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Life has been exciting and excruciating at the same time these past few months. Somethings inexplicable, others inexorable, but everything a learning event. Taking it a day at a time, with my assessment around the corner. I’ve completely given up preparing for it, already expecting the worse, even before stepping in!

The papers keep mentioning the overload of housemen in every hospital, and this has gotten me quite worried. If, in the current situation there are too many housemen, there is still so much work to be done that I have till date never gone back on time, how would it have been prior to this when there weren’t as many housemen?

Anyways, back to work. Things have been pretty okay, and I’m chugging along at a decent phase. Albeit I wish my progress was at the speed of which I chug down beer, the sad truth is, it’s a bit slower than that.

For starters, let it be known that I’m not a medical man. Every fiber in my being resonates to the tune of being a surgeon. The precision of the incision, the power of an excision, the beauty of each and every suture! Then again, I’ve not done my surgical posting, so we’ll just leave it for the future! Going into medical, I knew things are going to be a bit tedious, considering how much practical knowledge the Medical Posting demands, and how each and every decision we make affects the wellbeing of the patient we’re caring for.

Some cases are blatantly obvious, staring at you with large fixated eyes (much akin to Sasha’s), and others come with subtle symptoms easily missed with deadly ramifications. You need to always be on your toes. Competency is another thing because when you start your treatment, you want to make sure you’re doing the best for your patient. There is no room for complacency and incompetence. So you’ll always want to improve yourself.

Sometimes, you will feel that there is no end to all this work you’re doing. However, I find it very calming to know that there is beer at the end of the tunnel. When I feel I can’t go on, I just think of the ice cold pint that I can down at the end of the day, and it rejuvenates me, and I’m good to go for 12 more hours. Perhaps everyone needs to find out what regenerates them, and focus on that instead.

Recent times have been quite challenging. My ward is divided into Acute, Subacute, and 5 other cubicles, with each cubicles housing at the very minimum about 10 patients, with the possibility of extension beds to increase the numbers up to 15-16 per cubicle. Klang gets messy because we don’t turn anyone down, despite running way beyond capacity. Twin-edged blade really. Exposure to more cases, workload triples. I’ve been told Hospitals like Selayang and Sg. Buloh won’t allow admissions beyond the computerized maximum. Any extra admissions beyond capacity is dumped to places like Klang GH . It should be like this, as this will ensure patient care is not compromised due to overworked staff, but where will we send the sick people in need of care?

Anyways, recently I was put in charge of the Acute cubicle, and as the name implies, it is for acute unstable cases. Suffering from a STEMI, ICB, SEPTIC SHOCK, DKA, or generally being unstable will buy you a ticket into the acute cubicle. This basically implies TDS rounds, constant monitoring, quickly attending to any and all issues followed by an entire day of being on your toes.

Tapering Inotropes, Intubating, Resuscitating, Bagging, tracheostomy, it all can and has happened in here! My time in acute was exciting, as it was my first time managing the difficult cases by myself. Calling MO’s for anything is generally frowned upon, so taking care of everything by myself, and sometimes with the help of a senior colleague really bolstered my battered confidence.

These are things that no matter how many times you read in a book, is something that you must perform to learn. Of course I find myself experimenting with inotropes and the like, I’m able to gauge what kind of response I can get from a patient based on the dose I’m pushing, be it single strand, double strand, or multiple inotropes.

Procedures are the most fun of the lot. Of course I am not talking exclusively about the Per Rectums that we do and observe on a day to day basis. BMAT, Pleural Tap, Abdominal Paracentesis, Peritoneal Dialysis, CVP, Chest Tube, LP, Pleural Biopsy, so on and so forth.

“Watch Two, Do Two, Teach Two, You’ll Remember it for life” is the Mantra to live by.

When I did my first Abdominal Paracentesis, I felt manly, the second one, still had me tingling, today, every one I do has me relaxed throughout the procedure without too much worry. I tackle the safety points with greater ease, and am even comfortable navigating the branullae around to find the sweet spot for best drainage. I can still remember my first attempt, whilst successful took longer than humanly needed. This was because, I kept percussing 300x to ensure I was making the entry at a safe point, trying to avoid any major arteries and/or organs. When that was done, I just made a 60 degree incision, straight in and refused to budge the branullae in fear of rupturing nearby organs. Yes that’s right, at one point I thought I would push a grey branullae so deep inside that I would perforate intestines!

Today was a bit exciting, I was able to do my first Peritoneal Dialysis. Not Observe, but actually do . Of course the western world would scoff at us for still practicing this “barbaric” procedure, but to heck with that, I felt accomplished and manly (I find myself feeling manly quite a bit these days)! The only sad part was that the patient suffering from Advanced Renal Failure was a 23 year old young man. Presented with Urea of 56 and Creat of 1700, Potassium of 5.9 and severe Uremic Symptoms. I chased him (Insulin Chase or Lytic Cocktail), and started him on oral kalimate. Few hours later after the chase, Potassium was 5.3. Looking forward to see him complete 60 cycles of PD at 1.5% bags, and a downward trend of his RP.

Of course, I had to work 4 hours after my shift ended before we could get to the PD but it was well worth it. There is great satisfaction in knowing that I’ve helped this young man, and he will walk out of this hospital after finishing his PD simply shadows over working 4 extra hours after your shift has ended. Speaking of which, I have till date, never gone back on time when my shift ends, with 3-4 hours over time appearing to be the norm.

I’m glad I have job satisfaction at the end of the day, because without that, every demotivating thing that occurs during housemanship will lead anyone to the extent of quitting (and many have). With assessment around the corner, I’ve decided to simply forget about it. My thinking on it is simple, come what may, I’ll just do my job and sit for my assessment. If the powers that be believe I’m good to go, that’s great, if they think I need more time in Medical, that’s fine too, I’m not going to let it bother me anymore. At the end of the day, the more I gain at work, the better it is for me!

To those of you who have sat for your assessment and passed, Congratulations . To those who have yet to sit for it, the best of luck, and may anyone but Beelzebub guide you to success. For those of you who have sat for your assessment and are held back, here’s to you knowing more than anyone else ever will from your department!

For the rest of you who’ve had a walk in the park getting through, congratulations too Please publish your hospital lists so the future generations can follow through your footsteps!

So it has been quite a while since I’ve blogged anything at recent times. So lets start with some of the exciting things that have happened at work.

For starters, going into work, I was constantly plagued by news reports often times stating the bad state foreign medical graduates were in. Let me just say, after joining the work force in Klang GH, I must tell you this doesn’t hold any weight, at least in the Medical Department.

There are so many MO’s and HO’s from Russia, and Ukraine who are bloody good at their jobs. It’s a bit inspiring really, truth be told. I’ve seen a Moscow graduate do Bone Marrow aspiration and trephine whilst teaching it to another MO and myself. Another Moscow MO casually handling a patient crashing and successfully stabilizing her. While he’s intubating, and pushing in medication, he’s explaining it to all the HO’s helping him. Imagine that. Here we have a patient with SVT, and he’s explaining everything that he’s doing, even before cardioverting.

Basically, what I’m trying to say is, don’t be disparaged by the numerous reports you’re reading online. I am not doubting that there are plenty of HO’s that don’t give a shit, but if you do give a shit, you’ll learn. Whether you learn as fast, or at a slower pace is irrelevant, as long as you learn. Just the other day, our good Uncle Sam from Surgery referred a case to the medical ward for hypoglycemia, and the Medical MO was rushing to push D50, our uncle Sam just provided Kit Kat and rectified the situation. Of course he was hyper later, but that’s not a problem. Just keep your cool and you’ll be fine.

The biggest obstacle we will face is clerking new cases and learning our medication name and doses. You’ve probably learnt it in trade names, or generic names, and the hospital you may work at is probably using the other. Tough luck, all you can do is to learn it as you go. Learn the doses, it’s just a matter of practice, and soon it will be finger tips. It’s not too hard, you’ll see the same cases quite often, so you’ll have plenty of time to learn the management.

As for clerking case, it gets a bit trickier. All those years you’ve been copying and pasting your history bolezni makes this even more daunting. However, it’s a real simple procedure. Clerking and Presenting cases can’t be taught per se, but something you will learn as you practice it. Of course there are some guidelines you can follow to make it easier for you, so if I ever find the time, I’ll make a post about how to clerk and present. Whilst it may not be the best way to do so, it seems to work, at least for me.

Final word of advice…whatever you do, go to a computerized hospital. Do not be a smart ass and opt for one that isn’t. It’s asking for a shitload of work, and becoming Kerani Kerajaan. If you want to finish your work on time, and fast, computerized hospitals are the way to go. Otherwise, you’ll find yourself running to the records department to trace a patients old notes, running to the Echo/USG/CT/MRI room to get appointments, and even then you must present the case to the MO/Specialist there to convince them to give you an early appointment. If you suck at presenting that case, bye bye early appointment .

Another thing is to not get discouraged for getting yelled at. In my first two weeks, whilst I wasn’t getting “yelled” at, some MO’s and Specialist did indicate what were my shortcomings in my clerking and presentations. Over time, I suppose I’ve improved, as criticism has reduced on their side. Reduced, yes, but not completely stopped. However, make a mistake once, and don’t repeat it. If you repeat the same shit again, then you’re just asking for it.

Klang GH Medical is known to extend HO’s left and right, and recently a few of my colleagues were extended. These are competent, hardworking, and pleasant colleagues who do not play truant, finish their work and help out others. The day I started work here, everyone told me how Medical in Klang is. So all I can do is do my best, hope to be competent enough when assessment comes and see what happens.

P.S. Fill up your log book. Having an empty log book is also grounds for extension. Not 1 week or 2, but a 3 month extension!