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.

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. 

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.

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!

My Current Mission

I AM ON A MISSION

TO FINISH MY LOGBOOK.

And also to really truly decide if this is THE posting for me, because I have never enjoyed a posting as much as this one.

Seriously.
I'm thinking of taking MRCOG, this is how serious I am - and I haven't even REALLY truly conducted a delivery all on my lonesome, nor have I done a cesarean section!

Even during the most busy days I find myself enjoying it and that is just insane.

Also on a mission to

- Lose weight
- Be healthier
- Get married
- Be more patient
- Earn more money
- Be more disciplined
- Have more books

etc, etc.

Counting Work aka Berkira Kerja

No lah I'm not going to write about some vague friend here.

I'm writing about myself.

I have caught myself, time and again, 'counting work' - literal translation from the Malay saying berkira kerja. Or berkira tulang urat- counting bones & veins. Hey, that may be more relevant now.

I entered the posting with several other people.
And I found myself to be the pioneer among them.

First to get more patients to review.
First to get more acute patients.
First to present cases in the morning passover.
First to... well you get the drift.

I started bemoaning my tragic life:
Why am I the chosen one? Why do I have more patients to review than them, they are also taggers? Why do I have to go into the OT with the known malignant MO EACH time he covers EM OT? Why do I have to present two times in a row? Why me, why me, why me?

You see, hearing about this likely made you a little (or a lot) uneasy around me.
But that's the reality- I am far from perfect.
I forget so often that nowadays I have much less patients to review and the workload is so much more manageable. Although there are definitely other added stressors in this posting, I can definitely say this is a posting with minimal workload compared to my two previous postings.

I easily forget that I still have a stable job and am able to live on my own, rather comfortably, while others may be suffering from unemployment, and also countless other real tragedies.

How selfish of me to bemoan a difficult relative, or the fact that yet another patient got into an accident, and yet many others still have to be referred to my department due to whatever reason, even if they were direct results of their own mistakes.

...

I wanted this job.

No one put a gun on my temple and threatened to pull the trigger unless I took up this vocation.
I recall multiple attempts to persuade other people that I am worthy of this course. Letters, essays, interviews...

Oh God.
Why am I so weak when tested?

Yes, I am human, but I am capable of much more than this.
My lips are too fast, my temper too easily roused.

Sometimes in my head I think "Why must this patient be assigned to me? Such a difficult patient, to present to such a difficult boss..."
And almost in that same second, I rescind my thoughts. Forgive me, my patient. Forgive me, God. Forgive me, my past teachers and lecturers and colleagues- my selfishness has overstepped boundaries! Even if I don't vocalize most of my thoughts, their toxic energy permeates my psyche and results in actions that are less than pleasant. At its simplest, a distasteful expression. At its most complex, hurtful words.

It's so easy to snap at a colleague when I can feel the boss getting mad at me over the phone- "Get me the BHT for Bed 01 STAT" I would say- nay, snap- to the newer poster who was a little overwhelmed and could not answer my question.
I catch myself almost immediately and try to smile and lighten my tone, thinking that no matter how I act if my boss is already mad, his temper is hardly going to improve... But by then the damage has been done.

So easily do we hurt others while we try to proclaim that we care, that we're in this profession for noble intentions.
While we try to act our best and smile to our patients, do we extend the same gesture to our colleagues; our supporting staff; our bosses? Never mind that they're not doing the same to us.

I'm not even at my counting work topic yet, not fully.

...

"Eh AA look lah, why must I do this twice? BB hasn't even done it once! And look I got a difficult topic some more! Why is this distribution so unfair?"

Never mind that BB is a first poster who takes more time to learn the ropes compared to his fellow batchmate, CC. CC is more proactive and learns quickly, volunteering to do work where BB prefers to hide in the shadows. But do I understand BB's motives? Do I help him more than I talk about him?

Sadly, no.

A new case comes in.
I just did a procedure, and prior to that I already clerked the last case that came in.
I looked at BB, whose gaze shifted around uneasily.
"You go clerk that new case," I said. More a command than a request.
He needed the experience anyway, I reasoned to myself.

My senior already left to do an emergency operation- 'No doubt to avoid the wardwork and just chill with a rather cool MO', I thought bitterly. This senior also gave me OT time with a more malignant MO, repeatedly, while he/she goes into OT with cooler MOs without even asking any of us if we wanted more OT experience, being new and all.

Astaghfirullah.
What devious thoughts.
So easily does the mind come to conclusions that are less savoury.

I got up and went to BB.
"Okay tak?" I asked.
He nodded, and went to clerk the patient.
Full of trepidation, no doubt, but rising to the occasion- because his senior told him to. Perhaps he realized that there was no other option.

I could have been nicer.
I could have offered to clerk the case right as I returned from doing the procedure in another ward, and offered for him to stand by and watch- but this wasn't going to help him in the long run.
In conclusion, I could have been nicer. Could have had more noble intentions. But as I commanded him to clerk the case, all I was thinking about was how tired I felt.

And I shouldn't be, because come on, what did I do the entire day?

*slaps self*

This is just one simple example of berkira tulang urat.

It happens to most of us.

Some of us are just more noble, more patient, and thus more pleasant.

...

I've been told in older postings that I was a hardworker.
A good senior.
Sometimes I scoff at those remarks.
I also get snagged by selfishness and impatience.

It's just... I try to make up for it later.

I seek forgiveness from God.
Try to be more patient with those around me.
Try to be more mindful of what I say to people, even if those people agree with my complaints.

If my toxic environment affects me, my toxicity added to the environment will not improve anything in any way.

So,

I have to be more mindful.

Actively try to quash any negative thoughts- no matter how numerous. Counter them with good memories and vibes, with humility. Repeatedly tell myself why I wanted this job so much. That I can, and I will, make a difference in this system. That I will be better than my toxic bosses. That I will not treat my juniors the same.

And for that to happen, I have to start now- with my colleagues, with my patients.
If I could be impatient to a colleague who's my junior only by a few months, what's to say I won't be a malignant MO to my HOs in the future- who are my juniors by years?

If one case makes so much of a workload difference, what's to stop me from being an utter devil when people refer cases to me in the future non-stop, just because it's one of those 'J' days?

I will break the negative cycle within me before I could break the negative cycle outside.
I have to stop thinking about what I want, and more of what I need.

Patience. Resilience.
More (even more!) humility.
Knowledge- no matter how tired I may be, I can always squeeze in some quick facts. ALWAYS.

Because my patients entrusted themselves to me.
Entrusted their most embarrassing histories, body parts, habits, to me.
So I can make them feel better.
So I can heal them.

And more often than not, I spit in their faces by being lazy and impatient.
Assuming stuff about the more difficult ones.
Wishing they never came during my shift, to my hospital.

The nerve of me.

Do I know how difficult I can be if I were the one in their shoes?
I don't.
So why do I judge them so easily?

What is one more presentation, when I can learn from it?
What is one more patient, when I have the opportunity to make more people happy?
What is a kind word, when it can change the mood for an entire day?



Everybody needs to be reminded at some point.
I'm almost halfway there.
Right now is a good time for a reminder.

I'm sorry for disappointing you with this.
Perhaps later, more positive stories! :)

Off-Day Thoughts: RTD Summons & Obligations

I just used my Raya 'bonus' to pay a traffic summons from 2015.

Why didn't I pay it earlier? Because I didn't have the money for it and felt too embarrassed to ask my father to lend me his money for a third summons that I received *laughs*

Instead, I vowed to myself that I would pay it with my own money once I worked; funnily enough, I kept forgetting to do it until today. And I thought, "What better way to use the extra money the government gave me, than to fulfill what is due to said government?"

So... Yeah.

Why did I get the summon? Honestly, I didn't know the speed limit changed in that area, and suddenly there was a flash of light. It wasn't an area I frequented. Oops. I think I was even talking to a friend at that time, so I was preoccupied.

Anyway... This is a weird topic to blog about, it seems, but my message is this: If you have something pending, and you have the money to pay for it, then pay for that first instead of things that you want. Like, I could have used the RM 300+ for extra books, which I always want, but I didn't. I also wanted to save the money for my wedding, but I couldn't.

Don't talk about baju raya; I won't get new clothes unless I really have to, and it's not like I can really celebrate raya this year. Haha.

Plus... When Raya season comes, there will be a barrage of things I feel that I need, especially now that I'm earning my own money. Kuih raya (like I would even have open houses, those things are for ME), raya apparel, Corelle dinnerware... Whut?

It's very difficult to be on social media and abstain myself from looking through various shopping catalogues- when I have the time, that is. Even gaming laptops have special prices this season! If I had the money, I'm not entirely sure I would be able to resist!

But you know. All I need to do is close the tab for that particular product, and think to myself: Do I really need a Corelle dinnerware set to survive when I can buy plates, bowls and mugs for a small fraction of the price in the supermarket? Sure Corelle sets are famed for their resistance to breakage, but how often do I break my plates or mugs? The answer is probably once in a few years. And replacing them is still cheaper.

Same goes for baju raya- once I wear it often enough, the novelty wears off and it becomes just another piece of clothing.

And books... Well, books are another different thing entirely. I can't say the same about them, but I can talk myself out of splurging for them online most of the time.

Instead, how about being responsible, or using the money for other people?

Being charitable is something that never gets old. There will always be people who need help, and that satisfaction you get doing charity, that is a feeling normal humans will rarely get enough of. Not to mention, it is an investment for the afterlife, and every little bit helps. But even if you don't believe in such things, think of how you would want the world to be for your children and grandchildren. If there was an important lesson I learned in my life, it is the fact that law of attraction does exist. When I do good and feel good, good things tend to come my way sooner rather than later. Different beliefs and languages just have different names for it.

Giving to your parents: Social obligation where I'm from, AND a form of charity. Double yay!

Fulfill your obligations.

The rewards will come your way soon enough!

Off-Day Thoughts: Achievements?

It's really flattering when your boss asks you to take her blood when there are many others around to potentially do it, too.

Thanks for the trust, boss. Also thank God I got it in one stick and filling the tube barely took a few seconds.

*****

I was a total vampire on the last call.

I poked no less than 15 babies. Maybe even over twenty, I'm not so sure myself. Some of them were for three tubes of blood (Day 1 Jaundice workup, ya know what I'm saying?). After a while you just stop counting and just watch the blood drip, drip, drip...

I'm pretty good at poking babies by now. My success rate at intravenous cannulation of babies is now once in an average of 3 sticks- this of course includes harder sticks. Okay, maybe it's 4 sticks. Or more. But this hospital has a policy of only 2 unsuccessful trials before asking for help.

I'm glad to say that for older paeds cases, I usually get it done within 1.5 sticks (yes including those who struggle like mad- so that's an achievement). Usually just 1 stick for non-neonates; veins are more easy in normal-sized children. Cherubic ones are another matter entirely >.<

Also, who the heck keeps track of their IV cannulation success rates?!
Me.
I do.
It's for self-improvement purposes.
The post I uploaded earlier did help!

I'm pretty sure I had a better idea for my post today but I forgot. Too much sleep during the off-day will do that to you.

*****

Last few calls ago, I had the opportunity to hold an ultrasound probe and perform a bedside echocardiogram, thanks to Cute MO (YES I KNOW). I didn't even ask for it; he just told me to do it and as I asked "Are you serious?!" he replied with "It's easy, just point the probe and if you see something, you're doing it right." And he gave his trademark cute chuckle after saying that. And yes, he talked and guided me through the entire thing as I was clueless; though I knew what I was looking for, more or less, because I watched a lot of my bosses do it, and one of them even showed me in detail what to look for once- he will forever be one of my favourite MOs and will probably make a great specialist and lecturer in the near future.

But Cute MO did say I was good and suggested that it may be the start of my career as a cardiologist. We both laughed at that (I did most of the laughing, he just cute-chuckled with me).

See, not only are my MOs cute, they're also really encouraging and helpful.

I took photos of my first echo snaps. Baby's First Echo!
Literally, because that baby had his first echo done then. Hehe.

*****

My biggest achievement has got to be the fact that I have been able to gain weight during the entirety of this posting. I'm not even kidding. I gained like 4 kgs- that's like 1 kg per month!

And my final assessment is coming up soooooonnnnnn
I should be studying!

So those are my random train of thoughts for this post.

Off-Day Thoughts: Jonah or Anti-Jonah?

I've come to the conclusion that there's no such thing.

It's too complicated. The admission rates do not depend on the MO, HO, or SN on duty; rather, it has many extraneous factors too. You can predict that it will be a week with many admissions for AEBA and MVAs, for example when it has rained heavily; or for drowning and burns, during holidays and large national celebrations.

But there is no telling which healthcare personnel really contributes to a sleepless on-call, no matter what. Even if an MO has been having an unfortunate streak with admissions, eventually that he/she will get a break- and vice-versa. This entirely dissipates the J/Anti-J theory.

Of course, it's just more fun to look up the MOs on duty and try to anticipate the admissions.
It's part of being a doctor in the government, to me- it could even become the starting point of a great discussion and subsequent bond with your colleagues and superiors. But never put too much stock into what others tell you as a 'bad case of J-ness'. Unlike asthma in young children, and apart from the abovementioned environmental factors, there is no solid predictive index for admission rates!

But hey, if that trend really persists with someone you know- or even YOU- at least you know there will be extra EXP & pahala! Ka-CHING!

Off-Day Thoughts: The Doctor

When you enter medical school, you must have been asked the Golden Question:

"Why do you want to become a doctor?"

This question will be repeated, time and again, and will not cease even after you have attained the seemingly prestigious title of "Dr." in front of your name- which, by the way, I've never used outside the context of work.

Remember your initial reason? It may involve a tragedy in the past, or other emotional incidents. I am sorry for your loss.

But I- honestly- don't remember a good reason as to why I wanted to become a doctor. 

Initially, I had the most noble of intentions- perhaps reasons interviewers are very familiar with. But over the course of years, and with countless introspection, I realized that my reasons, like many others in our culture especially, are pretty darn simple:

Preconditioned to think that it was A Great Occupation, and The Most Noble of Professions, as an overachiever in primary and high school people just told me stuff like, "Hey, if anyone can be a doctor, it would have to be you." This, and my parents and family's perpetual nudge in that direction ever since I can remember, led me (willingly) to a rather turbulent path that ended with my assignment as your friendly neighbourhood Spider-Man er, Humble Officer. 

Currently one of the most ridiculed positions nationally, and arguably the most criticized.

Gone are the days when being a doctor entitles you to special treatment. Your position does not command the respect it did, and neither does it make you better equipped to deal with others. Doctors nowadays do not perform as well as those 'back in the day', we are too reliant on technology and too lazy and entitled. Et cetera, et cetera, et cetera.

At least, that's what a lot of people say.

But is it true, really?

Nope.

We still get special treatment- such as our insane starting salary, for this country's standards at least. And despite the increase in waiting time, we still have guaranteed jobs (hopefully that will continue to be true for all our juniors)! We take this fact for granted a lot. My advise to recent graduates, enjoy your prolonged holidays and do not be too antsy to start, if you can afford the privilege of waiting.

Your position still commands respect, if not with everyone then with a lot of people still. All those years in my medical school, at least, does equip me better to communicate with my patients and colleagues and superiors. And come on, with the help of technology we SHOULD be able to perform better than our predecessors in The Land before Time (meant with the utmost respect). What matters most is how we utilize the technology!

But laziness and entitlement? True as well. Too true, in fact.

How many posts have you seen about doctors, written by doctors, emphasizing on how being a doctor is extremely dreadful and that we should be appreciated? Not limited to doctors themselves; sometimes medical students write them and viral them, too. And as much as I am for freedom of expression, there is only so much viral posts I can see before I get agitated.

Yes, we play with blood, fecal matter, and other body fluids, but so do nurses and MAs.

We have ungodly working hours, well so do most other people trying to earn a decent living, some of whom have 9 to 5 jobs but have multiple jobs to support their families.

We don't have time for our family members. The same goes to anyone who works every day, 9 to 5, even with weekends off- there simply ISN'T enough time with your family as long as you're in your working years, unless you're one of those lucky people working from home or somewhat.

And every job is stressful. Many jobs involve human interactions, and there are less pleasant humans in any possible setting involving human interactions.

My point is, there is no need to repeatedly tell everyone how miserable your job is, because it doesn't command their respect all the more when you repeatedly whine about it. Every job can be miserable.

Again, I say that with the utmost respect.

This is not an easy job. At the start, no job is an easy one. But I can tell you why our job is harder than most: It's the fact that people's lives are directly entrusted upon us. Their demise would be entirely upon us. And no matter how many people are involved in their care, the doctor-in-charge is the one who will take most of the blame, as compared to the nurses, or MAs, or any other healthcare provider. There is no way around it.

And this is something everyone expecting to go into the profession should bear in mind.

Human lives cannot even begin to be equated to money or paperwork.

Yes, you may be able to tolerate long working hours. And yes, you may be able to handle insults and degrading remarks hurled towards you. You may be able to stand holding in your urine for over 12 hours, or function on an empty stomach for over that duration, and not sleep for 36 hours straight while still maintaining a pleasant expression and managing to remember your cases. You could even take the blood of, and successfully dispatch, over 20 patients within the span of 2 hours.

But can you do all that and trust yourself with the lives of others?

Can you defend yourself, your own integrity, when you are questioned on why a patient died while under your care?

Can you do this in a room filled with strangers, some of whom are trying to pin the blame on you?

[Ugh, I started a post talking about how this job is worse than others. Sorry.]

Now I, for one, am not one of those people who will discourage other people from becoming a doctor, nor am I one of those people who think our country has 'enough' doctors. But I can tell you what I feel from personal experience, and that is the fact that this isn't the most horrible job out there, nor is it the most rewarding career for someone who is academically brilliant. I think we are easily deceived by the fact that this job immediately gives you a title in front of your name- something that doesn't come with most jobs in the world. 

We have deluded ourselves into thinking that this is the best job for our overachievers; only for the best of people. When in fact, this is a job that can be done with above-average intelligence (yes, you need to be slightly more intelligent) but most importantly by anyone hard-working and resilient enough to endure abnormal amounts of stress; anyone with the passion to care about others more than their own immediate needs.

Being a doctor is not as prestigious as it used to be, but with the changes in current demands you can bet that it's becoming harder. Your faults can be easily found and spread by various social media, making them more permanent. Doctors in the past got away with many mistakes- whether or not they divulge them is another thing entirely. Contrary to what some may say, doctors in the past DO make mistakes, too. They're just not able to go viral.

But with technology, it's also easier for us to seek help, and for others to know our side of the story. It's easier to disseminate information and to keep in touch with the latest and greatest. We are not bound to our hospital walls- we can go beyond it, and combat the misperceptions with a few taps of our fingers. Several people have been doing this to great success at the national level.

People are becoming more and more tech savvy, and believe it or not, more often than not, they DO see reason. It's just, empty cans are the loudest.

So, to quote a famous franchise: With great power comes great responsibility.

Remember that as you go forth in life.

Do not let your years of studies and that title in front of your name go to waste.

And keep praying to do the right thing!

Off-Day Thoughts: A Rant on Intentions & Many Other Things.

I lost something valuable in the wards within last week.

When I let the information slip to my MOs, they went to the ward sister about it (I didn't want to say anything to avoid exactly that).

When the ward sister was about to reprimand me for leaving my valuables somewhere unsafe, they immediately defended me and asked instead why she wouldn't provide lockers for HOs in the ward.

And proper rooms for our on-calls.

And other things but I left because I felt awkward for indirectly demanding stuff.

Point 1: I am not blaming the Sisters for it; it was my fault. Also, I don't mind napping on the floor. It's not like I ever slept more than 3 hours straight in that ward.

Point 2: My MOs (like 99% of them) are amazing.

Yesterday someone told me my valuable has been found. I'm not sure if it's really mine, but the brand is the same so I'm 99% sure it is. I am so excited.

99%.

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

I try to control my words, but I can't really control my facial expressions. I try hard, I think, but I haven't mastered control over my face when I'm exhausted and/or stressed.

This is called moodiness and it really intrudes into professionalism.

Actively trying to combat it. It's easy to talk about now, but when I'm tired it's another thing entirely. And let's face it, one gets tired a lot in this line of work and people often get irritating, too.

So. Let's see if this will be less of a problem a few months down the line.

Maybe years. But I'm trying to be optimistic.

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

It's weird being the person taggers look for to do procedures or ask about things when the're unsure, but that's part of being a senior- even if you're only a first poster and the other person's in his/her third or fourth.

I am glad to say I was of some service. Heheh.

The SNs start to look for me instead of my senior too, now. And so do my MOs.

I am beginning to be trusted to attend calls alone.

It scares me, the prospect, but I know of many friends who have been attending calls alone for weeks by now- ever since they went off-tag, actually. I've just been privileged enough to attend calls with other people so far.

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

I feel... I feel like I'm still sub-par. There are questions my consultant asks me that I cannot answer and, in retrospect, were super easy. Ones I can answer are simple and I still sound doubtful that even my consultant notes that doubt in my tone, with amusement. My consultant isn't mean, in fact she's amazingly encouraging despite her strict work ethics, but I respect her so much that she intimidates me.

And this is stupid, guys. 

Do not be intimidated excessively by anyone, especially if that person isn't even mean. It just blocks your thinking process with self-doubts and imagery of unnecessary repercussions. Take it from me.

It's okay to make mistakes. It's okay to not know stuff- sometimes.You're only human.

But make sure you know things you're supposed to know, and do not repeat those mistakes.

Do not care too much what others think about you- it's half the reason why you're so scared of getting scolded, maybe even more.

But I know, I know: It's easier said than done.

Like I said, sometimes I ask my seniors to tell me where I fall short, toughen my heart for the criticism, and take it into stride for future improvement. I care too much; some just adopt a more easy attitude and let things slide while still improving, which is amazing but realistically something I cannot relate to.

So I see some improvement in my work. I better; it's almost been half the posting already.

But there are still multitudes of things I have to improve upon.

Reminder to self on this almost halfway-mark to EOP:

Focus on your good traits. Do not focus on your feelings when making mistakes, rather focus on how you could improve yourself once those mistakes or shortcomings are identified. Do not dwell on what others may think of you, positive or especially negative. Do your job, and improve, for yourself and for an increasingly better service towards mankind.

Intentions must be kept noble, at least at heart. It's okay to be selfish in times of most stress, though- you're only human. But remember the ultimate goal of why you joined this field instead of taking, say, Geology or English Lit.

Your father invested a lot of money and effort into you.

Don't let it go to waste.

Make your family, friends, and teachers proud.

But don't focus on that pride because it will destroy you with a persistently-inflated ego.

Intentions, intentions: Keep them pure. Keep them noble.

Off-Day Thoughts: Volunteering

I made a fool of myself in front of my colleagues and some of my superiors today.

I did it by volunteering for something I was unprepared for... because no one else wanted to do it.

I can't look at my kind MO and just leave him hanging with imaginary cricket sounds in the air when he asked, 'So who among you first posters want to go in front?' It's unfair to his time and honestly I have to do it anyway in the future. It's not like I got assessed...

Actually maybe I did but now it's too late to think about that.

Anyway, I volunteered because I can't NOT volunteer.

When everything is over and people have laughed their fill (because I'm a goof when I don't know things so far), in the end a friend questioned why I volunteered when I said I was unprepared. She was like 'Why, I thought you were so keen to go.'

But like I said, I knew I wasn't prepared. I just knew delaying the inevitable isn't helpful, and I tend to have this tendency to offer myself when no one else volunteers for something you may consider good.

I have to say though, you learn a lot from your own mistakes. It's better to learn from others' mistakes when you can, however, so don't look forward to mistakes! Just take them as they are when they happen and try not to repeat them.

Also, all things considered, better goof and panic during a role-play than the real situation :)


Also at the end of everything my MO said 'Good!' to me, so my goofing must have counted for something...


On that note, I've been forcing myself to be increasingly independent. Passing over cases to the superiors in the morning on behalf of my group, handling the ward alone while my colleague goes somewhere, doing obviously not-so-easy blood taking and clerking. I'm not as fast as senior posters or HOs, but I can see myself progressing both in skill and knowledge. Not to the extent that it's braggable, but enough to make me want to work more.

Enough to make me feel more at ease with the working environment.

Except I'm still clueless in many things. In the end, barely a month of experience cannot compete with a year or more spent in the hospital in various postings- not entirely. I would ask my group mates to tell me where I fell short, although I know I would not be too happy to hear them, so I can improve. A major part of this is putting my stupid ego aside and just listening, and internalizing those facts so that I may be better to myself and to others.

A lot of this is possible because my busy working environment is relatively stress-free. My superiors, as I have said repeatedly, are very helpful and kind. It is the perfect kind of environment to learn and grow!

And yes, by grow I also mean girth-wise :p

Off-Day Thoughts: Where Does the Money Go?

First salary has been here for barely a few days, et voila! More than half is gone.
Such is the way for salaries, I suppose ^^;

There are two ways this could have gone: You could have expected it and shrugged it off, budgeting for the rest of your month, or this could have been a total shocker and you find yourself floundering with almost no money to spend for the rest of the month.

And guess what, if your student-day allowances don't fulfil your needs, chances are your working day salaries won't either, despite the hefty increment.

So what gives?


PLANNING

If you fail to plan, you plan to fail, an old adage goes. I concur with this.

I am very much the planner type. To avoid future mishaps and try as much as I can to navigate the unforeseen, I plan ahead- very much ahead.

In fact, knowing more or less the salary I would be given, I have started planning- very amateur-ly- my salary since my second year of medical school. From then, I knew the luxurious lives people keep saying doctors have, is utterly non-existent in my earlier years of working. I expected that I wouldn't be able to get a decent gaming laptop until at least several years of working and not spending on anything. I knew I wouldn't be able to realistically change my cellphone to a newer model every year without having to lose weeks' worth of groceries, and thus that is not going to happen.

I knew all this since my pre-clinical years in medical school.

I have thoroughly planned my salary division since a few months prior to entering the workforce, and I know how much I can expect to have left to myself after all the essentials are paid for- essentials being rent, bills, loans and insurance, as well as some fixed savings. I already know how much I can afford, more or less, on monthly groceries and phone bills.

This means even before working, I know what I can and cannot afford and I did not get anything I feel I cannot pay for in the future.

This will be grossly different depending on the lifestyle and upbringing you already have. I know of some wealthy people whose parents still give them a hefty sum of money every month even after they start working. I know of people who have to pay for EVERYTHING of their parents' after they start working. The key here is to suit your own budget, and NOT expect to get anything for yourself the first few months. That way, even the smallest extras for yourself feel rewarding!

Which brings us to the next thing...


MINDSET

Reward yourself, but don't do so lavishly.
Unless you're wealthy and you can afford it.

If you think a RM 15 chicken chop is a just reward, it WILL be. But if you keep on fixating on a RM 250++ lavish hotel dinner course as a just reward, then your pay as a new government servant won't be rewarding at all.

Therein lies the problem in most of my generation: We are so self-entitled, we think we deserve better than most people, when in fact, we ARE most people. And it's so much worse in new doctors sometimes, because they keep thinking their salaries are so high that they should be able to spend more than the regular office clerks or other hospital staff.

What we should realize is the fact that 1) those clerks we see have been working WAY longer than us; 2) people have other sources of income than their full-time jobs nowadays; and 3) most of us have massive student loans to pay for. The combination of these three points alone is enough to make you feel like salary-pinching.

So you're going to be a doctor.
That doesn't mean you can afford that expensive smartphone contract for 2 years.
So what if you don't have the latest phone? In reality, in the hospital, NOBODY CARES WHAT PHONE YOU USE. You can use the NOKIA 3310 and people will be stupefied, but any smartphone capable of making calls, staying in touch through group WhatsApp and surfing the web for medical information is enough for any young doctor. And these things do not require a RM3500++ stylish iPhone.

That contract looks small in comparison to your gaji.
But believe you me, small things tend to pile up, and there are always other costs incurred that you've not even entertained before.

So where does the money go?

Where your planning and mindset would lead them, silly!

Ah, and always keep aside some of your salary for your emergency savings account!

Okay bye must enjoy the rest of my off day!