The Half-submerged Duck

First and foremost, an apology.

I skipped blogging for almost two long months. During those time, a number of things had happened. Some days were monotonous while on some days events were taking place like a raging storm. Notably, again, I didn't write anything during the month of holy Ramadan. Nothing enticing happened, either. This is the second fasting month that I felt I could have done more but a sick spell made me feel weak throughout the month. This strain of malaise is particularly strong and I was crying out for mercy by the end of it.

I was really out of it for quite some time and thus, my laptop remained untouched. I felt the need to blog, to pour over my thoughts into the cauldron of strewn words and undulated stirred emotions was a bit too much for me to handle. Plus, I normally sit down and write with the company of a cup (or two) of coffee somewhere in the cafe anyway (wow, vogue) of which is unattainable when you are fasting.

Secondly, a brief recollection of memories.

Things pretty much had fallen into place. I am becoming more cautious yet confident in seeing patients. True, every mistake is a great tool for learning. I disapprove that mistakes are the greatest teacher. They are simply the tool for you to improve. You still need someone, or sometimes the whole faculty of a department, to tell you what are the things you do wrong and why is it so and what to do instead in the future. They are your teachers. They can be anyone, from consultants to the medical students, so I learnt to be humble and swallow down my ego. Only the other day I learnt how to do a HiNT examination from a houseman (also a colleague) and I'm forever grateful for it. Being arrogant doesn't lead you anywhere, only backwards.

I learnt to stop antagonizing every little thing that irritates me. Sometimes I succumbed in my stress, but alhamdulillah, I feel that I score well in that department. I amazed that all my anger or frustration or annoyance stem out from my colleagues rather than my patients. Well, I only curse to myself about the patients that are abusing the service in green zone. I do managed to find bits and pieces of satisfaction when working in ED or at locum clinic, tho. Patients who thanked me, wishing me well, or those who simply still being civil after waiting for hours for consultation - they are what makes my job here bearable.


I managed to get into good rapport with most staff here in ED. Some of the MAs really like working with me in the same overlapping shifts because apparently I "work fast and confident in discharging patients" .Well, I do take it as a compliment although I know that they really like it because the more I discharge, the less patients they have to attend to LOL.


I was scheduled into roster with other newer floaters and it felt really weird for them to come to me to discuss cases. I accepted it with grace - overall, the more cases I know of the more I could learn from it. Although not many, I do helped out the housemen as well. I think I did okay - no condescending tone, no harsh words, encouragement given etc. Well if any of you reading this felt eh, poyo, this is far from the truth! - forgive me for being a bitch.


The only concern for me is that for this long 6 months of working in ED, my exposure in working in resus (red zone) gradually waned. I only worked twice in this half year in red zone, and I am afraid I will be stuck in limbo when true emergency happened in front of me. If you recalled, I am still very much poor in intubation, in handling ventilation settings and in administering emergency medicine boluses. With other things in my mind and my decision to drop from taking FRCEM Primary paper this year, I pretty much had neglected opening up any book to study.

I think it's prime time for me to turn things around. I just need a few adjustments, a refresh outlook of way of life, and a rekindled spirit to resume my chase for the professional paper. These all take time to materialize, partly because I was so busy in these past two months, and another reason is because I was waiting for the next chapter of my life. Of the latter, which now brings us to this,




The third matter and at long last, an update!

• On 30th May, right out of the blue, there's an update from the semakerjaya website regarding the contract or permanent offer. You can imagine the mounting pressure and trepidation when opening the website and logging in to check your status. Alhamdulillah, I got the permanent offer as a Medical Officer UD41 (not 44, wait, there's more to this). Some of us did not make it, and based on what I knew so far, the first cohort of us here who completed the housemanship program without a day of extension managed to get a permanent offer. 
• But there's some outliers here. I've heard people from some hospitals weren't as lucky as we are. I don't pretend to know what's going on exactly, but my most educated guess is that there's simply way more qualified doctors than the permanent position available to be offered.
• Those who were offered either contract OR permanent position as a medical officer UD41 were unofficially called the first cohort. Those who their names are still not in system are in subsequent cohorts, depending on the order of who finished the housemanship first and had their documents all sorted out.
• On 13th June, again there was an update from the semakerjaya, but this time regarding the placement place for those in the first cohort, contract and permanent alike. I was praying like crazy not to be transferred out to East Malaysia and guess what, I got my second choice!! I mean, okay, I actually didn't think much of the state and there's some out-of-reach areas there but hey, not bad indeed. 

• Yesterday, we received further emails regarding accepting the position offered and more documents to be filled like usual. Now, this is entering our usual territory of paperwork so no issues there.
• Yesterday as well, six of us floaters from ED who got the placement prepared a farewell party to all the ED staff. Well, five of us, seeing that I already went back home to enjoy my week holiday LOL.
• I am supposed to settle a few checklist with my hospital's admin before leaving it for good. In this short week as well I would need to do a medical check up and get an akuan sumpah form stamped and signed by a Commissioner of Oath. 
• I tried calling the people at the Jabatan Kesihatan Negeri about any chance of me finding out the exact placement in the state (whether it's a KK or a hospital, a district or a tertiary) but after a few excuses I had a strong suspicion that they will only release my exact placement on the day of reporting in, which is on Monday the 24th.
• Regarding the offer itself, it is of UD41 although we had completed our housemanship. It will take some (a year, roughly) of working as an MO before your grade will be changed officially to UD44, together with some adjusted added salary. My advice is, don't fret about it as it will happen eventually.

That's it for now. I guess this will be the last entry of mine under the label floating MO. It has been a long, but fulfilling experience working in ED here. Till we meet again, see you when I see you~!

The Light in Their Eyes

Here's a quick update: I've been floating as an MO in ED for exactly 4 months now. Last month a colleague of mine had called the KKM and was told that the placement would be out in April. Now came April and another colleague told us that KKM will only inform us about the placement in May. Considering that this sounds exactly like a wolf cry and we are going to enter the month of Ramadhan anyway I would take this news with a pinch of salt. 6 months or a year, even, bring it on!

A number of things had happened this month. I had to prepare and present a maternal mortality review for one pregnant patient in labour who was referred from Banting for meningoenchephalitis (brain infection). The baby was delivered fine but the patient later on succumbed to death a week later. The patient was in ED for only 4 hours, but as all who were involved are required to attend the meeting, for my department I was told to prepare the slides and presented it.

It's kinda of scary, to be honest. Those who were involved include from the very first point of contact the patient encountered to the last person who saw the patient. Each department or organization level had to present and the rest will raise questions and asked why so and so were done or not done etc. It was kinda uncomfortable because there's an aggressor present in that meeting. They (he or she is not revealed) will blame everyone, including themselves, but they will blame others more. Of which, by the way, is not the objective of such review meeting. 

I was glad that from ED there's no question asked about our management as the referred team, O&G was informed almost immediately when the patient came to our red zone and was attended to in mere minutes by them. I was further relieved when I didn't have to present at state level (all maternal and dengue mortality have two-tier review meeting, hospital and state level). All is well. Inalillah.


Remember the mishap I've had last month when I missed a fracture from an x-ray? Since then I was feeling down and from time to time I had doubts upon my own competency being a doctor working in this ED. The first few weeks after the incident I felt that other registrars or EP no longer trust me nor my judgement as much as I used to think they did in the past, that some of my plans may be questionable or downright wrong. I get the feeling of the looks they sometimes give me, and while it's all in my head - I might be wrong completely and they are not actually act or feel that way - these doubts are gnawing inside of me and I feel hollow.


Subsequently, it led to a shaky decision to drop from taking FRCEM Primary paper I initially aimed to take this December. It was too hasty and I am too green for it and there's no chance of passing it if these dark clouds of despair are storming in my mind. I noticed from the weekly timetable I am being assigned to more and more green zone and secondary triage. Some of my colleagues have already been assigned to work in specialized yellow zone areas alone. Again, I am assuming the worst. Maybe I am not good enough to take care of the semi-critical yellow zones? And if I do, there's no way they trust me to work there alone, don't they?

Sigh.

Moving on, there's a new aspect of being a medical officer (MO) that is rarely being discussed or mentioned that is doing locum work. I only started doing locum work at a private GP nearby for a month or so and I will talk about it more in my next entry later on. What I can say right now is that doing locum exposes you to a whole lot of new perspectives of what being a doctor is all about and how much of an impact you really can be to your patients. This time, by doing locum in the clinic has helped me a little bit to come into terms on my work at the hospital.


Ever encountered patients of foreign nationalities with poor language understanding at work? Imagine that your workplace, either in the ward, in ED, or in a clinic, is packed choke-full with patients. You are pressed for time. There's a difficult patient who demand a lot of things, angry relatives who shout at you for having to wait for hours, patients demanding MCs for silly things. And then come a foreigner who can't speak well either in English or any local language.

Most of us, myself included, will feel an immediate exasperation. You don't understand a thing they said. You ask the whys and they answer you with a what. You simply don't have time for this. Attempting in communicating in itself is exhausting. You know you will obtain poor history. Detailed presentation of symptoms will be missed. What they want, their concerns, their understanding of the illness, gone out of your inquiry. You are lucky if you even get a chief complaint.


These build up into an unnoticed kind of racism which is racism towards all foreigners (except the whites, because we just simply worship their advancement in society) who come to hospital / clinic to get a healthcare treatment. You think they don't notice your sigh of contempt, the glare that you give to them? Of your harsher tone and loud voice, as if by shouting at them will make them understand you better? Of the lack of explanation to medication that you give or the illnesses that they have?

The other day at the locum clinic I met a foreigner who came because her toddler developed a simple febrile fit. She came with her aunt who is more fluent in Malay language, complaining that they had went to a different GP earlier and were confused when they were prescribed with syrup Paracetamol with the dose of 5ml four times a day. They know that the toddler shouldn't get too much of the medication. The weight of the toddler was never measured, the consultation was brief, and the mother did not even understand anything about febrile fit.


And so I did what I thought was right. We weighed down the kid, get the correct dose, and I sat them down and explained to them what febrile fit is and what to do when it happened. All those training during Paediatrics rotation paid off here. I made sure they understand what is going on, and before they left the room the aunt thanked me and quietly said that just because they were foreigners they shouldn't be treated any less than other people. That hit me hard.


Since then I tried to be extra patient to the foreigners. A Rohingya couple came to ED the other day with the wife complained of both hand numbness, among many others. She had had a stroke in the past and after much difficulty grasping what they were trying to tell me, I managed to gather that she's worried that it might be another stroke. Her blood glucose was high but not acidotic, and foreigners or not, I did the whole nine yard work up for her before arriving to a diagnosis of peripheral neuropathy secondary to diabetes mellitus. I wrote a memo to KK (klinik kesihatan) for further diabetes management at primary care and they thanked me before they left.


I admit I too had encountered foreigners and dealt with them not as well as I should have done. As usual, this is something I need to reflect on and strive do better in the future. This is why I write this down in the first place. Let this be a lesson for me and to you all to be a better and kinder doctor in the future.


Lastly, if you think about it, it takes them a considerable amount of courage to seek treatment in the country they are not accustomed to. They well already know that they will not be treated as proper as the locals. That their financial strain will hinder them from being able to pay for admission, for detailed imaging such as a CT brain scan or an MRI, or simply for a suture or two for their injury. But when you do them right with everything that you have in your power, you will see back the light in their eyes as they thank you sometimes with words, gestures, or even warm smiles.

photo credit: Annie Griffith

I may feel less than a person when working in this ED, but these encounters had helped me to keep moving forward. May God bless us all.

Of Humerus Fracture & Swiss Cheese Model

Yesterday as I left the clinic I was suddenly overcame with a feeling of trepidation. I felt as if I had done something wrong somewhere but it's a vague sensation with some poor memory recollection of what actually had transpired in the first place. Later that day in the ED group there's an alert of a patient being wrongly discharged with a soft tissue injury following a fall where in fact she sustained a fracture of her right humerus bone. The doctor who was seeing her did not noticed the fracture from the x-ray. Turned out the doctor was ME.

I was utterly devastated. I was only informed of the error when I entered my night shift last night. I knew that the x-ray was somehow familiar but for the life of me I couldn't recall which patient I was seeing and whether I had assessed the patient properly before deciding that it wasn't a fracture and discharge her home with just painkillers. The x-ray in question is this:

There's an EP (Emergency Physician = specialist) who is in charge of reviewing each and every x-rays done to all patients who are discharged home without referral to any primary team (Ortho, Surgical, etc.) and he was the one who saw my mistake. To my (and everyone) horrid, I was alone in managing the case and I did not consult any registrar or EP regarding the x-rays and just took the matter on my own. The EP and his team managed to call back the patient after multiple calls made (God bless her, she was at school the whole day! KILL ME!), a U-slab was plastered on and patient was discharged with a referral to Orthopaedics clinic as outpatient.


Upon further asking colleagues around, it was determined that the patient I saw was in fact a patient who was halfway been seen by another colleague who covered for me when I went for Friday prayer. She had assessed the patient but at the time when I came back and did the pass-over the x-ray in question was not done yet. Add to the fact that I saw the patient near the end of my shift, there's a lot of cases that I still needed to see - the pressure and stress to finish it without extending my shift hours for too long had added to the error. It was my TERRIBLE MISTAKE for not reassessing the patient MYSELF and subsequently missed the fracture, leading to a wrong diagnosis and wrong management for the patient.

In Medicine, there is a thing we called Swiss cheese model of incident causation. Whenever an error is made, there should be a committee or someone in charge who will evaluate the whole situation in finding out everything about the said error, from the cause of it, the risk factors that can lead to the error, people or systems that are involved in facing the errors, and finally to the consequences the error caused. This whole thing is called a risk-stratification. I now will continue with my shameful but necessary reflection using this model. Sob.


Imagine a stack of multiple Swiss cheeses like this:

1. Each layer of the Swiss cheese represents level in the organization involved who faces the potential error. Error here is the end result or the actual damage that happened. The arrows in the diagram above are the hazards, or simply put, a potential error.
2. An error is made when every layer of the organization failed to stop the hazards from going through the emmental holes or the flaw in the system / organization (see the longest arrow above).
3. Understanding what the flaws that exist in each layer help us to stop the hazards from going through, thus preventing it to be an error. A prevented error is also called a near-miss incident.
4. Notice that in each layer some holes / flaws are bigger than the other. However, the smallest flaw can still permit a hazard to pass through unresolved. That hazard then can pass on to the next layer with a potentially larger flaw.
5. In my case, the layers of cheese can be made up into three layers:
• Green zone, where I first saw the patient
• Registrar / EP on call, who are assigned to supervise the doctors in Green zone
• EP in charge of reviewing all x-rays of patients discharged home of the day
6. In this model there is also what we called latent failures and active failures.
• latent failures are the system or environment that passively contribute into causing hazards. In my case: congested patients in Green zone, too few doctors to attend the case, among the few.
• active failures are the one who directly causing the hazard. In this case, it's ME. I failed to assess patient myself, I failed, to correlate the symptoms with the imaging, I failed to notice the error, I failed to discuss with my bosses, among the few. In the future I would see myself ALL PASS-OVER cases that were handed to me. I will even retake the history and repeat the assessment MYSELF. Also, all imaging of high-risk patients I will discuss with my bosses, no matter how much I know it's gonna cost me more time and my patience.
7. In the second layer, I would say the flaw was that I found it cumbersome to reach my bosses when it was too hectic. They are available to be reached for case discussion, but they can also be terribly busy at most times. I'm painfully aware it's MY FAULT anyway for not approaching them and in the future, I would discuss with them all cases that I find.. high risk.
8. The third layer is when the hazard stopped. My EP noticed the mistake, made the patient to come back to the hospital to get the appropriate treatment, the mistake had been alerted and I had found it discerning but it is for my benefit anyway (sob!) so that I can reflect on it properly.
9. I would say it is not a complete error, because the hazard was identified and correction was done promptly. An actual error (I'm trembling now) would be that there is a neurosensory loss and the arm of the patient was affected badly due to my incompetence. I would say I felt the steely haunting stare of Miss Rifa behind my neck, cursing me on my stupidity and wishing she had never passed my Ortho rotation viva assessment back then.

After my last night shift ended today on which I worked the whole early morning with such a gloomy mood, thinking that I am never gonna be good enough, that I should just quit being a doctor and cursing myself for even thinking of taking paper, or that I would never see patients in the clinic anymore - now that I wrote this down, properly reflecting on what I had done wrong and planning on how to avoid making the same mistake, I feel a bit better. Well, I still know I am stupid, but now with a renewed spirit to become less of an idiot.

Okay, that's it for now. Pray for no more error from me in the future. Ameen.

PS: What's the fracture and what are the nerve and artery that rarely but may be damaged?

A shamble, A sham, A shame

It's been two months since I became a medical officer here working in ED. The last month was all about me fidgeting to become accustomed to the working nature of MOship and beyond. More often than not, I faced dissatisfaction and I would feel a sense of unease in the pit of my stomach. On more bearable days, I would end my shift with empty mind and an empty heart. You only know too little, react to changes too late, and feeling too much when reflecting upon your incompetence.


The only positive thing I can take from all this is that being an MO will forever make me humbled. Everyday I feel like an idiot. Everyday I am learning something. Although to be accurate, everyday I feel like "how-on-Earth-did-he-become-a-doctor" kind of idiot for not knowing or forgetting about certain diagnoses and/or their management.


True, we all cannot possibly know everything that needs to be learned in a short matter of time. And knowledge has a depreciation value in its nature - over time what knowledge not practiced or revisited will just be forgotten away. Add to the fact that I am very senile and forgetful it just makes it much harder for me.


All these bring us to another issue at hand - my readiness to take FRCEM Primary paper. I had set my eyes on the exam that is due in December. The paper is all about basic sciences - 1/3rd of it is anatomy, another 1/3rd is physiology, and the rest is divided into pathology, pharmacology, microbiology, and evidence-based medicine, or whatever that is called. I already subscribed to FRCEMtutor for practice questions and I already had a layout for my revision timetable. All I can say, I am marvelously in dismay and currently am drowning in disarray. I have difficulty following my timetable and as a result, I am already late behind revision schedule. It is all nothing but a shamble, a sham, a shame.


These incompetency that I feel, the insecurity that crushing in waves inside of me, made me question whether I am qualified enough to take the paper. I am less than a hatchling. I am not even measure to a struggling fledgling. I am the cracked skin off the rotten egg. Should I learn more, see more, experience more before attempting anything worthy? Or should I just dive ahead in the sea of misery and take the bloody paper anyway. Misery is nothing new to me so might as well go for it, don't you think? I feel that because as of right now, I don't think I can pass the paper anyway.

FRCEM Parallel Pathway in Malaysia

Wait, am I on the right blog? This fellow, talking about paper?

Well, I am not exactly talking about it in details. It's something that I want to pursue career-wise. Previously, I only know of people taking Master's program in order to become an emergency physician (a specialist). I know roughly that the path to it is long, terribly difficult, and painstakingly competitive.


Not to say that FRCEM is in anyway, easier. I spent an entirety of my morning researching about FRCEM and recently, my ED consultant shared in the telegram group of FRCEM as parallel pathway to become a specialist in Malaysia. This obviously is very interesting and appealing, but I have no clue on how to proceed with it so I googled around.


The best tips and info about it so far is from this Malaysian blog:

A Study In Scarlet

I once said that the FRCEM/MRCEM is more similar to MRCS than MRCP, because it is mainly used to supplement your entry into the local Masters programme. But not anymore. With the introduction of the FRCEM Parallel Pathway, the FRCEM exams are now more similar to MRCP in that you can pick one or the other to become an emergency physician.

I am so amazed with the author. They are such an inspiration and like, errghh, they prepared for the exam during housemanship and took the exams during floating MOship. What. A. Stud. I want to be like the author toooo.

JAWESOME DROP

I am not going to explain all the stages of FRCEM here because honestly, I am still not familiar with the whole thing and secondly, why bother where I can just show to you guys the one-stop link to all the things that you need to know about it!


So, here's the part that I want to let it off my chest with:

1. I want to stay in Emergency department. I really like it despite the workload here at the hospital I'm working at. I have an interest in ED for as long as I can remember.
2. There's this uncertainty of where I would be posted when the issue of permanent vs contract MO will be addressed. I am so afraid if they transferred me to some klinik kesihatan or into department apart from ED. Wouldn't it be rather useless than for me to take the papers if I'm not in ED anyway?
3. Even if I take the papers while not working in ED, do you think it's that easy to ask for a transfer to ED department that has specialists in it? All those stories I hear about people waiting for years begging to be transferred to somewhere else in order to pursue their studies. What a nightmare.
4. I am not a bright doctor. There, I said it. I struggled with my studies in medical school and while I completed my housemanship with no issues, I am not confident I can pass this whole thing.

My plan therefore, would be (bismillah!):

1. To take FRCEM Primary in 5th December 2019 (Application date starts on 1st July 2019)
2. Study and do practice questions
3. Fight and appeal to do ED at my next posting

That's all for now. I've taken the first step of registering an account. Hopefully my plan number 2 (the study part) is gonna take hold AHAHAH okay, let's do this. Laugh at me for I am a poor fool dreaming a fool's dream, but as long as I can dream, let it soar high!

Another Beginning

... and a happy new year of 2019 to us! Woohoo, another year to start off with. Alhamdulillah we are blessed to be alive and still kicking with some of us igniting new year resolution while some already resolved to get real and face the hard truth of not getting any resolution done LOL. Let's start the year (although I'm nine days late but, meh, it still counts) with a reaction gif from my favourite Doctor played by Matt Smith.

I must say, this year really started off well. Big part of it is because I had finally completed my housemanship and now working as a junior MO in Emergency department (ED). The sheer sense of relief that just washed me away feels so incredibly.. rejuvenating. It's like entering a dream-like state of mind. I still half-believed that I am no longer a houseman (I still work like one, more to that later).

Now, some of you might have caught something from my statement in the previous paragraph. A junior MO? Surely you meant floating MO, bro? Also, where will you go after this?

And the answer to all that, really, is made up of two following words: contract houseman. For those who are new to my blog (aceceh poyo gila) or need a sidenote, I am from the first batch of contract doctors (lantikan kontrak) that started housemanship in December 2016. Now, that alone didn't make any huge differences when we worked as a houseman. It's when we are done with it and moving on to being a medical officer (MO) that it becomes rather muddled up.

Why? Because contract doctors should mean there is a selection on deciding who gets to be a permanent MO and contract MO. That's the reason they made all this contract houseman in the first place. The idea is that those who performed less stellar or had many disciplinary issues and etc. will not get an offer to continue working with the KKM a.k.a the Government. That, in some sense, relieves the Government of some burden of too many doctors in the KKM (really?) and ideally, being able to control the quality of their workforce to some degree.

Initially I had already drafted in greater length about this nonsensical, whimsical, diabolical matter of the permanent vs contract MO shenanigan but I realised the tone of the topic contradicts the vigorous mood I wanted to started off with. Plus, it's all unverified in nature (they rarely not, really) so I summed it up about my status currently:

• Technically, I am a floating MO with a full MMC registration number who was told will float at this hospital for the next 6 months.
• In the period of this 6 months, the result of the placement will be announced. It can happen after 3 or 4 months, or some time much later. So, let's just agree 6 months is the period for all intents and purposes of this topic. That means, to clarify, I don't know where I will go next.
• Now, ED has graced us who float in the department by taking us into their cohorts. That means, my colleagues and I follow the same pathway new MOs that are transferred to this hospital ED take - two weeks of tagging before working in shifts like the rests of the MOs.
• In comparison, the previous floating MOs or new floating MOs under permanent housemanship already have their placement known and will float only for a month. They have lesser working hours and basically just waiting to report in at their new place.

Yo KKM, where my placement at?

Now, moving on, let's talk about being a (junior) MO!

The first two weeks of working as an MO in ED involves a period of tagging where I had to go to work from 8 am to 7 pm with both weekends and public holiday off. I must say, the feeling of having the measly ONE hour more before going to work is monumental (as a houseman we started work at 7am - that's the official one, anyway). It is liberating. It's like petrichor after a long, dry spell. It's daisy and buttercup. In other words, I like it. I like it very much. 

Not to mention the fact I had both weekends off. And public holiday, too, as well. Wait, didn't I mention this before? I did? Well, I have to tell you guys again, weekends off? Am I hallucinating or what? What is this, a trap? Oh, what about the 8am to 7pm thing? Isn't that still a lot of working hours?

Literally everything is better than being a houseman with their working hours.

And now that it's my third week of working, I now enter shift system. For the first 3 weeks, I will only be working either AM shift or the PM shift with one day off (eh, no longer weekends off?). AM shift is from 8am to 3pm (WHAAAT) and PM shift is from 3pm to 10pm. After they review my work and deemed that I am safe to work at night, I will then do night shift as well which is from 10pm till 8am and attending any postnight work. 

I have already worked AM and PM shifts and I tell you, it felt damn gooooood. I don't even feel an ounce of fatigue. By the time I reviewed most of my patients and getting the hang of the situation I will be left with only a few hours taking care of them and start preparing for the passover to the next shift people. True, some stations are more hectic than the rest and the passover usually take almost an hour so I almost never went back on time but nevertheless, I can't believe how much better being an MO working in ED is!

But being an MO came with another level of Responsibility® that I have to shoulder on. As a junior MO I will always be paired with a senior MO covering major stations. For stations that I have to handle on my own, any cases that I wanted to discuss I will do so by finding the registrar or EP (Emergency Physician) in charge of my station. 

At first, it can be quite difficult. The transition from being an HO to an MO doesn't mean you automatically being upgraded in terms of knowledge and experience to handle all the cases. If you are not familiar with some cases during the end of your housemanship you will still, unfortunately, still be clueless as an MO upon encountering the similar case. 

At times, you are stuck between making your own decision as an MO and to ask or discuss cases with other MOs. Some MOs will ask you to think on your own because you are already an MO while some will tell you to not simply do things on your own without consulting others. Because of the responsibility and the vulnerability of actions taken down when something BAD happened to your patients, that cold feet feeling is pretty scary to deal with, especially for cases like dengue fever.

NS1 positive?? AAAAAAAAHHHHHHHHHHH!!!

It is not too precarious of a matter to begin with actually, in my opinion. I do stumbled here and there but for me over time it will be better. I have an okay relationship with all the MOs in ED (I think!) and while I do not hesitate to ask for opinion, I usually approach them with my own plan and rather than asking what to do, I ask whether is there something else that I have missed. So far, I have no difficulty in voicing out what I think I should do to my patients and when discussing cases with the EPs it gives me plentiful learning opportunities that I deeply appreciate. This is another reason why I enjoy working in my ED.

If work can be enjoyable it should be when I work here in ED 

Another thing that I need some delicate balance is when working with my colleagues who are doing their HO posting in ED. Like I said before, there is like no huge difference between them and I. No upgraded skills, no improved knowledge, no added experience. Some are even better (haven't I told you I am an average doctor at best?) than me, actually. A lot of them are.

So I tried my best, at times, in asking them to help me at work. I really, really, really, don't want to sound like an MO who orders people around while not doing enough work myself. I really don't. Haven't I preached and complained about those type of people incessantly before? A vigilant reminder for me to look in the mirror and do some serious reflection.

Sometimes, not always though, but sometimes, I have this inwardly mental grumble that I am still doing a houseman work. Astaghfirullah. But it's true, I do sometimes feel that way. Whether it's about the staff nurse still asking me to insert line or some other work, I felt that I deserved to work less? not doing menial jobs? and I don't know, being treated like other MO?  when working. (gosh I broke all those grammatical rule with the question marks but it's hard to be articulate here)

I'm not pouting. You are.

And each time these thoughts intruded my mind, I stopped myself. Am I that bighead to demand such things? Am I good enough or important enough to not being occupied with those chores? And I will be reminded with memories of when working as an HO in ED being helped by the MOs in doing houseman work - that alone stopped me in the track.

I remember my bosses helped me with difficult lines, or made calls themselves to refer cases to other teams, or tracing blood and calling patient's relatives to get further information. I remember the good things my bosses still do like thanking us when they or us finished the work shift of the day. I remember the task being delegated evenly to cover the patients that are pouring non-stop into ED during peak hours. I remember that I love how teamwork is strong in ED and these things helped me a lot.

And so I try to be like them. Even though there's already a complaint made regarding new MOs (from my batch who just became MOs in ED) about being rather useless and ordering people without doing any real work, I will try my best to simply do my best (or should I not tell you guys about this issue in the first place? It's rather hushed up and "anonymous" LOL). I have good support of people who can tell me directly if I am not pulling my weight enough so I am ever grateful for the live feedback.

But overall, I'm happy. Alhamdulillah for all the good things that are coming my way now. I hope it can continue to be so. That's it for now. Here to a new year with yet another beginning. Bismillah!