“ KASUT! No brown shoes mister!!!” he continued.
Welcome to Malaysia. My ‘home’ for the next three weeks.
(note I refuse to name the hospital for fear of legal action, it shall henceforth be known as MH)
Final Med
“So who do we have here,” said Dr Ding, the elective coordinator. There were about 20 students from all over the world, converging to do a short stint in MH . Most of them were Malaysians studying medicine in Russia.
“Ah, I see we have students from Dublin. Final year summore” She continued
The room was silent. All eyes were on us. It dawned upon me that the tag ‘final year’ medical student has its own merits. Though I had a feeling that most of them would be disappointed with these so called ‘final years’ on show that day.
“Would you like to share something with us, seeing that you have been very privileged to study in such a high esteemed place, di negara mat salleh....”
I looked at my partner. Awkward silence ensued.
I finally found some saliva to ramble on about ethics, taking great care to praise the national system for producing very competent and skilful doctors compared to their European counterpart, which focused more on the professionalism aspect.
That seemed to impress her enough for the time being.
She went around the room asking questions. It was clear by then that she held us in high regard.
“We are expecting a lot from you, and hope that you can share what you’ve learnt with us” she added.
So no pressure huh?
Impetigo?
It would be hard to describe my shortened stay at MH. I skipped the last week due to a suspected impetigo infection. Though I cast some doubt into the diagnosis made by the local GP, as there were no typical crusty lesions associated with impetigo. No complaints as I took the last week off.
How to Take Blood, by a Medical Assistant
1. 1. Don’t bother washing your hands
2. 2 Prepare your gloves
3. 3. Use the gloves as a tourniquet (!!!!)
4. 4. Using your bare hands, find a vein in the dorsal aspect of the hand and stick a brannula in
5. 5. Push in the brannula and take the needle out
6. 6. Stick the needle into the chair (!!!!!)
7. 7. Take blood as needed.
8. 8. Dispose of clinical waste into yellow bins
She was a third year medical student from Moscow State University. Chloe was her name, and she was my partner down in A&E. If I could use one word to describe her, I would choose ‘innocent’
I made it clear from the start that I would have my own schedule, and made up my own rules. Chloe was very diligent and followed me around wherever I went. She also wasn’t shy in asking questions.
“Can you teach me X-ray ah?,” she said in her unmistakeable Chinese accent. She was from Jinjang.
I picked up the film and held it against the light. As I was explaining to her the basics of reading a chest X-ray, a few more Russian students joined in. I acknowledged their presence and welcomed them. Suddenly it turned into a crowd.
I realized that I was in the middle of giving my first tutorial. Soon enough, one of the doctors walked in and interrupted.
“Excuse me doctor, is this room free?” he asked, looking directly at me
“Sorry, I’m just a medical student, of course we will leave this room at once. I was just talking through a chest X ray with my colleagues here,” I explained, feeling very embarrassed.
He was nice enough to let me use the room. The tutorial continued. They were actually jotting stuff down. God knows if what I said was even half true.
Half Day
My mornings would start at 8am. The teaching in the A&E department was good. It usually lasted for an hour. After that my partner and I would trot up to ward 27, where another classmate of mine was stationed. There we joined a ward round that usually lasted an hour or two, depending on the patient count. All in all it was a solid routine. My day would end at noon-ish. I wasn’t going to exert myself and stay the whole day.
WARD 27
There had to be at least 50 patients in ward 27. It was a general ward, and they presented with varying illnesses. The acute cubicles consisted of suspected TB infections (almost unheard of in Dublin), HIV, and alcohol withdrawal. Dengue was also a prominent disease that one would be expected to know inside out if practicing in Malaysia. I knew nothing.
The beds were very close to each other and privacy was at the bottom of the list. Patients all wore the same fungi green overalls. The ward was stuffy and smelt like pee. It was depressing and felt like a prison.
Pakcik rasa....
One of the patients presented with warfarin overdose. He developed bruises due to an elevated INR, caused by ingesting too many warfarin pills.
He had a artificial heart valve that necessitated the use of warfarin, a drug with severe side effects if used without caution. His valves were replaced due to rheumatic fever, again, almost unheard of in Dublin.
“Pakcik, apasal pakcik makan lebih itu Warfarin?” asked the consultant, evidently of Indian origin.
“Oh, sebab pakcik tengok banyak lagi pil tu, jadi pakcik makan aje bagi cepat habis. Lagipon pakcik rasa....” he went on to explain how he made a decision on why he thought it was prudent to increase the dosage of the drug.
The consultant frowned. So did the rest of the team. We were dealing with ignorant people and couldn’t do anything to remedy it.
PUASA?
I made it a point to ask Chloe if she understood everything that went down in the ward round earlier.
Chloe : Can I ask you a question?
Me : Sure, go ahead
Chloe : Kamu ini bukan melayu ka?
I somehow knew where this was going. I’ve had enough of people dissing me about my Indian heritage. I let her continue anyway
Me : Kenapa, awak ingat saya orang mana?
Chloe : Kamu bukan orang Singh ka?
I humoured her even further
Me : Why do you say that?
Chloe : Sebab kamu tak puasa?
That caught me completely off guard. Curious indeed.
Me : Bulan puasa lambat lagi
Chloe : Tapi kenapa kat ward ada patient yang ada itu ‘sign’gantung tepi katil, “PUASA”?
Oh so naive!
Me : (still very polite) Oh that means that they’re not allowed to eat due to disease or imminent surgery, bukan puasa sebab ramadhan
Nurse Wars
After seeing patients in the acute cubicles, I disposed of my mask in on of the many bins by the side of the bed. The ward round continued.
Suddenly I heard a shrill voice from the end of the corridor.
“Ni siapa buang mask kat sini?!!”
A few of the patients even woke up to watch the drama unfold.
I looked for the source. It came from a smurf-like figure in blue uniform and white tudung. Only that smurfs are cute. She looked like more like a troll.
“SIAPA?! CEPAT MENGAKU!!! NAK SAYA CHECK CCTV KE?!!” the Troll went on.
I took a deep breath and stepped forward.
“SIAPA KAMU?”
“Saya medical student”
“MEDICAL STUDENT! BELUM DOKTOR PON DAH TUNJUK PERANGAI! KAMU TAHU TAK KAMU TAK BOLEH BUANG MASK DI SINI!!!
Despite me having at least 10 inches in height advantage, she made me feel really small. I looked to my left, Chloe stood next to me for support. Good girl.
The rest of the students cowered behind us.
I was on my own though. I picked up the mask and threw it in the yellow bin after being told to do so.
“KAMU TAU TAK SAYA SIAPA?! SAYA HEAD NURSE DI WARD NI. KAMU KENE REPORT KAT SAYA TAU, BUKAN DOKTOR. SAYA PERMANENT STAFF KAT SINI, SAYA YANG JAGA KAMU, BUKAN DOKTOR”
I merely nodded disinterestedly. The rebel in me surfaced
“KAMU INGAT KAMU BAGUS SANGAT KE HA?! BELAJAR OVERSEAS JAUH-JAUH, TAPI PERANGAI MACAM SAMPAH!”
I continued to roll my eyes. I could see that I was pissing her off further. I knew she couldn’t do anything.
It was a mask. As if that would be the cause main of infection in a ward crowded with TB and HIV patients. I kept my thoughts to myself.
Yes, she had a point. But her method of embarrassing me in front of the whole ward was in my cards unacceptable and unprofessional. Then again they don’t bloody teach professionalism in Malaysia do they?
Pre-Conclusion
At times, it was very hard to see myself working in this environment for the rest of my career.
Conclusion
No, I don’t wish to end on a negative note. Most of the posts were written when I was in the heat of the moment, ie pissed off at the world for treating me so bad. I do look forward to the challenge.
Dr Ding summed it up nicely during our initial briefing.
“I find that Russian students may lack so basic core knowledge when it comes to practicing medicine. However, they are so used to being shouted at that most of them do make it through the houseman programme. Students from UK and Ireland on the other hand, have this perception that no one can marah them because they are so used to the environment in Europe. Let me tell you that most of them cannot tahan and end up having emotional breakdowns in the middle of the housemanship. My advice to you is to toughen yourself up, learn to be patient, and most of all accept that fact that you will be shouted at, you will be insulted and you will be scolded. Then I assure you that you can make it through,”
Dublin has spoilt me. I lived in a cocoon where consultants fart rainbows and interns break out into random songs at will.
As I prepare myself to face my final year in Dublin, I can’t help but wonder what the future holds for me.
