THE WISH LIST

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.

ACLS COURSE

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.

FINALLY THERE

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.

ALMOST THERE

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.

THE ATLS HIDDEN SIX

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)

THE OFF TAG

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.

THE NEW ENVIRONMENT

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.

THE ONE WORKING YEAR

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.

THE WRONG IMPRESSION

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.

BAD WEEK

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 WE LEFT AND WHY WE WILL CONTINUE TO LEAVE...

"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.

RINTIHAN KEPADA PESAKIT-PESAKIT

DI HOSPITAL KERAJAAN


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....

DEMOTIVATED

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.

DOCTORING part II

M.O. : Did you know what happened with .... (something about the current news which I can barely remember)
Me : What?
M.O : Ooo I forgot. H.O. doesn't really have time to follow news
Me : *sigh*

I'd normally do not read news anyway. I usually prefer to watch the news. I read only news that does not come out on telly e.g. what says PAS/PKR or whatever non goverment party re some issues.

But since being a houseman, I rarely watch the news, let alone reading any. I always do turn my laptop on when I come back home, but most of the time ended up in the bed, falling asleep unplanned. I think I slept too much already, but my body is still aching, I have no idea what the causes would have been.

And lately I have this weird thing at the end of my meals - strong smell of liquor always stopped me from eating further. Lucky it always happened at the end of meals, or else I would have lost lots of weight already! I guess too much of ARM (artificial rupture of membrane) already! Weird, as I left labour room for 2 weeks now, and never had that problems when I was in charge before.

Anyway, today marks 2 months of my working life in O & G department. Things have been going better than before - I believe I have learned loads of stuff especially the practical ones, but I long for more teaching as I know there are lots and lots of things I still need to know. Especially thinking that I might be sent off to anywhere; where I might need to decide on everything and will not have M.O.s/specialists to consult - trust me there are loadssss of stuff beyond my shallow knowledge I am holding on to. The first viva is soon expected, and I can confidently say i am not yet ready for it.

And I still hate making decisions, being h.o. sometimes you have no idea when to decide by yourself and when to consult if something is so obscured but I guess that is just the simple rule of being a houseman. Every week we are being audited for mistakes we have done(which I believe in some cases, h.o. should not be blamed at all), but I do like being there when the audit was done as we learn so much from mistakes. (but despite saying this, I hope I will never be the one being audited *sigh* God I just hope this wont jinx)

So that is 2 months of working life - I still have not taken any leaves yet (I gave up the last time I tried to apply one). Please pray I will get some at the end of this year as I really badly need some holidays.

THE VICIOUS CIRCLE

by Ija (who I usually agree with, and whom I miss so much - we are working in the same hospital, but very rarely seen each other)

It has been a circle from the earliest of human developement. But as we are living in a community which demonstrates such a cruelty, it is a shame if we can't see it with our very own eyes.

It is not far from me, seeing what is happening in Terengganu, a state taken as an example. Known for its glorious culture,food and OiL it is also known as one of the poorest states. It is.

Truthfully, the federal earnings from our valued source-OIL is such of a great number. The federal earns multi billions from that. The people in Terengganu should actually at least get something in return - a proper education, facilities and at least a proper health service. But they are not.

So many people had realised and claimed that if the earnings are 'used' properly by the federal, each of us can at least enjoy a decent allowance monthly. The gas for cooking will be free! Education should not be a problem. The villagers can have a proper transportation getting to the hospitals. The students from remote areas can enjoy schooling as they do not have to wait for hours and hours to get a lift to the school. What a shame to the superiors who had let these happening.

Now that the earnings are being swallowed and smuggled into their own pockets, they are the ones who are responsible for the consequences of these poor people.

I want to show a typical example. It all started from being in an unstable poor family. Imagine a boy having to stop school because there is no breadwinner and he has to be one. He does not like school cause it's very hard to get to. Starts working catching fishes in the sea with fellow adolescents, eventually gets into drug abusing. It is very common here. Or they get into this popular social activity -they went merempit. Got into an accident, and admitted to the hospital.

These rempits got somone killed. The rempits got comatosed. The parents are worried sick everyday, taking care relentlessly with sleepless nights. The mother patiently cares for the boy who is now require an attention of an infant. And when they are conscious , they get back into their attitudes-being rude and not thankful to the parents. But the parents keep being calm,thinking their child is unstable hence letting them to be as such.

I am pointing out that if at least if these people get their proper education, the chance of them being a social junkie is much less. And why did they not get the education they deserve? Because those responsible in providing it is not doing their jobs.

The circle of social problem does not start with poor home education. It starts from the government. It starts from the way resources are being given to the people. It is even worse when the money is there, instead it is going to the wrong hands. This is a circle which should be destroyed, as more poeple will suffer the consequences.

DOCTORING part I

1. Requirement for a houseman.

This part is specifically for medical students who soon are going to do noble jobs of doctoring. If you think the main criteria you are obliged to have is to know everything especially the theory part of medicine - you are completely wrong. When your university said they want to produce a safe doctor who are able to treat patient, they are totally right with the aim. As a houseman, this is your job: You will be seeing many patients with various different presentations, either as referred cases or first hand patients then you have to decide what to do next and if there is need to ring the senior, just pray that they are in good mood (and not just woke up from sleep!).

If you study in the UK and pampered with the rules of giving feedback - that is to start with positive things and then only go on with the negatives - in which case, no matter how stupid or how wrong you are, most of the time you will still get credit and be motivated that way because people will start with 'the things that u did good was....' and end with '...but you can improve on .......', so if you are being pampered with this kind of feedback, please please please prepare yourself for a total 360 degree change where most of the time you might be criticised and the only means of learning might be through critics, or even humiliation. Especially if your brain works very slowly particularly under pressure (like mine), there is no other things you can do apart from you motivating your own self and continuous prayer asking for a better tomorrow if not a better you. I am sure all the seniors want you to be good doctors even when you are being told off by them - it is probably like parents scolding off the kids so they become useful people later on

In summary, if you want to prepare yourself to become a houseman, learn this:
1. Familiarise yourself with learning by humiliation/critics.
2. Do your jobs very very very quickly or you will be stuck in the ward forever.
3. Be able to present patient very concisely.
4. Know the name (especially specialists) of the person you are going to talk to before talking to them. Make full use of the committee chart even though the picture might be too small or too old for you to recognise the person you are yet to see.
5. Agree wholeheartedly that doctoring is a noble job and you are not to become a doctor because of the typical reason 'my parents want me to'. Holding tight to religious teaching and having Him who always listens helps.
6. Able to say no to jobs during your tagging duration because that is the only time you can learn even though patients are supposed to be your everything once you become a doctor. If you don't learn during the tagging time, you are in big trouble to learn
7. Familiarise yourself being called 'doctor' on your first day of placement.
8. Have lots of practical knowledge not just theory and be able to put them together quickly and be able to impress the consultants.
9. Appreciate that H.O = humble orang. If you did wrong, you are wrong. If you did nothing wrong, you are still wrong. If you did right and being blamed for, you are still wrong. Try not to answer back. This is the hardest thing of all I think, as human beings naturally have the tendency to defend themselves.

(to be continued, if there is time and mood)

I know the way I am writing this, it sounds so bad, but what I know is I am learning and trying to improve every day (slowly maybe, but getting there hopefully), and it is not actually that bad when you are enjoying the learning and jobs and the talking to the patients bits. I just hope I will survive my 5 consecutive EOD (every other day) oncall starting Sunday. Wish me the best!

PRE PROLOGUE

"I do solemnly declare that as a doctor of Medicine from Newcastle University, I will exercise my profession to the best of my knowledge and ability for the good of all persons:

- I will make the care of my patients my first concern, keep my professional knowledge up to date, and recognise the limits of my professional competence;
- I will treat every patient politely, with respect and dignity;
- I will treat my patients considerately, respect their views, provide them with information and involve then im decisions about their care;
- I will work with colleagues in healthcare professions in ways that best serve my patients' best interest;
- I will respect and aid those learning to acquire skills and competencies for the care of the patients;
- I will be honest and trustworthy, respect and protect confidential information, ensure that my personal beliefs do not prejudice my patients care, act quickly to protect my patients from risk, and will not abuse my position as a doctor.

In all this matters I will never discriminate unfairly against my patients or my colleagues. I will hold in due regard the honourable obligations of the medical profession doing nothing inconsistent therewith. Above all, I dedicate my professional life to the service of those entrusted to my care."

This is to remind myself the oath we all (the Newcastle students) have taken when we graduated as doctors.

THE PROLOGUE

I have just completed my induction and BTN course this afternoon. By right, I have already started working six days ago, as the pay slip for new doctors starts on the very first day they attend the induction. Induction was ok although I was expecting more talks about how health system works in Malaysia especially knowing that more than 99% of the participants were oversea graduates. And I do not have any intention to make any comments about BTN - loads of the government servants must have already known what it is all about!

I had survived my five years MBBS course which tortured me the most in my third year. I had survived the nearly two months well deserved break which had turned out to be too boring at some points that I had crazy thoughts haunting me (thank goodness Harry Potter books saved me from those thoughts - and by the way, raya and having a full house was great!)

I had survived the six days period of induction and BTN course, learning more about being a government servant in general or the so called 'house officers' in particular, and being proud to be a Malaysian, and not to forget the latest slogan that we have - the '1 Malaysia'. I had survived the long journey back to home, being the passenger for the first time at the backseat of the soon to be TAW 997. I had survived the very long thought about future life throughout the whole journey (minus two hours of the badly needed fine quality sleep, finally!) although practically I am still left with no wise decision.

After hibernating for nearly two months, today is very tiring! But I believe today is just the prologue. Tomorrow is chapter 1 - where the new era begins!

ps: to the patients coming to Hospital Sultanah Nur Zahirah, Kuala Terengganu, please beware of this new doctor coming to serve you.

MEDICAL STUDENTS, CONSIDERING ...

BUYING THE LATEST EDITION OF THE OXFORD HANDBOOK OF CLINICAL MEDICINE?

RE: new edition (Oxford Handbook of Clinical Medicine Feedback Form)

Thursday, 20 August, 2009 4:36 PM

From:"Ox Med Comments"

To:"afifah jaafar"

Dear Dr Jaafar,
many thanks for your email (and congratulations on your recent
qualification!). You've done right to ask, as the eighth edition is just
around the corner - we're working on the proofs now, and will expect to
see it in the shops early next year. I would recommend waiting until
Jan-Feb, when the new edition will be available for purchase. Many
thanks for your interest in the book, and we hope you will like and
enjoy the new edition.
Best wishes,
Mark Knowles


Systems and Online Development Manager
Tel: +44 (0) 1865 35 4024
Fax: +44 (0) 1865 35 3817
Email: mark.knowles@oup.com

-----Original Message-----
From: afifah jaafar [mailto:fifa_0304@yahoo.com]
Sent: 19 August 2009 04:22
To: Ox Med Comments
Cc: fifa_0304@yahoo.com
Subject: new edition (Oxford Handbook of Clinical Medicine Feedback
Form)

------------------------------------------------------------
Comments sent via OXFORD HANDBOOK OF CLINICAL MEDICINE Feedback Page
------------------------------------------------------------

COMMENTS:
Hi,

I am just wondering if you are going to publish the 8th edition any time
soon, and if so, when? It is just that the last time I brought the 6th
edition, the 7th one came out a month after that and I was a bit
frustrated as the 7th one is much better I have to say (well done!). I
am thinking of buying the 7th one, but thought it is worth asking and
waiting if the 8th one is coming out very soon. Please could you advise
me on this matter.

Thank you.

Afifah Jaafar
Newly graduated medical student

THE GROWING ALARM

A few days ago when I was reading the NST, an article by Koh Lay Chin, "Growing alarm over sexualisation of young girls" caught my attention. She had been watching how girls as small as 4 years old, dancing like a grown up with all those sexy moves. She speaks her concerns over the topic wisely, and I would have to agree 100% to what she was saying.

"But there was something hinting at sexiness in those tiny moves, and I was not the only one who felt an awkward twitch by it. Apparently, parents and adults are getting more of those awkward twitches every day by the sexualisation of young girls, who feel the need to look, act, move or speak in a certain way to get attention or keep up with their peers."

May I also quote her last paragraph of the article:

"I can laugh about all this now since I don't have children, but I dread what I'll do in the future should I see my young child doing the provocative "booty shake". Summoning a crowd or videotaping it for posterity? Nay, I may just have to blow up the television set and lock Buttercup in a room forever. And ever."

I have been watching some ads on the telly promoting a tv show called bintang kecil or whatever equivalent (can hardly remember what the show was). Presumably, it is a singing competition between the young children since there were short clips of them singing in the ads. And dancing to the song, of course! Well, maybe I am just exaggerating the show, but I am sure there are lots of tv show nowadays that encourage kids to do some very provocative acts and I wonder what the parents think when they allow their kids to do such things.

May I quote again Koh Lay Chin last sentence:

"I may just have to blow up the television set and lock Buttercup in a room forever."

THE GRADUATION

I knew this is too late already, but just to thanks all that have made it all possible. Especially the batch, the family, housemates and friends, the teachers and most importantly The Lord of course. And thank God all Malaysians in our batch graduated this year!

*missing in the Malaysian batch picture: Iris, Nithia and Su Ann.

So that was the end of the student life, and honestly I do not really look forward to the working life that quick. At least not at the moment. I am back in the hometown now - but everyday, I wake up thinking that it is no more holiday this time. Unlike the previous summer holidays, I am not going back to Newcastle, not within few years time at least. And that makes me miss Newcastle so much, especially that I have no clue to when I will be seeing the people I love there.

But yesterday has gone and all I have is today.