Just some closure, after so long.

I quit. It wasn't an easy decision, but it had to be done.

What did I quit? Not just KKM, but medicine in its entirety.

I think it was a long time coming.

I pray for the welfare of our healthcare system in the future.

A system more compassionate towards its family. An affordable system that is also self-sustaining. 

Because no system is perfect, but there are many decent human beings in this one who are trying their best to help others with their blood, sweat and tears.

I pray for a system that does not make its biggest decisions based on politics.

There are many other things worth praying for as well in current times, but this is my specific prayer as I close this chapter in my life, and with it this blog.

God bless.

No Time to Die

It has been a long while.

Well, things are starting to look up. Many things happened between my last post and now, which is funny considering it's only been like 4 to 5 months, but it seems like a lifetime has passed.

I haven't posted here because even a reminder of work was bothering me. I decided to focus on myself, and it has not been an easy journey but overall it has made my life a whole lot easier - or so I'd like to think.

I considered quitting medicine, I really did. I was so close to doing it, too. But I surrounded myself with the right people and slowly pulled myself away from things that were perhaps a little too 'toxic' for me, and I managed to hold out on the actual action of quitting and settle for something that may perhaps be better for me in the long run.

I didn't see myself being here in particular when I started working. I did foresee it, apparently, as a medical student and I admit I am proud of how astute I can be sometimes. Then again, we are all egoistic and think we are above certain things in life until life slaps you in the arse and you fall into the muck and realize you are, after all, not below those things but rather under them, until you get back up and brush yourself, or rather hose yourself down, and are above it all again.

So that's what I'm doing. I am getting up, hosing the muck off of myself, and stepping away from the mucky area for a bit until I absolutely have to go through it again.

My parents are a bit hesitant, naturally, but my husband supports me wholeheartedly and so do my siblings. My in-laws may also be hesitant about it but they are polite enough to refrain from saying it outright to my face so far.

Anywho~

I guess I'll see you when I see you.
And all the best to your future endeavours too.

Always seek help when you need it. Nothing is too trivial. :)

Ain't Nobody Bringing Us Down

Recently there was a letter to a rather famous online news site on which an MO (around my age in service years) lamented on her fate- she was posted to Sabah in a district setting, has a husband and parents waiting for her on mainland and is wondering why the huge amount of new MOs stay in tertiary and not get posted to places like hers throughout all these months.

Story of my life.

It was shared on a prominent facebook group of Malaysian doctors.
And most of these individuals in a group of professionals decided to focus on how whiny the letter writer is. Was.

Speaks volumes about the profession here, to be honest.
Or, do the kinder ones in the profession tend to shun the limelight and keep quiet?
I may never know.

Anyway, although it wasn't me, I feel for the person. I don't think the letter was whiny, but apparently that is not the general consensus.

I don't necessarily blame MOH for my situation, though...
Just my brain.

A Strangely Common Occurrence

You feel like you have assessed and managed a patient properly, treated them well enough to see remarkable improvement. You feel the patient is safe to be admitted into your wards without referral to a tertiary hospital.

So you happily send the patient on his merry way to the ward.

Barely an hour later, the patient has apparently deteriorated and needs to be sent to the tertiary hospital- intubated.

So...

Is your assessment really good?

Did you miss out obvious signs of deterioration?

Did you even manage the patient properly?

The vital signs chart, does it lie? 

Was the entire department complicit in pretending the patient has improved clinically just so the doctor in charge doesn't have to pick up the phone, discuss the case with her superior and refer the poor, unfortunate patient to the nearest specialist hospital?

Did some supernatural process weave its way through to plant its horrendous, cursed lips on the patient while he was in transfer, leading to a rapid decline in his well-being?

Weird stuff happens.

You could be the first doctor, or the second one.

Your level of knowledge or competency tend not to matter much in these strange aberrations.

The second doctor, kudos for catching a deteriorating patient and doing the needful before proverbial feces hits the proverbial fan.

The first doctor... Well, let's hope your documentation is sound and you have a good track record.

Let's be real, I've been in both situations. 

And only recently was I in the situation of the first doctor.

I kept rewinding through my memories, thinking where did everything go wrong... 

I was by the patient's side for most of his time in the emergency room.

I assessed the patient myself instead of relying on the nurses for vital signs.

I managed the patient as thoroughly as I could.

I gave the final word that the patient was stable enough to be sent to the ward without requiring specialist input.

And much, much later, when my colleagues told me the patient's condition in ward on arrival, I was utterly shocked, because from what I hear the patient was in a worse condition than upon his arrival to the emergency department.

The irate second doctor who had to manage the patient was understandably cross with me, assuming I was dumping proverbial feces into her ward so she could clean it up.

Honestly... 

I think we are all in this field not to dump feces, but clean it up.

Plus the specialist in question that day was actually quite pleasant, so what would really deter me from speaking to her?

So what happened to the patient??

Sigh.

I keep beating myself up for things that are out of my control.

Vital signs that do not tally.

Magical changes in condition.

Troublesome people.

Miscommunication.

Feeling like James Blunt on a moody day...

I think I am considering taking a long unpaid leave to be with my husband.

If things continue this way...

I read through this blog and realize my posts have been negative as of late.

Where were the inspiring posts, filled with positivity and tips for others?

Where did the optimistic HO go?

Quitting entirely would be a waste. I will still have my APC as long as I practice somehow until whenever, but I would like to contribute to my family too, and let's face it, that's the only reason why most of us stick in government jobs- for the safety of the future. For our families. 

Not to change the system to be better, it seems.

See? See where I'm going again with the negativity?

Maybe a small break for now. It's hard to think when your emotions are so clouded, and a nice break may put things into a different, better perspective.

In the Haze

In a life filled with record-breaking moments, there is bound to be one that resonates with you more than most.

I rarely post about my patient encounters. I fear they may be unprofessional, a way of pandering to the masses; an accidental show of farcical empathy and intelligence; you name it. However, this is something I had to get off my chest. And let's face it, there is no real way I can be posturing with this particular story.

Be aware that this story might not be... savoury... to a lot of people. I am a Muslim, and that comes with certain obvious expectations. Malaysia has its own set of rules, too, regarding what I'm about to document here. So if you are not one of the above, you may be unable to fathom why I reacted how I did... 

But you can try.

In the wee hours of the night of a public holiday, a middle-aged lady was supporting her daughter as they walked into the emergency department, the daughter clearly in pain. The daughter had put on a green batik nightgown over which a kain batik was tied to her neck, massively covering most of her front. Mother, in a long-sleeved blue shirt and pyjama pants, called out, 'Help! My daughter is having severe back pain all of a sudden!'

I was in the midst of filling out a prescription form for another gentleman who came in with an unexpected allergic reaction. I eyed the duo as they swerved over to my assistant medical officer at the registration counter and were directed to the closest beds. The mother was told to lay her daughter down and register. They were non-locals and had to pay RM 100 instead of the rate we enjoy, a hundred times less.

Feeling the gentleman eye the duo with more curiosity than necessary, I hastily finished my explanations to him, discharged him and got up to see the lady.

Introductions. Then a quick look-over.

I am not blind. She was obviously having an abdominal distension suggestive of a gravid uterus.

I pulled down the kain batik, and pulled up her long nightgown. Sure enough, the linea nigra appeared into view along with a uterus of about 24 weeks' size.

'How old are you again?'

'18.'

'When did you turn 18, exactly?'

'Earlier this month, on the nth...'

'Are you married?' - typical Malaysian doctor questions. Don't ask if you ain't here.

'... Yes.'

'Doctor, the mother told us she's not married,' interrupted one of my nurses. 

It's not uncommon for a teenage girl to be married around these parts, especially for non-locals. But deep inside, I knew this was not the case.

'Do you know you're pregnant?'

A pause. 'Yes...'

'Does your mother know?'

Another pause, this time more pregnant.

'No.'

We'll see about that, I thought, as I reached over to the ultrasound machine. First things first, let's see how premature the baby is.

Probe on suprapubic area. No head.

I moved it upwards. A tangle of bodies.

No.

Two skulls.

NO.

Yet sure enough, as I moved the probe around, two fetuses were actively moving around, separated by a thin layer of membrane, head to head. They were around 20 to 22 weeks gestational age.

For many people, being pregnant with twins is a delight. But for healthcare practitioners, we know how complicated these pregnancies can be to the mother and both babies. And for a young doctor like me who isn't within the O&G department, even the seemingly simple act of scanning the patient becomes a massive chore. The case will need to be discussed with the specialist.

In the background, the patient is moaning in pain.

I have cussed internally and perhaps externally, but I have asked my nurses to bring the speculum and vaginal examination set over.

'Do you have any water or blood discharge from your vagina?'

'No, doctor, help me, it hurts so much!'

'Labour pains will get worse, girl,' my nurse told her, 'so be strong for your babies.'

For it was clear she was having contraction pains. 

These do not happen for no reason, so far into the pregnancy.

Examining her, I found her to be one centimeter dilated. I took the necessary investigations.

'Have you ever checked your pregnancy with any doctor before?' I inquired.

'No, this is the first time. Ow, it hurts!'

'Please be honest, miss, I'm trying to help you. Did you take any medication before this?'

'Yes.'

'What for?'

Silence.

'Did you... take medication to abort the pregnancy?'

'Yes...'

An external curse word escaped me, in a record-breaking moment.

'Where? Where did you get it from?'

'From a friend in town...'

'Where did she get it?'

'I don't know, she used it before too.'

'Did you bring it?'

'No...'

'Are you aware that you're not just murdering one, but two babies?'

'... What?'

'You are pregnant with twins!'

And I have never heard such words being uttered with such venom from a healthcare professional, as she stared back at me, flabbergasted.

The next few moments were more of a blur.

I rushed to the mother.

'Do you know that your daughter is pregnant?'

'Oh, oh what, really?' An unconvincing show of surprise, eyes widening too late, too long, barely any tension in her muscles- just not how most mothers react to an unexpected teenage daughter pregnancy announcement. The mother knows. Call it a hunch, but she knows.

'Why did you go to town today?'

'Just going out, you know...'

'Are you aware that she is trying to terminate her pregnancy?'

'Well, no, but she is in so much pain, please help her! Surely you can help her ease things a little...'

'She is pregnant with twins, you know.'

The mother stared at me, almost deadpan.

'And you are more worried about her pain than the fact that she tried to kill her own babies?'

'I, uh-'

'You are a MOTHER! How can you be so evil? How can you allow her to take the lives of her own babies? You're also a muslim! You know that it's murder!'

The mother's expressions were hazy behind my watery eyes. I realized I was screaming. Gesticulating. Frustrated.

'Doctor, it's okay, you have the full right to scold me. Just scold me, I don't mind, please... It's my fault,' she told me. And in my whirl of emotions I can't even tell if she was being genuine or simply trying to expedite the process.

I was losing my cool.

In fact I lost it, for I have never had violent anger outbursts in front of my own patients.

I stormed off.

And in the treatment room, I cried for the innocent little souls I saw on the screen- the two skulls next to each other, moving around. Hearts beating, limbs active, strong, surviving.

For how long?

I was not equipped for this. Being alone on-call, my staff unable to console me or advise me.

I wept.

I wept for the babies, and the naive young mother, and her mother.

I wept for my inadequacy and loss of professionalism.

I wept for the people who tried and failed to conceive for long years.

I wept for long minutes, an ugly mess of tears and mucus and loud sobs.

I dried my tears momentarily and called up my specialist for advice.

And wept some more over the phone despite all attempts to the contrary, much to my chagrin (and the specialist's).

She told me there is nothing she can do, and it is not really an urgent case.

I remember her telling me that there is no need to cry, because it does not help things.

I apologized profusely.

But since when has crying ever helped? It's out of our control and I hated myself for it.

'Did the specialist scold you badly?' One of my nurses asked quietly.

'No, it's not that, it's...' I couldn't begin to explain.

'The mother knows, you know.' The nurse told me, and said more of the circumstances surrounding the pregnancy. The guy refuses to be responsible. It was of little import to me.

I did what was necessary and what was ordered by the specialist- the police report, the plans to have her admitted overnight- and refused to see the patient.

What was I supposed to do, hold her hands and tell her everything is going to be fine?

I was a mess and so was she; neither of us needed to see each other.

The rest of the night was a tumultuous blur of emotions, for as I mourned the possible loss of lives, I mourned my reaction to it, too. I wondered if it would ever be possible for me to process such a case with less emotional outburst. I mourned my lack of knowledge.

I prayed to God for all of us.

I hurt myself.

And to stop from going further I began writing into my phone, writing all those feelings, pouring them out from my heart in an event lost to so many years.

I was glad of the reprieve I got after the case; no one sought the hospital in the hours that passed afterwards, probably sound asleep in their homes. Quitting was an idea that appeared in my mind often, painting violent streaks into my thoughts.

I walked around the hospital grounds in the haze, omitting my N95 mask entirely. The thoughts within were enough to suffocate me.

There is news that came with the dawn- the patient has stopped having contractions altogether in the ward. There is a huge chance that the abortion attempt failed.

I wonder what the coming days will bring to the mother, her mother, and the two unborn babies.

But most of all, I wonder what they will bring to me.

EDIT: The ward staff told me over electronic media, on my off day, that the babies were delivered the day after. Of course they came out alive, and it was quite some time before they passed.
I want to say that I wish the mother and grandmother are happy with what they've done.
But that would be lying.
They didn't just kill the babies, but a part of me, too. And that would never change.

Over a Year as a Full-Fledged MO

Okay.

So, they are right.
It gets better.


There are days when it feels like absolute S*&# and you fear the slippery slide to insanity, and best believe those days sometimes come more often than not...

But overall,

it

     gets
         
          BETTER.


Believe in your dreams.
TRY to be patient and not morph into the malignant boss of your nightmares.
No matter how stressed you are.
Pray hard to Him and ask for His blessings in all that you do.

InshaaAllah, it will get better. It may take months, maybe even a year, but it will improve.

So, hang in there.


And when it does get better, remember your dreams (ahem, specialisation?) and GO FOR THEM.

As my favourite medical specialist has told us, do not settle- have an ambition and chase after it. Always strive to improve yourself and move forward; never be too comfortable with where you are.


Thanks, Boss. You will always be our superhero.


And hey, ignore the meanies who tell you you're stupid and make you feel worthless.
Take their advice when given, but ignore the insults.

ACCEPT that you may be so stupid sometimes, it's absurd. Do not have too much ego, okay?
Just accept that your lack of knowledge at that time was inexcusable. You are not super intelligent, even if this title required you to score the highest in all your school years- it means jacks@#& because you are in a field filled with so-called overachievers so again please just accept that.

LEARN. Consolidate. And most importantly, MOVE ON.


Yes it's particularly hard when it concerns certain... beings... but try, for your sake.



Belated Title: Advice to Past Me.
Proper Title: Advice to All Ailing New MOs.

P.S.: I am STILL a new MO. One year does not a senior MO make.

Joy to the Tears

There is no feeling in this world to equate to a post-call after an eventful call.

And there is no feeling quite like realizing, 'Damn, I have the best colleagues.'


There I was, trying to resuscitate an unstable patient in the Red Zone.
Green cases piling up in the background.
Some yellow cases too- being handled with my other shift partner.

Some friends left a Christmas party in the maternity ward momentarily, just to see how things are in the ETD.
Saw the "festivities" taking place in the ETD (*cough*disaster*cough*).

And immediately began clerking green cases. Helped me and encouraged me in decision-making regarding the resus case. Helped me try NIV and coax the patient to follow through- even though that failed quickly.

Helped look after the patient as I called boss for the nth time that night to aid in decision-making.

When the time came to intubate, they were there at the ready- one holding the BVM, another positioning the patient's head, another holding the pre-meds- in lieu of the SNs and MAs who were busy suturing, serving medication, and registering other patients in the background. Supporting me emotionally as my nerves were tattered and frayed from all that has happened.

When intubation was done, they helped set up the ventilator (I am next to clueless when it comes to ventilator settings), secure the placement, fill out and send the post-intubation CXR form.

Stayed there a while longer to ensure everything else was running smoothly, giving input when needed.


They could have spent that time in the ward singing Christmas carols, enjoying more of the delicious food arrayed, chatting about fun stuff or enjoying the reactions as presents were being exchanged, cheery Christmas music playing in the background, laughter a constant presence.
But they didn't.

They helped out someone in need instead, in a place less desirable: filled with beeping monitors, disgruntled relatives, patients groaning in pain and body fluids galore, air filled with infectious microbes- during their off-hours.

If I could award them with APCs, I would award one to each of them. Because my colleagues put the needs of their friends and patients in front of their own desires.


They are the best Christmas presents I have ever received. 

Dignified and Truly Professional

"Dr, Klinik XX nak hantar satu patient. NCC*, non-local post-SVD** 3 hours ago at home. Patient unconscious--"

"--S^#T!" I responded in the most dignified manner possible.


There are several cases that warrant the most dignified response possible when you're located in a remote setting over an hour from a specialist hospital:

- Maternity cases with a high chance of morbidity and mortality
- Paeds cases (especially under 5 years old) with a high chance of morbidity and mortality

Those two are the most important to remember; the rest are nowhere near as frightful.

Because at the end of the day,

even when the patient was roused from a deep and seemingly unrousable slumber by you;
even if the blood pressure picked up and heart rate dropped rather dramatically after your fluid resuscitation;
even if the patient managed to arrive at the referral hospital with almost-perfect blood results, normalized vital signs, fully conscious and cheerful;

if the patient dies at the referring hospital
- leaving you flabbergasted as to what the heck happened there after all that??,

YOU
ARE
GUILTY
OF

...

SOMETHING.
Trust me.

Cry two nights in a row and then, puffy-eyed, go to the mortality meeting and explain how you have done everything within your means to help the patient; fingers will still point toward you for something completely out of your immediate control.

How would you think the patient will die because of a diagnosis you cannot arrive to, simply for the fact that it hasn't developed yet at your center nor do you have the facilities to diagnose it?
Doesn't matter, you were the cause for not having prophetic powers.


Conclusion:
1) Mortality meetings exist solely to shift the blame and not, as they are touted, to improve patient care, avoid further mishaps or 'banana trees fruiting twice'.
2) Don't become a doctor. It sucks.***




*NCC - non-clinic case
**SVD - spontaneous vaginal delivery
*** Okay it has its perks. But seriously don't do it unless you have a ten-metre-thick face and a heart encased with 5-ft steel, resilient to the most pointed misfortunes, insults and humiliation directed to you. Or just go non-clinical, heard the grass there is so green it's fluorescent.

Minefield, Field of Mine.

You would think that after being an MO, you would have more days to be free and thus type in your blog.

THINK AGAIN.

It's not the time that is the issue; rather, the fact that you are too scared to voice your opinion because somehow, with the so-called upgrade in your job title, comes even more fear of being reprimanded. You are even more accountable for what you say.

Hence the anonymity.

I have so many things to say that at times, I am almost bursting. It doesn't help that so many interesting issues are viral particularly in the healthcare sector. But, as always, I prefer to keep mum and let the more outspoken and confident people deal with what they would. Any word or action can and will be held against me at the most unexpected moments.

What a minefield, this field of mine.

*****

I have never pondered quitting so much as I do now.

During my housemanship this was not something I lingered on. I believe I do not have the option to quit, and that I should grit my teeth and bear any form of torture until I am free of this probationary period, when things would become better.

Little did I know things will never become better in this minefield. It just gets seemingly worse.

I am still getting my measly HO salary, but money's not the main issue.
My on-calls are almost always not worth the stress and hours.

You think the brunt of scolding ends at housemanship? Think again. It's not a pleasant experience being scolded, much less when you are being devalued for having less knowledge than a medical student- in front of your juniors and patients.

This is worse for MOs who are not serving within a department with its own boss- the jacks of all trades but masters of none. The KK and district and OPD MOs.

There is too much anxiety and second-guessing. It's getting worse by the day, and quitting seems to be my everyday mantra. It's weird because we are thought to be living relatively peaceful lives.

So guess who just found out that clinical life is not meant for her.
At least, not in this country.
Not in this very toxic environment.

I never thought I was stupid, particularly, but I'm rethinking that thought entirely.
I think too many of my brain cells died and created large dams of negativity held in by strong anxiety walls, surrounded by forests of fear. There is no path for the river of knowledge in my brain anymore.

Everything dead-ends.
Never have I been so unhappy.

Is this the real life?
(DON'T continue singing. Oops, you continued...)

I want to better myself by armoring myself with knowledge and experience but knowledge is a word that sounds too much like no-ledge and it is slipping off of me, repelled by me, and I am scared that I am not getting the blessing nor fruit from all this stress.

I do not know what to tell my parents. Their whole lives led up to this moment of seeing me as a doctor in the family. And now barely 3 years later I say I want to quit?

So, that's what I'm doing right now.
Grinning and bearing, until it gets more bearable, because people say it will.

What Irks

You know being an MO is not all that bad.

Says the MO who has never had to go to a mortality meeting.


And once again I am going to talk about how much I detest the bullying culture that is rife in our  healthcare system.

There I was, in a workplace that is mine but not really, and all the MOs think it's alright to shout every single order to their HOs.
One of the nicer ones even told me, 'It's fine. Use them as your outlet. I do it all the time.'

Um, what?

Of course one can't really go all 'Oh but that is very wrong!' and go on a diatribe on positive workplace environment when one is just briefly visiting, so all one can say is, 'Oh, I'm not really much of a screamer-type. I think.'


It makes me think of my hospital back as a HO, and I thought... Damn, that was a good place for HOs to be, all things considered. Even in one of the most well-known malignant departments throughout Malaysia, we had it good. Most of my MOs do not shout nor humiliate unnecessarily, and some became very good friends of mine.


It starts from the top, as always. If it is very important to the specialists and HOD especially that no bullying should occur, then bullying would be very rare indeed in such a department. If a person is allowed to berate and humiliate their juniors publicly in front of their boss without being reprimanded for doing so, then chances are such behaviour will continue and become the culture and norm.

Which is unacceptable, for me.

Yes, patients' lives are at stake. And you defend your actions by saying you only have the patients' best interests at heart and want your juniors to 'learn'.
Yet all you are teaching them is how it is okay to lose your cool and displace your frustration to those who can't speak up against you. And why is it even necessary to publicly humiliate a junior for the way he/she talks? It's not a life-threatening issue, is it?


I hear one say 'Oh I was nice when I first started. But these kids keep on making the same mistakes and month after month I became 'malignant','

May I just ask, Is it because month after month these HOs change, perhaps, to newer batches?

It's not like we've all never done a lot of the mistakes they did.
I am all for being upfront and scolding where it is due. But do not do so with impunity. Do so with care, and the full intention of correcting and helping, rather than just venting out your anger.

Yes, there will be days when our bosses i.e. specialists and super senior MOs (another race not to be trifled with) scold us, for what seems to be the HOs' faults in the first place.
They will scold us regardless, and talk behind our backs- just as we do behind theirs.
STILL does not make it okay to scold our juniors and nurses unnecessarily and especially publicly.

Instead, reflect on what happened. Maybe you needed that humbling kick in the butt to remind yourself of your place in this world.


I hope I won't evolve into a 'malignant' boss. God forbid.

Never Enough

It has been a long while.

It's funny, because I now have more time than I had the past 2 years as I have already finished my housemanship and am 'floating' in our ETD. In this department, floaters are not really accountable for much nor do they have the usual workload of a HO. Floaters work 8 to 5 with lunch breaks. And I have floated for over a month.

In other words, I have been very unimaginably lazy.

I also have gone for a rather lavish vacation overseas in some countries far colder than Malaysia, and I just have to say if it weren't for my parents I wouldn't have been able to afford even half the trip with what I earned the past two years unless I spent money the way I did as a student. Also, that half my heart is still where my vacation was. I am incomplete.

Speaking of incomplete.

I have received my new placement and I am glad to say, it is in Borneo.

GLAD?!

I am glad to say, I have not appealed to stay in Semenanjung.

But I did ask for a 2-week delay to report for duty, as I was informed quite late of my hospital (which will stay anonymous) and being quite the lone ranger, I need a lot of time to pack up my 2 years' worth of accumulated sentimental garbage.
And furniture.
Bet you ten sumpit-ed crocodiles they don't have IKEA where I'll be posted.

Which means I have to majorly save for my move back to Semenanjung if I were to move within 5 years, which is probably the case.

To those 2 of you who read my blog, thanks for following my rather truncated journey through HOship and here's an update:

I'm still alive.
HOship was the bomb.

Procedures, procedures

I have a 100% success rate with chest tube insertion and a 66% fail rate in intubation...

Of course, those involve really tiny sample sizes so they are very inaccurate.

I have the rest of my life to improve my sample sizes?

You wish the view was this nice all the time. Sauce

P.S.: Turning your failure rates into statistics may seem smart, but it's actually rather demotivating and may lead to sudden bouts of screaming out loud. So, sensitive junior doctors out there, don't do it.

The Road to MO-ship

Almost there. Sauce

Or should I say, 'well-beaten yet overgrown dirt path'?

I cannot find good resources on how people filled out the forms required for MO-ship.

Where I'm concerned, the process I'm currently undergoing (because I still have yet to receive my MMC number and would say I'm not really qualified to say anything of it) is rather easy so far. As I have documented earlier during my early HO days, my hospital's administration staff are highly helpful and efficient. I just ask and they will provide.

Just makes our jobs a lot easier; I can't begin to imagine how much of a headache the staff in charge of us feels, now that there are over 100 HOs in the hospital (I kid you not)! But she's always very pleasant and eager to help.

Anyways, once I have more details I will update this space.

For now, all I can say is:

1) Send your logbook from your 5th posting EARLY. Try at least 2 weeks before ending, so your admin staff's work is easier.

2) Prepare RM150 for the full registration fee (which could be reimbursed later LOL) and this will have to be done by wang pos, mostly.

3) Think (and pray) hard about what you want to do later and where.

4) Don't get hung up on a specific place/department to practice for now, unless you're married or have strong cables (yaknowwhat'msayin') OR have passed the first part of the paper, if applicable (i.e. MRCS, MRCP and the ilk).

5) Don't panic and freak out.
Which is exactly what I'm doing.

And perhaps,what I should be doing better,
6) PREPARE MONEY FOR THE UPCOMING UPROOTING TO UNCHARTED TERRITORY.
Movers and house rental deposits? Not cheap y'all, not cheap.

7) Get credit cards
Seriously, don't panic and freak out. Just keep revising man. It's all on you in a few months, man. All that responsibility and life-altering decisions.
All you.
So, you know, don't freak out or anything. It's chill.

The Curse of Time Awareness

When we were younger and carefree,

keyword here being 'carefree',

we are less aware of time.

We progress through our days as our parents and teachers dictate.

Wake up in the morning from our mothers' not-so-gentle calls.

Shower and brush our teeth because we are supposed to.

Go to school because that's what our parents tell us to do.

Attend classes as our teachers change, lesson by lesson.

Go out into the field and run because it's part of normal school activity.

Have fun with friends because we are supposed to.

For most of the Malays, school doesn't end in the afternoon.

"Sekolah Agama" beckons until later in the evening.

After that, come home and shower.

Then tuition, or Qur'an classes, until night time.

Then an hour or two to spare for homework, and maybe some TV, before we are forced into bed.

Weekends are largely dependent on how free our parents are (or how financially-constrained, but we rarely realize that until much later).

I don't know how different it is compared to the days of children now, but I rarely count my moments as a child, and well into my teens. I wasn't trying to deduce how many hours of me-time I have left. 

I left it all to the authorities, the 'rentals.

I was devoid of care. 

Entirely carefree.

Where time is concerned, all I want to do is grow up.

Now, every hour is calculated, every effort a pending reward.

I am too aware of the time I spend.

I couldn't recall, during my childhood, there being a time when I'm thinking, 'Aw man, only three hours before I have to sleep!' or 'What, only two days left to school holidays?!'

My days went by as planned by those older than me, and I willingly accepted whatever routine or non-routine activities mostly planned out for me.

I never questioned much of my time. Even in high school, when work began to pile on me and my many younger siblings meant that I have to dedicate most of my free time to helping around the house, I still barely thought about all the free time I'm missing.

Is it because, back then, I had close to nothing to do?

I didn't have free reign to the only PC in the house, nor do I play the old PS2 all that much. 

I didn't own a great deal of books. Most of my reading material were from the school library (and even then I wasn't as picky about what I read, I just devoured what books I could get voraciously).

My goal was to do medicine in a university in the UK, and for that I studied very frequently, mostly without prompting. The dream was only half-fulfilled- and I wouldn't have it any other way.

I often turned down invites to people's parties, and by my geeky nature, it was only a matter of time before invites trickled down to the closest of friends.

Let's not even get into the fact that I did not get into a relationship until I was in my twenties.

So, yeah. 

I didn't have much to do, and I wasn't aware of those times I might have missed out.

My parents didn't realize until way later, when my siblings have all grown up, that I was the easiest child they ever had to care for.

I despise how time-aware I have become.

Now, by the evening of my day off I'm already dreading the next working day; already thinking of worst scenarios to happen, already cursing myself for things I did not do in my free time. 

I spend nearly a quarter of my free time worrying about what's to happen during my working time.

It's a curse.

I have no idea how to get rid of it. How do I return to those days when I take each day as it is; without overt worrying, without putting undue stress on myself? Did I develop an anxiety disorder as I grew older, or is this simply the normal course of an ageing mind?

I am not a young adult anymore. 

I am a full-fledged adult. I can do everything; age restrictions don't apply to me, until such a time when I have to look forward to discounts for being in my 'golden years'.

Where I wanted to fast-forward time, now most of the time all I want to do is slow it down.

I need a Dr Who in my life.

Emergency Medicine

I'm loving this way more than I thought I would.

There are some seriously bad days, but 99.9% of the MOs are very nice (and even the 0.1% is nice in his/her own way).

NO AM ROUNDS WOOHOO!

Short attention span is fine.

Clerking is short.

ADRENALINE RUSH IS REAL.

YOU give the diagnosis.


I dunno man, it feels pretty real up here.

No ragrets.


Except, I do feel stupid a lot here haha!

Staging the Malignant Tumour & The Norm.

I'm lucky now that I'm in such a positive environment.

This is probably the department with the most relaxed, least angry bosses in the hospital.

Also the department which people from other departments are always condemning, but whatever.
Condemning other departments is normal, no?
At least in any hospital with departments to condemn.

And although that is the norm, it is rather toxic.

I rarely- RARELY- hear my bosses in any department defend their colleagues in other departments.
It's weird.

Why?
Because it's the norm.
That's how their seniors worked, and that's how they work now, and that will be us in a few months.

In fact, I know of some people who take pride in being known as 'The Malignant Senior HO'.
They take pride in the fact that fellow malignant bosses also approve of how scary and intimidating they are to their junior colleagues, their fellow staff, and patients. Apparently, being 'malignant' is encouraged- and a sign of aptitude!

And hey, take a gander at how they will run their future department soon!

Mocking other people.
Mocking other departments.
Mocking other hospitals.
Especially those that are considered 'beneath' them.


Repeatedly, I have called up certain departments to request- kindly- for a process to be expedited, or an investigation that requires expertise not available in my current facility, only to be shot left, right and centre even before I could even begin to tell my story. Simply from the introduction which indicates my HO status, the previously semi-warm greeting plunges into icy tundra, and all hell breaks loose.

Telling my seniors or bosses (with amusement, because that's how you're supposed to wave it off) only results in further remarks on how that is expected and usual, and that it somehow builds character.


I was quite surprised to find that there are decent people out there, who, when faced with the fact that we simply do not know how to properly present relevant details, will actually teach instead of scolding or slamming the phone down.
They realize that we are not experts in the field as they are, and accept it with patience.
They persevere in teaching us, so that we may do better next time.
Besides, it will definitely benefit them in the future.

Just as it benefits our health, mentally and physically, to encounter such positivity in our working environment.

These are the types of people that should be the norm in this field- this career that demands so much time and energy devoted into the caring of others--

--and yet 

they are 

the minority!

I don't even have to ask why.

It's because we accepted that things should be tough for us.

We accept that
those supposedly higher in rank have the right to scold us unnecessarily;
that despite how wrong they are, we should strive to accept their words and not defy them.

We accept the hierarchy that has been established, blindly, and do not strive to improve our own fraternity because 'it's working'.

The hospitals are running, people are coming, so it's working.


In the journey after medical school going to fully-licensed medical practitioner, we lose our humanity and accept this so-called 'norm'. Come MO-ship, almost all of us are same ol', same ol'.
Those who don't accept this status quo are shunned by the fraternity, then ultimately leave for greener pastures (private practice or leaving the medical field entirely).

And what a shame. What a bloody waste of talent and resources.


I notice that the department in which house officers thrive- stay happy, and excited to work- are those in which the Head of Departments have zero tolerance for HO bullying.

They do not condone harsh teaching of their HOs by the MOs or other specialists or healthcare staff.
They tell their staff to treat the HOs like their younger siblings; to respect them as human beings and junior colleagues.
They actually will tell their MOs NOT to do something right in front of everyone, when they think it's wrong.

These thriving departments are not the departments which justify their MOs' legendary repute for yelling, screaming and borderline physical abuse because 'conditions are stressful'.
Sure, they say, your MOs will shout at you at first, but it's okay because they will be better to you once they know you're able to do work. And you will learn either way, if you're a tough HO, because remember, only tough HOs make it through!

And this attitude is exactly what needs to be corrected.


But who am I?
Just a HO, green from the pastures, with nary a ring to put to my career span.

Going Back

There are many ways in which people gauge the status of a houseman.

Competency, that is a no-brainer. Are you able to manage the common emergencies or cases? Perform the basic procedures without much difficulty? Diagnose a life-threatening complication of your patients in ward? A competent houseman is, more often than not, a good houseman.

Then there's knowledge. This contributes to competency. Safe to say, most of us have knowledge, because let's not forget that the journey to becoming a medical student wasn't easy- at all. More often than not, it's just a matter of doing proper revision, and more frequently. Otherwise, everything our specialist taught us during the rounds just fly out our memories within the span of a week (or less).

But attitude... Now that's something to contend with.
How would you gauge attitude?
What defines a houseman with a good attitude?

It's easy to speak about it theoretically, I'm sure. But this is probably the facet that is hardest to evaluate objectively.

A houseman may seem very competent and knowledgeable to her bosses, and hardworking too, but shunned by her colleagues. Turns out, the houseman shirks from work during all times except when her bosses are around.

Another houseman who seems likable and hardworking, but avoided and talked about by nurses. Competent enough, but lacking in communication skills and the tact to deal with people who are seemingly under him.

And on and on.

It's very hard to judge a person when you only see them for a total of less than 6 hours in a 70-hour work week. In those few hours, that person may be having the most difficult time, and have done some major blunders that do not define the person at all. After all, to be human is to err.

But that is what happens.
Because, like it or not, first impressions do matter.
And second impressions.
And maybe third ones too.

So how to define attitude more objectively?
Therein come the logbooks with the attendance records and multisource feedbacks, and other things associated with them.

**********

Attendance is a very fickle thing.
For the most part, it is believed that the longer hours a houseman works, the more positive his attitude is, and thus a better houseman he will be. However, in those supposed punched-in, punched-out hours recorded, how did the houseman fill his time?

There are housemen who diligently come and go on-time. And these are scoffed at, because they do not put in extra hours, and must thus be less hardworking.... Right?

Those housemen who leave late on record, now those are the hardworkers! ... Right?

Anyone who's been a houseman these days know that this is not entirely the case.

I know of people who punch in on-time, and punch out extremely late almost each shift.
These are the same people who disappear while they're supposedly on-shift, doing God-knows-what and leaving the abundance of their other co-workers- because yes, nowadays there are more of us working and the days of single-person shift are fast coming to an end- to deal with the work.
These people will unfailingly be there when bosses come and act like they've done all the work.

These people will disappear again afterwards.
And well after their working hours are over, they come back to the hospital to punch out.

Whereas those who come and leave right on time aren't necessarily lazy. They spend the required hours doing all that is required of them and maybe more, and by the end of the day they deserve to punch out on time. After all, some of them have families to come home to; work is not their entire lives.

And yet we define the attitude so easily based on some scraps of paper that supposedly record our hours.

**********

So, I've been in this leave early (aka on time) or late dilemma too.
But then I realize, it's all so simple- if I don't come to work merely with the intent of pleasing only my bosses or other authorities watching over me. I come to work for myself, and for something larger than me and my bosses.

And there is an omnipotent being monitoring all my moves.

So people may think I go back early (aka on time). So what, if I know I've done all that is required of me?
I have also gone back late because I was helping others with their work.

No matter what happens or what the people monitoring my time card may think, I know that I've earned my keep. I know what I have done and what I would have shirked. And God certainly knows more.

And if I'm doing right by Him, then nothing can truly throw me off my course.


Not that I have ever had attendance issues.
Nor has this been a raised issue for me.

I am on both ends of the spectrum.
I have clocked in some rather long hours too in the past years of my life.
And I have clocked in some punctual hours, too- more so now that I have matured enough to care less about what other people may think.

It's just an interesting issue because I heard of a colleague bragging about how he/she is always around within 30 minutes after the supposed end of shift, and this colleague has a habit of disappearing within working hours and subtly leaving work for other people to settle.

Longer working hours are not entirely impressive, people.
Get over it.

So if no one in the ward needs your immediate help, and your work has truly been done (or any appropriate work passed over), then go home.

But God help you if your friends are dying for help and you hightail out of the ward like a convict on the run.


P.S.: Housemen in Malaysia get the same pay no matter their working hours. It varies slightly depending on where you work in relation to where you live, and your seniority. Other than that, we do not earn extra for the extra hours we put in, or which public holidays we work in.

I'm in awe~

Perhaps I was too afraid to jinx my experience so far, but this has got to be the most relaxing posting I've ever gone through.

Ever.

I'm just in awe.

Well, in awe at how superstitious I've become, but also at how amazingly nice this posting has been on my mental status.

Bosses are way nice.
Workload, most days, is negligible.

And not to mention, generally this department has a really quick turnover rate. Results are easily seen. And people get happy with their after results.

Not that there weren't unhappy people (they ruined some of my days, I tell ya) but that's a given.

Except I haven't been doing the bulk of what this posting even says- SURGERY.

Most of my work is in the ward!
Or in the emergency department!
Or in an ambulance!


Man, good stuff!

Where you lead, I will follow

Re-watching Gilmore Girls.

This time around, I'm closer to Lorelai's age than I am to Rory's.

SO weird.




END OF POSTING WOOHOO!