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!

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

 

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.

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.

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.

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

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.

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!)

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.

Happy Cancer Ward

Took charge of the GyneOnco ward for the past 2 weeks.

And its one of the liveliest I've been through! Despite having cancer, undergoing chemotherapy and radiotherapy, the patients are mostly cheerful and laughing. They are very friendly to us doctors. And some of them comel sangat! Seriously, its like taking care of big kids.

I'd like to think the condition is mostly due to our happy go lucky Dr Mary, our GyneOnco Specialist, who's strict with her time and care for patient's but at the same time maintain a cartoony and goofy part that makes her funny a lot of times. But mostly I like to think that patients over here (Sabah) are just like that, happy go lucky in nature.

I definitely had fun during my rotation here. Work's pretty relaxed too compared to the other wards.

Today one of my MOs treated all the patients with Conetto. Houseman not allowed to have some though but its ok. It's because watching patients happily licking on icecream is a wonderful sight. It's really adorable!

I recall one time my patient told us during rounds how she didn't mind spending money on supplements. "Kamu guna duit beli handfon, Iphone, barapa lama boleh hidup untuk guna? Kesihatan lagi penting." She told us that. What positive thinking.

On the sadder side, some patient's really look pathetic. I pity one who had feces pouring out her vagina due to a rectovaginal fistula she developed, from the cancer? or the radiotherapy shes being given? And patient's with no veins that us HOs have to poke multiple times and cause endless pain... "Duduk hospital makin sakit ada..." And some patients are dirt poor and they come a thousand miles away from treatment, that even after finishing treatment they have no money to pay to get back home. Chemotherapy cost thousands depending on the regimens. Treating cancer is not cheap. And it breaks your heart to see a recurrent case, cancer cells lying dormant after all that surgery and chemotherapy, the breaking news is indeed heartbreaking.

Taking care of a cancer ward opens everything. Your eyes, heart especially. Try switching places. You with the patient. Your mother with the patient. Will things be different?

Will it still be a happy cancer ward?

Changing Perspectives of People

Being a student, houseman, we tend to 'fear' certain MOs, specialist, consultants. When we fear these certain individuals, we avoid them, we paint very negative views of them, and we infect others with that views so that these people will carry a bad name wherever they go.

I think its not fair to them despite them being damn malignant, and moody. Sometimes we get a scolding for no reason, although I would like to think most with reasons. But these people may actually be nice if you talked to them and meet them outside of work. They are humans too, and being human they have their own characteristic that we may not like but however have to bear.

Here's an experience of mine.

A colleague of asked to switch oncalls with me as he had something that day. Thing is, that call was with an MO with a 'negative' reputation. HOs shudder at his name, and try as best as possible to avoid him. I heard of him even before I started my posting. My colleague couldn't find any other replacement as nobody wanted to be oncall with him. I accepted and just vowed to do my best whatever happens. Gotta face it someday anyway.

And guess what? I went through the oncall without any scolding at all. He listened to my presentations and we communicated well (I think). He even thought me how to do an ERPOC, which nobody wanted to do with him. All I had to do was to call him and ask his permission to perform the procedure and he said OK.

He did scold a few other of my colleagues (some quite severely) but somehow I went through well.

That colleague of mine who changed calls with me said a few days earlier that quite stuck to me, "If you do your work well, and did your best, you have nothing to fear and cannot be scolded. Even if you are, take it as a learning process."

Face it, we'll face people like this at anytime in our life. We just have to deal with them and there is no use in judging someone negatively as you will only react negatively which in the process make life more miserable, for you. I don't think the person gives a damn anyway.

It's easy for me to say this, but it's also a lesson for me.

It's not nice when people paint a negative perception of you. Try thinking positive and see things in a different light, and Insyallah things will improve and work will become less stressful.

_______________________________

Polyhydramnios - Spectrums

I've decided to write on interesting cases here. In the future I'll decide if they would be included in the travelogue.

Polyhydramnios - Spectrums

Case 1

22yo Primid @ 26W + 3D

Late booker

Referred for further management of fetal anomaly seen in TA scan and reduced fetal movement.

Patient was aysmptomatic, not in labour. V/S were normal. Per abdomen SFH was 30W size, with difficulty to papate the fetal parts and positive fluid thrill. There were no contractions.

TAS revealed:

- Dilated fetal heart. Still beating.

- Fetal ascites.

- Empty mother's Morrison's pouch.

What are other TAS features to look for?

What is the probable diagnosis?

What are the investigations to be performed in this case?

--------------------------------

Case 2

28yo, G4P3 @ 38W+1D

Antenatal problems: Anemia in pregnancy, AFI normal throughout pregnancy, no GDM, fetal anomaly scan not done.

Came in active phase of labour.

V/S stable

PA: Ut size: 38W, singleton, cephalic, head 5/5 floating, difficult to plapate the fetal parts/

Admitted to labour room for controlled ARM. CTG was reactive prior to admission.

On rupturing the membrane, 1.5 L of liquor was drained with fresh blood stains. CTG worsened showing unprovoked decelerations.

Impression was placenta abruption secondary to ARM.

Posted for EMLSCS.

Intraoperatively uneventful.

Baby boy delivered with BW 2.1kg. Admitted to NICU for TTN. Later discovered to have tracheoesophageal fistula, imperforated anus. Planned for thoracotomy, TOF repair and colostomy my the peds surgery team.

Mother was well post-op.

--------------------------------

Maybe I'll write a bit on polyhydramnios when I'm a bit in the mood. I find both cases interesting. There was another with hydrops fetalis but I didn't note the case.

Other cases of polyhydramnios I'm on the lookout for are:

- diabetic causes

- Twin-twin transfusion

- Other fetal anomalies (ie. Spinal disorders due to problems swallowing)

The Backbone of the Wards - Nurses

Hada request from a friend to write about nurses in Sabah (she's a nursing student) and compare them to Peninsular Malaysia nurses. She hears them grudgingly back talk about doctors almost everyday and would like to hear from me if there's any difference.

I think its human nature to back talk whether they mean it or realize it. I'm not encouraging it but just acknowledging its existence. Yes it exist here. Not just among nurses, but among doctors as well. Nurses back talk that arrogant houseman, houseman backtalks that malignant specialist, patients backtalks that nurse. Sometimes you don't hear it, you just sense it. Makes you wonder what people talk or think of you behind you back.

But so far I enjoy working with the nurses here. Its too early to make a general overall conclusion but the nurses I've met are really helpful and most are fun to work with. The labour room staff are a cheerful bunch. They offer food and invite us to Raya at their place. They are the ones who cover our asses and remind us of jobs. They tell us the correct dose for medications and help teach us stitch. The nurses I've met taught me Caesarian section. I have a feeling they'd be able to perform a better C-sec than most new MOs if only they had the license to do so. Most importantly they keep the wards organized and in-check. I believe them to be more professional than most doctors regardless of rank.

Prof Nasa was right. You should treat your nurses you work with with RESPECT. They are not down the food chain. We work together to achieve a common goal. This would be much easier if everyone did not talk behind each others back and be suspicious of each other.

I love my nurses. Make them love you too.

Oh, nurses in KK I've met a lot are pretty and cute too =D

____________________________

Malignant Potential

My colleagues sees me being a potential malignant MO.

When compared to IIUM students back home in Kuantan, I less commmonly see UMS students around in the hospital. But when they are around, I do my best to share what I know, tutor style. Apparently, my style of asking questions and waiting for answers got me branded for being potentially malignant.

Back in medical school, most teachings and learning were from making you think. The process occurs better when triggered by a question and those asked finding the answer. Some lecturers ask in a sarcastic or aggressive way. These are the malignant ones. But I still think that these types of teachings are the best. It conditions you. By being scolded, you are more likely to look for the answer in the hope that when next time occurs, you are able to answer and deal with the situation better.

How different it is in the working life? No different. Only that your actions have repercussions. You are still scolded like a little child when you make mistakes. But again, this is another learning process that the mature will take as a lesson instead of as a personal insult. MOs gets the same treatment, specialist gets the same treatment. Always questions first. Makan suap does not suit the medical field. Its how we are trained.

So I don't think becoming malignant that way is that bad. Hell if that will make my apprentices better, than malignant I shall be. But I'll try not to let emotions dictate my actions. Besides, I''m not known to marah orang.

Right? >:D