Virus and I

We are entering the second half of the year so far, and I believe we all agree that this year is just unbelievable. What were we thinking in January, to be scared of the possibility of the third world war when we were already at war with the pandemic? This viral enemy that kill indiscriminately, at times insidious and covert, rapidly and surely draining our finite resources to combat it.

I was unfortunate to be absent from writing for too long. With the virus occupying most of my responsibility at work, I was dismayed when my laptop broke down in March. With almost half of the services in the country halted to contain the spread of the virus, I was left at the mercy of the clinic's computer to do my work. Writing about my travelog will have to stop, for now, seeing that all my pictures and videos are stored locally in the old laptop.

For me, all of these started last year when we are dividing our work portfolios. Before this, I am responsible for managing verbal autopsies in our health clinic, along with other two minor portfolios that I haven't been briefed about. Then, I was tasked to handle infectious diseases as well. Prior COVID-19, our infectious disease folder include ebola and MERS-COV guidelines, forms, and work flowcharts. In December, 2019 nCOV was added to the list. I was okay with all this because we never thought it was going to hit us big at that time.

Because I handled 2019-nCOV (later coined to COVID-19) for my health clinic at that time, I had to attend all district level meetings pertaining to this virus. I was responsible to make sure our health clinic is ready to attend COVID-19 cases at all time. Thus, my work slowly piled up from setting up camps outside clinic, making flowcharts and flow map, updating the staff regarding changes in PKD directives, addressing issues and concerns, making rosters, and also managing the 'front line' allowances for the staff. I was put in a different position because in other clinics, the ones who handle COVID-19 are all the MOICs (MO In Charge) while I just handle one portfolio, not the whole clinic.

But I was lucky, in a lot of ways. Yes, the pandemic surged in March and early April but the cases are significantly low in my district. My clinic, in particular, although it is the third busiest in the district it is still way under capacity. I consider my clinic as a rural clinic, even though the building is new and fancier than the others. Changes in how clinics operate during movement control order (MCO) to combat the spread of the virus also have seen a dramatic decrease of patients that come to to the clinic seeking treatment.

We still saw some actions, tho. Those PPEs that are sweaty and stuffy? Yes, we all wear that as well. Bringing suspected patients into isolation bay, referring to our FMSes through plastic-wrapped phone and distorted voice, deconning (decontaminate) ourselves once patient had safely been brought away by ambulance - we all done that except making selfies, that is. I find it to be callous of me to have selfies in PPEs, simply because I think we are fortunate enough not to wear that too often.

Personally, COVID-19 affected me greatly in other ways. Firstly, my parents in law had planned for them together with my wife and I to do Umrah pilgrimage back in March. I had already had my leaves approved and I drove from Penang back to KL on the weekends we are scheduled to fly. The day before our departure, Saudi Arabia had barred all pilgrims from entering Mecca and Madina, the two Holy cities in Islam. Further confirmation with our pilgrimage tour company had reaffirmed the worst - our Umrah was cancelled until further notice.

The quarantine, or the MCO, came in two-week stages. Among the many restrictions imposed to the public, the one affecting me the most is the interstate travel ban. My wife and I are working in different states and usually, one of us will take turns travelling to each other every two weeks. The ban was lifted partially in May to allow couples like us to travel home to our significant others. Thus, after almost two months of not seeing each other, my wife finally drove all the way from KL to Penang to meet me. Such reunion was special and holds a different significance to both of us.

In term of career-wise, both of us are working in essential services, although in different fields. Our finances are not affected at all during this troubling times and for that we are very grateful. My locum hours are cut shorter by two hours in view of the locum clinic has to be closed earlier than normal, meaning I am losing around 20% of my usual locum income. Despite that, my salary was adjusted in May, making me earning back what I was due starting from October last year. Together with the COVID-19 allowances and Eid bonus, I have enough as usual.

Seeing the trend of the cases in the past two weeks, our district is currently in the process of preparing for post-COVID health clinic settings. The new norms must stay and changes must be done to ensure all clinics stay ready to accept any unforeseeable events like a new surge of infection in the future. The task fall back to my colleague who is the MOIC for the clinic. I gradually had more free time on my hands due to this, and I hope that a vaccine is found soon so that we can contain this more properly and surely. With this I end my writing for now. Stay vigilant and stay safe, everyone.

 

Part 2 - Reporting In

After a scrambling long drive from JKN, I finally arrived at the district PKD around lunch time. Two colleagues of mine, Y and N, were also stationed at the same district as I and we agreed to meet at the PKD office after 2 pm. When I arrived, they weren't there yet and I hadn't had my lunch so I wanted to go somewhere first to eat. Luckily, beside the PKD there is a Mydin mall building. I never saw a Mydin mall this big anywhere in the Klang valley - I know there's a huuuuuge one in Kuala Terengganu but this one was maybe 4 or 5-storey tall.

Anyway, I searched over the Google Maps and found out that this Mydin mall is the only mall-like structure in the town. Upon entering, I quickly realised that the only thing worth to be excited about this mall is the Mydin itself. The rest of the shops inside this "mall" are so.. disappointing. The town itself is quite a medium size one, actually, with blocks of shop lots that kind of have everything that you need. I counted a number of banks, restaurants, hardware shops, furniture shops, etc. But no malls. I saw one KFC franchise, no McDonalds, no Starbucks, no TGV or GSC cinemas (not even an MBO). But this town is the closest to Penang (is this a clue enough to guess where I am now?), which by my standard is similar to KL thus should offer me more of a city life that I am forever addicted to have.

Me hyping myself helplessly while my inner me just groan at this town

At around 3 pm, the three of us went to meet the boss of the PKD, Dr Z who is also a PKD. Not to confuse anyone here, but his title is the Pegawai Kesihatan Daerah of the Pejabat Kesihatan Darah here. He's so friendly and enthusiastic about us reporting in here. We were midway of listening to the introduction of PKD organization and filling out forms when more MOs came to report in as well. He was jubilant. In total, there's seven of us newly transferred here and they (the PKD people) were very happy in assigning us to the various KKs that are under this district's PKD.

There is a total of 10 KKs under this PKD and they are divided geographically into two and named as KK Laut and KK Darat respectively. I was assigned to this particular KK Laut (literally, my KK is very near the beach) because they needed a male doctor to balance out the doctors there. I did not have a say in this matter, unfortunately, unlike the rest of my colleagues. My face cracked a little and I felt myself showing a disgruntled face to my new boss - I told you I had this terrible poker face that is very much loathed by so many people. But I couldn't help it. This KK is so far to the west that it took me a solid 45-minute drive from my rented house (more on this in next blog post!).


You will be directed to a Pegawai Tadbir (PT) who usually is assigned to handle all MO-related matters. That person is the most important person that you need to remember when handling with matters related to the PKD, apart from your bosses. They will handle a number of things that need to be cleared out when first reporting in to a new place. In no order of importance, it include:

• delivering the letter from state JKN that says you are to serve at that particular district
• HRMIS update
• CPD points of the next year
• transfer claim
• new KKM ID (passport photograph required)

Of those, the most exciting part but equally exhausting to complete is the transfer claim. The PT will ask you for a screenshot of the kilometres travelled from your home to the state JKN, from JKN to your district PKD, and finally from your district PKD to your KK. They will also need a copy of Touch&Go transaction, the original invoice of the first three-day hotel stay, a copy of your car VOC (vehicle owner certificate), the letter from the JKN and the letter from SPA. They will calculate how much you can claim, taking into factor of your car type (mine is less than 1000cc, so it's a C class or something) and they will also include meal allowance.

"Finally, all documents are here!"

But once all those done and dusted, just wait for the claim process to be approved in a week. The claim is noticeably more than you had spent. It's more due to the fact that we do not take into account about the meal allowance, lodging and etc. I'm not complaining, though, cuz I need that money HAHAH. This whole transfer thing just sucked all my savings into oblivion. So, a word of advice, do a bit of saving 3-4 months prior your transfer!

It's funny how much screaming I have done whenever I went to the ATMs

Another very, very important aspect that you need to highlight quickly during reporting in is that to REQUEST FOR THE WHOLE FIRST WEEK OFF! Again, I remind you, this is very important. Know your right to request. I was fortunate to ask one of my ex-colleagues at my previous hospital about the whole process of transferring. He said that not all PKD or the KK allow for day-off request, which is totally absurd and cruel. He had to argue at the PKD and threatened not to come to work anyway if he was denied the off-days. He eventually got it. Imagine you just had travelled tens or hundreds of kilometres, even, and they had the audacity to ask you to work the very next day? You don't even know the area, you don't have any place to stay, where to find food, etc. So do the sensible thing - ask for the whole week off.


I quickly asked for the week off on behalf of all of us. We are lucky that there is no KK that operates past 5pm on weekdays and none have to work on weekends, so our weekends is pretty much untouchables. We were granted the whole week off except on Thursday and Friday as half day as we had to attend an orientation course for the monthly new staff transfer. That's cool.

After the business at PKD concluded, I decided not to visit my KK just yet. It was already late in the afternoon and I did not have any place to stay yet. A quick thinking and I decided to find a budget hotel to stay at Bukit Mertajam, Penang. I didn't care that it was far. I didn't care that I had to pay toll and had to suffer traffic jams. The sight of Starbucks, McDonalds, and Xin Fu Tang (even though I stopped drinking boba teas long time ago and never join the bandwagon) just somehow soothed my soul and calmed my mind. I found a sensible hotel there and booked for a two night stay. I had a quick dinner, showered and went to bed.


The next day then was the start of a brand new day which is The Hunt for a rental house. This will be covered in the next blog post, so that's it for now!


(read Part One - The Long Journey here)

Part One - The Long Journey

It has been almost a month since I received the transfer letter and started working at a new place. A month filled with multiple burnout drives back and forth, travelling to far and near places. The long travel, the reporting in, the hunt for a place to stay, and the settling in has kept me much occupied that I neglected to blog here. I've been meaning to write the whole experience of the transition between a floating MO to a regular MO post-transfer and now I got a bit of time to do just that.

I'm sure my batch's experience is different from the previous MOs because we are the first batch of contract HOs being offered a permanent posting as an MO. Everything is digital, too, with the offer letters and the transfer letter just needed to be printed. Once all the forms and letters are ready, I packed my essential belongings that can sustain me for a month, shoved them all into my tiny Viva car, bid my farewell and start driving.


I have to make multiple entries because there's so much to tell so here we go.


Part One: The Long Travel

When we first got transferred, we are supposed to come to the health state department (Jabatan Kesihatan Negeri) of the state that we got. I departed from home very early as I estimated it would took me 2 hours to reach there and it was. Upon arriving to the meeting hall, I was surprised to see there's a huge number of us (122 people!) got a transfer in this state and all I could think of was, uh oh.

Usually JKN people will receive around 20 people reporting in for transfer in a month. And there I was, among the sea of a hundred people and few colleagues who got the same state as I was, waiting for them to hand in the official transfer letter that tells us the district we are transferring to. A few of us managed to call the JKN beforehand to know which district they've got so no suspense there but to majority of us, we were all waiting anxiously for that damn letter.


In any KKM organization at state level, us doctors usually work either under Medical or Public Health. Those under Medical means they will work in hospitals. It can mean a district hospital, a tertiary one or above. If you got Medical, you will be told which department you got once you report in at the hospital. Public Health doctors are the front-liners who work in health clinics (klinik kesihatan). We were told that in view of a large number of us transferring at the same time, half of us will be transferred to klinik kesihatans and another half will be sent to the hospitals.


Priority for a hospital transfer was given to those who passed (parts) of professional papers like MRCP, MRCH, etc. and those who are contract-based MOs. The reason being is that for doctors who have passed first paper of MRCP, for instance, they will require more training at tertiary hospitals under a specialist guide. Meanwhile, those who are contract-based supposedly will also be sent to tertiary hospitals because they will need to be evaluated by a specialist before being offered a permanent post.


After I received the letter and learned of the far-away district I've been assigned, I straightaway left the JKN building and started driving away. Afterall, it would take another 2 hours roughly from JKN to the next reporting place. I've learnt later that some of us stayed behind at the JKN for "haggling" - they tried to swap placement among themselves on mutual agreement. Some would want someplace more south or more north, closer to the east or to west, for instance, depending on their preferences or personal circumstances. Some succeeded while some did not. There's no guarantee.

Imagine this was me driving not under lamp lights but under the basking sun

The journey further north was a bit quiet with a whip of whirlwind perturbing my mind. After all I was, at that moment in what I would call uncharted waters. I was wondering throughout the drive about what is it like working in klinik kesihatan in a less populated district. Would I be left frustrated, unable to cope with the limitation of a clinic setting? Would I be wondering aimlessly, go in and out of work without the crazy rush of emergency I normally had back when I was in ED? What about my future? My aim for a paper? What about settling down? Having a family? How must I proceed?


It was a totally different kind of journey with a different kind of feeling. When I first left the house in the wee hours of 4 am, I had an endgame. I had it all planned and prepped. I googled JKN days before departure, finding out the best route and how long the drive was, determining where to change clothes and gauging whether my packed bags are sufficient or not for the months ahead. I was confident. I was ready.


The second journey was not the same. I did not know where the place was. What's the people there like. I know for certain there are a number of KKs there and I don't know which one suits me the best, or whether I can choose which KK to serve in the first place. The more I traveled, the more alarmed I felt about the future that lies in front of me. The weather was not endearing, either. It was cruelly hot and dry. I felt my lips cracking and my shirt sticking to my body. I definitely did not smell pretty. But I drove on and on, until I reached my second destination of the day -  the district health office (Pejabat Kesihatan Daerah or PKD).





(to be continued in Part Two - Reporting In)

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

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.

5 Reasons Why People See a Doctor

When I was in university, there is a module where we learnt about the models of lay health beliefs and illness behaviours. It is too detailed to explain to all what those are all about but in simplicity, we were taught (or more ineptly introduced,) to the concepts of what most people think health and illness are all about. 

How do you define the word 'health'? How do you use the word 'healthy' in an everyday's context? Is it simply the absence of diseases? If one is to live without diseases or disabilities, are they truly healthy? Being healthy is not just about not having any diseases or illness. It is about the presence of general well-being that encompasses the physical, mental, and social aspects of an individual.

When we are sick, we sometimes seek treatment. Most of us go see a doctor. Others do self-medication, either by using alternative treatments like ointments or herbal products they bought in the market. Some people just ignore the symptoms and continue on with their lives, hoping that time to be the healer of all wounds. Sometimes they only seek treatment when the illness has manifested deeply and it is too late to treat it completely. 

People react differently in the face of an illness. You may have a relative who stubbornly refused to go to see a doctor, claiming that their symptoms are not something to make a fuss about while you were worrying out of your mind, thinking that surely the symptoms they have are morbid-looking and prelude to something more sinister. You, on the other hand, may be the sensible one - seeking a treatment only when you deemed the symptoms that you have are serious.

In order to understand why and when people do (or don't) seeking a treatment, Zola published a paper in 1973 about the human behaviours when dealing with a disease or illness. In his study, he famously pointed out five reasons that prompt people to seek treatment and they are called the Zola's trigger:

1. The occurrence of an interpersonal crisis

'Interpersonal crisis' simply means when you have a problem with the normal functioning of your body. This is the most fundamental reason for seeking a treatment because the sufferer would want the 'crisis' to be resolved. Having difficulty to breathe, getting bloody diarrhoea or constipation, pressing chest pain, or hearing threatening voices in your head are some examples of the hundreds of interpersonal crisis you may encounter that prompt you to see a doctor.

2. Perceived interference with social and personal relations

People also seek treatment to their illness when that illness disabled them from going out socializing with their circle of friends or when relationships are affected. Some illness make it more difficult for the sufferer to go out and mingle. Think of chicken pox (herpes zoster) for example. Not only that it is contagious, it also causes rashes that may embarrass the sufferer from going out with friends.

3. Perceived interference with vocational and physical activity

Some people can handle their interpersonal crisis well and would not want to seek treatment until it interrupts their normal daily activities or work performance. A teacher with a sore throat and cough will most likely go for treatment as it most definitely will interfere with her teaching. Similarly, an athlete with a broken fibula will not play on the field (or even move around) until he gets his leg treated completely. 

4. Sanctioning by other people

This is when other people, whether relatives or close friends, told the sufferer or bring them to see a doctor. In other words, this is when other people are concerned enough with the sufferer's illness that they decided a treatment would be the better choice. Often seen in scenarios where the stubborn parent is being brought to the clinic by their children who are worried about their parent's health. This trigger is least found in sick people who live alone or homeless, making it more difficult for healthcare professionals to detect and recognize the illness until it's too late.

5. Temporalising of symptoms.

The sufferer has specific ideas about how long certain complaints should last. For instance, we know that normal fever should last 1-2 days. We have, somewhere in our mind, that if by the third day the fever is still not subsiding, we may have to consider seeing a doctor. Come Day 4 and the fever is still there, you may think, "Okay, if I still have the fever on the fifth day, I will go see a doctor for sure." This trigger is one when the sufferer makes negotiations with his own symptoms, often in terms of number of days having illness (like the example above) or in terms of severity of the problems (if the temperature of my fever gets worse I'll see the doctor tomorrow).

It is important for us to recognize these triggers, both for the public and the healthcare professionals alike. It is often the case where the sufferer doesn't realise they have more than one reason to seek treatment, so by realizing these triggers to them (or by sanctioning it!) you can help them to get the treatment they deserved.

For the primary care physicians, identifying which triggers that prompted them to come to the clinic is equally important. Some triggers are presented together while in some cases only one trigger is predominately presented. Sactioning by proxy is proned to cause compliancy issue as patients feel forced to undergo treatment or taking medication. By addressing the issue with the patient, doctors can gauge the level of patient's understanding towards their health beliefs and help them to come into terms with their illness. This is vital as sometimes patients will present with denial as a grief step process when taking in the news of their illness.

Interview week

I have an interview coming this Friday from SPA that I have not prepared. Literally, I still have not done anything about it. There are still documents to be printed and copied, my trousers are still to be ironed, my necktie is nowhere to be found, but most importantly, I have no clue what to prepare myself with for the actual interview session.

My interview is on the last day of the interview session for the Gred 41 Pegawai Perubatan (housemanship doctors), meaning that my friends have all, or are currently, undergoing the interview session themselves. Despite them sharing their interview questions on the Facebook, I still have jitters about it. I am no good in interview. For years, my nervousness had penalized me during MOSLERS and OSCES; I will have thought block and nothing good can come out, I will forget everything that I'm supposed to know when I am nervous, and more than once I was scolded for being seemingly unprepared.

Marks the day I'm done with school!

Goodbye to you my friends, at last shall we part;

Worry, my trusted fellow who sleeps with me every night,

My companion, Despair, when I drove back from campus or hospital,

Envy, who never lets me look at other people whole-heartedly,

To he who lets me down, Self-hate, I will miss you not.

Fear is what I breathe constantly, and it is suffocating,

At nights when I awake what-ifs are my tears,

My dreams are scarce, my hope is rarer still,

And yet at last my prayers are heard, blessedly answered.

So alhamdulillah, alhamdulillah,

and alhamdulillah,

Today marks the day I'm done with school!

*I have passed the final examination and have been awarded the degree of Bachelor 

of Medicine and Bachelor of Surgery (MBBS) from Newcastle University Medicine Malaysia (NUMed)

Life tests

Despair comes one after another, despite me telling myself that I did the exam paper reasonably well yesterday. In reality, after the paper ended I was left feeling numbed. The last 10 minutes was spent to answer the report of an ECG. I don't have any real hope of getting it right, so that initially left me with 11 promising correct answers.

Apologies.

It's getting a bit better now, so I've decided to delete the awful blog posts of mine. My first exam is two days away, and the written exams are 6 days away.  *breathes in deeply*


*exhale*

The Story behind the Nasal Prong

I remember taking the history from the patient's uncle sometime last week. He was unrousable at that time, lying in bed and seemingly unconcerned with anything that was happening around him. Nobody really knew what happened; the workers at the factory simply told the relatives that he fell down and was unconscious for an hour while on security duty. The details are sketchy. It happened around 8.00 a.m. and they then brought him to the clinic. Before he was sent home, he was advised by the panel doctor to go to the hospital. At home, he vomited twice.

The old and familiar panic button

Quick intro: I am rushing against a deadline for my elective assignment, I'm in my second ESR rotation, and I'm in trouble with MARA. My parents are coming back from Makkah this Wednesday, my grandma is getting discharged from the ward anytime this weekend, and I am feeling miserable with my final year.

I am backwards in my study. I feel restless and stupid. It's hard to find rhythm and tempo in my study. Also, my car is fast becoming an old car. I learnt to change a tire the other day. I haven't wash it in months. Also, I eat a lot now. I spend a lot now. Despite my allowance from MARA is non-existence now, I still feel I am spending the money I borrowed from my sis quite lavishly. 

Back to my study. I am really afraid right now. How am I supposed to be a doctor like this? I'm not ready. Everything seems hard and difficult. I can't remember everything. I don't even know what are the things that I shouldn't forget. Also I am still can't decide (shit my grammar went all over the place.) how or where to study effectively. My room is too hot the chair is too low and too stiff I am a chronic user of Internet how la weyh to focus.

My parents still don't know about my MARA allowance situation. It's gonna cause me a massive headache once they freaked out about it. Again, back to my study. I am restless. I have plans on how to tackle this year but it seemed it's going to be so tedious and tiring and long-winded there's a high chance of falling off the wagon or a slip.

So here I am rattling off about my problems. Heck, it's not like there's anyone reading about this. Plus I updated this blog once a month I think it's pretty healthy for me. I really don't have time to type a lot of things here cuz you know final year sucks and scary and terrifying I am fast developing inferior complex towards my juniors (don't ask me why or how I am really insecure about it) I need a big, red panic button to chill my asses off.

A Death in ED

There is death waiting and lingering around the corner. You never know it is there, even when the torrents of fate whisking the life away from him as clearly as the rage of midyear's monsoon. You see it with your eyes, like a spectator too horrified at what they are seeing but seemed unable to tear their gaze away, of the sequential events unfolding in front of you. You have an inkling in your mind, that one of the outcomes of this is ultimately death. Revival is another, being in a critical is another. But as long as Izrail has not arrived, you never think that death can come as swiftly as a thought.

You think that it is impossible to happen. Well, not impossible, but highly improbable. He was fine when he came in through the door. A grazed wound on his shoulder where you can see red, angry patches of what the skin should have been. His shirt was torn at his back, and from the say-sos of those in the room you found out that he was brought in due to a motor vehicle accident. A bike versus a lorry, and only a little skirmish from the look of the wound unlike the horrible, terrible accidents where bones meet outside air and scream is the language of pain. He was on the stretcher but was well enough to give his ID for identification. Hope is aplenty at that time. Triage coloured him amber, not knowing that Izrail does not pay heed to hopes and favours of men.

Red Herring

If you see a patient with bilateral leg swelling and redness up to the knees, right iliac fossa pain and bile vomiting, all for the last 3 days, what would your differential diagnosis be?

And to Him we all return

I have to read the case again tomorrow, for the sake of complicity. 
If I can, I will update this entry.

Saya Yang Menurut Perintah

I've heard that doctors really hate it when the higher ups (the Ministry as such) put words like "Saya yang menurut perintah" in official letters and government statements when addressing them regarding new protocols or changes in the healthcare.

As Datuk put it, doctor are not in the army.

They are servants to the public.

Seketul daging sebekas darah

"Ya Allah berdebarnya hati ni hanya Engkau saja yang tahu."

Dia tahu apa yang terjadi pagi tadi adalah satu perkara yang amat membimbangkan. Suaminya sudah bertolak menuju ke tempat kerja dan dia tidak ada sesiapa untuk menanyakan tentang apa yang terjadi. Tekad melampaui ketakutan, dia bergegas mencapai kunci kereta di atas meja dan memandu seorang diri ke hospital.

Results are out!

Alhamdulillah, I passed!!

I got 55.6% (the passing mark is 52.79%). So close, isn't it? See, I worked my ass off and although I was rewarded it is still marginally too close for comfort. Now that one BIG obstacle of the academic year is over, it's time to enjoy my SSCs and electives!

Oh, I also have a nazar to fulfill.

Surviving hell

This post is about surviving stage 4 MBBS course in Newcastle University.

I just finished my second and last exam paper today. It was freaking' harder than yesterday's paper, which was already difficult enough that it could make my go bald just from sheer stress. What makes my uni's exams so bloody difficult to pass is that they used Single Best Answer style, also called as Best Of Five. 125 questions over the course of 3 hours are not something that most students can deal lightly, and during exams we have tendencies to think in a way way way so differently than what we normally do like,