The End of Things

With a very heavy heart I have to announce that there will discontinuity of my writings here on this blog. Already enough excuses have been uttered and chances have been given but the hiatus keeps getting longer and longer. Topics are scarce, diminishing in frequency; provoking thoughts are laughable in essence and clarity that it is increasingly embarrassing to write, let alone for readers to sully their eyes reading. 

                                                                                                                                                                                                                                                                                       

Sorry, did I say that it's only the end for things this year?

I will not promise to write more in the future, but as things stand, this blog is very much alive. To end this year, here's some updates about my life so far:

• Successfully moved into my new home. I spent a bit on grills, lamps and fans, air--conditioner, window tints, and kitchen renovation.
• As of now, my kitchen renovation I estimate to be 50% done. Considering I started hiring the damned contractors back in July, this is late. Very late.
• I had changed my mentor for Public Health logbook twice - and until I have transferred to PKD and not working in KK, my logbook will remain empty until the true End of Things.
• Naik pangkat to UD48 a few months back - now I feel old but still stupid at heart. 
• My weight inceased again - I'm too tired to get upset about it. Hmmmm.
• Will be having a very good news in two month's time, God willing. I will share more later.

Okay that's it for now bye bye!

Ladna

One day, the sister came to me to inform about a new antenatal case coming up that we were expected to handle. It's not always, but from time to time the sister will inform doctors of any foreseeable complicated antenatal cases so that extra care is required for those patients. As the patient is from my care zone, the sister came to me, all whisper-like, of which I initially thought, "eh, sister ada hot goss ke nak cerita?"

I am only just been working here for 1 year, 5 months, and 8 days. I am also not from here. I know nothing about some of the more distinguished local people here. So when she asked me whether I knew about this one particular patient that just became pregnant, I just politely shook my head. In my head, I was already making few educated guess about what high-risk conditions that the patient had in the past. On top of my list: uncontrolled DM, pre-eclampsia, anemic, some cardiovascular conditions, etc. 

It turned out she has a myriad of social and health issues. Something like a bad apple of the community. A heavy smoker that takes occasional drugs, having multiple partners, no family members, unmarried, moving places so often that it was hard for nurses to come and check on her, has uncontrolled diabetes, but most importantly were also pregnant. The nurses all had a collective groan when they talked about her. Everyone knows something about this woman, except me. It turns out that small communities really talk the loudest.

One of the earliest issues we had was her address. She had changed partner, meaning that the one she was staying with at that time was not the one who impregnated her. She doesn't have any home, so she stayed with her current partner. But often when the nurses came to do house visit, she's not at home. She also smokes a lot, and after repeated nagging from us she cut down the smoking. She complied with the hematinics, and she went for her appointments as instructed. 

Her diabetes was manageable, but it kept us on the edge of our seat throughout her pregnancy. Our next concern next was on postpartum, on how she is going to take care of the baby once delivered. We were unsure on her family support, the logistics, etc. But she assured us that she will stay with her partner's family. We were skeptical, but didn't press on.

Her labour went well in the end. The next time I saw her was during her baby's check-up. I did a small double take when I saw her. She looked different somehow. More reserved and looked at ease with herself. She was cooing her baby while waiting for their turn, and the baby looked very healthy. The nurses all cheered her on, and I thought to myself that she was alright after all. Of course, our next management is to make sure she registered with our PPC (Pre-Pregnancy Care), and to continue her diabetes treatment. 

This week I was informed that last weekend, she came to the clinic with her now 1 year old daughter, distraught and near panic. She was bathing her daughter that morning. When the water touched her daughter's body, she cried suddenly. Her private part was red and she cried in pain when her mother touched it lightly. Fearing the worst, she brought her straight to the clinic with the heavy suspicion that her 70 year-old father in law had molested her daughter. My MA who examined her daughter brought them to police station to lodge a report before referred her immediately to the tertiary hospital. 

I was stunned silent. How cruel it must be to have this wretched accident happened to your most loved one. Her life was hard enough, and when she finally had the chance to turn over a new leaf, this devil disguised as a decrepit old man dared to molest her child? Both of them are admitted to the ward for a few days before being discharged. While admitted, I asked the nurse for a daily update on her case.

This all happened end of last year. Much had happened since then, of which I think the outcome is much regrettable. When she was discharged, she made a decision to move to her brother’s place in another state. She gave no contact details that can be reached, and the name of health clinic that she’s supposed to go was not given. I suppose she wants nothing to do with us here, seeing that being in touch with us will also trigger her trauma. I pray that she and her daughter find solace at the new place, far from the evil human can make. 

This draft has been sitting in my folder for 5 months, and in conjunction with Happy Mother’s Day. I dedicate this writing to remember the hardship all mothers endure in raising their children and hoping for a better treatment to the injustice that they have.

Work Diary at Klinik Kesihatan

0645

Left home for work. Made a hot milo drink beforehand to drink while driving, with its liquid steaming warm and cozy in the black tumbler. Had to endure exactly 11 traffic lights during the drive, which depending on luck, will almost all turn green or red upon approaching the lights. The drive usually on a happy side of note thanks to the radio morning talk show and the calming paddy field scenery along the way. Sometimes curses words were uttered as I had to tow in line the tortoise-pace of village folks cycling or riding motorcycle in the middle of the village town road.

0735

Arrived at KK. Parked the car at the back of the main building at the usual spot. No roof or anything, but it's the closest spot to the building. Do I worry about the scorch of the sun baking the insides of my car and melting my wipers? Yes. Will I do something about it? Nah, fam. Punched in for the day and went to my room. Brought out my laptop, plugged the cable in, refilled my cheap-ass China-made humidifier with the tap water at the sink behind my chair, switched on Spotify and picked the Malay classic playlist.

0745

Walked to the shop lot next to the KK compound as my only sole sorry excuse of exercising. There's only three things to do in one of these days. It's either a walk to the bank to deposit my hard-earned locum money or going to the 7-11 store to buy sambal ikan bilis bread, or a walk across the road to buy kuih. 

0800

The official starting working hours of klinik kesihatan. Usually patients already came as early as 7.30 am (you people are insane) where they will register first, wait for their turn to have vital signs taken, then wait some more before being called for blood test or nurse check up or to be seen by doctors, respectively. Sometimes there are other things to attend to so early in the morning such as quick meeting among us doctors, other portfolio tasks or auditing work that need to be updated. Or it could be just a casual morning with casual conversation all around.

0830

Started seeing patients. Here we see patients according to the zones covered. There are two zones, each covering a number of villages. I cover Zone 1, meaning all patients who come from Zone 1 will be seen by me. The two big chunks of cases I see are of NCD and MCH. NCD is non-communicating diseases such as diabetes mellitus, hypertension and cholesterolaemia. Those big three is usually coined as penyakit tiga serangkai. MCH stands for Maternal and Child Health, and that includes seeing pregnant mother, postnatal cases, family planning, and child development milestones. 

I hated my O&G posting when I was a houseman. I hated kids as well, despite it was a smooth sailing during my posting in Paeds back then. Just my luck to land at KK to do this day by day! But I kinda enjoy it. No lousy rounds, no shouting or telling offs, and definitely no malignant people. I do feel intimidated and unprepared from time to time, but I think I gradually do okay. I make sure my documentation is thorough, so that hospitals won't question my management here. Ye la, MO KK kan MO cabuk je.

1200

Patients started to dwindle in numbers. On better days, I became jobless as early as 11.30 am. On bad days, I finished seeing patient exactly at 1 pm, which then I proceeded to have my lunch.

1300

Oooh, here came the one-hour lunch break. Walked across the road to tapau lunch food. White rice with either chicken or beef with vegetables usually cost me RM4 - RM5.50. Went back to my desk, ate my lunch with much gusto. Once full, I walked to the bed in the room. It was time for daily siesta. Oh yesssss...

1415

Woke up groggily. It's always a good nap if I managed to score one or two dreams in it. Went upstairs to pray Zuhur. Aha, an empty office chair! A lil quick nap of 10 minutes after prayer then.

1430

Patients started to wait outside the door. It's time to see them. Mood still over on the high side, because it's only for another 2 hours and half before finishing work.

1630

No more patients in the clinic. Went upstairs to pray Asar. Started to pack my things.

1657

Switched off the air-conditioners and humidifier. By the time I reached the attendance clocking machine, it would be exactly at 1700 (it comes with a lot of practice of going back exactly on time LOL). Once the machine said, "thank you", I walked to my car, started the engine, and drove away without a backward glance.

1700

The official closing hour of a klinik kesihatan. 

1740

Reached home or locum clinic.

Part 4- Settling In [end]

On my second day of working in KK, I ran down a man with my car.

It was just after work. My fingerprint ID was not registered in the system yet, so I just walked out the clinic once the clock stroke 5 pm. I parked my car in front of the main building; the sheltered parking slots for medical officers were full and I don't have my favourite parking place yet.

My mind was in a dazed. After two days of learning the ropes of working in KK, I more or less managed to function serving the locals here, albeit only at 60% efficiency I gathered. I learnt the basics of antenatal ultrasound scanning, doing the RMEs (routine medical examination) for both the pregnant ladies and children, managing the diabetes mellitus and hypertension patients, and knowing when to refer to the district hospital or the tertiary hospital.

Before I reversed the car, I had checked the rear mirror and it was clear. But stupid me didn't realized that I did a left turn reverse. And who was there, minding his own business as he was putting his medicine into the basket case of the motorbike but an elderly gentleman with a DISABILITY?

The crash was soft but unmistakably "crunchy". I thought I only ran over a parked motorbike. I quickly went out to inspect the bike but to my absolute horror there's a man lying on the ground, his already deformed left leg pinned down by his own bike. I heaved up the bike, releasing the man from the weight and the other staff, who quickly went out to see what's going on, helped the poor man on his ground.


We assessed the man and he was fine. He repeatedly said he was fine, that he had nothing serious. But I was chagrined and feeling dreadful. The old man then rode his bike off with his broken side mirror without me having the chance to give him some money. There's a slight dent at my car's bumper but the dent in my heart was much bigger.


I met the old man, again, last month when he came for his appointment. Turned out he was in my care zone (I covered a certain radius of area here that covers a number of villages, including the one this old man from) and I was free to see him. When he came in to the room and sat down, as soon as we had eye contact both of us were remembering the day I ran him over. Both of us smiled sheepishly and we ended the consultation with a laugh.


There's too much to tell about what's happening in the last 4 months of me working here in KK. Much of it is uneventful. At times I do miss the craziness and the peculiarity of the cases found back in Klang, but with the advantages of lunch break, acceptable patient load and the very fact that I can go back home by 5pm sharp on weekdays (weekends off, uolls), I am liking this new workplace very much so.


With it, however, came an end for my ambition to pursue FRCEM papers. I took a few months to come to term with it, and as of now, I am not looking to pursue any paper, not even FMS. This might change in the future, but for now I am very much in the knee-deep preparing for a big chapter in my life and what may come later will just have to wait.


That's it for my last part of new MOship transfer posts. I will be posting less frequently about my work here (seeing that there's hardly exciting thing to talk about) and I foresee that I will actually post only 3-4 posts per year. This blog is far from dead, though. Just drop a comment if you guys have any suggestion/question and thank you for reading!

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)

The Half-submerged Duck

First and foremost, an apology.

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

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

Secondly, a brief recollection of memories.

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

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


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


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


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

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




The third matter and at long last, an update!

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

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

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

The Light in Their Eyes

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

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

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

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


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


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

Sigh.

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


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

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


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

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


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


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


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


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

photo credit: Annie Griffith

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

Of Humerus Fracture & Swiss Cheese Model

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

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

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


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

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


Imagine a stack of multiple Swiss cheeses like this:

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

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

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

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

A shamble, A sham, A shame

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


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


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


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


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

Another Beginning

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

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

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

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

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

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

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

Yo KKM, where my placement at?

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

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

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

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

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

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

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

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

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

NS1 positive?? AAAAAAAAHHHHHHHHHHH!!!

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

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

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

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

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

I'm not pouting. You are.

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

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

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

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

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.