Wednesday, September 21, 2011

The Real-life Medical Syllabus


Today is my 57th day at work.

The wall art reads, "Dr Yusoff was here." 

I realized that I haven't been writing about the medical posting itself.

Internal Medicine in the real world is all about medical emergencies. And when we say medical emergencies, there's only two words associated with them - Sarawak handbook.

It's the ultimate guide to medical life, used by MO's and HO's everywhere.

What you find in there is what you'll find out there. From the very dramatic status epilepticus to the very silent hypertensive emergency, every topic is covered and presented well. Plus, the mid-posting and end-posting assessments will cover medical emergencies usually.

Another awesome mini textbook is the Oxford handbook - complete, concise, can fit in the white coat pocket.

If you're tech-savvy, then your smartphone should already have Medscape.


ACS (UA, NSTEMI, STEMI), CCF, APO, CVA (ACA, MCA, PCA; SAH, SDH, EDH), AEBA, AECOAD, URTI, CAP, HAP, HCAP, PTB, DM, DKA, HPT, DF, ARF, CKD, CLD, AGE, UTI, RVD - to put it simply, those with abbreviations are encountererd on a daily basis*.

My post-shift jajan binge collection - also encountered on a daily basis.

The main diseases need to be understood thoroughly - from the various presentations to the investigations to the management and progress.

Honestly, it's hard to focus on the subjects of the posting if you're a first poster since you'll be more focused on adjusting to the system and the associated life (or lack thereof).

To overload or not to overload? - that is the question. 

The management part is a bit tricky in the beginning, but after a few encounters with the same disease in a variety of presentations, it'll become second nature. Understanding the disease process and pharmacodynamics of the medications will help tremendously, rather than blind memorization of the treatment.

So kids, learn your stuff well while you still have the free time.  

 Free time well-spent.

It took me around one month to get settled in - even then, I still get scolded at times for reasons associated with lack of comprehension of (and adaptation to) the system.

Holding on to important things in the crucial moments. 

As for the compulsory procedures, my logbook is still free of signatures (and my midposting assessment is next Monday, haha). So far, I've done one chest tube insertion and one peritoneal tapping. And oh, countless CPRs (personally managed two resuscitations by myself while the MO is busy somewhere else).

Learning the system, one leaf at a time.

There's a lot to cover in medical posting - and honestly, I don't mind a one-month extension as I can get more medical exposure and training.

*This list is not exhaustive - I can't find an abbreviation for epilepsy, leptospirosis, melioidosis, deliberate self-harm (paraquat, organophosphate, corrosive agent ingestion), alleged snake bite, dehydration, non-compliance. And let's not forget the medical emergencies.

Monday, September 5, 2011

The First Eid As A House Officer


I hope it's not too late to say Eid Mubarak, everyone!

Today, I'm on my ON shift; it starts at 10pm until 10am tomorrow.

So I usually use the free time I have during the day to 'live' a little - I wash my clothes; I buy grocery supplies; I edit the pictures I've snapped and share them with you people; I write this blog; I take a joyride on the scooter, letting the road take me on an uncharted adventure through Kampung Paya Luas behind the hospital; and many other stuff unrelated to Medicine.


Initially I didn't plan on getting any Raya leave as I've been taught that sacrifice in the early years of medical profession is a given.

But then, during the departmental Raya meeting, my off day was coincidentally on Raya day 1. So I thought, I might as well get leave on Raya day 2, so I can spend my last Raya as a single person with my family.

Iftar as a single person.

For my department, getting an off day meant working the ON shift the night before. In other words, I was to work on Raya night amidst the happy Takbir and cheerful firework sounds in the night air. Oh, how it'll hurt.

So I informed my parents of my two-day leave and Dad planned to come and fetch me after Raya prayers. I planned to finish my work earlier and leave for prayers earlier (at 9am). I was expecting little work on that night.

Usually as Raya day approaches, the admissions would drop, chronic patients would request for AOR (at-own-risk) discharges, and cases at A&E would request to not be admitted.

But not this year.

Iftar at departmental level.

When I reported for duty, there were more than 10 new admissions that night. What the..!

That's the number of admissions on a normal day until midnight. As it turned out weirdly this year, patients requested to be admitted, not many patients requested for AOR discharge, no deaths and no terminally ill patients. So the ward was choke-full of patients on Raya night.

It's not a problem to clerk new cases, manage them, take blood and present the cases to the MO. Plus, the specialist on-call planned to come the next morning. So, no pressure there too.

The problem was taking the routine morning blood for tests.

That early morning, after finishing rounds with the MO (total new cases: 17), I only started to collect blood at 6am. Blood collection by a junior HO in the medical department usually takes 5 hours if done alone.

I take my jajan breaks and pray Subuh when I got bored or pissed off at veins of an IVDU patient.

I favoured the blue needle since it was small and less traumatic to patients, but I found that it was slowing me down if I didn't get the vein on the initial prick. Fatefully, the supply of blue needles on the blood-taking trolley ran out. So, I decided to use the green needle (a slightly bigger caliber needle).

Surprisingly, my work became a lot faster! It was easier to find runaway veins, hit arteries, draw blood, less sample lysis, and since they're rarely used, there's tons of them on the trolley.

But that deciding factor came too late. I finished at..


So, I missed my Raya prayers.

Dad, who came to fetch me as early as 8am, was forced to wait for me after Raya prayers for 2 hours. I felt horrible for making him wait, but he said that he made use of the spare time learning Arabic via audio CD, so I was a bit relieved.

I slept on the journey back home to Bangi.

My family spent one night and one day in Gopeng, Dad's hometown, visiting relatives, paying respect to those who've passed on and ate a lot of kuih Raya.

I'm sure my younger brothers missed the joyful mood of Raya this year but for me, I enjoyed this little time even more. Somehow, after talking to dozens of strangers, feigning interest in their lives, my communication skills with my relatives have improved.

That, or either I've matured (I don't think it's the latter).

p/s My first pay was spent on duit raya for my brothers and some smaller cousins :) 

p/p/s Me - taken yesterday. No weight loss or gain. Macho as ever.