1 year in & 1 year to go!

Time flies.
It has been over a year since i started my housemanship.
I have completed Orthopaedics.
I rocked though Surgery as team leader.
I crawled through Medicine, barely alive.
Currently I'm in Paediatrics, and a team leader once again.

If this were 5 years back, I would have been an MO by now; a fully qualified Medical Officer. Now that kinda puts a different perspective on things: I try to settle things and formulate plans on my own, but i discuss/seek approval from my superiors before carrying them out.

I've had my ups & downs.
I've had days when the nurses would find me crying in a corner due to stress and exhaustion (to put things in context: i've had 3-week stretches with no off days, i was functioning alone on most days in a ward that usually has 3 housemen, and i wasn't feeling satisfied because i couldn't learn much of anything as i was too busy doing the running-around donkey work & paperwork...i have no idea why UMMC does not take in more HOs, or if KKM has limited the number of HOs they send to UMMC yet flood other hospitals time & time again). I've had nights when i just couldn't sleep, and mornings where i would throw up before and when i got to work. On the other hand i had days when my bosses/superiors were extremely nice and frank to me, giving career advice. I've had the pleasure of working with and learning from many of the staffnurses. I've made (some) friends who have showed me incredible support, help me motivate and renew my self-belief when i had none; and i've drifted from some others from the sheer inability to find common time. I've had days when i don't even remember if i've eaten, only to be surprised by the hospital food servers with some fruit, milo, or an unclaimed meal.

But i want to remark on several patients and relatives who have warmed my heart, lighting up my days whenever i think of them.

1.  There was a patient, whose surgery was postponed several times because of difficulty building her up nutritionally. It was my first few weeks, and i just wanted to insert a new branula for her to receive her TPN (simply put, intravenous nutrition). Out of the stress and despair, she got angry and just threw a fit, tired of being poked numerous times throughout her stay. I sat with her, i let her cry, and tried to see things from her side: away from her children, and husband, unable to eat, with a constant nagging tummy ache. I eventually convinced her to let me put the line in. Days later, she apologized for her outburst. I say her many times over the next several weeks, after her surgery and long recover, until it was time for me to leave that ward. I said goodbye to her, and wished her all the best. She thanked me. It meant a lot.

2. There was another lady, also a long-term patient whose dressing i had to change every other day. Once her skin got so bad, and it so happened that her dressing was delayed because i was waiting for supplies. She screamed and yelled and cried and threw things around the room because she felt neglected, mistreated. I sat with her. I let her yell at me. Thankfully the materials i was waiting for had arrived. She calmed down as i cleaned her up. Just like the other lady, i said goodbye before i left the ward. What surprised me was, weeks later, i just walked around visiting my friends at that ward, and this lady with a huge smile on her face waved at me "Dokter!!!". We talked for a while. During my oncalls there, she would always smile and wave whenever i passed by reviewing patients. My regret? I didn't manage to see her before she was discharged.

3. I had this patient who called me "Dr. Awesome". It really was amusing, and a teeeeeny bit embarrassing when he does that in front of my bosses. It always makes me laugh a little. I remember he was adventurous, and he was surprised i was a licensed scuba diver.

4. There was this elderly man, who i initially dreaded taking his blood in the mornings because he made too much of a fuss. Then i learnt something about his medical history (which i cant elaborate here due confidentiality), and i asked him more about it. He then told me about his wife, and how he cared for her after her stroke for years, until the day she passed. And now every day, he looks at her photo; he wants nothing more than to see her again. He had tears in his eyes, and said "hati jantan, u tak tau!". I cried with him. That built our rapport, and bloodtaking became easier...he said he wouldnt let anyone else take his blood because he says i dont cause too much pain. His daughter said the same thing. He didnt fault me when i failed that one day. This was during the time when we lacked manpower, and i was the only one they kept seeing in the ward, to the point his daughter asked, (almost in horror) "Doctor, don't you go home? What time do you finish?". The time came for him to be discharged, and i've explained some things several times to the daughter. I was rather pressed for time and she could sense that. So i'm back to my paperwork, and his daughter came behind the counter  with a hopeful look and said, "Sorry, doctor, i know you are very busy. My father has been discharged, he really wants to see you and say thank you; he really likes you". Needless to say, i dropped whatever i was doing and met him, saying goodbyes & well-wishes...and i told him "i hope to see you again, uncle, but not in hospital!" And i said "the hospital is the only place where if we like you, we dont want to see you back in here"...They laughed, and headed home.

5. There was this cheerful old man; he has this calm air around him. His family members were always around, and they were nice and friendly to me although at this point in time, my contact with patients was limited to the morning bloodtakings, clarifying certain facts, and elective admissions. He was in and out quite a few times. In stark contrast to the majority of patients, he had kind words to say about the hospital staff : very attentive, rapid response. It honestly came as a surprise to me as i was used to hearing the opposite, day in and day out. When he was readmitted a few weeks later, i came into the room to set his line and draw some blood. His family saw me, smiled and said "Oh, doctor, i'm glad it's you". After a brief conversation and i did my thing, he said "thank you, you are very good, no pain!" with a satisfied look on his face...and i would always say, "boss, dont say that...its minimal pain...coz once other patients hear 'no pain', expectations go waaay up!"..and he'd laugh. Then came the time he was about to be discharged, and i was explaining a few things to him and family, he asked me how much longer before i complete my training, and then he said , "Doctor, i wish you all the best, and that you specialize one day. I hope i live long enough, and you will have a private practise somewhere, i would definitely want to come and see you". I was speechless; definitely uplifted my morale, renewed my hope and self-belief that i am actually doing  something that benefits society, that i am doing good!

I guess those were the highlights. The good ones that i want to remember. 

I guess i do like my job.....for the most part! 

Tll next time, ciao!

When the Present is all you've got

I'm just gonna go ahead and start rambling.

1) Work
I've been a houseman for about 2+ months...i've just switched from the Yellow trauma team to Spine team...and it's like the beginning all over again. New bosses, new terminologies, new teammates. I can't even begin to describe how miserable i am. Of course, friends and colleagues tell me its normal coz i'm still new, in my first posting, it is expected that i'll be slow and miss out a few things. It will take time to find my footing and pick up the pace, they said. Logically, i know that. The reality; how many times can you say 'i dont know' to your bosses & colleagues without getting demoralized? Before things get better in the future, it will be hard...and it is tough now.
And i cry...a lot
I talk to friends who have moved on to different postings...after all, Orthopaedics is the most relaxed posting in housemanship (and i'm struggling)...and they're depressed. I wonder how am I gonna be able to cope. My basics are worth shit. Many a days i question my decision to stick with the medical line.
Naturally I am envious of those who do better than me...and i'm not comparing myself to seniors...just those who started around my time.
When i am off the clock, my priorities are : go out with friends or sleep. Frankly those are the only things i know to do so i do not feel so alone. Mentally, i'm too tired to study though i know i desperately have to. Lets not even begin to describe my living conditions...I'm just thankful my grandmother helps me out

2) Reminders of mortality
Last saturday a friend/colleague of mine was met with an accident. All i heard from my yellow team bosses was he's in an accident, going into surgery now. The humorous bit : he'll b admitted in his own ward, where his gf is working, operated and managed by his former team n bosses.
Back to the serious stuff.
Trying to find cosmic significance in everyday events will drive you crazy, but in this case it was a slap in the face. On that same night, I actually had plans with friends for...lets just call it an 'unconventional escapade'....and BAM! Another friend gets hit by a car. Its as if the powers-that-be is screaming DONT DO IT!!! I cancelled my plans and went to the hospital. He's actually quite alright. And awkward 'ol me, i just didnt know what to say...we're not thaat close for me to let him see my dramatic overreaction. Plus his mum n brother were there. He'll be discharged soon anyway. I had a flashback to Eizlan's accident, i wrote about it a few years back. All in all, i'm glad he's OK...rather sad that he'll have to extend his housemanship when he's sooo close to finishing...he wont be able to step on his foot for at least 2 months.

There is also another incident, this time involving my patient so i can't talk too much about it. He was quite well when he requested to be discharged. Then i got word that he passed away at home. Although he didnt pass away in the hospital, technically he is my first patient to go. I was in a somewhat sombre mood after receiving the news. There was nothing i could have possibly done. But fact remains that i was the last doctor he saw before leaving the hospital and got his discharge papers together. Its OK..perhaps he's in a better place.

I guess that's it for now. I can't think of anything else.

Housemanship @ UMMC

After a really, really long hiatus of inactivity and non-productivity, I've now started working. I haven't really had time to rest since my induction : I called the MOH office to let them know that my registration finally came through, and they told me the next induction intake was in 4 days and i had to RSVP before the end of business that day. After discussing with friends & family, I went for it.

The induction : 4 days of really boring technical & procedural talks. I didnt really know anyone else there. Anyway. I found out that i was to be posted to UMMC. Apparently, most other states were not accepting new housemen at the moment. They were only sending to Kedah, Perlis, Kelantan, Terengganu, Sabah & Sarawak. In Selangor/KL, they were only sending to HKL.

So getting into UMMC...well, i was really hesitant. On one hand, thank God i wasn't sent to Kelantan/Terengganu : the dialect itself would have rendered me a catatonic imbecile. BUT on the other hand, i really, really regretted applying to UMMC coz i felt that i needed a clean break, a fresh start somewhere else. I cannot emphasize how much i do not want to see my lecturers again coz lets face it, i wasn't a very good student. I dont want my record as a student to colour my future bosses' opinion of me, and i didn't want my knowledge/fears/preconceived notions of my lecturer's demeanour/demands/personality to affect my ability to function at work. I didnt  know what to do : the fascilitator at my induction was somewhat hostile...saying if u appeal to get into the fully occupied hospitals, or if u appeal when u've got into one of your 3 choices, you might be sent to the states i mentioned earlier. I dare not take the risk. Reluctantly, i made my peace with it.

It was a 3 day weekend, so i got an extra day off to get prepared. I dont know how others manage to pack up and leave and report for duty on monday, especially those posted to Sabah/Sarawak. But anyway, as luck would have it, i fell sick. I had to go back to Penang to retrieve my work clothes and medical books (I had sent them back months earlier, feeling so confident i would be working at Penang GH). Tired and miserable, i just had to get it done.

Fast forward a few days : I'm posted to Orthopaedics, under Trauma yellow team. Again, i wasn't so thrilled about starting in ortho but i didn't really have a choice. In my first few days i think at least 10 ppl (colleagues & bosses) told me that its not good, or a pity, that i started in ortho.  Ah, what the heck. The first few days of work was.....miserable!!! I've always hated waking up in the morning, and now i've gotta try to be at the hospital by 5.30....and of course, my feet were silently screaming n shattering beneath me. Morning rounds with the bosses were nerve-wrecking (the same way i felt during ward rounds as a student), especially so because i just didn't know how to exist there and was completely non-functional. As it turns out, i entered at an awkward time, cause the yellow team was really busy with new admissions for the week. I couldnt remember anything from med school, I cant keep track of the patients, and I had no idea what do to next...i was still recovering from my fever, and sorting out administrative details. So day in, day out....i was getting exasperated; frustrations were building up and i was too tired even to eat. I did break, and cried several times...out of frustration mostly...and embarrassment

Now i'm into my second week, and the pace has significantly slowed and i'm not as anxious as i was. My bosses are really, really nice. This week, we've had breakfast 3 times with the bosses : on their dime! And there was a food gathering in the ward, sort-of a belated Merdeka/Raya celebration. Most for the patients from last  week have been discharged, and i have a more 'understandable', 'cope-able' workload. The senior housemen in the team are helpful too...freaky coincidence: one of em is married to a friend of mine. Haha, small world. The other guy, i recognized from my obstetric posting as a student; he helped me conduct deliveries n kinda taught me to suture the tears. And the other guy, i knew coz he was my classmate back in first year...but for some reason he's a bit of a prick nowadays. whatever. he's a good houseman; just learn from him & ignore him. Also, i've met my current n former batchmates who are also doing ortho, i'm getting to know the other housemen and nurses n other staff...so right now i dont feel too much of  a sore thumb .

One thing hasn't changed : I still hate waking up in the morning.

PADI Open Water Diver Course

YEAH!!!!

Now comes the REAL Tioman story..wohoo!

On my first day there, I was introduced to my instructor, Kelsey from UK. She was really friendly, and kinda eager and excited to have students. We were only starting the next day, and she told us to be at Eco-Divers around 9am. The course would take 3-4 days, so we had ample time to accommodate.

And so Karyee, Yihou and I made our way to the dive shop for Day 1 of our Open Water course.

A bit on the course contents:

5 video sessions

200m swim test

10min float test

5 confined water sessions

4 open water dives

After filling in the registration and medical review forms, Kelsey decided to let us watch the videos first, get them out of the way. In a way it was good; it gave us a good overview as to what we'd be learning from our manuals. I have to admit, i did get sleepy by the time it was video 2-3...didn't realize diving was quite technical (facepalm)...my physics is very well rusted by now, but nevermind...the course was designed for lay people anyway. Its for recreational diving, not technical/professional stuff. The PADI Open Water Diver course is the first step for the absolute beginner...as long as you can swim a bit and you are in good health. Cost? At Eco-Divers, it was RM1050...inclusive of the manual and equipment rental.

Anyway. Once we were done with the videos, it was around lunch time. We took a break, then came back for some practise on equipment assembly. Dang, that air tank was heavier than i thought! After that, Kelsey gave us the day off, told us to look through the manual and start doing the Knowledge Reviews. Told us that we'll be doing Confined Water 1&2, Open Water Dive 1, and the swim & float tests the next day.

OK, i thought. That night i read through the manual page-by-page, barely finishing Chapter 1 (I had read through the intro from Avni's book the night before)...There were 5 chapters altogether, corresponding to the 5 videos we watched; there are mini quizzes for each subheading along the way and there is a Knowledge Review at the end of each chapter. It is compulsory to finish all the Knowledge Reviews before the end of the course as there will be a few quizzes and a final exam.

Day 2. Time to suit up!

We assembled our scuba equipment : attached the BCD (i.e the vest) to the air tank, connected the regulator (i.e the hoses) and tested everything...put on out wet suits & weight belt (as if i'm not overweight enough, i had to wear 5kg around my waist), put on our scuba unit, grabbed the mask+snorkel and fins and headed to the waters. We did our Confined Water sessions in the shallow waters instead of in the swimming pool like most people. Here learned and practised useful skills that we'd need underwater. Example, clearing  the mask, finding/locating the regulator mouthpiece in case it comes off, controlling buoyancy...a lot of other things that i cant seem to recall for now. Then we headed to deeper waters (around 6-9m) for Open Water Dive 1, where we basically just swam around and got more familiar with our equipment & adjusting buoyancy and equalizing the pressure in our ears as we descend deeper.

It was quite tiring, because we are so conscious with what we're doing....and the walk back up to shore was  particularly painful, coz we had the scuba unit on and you can feel the full weight of it slowly returning as you come out of the water and climb the steps up to the dive centre. we took off our equipment, rinsed everything and went to lunch. After lunch, we were joined by Neil, who is taking his Divemaster course; a part of his requirement was to assist in an Open Water Course. I thought he was rather cool : blonde dreadlocks...tattoos...and a left nipple piercing..hah! first time i've seen one up close.

Back to diving. Neil took us for something extra : Skin Diving. Its basically diving in shallow water with only fins and mask+snorkel. I found that to be scary, coz the water was a few metres deep and i had nothing to keep me afloat. In the end i had to grab onto the float whenever Neil was giving a briefing or demonstrating. Kelsey was there behind us, keeping an eye on everything. After skin diving, we did the swim test and the float test. I thought i could relax when floating but suddenly i heard Karyee and Kelsey calling me back coz i've drifted too far away...huhuhu

After skin diving we went back to the dive centre, put on our scuba unit and headed back into the waters for   Confined Water sessions 3, 4 & 5. Here the skills we did were more for emergency-preparedness. How to share your buddy's air source, how to breathe without a mask, emergency ascending, removing and replacing the weight belts underwater...and the worst of it, BCD removal and replace. This was the time i truly panicked coz i couldnt get it back on. We had to do it both underwater and on the surface. Underwater it was quite manageable, but on the surface with the waves pushing you here n there...well.. eventually i managed to get it back on, and i was exhausted. All 3 of us did this last skill pretty badly so Kelsey said we'll do it again the next day. She also said today was the most tiring day of the course, so we can expect lighter activity the next 2 days. I was so tired by then, i dont know how i managed to do some studying that night.

Day 3. Open Water Dives 2 & 3.

Frankly i didnt wanna get out of bed. Partly coz i was tired, and partly coz i was scared of the BCD remioval & replace that happened the day before. I didnt wanna panic n feel helpless again i the water.

I dragged myself out anyway and walked to the dive centre...put my equipment together and went into the water. We went into deeper water...about 12m and revised some of the skills we learnt the day before...swam around...and i relaxed a bit. We got up, got out of the water, and went for lunch. In the afternoon we had Open Water Dive 3 : our first boat dive. We were taken to Renggis Island nearby, and after gearing up aboard that tiny dive boat, rolled ourselves backward into the water...which was fun. Underwater we practised some skills with Kelsey, and then followed Neil's lead for the dive. This is when diving truly begins. I saw a sloping wall of corals on the side and down below...a puffer fish!....and we found Nemo!! Saw a few anemones and the clown fish that live in them. Some angelfish.... We also saw a big black eel...well, just the head really coz its body was within the reefs. Kinda scary looking. Saw a lone barracuda... and the Neil was trying to point out a black-tipped reef shark, but we all missed it...partly because we couldnt understand what he was signalling. The experience was great; i was reminiscing on my snorkelling trip in Redang a few years back and how it made me wanna go diving. Getting back into the boat was quite a challenge for me...it was hard to find my balance after being underwater. I even got a little seasick. 

That night was mugging time. I started to worry about the exam we were gonna face the next day. I was only at chapter 3! I stopped reading page to page and jumped to the mini quizzes and then do the knowledge reviews. I was halfway through chapter 4 when i decided to call it a night.

Day 4. That morning we were just sitting at Eco-Divers, finishing our knowledge reviews. Then we headed to Pirate Reef for Open Water Dive 4. Again, we practised some skills on the surface, and again on the bottom. Here there are a lot of cement blocks at the bottom...meant to be artificial reefs. Frankly i preferred the sights at Renggis. But anyway...the dive is more relaxing, and this time we went deeper...up to 15m. As Open Water Divers, our maximum depth is 18m.

Back to shore. After lunch, we just chilled at the deck at Eco-Divers, going through the knowlegde reviews with Kelsey while Neil was nicely sleeping on the hammock...After that we did 4 quizzes and surprisingly, i scored 10/10 on all 4 quizzes....wohoo! On to the final exam...which was basically the same questions as the knowledge reviews and the quizzes. For this, i scored 47/50...not too bad.

Great news : we are now qualified PADI Open Water Divers!!!

Time for paperwork. We filled in a form, and now we have to mail it to Australia to get our certification cards...which takes 1-3 months.

That's it really. Now i'm looking through what specialty dives to take for my Advanced Open Water Diver's Course in future....but i'd like to have a few more dives under my belt first before i proceed. Hopefully, my next diving trip will be around October this year...probably heding to Redang..we'll see

Thank you Kelsey Jade Foot, thank you Neil-from-Scotland, thank you Eco-Divers for making my scuba dreams a reality.

The Tioman Excursion

Hello everyone!
I just got back from Tioman Island. I had been talking about getting my scuba liscence for years, and been planning this trip for months; the only obstacle (albeit a huge one) was passing my MBBS...and i did it! So this little diving trip is a reward, a vacation and a dream fulfilled. More about my diving course in the next post.

My trip was from 16th-21st April, with Loo Kar Yee (the same gal i went to Korea with last year) and Avni (my classmate & seeming to b a new permanent fixture in my life)...the night before the trip, Karyee dropped a bomb saying the brother was coming along...tickets were already bought, room reservations were already made...oh well, her problem; i thought.

That morning my aunt dropped Avni & I at an LRT station...we made our way to sentral, then taking the KLIA Transit to Bandar Tasik Selatan where we were supposed to meet Karyee n board the bus. It was almost 9 and Karyee was nowhere in sight...when i called her, she dropped another bomb : she thought the bus was at 9.30!!! Mind you, she was holding ALL our tickets. I was majorly let down and was ready to cut my losses, but somehow Avni managed to negotiate with the bus driver to let us aboard without having the tickets.

5 hours or so later we arrived at Mersing. Took a cab to the jetty where we agreed to meet Karyee & brother. Within 2 minutes Avni got impatient and dropped a bomb : said she doesn't wanna wait till 4.30 and wants to get on the 3pm ferry instead. Personally i prefer everyone to just stick together. My preference aside, we got on the ferry, arrived in Tioman 2 hours later and headed to Eco-Divers to confirm my diving course. Thankfully they were able to accommodate another student (Yi Hou, Karyee's brother).

Next we walked to the end of the beach to Nazri's place, where we made our reservation. Unfortunately, there was only one budget room available. We walked back, stopping at every chalet asking for available rooms. It was 6pm and most of the chalets had noone attending at the reception. Then Avni dropped another bomb : she's not willing to pay 50 bucks a night. Mind you, MOST of the chalets cost around 100 bucks per night. She intended to bunk in with me and karyee and split it 3 ways...but now with Yi Hou in the picture....she wanted all 4 of us to bunk in one room. That's it, bitch mode is on. I'm not willing to spend my vacation all crammed, and sorry, i'm not willing to share rooms with a guy.

We walked on till we reached Mawar Chalets. We checked out the cheapest room, RM35 for a fan chalet...Avni wanted it, I didnt. I refuse to spend my vacation battling mosquitoes in a shabby room with only a wall fan that looked even more rickety than the one i had in my hostel. So, NO. We looked at the air-conditioned room...it was larger, with a queen size & a single bed...cost 100 bucks a night, excluding food. We took 2 rooms...one for Avni & i, the other for Karyee & Yi Hou. After putting our bags down, we headed further down the beach to B&J, a different branch of the dive shop where Avni had her initial scuba course. She asked about completing her certification, then once that's settled we headed to the jetty and watched the sunset....

Finally, Karyee and her brother arrives. I filled them in with what's goin on. On the up side, at least Mawar Chalets is closer to Eco-Divers. We had dinner, walked around, and headed for bed. now THAT was a bumpy first day.

Anyway...truth be told i was very disappointed that night and the following night...wondering to myself : is this how its gonna be for the rest of the trip? I initially regretted choosing to stay at that beach (ABC) because it was mostly rocky & full of corals, with only a few sandy patches along the shoreline. But on the up side, the water was really clear, clean and calm...This stretch of beach had chalets...several restaurants with very similar menus...a few convenience shops...and even fewer souvenir shops. A dive centre here & there, a few bars, and that's about it. And you know what, the forest is right behind you so there's bugs & frogs, monkeys in the morning & evening.....and i can assure you, you WILL come across a monitor lizard every single day.

Towards the end of the trip, i kinda got used to the surroundings...and thankfully the 4 of us got along great. And as expected, none of us wanted to leave the island. On our last night there, Karyee and i just sat by the beach at Sunset bar, enjoying the atmosphere and chatting about our dive trips, dreaming of future dives. We were savouring the moment as certified open water divers...wohoo! Avni & Yi Hou joined us later...they were busy trying to capture photographs of the lightning. Karyee and i just lazed there enjoying the lightning like a quiet fireworks display. At that moment, i felt so relaxed. I didnt realize how stressed/tensed i was before....it was a distant memory

Back in the room, slowly packing...suddenly Avni n i found ourselves at war with a grasshopper....or whatever it was. Haha...evetually i managed to get it out of our room. The next morning we had breakfast, said goodbye to Eco-Divers & Kelsey, my lovely instructor. We got on the 9.30 ferry, and then managed to get on to the 12.30 bus to KL...All through the bus ride, i slowly felt reality seeping back in....all my worries, the endless to-do list, official tasks, private dilemmas....all of em....I miss the island already. Then, on to the KLIA Transit to KL Sentral where we parted with Karyee & Yi Hou. Avni & I had dinner and took a cab back to my grandma's place in PJ.

Haaaahhh.....what a life.