WOOOOO

Just as you thought you had it worst,

Welcome to...

A New Posting! 

*party streamers* *vuvuzela noises*

Where everything is ALWAYS worse the first few days in.

Ahaha.

No seriously I just, I dunno.
I feel stupid.
And humiliated.

Some postings just have a more generous share of, let's just say, vocal bosses.

This posting is one of them.

If I continue to not let their loud comments slide, I'll be beaten by the end of the day. I usually am.

NEED TO SLEEP STILL TAGGING BYE

A Post Dedicated To New Taggers

Dear new first-poster taggers,

Welcome to the working life! It will be filled with many ups and some downs. More importantly, it will shape you for many years to come. For many of you, it would be your first experience holding a job and finally, FINALLY being responsible for your own needs. Congratulations! It's not easy, but you're here to start and learn to be the captain of your own ship. The ship called your Career in Medicine.

Let me give you some tips, hopefully humbly, from the perspective of one who was, in the not-too-distant past, in your shoes:


1. Be proactive
More often than not, you will feel overwhelmed the first few days of your working life. Especially if you're not used to the system, i.e. overseas grads.

My advice is to be proactive- anticipate what you should know, and offer to do things. Ask for assistance- any good senior would be too happy to stand by you during your first couple of clerkings/procedures. But learn quickly, because most of the time everyone is too busy to just stand by you and be your guide. Everyone has their share of work!

My advice, as I have said, is to anticipate and prepare. Read about housemanship duties (from other people, blogs, or books). Watch videos of procedures. Read back on your theoretical knowledge and basic clerking skills.

But if you haven't done any of the above during your holidays, and only realized belatedly, then at least volunteer first and learn second. Seize the opportunities!


2. Listen to those more experienced
If your SN says she is concerned about the patient, chances are she has a good reason. They have been working for way longer than you most of the time and know when something is wrong. Listen and attend to the patient, and chances are you'll learn something new.

When your seniors say you should do a certain thing before another, there is a very high chance that you should listen to them. After all, they are most probably better at prioritizing tasks than you are, having been there for longer. This is something only experience can teach you; books only do so much. So if they say the clerking of a case can come after the blood C&S of another patient, then better do the latter first. This is only sometimes true- like when an antibiotic has to be given STAT and the patient is septic. How would you know? Experience.

Of course, as always, come prepared. At least you would have an inkling why they prioritize certain things more than others, and are less blind!


3. Try before you could even think of being intimidated
It's easy to be intimidated by new procedures the first few times. Even the simplest of things like blood taking may scare the wits out of you at first. Chillax, that is normal for new taggers. Eventually, blood taking will be the least of your concerns.

So try.

Seniors will likely point new people to easier patients for procedures, because they know that giving you harder options will likely make their jobs harder as well. So before you say you can't, if you've seen it being done before and know more or less what to prepare and how to do it, try. Try before you fill your head with negative thoughts of failure.

Failing the first few times is alright, but you will improve with practice. Most important is to attempt!


4. Find time to learn- quickly
You should have done at least some reading and preparing in your long months of holidays.
But if that's not the case, then learn while doing.
And learn quickly.

While you are in your tagging period, especially as a first poster, people will give you slightly more time with clerking and procedures. So this is good for some quick learning! For example, if you're clerking a case of adult pneumonia, open the Sarawak Handbook (3rd Edition) while you write out your plan. And if you're so swamped with work it's not possible to even open a handbook, then learn from the management plans given to you by your MOs/senior HOs. Internalize them and be sure to be able to manage the next similar case. During your first few days you are more likely to get away with making wrong diagnoses and not having any management plans, but some bosses are stricter and less lenient than others.

Bring a tiny pocketbook to jot down important facts. It will always come in handy, believe me.

If you have even more free time in the ward, as soon as you sit down and have no carry-outs then open your books and start revising based on the cases you just managed, so it is easier for you to remember the facts. And if your seniors or bosses tell you to revise a certain topic, then do so! It's probably very important and common.


5. Come early!
So you feel like you have no time to review your assigned patients before your bosses come? Unfamiliar with most of the terms you see (especially for those not used to the local system)? Want to practice blood taking? Want to know a bit more about the cases you're managing but once you get home, all you want to do is sleep?

Come early!

As new people, you are expected to come earlier than your seniors to familiarize yourself with the new environment. You cannot expect to be as speedy in reviewing as those more senior to you. If you do not feel the inclination to come early and you are a new tagger, shame on you. I'm sorry but this is true.

Please remember that even if they do not force you to come early, it is your onus to do your work to the best of your abilities. It's only for a period of time, until you're more confident of your own skills. And it may make a difference as to how others perceive you. If you're rather clueless but people see you putting in extra effort, chances are this will make your job way easier in the future. People are more likely to help those who show effort!


6. Take it one step at a time
Feeling depressed? Everyone went through it at some point in their working lives. You may feel alone but across space and time, you're one of many. Scoldings are normal (they shouldn't be, but alas they are in many hospitals).

For every single day you wake up and brave your workplace, is another day closer to the end.

Take it one step at a time.
One more day close to the next off day.
One more day closer to the end of the week.
One more day closer to the end of the month- and your salary!

And within the blink of an eye, your posting is half gone (talking about myself now)...


7. Keep going! Motivate yourself
Awful bosses? Snobby SNs?

They're only there for a blip in your entire existence!
4 months (inshaaAllah)! Not that long!

And look forward to future events.
If you love book sales, look forward to the next Big Bad Wolf Book Sale!
If you love traveling, look forward to the next Matta Fair!
If you love gadgets, look forward to the next PC fair!

And how about holidays with your loved ones? Plan your leave early and look forward to that!

Remember, this is temporary. It's just a tiny phase in your life.

Soon you'll be out of it and on to greater things. But how you react to what you have now will define you in the future.

Seize the opportunities, smile often and try to be sincere. It gets hard at times, but if you consciously try, God will help you.

Take care and remember it's all temporary! Persevere and you SHALL be rewarded!

Note to Self: Control Your Emotions!

"Dr, kenapa Dr tagging lagi? Dr dah pandai dah..."

Hehehe.
Occasional nice comments make my day.
You'd be surprised at how the smallest things can make your day when you feel downtrodden, and hold the lowest of the low rank in the food chain of the hospital (or at least department).


Because most of the time, comments are more like,

"Dr, takkan itu pun nak tanya saya?"

"Dr, tengok sendiri boleh tak?"

"Dr, bila nak buat *insert procedure here*?"
And all in very irritating tones.

And let's not get started on the snide remarks and outright humiliation one could get from one's bosses.

They- meaning *some* of these beloved human beings- can't see me sit and relax. They'll always ask me to do something.
Never mind that I've been working hours and hours longer than them. Never mind that they had time to take breakfast or lunch, and I didn't because my work started before either meal times and didn't stop.

But to take it personally is a waste, because had they given up on me entirely, they wouldn't call me to do anything at all. When you're so dysfunctional/lazy they give up on you, and even forget that you're working in the ward- or just ignore you altogether because they know you're too slow or tend to avoid doing things. So the fact that they keep asking you to do anything means they think you're capable of carrying it out.

Expect that they will scold you when you ask them how to perform something that, to them, seems basic. Some of them are just impatient- they'll come around when you prove that you are more capable. Or they won't, who cares- you're a HO and hopefully you won't be stuck with them for more than 4 months!


Today, I got so bloody pissed at a lot of things and it barely took all my effort to keep myself from outright shouting (I kind of snapped a little and my face might have shown it).

Then I got sad.

And then I got grateful & happy (it might have to do with the fact that I got to eat hehe).

This posting is turning me into a moody monster. It's awful. I pray I improve in terms of controlling my emotions. Pray for me.


Even the best and most patient of people have a breaking point. I've been very lucky because despite the meanness I have experienced, I could still find many kind, fun, and uplifting moments. But that doesn't mean that in that very dreary moment I could still feel unfiltered joy. It takes a lot of effort to think of life beyond that precise moment of horror.

You may think I'm writing for your sake.
Sometimes I think that too.
But I started this blog to remind myself of my moments in working life, and that means my personal good AND bad moments. I'm only human, and I'm far from perfect. I have ugly moments too. To whitewash them would be the opposite of my goal with this blog.

So forget about appearing like an exemplary HO.
This is the story of a normal HO, struggling with stupidly common HO issues like being bullied by SNs and bosses, and trying to be more competent in procedures that are easy theoretically, but actually really hard the first few times.

You may expect more blunder posts later, I think.
The best way to learn is to learn from others' mistakes and avoid them. I shall be your anonymous scapegoat when I can.
And I also get to remember how awkward I was, later in life!

~

Yours Truly.

I am the roach

You will approach

To give complaints

And ease your pains

But you forget

The moment we met;

I have feelings, too

Just like you.

I don't just poke

Because I can.

When you get stroke-

CT Scan.

I order them all

My bosses will call

Cause when I forget

They'll make me regret.

You lie on your bed

All covered in sweat

And call me nurse

But that's not the worst;

The moment I approach,

A tired, hungry roach,

You shoo me away

And make me pay.

My bosses yell

Roach, you're so slow!

Am I in hell?

I cannot tell.

When will I get

A morsel to eat?

You lie on your bed

"Roach, put up my feet".

I'm not your servant

Though I am the government's...

I guess that makes me

Your servant, honorary.

Yours Truly.

17 July 2016

You can't spell 'MOODY' without 'MO'*

Day 9 of tagging (8 if you deduct the day off I took) and my MO was already asking me how long I should tag for.

I got scolded by that same MO for informing him of things and not looking at the patient first.
Too used to my previous posting modus operandi, I suppose. Also my previous posting MOs.

Like, he actually swore at me and snatched the BHT and observation charts before stalking off to see the patient while I stood there for a few moments, blinking my confusion (and guilt). Then I followed him and had to endure him telling me how incapable I was and that I was a Dr., not an informer, and that I should be able to clinically judge the patient, yadda yadda yadda (believe me I took everything to heart but I can't tell you everything. I don't dismiss my bosses' complaints to me no matter how hurtful they are).

Half an hour later and throughout the rest of the day he was very playful with me.
You can't spell "moody" without "MO", eh? Eh?

**********

I have been targeted by several MOs for various reasons that used to not make sense to me.
Like, the way I talk.
Or the silly mistakes I did.

The more playful some MOs are with you, the more likely other MOs are to dislike you (or target you, whichever way you see it). It's something this department is famous for. It's weird, after being in such a different environment in my other posting.

But after being in this posting for such a brief period, I can sort of understand where they get all their stress and anger from sometimes. It's such a demanding posting, and you have to be meticulous yet quick and efficient; have compassion and yet still have the emotional range of a robot when it comes to carrying out certain stuff. How does one find the balance in all that? No wonder they're all moody as anything.

Of course, being the planktons in the food chain of the department, HOs are the main source of consumption.

Lesigh.

**********

Joy in the little things.

Like when one of my patients accidentally called me 'Misi', but continued on with 'Misi, misi maanyak cantik'. Tiredness = Evaporated. I mean, she might have an eyesight problem (she does, to be fair) but my heart flowered and burst into many colourful, fragrant pieces that shattered the dreariness of the day in one single, brief moment.

Then the patient next to her had to comment that she has been saying it since earlier that evening, but she might have been mistaking me for a ghost. That was a total downer zzz.

Or when one of my MOs showed his amazement at my ability to clerk a patient, and include relevant scoring systems pertaining to her condition. Sadly, he was comparing me to another person who was also in my batch, also the same number of postings- and stating how we were so different in working quality. I actually knew there were other factors (I had ages to clerk the case as my MO was busy doing other stuff, and the other person had so little time)... And how I still relished the comparison that I was better than someone.

It's an entirely disgusting, human thing to feel. Most of us do not want to admit that being told we are better than others is actually cathartic. Unfortunately, that is the truth.

Being able to take a patient's ABG.

Having the patient who was previously dreading my approach, actually smile at me each time I review her and being more willing to let me take her blood and insert IV lines for her.

Having patients and relatives thank me for the smallest of things.

Of course, there are many other bad things that happened to me, but why would I waste my precious energy memorializing them? Heh heh.

 **********

When the going gets tough, the tough gets going.
I make sure I have other things to think about.

Life outside the walls of the ward.

Days away from the hospital.

Not to mention the satisfaction of well carried-out plans.

The Grand Scheme of Things, in which these 4 months are but a blip in the existence of my life.

So many things to look forward to, that it is stupid to stay stagnant in a pool of fear over what a single MO has done to me. Or several.

**********

And you will need to vent.

You will need an outlet.

It just so happens, one of my best outlets is this blog.


I know I'm improving, and I will prove that I'm not the non-functional tagger I was on my first day here!
Eh. I sound so confident here.
No lah.


* - Disclaimer: I love my MOs. Just like they love me. Haha.

How's Work?

"How's work?" my lecturer queried on Facebook chat.

"It's great, Prof :)" I replied, tears streaming down my face.

That's the thing about social media- it allows us to be polite and act like everything is amazing when in reality, it's not.

**********

It took me 5 days to get to this phase.

I thought it was going to be shorter, so well done, me.
Finally crying. Finally met the malignant one (and it wasn't who I thought); still have more malignant ones to meet. So many MOs in this department.

But for each malignant MO, there will be three or more really decent ones. And so far all my specialists are amazing; so who am I to complain?

Although it doesn't erase the hurt from the shame and guilt that comes with getting scolded, it's a good reminder to always think that there is life beyond this department, beyond the walls of these wards with their negativity. I am worth more than this silly little mistake.

But crying is good, I suppose. It's a release.

First Day in General Medical Wards...

And I haven't cried yet!

I managed to drink!
And even eat! (A single cup Maggi for the entirety of the day, and even that after 6 pm, but still).

I ONLY CLERKED ONE CASE!
Surprisingly I still felt like I barely had time to relax.

I mean, it's hard to define the busy status of the ward and your efficiency from things like cases clerked- or any single parameter, really- because you always have to run around attending STAT calls, taking blood, reviewing dengue and investigation results and other patients that need reviewing, and you know... Take it all in. Basically your work is multifaceted.

But I was still pretty damn slow.

Most of my time was wasted on doing simple tasks for very long durations due to my ineptitude secondary to my newbness, also due to my repeated second-guessing secondary to lack of confidence secondary to lack of knowledge. Secondary to newbness.

Heheh.

I took almost 2 hours clerking a single patient from start to the moment I signed off my entry!! Three, if you count the moment when I finally had the guts to call my MO to review him (!!!). In my defense, the patient was very jovial and liked to talk, and I can't find it in me (yet) to cut him off.

It's great that God gave me a nice MO on-call, a kind MO post-call, and a gentle specialist on-call on my first day here. Also some seniors from my previous posting; ones I was actually rather close to. It's easier to transition in.

WAIT UNTIL TOMORROW WHEN THE FAMED STRICT SCOLD-EY SPECIALIST GOES FOR ROUNDS.

Please be strong, please be strong, please be strong and knowledgeable, self...

Of Awesome MOs

*Large clock behind ward counter reads 0945 P.M.*

MO on-call: *sees clock then stares daggers at us two taggers* Eh, what are you all doing here? Faster go home la!

Me: Dr, cannot punch out yet, still not 10 pm...

MO: You walk slow-slow, by the time you reach the machine it's 10 pm already. Faster go go!

*10 minutes later we're still behind the counter doing stuff*

MO: EY! I already told you to go home what are you all still doing here?! Go home la!

Did I mention this is the third consecutive time this week that the MO on call told us (nay, shooed us is more precise) to go home on time? And each day is a different MO.

This department is so awesome I think I'm getting manjalitis.

"Doctor posting yang berapa ni?"

Sister: Doctor, posting yang keberapa ni?

Me: Posting first, Sister~

Sister: Ye ke? Laa, saya ingatkan dah berapa. Cara Doctor macam bukan first poster~

That simple remark just made my day.

And possibly my entire week.

Never underestimate kindness. Such an off-hand remark from a friendly ward sister and it was enough to make my heart bloom again; made me treat patients with a bigger smile on my face... 

The impact is astounding.

Also the 'Thank you, Dr!'s I got from patients and their parents. Today was filled with it- even though I only took care of the ward for two days. One even personally shook my hand and thanked me for the care I gave to her son.

Just... Amazing.

And to think just a few hours prior to that, I felt useless and felt I had no role in anything.

Today is one of those days that remind you of how rewarding this career is.

This kind of day is not guaranteed to happen every day.

I left my house crying today. For the first time since tagging, I really cried and wished I could quit. I considered taking emergency leave for my sanity. But someone saw me through it, and made me drag my butt to the hospital. For a while, the only thought in my head was "I should stop being selfish- there are people who need me."

And it was one of the greatest days I've had in a hospital.

There is no guarantee of what to expect.

Each brand new day is an opportunity for you to experience life's greatest pleasures, even in the most dire of times.

Believe in the silver lining. Believe that no good deed goes unrewarded, and that no bad deed goes unpunished. Just believe.

I don't intend to make this post braggy; I'm sorry if it sounds that way.

But it was an amazing day, and I know there will be more days like today- just like there will be more days like yesterday. But until and unless you wake up and bring yourself to greet the day, you'll never know what you'll miss!

And don't get me wrong, busy is busy. But there are types of busy that are more enjoyable, less hectic, mmkay. HOship is not a cakewalk!

Zzzz

Today, I got burns where my socks met the dorsum of my left foot.

I managed to drink two packets of Milo and eat some bread. That was it.

The food provided went into the trash.

What a shame.

But I know that I have got some good friends and superiors so that's amazing.

Also one of my MOs is super cute. Like, swoon-worthy cute.

Not that that registered in my head for more than a couple of hours before I got super busy and he left the hospital to do what cute MOs do when they're outside the hospital.

Also did I mention I'm getting married soon?

That said, I am now certain I do not want to become a paediatrician.

GUYS.

Buy lots of packet food for tagging period.

If you get hyper on coffee, GET IT. You need that extra energy.

Don't dwell on how horrible one superior makes you feel. Rather, try to put the feelings aside and focus on other things you have to carry out. Believe me, you're not the only one and not everyone else hates you for the same reason. Many people sympathize.

And be a total team player. #1 rule.

Also the occasional cute & kind MO does help a little.

This Posting is Sorta, Kinda Amazing.

Life is so amazing when you have helpful colleagues and superiors.

The hard tasks seem way more bearable.
Honestly. Sometimes I shudder to think of myself in other postings where the superiors aren't as nice. This department's reputation for nice superiors and colleagues and working system really exceeds expectations.

Even in the busiest of times, you do not feel too pressured. Don't get me wrong, the pressure is there. But knowing that your MOs will understand your business and help you with other tasks that are usually way below MO job scopes is a blessing. They do not force you to do rounds at a specific time. They know you're doing your job, and they do their best to help you, too.

When I ask for help or pointers, the worst reaction I can get is a slight remark in my need to study a topic- which rarely happens anyway. Most of the time they are just glad I asked questions pertaining the management of the patients, and explain their actions patiently. When I fail at a certain procedure more than twice, I can ask for their help to do it. Sometimes, I don't even have to ask- they'll just appear and volunteer to do it for me.

What. Even,

I haven't met all of the available MOs and senior HOs in my department, but I'm really happy with the ones I have so far. After tomorrow, though, I will be in a different ward... With different people. I'm kind of scared I'll do worse.

I'm not a super HO or anything, but I can find myself smiling as I do my work. The nurses are becoming friendlier and friendlier by the day. Everyone tries to help others in the ward.

This posting has so far been a great blessing. I was right; I wanted a different department initially, but thought that if I didn't get into that department, then God knows that's for the best, and I should stick to it.

I'm glad I did!

Off Day Thoughts

Yes, this exists even for taggers. But this may depend on the hospital because I have a friend who claims she doesn't get off days during the entire tagging period.

There are busy days, and there are slow (relaxing!) days.

I learned a lot in the past 4 days of tagging in an SCN/NICU:

1. You do not disturb the nurses when they have passovers to conduct, but they can very well disturb you during your am review, pm review and procedures to imply that you're being rather incompetent
2. A lot of nurses are very helpful despite their loudness
3. Your competency during your clinical years in medical school doesn't hold a candle to how your working days will be.
4. Remember when you were surprised at how messy and unorganized and incomplete the histories are for patients in the BHTs you read? YOU WILL DO IT TOO because you're simply pressed for time!
5. The success for blood-taking is 70% in your head, 30% skill. 40% what you learn from your senior HOs.
6. Your MOs are a blessing when they cover for you while the specialist asks questions you do not know the answer to. And these MOs may appear to be the stricter ones
7. My MOs are so good at blood-taking, they must have x-ray vision, but not limited to visualizing bones and soft tissues only.
8. It's actually easier to take blood from a neonate than a child, or even a grown-up... Most of the time
9. The useless feeling I get when I fail at blood-taking but my seniors do it in one simple go-
10. The helplessness I feel when the MO says something like 'Take blood C&S', 'TSB level QID', 'Prolonged jaundice workup' and 'Start IV C-Pen and Genta for this patient' because it means poking the babies!
11. Other than during a procedure, one of the worst moments in a day is when you have to wake up and get prepared to go to the hospital for another brand new day.
12. But when your patient recovers, you feel super happy
13. And when they come back after being discharged, you wonder if it's in any way your fault
14. Tedious things like writing discharge summaries take up time!
15. Learning to ignore negative reactions to you will be your best shield when your knowledge and competency is not up to par yet. And keep on trying and practicing because it will contribute to your future.
16. During tagging, you are expected to be functional- but your mistakes will be forgiven, especially when you're a first poster.

Et cetera.

But this is my first off day after a series of actual working days.

So I'm gonna rest and not think about hospital life too much.

And just FYI, I'm not exactly miserable during tagging periods. Sometimes it's actually really fun and makes me feel like dragging my butt off my bed in the morning was totally worth it. When it's totally horrible and suddenly the entire ward is in chaos, I reserve some of my thoughts to some of my favourite things, ala The Sound of Music. And always remember that the storm will pass, and there are people who can help me no matter how dire the situation feels at that moment.

Like now, I am just chilling in bed. The storm has passed.

Until tomorrow comes.

Then I won't be chilling anymore. But it's okay, chill days will come and experiences occur. And good deeds will never go to waste. :)

Kay bye need to do more chilling!

Early Morning Rant

Suddenly I'm so tired and feel like not going to the hospital.

The thought that keeps me from just breaking down with exhaustion is the fact that

1. It's not as exhausting as some other people's postings
2. I have great colleagues and superiors so far
3. I still have time to eat so why am I complaining and
4. The patients.


T____T

I'm telling you, there is no way I'm letting my children take up medicine. It's rewarding, truth be told. But sometimes it's more frustrating and tiring than rewarding.

Okay enough chit-chat must go.