Sep 5, 2017

Maybe It's Just Medical

There is a few things that I wanted to blog about, mainly about leaving my second posting Orthopaedics and another is about the daunting aspect of entering Medical posting. In between, there are things worth mentioning as well. But things happened during that time, and when it subsided many more things had pressed me to adjourn the writing.


And hence, a super-packed confusion hella of post today.


Thank you Orthopaedics for being nice to me. Not everything is nice in it, but overall better than my first posting. I feel disappointed towards my viva performance but after a while, knowing you passed out of pity and be graded more towards performance (and your lack of issues) as overall instead of knowledge is definitely better than not passing your viva and having to be extended for another two months. Even though you do feel shitty afterwards because it did not went as well as you hoped.


Entering Medical is a bit funny to me. People called us seniors because I'm the third poster already when in fact I feel as useless as a strata rock under the sun. It's not like I know any better. It's not like I can draw blood any faster. In fact, my venepuncture skills more or less is at where I came from - minuscule on average, lucky at best. There are tonnes more things I don't know. I don't even think I learnt much in my two previous postings.


So when junior housemen said things like, "Kau takpe, kau dah senior," "Ala, kau dah power, kau senior," I was like, "Tang mana aku powernya?" I'm still scared shitless when patients desat in the ward, I still don't know what to do when nurses came up to me to show that the patient's DXT is deranged, I still don't know what to do when patient's BP is dropping or sky-high. So far I'm not liking my latest week of working night shift here.




But I'm learning. That's all I have to do. I'm learning.


I have entered the third week in Medical now. The first week is the tagging week where I had to complete my taglog by simply listing up a number of procedures and asking MOs signature for each of the procedure. The second week I worked at night shift, where people who had already underwent Medical posting are green with envy looking at the number of houseman working at night - two, to be exact. I for one have no complaint about it. I certainly couldn't cope working alone at night at the moment, and the time when HO shortage to come is inevitable eventually. But for now, I take what I can.


I still couldn't adjust to the busy working condition in Medical. I wasted my post night sleeping due to fatigue. When I woke up, I still feel tired. Not to mention there's a tonne of things I want to read about but all the time I have left I either spent it sleeping or complaining about the need to sleep. Partly there's Orthopaedics to be blamed. The working condition in my previous posting was so chilled and relaxed it felt like a holiday compared to Medical here.


When I'm under a lot of stress and being overwhelmed with fatigue, that's when my health deteriorates. I do get sick easily and the frequency of me catching illness is so often I can predict when next I will fall ill and won't be able to get up to work like I normally do (for instance, today I don't feel so good). Anyway, when I do get sick, I still go to work - but I'll be covered with a face mask all day and my mind would get sluggish and I won't be responsive and cheerful. I'll be a walking zombie, ordering medication and checking more zombies in this place I called a hospital.




Aug 27, 2017

Spotify Playlist #2: ORTHO

I have finished my second posting uneventfully with the help of these tracks of songs. This time, Human by Rag'n'Bone Man really resonates with me, especially at the part -
"But I'm only human after all 
  I'm only human after all 
 Don't put your blame on me 
 Don't put your blame on me"

 ...because you know, being a houseman, you will make a tonne of mistakes and some of them are not even yours to begin with or out of your control. But the blame and the scolding will have a direction, and as always, houseman (a.k.a poor me) is the ultimate destination.

The Thing

We have this upcoming thing that has been in slow talk over the past few weeks that we simply called as 'The Thing'. I think it's high time for us to discuss about it, but I don't intend to rush it because rushing things will only cause confusion and panic.


So far I'm enjoying this very much. I know there is a lot of stuff to take care of for The Thing, but doing things together, working out where and what and how excites me. I don't mind the stress at all because I have a wonderful partner to do it with. I hope everything will go well ameen. The best thing about this Thing is that every time we talk or do something about it, I will get all giddy LOL. 



Aug 12, 2017

A hiccup

This is far from over, but I'm taking a break.
Away from scrutiny, away from being judged based on what I write.
I want that peace; the anonymity and the untouchable realm of a writer
Yet remained relevant, personal, exposed,
Eternal.

Jul 19, 2017

Character Flaw

The other day I had a fight with a colleague. It's a series of texts between us through Whatsapp (and one phone call) sometime last two weeks. I just finished my ward Peri rotation, and on that last day I had forgotten to update the patient list that Peri needs to cover. Subsequently, the new person who was covering did not get notified on the new patients that were needed to be seen by the specialist. The one who called me then blasted me over the phone and after explaining my error, I had apologized.


I truly admitted my mistake. That was indeed my fault in the first place. The fight continued because almost three days later the issue was brought up again by the same person who called me the other day. I was tired and a bit in a foul mood. The part where I didn't understand at that time was where the call was made just to get mad at me over the same thing where nothing else I could have done otherwise.




The bombshell that the person then threw at me was that they had finally figured out why I am not pleasant to work with in the first place. They talked about me behind my back and generally described me as someone who don't give a damn about anything. Of all anything unpleasantries that I can stomach in life, this is painfully one of the few things that hurt me deeply.


Then over the last weekend  I went to my friend's open house. There, they told me that they have friends who are also working in the same hospital as me and they said I was cerewet and unfriendly to work with. Fire in a hole, Safuan. Considered me dismayed, albeit hidden from my facial expression at that time.


If I'm to summarized all the things I got to know what they were saying about me behind my back (as far as I'm concerned - I know they are lots more!) it could be like this:

KYS
  • Kerek
  • Get heated when talking (almost shouting-like level)
  • Criticize people but unwilling to receive criticism well

A-LEVEL
  • Foul mouthed
  • Bad tempered (really bad, bad tempered)
  • Generally people don't like me
Honestly I didn't even like myself back then. I guess it was a really, really bad phase of life I was going through.


NUMED
  • Kerek
  • I kept to myself a lot during my time in Medical school. Thus, I rarely got wind of what they were saying about me back then
  • Arrogant (a comment from a lecturer) (Fine, I guess I am a bit snobbish)

WORK
  • Kerek
  • Don't give a damn 
  • Cerewet (apparently I terkasar bahasa with a first poster)
  • Getting the feeling that people don't prefer to work with me


If I want to do a proper and thorough reflection on this whole matter, it's gonna be days of me typing it all done. So instead, this list here are my thoughts on my character and its flaws:



1. I am unfriendly, or kerek, by nature.

I am not the type who can easily make friends with everyone. I got nervous around people, more so towards people that I do not know. When I am around unfamiliar people, I will stay silent. No beramah mesra, no ice breaking - we can stay and work comfortably in silence all day for all I care. Making friends is a tough job for me. It's not in my nature. And I am terrible in keeping them, too. So yes, if you have to describe me as unfriendly or kerek, go ahead. I am what you described me.


2. Zero poker face

One thing from the earliest of years in KYS I had discovered is the fact that people do get irritated by my facial reactions. Buat muka, they said. Later, I got to know another thing about me - I display outrightly what I was thinking or feeling freely. Sometimes they manifest in gestures, movements, and vocals. When I got frustrated I rustled up my hair with both of my hands in exasperation, when I got hold up waiting I will sigh loudly and get impatient (oh yes impatience is one of my big flaws), and if there's something that I don't like I will make that irritating faces that seniors, teachers and bosses alike hate.


3. Snob
I think, well, a part of me (that isn't snobbish) thinks, that I am a bit arrogant. It's time I think to accept the criticism. I am only just a second poster, but I already get the superior airs when around my batch colleagues or with the juniors. Case to point, the prefix names of my colleagues in my phone contact list are divided into three: HO, SHO (senior), and JHO (junior). I reasoned that it is necessary to distinguish which ones are which as there will people with the same names, and I am very bad with names and faces. I always have this feeling that I can do better jobs than them while the truth is very much proven to be pointing the other way. Of this I have to acknowledge that my snob needs to be corrected. Be more humble. Oh, easy to say! But, of this I must try to change myself.


4. Don't give a damn attitude

This one I have to mull things over. I wished I had asked what manner of 'don't give a damn' attitude they were talking about. Aside from that one slip up, I had never leave my work like that. When the other colleagues are doing their work, I do other ward work so we all can finish it early. When it's near the end of the shift, I always ask them if they want help or wanted me to stay before I go home. One time I was unwell and I needed to take a break for a while. Even then I asked them repeatedly to call me if they needed help. I had never said, "Oh itu bukan kerja aku. Aku cover bahagian ini and itu etc." What don't give a damn attitude are we talking here?

To the best of my ability, I help out. I don't complain when I came to work at freaking 4 o'├žlock in the morning. I don't complain when I have to go back 3 hours after my end of shift. I don't complain when I have to do other people's work. I don't complain when other people pile up their unfinished work on me. I don't complain and argue when my division of tasks landed me the most number of cases among us. So tell me again what attitude are we talking about?


5. I don't talk shit about people behind their back

You have to be the subject of the conversation to appreciate the dreadfulness this culture can bring to you. I have experienced it, time over time, so I know now the consequences it can present. For the life of me, you will never hear me comment on other people when they are not around. A few of my colleagues do come up to me and asked, "Hey, how is X? Okay tak dia kerja dengan you etc." while expecting me to spew up the same negative things about the said person. My answer will always be the same, "Okay je dia." 

I will not start a conversation talking about what other people less stellarly did, what bad habit they might be having, or generally on why it's unpleasant to work with some people. I will make it my mission to steer away from those topics, and the least I could do is to stay silent during those conversations.


Another thing that has changed my perspective is how people can do normal things like being all friendly in front of you yet they say totally different things behind your back. They come up to you like friends do talking about this and that, but with different people they talk about other things about you. Doesn't that hurtful? And to make it worse, somehow, that twisted carried talks come full circle when they talked about what other people talked about you to you.


Which makes me trust other people ever more. Yet another defining character of mine, you might add. How to be friendly when you can't trust the people that work with you day and night? To trust their smiles and jokes, then later got wind of the scorns and hate behind your back? I rather like those who say they don't like me straight to my face. That way I know who to avoid and steer away. 


I am sensing that there will be more incident in the future unless I changed myself. Namely, don't too eager to let go of my work to someone else before checking that everything is alright. Secondly, don't trust my thoughts and feelings to someone else. Who knows how far my conversation can go and to whom it might reach. I rather be unfriendly to all and stay away from them all. It's better not to know about other people's sordid affairs than to get wind of what daggers are pointing at my back. But to suffice to say, this issue had broken me again. I have to remember this well so I won't make the same mistake again.


So, future me. Read this again and again. And remember when you suddenly feel too good about yourself that somewhere, people are talking shit behind your back and there's nothing you can do about it.


Jul 8, 2017

A Mother's Strong Back

No one has ever truly appreciated what I do as a doctor and how I do it. I am in Peri team almost two weeks already - everyone has to be in that rotation for a fortnight - and I am counting days to finish with it. Being in Peri means you are going to do a lot of walking (and running) from patient to patient, ward to ward, and inevitably, from building to building.


I am covering the Ortho cases from the medical female and isolated medical wards which consist of the entirety of the 7th floor. There are four of us hamba orang (HO) covering the whole hospital that includes Paeds, Surgical, ICU, etc. so we divided among ourselves on which wards to cover. There is a lot of pro and cons covering certain wards, for instance: Covering as a Peri Ortho in Surgical ward will give you very few patients to review but the cases are severe. That is because the patients who are treated under two departments such as Surgical and Orthopaedics very usually mean that the patient is of multiple trauma e.g. motor vehicle accident.


And for me covering the medical ward, the usual cases I see are the diabetic foot ulcer, pressure sores, and infection of the skin (cellulitis). The cases may be simpler and after a few days, become repetitive, but the number of cases that I have to review every day is simply stagnantly a lot and burdensome. 


And for that reason, coupled with being chewed and gnawed by my super scary specialist after not presenting cases properly during round (because I didn't have the time to review them all), I had to come early to work every day. Like, super early as in I start reviewing my first patient of the day at 4 am in the morning. That's how early I have to be. And in the hands of newly and fresh MO out of the oven, work became inefficient and as a result, I hardly be able to go back from home on time.



There's one patient I met in the medical ward that strongly reminded me of my late great-grandmother, Nenek Ik. I was notified that there is one patient to be admitted into female medical ward from the Red Zone Emergency Department. She was brought to the hospital the night before, and only late in the afternoon the next day she was stable enough to be transferred upstairs.


She was septic and her conscious level is deteriorating. We were referred by Medical team to have a look at the cause of her sepsis which is her back sore (sacral sore). For those of you who don't know what sacral sore is, you can try research for it from Mr Google or Grandpa Wiki. The way I usually explain to the patients and their relative is sacral sore happened to the person who was bed-bound for a long time. What happened then is that the body's gravitational weight put a pressure on the point of contact between the body and the mattress. Don't be shock - even though the mattress is soft and comfortable, the long contact pressure of your body onto it can cause a break in the skin (like melecet, or bergesel) and once the skin breaks, then the muscle, tendons, and even bone follow suits.


Skin is one of the vital organs of our body - it is waterproof and the first wall of defense from micro-organisms that cause infections from entering our body. Thus when the skin breaks, the layer of body tissues underneath it are prone to infections.


When I came to see the patients, one of her daughters was sitting in a plastic chair at the end of the bed. I was unsure whether she has been with her mother since last night or she just newly arrived to accompany her mother to the ward but nevertheless, seeing her mother's poor condition I had to retrieve the information from her instead. She has nine siblings, and she is the third eldest. Her mother previously lived with the 5th son for a few years but for reasons unclear then she lived with the 6th son for the past 5 months.


She claimed that her mother memang dah nyanyuk sejak enam tahun lepas and needed assistance for eating, bathing and etc. When I asked what exactly happened that led to the admission to the hospital, she said she didn't know much but the one who is taking care of her mentioned of her not being responsive and was rapidly losing consciousness. They straight away brought her to the hospital. When I asked about the wound at her back, she said she didn't know about it.


At this point, my mind went straight away towards Nenek Ik and the similar circumstances of her illness. My voice went strange as I fought the anger in my voice from leaking out. I had to put down my pen as not to show to her my hands that were actually shaking. I had already read the review the ED Ortho team put down. The wound was big, necrotic, emitted really foul smell with pus discharge and slough.


"Anak lelaki yang jaga mak tu, bila dah perasan ada luka kat belakang badan mak dia tak bawak pergi jumpa doktor ke?" I asked her.

"Tak, dia tak bawak pergi jumpa doktor," she replied.

"Kenapa ya tak bawak pergi jumpa?" my voice went a quarter octave higher.

"Saya memang taktahu doktor," while shaking her head slowly a few times.

"Dia ada bersihkan luka mak tak?"

"Ada."

"Berapa kerap dia bersihkan?"

"Tiap-tiap hari dia ada cuci, doktor."

"Habis tu kalau dia cuci setiap hari takkan dia takperasan bau busuk?"

"Dia perasan, doktor."

"Bila dia dah perasan bau busuk tu pun dia still tak bawak pergi jumpa doktor?"

"Saya memang taktahu, doktor. Saya tak jaga mak saya."


Right on cue, four more family member came to see their mother. I was unsure whether all of them are the patient's children, but if they were, then that made two sons and three daughters were present when I reviewed the patient.


"Ni ha yang lain boleh bantu doktor" - while speaking to the rest of them while retreating to make way for them to come forward - "...saya dah takboleh nak tolong. Doktor nak interrogate korang pulak."


They also gave similar answers to why nobody taking care of her pressure sore properly. The daughter then showed to them (and me) the wound she snapped from the ED downstairs. It was small, roughly the size of the thumb that was black (gangrene patch). From the picture I couldn't determine where the sore really is but I highly doubt that is the extent of her wound.


Then one of the sons asked me the reason for the mother's illness. While I explained to them about sacral sores again I asked about their mother when one of them held up a handphone and told me I could ask the one who was taking care of her directly.


And lo and behold, the exact same story he told me, now added with excuses. He mentioned that because he was busy with business (berniaga, not cooperation that kind of business), he didn't have time to bring her to see a doctor.

"Habis tu siapa yang cuci luka belakang mak?"

"Saya la, doktor"

"Macam mana encik cuci luka mak encik?"

"Saya lap kemudian saya cuci dressing luka dia tiap-tiap hari."

I had stopped listening to him. I was so fed up and I handed the phone back to whoever that gave it to me in the first place while the caller on the other end was still talking. I had enough. Then I spoke to them all.

"Saya dari bahagian doktor sakit tulang. Saya sini nak tengok luka belakang mak ni sebab luka ni yang menyebabkan mak jadi sakit macam ni sekali."

I added, "Oleh sebab tu, saya nak encik berdua (while pointing towards the sons) untuk tolong saya pusing badan mak supaya saya boleh tengok luka mak. Yang lain pun boleh tengok sendiri luka mak macam mana. Sambil tengok luka saya kena ambil gambar luka tu untuk memudahkan kerja doktor yang merawat."

So I pushed the bed a little bit so that I could stand on one side while the other two could stand on the other side. I instructed them to don on the gloves and taught them on where to put their hands for the turning. Then on my count of three, I asked them to turn their mother's body 90 degrees side way.


And the sight of the wound was horrifying.


The older son whimpered. "Ya Allah, Ya Allah.. Mak.. mak.."


Once I quickly snapped a picture for documentation, again on my count we carefully turned their mother back on her back. Then the crying began.


The son's legs gave in as he cried into his sister's shoulder. The sister had to support him halfway, herself crying upon witnessing the actual wound on their mother's back. I heard him repeating himself, "sampai hati buat mak macam ni. Sampai hati buat mak macam ni." I could only pat him gently over the shoulder as I gave them space to grieve. The younger daughter slumped against the wall, covering her mouth as she cried. The anger I felt initially burst away, filled suddenly with a profound pang of sadness. I was reminded of Nenek Ik, again, and how she, too, went down when no one had properly taken care of her.


I had nothing to say to them. Nothing left to say that could help them. I finished writing down the findings and I ended my clerking with a heavy heart. I felt disturbed at the sight of them all and there was a huge lump in my throat whenever I glanced at their direction. I went back from work later that day, hoping to write this all down but the sight of the wound, the patient's dying condition, and the reaction from them made me stopped halfway and thought of my own mother.


There is no way I will let that happen to Mama. There is no way Mama will be treated in the future, even when the memory and the body should fail her. There is no way I would let it happen.


May Allah granted all mothers the highest order of jannah, for they have carried all of us and the burdens of the world on their stong back, thus so truly the heavens lie at their feet.