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.