Ramblings from The East

We meet again, my wonderfully neglected blog.

It has officially been.....37 days since I started working here in Sandakan, Sabah.
Don't get me wrong, I asked to work in Sabah.
I had many reasons actually
- I've never really been far away from my family, and at 28 years old, it is about time i learned to be more independent.
-I wanted a fresh start at things. 10 years in UM is longer than the life i'd lived in Penang. I was getting claustrophobic
-I needed to get away from all the drama, the people, the heartbreak, the frustrations, the empty promises, the so-close-yet-so-far. Enough.
-I wanted to be more hands-on at work. Everyone says you'll get good training in Sabah.
-I definitely don't mind the extra income
-I've had enough of the bureaucracy that money can buy, the ungrateful city dwellers. I'm not running a business, I wanted to provide help where help is needed.

Anyways. I wasn't going in with my eyes closed. I was aware of the 'unregistered population', and the problems of limited resources....but you'll never really know something until you see it first-hand or get smacked in the centre of it.
To me, it is depressing.
The first question when i get a referral, or see a patient breathing with an oxygen mask on her face becomes "Kakak ada IC tak?"
I have no intention of getting into the politics of it all, of how some are citizens and some are not. Have I had any inkling of interest in the political/admin side of things I would have joined politics and believe me i have enough strings to pull for that.

You see, back in med school, and in all the Millennium Development goals, in anything that advocates the growth of a population, the improvement of living standards, the alleviation of poverty and/or suffering; it has always been about Education, and Healthcare.
And here, i see first hand of where both of these have gone wrong in what i can only imagine is the continuation of a vicious cycle that has been inherited through generations.
They dont seek healthcare because they dont know any better, and truthfully, they cant afford any better.
And they arrive in the middle of the night with fantastic time-bombs and complications to the explosive delight of the on-call medical officers.

With limited resources that borderlines on neglect, many are forced to......'improvise'.
Some things seem inhumane, but it really is the only way left. Coming from a cushy, privileged, top notch hospital where i was from, I still havent quite adjusted to that. In all honesty, part of me refuses to. I've been laughed at, by friends in similar situation, for my inability to just do it.
"balik semenanjung je la Dima".

Today i found myself driving aimlessly. Good thing about this place is that it's basically just one long straight road that leads to everywhere. I passed stretches of road bordered by overgrown weeds that are probably more than half my height. I passed bumpy patches with no street lights. I was lost in my thoughts, until i saw Klinik Kesihatan Batu 10, and i thought, "you mean i'm still in Sandakan?".
The iceberg phenomenon dictates that what i see is only 10-20% of the real situation and once again i thought of the patients: is this what some of my patients go through to get to hospital? switching 2 bus rides in unlit roads? some coming by boat from go-knows-what island?
You folks in KL have no idea how good you've got it.

Many times i've been told: i'm an idealist, i only see things a certain way.
And i strive for it, with a hint of perfectionism that more often than not, fails.
And i get disheartened, disappointed.
Conclusion : maladaptive coping skills.

More than ever, the words of my teachers, my seniors, my friends ring strongly in my mind:
Dr. Bharti said "you see, that person may be simply one of your so many patients but to them, you may be the only doctor they ever see"
Dr. Susheela said "i'm surprised that Medicine has not hardened you, which is good...dont lose it"
Dr. Shazni said "sebenarnya kan, the challenge of being a doctor is hati jadi kering"

Well.
I did not remain in this profession to lose my humanity.

Here's to a few more weeks of tagging, skill-acquiring and knowledge reviews.
Cheers.

28 Things That Make Me Smile

Here's something I've not done before.

I'm always reflecting and recollecting and writing on events and experiences, in hopes of never to forget them.

Since I've been in a really great mood since yesterday, I thought of making a list of things never fail to make me happy coz well...I forget how to be happy sometimes.

Happy (very) Belated 28th Birthday to me!

Here goes :

1.  A hot cup of coffee on a rainy morning.

2.  The luxury of rolling in bed and not having to go to work (or anywhere) all day.

3.  Really good chocolate anything.

4.  The beach, being at sea, the sound of waves.

5.  Receiving a text from the person I like.

6.  Dancing.

7.  Baby animals.

8.  A long drive in clear roads.

9.  Thinking up and Googling my next trip.

10. My sister.

11. Random acts of kindness/helpfulness.

12. Learning/trying/mastering a new skill.

13. Meaningful, extended conversations with friends.

14. Looking at old photographs of my family members.

15. Having a suitable occasion to wear my high-heeled boots.

16. Uninterrupted reading time.

17. Barbecue gatherings.

18. Great teamwork.

19. A good massage.

20. Fresh flowers.

21. A lively, energetic, majestic, emotive musical.

22. Certificates.

23. Finding the darn thing I've been looking high and low for the past number of days/weeks.

24. Aromatherapy oils.

25. New underwear.

26. Browsing slowly through a pharmacy, a bookstore, a pet shop, or a grocer.

27. Reality-based jokes.

28. Seeing loving, elderly couples.

That's all! :)

Where do I go?

It is approaching the end of March.
This means I have about 6 months left of my housemanship...provided I don't get extended of course.
I'm currently half way through my 5th posting which is Obstetrics & Gynaecology; a posting I had intentionally saved for when I was competent enough to function independently as a houseman.

It is no secret that I enjoyed O&G as a medical student, and that I was considering to specialize in the field one day. Having said that, I didn't want to make the decision prematurely before actually working in the field, knowing full well that working in it is very much different that my student days.

The questions in my mind are:
1) Do i really want to go down this road?
2) Should I stay in PPUM as a service MO in O&G? (which i stand a good chance, because the O&G department has only 1 service MO at the moment)
3) Should I go out to other KKM hospitals, to gain experience and perhaps independence and confidence as Medical Officer?
4) Should I register and sit for the November MRCOG or should I sit/apply for Masters?

1) Do I really want to go down this road?
OK. O&G has always been a familiar field to me, thanks to my mother. She doesn't even seriously push me toward the field, I'm just drawn to it. More towards the Obstetric side (mother & child) rather than the Gynaecology side (reproductive health, cancers, etc.). Growing up with my mother, I know how demanding & stressful the field is. Not to mention the fact it is the most litigious specialty in Medicine, simply because everyone wants a perfect child, and needs someone to blame if/when something 'goes wrong'. At the moment, I don't have a family to think about...as in, I don't have a husband and a child whom I'm solely responsible for....So O&G makes perfect sense.

                                 

But what are my hopes, what are my dreams aside career ambition and the thrill-seeker side of me? I do want children. I am 28 this year. No two ways about that. Though friends & family don't take me seriously when I say it, I am considering adoption by the time I'm in my 30s.
Financial stability, independence, wisdom/maturity (hopefully) : it just makes sense.
But if i DO decide on going down this career path, i'd probably live the job.

2) Should I stay in PPUM as a service MO? 
Truth be told, I'm sick to death & claustrophobic with UM.
I have been in the UM vincinity since i was 18 and registering into PASUM. Add to that my prolonged stint UM medical school. Add on my 2 years of housemanship. There you go, 10 years if my life in UM and i'm not even 30.
Aside from that. The good part about staying in UM is that you learn from the experts, the frontliners of research and progress in the local setting. You are exposed to academia. resources are (somewhat) plentiful. You are trained the correct way right from the start and dont get the chance to develop bad habits. Senior colleagues are always around to help/guide, and you KNOW they are capable of teaching coz they are...well...lecturers!
                                 
Being a houseman in UM, i always hear my MOs complain about how castrated they feel because back in their old KKM settings they had more leeway and independence to do things as opposed to the setting in UMMC. They complain that housemanship in PPUM in crap, in a sense that we are pushed to the background doing running around donkey jobs and menial tasks instead of hardcore clinical learning and developing crucial procedural skills. They lament on being 'downgraded" : MOs doing HOs job, HOs doing nurses & PPK & clerk's job. And now myself as a senior houseman, I agree! I'm no more than a glorified phlebotomist & appointment secretary.
What they also say, here in UMMC we tend to over-order things, just because resources are available. Once again, I agree. The scan appointments I'm requesting for : I can't tell if these are standard practices or are they for research purposes. MRI/MRA Brain for every stroke patient? MRI Pelvis for a fibroid? Cardiac perfusion MRIs vs. Stress myoview (nuclear medicine) vs. CT coronary angiogram vs. Stress test vs. Structural Cardiac MRI for my cardio patients. Perhaps this may be due to my own lack of studying, but still, we do learn from our daily routines.

3) Should I go out to other KKM hospitals, to gain experience/independence/confidence as Medical Officer?
                                                  
This is just further add-ons to my previous point.
I remember back in first year medical school, my anatomy lecturer Dr. MK Bharti.
She used to say 'you have to become the doctor who can survive anywhere, the kind of doctor who can work under a coconut tree'. Meaning to say, rely on your basic knowledge, develop good clinical skills and not be dependent on the latest techno gadget and hi-fi trend, because you never know where you might end up and what kind of situation you may get yourself into.
I'm inclined to believe her.
Yes, I'd love to be a doctor with a specialized skill set....that's what being a specialist is all about.
But I'd also like to do justice to the title "Dr."- i dont think I've earned that yet, and I'd never truly feel like I've earned it if I dive into a specialty too early.
There is no right or wrong answer, however.....
                                      

I dream of getting myself involved in programes like these. I remember watching a ?documentary about Doctors Without Borders on Astro back when I was in high school, and it is truly noble what they are doing. Going to where help is needed the most, and this is exactly what I envision medicine to be.....
Not entertaining the primadonnas I meet in the wards, and the ungrateful write-to-media relatives that accompany them.
                                        
At the end of the day, I just want to do good.

4) MRCOG or Masters?
Truth be told, I actually decided to sit for the Part 1 MRCOG exam in November.
I thought there was no harm getting in gear back to studying, refreshing my knowledge, relearning the basics with new eyes.
I was just waiting for regitrations to be open in April.
I was looking at books online, and creating a shortlist of which ones I want to buy.

                                           

Then my Head of Department told me not to.
He says the ministry may be working toward creating a dual system of specializing, and having your MRCOG would 'disqualify' you from masters. Apparently what has been happening is that some candidates sit for both and when they pass their MRCOG, they quit the Masters program hence 'wasting' the space. I don't know how true that is.
He told me instead, to sit for the Entrance exam; a prerequisite for the Masters in O&G.

                                                         
Something I never considered. The Masters program is more rigid, structured, I think....like going back to school. I can always sit my MRCOG after completing the Masters program if I still want to. Masters, is recognized in Malaysia, and a few other countries. MRCOG is worldwide. MRCOG is studying at your own pace (within the allowable time frame & attempt limits), being in a recognized training hospital, joining/enrolling in revision classes and clinical workshops at your own volition. Masters, i haven't read much about.

And so. After all that.
Where do I go?

Reflections of 2013

New Year's Eve.
The New Year.

It has always been my favourite holiday in the entire year. Perhaps it is the spirit of hope and new beginnings that i relish...a time to forgive yourself and start anew, a blank slate. A time where people reflect on the year that's ending, wondering on the ups & downs and memorable experiences. I'm here to do the same.

Let's see.

 On the job front, 2013 is the bulk of my Housemanship training. Started the year finishing Orthopaedics, went on to Surgery, then Medical, and now Paediatrics. I'm proud to say I'm surviving! Better yet, I realized I do enjoy working in the medical field; although not in its entirity but enough to keep me going. In my 2 stints as HO Team Leader, may I say I think I did a pretty good job: everybody got the leaves they wanted, everybody who wanted to go home for elections managed to do so, no team/ward had to function with shortage for extended periods (I was lucky we had enough manpower during my time), and nobody died! Haha. There will always be disgruntled customers though.... I admit the stress got to me; I wasn't particularly cheerful/pleasant to be around.

Oh well.

 I met several patients that turned my gut inside out, patients that remind me that there is good in this world, patients that show me that love isn't an abstract concept, patients that made me regret entering this profession, patients that make me question my future and the direction I'm heading. I've had bosses who have shown great appreciation for my smallest, most measly contributions, and others who disregard all I've done after one blunder; seniors who were patient with me and generous with their knowledge, how I wish i could thank them all!
And so, I welcome 2014 (hopefully) with my most anticipated posting, Obstetrics & Gynaecology.
And I say....bring it on!

On the er..."recreation" front.


Well, I'm glad to say I managed 2 dive trips this year, a total of 7 dives; all of them in Sabah. And it was wonderful. The planning and anticipation starts looong before the actual trip, and each correspondence via email with the dive companies fans my excitement! And because I go by myself, I get assigned random diving buddies. Met a bunch of almost-graduating medical students from UK, a Canadian (teacher, was it?) who was also travelling alone, a Singaporean father of 2 who just recently introduced his children to the joys of the beach, a lady from Holland who is taking her Divemaster course. The instructors were just as colourful : local Sabahans (one with the same name as my Dad, mind you...funny coincidence he was my partner on my birthday), Filipinos, English-Iban....

Even the boat ride to the dive sites was liberating....I find freedom in the whirring engine, splashing foam, and blasting winds....I didn't even care if it was raining. Then there's the dive itself....It's fun to tumble from the boat...scary when i first decend and adjust my buoyancy....even scarier (but empowering) is when you realize that you are voiceless under the sea. It is just you, your thoughts, and the wonders of nature. Knowing that even 2 dives at the same spot on the same day will never be identical, makes each dive special.

Aside from diving, I also went to Singapore twice....for musical theatre!

Since I've started working I know it will be close to impossible for me to dabble in theatre again...I have looked up classes/workshops but fitting it into my schedule is a bitch! (even with me making the master timetable!). So instead, i participate in the audience.

I went to see Dirty Dancing, which was totally  amazing (say what you will!). I was in the very front row, and the energy of it all was radiant! Oooh, how I wish i wasn't the uncoordinated klutz that I am... I got a bonus:

managed to meet the cast a few hours after the show....in the gelato shop next door! Beautiful people,

talented people, and friendly.

The following month, I went again for The Phantom of The Opera. I admit, watching it live is one of my so-called 'bucket list' items. I haven't crossed it off though....I wanna see it again someday in Broadway or West End....or even Sydney...Somewhere that I know the opera house/theatre has the capacity to house a show of this calibre....Some time when I have more money! But yeah, the experience was wonderful. I was lucky to watch Brad Little play The Phantom : a role he has played on stage over 2000 times!

What else...
On the "close to home" part..

I lost an aunt to breast cancer. I admit, i barely knew her, but we bonded over long chats of life, religion, and relationships during my med school final exams. We never got to meet up; I kept postponing it and she was never quite well. Her passing caught me off-guard, and I managed to persuade my relatives to take me to Melaka for her funeral.

My sister graduated with her ATCL Diploma, something she has worked so hard for despite my family's initial resistance : her passion for music. If there's something I admire about my sister is that she knows what she wants and is not afraid to get it, by whatever means necessary. Having said that, it was the proudest moment of her life, even more than graduating from law school...and now she's doing her Masters in Music, right back in the family Alma Mater, Universiti Malaya. And, she's a tutor there too! For the generation of school-leavers enrolled in the Foundation programme....which, if I may add, that she helped to draft and got it running! So yeah, I'm proud of my sister, I know she's happy. Oh and did I mention that she has a guy who is, honest-to-God, truly cares for her? In the (2-years?) that they've been together, he has never made her cry, he's always there for my sister, more than I ever was. I just wish family politics could stay out of it. I wish them happiness, I know my sister is happy...maybe even at peace in comparison to her previous years.

My mother has a new pool! It's totally awesome. I brought my highschool friends+baby for a swim! It was a great weekend. Overall, I'm glad that my relationship with mum has improved....I think in large part because I'm working, and doing OK...finally, I'm not a loser after all. I admit, I shut her out a lot....I can't bear to show her my moment of weakness and vulnerability....I only call her once everything is OK, so that she KNOWS I'm OK. I can't imagine life without her. Everytime I think about it,it breaks my heart that she's all alone in Penang...not because she's dependent of fragile or can't survive....she's MAMA! But I just don't want her to be alone.

My dad, on the other hand...well, I haven't spoken to him in 3 months. Let's leave it at that.

Both my grandmothers are healthy. Each day they're around is a blessing. Somehow, my grandmothers manage to zero me on reality whenever i get to caught up in something. My mum's mum just KNOWS whenever i seem a lil off...i wonder if she bugged my room... My dad's mum, in her more conservative ways, always manages to remind me that I need my family, and how I yearn for structure and stability.

Oh, 2013 is also the year i gor my own vein cannulated for the first time, on account of terrible gastritis, to rule out pancreatitis!  2013 is also the first time i got my hair dyed :)

So I guess that's it!
That's all I can think of, my 2013 in a nutshell.
I have an inkling to what 2014 has in store for me :
-decisions on career path
-turning 28 (yikes!)
-building/finding stability

Have a Happy New Year.
Cheers!