Never Enough

It has been a long while.

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

In other words, I have been very unimaginably lazy.

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

Speaking of incomplete.

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

GLAD?!

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

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

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

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

I'm still alive.
HOship was the bomb.

Procedures, procedures

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

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

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

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

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

The Road to MO-ship

Almost there. Sauce

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

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

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

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

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

For now, all I can say is:

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

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

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

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

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

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

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

The Curse of Time Awareness

When we were younger and carefree,

keyword here being 'carefree',

we are less aware of time.

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

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

Shower and brush our teeth because we are supposed to.

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

Attend classes as our teachers change, lesson by lesson.

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

Have fun with friends because we are supposed to.

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

"Sekolah Agama" beckons until later in the evening.

After that, come home and shower.

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

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

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

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

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

I was devoid of care. 

Entirely carefree.

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

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

I am too aware of the time I spend.

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

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

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

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

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

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

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

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

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

So, yeah. 

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

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

I despise how time-aware I have become.

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

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

It's a curse.

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

I am not a young adult anymore. 

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

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

I need a Dr Who in my life.

Emergency Medicine

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

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

NO AM ROUNDS WOOHOO!

Short attention span is fine.

Clerking is short.

ADRENALINE RUSH IS REAL.

YOU give the diagnosis.


I dunno man, it feels pretty real up here.

No ragrets.


Except, I do feel stupid a lot here haha!

Staging the Malignant Tumour & The Norm.

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

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

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

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

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

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

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

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

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


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

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


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

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

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

--and yet 

they are 

the minority!

I don't even have to ask why.

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

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

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

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


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

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


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

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

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

And this attitude is exactly what needs to be corrected.


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

Going Back

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

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

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

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

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

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

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

And on and on.

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

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

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

**********

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

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

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

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

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

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

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

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

**********

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

And there is an omnipotent being monitoring all my moves.

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

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

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


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

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

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

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

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

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


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