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 Ending Days of Housemanship

So here it is, the second stop in my journey. I couldn't believe how fast time flies despite the many instances where I cursed and complained about working as a houseman here. There's a lot that I wanted to talk about, so many things that I want to share but I think the reality of it all ending hindered the process of updating this blog. For that I apologize.

I want to thank you guys for reading my blog for the past 2 years (or more), beginning with the day I graduated from medical school, preparing for the SPA interview, the antagonizing ehouseman mishap and the ever popular PTM post (it's still the most viewed post of my blog). Also not forgetting the ever-macabre morbidity posts about patients dying in the hospital. This blog is my number one place I go to to collect myself. I need only me rereading what I've shared to reinforce myself of the values and lessons I wish to never be forgotten.

So here's the recap of my whole personal & housemanship journey so far:

• I'm one of the people from the first batch of contract housemen that began the housemanship process with the threat of being terminated prematurely for any gross misconduct etc and the uncertainty of being offered a permanent place as an MO later on.
• Started my first posting in O&G on 21st Dec 2016 where subsequently I fall into the most bleak moments of my life due to the nature of the department. Alhamdulillah, managed to proceed to the next department, Orthopaedics in April 2017 without extension (only 1 explanation letter LOL).
• My mood improved significantly in Orthopaedics from better working environment and people encountered there. Almost got extended during viva with the ever-scary Miss R (you will be tongue-tied with her. Her stare is like of a.. tiger?). Also I was down with shingles for two weeks so I burnt all my leaves and MCs.
• I entered Medical in August 2017 and immediately felt the brunt and burnouts from work. I gained more confidence in blood taking (it's not about the higher chance of success. It's about your readiness in attempting it). I was lucky to get nice specialists for my assessments so that went like a breeze. 
• Had my one and only needle-prick injury during branula insertion to a MRO patient who yanked everything out and we ended up 'brawling' (at freakin 3 am!). Was super pissed-off, went emo thus I refused to insert any branula that morning and feeling ashamed that the wife of the patient noticed it and apologizing back to me. All was well.
• Oh, I broke up with my super longstanding girlfriend for a whole lot of painful yet unreasonable reasons (such as objection from my parents) in October 2017. Had a second meltdown around that time so I spent ALL the money I had saved previously.
• Got my first annual increment of RM225 as the result of completing HRMIS online in time.
• Moved on to Surgical in December 2017 where the stiff ego and stuffy attire suffocated me on daily basis. Dismissed it as my everlasting dislike purely towards the surgical-based rotation and anything to do with OT and scrubs. Being liked by the MOs, not causing issues and being depended on to take care of the ward helped me a lot in completing my logbook in due time (get the hint).
• Entered Paediatrics in April 2018 with some preparation on what to expect. Paediatrics here is more or less like the O&G - high extension rate, tightened tensile atmosphere with the crappiest of working hours. Had a few very close shaves of getting extension. Was down with super bad viral fever during the first 2 weeks of working in the ward. 
• Received call from Human Resources that my slot for Klinik Kesihatan placement in 6th rotation was taken. They offered either ED or Anaes. After a few hours of asking opinions and consulting seniors, I chose ED.

• On 15th August 2018, was told to fill in the form for MO placement.

• I antagonized myself in deciding where to go next as an MO. I am not married, I have no commitment nor any specific ties. The chance of being transferred to East Malaysia is high. As of this moment of writing, we are still not told of our placement yet. Usually, the placement will be announced during the 3rd month of our last posting.
• Had the most enjoyable posting ever. I have a liking towards ED since I was in medical school and some idea of pursuing ED as my career  progression were already formed in my mind from time to time.
• Received my second annual increment of RM225. See? HRMIS is super important. Do not missed the deadline!
• Heard rumours from the admin staff and colleagues that my batch will float in our respective hospitals for SIX MONTHS. The issue of permanent MO vs contract MO - how they decide who gets what, when the status is being announced, etc are still unveiled.
• On November 22nd 2018, finally received good news that my full MMC registration number is done. Simply google this, "MMC full registration" or go to this MMC site directly. Type in your name and voila!

• The next step that I needed to do was to fill in the APC form (Annual Practicing Certificate) for the year 2019. Any APC for the year must be completed before December the year before. Seeing that I got my full MMC registration number at the end of November, I was considered late and subjected to a fine of RM100.
• To prevent the fine, I had to hand in an explanation letter together with APC registration form. What is it houseman with the never ending explanation letters?
• A few weeks before finishing my last posting, was further told that all of us finishing will be floating as MO in Medical department. What a bummer! Apparently ED got wind of this as well and proceeded in securing 8 slots of floating MOs.
• Without further ado, I handed in an appeal letter to the admin to float at the ED instead of Medical. Handed in my completed logbook with all relevant documents to ED admin office last week.
• Called admin staff yesterday to confirm that I managed to get ED as my placement to do floating MO. I am currently at home, watching Netflix, playing games, and eating chocolates to my heart's content. Some people went all sorts of places during their EOP, but the lack of money and motivation to travel put me here in the comfort of home.

I will be starting my work as a floating MO (or drowning MO, depends on my level of anxiety HAHAH) on Friday. It's good that I didn't bid farewell to ED peeps yet. It would be quite embarrassing to say goodbyes and then came back to work the next week meeting the same people LOL. 

It has been quite an adventure, eh? I still have two topics to post, namely the final Spotify playlists and the annual meta reflection post that I fabulously missed the deadline. This would be my last entry written with tag #housemanship. Again, thank you all for sticking with me till the end. All the best with your future endeavours, dear readers, and till we meet again.

Do You Want to Quit Housemanship?

This is a seasonal post, trust me. If you are reading this around the time this post is published, chances are you also have read the viral facebook posts by Miya Wong about the reasons why she quit being a houseman in Malaysia.

Statistically speaking, and I mean I don't know who came up with the numbers and there is no creditable sources to back this up, but again, statistically speaking:

• 1 in 5 junior doctors undergoing housemanship do not complete their training and quit being a doctor.
• 1 in 3 housemen having to be extended beyond their 2-year stint of housemanship

Before we start taking sides and bash each other with tonnes of personal tragedies and triumphs, we have to agree there are valid reasons why we sometimes feel like quitting our housemanship training program and just, be done with being a doctor altogether. Those reasons could be, in collection or isolated, included in this list:

• long working hours (major stressor)
• odd working hours
• no leaves (major stressor)
• not enough leaves
• odd-hour leaves
• shitty colleagues
• no colleagues (major stressor)
• shitty superiors (minor stressor)
• really, really shitty superiors (major stressor)
• really, really creepy superiors (major ALARM BELL)
• homesick
• no support system (family, spouses) (major stressor)
• financial issues
• health issues
• realized that you hate working with people
• realized that you hate healthcare service industry
• crime
• oh, salary
• yeah, about that salary
• benefits, bonuses compared to private sectors
• business opportunities
• being a celebrity
• (insert your reasons here)

For whatever the reasons that nudge people closer and closer to the edge, please, and I genuinely plead that you respect their decision whether to make the jump or keep hanging on to the cliff. You are crude and arrogant to think just because you can endure it, that means everyone can and shall endure it.

I say this because as much as I think I enjoy where I am now, I still have the burnout and the lows when working from time to time. In fact, I am in a slum right now. The burnout is here and I have to deal with it. Always is and always will be. But even then I still remember very clearly what I felt when I first started working as a houseman. I still remember the dread, the loneliness, the emptiness that dwelt inside me in each waking hours and in every sleepless nightmares that came haunting. 

To emphasize again and again, you wouldn't believe how lonely Medicine can be to some people, oh if only you knew.

Then again, to those of us who are nearing the breaking point - take comfort in knowing that it is okay to have this feeling. I have friends who quit being a houseman, I have friends who regretted quitting housemanship, and I also have friends who quit and happily never look back. I understand the bottled and suppressed emotions that just begged to be released like a vortex into the black void. That feeling that you don't quite know what to do with it and there's no one that you can talk to that truly understand and empathize with you.

And you take it with you everyday. To work and back home, each day feels like a riptide being pulled by the Moon.  Each day feels heavier, there's no way out, and you cried to yourself alone at night. You started to lose hope. You started to lose sight. The future that you envisioned for so long just disappear in the mist of the blackest fog. You can't stand the stare from the onlookers that watched silently as you being roasted daily by the end of the patient's bed. You hate the stares, both venomous and full of pity alike. The coat and its stuffed pockets feel so heavy on your shoulders and your stethoscope around your neck just feel so suffocating. 

And that there's only so much that you can endure, that you can stomach. What happens when you can no longer stand it, can no longer swallow it - what happens when you can literally feel your body shattering into pieces, crumbled and billowed away? Would you want to listen to the endless rant of people who do make it, who triumphed over their demons, and practically prattling about their tips and their too-late advice? Would you?


If you have an ounce of humility in you, at one point or another, you would also experience if not all but a shred of what I once experienced. And if you are a broken soul, as I was and sometimes are, you would learn to recognize it in the eyes of your other colleagues. The same defeated eyes, the hunchbacked postures and the low speech pattern of those who are bearing the brunt and tired of getting the short end of the stick.


Offer a helping hand. Help others as much as you can. Be a good colleague to others. Be a good listener. Share stories and motivate as often as you will. Never be afraid to ask for help. Seek out constructive outlets. Indulge in your wants and desires. Invest in your soul-cleansing. Do not shy to ask for opinions, for a willing ear, or a shoulder to lean on. Never feel guilty for being weak. For being lost. For being less than whole. Never ever feel that you don't deserved to be saved.

I have been writing my experiences since before I started being a doctor and will continue to do so from time to time. Reach out if you want to talk and I will listen.

A Step Back

To give credit when it's due is what I should do and that is exactly what I am doing right now. Entering ED has given me ample time to think of my current situation and an idea of the path I should take next. While working in ED eliminates that nagging worry I sometimes had when working in wards regarding the progress of the patients under my care, it also gives off a false sense of security.

Work in ED screams hectic and urgency and all that, but it's basically just touch-and-go practice. Assess the situation, stabilize the patient, do basic investigations and initial referrals, then proceed with either observation before discharging or admitting to relevant wards. The clerking is brief with only relevant important positive and negative findings are asked. We expect the worse thus the nets are always cast wider to avoid missing catastrophic emergencies before narrowing it down to a number of workable diagnoses.

Because of the nature of working in ED is like this, it gives you a lulled sense of urgency of what you should be prepared about in the first place. ED is an elective rotation usually given at the fifth or final posting of housemanship. It's the last pit stop before you are burdened with real responsibilities working as a medical officer (MO). If I'm to caught up in the easy flow of coming to work mindlessly day in and day out, I will miss a lot of things.

The deadline for my annual meta life-reflection post is approaching. I tried not to think about it because if I do, I will just get upset and depressed. If I don't think about it, I can see a bit of a glimmer for the future. I would feel that I can do it. The periodic zaps of reminder for me to buckle up may be infrequent, but at least I am aware of it and what I should do. There are still lots of things I want to know thoroughly before I ended my housemanship.

It's time for me to get serious, like serious serious. I have to do this last rotation really properly. I may not get the chance to learn how to perform some of the clinical procedures other housemen did before this but I really want to know how to do it before I leave. This is the number one major concern of mine - I lack clinical skills. I want to know the management of all the cases that come under the sun, or at least the basic principles of them. I want to know how to read ECGs (my worst enemy), x-rays and CT scans better. I want to learn how to present and refer case properly and efficiently. I want to know how to prepare basic medication and memorize their doses (I'm still bad at this). I want to learn to do basic ultrasound scans and more importantly to make sense with what I'm seeing in those scans. I want to be prepared. I want to be ready.

And so I have a lot to thank my ED in this. The bosses are friendly and supportive. There's a lot of opportunities to learn here. So many cases coming through the door that beg me to learn them all. I have to stop procrastinating and kerja goyang kaki like I usually am. I don't mind being scolded (so far I don't meet any of the screaming bosses yet) as long as I get to learn. I hope I can do this. I hope my enthusiasm lasts. In sha Allah all will be well. Ameen.

I Hate Kids (and Babies)

I am already 7 weeks into my fifth posting Paediatrics (wow, already fifth. How time flies erghh) and I. AM. NOT. LIKING. IT. ONE. BIT. I feel ill-equipped to work despite having to undergo tagging for three long weeks, all because I had the misfortune to catch a viral fever when working in the general paeds ward. It's not that the work is difficult or beyond my understanding - it's just plain annoying and irritating.

As I mentioned before in previous post, this department is generally stricter as compared to other department. Monthly finger-flex attendance sheet, NRP, short case and long case, compulsory Journal Club presentations and CPGs to attend, mandatory meetup with supervisor at certain weeks, and the very fact that the leave allocation is handled by an MO who opens it periodically pretty much makes it unbearable to take. 

I am so used to asking leave whenever I wanted to (within reason and time constrain, of course) from my houseman leader previously in other departments, that when I came to Paediatrics this limiting issue gnaws at me very much so it puts me in a near foul mood every time I think of it. I can't possibly plan my leaves a month in advance - what if on those days that I applied for leave I have a rescheduled assessment or something? Idiotic, kan? Why can't we have that freedom to ask for leave one week in advance like the rest of the housemen do in other departments? WHYYYYY

And don't get me started at the number one reason why I hate this department - the patients themselves. OH MY GOD this department is testing my patience very much so. There are two main wards all HO need to work at initially - the general paeds ward and the special care nursery (SCN) for neonates (babies less than one month old). Once they completed their rotations in these two wards they will move on to NICU, labour room, NBS, clinic, etc.

Now, the paeds ward is very much like my dreaded medical ward upstairs - full to the brim with patients but the difference is that the patients here are pretty much the mini-versions. They are small, fragile-looking, ill-looking, BUT VERY NOISY. True, adult medical ward has its own share of noise but here they are constantly screaming and shouting their lungs out. They do run around in the ward from one end to one end, shrieking or crying or doing both at the same time.

The most vexing of all comes when trying to take blood or inserting a line to the children for a number of reasons. One - we can only do so in the treatment room, far from the watchful eyes of other children and patient's parents. The thing is, there is only one treatment room for the whole ward that can reach full capacity of 65++ patients. In paediatrics we cannot draw the blood at the bedside. Kau gila apa nak buat macam tu. Once the other kids (and their uncooperative parents) see what we are doing, the whole cubicle will go bonkers thinking it's their turn next to be poked with scary big needles.

Two, that said treatment room is also used by radiographers who will come to the ward for any portable chest x-rays that we ordered. We will bring the child to the room and have it scanned there. So you see, if there are 10 children that needs to be poked, it will never take 5 minutes each. It will take at least half an hour each. What deems to be a simple enough process will take an unbelievable amount of time it drives me crazy.

And three - these kids are really something. They shout, they cry, they scream, they spit, they bite, they kick, they thrash around, and it takes a lot of energy and personnel to get hold of them to lie still so that any procedure can be done once successfully and without failure. I really cannot tahan with this. More so when I had to work at night where staffs are fewer and there's not much help available at that time. So apa lagi, cucuk je la selagi boleh sampai dapat. Doesn't matter if it's a small child or a baby - they all are intelligent enough to give me enough resistance and resentment.

So, to conclude - I hate them all. I hate those persistent cries and screams. I hate the inability of them to listen to reasons. I hate them all for having problematic parents who can't even take care of the branula site carefully and just buat bodoh je sampai branula tercabut and the bleeding just spurted out. I don't have time to poke your cute, chubby kid with bluish bruises again and again in a day just because you are so negligent in taking care of your kid. I hate it so much that I'm wasting so much time doing one stupid procedure when there is a lot more work to be done. 

I hate it all so much but rest assured, babies (and kids), you are in a good hand. Even if I hate you LOL.

Yeah screw you too, kid.

Sensational Surgical Stories

Per rectal is the surgical fave like how VE (per vaginal) is for O&G lol

Can't believe I'm near the end of my Surgical posting. I remembered I was feeling restless working in the ward during the first three months. At the beginning, that feeling of having to get accustomed to new environments, new bunch of people, and new stressors at work is something I truly hated. Not all wards are unpleasant - there's one I really like working with because the staffs are a bit better than the other two, but I was really counting days to leave ward work and to start peri work.

For the record, any surgical-based posting is not something to my liking. It's not that I hate it - I just don't prefer it. There's something about surgical that really does not resonate well with me. In the first place, I hate being in the OT (operation theatres) because it's freaking cold and I had to lower myself when assisting the surgeons because I am quite a tall person. It hurts my back and I am not a fan of wearing scrubs and rubber boots. Secondly, I am really bad with anatomy so it goes against everything in Surgical to be poor at identifying which arteries or nerves supply which organs etc. 

But ultimately I am bad with anything and everything huhu. I just know how to do work - just a functional houseman but not really a lighted bulb person. I'm not even a hardworking doctor. I just do my job diligently without causing any issues to my bosses. The keyword here is: be a safe doctor. That's the minimum that you need to achieve.

There is a few cases throughout the four months in Surgical that have an impact on me. I never had the time to properly dissect each event and do a reflection on it, so this time I'm just gonna list them all out and briefly remind myself why each of them is important to remember them by.

1. Confused man yanking his catheter out

A male person with severe head injury after getting into motor vehicle accident - he was not fully conscious, in a lot of pain, and he sensed that a rubber tubing was inserted into his penis (it was a urinary catheter as he couldn't control his own urination) so in such a confused state, he proceeded to remove his hands from the restraints he was on in bed and savagely tried to pull the catheter out. 

Because a catheter is designed to have a balloon at its tip that can be pumped in the bladder once inserted (so that the tube won't come sliding out on its own), it can't be removed by pulling it out without deflating the balloon first. So that person tried yanking it out. The tube was stretched and stretched and when he couldn't get it out, he let go of it. Yep, it retracted back like any rubber does - straight into his penis and abdomen. He grimaced in pain and I couldn't do anything. Blood started to come out from his penis because of the self-inflicted injury and I was left with my mouth open, wordlessly gaping as I silently cursed in bewilderment.


I was at that time, holding his other hand and body from falling out of the bed. It happened so fast and that's the best I could do. It taught me that with people having severe injury to the head (and brain), they must have a lot of extra safety precautions. I have to anticipate the things that may go wrong and to be alert with the changes. It happened during the first week of entering Surgical so it really did nothing to improve Surgical's first impression to me.


2. Four foreigners being shishkebab-ed with parang

I was working in ward when my leader asked me to become a runner for a multiple MTP (massive transfusion protocol) cases in ED. Without missing a beat I agreed (anything to get away from the ward) and I started running to ED. Long story short, four foreigners were assaulted with parangs. All of them sustained bad penetrating injury with lots of blood loss, so MTP was activated to all of them. Runners (there's four of us) are tasked with the job of getting all the blood products from the blood bank as quickly as possible. In this case the transfusion is required direly to replace the blood loss. It was very tiring. I think I lost some kilos from running up and down the stairs many times that day.

I am making a mental note to never, never, ever set foot in Klang again once I'm finished with my housemanship. There is so many weird cases that I am certain won't be happening in more peaceful area.


3. Man choked on fishbone

A young man was choking on a fishbone during meals at a wedding. It was a big one based from the drawing he made. Apparently following that he took a page straight out the old midwives' tale - he pushed more rice down his throat in an attempt to relieve the choking. It didn't work, obviously. He vomited blood the next day and was admitted for an upper tract scope assessment (OGDS).


After the morning rounds in the ward we all started to do the morning tasks. For that patient, we had to get his consent to do the scope. As I was available at that time, sure, let me do it so I can tick him off the ward job list of the day. I was busy filling up the form at the cardiac table in front of his bed so that all the patient needed to do is to sign the front and the back page of the form when a student nurse interrupted me to inform that the patient is vomiting blood.

I already know the patient's case. So I said to her that it is expected to happen. It was a small amount, we are planning to do scope anyway, bla bla bla. I was a bit crossed for being interrupted. I just wanted to finish my work fast so I can move on with another patient after that. Then the patient vomited again. And again. AND AGAIN. He was holding the yellow plastic bag to contain the vomit but the blood he vomited was wayyyy to much. I was still holding the stupid pen and paper form in my hands, watching him as he bled all over the bed and onto the floor (and my pants and shoes too).


I quickly said to her, go get help. Now. I straight away called my colleagues as well and we attended the patient. He was in a dazed and not responding to our calls - a sign of shock due to blood loss. My internal bell is ringing with frantic alarms. The patient was pushed to acute cubicle, we ordered first stage blood for transfusion straightaway and patient was pushed for emergency scope. I was so caught up with wanting to finish my work I had neglected the thing that mattered most - the patient. Sufficed to say this is the biggest lesson I learn throughout this posting. After the incident I tried to stop any work I was doing when I need to attend to patients. I also avoided from eating fish for weeks afterwards. Seram mak.



4. Elderly lady with low blood pressure.

I kinda make it up when I met this elderly nenek who were admitted because of surgical site infection. Her thick abdominal skin was infected and was removed, leaving muscles exposed. One day when I was reviewing her in the morning, again one of the student nurses informed me that she had a low blood pressure. I asked her to repeat the measurement and the reading remained low.


This time I properly took my time and examined her thoroughly. She indeed had low blood pressure, and together with such a big wound across the belly, I suspected that she was in shock due to blood loss. Her gauze packing under the vacuum dressing appeared to be soaked, so I thought there must be some active bleeding happening. After ordering for a pint of run-fast crystallloid resuscitation, putting her on high flow mask oxygen, ECG and cardiac monitoring, I straightaway called my MO to inform him.


I felt good when thinking back of my plan at the time when I saw the patient. I was able to think calmly and did the right thing. My MO didn't correct any of my continuation of the plan - we both agreed to it and worked on doing them all. But after that he forbade me from touching any high-risk patient because he said if I started touching the patients sure more issues will come out of it afterwards HAHAH. The sad news was unfortunately weeks later I was informed that the patient passed away eventually. I was a bit saddened because she was such a softie and I tried my best to comfort her when she was in pain. Inalillah.



5. MO getting into a motor vehicle accident.

One of our MOs was involved in an accident and was admitted here. Long story cut short: this incident had prompted me to have a Takaful. I have a friend who is a Takaful agent and after a very short consideration, I took a Takaful with a few adjustments made that I think will benefit me the best. Takde kuasa aku nak kena admit kat hospital gomen, lagi-lagi kat tempat kerja aku ni. Kalau betul terdesak for operation, maybe yes, but afterwards nak mintak transfer balik ke private for better nursing care. Hey, that's my two cents anyway.

_________________________________________

There's only a week or more left for me in Surgical. I just need to complete my logbook, present my slides on next Friday, planning on what to do during my four-day EOP leave before return to the vicious cycle of hellhole tagging in the worst department of all - Paediatrics! NIGHTMARE OKAY. I AM SO NOT READY. KILL MEH

Jonah

The first time I've heard of this term when I was in final year of medical school. I naturally didn't understand much about it because it's hard to understand things if you're not part of it. Siapalah aku kan time tu, just a medical student yang blur blur dan tak paham apa-apa. But in essence, I roughly deduced it means someone who when at work will attract incidents that will make their work shift eventful.

Kata-kata orang yang bangga dengan dirinya yang jonah

The term jonah is a slang word used exclusively among healthcare professionals in Malaysia and is very popular among housemen and staff nurses. Medical officers used the term less, and it is almost unheard of among specialists to utter the word in conversations. It is often used to tease colleagues who often appear to have very eventful work shifts when compared to other colleagues. We usually tease them in light-hearted manners, although I've once witnessed a staff nurse throwing a bitchy temper when she learned a 'jonah' MO is oncall during her shift.


As a Muslim we believe in qada and qadar (takdir dan ketentuan) and accept that no such thing exists - no person is unlucky and to truly believe in jonah is a thing of khurafat. To just tease each other with it is fine. No harm done.


In a working environment where there is no consistency in the form of work load, I find that it is peculiar that such a word is coined to describe people who bring 'troubles' to work. If you work in the ward, yes, there are jobs that are a constant - a work routine that we do and follow as standard operating of procedure (SOP). For a houseman, that would be to do morning reviews, trace the blood investigations / formal imaging reports / formal lab reports, follow ward rounds, and performing the tasks ordered by the MOs or specialists. That much is expected.


What is also expected is that no two patients will present identical workload to the doctors / staff nurses. Similarly there is no two days that are identical. We expect that the number of new admissions to the ward differ from day to day and that different patients can collapse or deteriorating at any time. There is simply no consistency in that. We cannot say that a day which has 12 admissions and two patients desaturated of oxygen as a 'troubled' day because no matter how bad any day is, it is all within expectations when working in a hospital. Dey, kalau kau tengah attend CME hospital then tetiba ada orang collapsed kena heart attack itu baru eventful, macha.


Nevertheless, it is a culture I enjoyed to be a part of at work. More than once I have been labeled as jonah (even though I think some people had it worse than me). I used to hate it very much being a jonah when I was in Medical because working night shift in Medical means you will be busy working clerking a handful of new admissions and taking patients' blood for the whole ward. Granted, during my time I always have a colleague working with me and we don't have to rely on the runner for blood taking, but I absolutely loathed it when other things happened like relatives wanting to speak to the specialist to make complaints, patients making a scene or developing blood transfusion reaction at midnight (hence it is imperative to not transfuse blood after 6 pm unless it is absolutely necessary!).


I don't mind if things like patient developing a temperature or a low blood pressure or even an active patient (as opposed to a DIL) collapsed and needing CPR - it is within my responsibilities. But to handle things that are time-consuming and irritating in nature? Things like wrestling with a severe head injury patient to prevent him from yanking out his urinary catheter and failed, then watching in horror as blood dripping out from his penis due to the injury he himself inflicted, or trying to calm a patient down as he angrily shouted at us wanting to sign an AOR (At Own Risk) discharge form (which then my specialist said go and refer him to psychiatrist for delirium at freaking 9pm WHICH IS NOT THE CASE! HE JUST WANTS TO GO HOME, and which we did discharged him close to midnight eventually after calling the patient's whole family for a psychiatry evaluation and conference), or attending a staff nurse who had an ankle fracture after she slipped on the floor in the ward (yes, I even pushed her on the wheelchair to do the X-rays at 11pm, gosh that was funny and annoying at the same time) next to a patient's bed who late at night we heard a loud bang as the patient also fall to the floor as he tried to get up from his bed (and failed). LOL thus an incident reporting was issued.


That is what I personally think what a jonah is about. Sometimes all I could do is to gape open-mouthly at the absurdities of what is happening in the ward. Other times I would find myself grasping at my hair and screamed silently in consternation - being jonah is absolutely a true exasperating moment you have to experience it yourself. You will come to be proud of yourself at the end of your work shift - either because it finally ends or you managed to emerged unscathed with no harm to patients done - and calmly accept the fact that yes, despite dah mandi segala air mandian bunga, avoiding all red undies and clothes, dah sembahyang cukup-cukup siap tambah solat hajat tolak bala - you are indeed a jonah.

Why I (kinda) Like Being a Doctor

I have come to realize that I have never write a post, a proper one, that shares insights of what being a houseman is all about. You know, the one post that is just full with positivity, optimism and general good vibe feeling when reading it (Wait, I haven't? What did I write all year long then?). Sure, I wrote about my misfortunes and my depression and my encounters with patients but it's about time I write some good things instead. This blog is becoming darker with each post (thanks, sis, for pointing it out cis) so some sort of a balance is needed here, fellas.

Feel-good, positive vibe coming right up

And so here I am, as promised, after some time of pondering and wrecking my brain to figure out my key highlights of being a doctor. I will try my best not to sound generic and cliche like what most doctors or future doctors like to tell. Yes, I am sure some of them would say they like being a doctor because of that satisfaction of seeing their patients getting better or because it's a noble profession etc. yeah I'm sure they mean it but it's not meeeee, okay? You want my honest feelings of why I sometimes don't hate being a doctor (sheesh, fine, I like being a doctor) so let me have my say here.

I guess the first time I feel satisfied with what I am doing right now was just this recently when I met this patient that I clerked when he first came in and subsequently under my daily review (meaning I know the case inside out and can present to the specialist without even touching the BHT ceh ceh ceh). I had to request for a KUB ultrasound imaging for his acute urinary retention (meaning the urine won't come out) and so I had to present it to the radiologist on that day. The radiologist listened to my presentation attentatively, asked few questions and we even ended up discussing about the case.


What I want to say is that it feels kinda great (it's actually a fantastic feeling for me) when the one we are referring to (or requesting for an imaging) genuinely wanted to know why we are requesting or referring to them. You will be surprised at how often you will encounter people who are irritated or annoyed whenever we approach them. When we present, they are not looking at what's really wrong with the patient, instead they would find reasons to reject the referral or request.


I mean, I GET IT that they can't approve all requests or accepting just any referral made to them. But their lack of interest or the annoyance of the possibilities of their work to be increased is just.. well, fucked up. That's why when that fortunate encounter happened, I feel very satisfied doing what I do. That was one of the rare moment when I feel that I truly work in a team (an interdepartmental one, too!) for the benefit of someone else. Even if my request is denied or when the referral is rejected, I feel satisfied aplenty if they explained properly why they think the rejection is warranted.

NO NO NO NO NO 

only happy thoughts here, fellas. Happy thoughts. Positive vibessss

Moving on, another reason why I kinda like being a doctor is related with the patients themselves. Okaaaaayyyy, it does sound a bit cliche but I can't help it, can I? Don't get me wrong, who would not feel brightened when patients who were near death's door when they first admitted slowly get better and were discharged with leaps of improvement? The last patient who recovered like that made all of us grinning from ear to ear whenever we were reviewing him. Such a wonderful feeling.

But most of the time, I wouldn't care much about the patients that way. When you work in a big hospital with such a high patient turnover rate (meaning a lot of patients admitted and discharged at one time) and being in charge with a lot of patients, you will miss the luxury of being emotionally spent in every patient that you found. Often you will just be glad that patients are being discharged so that you don't have to take care of them anymore HAHAHAHA it's trueeeee! You will see, this will happen often enough especially when the patients are difficult both to treat and to please. 

I have lost track of times I resisted from doing this facial expression when dealing with difficult patients. One classic example: Approaching patients to draw blood and I didn't even start or anything yet and then they will make a tssch sound and scolded me as to why I need to take their blood everyday. A proper scolding, mind you. Like it's my fault they got sick or something. Jadi doktor memang best sebab boleh kena marah dengan semua orang dari patient ke relative ke staft nurse ke specialist yeay~

So how do I, a fairly cold-hearted bastard (as claimed by some), enjoy the nature of my profession? Amazingly I do enjoy interacting with my patients, and they more or less also appear (I hope!) to enjoy interacting with me. I do this by doing a lot of small things, really. I found that small talks, gestures, and tiny acts of kindness often reciprocated with grand gratitude from them. Be it just an insight to their meals and the shared feelings towards the taste of the hospital's diet, a lending hand to sit up or for a walk to the loo, offering my hand for them to hold whenever they are in embarrassment during a procedure or scared shitless with the state they are in - they appreciated your presence very much. Even if they don't tell you. Even if you don't think it matters much.


At times, they make it known they are grateful. A gentle pat in the back while I was doing my work to inform me that they are going home now, a good morning/bye bid whenever they see me, or a simple sentence like, "Ahh, you are the one I want to see, doctor" can make me swell with this yucky thing called happiness. Thank you for thanking me. Sobs.

And the third reason why I love being a doctor is how this "noble" profession, which when you think of it, IS NOT noble at all when all you do is doing gross stuff like sticking your finger literally into people's arse or vagina and slicing off dead tissues and rotten flesh from their sacral sore or diabetic foot, is how it makes me hmm.. humble. (AM I, THO? HUMBLE??)

In a self-reflecting note, I think I am. I don't make a fuss about me being a doctor, no, not really I should think. Blogging about being a doctor is a different matter. I'm talking about my humility while being someone in the profession of taking care of other people's health that I don't think of myself as being superior to others. Working in a hospital you are bound to meet a lot of people from various walk of life. Most often than not, doctors are indeed, humble (some of them, la. Mana yang berlagak nak mampus tu pergi mampus LOLOL). 

I guess I am arriving to the same conclusion that they might have already drew years ago when they started working that as a doctor, be it a first-posting houseman, a senior MO or a consultant, that we can't possibly know all the things. Even if you know so much about your specialty, you can't possibly be able to treat the patients with just your expertise. Older, experienced doctors often know about this, that's why some of them are blissful to work with. They know their own strengths and limitations, and they do not hesitate to ask help from other department.

At this point of being just a houseman, to me, being a doctor is all about doing tasks they entrusted to you whether you know it or not. The point of doing them is to learn about why you are doing it and how to do it properly. The why can be learnt from books or from your superiors, but the hows is more versatile. Never, ever, be arrogant enough and not asking for help. I love to ask the staff nurses on how to do things like suturing, preparing IV drugs, bladder irrigation, and thousands more things. They KNOW more than you do. Sometimes, patients also know more than you, because they have been dealing with it longer than you do. Do not feel ashamed, even if you think it caused bad impression of you to them. It's better to learn and do things right than being arrogant to admit that you don't know and doing it wrong.

So that's it! Yeah, it's mightily a short list to begin with, but these are what making me keep on going. At days I will lose all hope and nothing will feel right, but on some days, when these happened, I think I don't regret for choosing to be a doctor. My advice to future doctors and aspiring students alike is: Chin up. You can do it. Good luck with your endeavour!

Of Raw Rage that Galvanized Grief

There's a rage in every grief. It can be a small thing - the silent clench of hand, the murderous angry stare that aptly targeted to everything and everyone, or the slow, hot drops of tears as curses fly at the world and its unfairness. It can also be huge and eruptive - the wretched wails, the uncontrollable violence and mayhem, or the sheer explosive of raw anger at the misfortune that befall.


I've witnessed the latter kind of grieving anger today when one of the patients died, in the day of relative tranquility often found when working over the weekends. I have seen a lot of families with their relative succumbed to death in the hospital. It was never a pretty sight. It was a horrid affair, it is horrible to witness, and it sticks to mind too long when it should have been long forgotten.

A Checkpoint In Time

Inveritably, at one point in the future you will come and read this entry again, so that you will ascertain with a greater portion of certainty if your doubts are indeed, valid in the first place. Remember that at the time of this entry being written, there is so much that you don't know, so much that you are so unsure of, that begets me to establish a checkpoint for a later comparison.

And here you are, reading this again, as I am certain that you will, of which I am doing it right now, both at the time of writing this down and also in every instances that exists in the future. This entry is purely for us; you need to see whether your suspicions are true yourself, by comparing the future me (which is you, in case you lost all your memories) with the past me (currently at the time of writing).

This is maddeningly confusing, but you are a master at confusing yourself, so you'll be fine.

In a year or more, you will read this entry with a different tone. There will be different emotions generated from it. I suspect the weariness will still be here in a year's time. A sense of dread, too, if by my calculations is correct and you will be at the time where I think the end is approaching. More than that, I think I want you to read this entry again with a thought that you are better than the past you who is currently writing this down.

It's hard for me to put what I want to compare to in words here. I want you to be still be able to comprehend my unease here, my obscure in writing, more than words can tell. That my concern is about the future that begins with my chosen place of work, the particular lack of skills and knowledge that I get here.

There are so many things that I think I am lacking, so much that I do not know. It has been a year, and I think I am running out of time. I want you to acknowledge my concern now in every visit, in every lines of words read, in every thought that crosses your mind. I think I made a big mistake of choosing this hospital, that it didn't provide me enough skillset that I thought I would get coming from such a big hospital, or that maybe I didn't take the chances that it gives, however few that I could find.

I am thinking I am missing on all of these, that I am becoming quite a poor houseman, and it scares me. I am thinking I am not learning enough, not motivated enough, and you are the result of what I am going through. So many missed chances that it simply terrifies me into thinking that I will make huge blunders when I became a medical officer later in the future.

If you are still like me, not knowing shit from anything even after all these years, we are screwed. I see no motivation for an improvement, so I am very sorry that I can't see any way out of this. I am still emotionally wrecked and I am still very bitter about my life. I have so much hate and anger and there is this indescribable feeling of negativity that either will provoke me from time to time or drive me to tears out of nowhere. Are you still like that?


 I think so.

In a year's time, I want you to make another checkpoint entry. Compare where you are with the future you when you started to work as a medical officer. It's alright if it is still as confusing as this one. We are a bunch of confusing, twisted lump of insecurity and indecisiveness. I already feel down writing this down, and I very much hope that you will have better luck when writing yours down. The cumulative thoughts for this year, compiling the fast disappearing medical knowledge and the lack of more various skillset that I should be learning as a houseman, are yours to peruse and compare.

So do you feel better, a year from now on?

The Man Who Asks Too Much

Sometimes it is unrealistic to be true to your profession. The four cardinal ethics of being a doctor that has been repeated over and over in my university days (and still stuck to my mind) are patient's autonomy, beneficence, non-malevolence, and justice. Briefly, it means that patients have their own rights, we must do good, do not harm, and be able to fairly decide which patients are more in need for the limited resources at your hands. But just by being ethical does not make you a doctor. It is only one of the many facets of the existence of being a doctor.

Ding!

As I have a few more hours to kill before going to work later this evening, I want to talk about something hashtag #irritating that everyone will encounter when you are in this hospital. Well I am not naming my hospital, but maybe some of you know or don't know where I work, anyway let's just leave it as it is. That something #irritating is called,

THE LIFTS.

You may laugh and pointed out how callous or petty my topic is but believe me, the lifts they have in this place can and will drive you all to nuts. As opposed to new hospital buildings which have more than one lift lobby, my hospital only have one main lift lobby with 5 + 1 lifts and a smaller lift lobby at the far back that is used for VIP or royalties. The far back one has two lifts and they are also connected to multiple floors of operation theatres. 

Now, to all visitors and staff alike, the lifts that we use are the ones in the main lift lobby. There are 3 lifts in a row facing two lifts opposite and another one lift to the side that is for sanitation materials and waste use. Let me draw a quick sketch of the plan of the lifts in the main lobby:

Okay just imagine this is it, alright? It's not accurate so don't bother pointing it out.

Now to begin with,

Ever since I started working here close to 11 months now, LIFT 4 has never been operational. There is always a stop sign in front of its doors saying close for maintenance. Or wait, there might have been in the past, now I don't even remember about that lift because I never use it.

Lift 5 is reserved only for patients, in the sense that the patients being transferred in wheelchairs and in bed. The transit is both ways, either from ED to the wards or from the wards to Radiology department for imaging or being sent to different floors such as ICU or to OTs. There are security guards stationed at every floor that keep track of the movement of that lift to ensure that the waiting time or the transit time of the transferring patient being kept at the minimum.

I have no quarrel with that lift. That lift is a good boy.

The remaining lifts are straight a-holes. 

Lift 3 can go between Ground floor up to the 6th floor. Now I am in Medical posting at the moment, which are in the 7th and 8th floors. Yes, I can always use that lift and take the stairs to my ward, and yes, it will keep me healthy, 

And the #irritating thing about that lift is that its bloody doors won't even shut off properly. Imagine being in my situation; you are late / tired / in a hurry / claustrophobic and the lift decided that as the doors almost close it opens the doors back 2 to 3 times. There is no one outside who is pushing the buttons and no one inside pressing the open door button but that damned lift still like to toy with my feelings and wastes a good 5 minutes just to close the bloody doors. What a dick.

The next #irritating lift is Lift 2. This one is an epic one because you can only press the buttons 7th and 8th floors. They used to put a plastic cover but they changed it to a freakin' metal cover with three square holes so people inside can only press G, 7, and 8. The idea is that this lift is meant for people who wish to go to Medical wards faster. That idea is a novelty and naive at the same time simply because it won't stop people from stopping that damned said lift from other floors! So what's supposed to be quick ride upstairs or downstairs can be equally exhausting and long if the lift stops at every floor to load and unload people.

Adjacent to it is the Lift 1 which is supposed for people to go from Ground floor to the 5th up to 8th floors. During the peak hours there will be a guard manning the lift from the inside who will stop people and ask which floor they are going. If the answer is less than 5, they will stop you and ask to use other lifts. In practice, this is also a dick move because like I explained earlier, have you seen the annoying bloody lift directly opposite like?

Apart from that, Lift 1 has this #irritating quirk which that in between the stops, it will sometimes reset all the buttons. All the lighted floors will disappear and if you are not quick enough, what's supposed to be a going up lift will suddenly become a going down lift when someone downstairs is calling for the lift. This, my friends, is enough to make anyone scream with frustration especially when you are from 8th floor going down to Ground floor and on the 1st floor it happened and now it goes back up to where you came from. #TrueStory bro.

Most of the times, Lift 6 comes to the rescue. But it has its own drawback as you will be sharing it with huge waste and sanitation bins. The floor sometimes is wet from the leaking bins, and sometimes it is as smelly as the darkest pit of Tartarus, and one time it lost all lighting and air ventilation for a week and hence the smell magnifies to a hundred-fold. I had to be in complete darkness with odors of garbage and human piss or whatever bodily fluid there are  but that lift is the only lift with no stupid quirk that #irritates me to no end.

Now that I let it off my chest with this rant of mine, I do feel lightened up. It is as if my spirit has lifted up!

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.

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'çlock 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.