Saturday, September 24, 2011


I have just finished updating another week's shift rota and my eyelids are so heavy already. It was a tiring AM shift especially at the beginning. Enough to say that I and my lovely MO oncall today had to standby at OT for a triplet emergency delivery - not to mention that there is a DIL patient in NICU, also another one with PPHN on HFOV. But still, I'd prefer neonates than general paediatrics.

The picture above was posted by a friend in my facebook - it is a wise reminder for me at time because I am so not looking forward to be responsible for HO in my department - but it's a duty I cannot run away from and I think it is failing me - I have never been a good leader, I suppose. God, help me. I should have been more grateful.

Tuesday, September 13, 2011


About a month ago, the head of HO in my hospital asked me to send him opinions from paeds HOs regarding the HO shift system. These were the feedbacks I managed to gather from the team, at time with the assumption that the shift system planned for implementation is a similar one to the one used in A&E posting:


1. Enough rest in between work

More energetic housemen and presumably less mistake. Hence, shift system is probably good with departments with expectedly non stop works, and with not much of continuation of care which need brief passing over– for example, in casualty and labour room, but not in wards where continuation of care is essential

2. No oncall allowance for housemen (*definite cons for housemen though)

A huge reduction in the money spent on the health sector by government – good as money can be spent on other healthcare needs, for example hypoallegenic gloves (as part of right and welfare of the employees with sensitive skin) or to get better equipments for treating patients

3. Working time not adhered to regular office hours might be beneficial

Ability to run any errands that need being done during office hours eg going to the bank


1. Number of housemen in each department is labile and not fixed (due to possibility of extension)

Not enough numbers to be divided into shift hence difficulties in coordinating the shift duties

2. Limitations which makes hectic morning shift – and might lead to major dissatisfaction if shifts are not properly assigned

Morning shift will be particularly busy – with the specialist ward round, blood takings needed being done during office hours, attending clinics. Surgical based posting with elective surgeries in the morning makes it rather difficult to organise the shift system. Few housemen might be left in ward, leaving jobs passed over to the next shift, but unlikely to be done on the same day if those jobs are limited by office hours only – hence the unnecessary delay

3. Less teaching

Teaching done during office hours, some might miss the teaching

4. The pass-over tradition which in itself is time consuming and might not work well in all departments especially in ward

Those who are less responsible will become more complacent, passing over the jobs to the hardworking/more responsible ones.Either the hardworking ones will continue to suffer or a viscious circle to happen where jobs might be passed over on and on before being noticed, which might compromise the patients’ care. Also, jobs might be missed if passing over sessions are not properly conducted so, effective hand over session is very important, and a clear guideline is required. Having said that, a proper pass over can be very time consuming, hence more time spent for passing over, less work done in time, less care and time for patient

5. No oncall allowance for housemen

This is probably not too bad, providing the working hours is much less than the current oncall system. However, it is of no guarantees, and the working hours might end up with mere minute difference. These extra hours should be entitled to some compensation too

6. No more weekends or public holidays

Difficulties in arrangement of holidays as everyday is a working day, hence ending up with less rest throughout the month even if there will probably be enough rest in between shift. Cumulatively, working shifts might be more tiring


In conclusion at that time, consensus I think was NO, DO NOT implement it until we are all ready. Or at least that was the consensus among me and my colleagues in the same hospital.

Good grief. I can still picture myself standing up in front of all housemen and DG in my earlier days of working, asking about whether or not the shift system is soon going to be implemented. And why on earth did I ever have the nerve to ask that question?

And now having been in the system for around 10 days, I can see the pitfalls here and there which I will try to conclude in another entry after having a post mortem with other colleagues of the department. Enough to say, I need daily motivation to go to work now....

Sunday, September 11, 2011


Today marks a one month away to completing housemanship. Loads of experience gained, with happy and sad times, with encouraging and upsetting moments, together with old and new friends. I am still in Paediatrics department, and since I am too busy with making the shift timetable for the housemen, this leaves me with headache. I just created a blog for the HO in my department to put up updated timetables which I am really sick with - I will comment about it later - and after creating a new blog, I made a change to mine as well.

So is the new layout. It looks weird, but sometimes change can be good. I need to accustom myself to new changes all the time anyway. I am sorry that there were previous posts that will come out without previous comments, or with white font colour which won't appear upon your eyes because to change it all will take me ages.

A few more things in mind before I keep myself busy next week for another rota:
1. Summary of my thought on shift system so far
2. Nice write up on HIS system - can I go on with petition?
3. Viva!!

Too much but too short and I still have not decided yet of my field of interest, huh

Tuesday, July 26, 2011


I was reading this one article that I accidentally found upon googling for articles on the yet to implement shift system for all housemen in Malaysia. Hilariously irritable. I repeat, irritable.

No offence to the nurses, my near 2 years experience have exposed me those who are unexpectedly of cannot-make-it calibre, as what the blogger named it. Go on, have a read:

DOCTOR, DOCTOR! by Home of the Manx (I think the blogger is a psychiatrist)

The head nurse of my main ward was slightly upset when I told her my opinion that some nurses of certain wards are of cannot-make-it calibre. But it’s true. The ones in my main ward are generally OK despite being relative greenhorns. They have an acceptable average level of intelligence, integrity and diligence, with an outstanding one here and there. On the other hand, some staff in other wards really make me want to bang my head against the wall. I tell myself that there is no point in sacrificing my noggin like that. If I used their heads to smack the wall instead, the building would crumble.


(Phone rings)

Me: Hello.

Nurse: Hello, Dr. Katie. This is staff from Long-Stay Ward Pee-A-Lot. Do you think you could come and conduct an urgent multidisciplinary ward round with the medical officer, nursing staff and pharmacist? This afternoon?

Me: (thinks: that would be the equivalent of chartering an emergency jet plane to buy groceries for tonight’s dinner) Huh? Why?

Nurse: We want to convert all the patients on Valiant tablets to Valiant syrup.

Me: Huh? Why?

Nurse: Because we had one patient who nearly choked on a Valiant tablet.

Me: Oh? When? No one told me.

Nurse: Last year, before this ward came under you…

Me: (moment of disorientation – this is late July, right?) Okayyyy…

Nurse: … so there was an enquiry, and now we have to think of ways to prevent further near-choking incidents, so I thought we should change his Valiant tablets to syrup form. Then I thought we should also convert everybody on Valiant tablets to syrup. That’s fifteen patients. That’s why we need you to do a multidisciplinary round for everyone to institute the changes.

Me: Whoa, wait wait. This patient who nearly choked – was he only on Valiant tablets?

Nurse: No, he’s also on Fluent tablets, Hallucinate tablets, Chlorophyll tablets, Di…

Me: Uhhh… so you’re telling me that putting him on Valiant syrup plus ten other tablets will prevent him from choking on tablets?

Nurse: Well, it was Valiant that he nearly choked on.

Me: And the other fourteen patients? I suppose they’re on lots of other meds too? For which there is no syrup form?

Nurse: Yeah…

Me: So how does converting them to Valiant syrup make sense?

Nurse: Well, true, it doesn’t… but there was an enquiry. We have to do something!

Me: (sighs) OK, fine. If there HAS to be a change, I have no objection to this one patient being converted to syrup form. Leave the other patients alone. No multidisciplinary round. Just get the medical officer to convert the Valiant to syrup form at the same dose.

Then came the clincher.

Nurse: But Dr. Katie, Valiant syrup is very expensive, you know. Are you sure you want this patient to be on syrup instead of tablets?

Good grief. No amount of bonus is gonna compensate me for the brain cells that died during this conversation.

My very shallow experience so far has enlightened me of how unbelievable nurses could be and of how much the nurses' works has shifted to become part of the junior doctors' jobs, because we (junior doctors) have apparently become the glut.

One example of mine:

One hectic night in a surgical based ward, a patient was having a problem to pass out urine post op (which is not uncommon) and another patient who has low GCS due to intracranial haemorrhage ran amok in ward. Not to mention there were another few cases who I had not yet fully clerked after seeing them shortly with my MO - at least the diagnoses and plans were already there. I was left alone in ward as another HO oncall in the ward had long gone into the OT to assist the surgeries.

Before handling the latter patient, I have requested the nurses who were chatting at the counter (and was probably finishing off their very important report which copied every plans by doctors) to prepare the catheter set for the former patient.

After the amok patient been taken care of, I upsettingly found that the set were not ready yet. To make it quick, I prepared it myself and pushed the trolley to the patient's bed myself, passing through the nurses who were too busy chatting or probably gossiping. Then I had to pull the at least 2 screens to secure the patient to his own privacy - there were no curtains in the ward you see.

And to make it worse, it was a male ward and I was completely aware that I was much in need of a chaperone for those kinds of procedures - but like that ever happened in this hospital anyway. Surprisingly in Malaysia or maybe just in this hospital where the chaperone appears in every single introductory papers to be signed off by new doctors entering a new ward, having a chaperone practically were made compulsory only if you are a male doctor having intimate procedure done on a female patient. Other than that, it is definitely not widely practised here.

So I shouted out that I needed a chaperone, in which later on as expected, nobody came to chaperone - let alone if I asked them to assist me. Again to make it quick, I just proceeded with the procedure but it was not as easy as expected. I needed a smaller sized catheter and hence shouted for another help.

Me (shouting): Akak, tolong bowok cbd size 12 se (nurse, can I have a size 12 catheter please?)

After twice or thrice shout out, a nurse came with the wanted catheter and she placed it on the trolley next to me who were all sterile.

Me: Thanks... (before I could finish off with asking for another favour to open the catheter packing up into the sterile set, off she went to the other two nurses at counter)

SPEECHLESS. That was all I remember. I was completely speechless! Hello, it was a only a common sense for you to open it up, d*** you.

Luckily my MO (who was quite new in this hospital at time) passed by and he nicely helped with the favour I was about to ask and chaperoned me until I finished off my procedure, asking during that while 'what are the nurses doing leaving you alone here?'

Exactly. So what do they do? Obviously we need more doctors to compensate for those jobs that previously not done by doctors. So why complain of the glut?

Anyway, having said that, there are some nurses who I love so much and I think these are the nurses that achieve the same standard as those in the UK. If there are awards I can give to the best nurses, I will definitely pass them to these two nurses I have met in my career so far - 1st one in renal male ward who would call you to clerk a new patient who needed a peritoneal dialysis at 3am in the morning and by the time you reach the ward, everything has already been prepared, and when you were doing the procedure she was closed to you so you do not have to shout to ask for favours (I know nurses have tasks to do too, not that I always wanted her to be on my side even though that is what u get in the UK), and when you finished off the procedure she would take care of the other sets after you thrown away the sharps as she knew your phone just cannot go silence for a while and there were other patients you need to see and take care of.

And another one I met in ortho ward who would call you to clerk a case and by the time you need sedation and analgesic for a close manual reduction, he said it was already prepared as he already anticipated it. Prepared as in already diluted, mind you.

Seriously, thinking about these two particular nurses made me want to cry, thanking God for still making them exist in my current world. How I wish things are different, but who am I to change things?

Thursday, April 21, 2011


It was one fine day where everything ran smoothly. But it was Monday, the day all the young wizards were gathered at a new building called the Cedric Hall to learn more about magic. A female young wizard had finished off all the works required in the main magical infirmary that morning. Off she went to the dining hall with another female wizard to fill her stomach up then to a room to commit herself to God, the One she believes in, before going to the lessons of magics.

The sign on the heavy, bulky door reads ‘staff room’. They very rarely went there before but it was one of the nice rooms in the hall for a prayer.

Suddenly the head of the fairies named Bathilda looked at them in a suspicious way, asking “which department are you in?”

“The art of human carpentry”, the young wizard gave her a short and honest answer.

“There is a room just outside here if you would like to do your prayer, you know”, said Bathilda, pointing towards a general room, probably at the back of the room they were in, where anyone with the same beliefs who came to the magical infirmary would perform their prayers there, as the main means of submitting themselves to God.

Of course, the young wizard already knew where the room was. And, of course she understood what Bathilda was trying to hint them both.

“But this one is more comfortable. It has the restroom inside here, you see”, again, the young wizard tried to reason herself. ‘After all, we are still staffs, are we not?’, she whispered.

“Even when we were treating the humans with potions out there, we still go to the outdoor restrooms”, replied Bathilda with a mean look, and as she was on her way out of that so labelled as ‘staff’ room, she took out her wand for a jinx to switch off the room cooler, making the room warmer than it had already been – that was after Bathilda started talking.

Speechless, the young wizard was reminded of Hogwarts. She used to study magics in Hogwarts before being awarded to become a wizard. In Hogwarts, things were very different. The welfare of the wizards in Beauxbatons, her birth country was comparatively horrible.

In Hogwarts, let alone the young wizards, even the students who were not considered staffs were being treated nicely. Tea was pouring endlessly in their cups during the hand-overs, a session where the switching team of wizards, witches and fairies gained information about the humans retained in the infirmary, their illnesses and the potions that worked well for them. Again, let alone the young wizards, those students of magics – mind you, who were not the staffs – were given a small cupboard where they can use a unique enchantments to lock up their valuables so they were not lost to the abusing power of black magic. And these students of magics were entitled to use the big, huge staff room that was equipped with a magical entertainment box that enabled them to watch news from all over the world, nice and comfortable seating and many more.

The young wizard never had these advantages of being a staff in Beauxbatons. At least, that small cupboards for wizards would do, coz all fairies had them, but not the wizards. And they even had them placed in wizard's rooms. What more can you say of a wizard being chased out of a staff room (which I supposed was meant for any staff) when a fairy could have their belongings in the WIZARDS' room?

Even though there were not many people who shared the same belief in Hogwarts, most of the people there would respect the young wizard when she had to excuse herself to a room – any room – so that she can perform her prayer wholeheartedly. Some of them kindly showed the way to the nearest quiet room where any believer from different religions were welcomed to perform their prayers. If there were no quiet room, the fairies, and sometimes the head of fairies would put an unlock charm to a locked room for her so she can submit herself wholely to God without any distraction. And these people did not share the same belief in the same God as she did.As Bathilda did.

And rumours say that the Beauxbatonians who used to study magics in Hogwarts not coming back to to serve their own people because of the higher rewards they gained in lthe atter. Nonsense! Well, it was true indeed that they gained extra galleons there – but that was only the benefits of staying in Hogwarts, not the reason. The young wizard can clearly see now that welfare might be one of the issues.

Not that she wanted the endless cups of tea or coffee, no. Not that she was so arrogant, being a wizard, who supposedly by hierarchy was higher up than the fairies, wanting to be respected too much like she had been a staff for long and knew everything about magic already. No, not that. (But sometimes even those higher up in hierarchy, the witches were outruled by the fairies in the infirmary, let alone the level 2, 3 or young wizards). On the other hand, of course those fairies were mostly more experienced and hence, the same respect that the wizards deserved for should be given to them too, no. So in the end, it was not a question of who should be respected by whom, but a matter of respecting each other even if you were just a house elves who served diets to the humans.

The young wizard was helpless and hopeless. She could create a parchment of complaints to King Arthur or Lancelot or even the witches - she might, but this might well get back to her as witches sometimes like to compare the way the were being treated when they once were the young wizards – those times where she assumed the welfare were never thought for or fought off. Time has evolved and people are more educated about their rights and it was never fair for people to let you being treated as they were before. If this still occured, then why use the apparation, the latest means of transportation, and not the old conventional broomstick?

As for Bathilda, the young wizard thanked her for finally triggered her to do something about the welfare of the wizards. A parchment of news would do, maybe? It might be the time to start fighting for the right. And hey, wizards are staff too, they do work for the infirmary!

*original idea taken from OF WITCHCRAFT AND WIZARDRY

Wednesday, January 19, 2011


Considering the quite regular basis of blogging I did over the first month in casualty, it seems like ages that I have not been updating anything on the blog. I have been quite sick - no, really sick with keyboards I guess, I wish there are devices which detect whatever I say verbally and turn them into the soft copy. No doubt there will be, in years if not too soon. The computerised system at the hospital is killing me, especially when there are way too many patients to be served. Now that we are moving forward to the second phase, I wonder if my eyes can endure looking at the computer screen too much. I hope it is the best for all.

Kinabalu Mountain; 16 December 2010 [Credits to Faizal]

I spent half of my holidays for this rotation climbing up Kinabalu, too much stories behind it that I refuse to type in, enough to share that I still have bilateral subcuticular haematomas on both my big toes, they are still black after one month coming down from there. Today, is my last day off in casualty that I am entitled to. Will be finishing off my rotation at casualty by 11th of February, provided I pass my viva of course. And the thickest logbook of all... Great, now these sound dreadful.

Three months being here, I have to say it is the best posting of all, despite the same moaning of unfairness and insatisfaction, it is a nice posting indeed. I still hate green zone as much as I used to at the beginning of the rotation, and I still love reds. Adrenaline rush...

Honestly, I do not mind staying at casualty for another 8months to complete my housemanship, swapping it with orthopaedic and paediatrics posting which coming up. New posting means new environment, new staff and superiors you need to be dealing with and get used to, new knowledge (which is good) and new everything. If only there is a way for me not to do the other two postings...