the clinic and other periphery wards, also the H1N1 breakout at time. I had a few EOD (every other day) calls that month. I came to work at 645am, carried on with the sleepless night with the oncall, then I only went back at 1030pm the next day after the all sorts of procedure done. Then next day I came back at 645am for the morning rounds, and was oncall again, only to be back around 10pm the next day.

Dear my beloved Damia me niece who always keep mentioning that all I do at home is sleeping, if only you could understand this, you won't blame me for coming home and sleep for sleeping is the best rest, after the long working hours with those sleepless nights. In medical. But please note that, not all days were like this anyway, especially in different posting.

Anyway, back to casualty. Only the 4th and above poster housemen are allowed to enter the department, so we won't get any new freshies here. The total of housemen in the department is reducing. Therefore, holidays are out of questions these days. Both my brothers' family are coming home for the upcoming eid (raya haji), and no holidays are allowed during the days they are back here. Now, these are the days I resent becoming a doctor.

I just pray that I will manage to apply a straight four days off I need in December, as I have already paid such a big amount for something I have long wish done. I give you a clue:

But I wonder if I had enough stamina for the much awaited event.

Tuesday, November 02, 2010


Today I was so upset and greatly reminded of the World of Courtesy ranking, produced by Reader's Digest four years ago. According to the ranking, which might not be accurate at all, Kuala Lumpur i.e. Malaysia is ranked the third least courteous country out of 35 cities of different countries included in the RD's global courtesy test.

A sudden regret fulfilled me for a while - I am not sure whether it was a regret of being a Malaysian, or being surrounded by majority of non courteous people where you cannot make a difference. Or a regret of not staying and work in the UK , and not even applied for a job there. Whatever it is, I feel guilty for having this regret, but it surely does bring back nice memories and life back in the UK, where everything seemed so easy and approachable. And the courtesy was at its most. I have been to most of the European countries and I think UK is still the best at courtesy.

Let me go through and see the differences:

In buildings with doors

I was walking 5-10 steps behind someone before reaching to a double door, and that someone I never knew would turn back to see if anyone was at the back, smile and keep the door opened until I reached the door, that sometimes I had to walk really fast to not make them wait for too long.

I was walking just behind someone's bum, even worse someone that I know who realised I was right behind them, and we were just about to enter a door with him/her right in front of me, and then....'bamm'. The door shut. Right in front of my face.

When you are in need a favour

People would ask politely, with the nice "Do you mind....." or "can you help me with....." at the start and the magic word PLEASE at the end. Even when the favour asker was a specialist asking for some help from a medical student. And help is at your tip of finger, especially if the favour you are asking is totally the responsibility of the person you are asking the favour from.

If you ask for a favour nicely, there is the slightest chance of you being entertained quickly and nicely. Even if sometimes it is supposed to be their job. Most of the time you have to ask them three times then either do it yourself or start shouting and complaining (then people will complain about you to the boss). Believe me, giving instructions, or telling people to do something with a raised voice gets the attention better. I have this one colleague who always give instructions instead of asking properly, and 'favour' done as instructed.

Hey, what is wrong with being courteous? Maybe they like instructions better.

At the workplace

If a doctor needs to perform a procedure, a nurse will be around (we call them dirty nurse) so to help us keep sterile while they can get things for us. Even when I was a medical student, I get my own dirty nurse to insert a catheter.

Me (in sterile condition needing another catheter of different size as I failed to insert two different sizes that I already prepared myself together with the catheterisation set) : Akak, boleh tak tolong amik CBD saiz 12 tak? Tolong eh kak, tengah sterile ni. Translate: Miss, can you please get me another size of catheter, size 12 please, I am currently steriled (shouting at 3am to the ***** who was gossiping at the counter, who were supposed to prepare the set after nicely being asked, twice.

***** (went to get the catheter that I asked for): Nah. Translate: Here you go (putting it on the trolley, without even bother to empty the sterile catheter into the sterile area, then went back to gossiping).

Don't I deserve a chaperone, even if you don't want to help me preapring the stuff or be my dirty nurse?

*ooops, I think this is a complaint already aye?

On the road

I am not a good driver, but driving in the UK was way much easier. Imagine you were turning right at a T junction or you were changing lanes. Even if it was not too busy, they will flash their headlights to mean that "you go on. I will slow down for you".

After you give way to people, they will flash their headlight twice implying "thanks", and not enough with that, they will put up the hand, mumbling thanks, again to show their gratitude. And you will put your hand up, mumbling "you're welcome, glad to help".

If somebody flashes the headlights, it means "It's my road. Don't you dare take over. I am speeding, can't you see?" I don't even dare to flash my lights to give way if I see someone is coming out of a junction I am turning into, just in case they misunderstand. So you see, there's no room to be courteous. You just cannot be humble on the road.

I was not in rush and let those from the front to pass first at the guard at entrance of my house, and I hardly get a hand showing thanks. Don't bother the lights.

And when I was grateful that people waited for me to pass the guard and put up my hand of gratitude, they just stared. Oh how I miss the courtesy of driving in the UK.

At the parking lots

Disabled parking lots are really meant for the DISABLED. And the disabled people do come out and enjoy their life even if they have to use wheelchair to move. The buses are even properly designed for them so they can travel easier.

SOOO many disabled people (parking for the disabled are always, always full), but I think most disabled people are usually stucked at their house and the only place they usually visit is the hospital.

And the ones below.... I cut and paste from Iris' blog, a good friend at the university, who is currently working in Selangor and just entered O&G department:

In encouraging labour
Midwife: Come on, push. Good girl. Push. You can do it. Push. You're doing very well. Just bear down. No, you're pushing the wrong way. Bear down. Push. Yes, gooood girl. You're doing reeeally well.
MO: Push, push, push, push, PUSHHH. What are you doing? You're not pushing! You want the baby to die? If something wrong with the baby, it's on you. Push. Do you understand ar? How many times I must tell you?? EYYY, don't push to your face..see, flushed already.. haiya... DON'T LIFT UP YOUR BUTTOCKKKK!!

On the welfare of the juniors
During handovers amongs specialists and senior doctors, there are always cups of tea that you can have...with some biscuits..someone might bring their homemade cake to share. And I was only a medical student then. And the cups of tea flow endlessly. From 3rd year to final year. Made for you. By nurses.
The Biggest Stitch: (On the suggestion to increase the number of beds for oncall house officers to sleep on) Actually I don't think housemen should sleep at all. It's good enough if you can sleep straight up in a chair. Or bring your own camping gear and camp in the parking lot. You think oncalls are for sleeping?? During my time............ etc.

When you gave the wrong answer to a pretty basic question:
Consultant: No, I don't think so. Try again.
When you gave the right answer to a pretty basic question:
Specialist: [stare at you after your answer] Some more?
Me: Erm.. can't think anymore
Specialist: [to colleague] Read out your list of answers (prepared beforehand)
Colleagues: bla bla including the answer I gave earlier
Specialist: Why didn't you say that answer?
Me: I did!
Colleague: She did.
Others: Yeah. She did.
Specialist: No, I didn't hear it. Oh no, it's because I caught you cheating. You shouldn't be spoonfed. That's why I didn't count that answer.
Me: ????

*LOL on the labour room situation* She is in Selangor and exactly the same words are being used, I can imagine. Can you see, it is happening not only at my place, but also at other city. I bet if you go to the north, or south or West of Malaysia, in general, the situation would most likely be the same. Oh how encouraging we are!

I won't deny that I am also losing the courtesy, I wish I won't. And I blame the environment. Tell me, am I guilty for missing UK so much?

Thursday, October 28, 2010


This is so what I really am in need of at the moment...

I will try to have The Lightweight this time. Of course, with the hope that I won't loose it. Perhaps I will have to chain it to me so not anyone can simply borrow it without returning this precious requirement to the owner.

Wednesday, October 27, 2010


I was wrong when I told you I was unfortunate not to be able to join the ACLS course. Apparently, Allah has planned better for me. Yesterday morning after the passing over session, when I was already mentally prepared to do my first shift at the red zone, I was told that the big boss wants me to join the course too. Hence, my morning shift was canceled.

So, total of three days of ACLS course. Yesterday, we only reviewed the basic and advanced life support algorhythm. Thanks to the recent BLS course, it did helped avoiding sleepy lectures on the first day. It is true that you learn more on what you already knew.

Today, the more complicated advanced cardiopulmonary life support was introduced. It is very useful, I'm sure. But I fell asleep on the afternoon lectures that I feel so guilty for the nice consultants giving the talks. I'm sure they could see me pretty clear with my eyes closed - how couldn't they when I was literally sitting right at the front seat? My eyelids just went too heavy and floppy. But thank god, I was wide awake during the last two lectures by the big boss - but, how wouldn't I when the big boss always gave me questions to answer?

Tomorrow will be the assessment day. MCQ and megacode i.e. practical session test. Teamwork today in the megacode practice was not satisfactory, my CPR was not the best, and I was failing myself with not sticking to what I was supposed to act as. I just hope I won't fail others tomorrow. Of course there's no need to worry about being a team leader as I was made into the last time - due to the fact that most other participants are either MOs from this hospital or from other health centers. Only five HOs are joining the course entirely and all are the new HOs in the department. People have been telling us how lucky we are, even the junior casualty MOs just had a chance to join the course, not the senior HOs too of course, so let alone new HOs finishing off their tagging. All five of us, we are not even officially start working as in charge at the department, but already been given the great chance of participation.

But this won't be good if it is going to create an issue, aye? Somemore, I was supposed to off tag for 2 days already, and I've been made off yesterday, and guess what? I just received a call from the HO leader - and he just rearranged so I don't have to work tonight (I'm supposed to work night shift today), so that I can study for the MCQ tomorrow. How nice! But seriously, I am starting to worry more if this is really going to make the issue worse. There have been queries at the background of why we get to go and why not others, you see. Very understandable as I might have queried the same too had I been long enough at casualty. I know this sounds selfish and I feel partly guilty about it, but how on earth exactly should I respond anyway - I am so not gonna let the opportunity off, you only get this once in a blue moon.

Headache with that. Headache with the numerous factitious algorhythmic lectures today. Headache with learning those guidelines, knowing that the latest ones are already on their way out, knowing that I will still need to learn the new ones later on. Let me just rest a bit for a while then maybe tonight I should really use the night off given to really study the nearly one centimeter thick ACLS guideline book, as that would have been what my pay is for, for today.

Monday, October 25, 2010


Today marks the two weeks of life at casualty. And some previous friendly M.O.s who saw me there today still thought I was there to see surgical cases. No, they are totally wrong.

I am going to officially work, starting tomorrow, a.m. shift at RED zone. First day in charge and already in red. Great. Preferrable than green still. Expectable cases - those with poor GCS or any candidates for intubation, those with chest pain, severe asthma or COPD exacerbations, severe trauma etc. Basically red is for severe cases needing very urgent and prompt treatment, yellow is semi-critical i.e. for those who are not as severe, but not as stable and green is for stable patients. So red for tomorrow. More things to learn, most likely typical cases, easier to discuss with M.O.s. Sounds daunting, but I think I like red. Or maybe I should be careful with my sayings coz tomorrow I might not like it at all.

I managed to intubate a patient today, but the one thing that made my day was that I managed to insert a short line CVP via internal jugular vein on the first attempt, under ultrasound guidance of course. It was my second try after the failed attempt on my first day tagging, remember? Lucky try today more than anything, but thanks to friends who were helping with the equipments. I love teamwork. More precisely, I love teamwork with people I can work with.

Anyhow, I bravely asked for an early leave from the nice M.O. so instead of still being at the hospital at this moment, probably glancing surreptitiously at the watch, hoping that 10.30pm will arrive soon enough - here I am, my fingers dancing on the keyboard, writing an entry to the blog. I left around 720pm after completed my Maghrib prayer. What a great day. Only later to realise how unlucky I am because the department will be having an ACLS course tomorrow, and apparently all the taggers are attending the 'what sound to be useful' course. Since I am already off tag tomorrow, I won't be able to join them, how unfortunate. I just thought I still need to work up on my very basic knowledge on life support, especially when it has something to do with ECG. Medical posting seems so long ago that all the details are no longer well stored in the brain.

So tomorrow it is. First day in charge. Morning shift. Red zone. Double shift the next day, then night off, something to look forward to. Hoping that everything will go well. Hoping to be given strength and good state of mind.

Friday, October 22, 2010


Today, I am officially off tag again. Another four days of tagging then I will formally considered start working, blending myself in the shift system at casualty. Almost there. It will not make much difference, I think. The jobs are the same, tagging or not. Less responsibility in tagging I suppose. The best part is that I won't have to work double shifts everyday like in the tagging period. There will be days I will only be working from 0730 to 1530. Plans are already pouring in my thought - one of them is to go and get a new pair of spectacles.

Too many things happened, but I can hardly recall what to share now. Not that I learned much new things. The one big lesson I have learned so far is how much I forget and not knowing my things. How shallow my knowledge is. There are just too much to learn. Even simple stuff that you practise everyday like the content of normal saline and hartmann solution. Worst, by knowing more, you will realise how much you still don't know. It is very upsetting, but life is a learning process anyway.

Yesterday I took diclofenac for my toothache, only then to realise that I am allergic to it. Itchiness and rashes started after nearly two hours taking it. Almost had my eyes swollen as I used to with ibuprofen, feels throat closing off. Self pre treated myself with IV hydrocortisone stat. Very scared to go to sleep yesterday, just in case my airway would suddenly collapse but I fell asleep easily anyway, thanks to piriton and tiring day. Weird, I can definitely tolerate ponstan, but maybe I should start avoiding any other NSAIDS now.

10 days in casualty and I still haven't got a chance to insert a chest tube or intubate a patient yet. I don't mind much about the latter, as I have done it in previous postings, but chest tube? It is one of my aims in casualty. I won't let myself do it the first time in a district hospital, without any supervision. Having myself alone to be responsible for it. Please let there be a chance. There's no more medical/surgical posting to find one. Unlikely needed in ortho or paeds, the upcoming postings.

11th day of tagging (off today, though, a very unproductive day regretfully). Had I known only two taggers are off on saturday, I would have come to work today and off on Saturday too. A quite tiring week that one night I could barely sleep for my legs were aching, not knowing what posture or position I should have slept in. But anyway, glad that I am almost there, although doubtful that I am competent enough to 'work' at casualty.

Sunday, October 17, 2010


I was looking for 'the hidden six' in secondary survey and found these slides - very good slides that I thought worth sharing it here. (read: good slides for medical personnel)

Saturday, October 16, 2010


Today is the 5th day at casualty, but I am officially off tagging today. A&E is generous enough to allow two days off during the tagging weeks.

I have not been productive enough here. Feel like moving at a really slow pace, which does not sound right as I AM actually in the EMERGENCY department. Still blurr with where all the stuff are. And not that familiar yet with the staff and system. Using the new H.I.S system makes things rather slow too. FYI, we have now started using the computer system, so every clerking and progress at casualty needs typing in the system. Still in phase 1, started since August but at least in ward, only the discharge summary needs keying in, clerking using the computer is optional. Phase 2 is coming up this November, which is next month already! Can hardly imagine how the phase 2 is going to drag the serving times.

Yesterday I merely clerked 5 cases. Prepared myself to go for ambulance call, but never had a chance to do so. Two days ago, I attended a Basic Life Support course which finished at 5pm. It just reminded me of how much I detest doing chest compressions, I got out of breath even before completing the first complete cycle. And hey, what is wrong with counting slowly and only made the final five counts loud at the end - even with this, I still get breathless, let alone counting from 1 to 30 for 5 times with the simultaneous chest compression with each count. Worst, the Boss randomly picked on me to be the leader of the first megacode scene. It was a wrong decision to step on the right hand side of the mannikin and started CPR myself, when I was supposed to be giving instructions to my colleagues. To count, compress the hard mannikin's chest, think of what to do next and give the relevant instructions at the same time (plus knowing it was only an act) was just NOT feasible! I should have gone to do the bagging, then it would have been easier to think and instruct. I failed the megacode, I can totally see it at my boss' face.

Went to green zone on my second night tagging. It is the zone where all the stable patients will be coded in to. There is always a long list of patients there. Patients who are unstable or in agony are triaged in yellow and red zones. That night I was made aware that I won't be a good GP. Too many patients to see, sitting at the desk asking questions, sometimes made the patients lie on the bed for proper examinations, having to include all the differential diagnoses into account which can be so wide - these just don't 'entertain' me much. I'd prefer delivering a baby and making a mother happy. Or doing procedures. Or resuscitating patients despite how breathless I can be.

Anyway, I am off today, planning to do some readings which has not started yet, hopefully will be carried on after attending my colleague's newborn's aqiqah.

Tuesday, October 12, 2010


Today is the first day of tagging at emergency department. The concept of tagging is as usual, you go as early as 7am and get back home at 10.30pm (thanks to DG who just made this official). But the environment is totally different, of course. The most obvious one, there are no wards. Meaning no ward round. There is one small observation room, just enough to place four patients at once, but that does not need a rushed morning round as in my previous postings.

I arrived at the department at 7.15am today as the passing over session at casualty starts at 730am, wearing a pair of black court shoes, having already been warned by a friend to wear dark coloured proper footwear - I sort of aware of the shoe rules two years back when I was doing my elective there. Then I was chased off to go and get the formal letter telling I have passed surgical and allowed to move on to the next posting. I went to SOPD for the letter and saw my favourite Miss there, and undecidedly asked her again whether I really passed my viva the other day, as I knew I did very badly in the viva session I wish I turn back time to do it all over again. Worst, I feel so ashamed to see Miss, having not been able to answer her questions to standard. I am sure she expected more. She gave me her cute smile "yes Afifah, you passed". Good. But still feeling so ashamed.

But anyway, came back to casualty with that piece of precious paper, and I felt like every eyes were on me. Unplanned, I introduced myself to break the silence. Right after that and after a few further questions about previous postings etc, I was told to attend a BLS (basic life support) course on Thursday and an MCQ session today! Goodness gracious, first day of new life, and an MCQ is something that is out of expectation, seriously.

Time runs very quick in the morning. I happily and confidently volunteered to insert a central venous line via the IJC, ultrasound guided - it was a failed attempt though, the specialist took it over from me and easily passed it through. Then get myself out for a brief lunch, hurried back and clerked a paeds case before attending the CME & MCQ. It was my first paeds case I clerked after the posting in final year which was probably 3 years back by now. So horrible, I do not know how exactly I am going to survive paediatrics as my 6th posting.

Attended CME on cardiac arryhtmia. Suddenly being reminded of those wavy lines, which if they go flat, every lay people would also understand that it means the heart stops pumping. In medical term, we call these lines ECG (echocardiogram). They might be easy to read at some points but interpretations can be quite mean, and I can hardly recall all those medical management learned in medical posting for those haywire lines. One thing I should start focussing on. To make things worse, there was this one specialist who really do fancy asking questions to taggers - I have already been given a homework on how to do a carotid massage.

Then the MCQ begun. 25 questions, each with 5 true or false statement in 30 minutes. Some are surgical based questions eg trauma management, not too bad as I just came out of that rotation, but paeds based? Not so helpful. I answered them quickly (as this was only meant for a baseline pre-posting mark, I supposed) so I could go out to perform my Zuhur prayer before the discussion started. When I came back, half of the questions were already discussed, upset as I wanted to know the answers! It might come out again on my real exam to pass the posting, you see. The miracle is, I passed. Just borderline pass, though. But better than expected. It does not mean anything though as I will still need to pass another MCQ in 2 months time. Or even worse, as they would expect that after 2 months duration, the marks should have gone higher. Huh.

It was nearly five. Then was pretty much helping other H.Os and M.Os, it si quite good around here. This is where I see quite a great teamwork. Whenever a patient passed through those double door, someone will go and clerk, others will go and set IV line, take blood, fill up forms and call the relative for registration. I think this is what I like about casualty so far, although I think I myself was not that useful to others - I kept wasting time when people asked me to get something, I just do not know where things are! And I am not practised to be well aware of those who still need blood takings done etc. Briefly, still disorientated to how it works here but slowly getting there. There are cases like MI, UGIB that ended up with intubation but I think the most horrible case that I saw today was a thirteen year old schoolboy who came with a nail stucked in his right sole. Please watch where you step on. Please. Oh, I should have captured a photo of it, some of my colleagues did.

10.30pm sharp, and they started chasing me out of casualty. It was the time to go back (so good they all!). Tomorrow, there will be an audit done in our department and I am supposed to read on the four main CPGs - dengue fever, NSTEMI, asthma and DKA but here I am, for whatever reason, feeling so eager to write while searching for the answers to my new homework - I guess, starting to write again in the last few days has fueled my interest in writing again.

Saturday, October 09, 2010


It has been long since the last time I wrote.

It was a year ago when I started my very first posting in the O&G department, the subject I used to like when I was a student doctor. Yet another two days mark the one year of my working life. It has not been the most productive year. Yes I am working, but I just do not feel me being as active and sincere in what I am doing as I used to. Moaning is like a must in daily life. I hate it, trying so very hard to control myself but it is just inevitable. I wonder where has all the passion gone?

O&G and medical. The worst has passed. Surgery has been quite an enjoyable posting, especially when I was given a chance to perform appendicectomy by the nicest MO - it has been a turning point, I used not to enjoy the posting before - but now, I would not mind if being called back as an M.O. Provided my favourite Miss and HOD are still there. Logbook signed up and sent. Presentation done despite the rush after being cancelled and having to make a rearrangement. Viva is coming up tomorrow. I am hoping for an easy pass but those previous viva questions that came across me ears sound very tough, questions like what the expected results of FNAC and biopsy in breast/thyroid disease are (which I still have not been looking for the answers), so I will just pray for the best. I do not mind if they are going to extend me, provided they put me in SOPD and no oncalls for the 3 months extension time. And another appendicectomy! These sound great that I might ask for an extension myself, but why would I , if I do not have to?

Off for another two days before the next posting in the emergency department, starting Tuesday (provided I passed the viva). When I was in my first posting, every H.O. were saying A&E is the best posting in terms of the working time - they have their postcall day off you see. So like in the UK. But the new shift system does not sound as great as before, and worst, there has been complaints about it. No comment on my behalf now. Wait and see when I myself be in that department. In the meantime, I will free myself from thinking about hospital and enjoy the less than 72 hours of holiday. At home. So true, there is no place like home.

Friday, June 04, 2010


I received some replies to my previous recent postings and I wonder if my blog entries since I started working have been putting the wrong impression about my personal view of a life as a houseman. People who read those posts might thought it is always the darkness that haunts a h.o. life. Well, it is nothing like that. At all.

To be honest, I usually write when I feel the need to express my feelings, so people know what it is like to be in my situation. It just feels good to let it out by writing. I am sure there are so many young doctors in my situation but nobody who just sees us as doctors would have understood our feelings. For example when a UK medical graduate stays to work oversea, people will say he forgets where he came from or he's so materialistic - like doctors are all crazy about money. They do not see the other issues that we are not satisfied with or we worry about.

Anyway, the fact that I very rarely write means that there were only few bad days in my life- if not I might have written more and more =P. There are always ups and downs in whatever we do, wherever we are. If you ask me now, I am happy with my working life, I just wish the system are more helpful and I could do something more. Nice M.O.s and specialists helps a lot of course. I am not an egghead, but I had survived O&G and soon to finish medical - the two most tiring postings (so they say), so I guess, it is not as bad as what I have been writing.

All the bad things that have happened that we do not like or disguise or regretted in doing them - they just add on to our experience. After all, experience is the best teacher, aye? And it is the mother of wisdom (so they say, again).

My advice to the future housemen: do not count your chickens until they hatch. Even though you might always heard about the bad side of our lives, it does not mean we do not enjoy our works. We just moan so people will understand. You will only understand when you become one.

Sunday, May 23, 2010


These few days I have been feeling very upset with the lab, with the nurses, even with the patients, but especially with myself. The peak was on Saturday, when I actually lost my temper on a patient that I think every patient in my ward could almost hear me scolding him. And I feel very terrible, it is still haunting me, even in my sleep. All those advice to be a good doctor received when I first graduated keep haunting me. But words are those things you cannot possibly take back. You can only wish you can turn back time and do it differently, but the fact is there is no time machine available and there will never be and you just have to accept that.

I blamed myself the most for not being able to cope with it. Being post call, the tiredness and the hunger, also the upsetting blood takings which sometimes provided me with no results at all, and the nurses who were not as helpful as what I expected them to be, and the patients with difficult veins and high demands not when the m.o.s are around, but only when they have long gone and I am left on my own to manage, plus, loosing 3 patients in a day - these all just add up to the weakness in me - I thought I have been very patient so far, but I lost it. I lost it already. I gave up.

It is never the patients' fault if they refused to do things we told them too - it is so up to them to decide, as the outcome will eventually be on them. (but again, how patient can you be with a non compliant patient who turned up to the ward very frequently even on day 2 post discharge?). We doctors just help managing them, in other way 'fix' them if possible and allowed to. I know I should never have scolded patients for moaning because who are us to determine how much pain they were in? I might not endure the same pain as my patients are enduring now.
The Prophet (saw) said, "The real patience is at the first stroke of a calamity."
Sahih Bukhari Volume 2, Book 23, Number 389

It hit me straight to the heart when I read this post at facebook from a good friend of mine. Indeed the real patience is far from me.

Today is the first time in medical posting in which I doubted my decision of coming back to work here. It makes me feel terrible. I actually very much enjoyed being in nephro ward, that I even asked for Kak Salmi to place me in the same ward for another 9 days before I move on to the next posting - surgical. But I just can't help it anymore.

How I wish there are tubing system here like in the UK where I can make sure blood goes right to the lab and not being wasted after all the hard work of difficult venesections. It hurts the patients too ok - and it took time to plead them for femoral blood as peripheral veins are either too thrombosed, or they are invisible and impalpable.

It is upsetting when I called the lab for important blood results at night time, when I had to wake up all night to review patients, and even waked them up from sleep just to see if haematocrite was rising - but nobody at lab even bothered to answer the phone because they were BUSY sleeping. Or when I needed ABG sent stat at night time, the PPK is nowhere when there are no diet to serve, nothing to do at night time but sleep and chat - yes, and it was all my duty so I had to leave the patient with a GCS of 6, went down to lab in hurry but then had to ring the bells for 4 times (harshly) to wake the lab staff up. If this is the case, PPK might as well work up to 10pm only, because doctors have to send blood to lab anyway.

And why is there no ABG machine in medical ward at all? (supposedly no budget, of course, how I forget Terengganu is one of the poorest country in Malaysia despite the money we should get from the petroleum). I have sent this suggestion to have the machine at least at neuro ICU, and the last time I went to the lab it was still there in the suggestion box, which funnily provides no pen nearby, as if no suggestion is encouraged at all.

This week has been terrible. I accepted the fact I am weak, but being unsatisfied with the system and all, I am changing my opinion to why doctors in the end leave government, or why medical students from developed country refuse to come back to Malaysia - it is because of how the system works here. I have to agree to the first few parts of this article, honestly because I have on my own been in this situation.


"Why be a slave in your own country, when you are a king in another?" He replied.

Indeed, if anybody would want to find a reason why all of us left, either after housemanship, after being a specialist, or even after sub specializing, and now, even prior to doing housemanship, they need not look at our payslip, or the wealth that we have gained overseas, but only to the Medical System that has been rotting in the ignorance and politic-based stupidity that Malaysia has been well-known for (in the medical field).

I have served the system for nearly 2 decades of my career, waiting for it to improve for so long, and only finding myself in despair, quitting with a 24-hour notice and serving abroad. The system is, in my opinion, keeping doctors, since the beginning of their career as House Officers to the end of it, in the lowermost priority. When I was working there, doctors are so ill-treated, while the nurses and the medical assistants are overpowering us.

I still remember the days when I was doing seeing patients and rounds as an MO, while the staff nurses would mind their own business, having breakfast in the pantry, or having gossip chats at their own leisure. My House Officers would then have to do merely all the labour-work, up to the extent of setting intravenous drips, and serving medications. If I am to expect the nurses, my patients would have been dead, or the work would have been too slowly or incompletely done.

When I was a House Officer, I had to run down 4-5 floors just to review a blood investigation of a dying dengue patient. The ward staff would either be nowhere around, or will say that he is busy (busier than the doctor?) or the answer I got at that time:

"Doktor nak cepat, doktor turun sendirilah, gaji doktor lagi banyak dari saya"

Read the rest of article here.

I am loosing my innocence (konon) day after day, and I hope I won't loose my patience inappropriately anymore as I do not want to be who I am afraid I will turn out to be.

Saturday, April 10, 2010



1. Kepada pesakit yang dibenarkan pulang...

Ketahuilah, kami sangat-sangat gembira apabila anda dibenarkan pulang. Maka sekiranya kami lambat menyediakan surat discharge anda, itu adalah kerana kami sibuk dengan tugas-tugas lain yang terhad masanya, contohnya mengambil darah-darah pesakit lain yang perlu dihantar sebelum habis office hour atau menghadiri CME (satu-satunya sesi formal untuk menambahkan ilmu kami yang tidak seberapa) yang berlangsung pada waktu yang ditetapkan atau berjumpa dan merawat pesakit yang perlu diberi rawatan segera. Ketahuilah, bukan anda seorang yang mahu keluar dari hospital ini secepat yang mungkin, kami juga begitu, lebih-lebih lagi kalau malam semalam kami oncall dan tiada ruang untuk melelapkan mata, maka bekerja terus menerus lebih 36jam. Bukan niat kami untuk melambatkan proses anda keluar dari hospital, tapi fahamilah anda bukan seorang sahaja yang kami perlu cater. Dan bukan anda seorang sahaja yang mahu pulang awal. Kadang-kadang solat pun hujung waktu, makan pun tak....anda marah macam kami duduk goyang kaki sengaja melambatkan anda balik.

2. Kepada pesakit yang anggap kami bertanya soalan secara suka-suka...

Mungkin ada sesetengah pesakit terutamanya yang sudah lama berada di hospital dan ramah pula, maka mungkin doctor-patient relationship dah menjadi lebih informal, dan biasanya ini tiada masalah sebab rasanya boleh tahu siapa yang kita boleh bergurau-gurau dan bercakap lebih informal. Tapi pastinya bagi pesakit baru, soalan-soalan yang kami tanya menjurus kepada untuk merawat anda, bukannya saja suka-suka. Contohnya, 'kenapa pakcik datang sini malam ni?' atau bila dah diberi jawapan dengan pandangan serong 'sebab sakitlah!', kami bertanya elbih lanjut lagi kenapa malam-malam begini kalau dah 2-3 hari lepas start sakit, tolonglah jangan menyindir 'sebab terbuka hati nak datang'. Percayalah, ada sebab kenapa kami bertanya. Contohnya seorang makcik yang datang sebab terpijak paku 2-3 hari lepas. datang pukul 2 pagi sbb katanya dari siang bergaduh dengan anak takmahu datang. akhirnya datang sebab pening kepala tak buleh tidur. Pening kepala adalah sebab datang, bukannye sebab terpijak paku. rupanya ada tekanan darah tinggi yang emergency.

3. Kepada pesakit yang mengadu doktor suka ambil darah, macam drakula.

Percayalah, kalau bukan untuk monitor anda, kami (saya-lah especially) adalah sangat malas untuk ambil darah. lagi-lagi kalau yang banyak-banyak botol maka banyaklah pula kena mengisi borangnya - lainlah kalau hospital kat malaysia ni dah macam kat uk, a lot of time saved by printing out blood forms. Lagi-lagi kalau kena bangun pukul 2 pagi ambil darah ABG (darah nadi) semata-mata, ataupun darah PTTK. Bukan sengaja. Mereka yang ada sakit jantung dan diberikan ubat yg berjalan dalam mesin tu, memang kena monitor darah anda setiap 6 jam, sebabnya ubat tu mencairkan darah anda, kita nak monitor takut-takut darah terlebih cair, maka risiko berlaku pendarahan kat mana-mana pulak, contohnya otak. Ya, ada sebab. bukan sengaja. Sanggup lagi saya tidur daripada saja mengambil darah anda pada malam-malam buta, kalau fikir logik akal pun, betul kan?

Nanti sambung lagi....

Sunday, March 07, 2010


It has been a while since the last entry. And with this entry, it is a goodbye to the story of people giving birth, or women with spontaneous abortion. Or being upset with those unmarried teenagers who can hardly bare the consequences of their own acts.

It is now all medical, and since I am placed in the male ward, I temporarily won't have to make any contact with the o&g department. The ward I am holding responsibility now is the worst one so far - it is always full and jobs never get done - the lists just go on and on and on like it will never come to an end. It has been nearly a month (omg) I am in medical now. And if you ask me how I feel; I feel like I have never been to medical school before! Too many stuff in medical, giving me reasons why I like o&g better.

But I still cannot see where my future lies. Definitely not medical, that is for sure. At least for now. Every day I found it hard to motivate myself - it is like I am a body without a soul, doing jobs just because I have to, and not because I enjoy doing it. The only thing that motivates me now are my nice ward M.O.s and specialist as well as a good team.

I need motivation, seriously.