Thursday, September 27, 2018

My Story - PART I

Lately, in my circle, an explosion of she-say, he-say occurs. 

Before I delve deeper into this issue and tell my part of the story, insignificant as it is, let me tell you the story of who I am, in the whole scheme of things.

I am no one. I am not famous, I did not make any significant huge contribution to any part of our society other than I am alive, working, functional and a consumer. I am whom you can say, partially vocal, partially reticent, like any other persons. I share my views for fun. I rarely divulge anything that is related to my privacy other than my hobbies and observations and some parts of my random travels and daily life. I am no celebrity, in the easiest terms.

I am a doctor.

My circle mainly consists of my small group of good friends, family and colleagues and friends from my life journey (from high school to various housemates from my years from living apart from my family to my friends I found at college, universities and work). So, my friends are mostly those who work in the health industry. 

My job is not my whole story. It does not define me as a whole, it is something I do every day and as I have said in my previous stories, my job and I have a love-hate relationship. Some days I am glad I am doing what I am doing, some days are just meh, and some are so torturous that I always feel like quitting and walking away. Now, why do I stay? This is the part of My Story.

I am just an ordinary doctor. I do not create miracles, my knowledge is shallow, as shallow as a puddle as compared to the information available in the medical world and I am competent enough to do what I do to be really honest. Now, since I already admit this, I am pretty sure people, the general populous will claim, 'Ah another idiot who is not fit to be a doctor.' 

If a doctor is not humble and thinks she/he is a God's gift, or God forbid, akin to God Himself, then I laugh at that idea. No one is perfect and everyone has their mistakes and weaknesses. I hope I myself realize my weakness and daily, while I work, I rely heavily on other people (my patients, especially my patients, my seniors Medical Officers at work, my specialists, my staff nurses and even my good housemen). I rely on them to remind me of what I am lacking, what I need to improve on and what I need to learn.

So my story starts like this.

Everyone is talking about housemen issues and our dirty medical world these days.

So many scandals, bullying and overall negative environment to work in. Generally, the whole population who is not directly involved in the medical circle has vague idea of our work and how stress is related to it.

But what they do not know it, this whole medical world is trapped in a vicious cycle.

All the stresses leads to mistakes leads to harm leads to more stress leads to bullying as an outlet to let go of your frustrations and exhaustion leads to more stress and the whole cycle goes round and round. What I always say is we are dealing with humans and human lives. Humans who are essentially different from each other and respond differently to treatments from each other. Humans who come from different backgrounds with different circumstances.

It is almost unique and unlike any other jobs in this whole wide world. Now, I am not saying our job is extra special, extra stressful than others and we are extra special snowflakes. No. What I am saying is no one else other than us truly understand how stressful our work is.

Try imagining this (I can only tell from my OWN experiences and perspective, I DO NOT represent the WHOLE WIDE WORLD'S MEDICAL SOCIETY):

Housemen (as I know it):

  • Wake up at 4-5am, starting work at 5am to 7am, depending on our shift/rotation/how many other housemen available (but hey if you have less than 10 for the whole department at that time, tough luck). Waking up when the sun do not shine, I always say.

  • End work after the sun sets, usually earliest at 5pm, latest 12am to 1am (I have seen some went back at 2-3am, poor souls). If you are lucky and your department is cool enough to have a shorter shift (approved by the department depending on again, the number of people working), you will have an AM shift, the one that ends at 5pm if, God willing, you finished your job on time and can escape after that immediately.

  • Now, some say, what is so bad about that. Mind you, we do not have the usual office work with usual office break. No. We work on our feet almost all the time, seeing patients, attending collapsing patients, taking patient's blood, doing procedures, doing paperwork like putting patient's information in our clerking/progress sheet, death certificates, discharge summaries, MC, labeling blood and samples, sending blood and samples, collecting blood result, writing memos and referrals to various departments, hospitals and other related field, consulting patient and explaining patient's current conditions to patients and families, conveying to families regarding patients death or impending death, attending calls, assisting in OTs, referring to various teams and hospitals, clinics to attend to, presentations, courses and CMEs (like training class if you will). I can list a lot more. All simultaneously.

  • If you are lucky and you are easily adapting, you will work fast. If your team is excellent, everyone will pull their weight and chip in. If you are the other end of spectrum who learns slower, not easily adapting and have a shitty team, then your luck is out. Shitty team is a team of people who avoids work by going to TONNES of courses, who kiss ass to their superiors making you the coolie with no glory, leaders who make shitty schedules, putting you at worst rotations and wards, putting themselves and their close friends in best rotations and wards and giving themselves glorious short shifts and offs, and those who love to 'mengular' or 'snaking' (not to be confused with 'snacking' as in eating snacks) in which these are the persons who will disappear like magic right after the rounds are concluded.

There is no middle ground.

  • If you are indeed lucky, you are 'Jonah'. I am not sure where this term originates from and if it is used widely all over the world, but it is special.

Jonah = So unlucky (depending on how you see it), that your admissions will be sky high, issues will pop out every 5 minutes and your patients need resuscitation every few seconds. And someone will always die on your watch.

  • Then, depending on your rotation, you  may need to work night shifts, or general population like to call it oncall, at least once a week. Now, it doesn't sound bad other than if you are unlucky enough, you are alone to man 1-4 wards. Did I say, alone? While you would have another 2-6 team mates but they have their own wards and work to do. Night shift is usually a double shift, in my case last time, usually starts officially (officially does not mean we can come at 8am, we have to come as early as 5-7am usually) at 8am, a break at 12pm to 7-8pm, then re-start work at 7-8pm until 12pm the next day with the day (work) continuing at 7-8pm again to the next day at 12pm. Now, again it sounds reasonable and fair, but usually it means no sleep and lots of work. And, not all shifts easily ends at 12pm, some dragged on due to unfinished issues and work which has to be finished before you go home.

That is just the nature of the job itself. 

  • Now we are adding the drama factors. We have malignant people in our jobs. Malignant means people who are so bad, they are actually bullies. They scream at you, hit you, throw stuff at you or around you, bully you in lots of ways from belittling you, calling you names and epithets, overall, they are there to make your life more miserable. Mind you, half or most of the time, all you can do is just take it and bear with it. We cannot even leave it. The explanation letters, the threats, the extension (which makes your life a living hell as you have to stay in that hellish rotation longer).
To be real honest, housemen are the lowest in the hospital totem pole.

  • Then, the days of work you have to do. The usual is 6 out of 7 days with random off days in between. Some, are lucky with 1 and half a day off or 2 and half a day off. Maximum 8 days off per rotation (a rotation lasts minimum 4 months that can be extended, because of various reasons, to 1 year maximum), if you are, again lucky enough to have superiors who allow it and the number of people at work to take your shift once you are not around. Again, this job is not a job where the whole 'office' can take holidays. Everyone gets sick and someone has to work. Bad days is when there is not enough people, you are sick and you still have to work unless you are dying or bedbound. Everything else is not an acceptable reason enough to take leave. Or when there is, again, not enough people, you have to work 14 to 21 days STRAIGHT, with no off days AT ALL. We are not freelancers here, where we can work at our own convenience. We just have to work. As illegal as it sounds (I think it is illegal to work more than 6 days straight, but hey, I have worked 8-14 days straight with no offdays and that is just how it is).
  • The exams. Ah, the exams. Viva and paper exams to offtag (the period when you are starting a new rotation when you have to learn enough to be deemed safe enough to work independently without tagging to a senior/MO and can be put into the night rotation), middle-of-rotation exam (some more than 1), on-the-spot pop quiz and questions, end-of-posting exams and viva. LOTS of examinations to pass a posting, to graduate, if you will, that indicates that you learned enough to survive and be safe enough to work in that rotation and to allow you to proceed to the next posting/rotation. 

Now, this should give a glimpse of how things work in housemanship. Mind you, housemenship is our internship, if you will, a time to train to be a fully functioning-enough medical officer later. But we are still FULL FLEDGE DOCTORS. Full fledge as in we DID graduate as doctors, not just medical students. We work like others, just that we are also learning along the way. It is not as if we are attending a real-time course as an observer only.  

I have seen some, I would call them rude and ignorant, people in social media calling out to housemen. As if we are the species you can look down because we are deemed not good enough to care for you, your family members and your loved ones. 

Hello, reality is in this government setting, housemen = in-house, they are almost the first ones who see you and attend to you (other than our dedicated nurses and medical assistants, a shoutout y'all!). Thus, looking down, talking down and talking bad about us will get you nowhere because no medical officers and specialists have time to personally do your blood work and put in your IV line aka branulla. Medical officers and specialists have their own roles in the whole scheme of things that does not include personally coming at 3am in the morning to take your blood (unless indicated, which is another story by itself).

My story in this whole scheme of things is not yet told. 

More coming up.

P/S: I am just post-call, and I have yet to sleep since more than 36 hours ago. I hope this post is coherent enough. The story will continue and I will edit this once I am a full human being later, not a zombie with a headache.

Saturday, September 22, 2018

When Your Eyes Just Do Not See

Well, this happened yesterday. I just did not understand why I missed a HUGE hole of a ditch right there and drove right into it. 

Thankfully, the staff of Restoran BP Briani Power, Batu Pahat was super nice and great. They helped me pull up my car. This is a special shoutout for these great people.

Thank you!

P/S: Super highly recommend people to go here!

Friday, September 21, 2018

Life Can Be Great

There will be times in your life, well in my life at the very least, that things just careened out of control.

These past 2 months since my move is such a time.

I know about my move months earlier, so mentally I was prepared for the move. The new life, new job, new people, new environment are the part that I was not prepared about. I felt so out of place the first few weeks I was here. I just could not orientate well, I could not adapt to new things, people and environment. Not to mention how moving costs me a LOT. A LOT. I spent tonnes on petrol, tolls, house deposit, hotels. I found my house quite late and I found my housemates way later, thus equals to another flurry of spending.

Then, just to add insult to injury, a series of mishaps happened. Something big happened at work. I was down, depressed, demotivated, you name it. All the Ds in the world, the bad parts, are mine to embrace that particular day. That started the ball rolling, and yesterday, I was notified about the report I had to make and 'presentation', if you will, that will come my way soon. 

To make matters worse, I received a letter from my student loan warning about late payment I've never knew about, which actually accumulated since 2014 (great, they waited 4 years to remind me, sorry, to warn me about this, just great). I made a mistake for not checking my re-payment, made wrong payment and voila, if I don't pay almost RM6000 in lump sum, I will be slapped with a lawsuit. I guess I just have to dig up my non-existent saving, or sell one of my kidneys to the black market for that amount.

At this point, you can see my life is just dandy and great.

Wait for it.

Then, out of the blue, a few of my friends sent me some texts yesterday. Asking me how I am. How things are. And I'm suddenly fine. I know things are not so good, but I know I can take things one step at a time.

So thank you. Thank you for being a friend. Thank you for making things brighter for me.

Thank you.

So, if you are a friend, sometimes, just texting a friend once in a blue moon, just asking how they are getting, can get them out of their blues. Simple to be real honest. But it really make a huge difference. It made me feel less alone. Less burdened by life. Less overwhelmed.

Thursday, September 20, 2018



2017 is long gone and 2018 is almost gone.

Here I am.

I saw my last post and I am amazed how far I have gone. I have to admit I did not reach where I am now the most traditional way, the normal route or path that others took. Mine is definitely longer and full of self-doubt. 

I doubt back then I am doing the right thing.
I doubt that I am heading to where I should be heading.
I doubt this is the life I wanted for myself.
I doubt that I am doing this the right way.

As I said, a lot of doubts.

Being alone (not really, I have an amazing family, but I live apart from them, so I am essentially alone, another story for another time), I have too much time to think of bullshits in life. Almost like 1st world problem in other people's life, if you will.

I first thought, hmmm, I will go down surgical/paediatrics path, I would NEVER do internal medicine. But hey, almost 3 months in, I'm QUITE settled in medicine.

It is AS BAD AS PEOPLE SAID, but it is NOT THAT BAD. How should I phrase this.

It has its moment. Some of it bad, some of it good. Some of it is just bleh, it is okay. I'm not an excellent person in my job, mind you. I am not hardworking enough. I am not knowledgeable enough. I am not skillful enough. I am full of loopholes and doubts. And yes, misery along the way.

To be truthfully honest, once I finished my training (2 years in total, but it does not really prepare me mentally for what is more to come), I am petrified thinking of my future as a medical officer. I have people coming to me ON THE FIRST DAY OF MY JOB asking for my opinions and plans. In my head, I was screaming, 'I HAVE NO FREAKING IDEA, I DO NOT KNOW WHY I AM HERE, I DO NOT KNOW WHAT TO DO, I DO NOT KNOW WHAT YOU ARE TALKING ABOUT, I JUST DO NOT KNOW!'.

Yes, in capital letters. I was in their position once. I was the one who pestered my seniors/nurses/MOs/specialists and whomever I could pester to get a plan. Now, I am on the other end and I was feeling like a fish out of water.

I am alone in a state where I have nobody to talk to. I am not even sure I am ready for this. But I was here and I have to be ready.

Thankfully they put me into an easier rotation the first few weeks. I did not even have to face the acute/subacute sections, let us just forget CCU nor ICU. Unluckily my luck ran out and I started to take over the acute/subacute section on my second/third week (was it my third week, but it was fairly fast). I have to do oncalls which is more terrifying than working normal shift (which is already scaring me to pieces).

Luckily, I have my seniors who were doing first calls to rely on. Every decision I make, I second guess myself. Every thing I do, I feel like I am on an uncharted land, blind and lost. Again, not so lucky on my part, I was 'promoted' to second call of which I am essentially alone on my second month of the job (read this, 4 weeks in, in other words, I am too stupid for my own good to be left with this kind of responsibility).

Second call. Ah. Another level of ball game here. It is not first call, but being third call has gave me a glimpse of hell that is called 'first call'. First call is the right name. I get calls until my ears feel like bleeding. 'Doctor, I am referring a case from red zone....', 'Doctor, a patient collapse in ward 4....', 'Doctor, a patient LO, please come and settle the death certificates...', 'Doctor, 6 patients arrived, first case is....', 'Doctor, a few medications need MO to counter-sign', 'Doctor, can I double check regarding this patient's medications....', 'Doctor, the family of so-and-so wants to see you to ask about....', 'Doctor, can I get an opinion regarding....', 'Doctor, I cannot cannulate a patient and he needs an inotrope...', 'Doctor, a patient is getting angry and he insisted on AOR....', 'Doctor....'.

You get what I mean. Calls and more calls, walking around the hospital from one end to another, top to bottom until I get blisters on my feet and I literally feel numb. Then, the next day I will be working as usual until 5pm, if I am lucky, if not, there are procedures to do before I can safely go home and find my bed. Or my floor. Whichever that is the closest.

Second call is special to me. It is scary in its own way that I have to do rounds alone and receive referrals from the other building. And ICU. That last part is the most terrifying. I used to follow my specialists and medical officers, typing down their opinions and plans. But now I am on the other side, writing or dictating a plan, which to be real honest here, most of the time I have none to offer. I am mostly stuck because the cases are usually complex that my brain just cannot synapse and make a good opinion and plan. Most of the time I have to call my specialists, yes, even at 2am in the morning. Thankfully all of them are nice enough to entertain my calls/texts and answer my questions. Making rounds post-call is another special brand of torture for me, considering I am almost burnt out from the day before, and my brain just cannot handle more difficult situations.

Boy oh boy I learned fast. I learn to put in chest tube, femoral lines, peritonal dialysis, IJC, intubate etc fast, knowing I am alone and these procedures can help people. And I have people depending on me to do it, and do it right. So far, I hope, I pray, I am doing this right. 

Anyhow, this is not a post to discourage new fledgling house officers, medical students nor medical officers. This is just my reality, which may seem different from others. Other people may not find things as difficult. It is not difficult per se. It is just...Tiring? I am not sure how to put this in word. I am often left feeling exhausted and unable to think straight by the end of my calls. End of calls, in other word, the next working day before I can finally go home.

Currently, I am content of where I am. I have made mistakes, some are more serious than others (another story for another day). I have days when I feel like walking out and walking away for good. I have days that I feel like I have made some small difference. I have days like today when a student nurse told me I look like 'Farah Fauzana' whoever that is (but that made me feel good because she was smiling and I assumed it does not mean that I look like a troll), or a few weeks ago a patient's family said I look beautiful as I was always smiling every morning when I am conducting my rounds (I have my good days when I came with a smile), or when my ward nurse said 'you looked especially pretty today in that dress'. Mind you, it sounds so shallow, but I take all praises that come my way to brighten my days.

At this junction of my life, if I compare my life with most of my contemporary, I am way far behind. Depending on how you see my life, how I see my life and what I want from my life, I lack a lot of things.

I do not have a husband/child of my own.
I do not own a house.
I have my student loans and debts to settle.
I do not have enough savings.
I do not give enough to my family.
I do not travel enough to feed my soul.
I do not own my Masters degree (or any sort of MR--, be it MRCP, MRCS any MR--)

But I am thankful. I have my parents and siblings. I have a car to get me around. I have my job to pay my needs and loans. I am safe. And I have my life. And to be honest, I am happy for everything that makes me happy. Like a new perfume, a new drama, a new dress, a new lipstick, a new dish/place to try.

For that. I am still thankful.

This journey is still, hopefully, long for me. 3 months, 6 months, 1 year, 2 years and how many years down the way, I will go back and read this and find funny things that I have said way back then.

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