Saturday, 31 December 2016

New Year's Eve~

So much has happened this past year.

I got a job and subsequently felt the advantages of working life- buying myself shiny things, being able to give my parents money and treat my family to meals for a change, and learned how to sort myself out better.

I'm pretty sure I had something more insightful planned for this post, but my postcall state is preventing optimal recall. So, sleep it is.

Happy new year to all, and may 2017 be better than 2016 for all of us :)

Sunday, 27 November 2016

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! :)


Sunday, 13 November 2016

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

Wednesday, 2 November 2016

The Almost End~

Handed in my logbook.
I'm free! I thought.

Last day pun kena oncall okay.
Also borang hijau mana, borang hijau?
Free lah sangat.


But whatevs.
I'M OFFICIALLY DONE WITH THIS POSTING! WOOHOO!

Next stop: Orthopaedics.
Where my old bestie from Paeds is yayy!

But for now, 15 more hours to last on-call with some difficult people...
Ahem. Not difficult. Just challenging.

Saturday, 29 October 2016

HOs Nowadays Only Work 8-Hour Shifts?

Recently, another story of a HO meeting with an accident went viral on Malaysian social media. Reportedly, the unfortunate lady was returning from a 30-hour shift at a tertiary hospital in Klang Valley when- presumably out of lack of sleep- she rammed into the back of a large container truck.

Her car was totaled, but she emerged from it virtually unscathed.

Thank God and the good build of the locally produced car, she's safe.

But that is only the introduction of what I'm going to write about today.


Following the shard article on a facebook page I was following, surprisingly, was a barrage of comments from naysayers-

"There is NO WAY HOs nowadays can work that many hours per shift!"
"With the implementation of the Flexi System, HOs do not work exceeding 8 hours a day. That is a fact."

"Even I did not work that many hours per shift 30 years ago..."
"Is the relative SURE the HO worked for so long? As far as I know HOs do not do oncalls now."



...

I am a current HO and I can say with confidence that quite a lot of us work over 30 hours a day.
And I am one of those people, in this current posting.

It's not because we are so generous and hardworking (though some of us undoubtedly are). By and large, the inhumane hours were imposed upon us.

Guess what, we still function- though barely. And you do not even want to imagine the mistakes that could cost our patients when a person has been awake for over 20 hours and working with almost no rest at all, then STILL expected to work further, until well over 30 hours have passed.

One of my MOs recently was taking a gander at our salary.
She thought we were getting at least 1k more than what we are actually getting.
I had a good laugh at that. Apparently, she got around that figure a few years ago as a HO- due to on-call allowances, and judging by our working hours she thought we were being compensated more fairly.

With the Flexi Shift system, we get a set amount of money per month no matter how many hours we put into our work- called the Flexi Allowance or so. Usually, this doesn't concern me in the least- I expected to work my arse off and get minimum wage (lol) even before I started working, because it's always what we were taught to expect right when we started medical school. But what truly irks me is the amount of people who do not know what is going on, and yet are so sure of what they are saying based on some statements by the authorities and higher-ups who obviously only know to make policies and not really enforce them.

And as a result, they think we are being pampered and mollycoddled, and that our voices of dissent over the injustice of it all are just a result of our lazy, self-entitled upbringing and environment.

Yes, the Flexi System was SUPPOSED to be implemented for the following factors- more manpower equals less working hours per individual equals less compensation equals more economical and effective outcome. Win-win all around.

But do we really have enough manpower?
Are the hospitals simply overflowing with doctors, and in particular, HOs?
Is there any rule out there that would strictly enforce this 'Shift System' policy with penalties for failure to comply?
Uh, no.

As a result:

  • Many hospital departments still use the on-call system, or very long shift systems
  • We work way more than the 'cut-off' maximum hours per week
  • We still do on-call systems like our MOs, but twice a week, without weekends off, and without the 'lucrative' on-call allowance nor ability to claim our weekends/public holidays to the maximum.
  • And worst of all, nobody is brave enough to change the system.

If a lone HO dares to voice out his or her dissent, he or she is quickly met with antagonizing stares and fast-tracked on the road of extension and eventually displacement to another hospital. If that weren't enough, he or she is also threatened with a delayed promotion to MO-ship for being arrogant and not sticking to the status quo. Such is the way of the medical fraternity, I have learned- many are quick to anger and say they suffered the worst, and generational gaps remain massive and for the most part, insurmountable.

Words like 'during my time' are thrown around a lot, often out of context.

Le sigh.

It wouldn't have bothered me that much if some non-medical people had the misconception about our working hours. But hearing it from our own seniors really breaks my heart. What kind of attention would we be trying to garner by faking our own working hours?

Wake up.

30 hour shifts (and more) STILL exist for HOs.

We do NOT work less than 8 hours per shift most of the time.

And most HOs do not have a place to retire to by the end of their shift. In many departments in my hospital, there are no specific rooms for HOs on-call to rest- in fact, we are not expected to rest, thanks to our 'shift' hours that are supposedly blissfully short.

It is truly disheartening at times...
But life goes on.

And the job remains rewarding if you focus on the more rewarding aspects- i.e. the care of your patients.

Monday, 17 October 2016

A Whiny Post (Sorry!)

Image result for whiny
Yes, I can be a whiny baby too. Waaaa D:

It's really disappointing when you suffer from the mistake of another individual.

But it's part of life.
Still, can't help whining about it.

I wish I had more patience.

On that note, please pray that I pass this posting uneventfully. If all goes well, I would be ending in a mere 3 weeks (less)! And my logbook still has some ways to go T___T

I really, really, REALLY do not want to get extended.
Really.
Not in this posting.
Please, God. I'm not sure I can handle the test.

Sure so far no MOs seem to be up my case or anything, but the boss can be quietly deadly.
Like, you think you're fine, and then BAM! Extension.

IT'S SCARY OKAY.

I do my work, it's true.
But the stupid thing is, it's so hard to get bosses' signatures on time for assessments.
They're often busy and/or in a bad mood. And when they're not, WE are often busy and too tired to even think of answering assessment questions.

It's something bosses seem to forget to understand.
It's not like I haven;t been rejected at least 6 times in asking for an assessment for one reason or another... And if bosses are that busy. then imagine us tiny little planktons, trying to carry out all their orders.

Sorry. Trying to be sincere here, but I'm only human and after over 30 hours of being awake and more than half of that doing something or another for other people while having your needs neglected...

Well. At least I'm sheltered from the rain and still get to eat afterwards, right?
And I get a steady income, right?

It's not all bad.
But that doesn't mean conditions can't improve for us measly little HOs.

Okay bye now before I get whinier.
I care for my patients, but sometimes people can be big bullies.

Waaaaaaa. 
/endwhinymode


Saturday, 3 September 2016

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!