The Academician

Salam.

We come to a crossroads at the end of our housemanship. Although we aim for posts with less work, most of us continue on with district MOship; others get admin jobs at health-related departments. Me? I took the road less traveled, quit  and joined my alma mater, USIM, to serve as an academician in Paeds.

Joining Paeds justifies having toys at your desk.

 It's not a popular move at HoSHAS (only 1 HO joined a university since 2 years ago), given the fact that the pay was not that good at that time, the job scope was unclear and that most of us still like hands-on work and disliked research. But I joined anyway. I love my university; despite not agreeing on certain elements, I still need to take care of it.

Damn, why am I so handsome?

Looking back, the first batch was often reminded to join and serve the university since Year 1 of medical school. The seniors knew that every first batch has a certain unwavering loyalty to the medical school (given successful past examples). A loyalty forged from hardship - the lack of teachers, the infantile administration, the uncertain future. We struggled as a trial-and-error batch and from that hardship, the faculty prospered into what is it today. After all that hard work, nobody wants to see it destroyed or neglected.

The Oath of the Muslim Physician.

So, after settling thick paperwork, I'm now back to Menara B, Persiaran MPAJ; only this time, I have a cubicle on Level 13, complete with a computer and telephone. I was also joined by my sidekicks - Hafiz and Miqdad - who, like me, are USIM graduates who just finished housemanship. Our job for now, according to the Deputy Dean, was to "help around, taste the academic life, understand that it's publish-or-perish!" and then, do clinical attachment in our field of interest before joining a postgrad programme within 2 years. 

Helped around, we did.

Every one I know is working their asses off and I'm just sitting here.. contemplating.

The first week was a culture shock. We were used to running around the hospital and being active, but after joining, we sat around doing nothing for the first week, punching in and out punctually daily while our colleagues in KKM continue to improve as MO's. I admit that I was a bit jealous and worried about being stagnant and rusty, but that worry slowly faded as work piled up little by little.

Baby Balqis also helped to give marks.

We briefed the Year 1 students about medical school life. We helped to teach systemic physical examination to the Year 3 students. We attended the clinical lectures (Hafiz even delivered one lecture!) and seminars. We followed the ward rounds and highlighted important clinical management and items that the students missed or were too shy/afraid to ask the specialist.

I shadowed a professor as he conducted short cases during the end-posting exams.

We  looked for patients for clinical exams at Ampang Hospital, managed the clinical exams and invigilated over the written exams. We also marked the case write-ups and tabulated the end-posting exam marks. We also squeezed out brain juice during a workshop to update the curriculum.

Don't ask us any questions because we don't know the answers ;-P

As for extra-curricular work, we attended the Medical Students Club annual meeting, set up the faculty Hari Raya booth at Nilai Indoor Stadium, got involved in the USIM Annual Health Conference (I was made to be the MC because I was handsome) and most importantly, played futsal with the students. 

We are also planning to set up a USIM medical graduates alumni soon. 

Baby-friendly meetings.

Oh, also, locums.

Of course, not all of the first batch mates are interested in joining USIM back. Some wanted to delay to get more hands-on experience first; some got extended during HOship; some sent the CV late because they underestimated the horrors of district posting life; some don't want to leave Kuala Terengganu. 

But no matter how much negativity we took from the undergraduate life, all of us still want to serve USIM within our means. Because we love FPSK USIM.

The Perhentian Pitstop

Salam.

I went to Pulau Perhentian for my end-of-housemanship holidays.

As an outdoor enthusiast, I sought basic services for the minimum price - to rekindle those mountain-climbing hardship days.. and because I'm a cheapskate too (saving money for a PS4). After searching on FB and jumping from one holiday blog to another, I decided on a fairly cheap snorkeling package to Pulau Perhentian for a group of three adults (me, wife and Bro #2) and one cherubic baby.

Why snorkeling? Because my wife has never snorkeled previously.

Why bring the baby? Because the breastfeeding lady has never snorkeled previously. 

Why bring Bro #2? Because he's the baby's caretaker while Daddy accompanies Mommy on her virgin snorkeling experience.

Why Pulau Perhentian? I've been to Pulau Redang; it's beautiful but very commercialized. Pulau Perhentian on the other hand is relatively untouched.

Why this package? I'd like to think it as giving the local entrepreneurs a fighting chance against those big resort companies. Sure, some things are substandard or relatively expensive but a little sacrifice is always needed to help the underdog. Think of it as sadaqah.

It was a 3-day, 2-night package (2 rooms, 1 snorkeling trip, 1 lunch) for RM800.

DAY ONE

We started our trip from Kuala Besut jetty. A pretty standard 30-minute boat trip for me; but it was a whole new experience for the little lady. Initially, she was uncomfortable by the wind blowing in her face and the occasional sprinkle of seawater, but later she acclimatized. She even dozed off during the last leg of the boat trip!

So many chalets to choose from.

White sandy beaches, cool sea breeze, de-stress.

Upon arrival at Coral Bay at Pulau Perhentian Kecil, we were greeted by clear azure waters, cool white sand and a gentle breeze.. in the middle of the afternoon heat! We quickly registered at Amyn's chalet and stayed indoors until the sun forgot about us and began its descent into the west.

Happy nucleus family :-)

The rooms were basic - they each had a queen-size bed, a bathroom, a flimsy desk, a chair, a ceiling fan and standing fan. Why two fans? Because it almost sweltered in the rooms during daylight. To make it worse, there were no windows. That translates into poor ventilation. A sweating baby is an uncomfortable baby; a crying baby means unhappy parents. Did I also mention that there were occasional power outages due to depleted diesel for the generators? No electricity means no fans.

Anyway, that evening, we crossed over to Long Beach, the west side of the island - a 10-minute walk along a trek across some shrubbery - to view the sunset and let Princess Balqis have her first experience swimming in the sea.

"Sea water tastes funny, Ayah!"

 There were many orang puteh sunbathing at Long Beach. With a windmill in the distance, the scene was like being in a foreign country. Too bad it was not a nudist beach.

DAY TWO

The main programme started on Day Two - a marathon snorkeling trip over five points, starting at 9am until 3pm.

I was eager to snap some underwater photography. In my unrestrained excitement, I foolishly dunked my Fujifilm X10 (wrapped in cheap sealer bag reinforced with cloth tape - don't laugh, it seemed plausible at that time) into the water to snap some pictures. I took two pictures before the screen fizzled out on me. %^&$!*

I was saddened by the loss but I didn't have time to wallow; I still wanted to snap some underwater pictures, so I rented an underwater camera for RM70 per day from an IT shop operated by some OA.

A waterproof camera in an waterproof casing.

The first snorkeling point was Turtle Point. When the boat came to a stop, the guide pointed to a flock of snorkelers following something underwater and said, "Turtles.". Honestly, that word was enough to get my attention. I immediately jumped into the sea and chased after the superstar. I unceremoniously left my wife on the boat with the baby - I was supposed to accompany her on her first snorkel!

I chased and chased after the turtle until I was able to stroke its shell. From a physiological POV, my fingers felt a mossy sensation from all the sea flora growing on the shell. From a psychological POV, I TOUCHED A TURTLE WOOHOO!!

Just like AC4: Black Flag.

The next point was Shark Point where we were supposed to see some sharks. We saw none. But at least, wifey gets to do some snorkeling.

After snorkeling for a few minutes, she forgot that I ditched her for a turtle.

The next point was Coral Point. There were some corals here; mostly dead ones. Some curious fishes. Standard snorkeling stuff.

Then, we took our lunch break at the fishermen village on Pulau Perhentian Besar. I saw a school, police station and a Klinik Desa on the island. Man, it must be cool to live and work on the island. Instead of rempit, you go island-hopping.

No, it's not a mamak stall.

We continued our adventure at the Diving Point. The guide stopped the boat at a mini lighthouse, stripped to his trunks and began climbing the lighthouse. Then, he jumped 15 metres into the sea. It looked fun! So, I thought, why not? 

Climbing up was uneventful but once at the top and looking down - and seeing how small the boat was - that was when I experienced a tinge of fear of heights. But before I had second thoughts, I jumped. 

The only thoughts going through my mind at that time was, "HOLY SHEEEEET IT'S A LONG TRIP DOWN! PLEASE LET ME HIT THE WATER AS QUICKLY AS POSSIBLE BEFORE I REACH TERMINAL VELOCITY!!"

I safely landed on my butt.

It was only when I was back on the boat that I realized that my knees were shaking with fear and adrenaline. Slightly tachycardic and nauseated, but otherwise conscious and enjoyed every moment of that leap of faith. Despite the excitement, I wasn't going to jump from anything for a long time.

The last point was Romantic Beach. A long strip of beach on Pulau Perhentian Kecil that has calm sea water, some corals and plenty of colourful fish. We snorkeled to our heart's content, knowing that this'll be the last snorkeling point for a long time.

The curious brown fish.

DAY THREE

We went back to Kuala Besut in the morning. It was a very enjoyable holiday and I'd recommend Pulau Perhentian to anyone considering a nice relatively isolated place to de-stress. I didn't buy souvenirs because I don't really believe in them. It's like saying, "I've been to this place; here's something to remind that you haven't been here."

* BTW the camera repairs costed RM385.

The Emergency Medicine Posting

Salam.

The Emergency Medicine posting is the last piece to the whole housemanship experience.

HoSHAS Emergency Dept a.k.a the de facto hospital information counter.

During this posting, one will learn, experience and manage the whole spectrum of medical diseases as a preparation for MOship. When I say 'spectrum', I mean all diseases and conditions covered during the five previous major postings, from the mundane outpatient cases to the adrenaline-inducing emergency cases. 

Think oneself as a junior MO instead of a final-posting HO to get the brain firing up in preparation for the wild world of district posting.

So, that's why it's important to familiarize oneself with the common cases, procedures and drugs during each posting. Alas, that epiphany only comes the first time you see a patient in the consultation room and wonder what the heck you should do with such cases. Before you experience that regret, I'm telling you now: jot down important notes in a small notebook during each posting. By the time you come to A&E, you'll avoid significant anguish when you have five notebooks readily available all the time.

I prefer to use the abbreviation A&E which stands for Accidents & Emergencies (it unofficially stands for Anything & Everything as evidenced by the retarded number of unnecessary green zone cases). ED which stands for Emergency Department sounds impotent. 

The A&E is divided into red, yellow and green zones plus an observation ward. Patients who come to A&E are triaged accordingly. Triaging is one of the basic principles of Emergency Medicine. All A&E staff can and will do it anytime/anywhere. Its purpose is to determine who deserves prompt treatment and who doesn't. 

For example, a 40-year old smoker presenting with chest pain:

• If he were breathless and clutched his chest, the triage MA will, without asking a question, automatically think of myocardial infarction, grab a wheelchair and rush him straight to the RED zone. 
• If the same patient comes walking in and complains of chest pain, then he will be sent to the procedure room first for ECG then re-triaged depending on the ECG (or sudden deterioration depending on your luck). If the ECG is mildly abnormal or vital signs are not stable (e.g. very high BP or tachycardia), then he/she will be sent to the YELLOW zone for further workup.
• If the ECG is normal and the vital signs are normal, he/she will be sent back to the GREEN zone for proper consultation.

That means if you come with fever, cough and sneezing, please shut up and wait while we attend to guy with the broken neck or the lady with excessive menstrual blood loss. 

Empathic pain - can you feel it?

There are other red flags signs and symptoms that warrant immediate management e.g. unconsciousness, fitting, or very rapid breathing. Pregnant ladies in late pregnancies involved in non-obstetrics conditions are also sent to the A&E. Referrals from KK and smaller hospitals also get the same triaging; they are usually referred for further workup or further management.

The UK NHS Choose Well campaign aims to reduce unnecessary A&E cases and hence, the posters above. But can such campaigns work in Malaysia? Can people recognize simple URTI, AGE or allergic reactions? Do they know what medications they need and are usually prescribed? The answer is no, yes, yes. People will still flock to the A&E because they want the best treatment for such ailments which is a government MC.

Typical day in the green zone.

As for my 4-month HO experience, I found that each zone has its own learning curve. The red zone is a place for immediate diagnosis and management; the patients have clear-cut symptoms and signs; treatment usually follows guidelines e.g. ACLS for heart cases, EGDT for septicaemic shock and primary/secondary survey for trauma. The yellow zone patients are usually stable and have masked or less dramatic symptoms; it's a place for thorough examination and investigations; if you miss something, it will come back to haunt you. The green zone is where the drama takes place; patients who don't understand triaging and complain about the long waiting time mentally write their complaint letter in the green zone waiting hall.

Once a life-threatening condition has been ruled out or unstable patients have been treated and stabilized, the A&E team will refer the case to a primary team. While most cases are usually accepted and admitted, there are times when cases are rejected or asked to refer to another team first. Sometimes, argument ensues between teams when both teams don't want to accept a case. When that happens, we sit back and enjoy the show.

The end of Emergency Medicine posting signals the separation of friends, the trial of the bonds forged during hardship and stress, the pursuit of further career advancement, the end of the gauntlet of clinical life and the beginning of a life filled with responsibilities.

Last day in HoSHAS. Will be back as paeds trainee lecturer at USIM.

Good bye and good luck, peeps!

The Smartphone Lenses

Salam.

I recently dabbled in the arts of online purchases and a whole new world of wallet-burning opened up in front of me! Usually, I'm a bit suspicious when it comes to online transactions but seeing that I'm not getting any younger, I threw caution to the wind this one time.

I bought a set of smartphone lenses from Photojojo for USD49 (that's about RM150).

It was a fun purchase. Experiencing the whole process from payment to delivery was an eye opener. After online payment via debit card, the items are packed and then delivered from the US to Malaysia. The package tracker was an anxiolytic - I got to know where my package was at the moment; no need to wonder whether it was still in the US, or got lost over the Atlantic ocean. And in fifteen days (faster delivery means more expensive fee), I got my lenses.

The way they work is by sticking a metal ring over the camera lens. The lenses have magnetic rims, so they automatically attach to the metal ring - on any phone! The magnetic power of the lens is adequate to support the lens despite significant movement, and it's easily detached. I dunno about the effects on the smartphone innards but so far so good.. haha.

I've been using the lenses for a week (mainly the fisheye lens) and here's some of the pictures.

So I guess it's goodbye to the Lomo Fisheye camera?

The Fasting Month

Salam.

I suppose it's not too late to wish everyone a blessed Ramadhan.

IFTAR AT WORK

For me, it's my third time as a HO. The first time was during tagging in medical posting. I had to break fast with dates that I snuck in my white coat while clerking new cases during Iftar. Now in the emergency posting, I sneak out to a wholesome meal while clerking new cases during Iftar.

It's all about prioritizing and time management ;-)

IFTAR AT HOME

Whenever I get the time (after NO and working PM or ON the next day), I'll go back to Bangi to break fast. I've been coming back home a lot these days. Usually by express bus followed by the LRT.

Aim: to meet my daughter but more importantly, she gets to meet me.

Plus, with the missus occupied with her finals these few weeks, she could use the rejuvenative sleep that's usually denied by the nocturnally active baby. So that's where I come in - I play with my daughter in the middle of the night.

After all, who could resist this cute face nudging you to entertain her in those ungodly hours?

The First Mobile Post

Salam.

I'm familiarizing myself with the Blogger android app. For those who expected an awesome post or something new to learn, know this:

The difference between ikan patin liar and ikan patin sangkar is the muddy smell when the latter is cooked.

New knowledge. Boom.

The Update

Salam.

I know, I know - I have a lot to explain for my absence from the blogosphere.

I haven't been writing for almost 1 year and a half (from my second HO posting until my sixth posting). Housemanship tends to do that to people - it drains out one's zest and interest. After a long, physical day at work, you come home beat up and just collapse on the bed. I also haven't been playing video games and taking pictures as much as I used to.

I can't also write or show pictures that are medicolegal.

I also have new commitments in the form of a lovely wife and a baby daughter. I got married to my junior in medical school in late January 2012 and a baby popped out a year later. Both have been wonderful and colourful additions to my otherwise bleak life. 

My happy family.

In addition, the age of connectivity made blogging a bit irrelevant - Facebook, Instagram, Twitter, WhatsApp - just a few phrases needed and voila! I've shared my thoughts to the whole world.

But having said that, I still feel like I missed a lot in sharing my crazy experiences as a HO. So here I am trying to redeeem myself. I'll share what I still remember but it won't be as much fun and riveting (?) as when I'm writing it in the heat of the moment.

Pre-haze KL skyline.

BTW, I have only 1 month left before finishing housemanship. Instead of getting thrown out into the wild world of district posting, I'm planning on joining my alma mater as a trainee lecturer. Because I'm the academician FPSK deserves, but not the one it needs right now. So I'll come back. Because I can take it.

I'm not a hero; just a silent guardian. 

A watchful protector.

An FSPK Alumni.

The Comeback

( •_•)     

     

( •_•)>⌐■-■

(⌐■_■)   I'm back!

* I'll write a real post soon (hopefully). In the meantime, try to find the little changes that I made to this old place.

The Base Jumping

Salam.
Once an outdoor junkie, always an outdoor junkie. All that is needed is the right time and the right amount of dough.

The Surgical Posting

Salam.

It's been almost 3 weeks since I finished medical posting.

My final assessment went well - I was asked about AEBA management and I went on a verbal diarrhoea, starting from initial management to history-taking, physical examination and investigations to further management. The key to tackling a viva voce is CONFIDENCE. And the finesse to cover up a verbal slip-up.

NEW POSTING

I'm now in surgical posting - a light posting in terms of workload made tedious by impatient bosses and TDS rounds. Plus, me being selected as the next HO leader.

The new blogger feature which fades the background to black when viewing pictures is sweet. Try it!

The common chief complaints are acute abdominal pain, UGIB, LGIB, lumps here and there (on the trunk, neck and head) and MVA (intraabdominal injury, traumatic pneumothorax and cerebral concussion).

So far, this posting can be summed up as half ward, quarter OT/endoscopy and quarter clinic duties.

Must've been one action-packed OT.

I'm currently placed in the female ward - there's less patients compared to the male ward (and less emergency/unstable cases) - but at the same time, I have to cover the periphery wards and night OTs.. which is still not that much work compared to medical posting. Plus, during ON shifts, I get at least 2 hours of nap time (never had that kind of luxury previously).

HO rotation is different for each department. For surgical department, the HO shifts are 3 periphery wards, 3 AM, 3 PM, 3 ON and 3 days off - for a total of 63 hours per week and 1.5 days of rest per week.

Scootering around town reveals many hidden gems.

Medical? 84-90 hours per week.

Am I missing medical posting? Heck no.

GRADUATION

Alhamdulillah, we finally made it to this important point - the point that everyone had been waiting for for a very long time. After all the blind meanderings on an unmarked road, we have finally paved the way for USIM medical faculty.

Terkejut macamane aku boleh dapat gambar awal? Click here.

It's wonderful to know and read about how juniors are inspired to strive harder after seeing our graduation ceremony. Do work harder but at the same time, enjoy student life while you can. Climb mountains, join debates, find a new hobby, get married, whatever.. because the moment you enter housemanship, you're going to put 2 years of life on hold.

SHUTTERBUGGING REJUVENATED

Speaking of hobbies, I've finally picked up my film SLRs after 6 months of abstinence. I missed the shutter sound, the mirror flap, the film advance, the anticipation of the resulting exposures and the mixture of satisfaction and disappointment when I get the developed products.

This is my preciousss.

And then, there's the editing and printing and scrapbooking. What fun!

First roll of film will be uploaded after this; keep up to date!

Here's a HTC Desire shot, edited (converted to monochrome, added grain) to get that film look. Not as satisfying as taking a film shot, but hey, it satisfies the addiction.

 

 Drool like Pavlov's dogs.

Looks like I won't be studying much during this posting either.