Tuesday, August 23, 2011

The Ramadhan I'll Miss

It has been a very unnoticeable Ramadhan this year.

Iftar and Tarawih prayers at the hospital lobby last week.

Rushing to review patients, adapting to the system, the core subjects to learn in each discipline - they make you lose track of the progress of this holy month.

Ordered some tarts from the nurses for my post-shift junk food binge.

I miss the gathering of friends for iftar, the spiritual nights of Tarawih and Qiamullail, the peaceful atmosphere. Heck, I miss a lot of things.

I miss my kittehs :(

But that's part of moving on.

One day, you're a medical student being looked up by society; the next, you're a junior doctor, 
a low-life, ignorant and inept.

See you guys in late September!

Things get better in the long run. Once you know your way around the system, you'll find your niche.

A mix of paper and paperless work is as confusing as a man with vertigo navigating through KL city blindfolded.


The shift system allows for more personal time. Some spend it sleeping it off, others spend it with their loved ones. 

Me? I like to keep busy with my hobbies. It's one of the things that keep me looking forward to tomorrow.

When I first came to Temerloh, all my favourite activities came to an abrupt stop. It was a stressful and alien time. But after a month learning and adapting to this new phase of life, I found that I can live through this stage without that much negativity. So, one-by-one, I kick-started my hobbies.

I started off with my photography.

It's red in colour because it's hot commodity.

I snapped pictures on my smartphone regularly. I'm always on the lookout for those moving shots of hospital life. Only drawback is the medico-legal aspect of it. None can be revealed too much. 

Aside from snapping those pictures, I also look forward to the fun of editing, printing and scrapbooking my photos. You know, for my later years when I'm nostalgic and all.

Nostalgia looking at this picture and exclaiming how much hair I have back then.

For now, you'll have to be satisfied with still life. I'm still not comfortable showing pictures of sick people - especially those in dire conditions or pain.

Until then, here's pictures of dull Temerloh.

Happy Ramadhan, everyone!

Friday, August 12, 2011

The Tagging Experience


It's been a hectic and strenuous two weeks of tagging as a first poster at the Medical Department, HoSHAS. As a tagger, I was required to work double shifts - come in at 7am and check out at 12am (but usually I finish work later than that).

Welcome to HoSHAS quarters, Block E.

The routine begins with morning HO review of patients. On the first day, I was given only one patient to clerk - AEBA secondary to UTI. I was scolded by the MO because I didn't put in any clinical plans - senior HOs were supposed to teach me the works but they were occupied that day.

Then, comes the MO review rounds. These are just refinement of HO management plans. It's during this time that I learn the most. I get to see how the MO's think and argue, and then manage.

The specialist review rounds comes later that morning. Specialist discussions are usually too deep to follow during the initial days of tagging, but slowly I caught on and asked questions.

Medical rounds usually last until lunch, stopped awhile for visiting hours, then continued in the evening.

 Hospital Information System (HIS) - berebut laptop dengan nurses untuk buat morning review.

After the rounds, it's time to work the clerical skills - writing discharge notes, calling clinics for appointments, writing referrals, tracing old notes.. stuff that will work itself out by trial-and-error over time. Here's the tricky part - all of these have to be done according to priority, some must be done before the end of the office hours.

Life in the Medical Department is a hectic one, compared to other departments. On an active day, admissions can go up to 25, ballooning up the ward, warranting transfer of old, stable cases to other wards.

My energy drink.

Here's a very brief summary of my tagging life:

On day 2, I was entrusted to cover one cubicle of 4-6 patients.

On day 3, I did CPR on 3 different patients.

On day 5, my post-HD patient developed ACS and died.

On day 8, I was reviewing 8 patients per day. Still slow.

On day 13, I pronounced the death of a patient. "Makcik, pakcik dah takde."

Death consists of five forms to be filled in.

On day 14, my newly diagnosed PTB patient absconded.

TB registry.


I've been scolded a few times for my lack of sense of priority but it's an understandable fault - first timers usually don't have the same awareness, sense of urgency or responsibility.

I've been scolded for not reviewing fast enough.

"Tunggul kayu ke? Pegi la clerk new case tu."

I've also been scolded not being aware of the events in the ward, especially the acute beds.

 Items to prepare for femoral catheter insertion.

Everyone gets depressed after a scolding, especially if it's not your fault to begin with. But bouncing back is key. And also, saying sorry if you're wrong, saying sorry even if you're right.

Accompanying a patient's transfer to HTAA.


Things that were previously awkward to do are now staple.

"Doktor Yusoff, bed 6 cabut branula dia."

"Doktor, bed 18 tak pasang CBD lagi."

"Doktor, anaes call, cakap bed 26 tak repeat ABG lagi."

Gotta memorize what each tube is for by the end of the first week.

What hand hygiene?

But the most routine-disturbing phrase has got to be this:

"Doktor, bed 24 collapse!"


Alhamdulillah, now that I'm finally off tagging, I have plenty of time to settle my unfinished business e.g. doing the laundry, stocking new supplies of food for sahur, Tarawih prayers, writing this blog, and recreational stuff.

It's a relief but a lot of responsibility at the same time. Some times, the night shift HO will be alone to take care of the whole ward. By merely hoping for the uneventful is wishful thinking; one has to prepare for medical emergencies. That's when you have to decide whether it's necessary to disturb the on-call MO.

If an ACS patient complains of chest pain, you take his vitals, do an ECG stat, give him sublingual GTN, compare the latest ECG with the old ones, review the latest blood investigations, then you decide whether to call the MO or not. If you're not sure, you can just inform him/her while giving her the important info.

That's just ACS. There's SpO2 dropping, hypoglycaemia, hypotension, fitting, etc.

But this level of clinical acumen will only improve by time. Until that time, you'll get scolded over and over again for not being able to prioritize or manage simple events.

 Blood culture company giving a talk, then freebies.

Oh, one more thing - night shift HOs have to take blood from the whole ward at 6am in the morning. If one starts at 5am, he/she will probably finish around 7-8am.

So medical students, do come and help, yes?