Admitting Guilt

I will be the first to admit, as junior doctors, we are prone to mistakes. Mistakes that stem from numerous factors, be it lack if knowledge, experience, or even confidence. Mistakes, that predictably have consequences, both to the patient and yourselves.

Recently I was involved in a somewhat sticky situation. Bearing in mind that the case is still under investigation, it is imperative that I hold back in sharing the details. Safe to say I felt that I was doing the best to my abilities, but at times, having good intentions isn't enough.

People say that admitting you're wrong is the hardest part after making a mistake. I beg to differ. The hardest part is having to face up to taunts and cynicism that ensues after admitting guilt. 

I can only pray for strength to face up to these 'challenges'.

Paternally Paranoid

In paediatrics, the patients come with excess baggage called parents. An anxious paranoid parent is a doctor's worst nightmare, regardless of the child's illness. A simple runny nose can turn into a nasty affair if not handled with care.

At times, wielding a stethoscope, and spending that extra five minutes pretending to examine a child whom you know is perfectly healthy, can do wonders for an over paranoid parent.

Communication and assurance is essential, especially in cases where medicine (ie drugs) has no role to play. Prescribing bedrest and fluids without proper counsel will not bode well with certain parents expecting doctors to come up with a magic pill to cure their child of all its problems.

Showing Who's Boss

A fellow houseman coined the term 'verbal rape'

To be verbally raped is akin to having your dignity stripped down for all to see, to be reduced to a pile of worthless junk while others can only glance pitiful looks.

Nobody likes being scolded. As adults, we should be past the phase of being told off like children.

The inherent lack of maturity and professionalism amongst the senior staff is extremely worrying. 

I accept that they were treated similarly when they were at our stage. Two wrongs most definitely do not make a right.

Getting a 'dressing down' in front of a patient is probably the worst punishment one can recieve. As houseman we are the point of first care, we spend the most time with the patients, and they probably appreciate us more than the consultants.

We need the patients' trust and confidence to allow us to do our jobs. Being 'verbally raped' day in day out will have detrimental effects to one's sanity as well as the patient's confidence towards us.

Barely surviving...

Post Tagging...

It is easy to stay grounded when you hold the title of a junior house officer. After all, housemen are the lowest form of life in the hierarchy of the hospital.

We are subject to constant abuse, be it mental or even physical.

The times spent as a medical student, dreaming of the day where people address you as 'doctor' seems pathetic and immature once working life starts.

You begin the journey at the bottom of the barrel, with no room to breathe.

Tagging day 10

Being 'tagged' for the past week has rendered me lifeless. Cruel shift hours start at 7am and ends at 10pm.

I often arrive home torn between two primitive needs. Sleep versus hunger. The former often wins the battle.

White noise

I used to empathise with sick children. Now I see them as mere tasks on a very long list.

• Fbc bed 10
• Trace rp bed 13
• Referral letter bed 20

The list goes on...

The treatment room is where all the magic happens. Some children are aware of the pain that lies ahead. they kick and scream even before they arrive. Some are clueless.  They smile and laugh away, oblivious to their surroundings. In the end they all end up crying anyway. 

Crying is just white noise to me; as long as they stay still while I poke and prod into their tiny veins to obtain blood samples. 

Innocent babies wailing at the top of their lungs do not phase me, as sympathy can only slow you down.

Tagging day 14

I thought the day would never arrive. The words 'off tag' never sounded sweeter. I had joined the ranks of other fellow houseman, finally afforded the space to breathe...

Let the fun begin....

The transition from senior medical student to junior houseman was an abrupt one. A steep learning curve indeed, especially for an overseas graduate such as myself.

One is expected to adapt to all the acronyms, to know by heart the management of tropical diseases unheard of in Ireland, and to be patient enough to withstand the bullying culture apparently ingrained into many senior medical officers.

Its going to be a long journey...

Tagged!

The first day was uneventful, despite the insomnia it caused the night before.
I thought that the end of medical school meant the end of hour long lectures. I thought wrong.

It seemed that every speaker had made it their duty to warn of the impending doom ahead of us.

Stories of houseman needing psychiatiric consults due to depression continue to be the hot topic amongst the so-called motivational speakers.

The highlight of the day was getting our name tags. Despite exuding an aura of extreme cheapness (budget cuts I suppose), the initials "Dr." at the beginning of my name is somewhat satisfying.

I begin a series of six rotations, starting with paediatrics.

Bring it on.

Welcome welcome.

Bismillah...

Two and a half years ago I started writing about my (mis) adventures through medical school. I was surprisingly consistent.  

Today this blog goes semi public. If you are reading this for the first time, I welcome you.  

Tomorrow I begin serving as a houseman in Hospital Kuala Lumpur, hopefully for the next two years. 

 

Do not expect to learn anything from reading my posts. I often toe the line between fact and fiction

I write things as I see with a hint of exaggeration. Do not believe every word.

I try my utmost best to preserve patient and colleague confidentiality. Thus, most names are made up.

My preparation for the big day

I tend to lose pens. So I bought twelve. One for each month.

I also bought a book called Sarawak Medical Emergencies. Why? Because so did everyone else.

Buying books calm me down. I like the security of having a book, regardless whether I read it or not.

My main worry about starting the housemanship programme is the fact that my brain has been idle for almost half a year. I have probably forgotten most if not all I have learnt in college. 

I am praying that there are people worse off than me to take the limelight away.

Cheers..

Post Graduation

Life after graduation has been great. So much so that I loathe the fact that housemanship will start in about a month’s time. It’s been almost 6 months since I last touched a medical book.

My last ditch efforts to study the night before interview wasn’t successful. It took me almost an hour to finish ‘reading’ through managing dengue fever. I then focused my ‘research’ on government policies and transformation programmes in the medical field instead. I now know that there are approximately 175 1malaysia clinics all over the country. I also memorized (right before the interview) the names of important people ie the king, and the minister of medicine.

About 1 in 50 candidates were asked medical questions, and I was extremely worried that I ended up being one of them. I knew nothing!!! (except dengue)

Amidst almost 200 candidates (including non medical ones), I patiently awaited my turn to be called into the interview room.

Despite the anxiety, the interview went well, ie the most challenging question was to recall my IC number and say it out in Malay.

The main concern now that I have been officially employed by the Ministry of Health(yeay); would be work placement.  With Klang Valley and Kuala Lumpur being notoriously popular amongst fresh graduates, I will be competing for a very limited amount of spaces available. 

I can only hope and pray that my ‘recently married’ status can be used as added leverage to keep me in KL. If not, Kuantan awaits….or Sabah maybe.

I imagined it to be different. To scream at the top of my lungs. Running around the spire screaming, “FREEEEDUHHM”, Mel Gibson style.

A victorious ‘whoohoo’ was all I did. Relief is probably the most apt word to describe my current state.

I find it touching that people around me seem happier than I am. Their happiness in turn makes me happy.

My celebrations that evening consisted of 6 straight hours of cleaning and cooking. At the rate of about 1 rubbish bag per hour, my ruthlessness in getting rid of all the  junk collected over the years (or memories, depends on how you see it),   would’ve made kakak very proud.

So,  7 years later, the journey ends. Call me doctor. At your own peril.

Oh that stoma....

Its been quiet, not for the lack of events, but the sheer exhaustion in anticipation of the finals creeping up ever so slowly.

Altruism?

Males that choose medicine as a career generally have a higher level of altruism compared to the average population.

A fact highlighted during one of the practical issue lectures I've been having over two weeks.

Interestingly, studies have also shown that the level of altruism drops significantly among doctors who've qualified and practiced over a number of years. The drop is so severe that it sinks even below the average Joe. That’s what medicine does to you.

I feel that I can relate to that.

Dreams

Pre university was all about dreams. Dreaming to be the best of the best, saving lives... the usual mantra that keeps the fire burning. It was always about making a difference; granted, I was on a high, as getting into the medicine program was tough enough. My future had now been mapped over the next 7 years. I was, a highly motivated individual, determined to make the world a better place. Grandiose at times, admittedly.

I find it hard to pinpoint where all this apathy started to take over. But it has. Coming to the end of one journey marks the start of another. And at this point I am a mere three weeks away from completing my medical degree, and it has been an extremely long and tiresome journey.

Motivation towards the greater good has significantly shifted towards getting the freakin thing done and over with.

Priorities

"At this point you're gonna have to try really hard to fail,"

"Your final exam is like being thrown into the water. We want to see you swim, stay afloat. We might throw a few things at you to put you off, but in the end we just want you to swim."

"The knowledge you have now is all you’re gonna have come exam time. It’s not about what you know, you’ve passed the theory part. It’s all about being safe to be let loose on the wards"

"Times have changed. We no longer have to hide in a room to look up stuff we forgot. It’s merely in our pockets. O yeah, everyone needs an Iphone,"

The overall air of nonchalance among my colleagues and teaching staff might also be a factor. People in general have just stopped caring.

This lack of motivation doesn't mean I have given up. Though priorities have shifted drastically. Its no longer 'all about medicine'.

All that idealism I had has been replaced with realism. Some say its just maturity taking over. Some call it burnout.

Mrs Murphy has now turned into 'that stoma patient', Mr McCarthy is just another COPD case. I don’t even know their real names.

The hospital has become a menu, with me picking off a list, choosing which disease I want to learn about today. At the first hint of a “boring” disease or a confused patient, I immediately finish up, wielding the stethoscope as a sign that the session is over.I immediately leave.. No more idle conversations, chit chat, banter...

Have these few 'tough' years really taken its toll on me? I can never stop wondering.

Sub interning

The reality of being an intern.

"So what time do we have to come in?" asked one of the res year students.

"Oh, 7ish will be fine for you medical students," said Katie the cute blonde intern I was assigned to.

Then she looks at me.

"And you, see you at quarter past six tomorrow morning, we have rounds to do,"

615am. Brilliant. Just brilliant

.Bestnye jadi intern bestnye jadi intern.

Oh stoma

"So tell me what that is," asked Ronan, the specialist registrar in the urology team.

It was in the right iliac fossa. It had what appeared to look like a spout. I went for it.

"Loop ileostomy", I cried with disregard to the fourth med student standing beside me.

The patient coughed. Straw coloured liquid started to dribble out of his stoma.

(Insert preferred swear word)

"Oooh ileal conduit," I said this time knowing that the sort of impatience and carelessness I had shown would've cost me a lot in my upcoming exams.

It was indeed an ileal conduit. But the way I jumped into a conclusion was deplorable.

Ronan wasn't impressed. He wasn't the sort of guy you'd mess around with. I felt like a fool.

This is how you learn.

“See one, do one, teach one.”

Sarah was all about teaching me to do stuff. She was the other intern also on the Urology team.

I watched her do a few cannulas. Then she gave me a minute’s runthrough on what to do.

“Now, are you ready?”

“Yeah I’ll give it a go,” I said, aware that I had no clue what was going on.

Wipe wipe, Tap tap, needle in, needle out. I got it on my first try.

“Good man, now you can do them on your own,” she echoed in the background.

Cannula technique. Check.

Oh, I grabbed a few cannulas to bring home. Gonna try to self cannulate.

Or I could just manipulate a few first years into volunteering their arms. Oh those lovely juicy veins!

ECG

“Do you know how to do an ECG?” asked Katie, who was really starting to grow on me.

“Yeah, I think I still remember,” I confidently answered

Except that my ECG guru was Tom. And true to his nature, he taught me a foolproof method that apparently never failed.

Just follow the fecking diagram.

After what had happened back during my baby res year (click here if interested) I was a bit apprehensive about performing ECGs. The show had to go on.

I failed my first attempt, as lead II showed that the patient had flatlined when he was clearly up and about chatting away.

I had to call in Katie to re-teach me how to do it the PROPER way. It’s all in the anatomy.

ECG number five

“You didn’t even have to look at the diagram like the other person,” said my patient.

She was lying on two pillows with her top off, totally relaxed at my apparent competency in placing the leads on her chest.

Small talk was the order of the day. It kept the patient distracted and creates the so called rapport the text books have been banging on about.

“So, are you nervous for your operation tomorrow?” I asked, knowing that she was about to have a CABG, ie operation on the heart. It was a major operation.

“Whhaat?! What operation?,” She exclaimed looking worried.

Right on cue, Katie pops her head in the cubicle,

“Oy, wrong patient, it’s the other bed,” she said menacingly.

Sure enough, I realized I was at the wrong bed. So no, she wasn't meant to have a CABG, ie major heart surgery.

Oh, I did patch things up with the patient.

It’s just one of those things you never ever want to bring up again. Ever.

Grandfather tales.

“You look exactly like my grandson. He lives in London. A very good looking lad like yourself,” said the elderly patient. (Yes, muka aku hensem and macam mat salleh woo)

“His father is of Indian origin, are you from India as well?” he asked.

Aww snap.

Not everything’s hunky dory but….

I guess there were a good few up and downs in my first three days as a sub-intern. I do not wish to elaborate on the downside, safe to say, just move on and deal with it. Good life motto right?

It's soo cold but where's the snow...

Reminiscing the winter of 2010 when it snowed and Dublin was beautiful.

Signs and symptoms of liver failure

Another random post on Saturday morning

I miss my camera. The plan is to go on a solo trip to anywhere in europe post exams. Just me and my d90 :)










These photos were taken a year ago, across the lake in Taman Tasik Titiwangsa, near maktok's house.

Apathy

Its been a frustrating few weeks. I'm not stressed or anything. I just feel indifferent. Almost bored.

I don't even feel like writing.

Pizza Hut Buffet

Round 1



Round 2

Round 3



Round 4



Round 5

And to end with dessert

No judging aite..:)

Onward we march

I honestly braced myself for repeats. That was how bad I thought it went. I had never felt as insecure.

In all my exams over medical school, this was the penultimate one. It marked the last assessment of the written or ‘theory’ part of medicine.

I passed. Alhamdulillah.

I didn’t expect to get as high, yet I still never did manage to get that ‘A” I’ve always craved during my clinical years. My overall CGPA was suddenly pushed into the ‘honours’ category. Again, totally unexpected.

The final 18% beckons.

At this point in time, according to my iphone, I have 99 days, 23 hours, 47 minutes and 58 seconds left till my final long case. And counting.

Only doctors

Only doctors can say, "I'm gonna need to tap that," and get away with it

A pleural 'tap' of course :)

For ye non medics, a pleural tap is getting rid of fluid accumulated in the lungs. Gah.

Easy does it

It's been a slow first week in Loughlinstown. I even took Friday off to study. Well that was the plan anyway. Cest la vie

As a medical student, I'm a huge fan of books that are simple, concise and straight to the point.

Bearing that in mind, I've made it a point to summarize my notes into simple, need-to-know facts.

Hey, if I ever need the gory details of meropenem's dosage in treating acute pancreatitis, all I have to do is ask google on my phone.

Here's a sneak preview of my latest 'mini-book'.

Just keep telling yourself you deserve it...

Leg of lamb, marinated in worcesteshire sauce, black pepper, sesame oil, oyster sauce
Semi mashed potatoes with garlic and butter
Terung goreng (malas nak check english translation) in the steak sauce,
Steamed carrots

Cost = 4.89 euro

My doodly notes

As I was browsing through my old notes, I noticed a recurrent theme. Lotsa doodles.



Depressed Much?



The ECT Misconception



if only my brain was a sponge...



An accurate self potrait




Making full use of the girls' colourful pens





WHO?




Maternal smokers should be hung

Tik tok

It finally snowed. For about 10 minutes.

I love snow. Especially when it’s all white and fluffy.

I hate rain. It makes you all wet.

Less than a day left till the final winter exams.


In 12 hours, it’ll be over.
Then I’m off and away from this wet gloomy place (which I is still love though) to Belfast, Galway and finally Scotland.

I’m already mentally filling up my shopping list. If only I could mentally add a few extra zeros to my bank account, grrr.


Ahh drama.

Hart of Dixie is a new show I discovered while studying really hard for the finals. 10 episodes (+ two packs of Cadbury choc cookies) later, I realized that I was hooked.

So a hotshot (and hot) young doctor dreaming to be a cardiothoracic surgeon is sent to a small town in Alabama, to do General Practice, in order to refine her somewhat flawed bedside manners.

Then all hell ("H E double hockey sticks", according to one of the characters) breaks loose.



So much for a medically-themed blog huh.

Four magic words

“Boss, pendek, tamau cukur.”

Then it’s just sitting back without a care in the world. I’m in safe hands.

For the past 10 odd years (I’m that old), getting a haircut has been an uneventful, safe routine back home.

Then I arrived in Dublin.

I’m not used to being pampered with a hair dryer. I get easily impressed with the fact he uses more than one type of scissors. There’s even ‘neck tape’ to make sure my hair doesn’t fall into my t-shirt.

Then he asks,

“How would you like your hair cut?”

“Short and neat,” I answered

“Well, can you be more specific?”

I panic. No I can’t be more specific. You’re the barber. You tell me!

“Em, use your imagination,” as I looked at him hoping for sympathy.

...............

It took more than an hour. He seemed reluctant to chop off my “soft, curly” hair, continually asking whether I was sure that I wanted it short.

At the end, I thanked him and paid off the 8 euro I owed. I left the ‘salon’ looking like a schoolboy. Urgh.

I miss home.

Oh, I finished the friggin essay.

High five!

All the luck I can get!