Housemanship and Birding

Both are of the same age of about 1 year plus. While both are similar in age, there is a difference between the two.

Sabah has provided me the opportunity for me to travel and bird widely, gaining experience and skills in bird identification. Along the way I have met new people with similar interest. The 'sports' is already becoming an obsession. Every free time in the early morning or late evening is spent to bird. With the shift system applied to house officers, birding opportunities have become even more abundant. My lifer list is now nearly at 250.

What about being a doctor, my true 'career', the job where I should put my dedication in making myself a better doctor? This is my 4th posting. I will be moving to my 5th if my department lets me. After 1 year plus, working as a doctor, I must admit that my skills and knowledge are not on par or to the level which I am satisfied. Sure, during the months of work I have gained experience and knowledge but honestly it is still inadequate in my humble opinion. Sure the shift system has given me a lot of free time for myself and sleep, but in the long run, it has made me more calculative and pampered. Within weeks after the implementation of the shift system I have forgotten the lethargy accompanying a busy oncall and to work the next day til end of office hours. I am honestly ashamed with my MOs whom are still obligated and dedicated to continue their work even being post-call.

Shift system is not all that bad or for birding. Perhaps I should capitalize with the extra free hours. Some of the things possible now are:
- Study for MRCP, MRCS or other exams
- Attend OTs or minor OTs to gain more hands-on experience
- Attach to pediatric surgery activities, my supposedly main interest in medicine.
- Read more on my spiritual aspects of life and other non-medical (and birding) aspects.


So where is my direction in my life career? Birds or Human lives?

Failure to change now would only lead to the detriment of my future patients. Islam demands the best in our work. To be the best requires realization and hard work as well as tawakal. Not solely the latter.

Shift System in Surgery

The government calls it Flexi-schedule or some shit.

But it's still the shift system.

We've started today.

In theory surgical department shifts sounds pretty good.

Work like usual:
Weekdays: 7am to 5pm (am shift), 4pm to 8am (night shift), then day off for night shift to return to work the next day.
Weekends: 7 am to 12 pm (am shift), 11 am to 8am (night shift), then day off again.


The way the number of HOs are arranged is such that everyone will work in the morning except for those in the night shift. So its basically the same as before only that night shift or 'oncalls' don't have to come in the morning and they get a day off the next day. Quite neat ;)

Only that now weekends we'd havta stay til 12 pm and not leave earlier when our jobs done. But that's no biggie.

I'm looking forward to the shift system, at least in Surgery as it frees up a lot of free time though not much change where birding is concerned but we'll see :)

I'll be doing night shift tomorrow. Am will be birding time nyehehe

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Death on Table and Trauma Alert

Retrospective entry, 24 September 2011.

Final peds surgery oncall today:

1. Death on table

- Day 5, term kid had a bowel perf. He was unstable from the go. Peds medical team insisted the surgical team went in despite not optimally stabilized. So we went in. BP crashed despite on full blast inotropes. CPR initiated. We all knew the baby won't leave the table alive. We closed him up. poor boy expired. Blame game begins.

2. 3 Neurosurgical admissions

- All 3 kids had some sort of fall and bang on the head. Admitted for observation. On admission all were normal active kiddies. Too bad the last one came in at 3 am.

3. Trauma alert

- Before that 3 am admission, I was on my way to sleep at ~12am. Then came the unusual trauma alert which I have never heard before. I ignored it and shut my eyes. The trauma alert was called the second time summoning my MO oncall that night. Shit, I said. It means there's a dying kid in casualty. I went down pronto and attended to a pale looking kid with a distended abdomen. He had a tractor backhoe fell on his tummy. Intra-ab injury. He needs blood. I went up - down for the blood. Scan later showed Liver and splenic laceration. Can't go in for this case as opening the kid up might distrupt the clots causing a tamponade effect on the injured liver. Opening him would cause him to bleed more...

4. Intestinal obstruction and excuse to not go too work :)

- Another admission at 6am. My perfect excuse to not go to work at SMC side :D Kid had an intestinal obstruction. History of gastrostomy for a stomach volvolus. Fortunately he was stable enough. Then followed peds surgery rounds.

Damn, I really wanna do peds surgery...

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Kuli

Our system in the medical field in Malaysia is of total hierarchical dominance. HOD's words are final, and housemen are dogs.

Nope. You can't question what you are asked to do. You must do it. It must be done. Specialist orders the MO to get it done, MO orders HO to get it done. Not getting things done will get the MO screwed and will get the HO screwed by the MO.

Some things that are requested are so absurd that the houseman's job is practically suicidal ie. requesting an URGENT MRI that is NOT INDICATED. The houseman will definitely get screwed by the radiologist.

That's the houseman situation: lose - lose. He gets screwed up and down, front and back.

Sure you can speak up and speak up your mind. But unfortunately we live in a system where questioning your superiors might be disrespectful and outright RUDE.

What you say doesn't matter.

In meetings, houseman gets screwed left and right and asked to pay for fines (denda saman) they don't deserve, "Apa boley buat? Bayar sajalah"

Then an angel (a special specialist) speaks up on behalf of houseman saying that we don't deserve this shit. We should stand up for ourselves.

"You guys are doctors for God's sake! Leaders!"

I smell the wind of change.

I'm not going to start rebelling. But perhaps the next generation of MOs and Specialist can change the system where we really do work as a team. Where opinions of team members matters! Where working might actually be fun and motivating!

Because this life of kuli is certainly demotivating. I hate my job for this reason. But I am not giving up on it yet. Hopefully I'll be a part of the tide of change that will be sweeping the old ways.

***********************

Rooftop Adventures

Sometimes you just need to explore a bit of your hospital and you'll find secret passageways to wonders beyond =D


Welcome to Rooftop of Sabah's Women and Children Hospital, or Hospital Likas.

Where people come to chill, smoke or in our case, take a few pics.






Thanks to Nadhir for acquiring the KEY.

(This is after working hours folks. Dont ponteng-ponteng. We are good boys :D )

IIUM Reunion in KK (2 July 2011)

Prof Nasaruddin came down to see his kid here in Kota Kinabalu while he and his gang did their electives here. So we decided to hava little get together at a local halal seafood restaurant (No Pork Served!)

Yes, I'm the usual loyalist, always feeling attached to something I once belong too. It was nice to see my fellow graduates dining together here far from home (except for Jai), gathered again for a temporary reunion. There's a lot of us I realized and we are all scattered all across the country, east or west side. Aishah, Fateha and Saiful Ehsan were absent here, along with some of our IIUM medical officers in KK.

All of us have one thing in common: we carry the name of our university we came from, the university that trained us to become who we are today. I guess its true when they say we reflect how our uni had trained us. I am proud that I came from IIUM and I intend to continue to set a good reflection of our university, and hopefully do it justice for all the training and teaching I have received from our teachers. I hope others feel the same way too.

It was nice to catch-up with Prof whom we noticed have lost quite alot of weight (diet ka?). He told us that rarely will you ever see one table filled with Malay Muslim doctors during his time. He is happy that times has changed for the better and hopefully more improvement will come from this.

After lobsters and buttered prawns, we parted ways. Insyallah that might come another day when another reunion will occur, perhaps in the west, in the East Coast, and this time we have changed into different persons.

Weekend Offs - Off

"Weekend off is a privilege, not a right"
Dr Suthagar, O&G Medical Officer (dunno why this quote stuck)

Orthopedics department was the latest department to have it's weekend off taken off following O&G, Pediatrics, Surgery (I'm not so sure about internal medicine). Reason given by Mr Nahulan, the Orthopedics head of department was that the replacing houseman (those covering patients on Sunday) could not perform well enough to present their cases. He feels that continuity is needed, in other words, the same houseman who had been taking care of the patient should be around to present the case when the MO or specialist does rounds.

It seems that the competence of housemen are in question. Despite having the numbers (even when halved, the current numbers still exceeded the amount of HOs that had to cover a ward a few years back) we still could not meet up to the expectation of our superiors. Why is that?

I refuse to believe that housemen are incompetent. Such labels are a disgrace after going through the trainings we had from high school to med school.

So what went wrong?

I believe it all comes back to attitude. I believe there is a lack of will for self-improvement. We took things for granted hoping that we could cover our tracks and hoping still that nobody finds out. There's no motivation performing better than what we could. As long as the job is done, nothing else matters.

Sadly this had to happen. With the weekend-offs gone, its back to 7 days a week work. No more early morning birding, no more over-time weekend sleep, no more weekend exercises, no more proper breakfast... In short, that's the end of 1 day of normal life.

The only thing to look forward to is that at least it's half day of work (although this might extend to the evening as in the case of O&G or if there happened to be additional unfinished work). At least its better than nothing.

I suppose we deserved what we got. Perhaps its for the best.

*************************

Enter O&G

Retrospective Entry:

After settling a few more video orientations, we took the shuttle to Likas Hospital to start work. Then we met Dr. SuthaGar.



Initially we thought of asking for a few days grace to settle 'stuff'. But once he heard that we already had a place to stay (even though he also heard we did not have any of our own transportations), we started tagging (work) straight away.

I was put in the obstetric ward. Everyone so busy, so alien, I was lost. I remembered getting scolded for just standing around and not doing anything by a fellow senior houseman. I was taken a back because truth was, I really didn't know what to do, how to start.

I felt really bad, not knowing what to do...

It was so different from med school. I remembered depression slowly creeping in... I wanna go back home...

But eventually with a few helpful colleagues I began to learn the ropes. Informed of some MOs to avoid pissing off and to look out for. And learn the routine life as a houseman.

Welcome to becoming a doctor.

Tagging in O&G lasted for 2 weeks, assuming that you passed the tagging assessment. It was med school exams all over. And tagging last til 11pm alternate with 9pm. We were required to deliver 10 babies, assist 3 C-secs, and repair 3 episiotomies.

Sad thing was, there were times when we finished at 11 but still went back at 1am as we didn't have our own cars then... We depended on a 'pirate', drebar for hire charging RM 20 for the ride back only to wake-up again at 5.30 am to start work again at 6.30am... For some of us, we couldn't sleep well either due to constant nightmares of hordes of babies coming out...

Somehow we survived the ordeal. All of us studied what we needed to and passed our assessment. But that was only the beginning of the toughest posting in KK.

Tips:

- For tagging assessment, know your CTGs and Obs emergencies. These are basic knowledge needed when you are oncall.
- NEVER piss your staff nurses. They are your best-friends and potential worst enemies.
- First postings are hard but tough it out and you'll survive. Don't go through it alone. If you came alone make new friends.

New World

Retrospective Entry:

I felt like an immigrant the first few days I was here.

When I first arrived I had mom and a hotel room. When mom left, I still had the hotel room but we just had to find a more permanent place to stay.

I was lucky that I had Nadhir, Jazmi and later Nurliyana. (poor unfortunate souls, unlike me, was thrown to KK, Sabah for their housemanship [Liyana didn't stay with us ok, she managed on her own:p]) around which made life less lonely. We stayed at the hotel a few days longer depending on Pak Tri (our cab driver remember?) to drive us around town, back and forth to the hospital to settle first few days of orientation.

We were also lucky we had Jai, our senior by a year who also happen to be in A&E rotation where their shift rotation makes it easier for him to help us out by showing places and lending his car.

KK didn't provide any permanent quarters for their houseman. Even their hospital looks like something out of Silent Hill. The only quarters at a nearby flat which they provided for a few days looked like something out of a Japanese ghost story where Toshio can just suddenly come out. We spent only one night.


All the while we have been looking through newpapers, mudah.com.my, advertisements on boards for any place to stay.

Again thank God Jai was around.

Food here is more expensive, and the local cabbies slit your throat (fares are minimum RM 20 per ride regardless of how near it is to your destination).

We couldn't move freely and food supplies were short as we didn't have places yet to place our groceries if we bought any.

In the end, I contacted a landlady and rented a fully furnished apartment located right in between all the three hospitals we were destined to rotate. Besides the furniture, the place also had a swimming pool and was surrounded by a few nearby churches. The nearest mosque was a bit to far to walk on foot. Oh yeah, no elevators and our apartment is on the 4th floor. Moving in was tiring but at least we had a roof. All we need now are wheels... My car is being shipped and is due to arrive in 2 weeks time...

In the meantime we still depended on Jai and Pak Tri.

Orientation week was heaven. Well not really but it sure beats working life. We still get paid while filling in tons of forms and listening to orientation presentations (I slept through most of it as usual).

Then we knew our postings.

Me, Nadhir and Jaz - O&G
Liyana - Pediatrics (though she had Trevors coming along, another fellow colleague from Manipal whom came along with us).

Reputed to be the toughest postings in KK. We were warned on day 1 that extension rates for both postings were high.

We started work on day 4 of the weekdays.

That was the start of everything new...

I remembered...

Depression.

Tips:

- Mentally prepare yourself for things to come even if you don’t know what. Me being mentally prepped to come work here helped a lot.

- Bring cash. You're like a UR over here. You don't belong. Not yet.

- Shelter, food, car, contacts. Contacts. Contacts. Fast. I can't stress how important.

- Bring lotsa pen and passport sized photos (like 30) cuz you'll need them during registration time.

Sorry you're not in the pic Liyana, tula sampai lambat. Meant to take a pic of us 4 before starting work but dunno why I didn't do it.

**************************************

Seniors

Dinner with IIUM seniors at the Filipino Market

Big reason for my choice of Kota Kinabalu for my housemanship is because I know there are good seniors from my uni there, though I never really knew how good us they would be.

Transportation and commuting was a big problem during our first few weeks. Big is perhaps an understatement. We traveled mostly with expensive taxis. During work time, tagging times when we finished late at about 11pm - 12am, even taxis were not available, especially at our Likas Hospital. We could only rely on 'pirates', hired cars, to bring us back home and come again the next morning at 6.30am.

Rozaimi was a big help especially. He showed us around, brought us to some place to eat and shop, and sometimes lent us a ride or his car when his A&E shift was at night when he couldn't come home.

For that we owe him a lot.

I realized that our bonds with students from the same Alumni runs deep. Perhaps its the university binding that kind of loyalty or just an individual's personality. But I know that a seniors' worth is a lot. Their wealth of experience to 'survive' during the first few weeks, months of 'life' is invaluable and most often unrepayable.

What I'm writing here is only a fraction of their contributions. Later there'll meet other seniors in the posting, regardless of the year they started. A first poster can be your senior even if he or she came in only a week earlier. Your medical officer is definitely your senior never mind consultants. They will be your teachers, in medicine and in life.

Respect your seniors, and you'll do well.


Tips:
- Respect, rapport with seniors from medical schools onwards. Don't be an asshole.
- Shop til you drop before you start your first time tagging. You might not see daylight for the next 2 weeks and starve. (Haha gila 30 days of night!)

Pilot

(retrospective)

I saw egrets through the windshield of the plane I came to Sabah on. They were the first birds I saw.

I came with my mom, God bless her. We arranged for a hotel to stay at for the next few days with the help of dad's friend who lives here.

What was my feelings then? Excitement was most of it. I was about to start real life. Working life. I'll be so far away from where I'm used to and I'll get used to here from now on, hopefully.

Met a friendly cab driver whom soon became our personal driver (at a cost of course). He was responsible for taking us around later and while we searched for a more permanent place to stay. I arrived a day earlier while Nadhir and Jazmi came in next day. I was ready to live alone but at the same time I am glad to have familiar faces.

Kota Kinabalu Sabah was my choice. My only choice. I hoped that I won't regret it. I can't turn back now.

My mother did not say it but I knew she needed me here. To start my own life and able to support my family later on. I know she is hopeful. That's the whole reason why she came all the way here with me.

Respect

As a housemen, or wherever you work, there will be someone (your superior) who's slow, garang, always makes lousy decisions, unusual or weird habits.

They make topics over meals or dinner of facebook notes (or status) where people start bashing them up.

Regardless I think this is not the right attitude (although I am guiltily sometimes a part of the bashing action).

Regardless of how that person is, I believe he deserve some sort of respect. Even if he is wrong, there's absolutely no need to downgrade the person. For all you know somebody is bashing YOU over lunch.

I think bitching attitude should be out of the circulation in working life. It would make working less stressful without all that negative thoughts and feelings (especially when you work with that hated someone). Besides, no matter who you are or where you are there are bound to be someone you hate that you'd have to work with.

Cope with it bah.

And stop bitching too much.

Sometimes You Gotta Be Hard

Saw my MO scolding a kid today becaused he refused to cooperate for chemotherapy treatment through his central venous line (Hickman's catheter).

Kid's a 4 year old boy with acute promyelocytic leukemia. He was due for chemo which he didn't want to cooperate as he wanted to continue watching Masked rider or something like that. He got a scolding from my MO which he then cooperated.

My MO told me that as a kid patient he had 2 roles, one a the sick role, and as the kid role. The sick role deserves to be treated, but the kid role must be disciplined. I agree with him in a way. Kids when left to be treated like kings, even when they are sick will become spoiled and ironically become harder to cooperate for treatment. This is made worst when the parents pamper the child more.

I suppose life goes on even for the sick kid with cancer.

How much privelege would one get being sick then? Later for that...

Whining on Oncalls

Its weird that despite me always getting stressed up for oncalls, I'm known to take someone's call without any exchange, payment whatever. And I'd get this look, "You crazy? Are you sure? You don't wanna swap with my call?" "No, lar just give me the call only." I have to admit I was inspired by a certain senior back in my university for this type of behavior. Though people take advantage at times. But oh well.

Even with RM100 incentive per calls for housemen, people would rather be back at home and sleep. A rare luxury for me indeed nowadays.

Funny how I wish that my oncalls would be cold (though they almost never are) and that I'd be able to get some sleep.

Pfft.

The reason why you are ON - CALL is so that people could call you up in the middle of the damn night to attend to - whatever. Wishing for a good night sleep is only WISHFUL THINKING.

Besides, the more you encounter during your oncalls, the more experience you get, the more procedures you are able to perform, subsequently building your personality to get over anything that work or life can throw at you. During my calls in O&G, I've had experienced red-alerts for post op intra-ab bleeding, bleeding miscarriages, high octane labour room calls, hordes of mothers coming into PAC to deliver, vacuum deliveries, ERPOC, caesarian section and for my most recent peds, I got to experience an intubation, exchange transfusion, and hordes of babies to poke and prick at 4 am in the morning. During these calls also I've picked up skills on management of certain common problems. I don't admit that I would know how to handle each of them again but the experience matters as it will most likely be stuck with you for the rest of your career.

Oncalls are then more valuable than the money earned, as in medicine, nothing is as important as the experience one gains during work. It's sort of unfortunate with the excess of housemen nowadays, calls are getting less. This may not be a good thing in the long run as we, young doctors won't be able to get the necessary experience needed. But I guess then one has to make the best of whatever they have and benefit from it.

People tend to get grumpy whenever they hava bad call. Me included. I can become a nit nastier than I usually am when faced with a bad call though I'm still generally nice :p But I'll try my best to be professional during my next call and do my best to go through them with a level head.


PROMO: If you need to switch calls, or need someone to take your calls do ask me. If I'm ok with it I don't mind the extra call. It'll only be beneficial for me.

****************************************

Mothers

I haven't worked in the hospital a very long time. But what I've seen amaze me time and time again. Working in O&G and pediatrics, I've seen durability or mothers, the immense sacrifice and time they take to nurse their kids. Heaven is at the footsteps of our mothers. Witnessing all this, it is justified to have mothers have at least a step in heaven.

I've seen mothers bearing child, while at risk themselves, harbouring life-threatening hypertensive disorders. These mom's are like Tamil Tigers suicide bombers carrying bombs. They can blow up at any moment. That's a metaphor. What I really mean is they can die just because they are carrying their precious child.

Labour comes. Along with the pain. Vaginal delivery, caesarian section. It doesn't matter which path both again carries risk of death. I've seen torrentous bleeding in both cases where the mothers life is just a few minutes away from death. The probability of mothers suffering post labour is like playing Russian roulette.

Then when the baby is out it's not all well yet. If she's the majority of the lucky mother, she'll have a normal baby that will grow to become you or me or better. But if fate has it that she is not, the baby ends up in the NICU for months, nursed til in good shape, if the baby's lucky. Ive seen twins nursed for 3 months for prematurity. And with patience, and support, mama and baby comes home well. And I've also seen baby with stormy post natal period ending up with a hypoxic brain. The baby is bound to grow with neurological defects, unable to live a normal life like you and me. Again the mother will suffer from the extra care the child will definitely require.

But she won't care. Because she's the child's mother. It's an inborn thing to care for her child. Whether her baby is diagnosed with Down syndrome, cerebral palsy, a restrictive lung disease with very poor prognosis and life span. She'll stay with the child until the end. Because that's what she does.

I've seen mothers spend almost half a year caring for her child with meningitis with hydrocephalus. She's in a hospital so far away from home with no nearby relatives. Her husband's earning is below average. Yet she stays. Coping with her whinny kid whom complains of everything. Her only company besides her kid is the nurses and the housemen. She'll be around for a long time. Along with other mothers with kids with tracheostomies, leukemia, and kids with malnutrition.

I've also seen mother's with kids whom are fat and thriving but still feel that they do not have enough. Kids whom whines for everything gets into trouble with everybody. Whom shouts back at their mothers when being told off about something. Despite all that, momma endures. For better or worst.

No I haven't seen everything. What I've seen are only fragments of what mothers are made of. Not every mothers are like this I concede, but most are. You don't a 'Mother's Day' to celebrate. That's because everyday is mothers day.

As long as she's around she'll care for you. Whatever you attempt to do to pay back for all that she's done will never ever be enough. But for her it will always be. Because you are your mother's sons and daughters.