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!

Selamat Hari Kemerdekaan!

Sementara negara menyambut hari kemerdekaan yang ke-59, jangan dilupa orang yang tersayang.

Berhati-hati di jalanraya; waspada dengan mercun dan bunga api yang merbahaya.

Paling penting, jangan hanya menganggap hari ini hanya sebagai satu lagi hari cuti di dalam kalendar anda. Hari ini membawa banyak maksud bagi mereka yang mahu berfikir.

Merdeka pada cara, merdeka pada hati.
Jangan biarkan minda anda sentiasa cetek.

Kemerdekaan berada pada ilmu di dada; kemerdekaan ada pada hasrat di jiwa.
Kemerdekaan adalah nikmat namun harus berpada-pada.

Berduyun-duyun manusia, rakyat Malaysia, yang membuat bermacam-macam cara kreatif dan alasan ke hospital untuk mendapatkan barang satu lagi hari cuti... Menyedihkan!

Ingatlah bahawa perbuatan anda sentiasa di lihat.
Ingatlah bahawa balasan sentiasa menanti anda.
Jangan dibuat sakit tatkala anda sihat!

Ikhlas dari seorang warga kerja hospital tanpa cuti umum. :)
Maafkan kekekokan saya berbahasa kebangsaan!

Slightly More Capable, But Still Not Knowledgeable

I know I'm slightly more capable now.

Despite the fact that MO D just told me I was really bad when I failed to answer some of her assessment questions post-call, which was humiliating because so many people were around us and, actually, in retrospect, I knew the answers to her questions in my head. Somehow I didn't vocalize them first/well enough. And she was right, they were pretty basic things.

But for an MO lots of things should be pretty basic things. That's why MOs can only become what they are after finishing HOship. Nevertheless, it is not excusable for me to not know things. I'm just... Really bad at being assessed. The panic energy is too much.

Anyway.

I know I'm slightly more capable because MOs can trust me when I say clinical findings, and history points. And so do some specialists. You can gauge how much they trust you by the way they react to your case presentation. Nodding, immediately giving their plans afterwards, and discussing cases with you are some positive points. But if they second-guess you and keep asking if you're sure, or keep reaffirming your facts with the patients, then you know you're not being trusted enough.

I've seen it happen. It has happened to me before, too. And some of your superiors just happen to be a bit more careful so they will always double-check, which is good. Therefore, don't take it too personally if you are being doubted. It's good that someone else will double-check your work, because at least you know the patient is receiving proper care.

I know I'm slightly more capable because the SNs will tell me things instead of other HOs, which is awesome and also slightly tiresome. Hey, I'm only human.

I know I'm slightly more capable because when given the choice, an MO would choose me to go with him instead of the other available HO. Which is annoying because I don't like being uprooted, but hey, it's an indirect praise. Also, job. Must do. Also when boss says do A, you better bet your arse you'll do A or get into trouble.

I know I'm slightly more capable because my more senior HOs would...
Oh wait.
My more senior HOs do not show trust in me.

Lesigh.

This department is a little bit bilirubin to the circulatory system that is my psyche.
It's starting to feel just a little bit on the unsafe side, the excessive side.
A little too... Toxic.

I'm too tired to study and too anxious to feel good about each coming day.
It's exhausting.

I'm getting back to the weight I had in my 3rd or 4th year of medical school.
Chances are I will lose more by the time the posting ends.

I'm starting to enjoy it, but the moment I get assessed and realize how much I STILL don't know, I get depressed again.

And it just goes to show, the toxic levels are mainly from me.

MO H asked me which uni I was from.
I told him.
He said I should be good, because all my seniors from that uni that he's seen were exceptionally good.
So he trusts me, he said.
I tittered nervously.

What BIIIG shoes you have, Grandma!
ALL THE BETTER TO SQUASH YOUR ANXIETY WITH!

On a Side Note

Yay: Losing 6 kg unconsciously over the past 1/12

Nay: Being in charge of countless TB patients for that same duration, with + cough on & off for >2/52

Double nay: Writing short forms on social media like they're BHTs.

Saving Lives in the Hardest Places

So while I complain about my life being rather miserable, there's this happening in more places than I dare to think. Not the mere act of saving newborns itself, but the cruel reality of violence that is pervasive in some places, more than others.

I am thankful for what I have, and repeatedly remind myself that it could be worse.

In the aspect of neonatal resuscitation- i.e. neonatal resuscitation programme, the current one that I learned in my previous posting, I have a lot to say about the techniques seen in this video. But when I think about it again, of the lack of resources and obviously manpower, and hence the lack of training that many of these brave souls might face... I am unable to say much.

All that's important, to them, is that they save lives. No matter how outdated the techniques. No matter the lack of equipment.
And that's what's most admirable.

So there's a quick recap of NRP and also a refresher for my soul.
In preparation of what may be the most dreadful day to come.

I fear it so much!




P.S.: Today must be one of the most relaxing days of my posting, which usually does NOT mean well for the coming days T___T I'm so superstitious astaghfirullah.

Sigh

Two patients, at a time, told me that my blood-taking technique was good.

Repeatedly.

But if you've read any of my previous posts, you probably would have come across the post where I said blood-taking is highly dependent on luck, apart from experience of course. And that is what I tell any of my patients who would say that my blood-taking technique is way better than my colleague's.

1. It does not pay to downgrade your colleagues. Shifts change, and luck does, too. I had bad luck with several patients who are very easy to my friends, but with me were just simply difficult!

3. The same patient may prove to be difficult several blood-takings later- the vein mainly stays in one place, but complications do occur and running/easily-collapsible veins exist (especially in elderly patients). So it always helps, to me, if I tell the patient that the ease with which my blood taking is might change

2. They should expect blood-taking to be a difficult thing- that way, they're less inclined to go to the hospital. Hehe. I'm only kidding. OR AM I?!?

4. I switched 2 and 3 and you probably didn't notice. Shifts change and sometimes patients don't notice that you're a different doctor than your friend (particularly if you're wearing a mask all the time)... So that praise might not be aimed at you.

5. Simply for the sake of humility, never be too proud of your own skills. But be moderately proud and hold on to those praises because they might be the only thing to keep you smiling on busy tiring days.

This is turning into a 'How to Handle Praise Anonymously' post.

Anyway, I wanted to say that I have some reason to be proud, at least. Internally proud, that is.

I really should stop typing for an audience and type for myself.

I felt like crap.

Got some praise.

Un-feel like crap.

...

Don't know how to do certain stuff properly.

Get scolded by MOs/SNs.

Feel like crap again.

And the cycle goes on.

Life of a HO in a normal posting.

My previous posting was indeed heaven for HOs.

Stained Glass

In my early(er) days as a HO in this department, I forgot to carry out a silly little thing and got scolded very heavily by an MO. Let's call him Bull (for reasons you probably won't guess correctly, believe me). So Bull's close friend in that ward is Crow (again, you won't get it correct).

Ever since those degrading few minutes when I got scolded by Bull, I always managed to evade him. And I wasn't yet in charge of the ward Bull was in charge in, so I rarely saw him after that. But I do get to see Crow a lot more- and Crow, probably by extension of Bull, always has a flicker of distrust in his eyes whenever I say anything to him. In fact, I believe Crow doesn't like me for reasons I do not know- probably because as one of the most junior HOs in this posting at the moment, I am probably expected to be the least reliable. And Bull and Crow like their HOs to be reliable because they do not like staying in the wards- i.e. the more reliable the HOs are, the less their headaches and the more time they get to do whatever they want outside the wards. Hey, I shouldn't judge, they might be attending cases in the OPD or ED all the time for all I know. But- NEWSFLASH- I'm human and yes, I'm slightly judging them right now. But I shouldn't just saying.

Anyway.

Many weeks (not nearly enough) have passed since then and today, as I was clerking a new case, lo and behold did I hear the bellow of the Bull from across the ward.

Immediately I thought, "FECES! Feces feces feces!"
The second thought was, "WHY did I let myself get thrown to help this ward instead of my other friends?!"
The third thought was, "Please don't remember me."
Or maybe "Please be kind."

My Mom and one of my aunts had taught me some things to say when facing those whom I think dislike me, to make their hearts more gentle, but at that time I forgot those entirely. In any case it's hard to remember such nice things when your head is swimming in feces.

Anyway, he told me to present.
Again inner thoughts.

I presented- croaked hoarsely, more like, because I am still rather sick.

And to my surprise...

He did not chuckle at my words nor make fun of me.
He did not show impatience when I fumbled some of my sentences or had to flip though the BHT to find the answers to some of his questions.
And surprisingly, the few times I dared to look at his face, it did not convey irritation, but much patience.

And not once did he raise his voice to me.

Truth be told, it was like he was a totally different MO from the first (and last) time I encountered him- though, if I remember correctly, he was wearing THE EXACT SAME SHIRT.

He told me his plans patiently. Just laid them out, no questions asked.
Told me to carry out some investigations.
Then left.

After some time while I was busy cleaning up the rest of the clerking I made after he left and tidying up the medication indented, the specialist came to review new cases. And I didn't realize it until Bull's voice called my name from in front of the counter. I whipped around, saw him and the specialist headed to my patient and quickly fast-walked to them, my coat hanging on to some spare steths on a nearby trolley and nearly toppling me. The specialist made a remark I couldn't hear. I just grinned apologetically his way.

Then Bull presented the case.
His history wasn't really correct, oh no. But I kept my mouth shut. They weren't important mistakes for managing the patient.
Except if I made those mistakes he probably would have humiliated me...
Or would he?

Then before he left, I asked Bull a question about the patient's medication, half-expecting him to give me a snide remark on how incompetent and retarded I am, but to my surprise he thought about it and gave me the answer nicely, as the specialist affirmed behind him.

Then they left.

And my jaw dropped.
But the hospital floor isn't sanitary so I didn't let it drop that far.

I finished all the carry-outs for that patient, said all that's necessary to him and his caretaker, and then finished up some more work at the counter.

And that day all the SNs were nice to me,  which was weird because the SNs in that ward used to hate me. I think.

When I returned to my ward, Crow happened to be around, and asked me where another MO was (let's call him Violin, also for reasons you wouldn't guess)- Violin is probably the nicest MO in this department, or at least one of them.
And there wasn't the flicker of distrust, nor the snide tone, that I was used to hearing from Crow. All I heard was a genuine question. And then he left also genuinely nicely.

How a person leaves genuinely nicely, I'll never know how to describe. But it happened, okay?

**********

But then here I am at home, and I've been thinking about it a lot, and I'm thinking...

Maybe the prayers worked.
Maybe my mother prayed extra hard.
Maybe all those bad times were the dark clouds hiding the silver linings.

Because not 48 hours ago, one of my other MOs (let's call her Dash- no guessing why again because you're likely to get it wrong too) saw me during morning rounds and asked me, "Why do you look like that?" and I answered, "I'm post-call, Dr," in my very sexy voice (by that I mean the sick kind, and not in the perv way, just in the health way, also don't make me elaborate this is getting awkward). She replied, "Oh, is that why? Your eyes are very red!" and I just smiled (from behind my mask, but I've been told my eyes smile along a lot). In fact I was very sick, and I was post-call as the only HO on-call in that ward the day before.

But then after my section of the ward was done with, she saw me again from afar and semi-shouted at me to go back- in a rather angry tone.
I was surprised. I thought, for sure I screwed something up and she didn't want to see my face.

But when I heard the reason...
"You look very sick! Your work ends in 2 hours, to me that's not a lot of time left. Have you done your work? Do you have anything pending? If so pass it to **** and go home!"
And when I looked confused and asked if she is sure, she told me she was, and that she only hates it when people lie- and I don't look like I'm lying about being sick (in fact I didn't even tell her I was sick nor did I ask to leave early).

... I nearly wept.
And I accepted graciously, for that is rezeki- a blessing from God. Also she was shouting at me, it's not like I can just dismiss it heheh.

She didn't hear me coughing the entire night in the spare bed where I was supposed to take some naps during those calmer times, then throughout the ward. She didn't hear me sniffle, blow my nose, nor croak my words to the patients and nurses, the day before. Neither did she see me with my pack of tissues and ever-present mask, and flushed face and swollen eyes. But somehow, I still looked so horrible the day after that she figured out how sick I was. *laughs*
Even Violin gave me a sympathetic look after that (and reminded me to tell our boss, too).

But the important thing is, Dash saw me being sick and gave me permission to leave a significant amount of time earlier... Even if it meant that she would have one less HO to carry out her orders for those hours.

And initially,

sadly,

I thought she was one of the more inconsiderate MOs.

**********

Which just goes to show...

A lot of the ugliness we see in others, is a result of our own dirtied glasses/windows through which we look, called perception.

What we perceive as reality, and what is actually there, are not just two different things, but in fact many, thrown across a broad prism of time, space and other things unfathomable to our logic. In fact, the way you perceive things, and how this results in how the world interacts with one another, all exist in different dimensions- and it's easy to grasp that notion when you think of just how complex your own train of thoughts are. The collision of so many perceptions and thoughts in this single dimension we call reality- now how does that chaos exist in such harmony? It simply does.

It's hard to see how any single perception is so similar to another when you think really hard about it.

In simpler terms, do not judge a person by a few of his/her habits or actions. Every person is a sum of all his/her actions, though of course there are some that are so bad or good that they almost nullify the other things in that person's character... But most of us do not belong in that extreme category. And all of us are neither the Angels nor the Devil himself.

Most of us are merely trying to find our way through life as easily as possible.
Most of us forget that this isn't the Real thing yet.
Most of us tend to forget that this is a test, and in the more negative moments spiral into darkness (God forgive me, that tends to be me, too).

Like I have repeatedly said, life will always have brighter moments.
Hold on. Just hold on, a little longer, and believe me the darkness and the hurt will dissipate, and give way to brighter, sweeter moments.

When the silence of humiliation or guilt overwhelms your senses, force the tiniest cracks of positive memories and aspirations through- they will wheedle in and take over soon enough, if you let them.

You can do it.
And when people get you down, and it feels like everyone is against you, this little thing should keep you going- that if your intentions are right, and only you and God should know that, then nothing- absolutely NOTHING- shall be futile.

So always correct your intentions.
Always, always try to think positively.
Make excuses for other people's meanness towards you, even as you avoid making excuses for yourself.

Remember that what goes around, comes around;
Kindness and patience is never wasted.


Now to sleep before my next lone on-call shift, and here's to hoping tomorrow's call will be bearable.
Just bearable will do. Preferably restful too.