Surgical High

I have achieved what I sought out when I first entered O&G and thought, "Since I'm here might as well take as much as I can." I can now perform the lower segment Caesarian section. Yesterday was my tenth solo.

Thank you, Angela for the pic :)

It might not be a big deal to others but it's a personal achievement for myself as it is the first surgery that I was able to perform on my own after tagging and tutoring with my seniors and specialists. It is a procedure that a medical officer is expected to be able to perform in the district. I am not perfect in the art of surgery but I feel that I am improving bit by bit. I started out with a virgin ab and 'presumed' fetal distress (baby came out with APGAR 9 in 1), yesterday was a first advanced labour case which the baby's head was deeply engaged.

I am finding that each C-sec that I perform is always different from the ones I did prior to that and requires different approach, techniques and creativity that I may only be able to gain with time and practice and more learning from others.

I have also realized that we are not just performing surgery. We are not even trying to save lives. We are only helping out. And that comes back to the old medical saying, "Do No Harm." And in surgery its inevitable to do iatrogenic harm. What needs to be done is just damage control and prevent further life threatening harm and in some cases, 'aesthetic' harm.

What frightens me and I am very sure of other surgeons is the possibilities after the abdomen is closed and the skin shut tight. Will healing take its course well? Is there something I missed? A bleeder that may not seal on its own? A viscus I perforated and did not realize? Germs that I accidently left in the tissues that may accumulate and pus? The postoperative complications is what frightens me. I should be afraid as that would and should make me more vigilant. Nobody wants to open up a patient twice.

A successful surgery is not just being able to perform what needs to be done, whether its taking the baby out, taking the appendix out, taking the whole bowels out, fixing bones, amputating. A successful surgery is one that is done so that after the surgery, the patient walks out alive and able to live as near a normal life before she had undergone surgery or before she was sick. It's not about cutting, it's about healing. And not just healing of the body but also of the mind and soul.

As I cut more and more, I also hope to suture also those cut pieces back together. Essentially as I go through more surgeries, I'm also dissecting myself. And I hope I can piece myself together more perfect than before.

Thanks to all whom have brought me this far. Please guide me to bring me further.

Perinatal Mortality Meeting

While I'm glad it was all over, I consider myself fortunate to be part of the team to be presenting on the statistics of labour room for this year. It sort of gave me a few insights as to the importance of data collection and analysis and how we can improve and benefit from statistics and its interpretation.

Perhaps I am an academician at heart.

The meeting was a quarterly effort done with the pediatrics team.

I presented mostly on the number of deliveries and birth rates, including modes of deliveries, number of multiple gestations, preterms, and most importantly in the meeting, stillbirths. The pediatrics team had their own presentation on NICU admissions and mortality rates. Later a few selected cases were brought up for discussions as to how to improve things.

I expected blame games and bashings between department but what I saw was a rather pleasant discussion without too much hostilities.

Some of the data I wished I had included:

1. Rate of success of ECVs

Success of ECVs would reduce CS rates for indication of breech. This would be a big help in preventing maternity risk posed by CS as well as risk to fetus during breech delivery vaginally.

2. Shoulder dystocia

The data would be helpful in seeing what could have been done for prevention and anticipation of similar cases.

3. Cord prolapse

This is potentially preventable. Response time could be assessed and discussed as well.

 4. Outcomes of instrumental deliveries

Success although may not very well indicate justification of the procedure, it may provide insight as to the baby's outcome. Many factors come into play here.

As a person with pediatric surgical interest, my interest in connection to O&G would be antenatal screening of congenital disorders, such as gastrochisis, congenital diaphragmatic hernia, duodenal atresia, and spina bifida. Outcome of baby's are greatly increased with antenatal diagnosis and subsequent deliveries in a equipped tertiary center with pediatric surgeons.

I do intend to do my part to make data collection more bearable and simple. A simple template may help perhaps.



"Those who do not learn from the past are doomed to repeat it"
Winston Churchill

EXIT - Enter O&G

Post housemanship.

I thought I won't see O&G ever again after I finished the posting during my housemanship.

I was SO wrong.

I was placed to O&G, just a stone throw away from the department of my choice, Peds Surgery. What was initial dread, fear of screwing-up, almost alternate tagging calls, incompetencies, morning prayers and high-octane action, turned out it's not too bad at all. For now.

Anyways, we had a first-ever EXIT (EXtrauterine Intrapartum Treatment) done quite recently, organized by the O&G team involving Peds Anesthesiology, Peds medical, Radiology.

It was a case of a baby diagnosed with a huge neck mass antenatally by our fetomaternal medicine specialist. Then he thought, "Hey, why not organize an EXIT for the the baby so he won't come out gasping from airway obstruction?". So he did. And it was a historical success for Hospital Wanita dan Kanak-kanak Sabah.

Pasar di OT

An LSCS was performed only the baby was only delivered halfway. Continuity of the uteroplacental-fetal circulation is the main objective of the procedure. During that time, I was the cameraman for that monumental moment. The O&G team made way for our anesthetist to secure an airway for the child. At first, attempt to intubate the child failed. Only after aspirating the cyst a bit did the anesth team manage to put in the tube. And the baby was delivered and transfer of care to peds medical team was performed.

The kid is still in level 3 while peds surgery team, attempts to shrink or if possible excise the mass so the kid could be weaned off his tube and ventilator.

While in O&G, I am growing in a way. Mistakes happens but that's how we grow. Sure there are ups and there are downs. Alot of downs. But we just have to keep getting up. Because that's the way to proceed.

In O&G I am learning sonography. I am learning surgery. I am learning mother and child. All requirements for Peds Surgery.

I'll stay for awhile to further grow then perhaps... I will become a better Pediatric Surgeon.

Link:
bcdecker.com/SampleOfChapter/550092359.pdf

We Need Guidance, Please

What we don't need are insults. We just need guidance. One of my favourite teacher was Pang Chee Hoong, physician whom took care of male medical acute and HDU 1 during my time there. And that was when I learned how to put in the central lines.

I was in my 5th posting and I still haven't done any central lines yet! But Dr Pang showed me the way and now I'm more confident. I came out of medical with almost 10 central lines and quite a few on my own with assistance from nurses.

Coming to anesthesiology, CVL are mostly done by MOs in the OT. I assume that even they want that bit of practice.

Last night though I had my chance of putting in 2 on my own. But shit did I panic when I realized that I haven't pulled out the guide-wire when I inserted the triple lumen! My heart pounded like hell and I thought I would end up in IJN instead of the poor patient with the thyroid storm.

Fortunately the wire was still there when I pulled out the triple lumen. Booyah! Still a good flow!

Setting up central lines is one of my favourite procedures as a houseman. Haven't tried it on peds yet but would like the experience. Hell I still need the practice to set up regular lines in peds. Still suck at it. Learning from them experienced nurses is not a bad thing. I still have much to learn. As always.

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

Tips to CVL insertion:

- Success is assured when patient and your position is correct. Failure is guaranteed when positioning and exposure is sub-optimal.

- Always have help around.

- The hardest part is getting the needle in the vein. Once that's done, the rest is a breeze.

- Know the potential complications.

- I know consent is important in the event of complications, but most of our folks, if we explain to them in details regarding the possible complications of CVLs, they would consult the whole kampung before agreeing. From Dr Pang: Do first, ask later. Save life first. (Up to you which you want to believe).

- Always pull out the guidewire first!!! Having a guidewire in the heart is equivalent to putting in wrong group match to a patient.

Have fun!

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

 

Interlude

I'm writing way too much on O&G!

I promise Pediatric experience next!

(bukan ada orang baca pong)

O&G Revisit: The Bully

I had an MO (name with held but you'd know whom I'm talking about). He was a bully.

He would deliberately find excuse to 'kenakan' new HOs in the department (seriously!). His mood is like a playground see-saw, happy at one spectrum and a nuclear bomb at the other! He even admitted his mood swings and sometimes apologized for it.

My first incident with him was when I had my case note flung to the floor in PAC. I think he was angry with me for not writing well (I don't really remember now).

My second, when I scrubbed up for an emergency C-sec and I couldn't get through to the Peds MO oncall for standby. Baby came out flat, blue alert was called and he was furious with me throughout the whole closing of the patient's ab.

I've seen him calling up HOs for not filling in certain forms or writing in a style he didn't like. There was a time he told us he would find faults in the case note just so that he could find an excuse to scold a HO.

Well that was the worst of him.


On the bright side, after the blue-alert event, he did tell me nicely what I did wrong after I approached him and told him how sorry I am and that it was a mistake. He advised me not to take it personally as he just can't control himself at times and to learn from my mistakes.

He also thought some stuff in the labor room like what to look for in the CTG and during vaginal exams.

During my last few days of O&G, he gave me a chance to do a C-sec with him thus getting a very much needed C-sec performance in my logbook.
 

Much of the scoldings and the bullyings though unwarranted most times do sometimes provide the much needed eye-opener. And bad guys are not always bad (though they may be on the bad side of the spectrum).

He is still in the department and from what I hear from other HOs he is still the time-bomb he was when I was in O&G. But I do hope he does well and cool down a bit.

Well that's life.


Tips: Ambil yang baik, buang yang buruk, bersyukur.

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

ps: I am so glad to be out of that department! =)

Final Posting: Anesthesiology

I remembered Prof Arif, my dear, Anesthesiologist lecturer in IIUM telling us how we should advise patient's going for op to pray as when the patient sleeps, it might be his last.

Undergoing anesthesiology rotation, I now can appreciate that anesthesiology is not a department where the anesthetist just 'intubate and extubate' or 'spinal' and just sit around in between.

Putting patient's to death with medications , maintaining airways and heart regulations while the patient is unaware, and reversing them back to life. Ventilator bag and machine replaces the patient's lungs, manipulation of his heart comes as easily with a push of the syringe plunger with the correct drug at the correct dosage.

My first impression of the anesthetist are that they control life itself!

Of course all this requires extensive knowledge on physiology and pharmacology to master this unique discipline. Just into my second month, I see that things do go wrong and shit happens and when it does, the patient's life can just slip from your fingers, and losing a patient on table is a horrible feeling when the patient (and family members) have entrusted you to keep him safe while surgery is on-going.

Things go wrong when you least expect them, ASA I patients, supposedly those undergoing short and routine procedures (I&D, CMR,  D&C).

Being put under is just damn scary. Putting someone under is just as scary. I have done a few successful intubations (20 is still considered few), and each time I still pray and hope that nothing goes wrong while I look for that vocal cords, epiglottis and put the tube in. This is by far the scariest procedures that I have to perform as a house officer.

Going through anesthesiology for 2 weeks in med school and 4 months as a HO is a very big gap. But that 2 weeks thought me a lot. Getting consent, RSI and inductions, MALESSS, holding a face mask properly and assembling the mask-valve-bag. And most important, the need to pray that things do not go wrong and the appreciation that life only belongs to Him and He is the controller of all life.


Lessons and Tips:

* It's OK to not be able to intubate. It's lethal to not being able to VENTILATE.
* MALESSS before intubating. It's a must!
* Label your medications.
* Check and check and check your blood products before giving them.
* Do NOT take things for granted.
* Remember that life is in GOD's hands. You are not god.

On the Table

I awake, only to die on the table
Pushed by bodies able
Through the door to the unknown
On my journey alone


Spark to those in need
Aiding best to those diseased
I greet him at the door
To push across the marble floor


Squeaky wheels turn
My inside burns
Fear of darkness
In a room brightest


My preparations complete
Although its no guarantee
My weapons to heal
Are those that might also kill


I am resigned to fate
This might just be my death bed
Again I'm put to sleep
I might never wake...



Life then lands
His lungs in my hands
Heart beats on screen
First cut done clean


He lies still
As his insides revealed
Blood pours then restored
How long can this mortal body endure?


'Wake up' I hear
What's far sounds so near
My eyes open I see
Life, has been given back to me

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

The Assessment

Started HDU today. Patient's are quite stable for now and not much movement. Things will be busier this Monday... Had a patient whom was tachycardic the whole day. Didn't think of it much till I noticed she had a temperature and BP was starting to drop. All after the relatives noticed.

I should have acted sooner. Fluid challenge and antibiotics stat. Because in sepsis, everything can change when you act just one few moments sooner...

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

I passed my assessment with a 70% mark. For the more academic and curious I'll share the topics:

• ECG: Pulseless ventricular tachycardia
• ECG: Complete heart block
• CT brain: Hemorrhagic stroke
• CXR: Pneumothorax
• Gen Med: Diabetes mellitus
• Clinical: Organophosphate poisoning
• Resuscitation: Hyponatremia and hypokalemia
• Resuscitation: Neutropenic sepsis

I don't think I did great. What the assessment showed me was how weak I was in medicine and management and how unsystematic I am. I think that's what assessments are about. To assess what you don't know rather thank what you know. Identifying your weak points helps you realize your weakness so you can work on it and take it to the next level. The questions are all med school stuff. Yet I still fumbled with answering.

And this is on paper.

Real life is different. More factors are equated in. Staff, teamwork, patient's character, your own character, the ward environment, the hospital system, your superiors, and of course your cases. Some people manage well in-situ, under pressure. I am not one of those people. But repetition and practice helps. The more you experience the better you get. You don't turn super overnight. Heck, you don't become great after months of practice.

I shouldn't therefore be too happy that I'm already a few more steps to leaving medical. I might be leaving but still lacking in the necessary skills and knowledge. This could be dangerous. longer stay however may just provide that extra push to develop.

After all that said... No way I'm staying in medical more than I have to :p I'm stressed with the work, but enjoy it at times. It's one of the only postings where opportunity to learn and practice independently is abundant.

I hope I've learned something and continue to learn.

Monster Change

Now I'm posted to Hematology ward. My HO leader wants me in ID, but my MO doesn't want to let me go. She wants me to stay. I'll just have to wait, CM to see how it goes. I'm quite comfortable in Hematology ward already...

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

After going through halfway through housemanship, I do notice changes. I think it's for the worse in some aspect.

I have become the monster that I despise most when I see the monsters (some of my MOs or specialists) that I dislike and hope not to be. In my struggle to perform for others, I have succeeded in slowly chipping away some of my past existence, revealing the ugly caterpillar one so much wished to hide. A reverse transformation of nature, that may only come with stress and power and greed and desire to self-preserve.

Wings that sprout to fly are made of leather and bones instead of soft, feathers. I may soar high but less than grace. My breath becomes fire all of a sudden that singes hearts if not burn outright.

Is this how the course of things go? Where one forgets the very being he once was and strive to improve or at least maintains?

I loath when my superiors act on impulse and emotions. Disregarding the feelings of others. Breeding only contempt and a vicious cycle of loathing. I today have succeeded in succumbing to anger from that irrational emotion. My mild, growing wrath licking like fire the hearts of my dear colleague, my co-working staff nurses.

For becoming a monster, I apologize.

I long for humanity once more. For humility that I should be.

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

Sudden Death

Again I haven't blogged here in awhile. Updates: I'm currently in Medical posting, it's already been about 2 months. So far I'm enjoying the posting quite a bit but the amount of death I'm seeing weekly. Today was another except that this was an unexpected one...

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

A patient was admitted into female medical extension for acute flare of rheumatoid arthritis. In casualty she was given PCM, tramadol, morphine and fentanyl but none seem to have helped. She was still in severe pain on admission.

We brought my MO to see the patient first when she came in to start her rounds. We thought we'd get back to her later to solve her pain issues at the end.

"She won't die from the pain."

Whether she died from the pain or not I'm not too sure, but she did die today.

Halfway through the ward rounds, the staff nurse informed me that the patient was not breathing. She was right. I called my MO and we initiated resuscitation. Oh how there were so many inadequacies at the moment when every second counts.

1. No crash cart in the ward
2. Patient's only IV line was blue and not functioning
3. Oxygen thank was not by the bedside
4. We couldn't open the patient's jaw for intubation; temporomandibular RA

We couldn't manage to revive her after 30 minutes of trying. She passed away.

Our impression was drug overdose from the amount of opioids given to treat her pain. I'm more inclined to believe it was hypoglycemia as her DXT showed LO value. Later we found out that someone from the A&E sent her blood for dengue serology IgM which turned out to be positive. Did dengue kill her?

Whatever her cause of death, it came swiftly, unexpectedly. We were caught unaware and unprepared. Death is like that. It comes when nobody expects it. But we can still prepare. We all know how. It's only a matter of implementation.

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

***********

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...

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

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.

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