Saturday Muse: Thankful

Our clinic session finished up very late a few days ago. By PM, I was half-anticipating the patients on my cue who had to wait 4-6 hours before their turn to barge in and complain when it was their turn. Instead, they asked me "Doktor dah makan?", while glancing at the clock I saw it was already 3 PM and answered no, I was very much thankful and relieved that they didn't make too much of a fuss about the waiting time. 

In fact, I felt rather grateful for them showing their concern, and felt more compel to sort out their issues quickly.

We do apologize for the long wait but it was not something that we chose to do on purpose. 

Really, thank you so much from the bottom of our hearts, for being understanding

Two Thirty In The Morning

Me and Sis accompanied Mom for a live show on August 30th, 2014. It has sort of been my wish since, perhaps 2 years back. (I also need an excuse for a really needed break)

Towards the end of the show, it started to rain and before we knew it, we were soaked. I swear that was my first (and perhaps last?) time I watched something in the middle of the rain. When was the last time we had fun in the rain?
(Not to mention, it was a long-lost secret wish to be able to get soaked in the rain like that, with a smile and feeling somewhat free and enjoying myself)

But the best thing was, we think Mom enjoyed herself immensely.

I have no idea if this little message will come across to whom it's mean to be. But in any case, thank you so much for such great performance, and thank you for making Mom happy like that :)

You know who you are.

@bornfreeonekiss
@1215thexiahtic

Madrasah Ramadhan #PrayForGaza

I am Hazwani, I live in Malaysia and I definitely, absolutely without any question #SupportGaza & #PrayforGaza

29th Ramadhan 1435 / Madrasah Ramadhan 

Normally, I dedicate this entry for us to look back and reflect on how much have we achieved so far- Did we fulfil all our goals set at the beginning of the fasting month? Or we were busy with our lives to dedicate extra time and money for ibadah?

But this year, this Ramadhan has witnessed the peak of ongoing slaughter and attack by Zionist on our brothers in Palestine; it’s as though it’s an INSULT to the holy month itself, it’s as though they are saying ‘we don’t give a damn of your Holy Month’, with more and more killings and slaughter on the children, women and civilian. 

BUT, because it has happened in the month Ramadhan, it has REOPENED, REAWAKENED, REMINDING us and the world again what long been going on in Gaza, REVEALING for the world to see all the secrets and excuses and lies that were kept and not-so-kept hidden before.

Because it is Ramadhan, more people, both Muslims and non-Muslims are much more aware of the apartheid and genocide going on in Palestine. Because it is Ramadhan, more and more truth is revealed to the world.

Because it is Ramadhan, regardless of religions and races, we try to contribute, even if in the least possible way- reminding and educating each other, or boycotting Israel-products, or donating funds for them; and we keep on praying for them.

Only those who choose to be blind will keep on being blind.

Ramadhan may have come to an end; but our prayers and small efforts shouldn’t.

Tomorrow when we wake up and celebrate Eid, please remember that our brothers and sisters, our mothers and fathers, our grandparents and our children in Palestine are still being killed and being bombed mercilessly.

Keep on sending our dua’s for them. Keep showing our support for them.

Kerana Janji Allah itu pasti!




Last but not least, Eid Mubarak, everyone!

Expectations [2]

Continuation from previous post: Tagging and Expectations [1]

• Weekends, day-off and time to eat and sleep: Housemen do NOT have weekends. Full-Stop. We’re doing shift system so our day-off might fall on weekdays or weekends. Different hospital and department have different shift depending on the number of houseman and patients. So do NOT expect to have weekends. Unable to eat lunch at lunch time is NORMAL. Worse come to worst, sometimes we have to jamak our solat because of short of time.
  
  My first 2 weeks of tagging in O&G as first posting, my lunch and dinner was at 10.30 or 11 p.m. and I had to qada’ Maghrib and sometimes Zuhur and Asar during Isyak; that on top of my families were 300+ kms away from where I chose to work and I got home with sore foot because of standing too much. I lost 10 kgs and had only on average 4 hours of sleep during my medical posting.
  
  Over the time, you will learn when to eat, how to get enough rest and at the same time enjoying your work. Learn surviving skills. Do not compare your job with ‘office-hour’ jobs.
  
  A great teacher once reminded our batch this: Toughen up during housemanship; even when you're tired or completely knocked down, just don't complaint. Do your best, make sure to give it all you've got in these 2 years. Don't be calculative (exact words were 'jangan berkira sangat') with your colleagues, cover for them, have good teamwork!
  I live by this mantra during my first few months as a house officer.
• We don’t expect you to be a genius who can come up with correct diagnosis on the spot BUT we need you to be functional, reliable and safe houseman. Learn what are stable cases and what are red-alert cases, what are important signs and symptoms or urgent/red cases that MO and specialist need to see urgently- you are the first liners, you see the patients first when they come to ward or in PAC so you need to be the eyes that filter things. Learn to prioritise your work- what needs to be done first, i.e. if you need to refer a case to respective department urgently, or you need to go and request for ultrasound or CT-brain, or if you need to quickly attend a patient who collapsed first. 

• Have common sense. This is related to point above.
• Learn surviving skills: Do a little homework about the department that you are about to enter- knows the requirement of that posting, get to know how the MOs and specialists are and how to ‘tackle’ them, learn which staff who will be able to help you out, fill in your logbooks early and with consistency, learn how and when to fill in your SKT and CPD and declare tax and so forth.
    
• Knows your limitation and yourself: If you don’t know, ask. If you are not confident in doing procedure, practice and ask your senior colleagues to teach you. If you know that you take a long time to review patients, come earlier to make up for the time you need.
  
  During my medical posting, MOs come to do round at 8 a.m., so all patients needed to be reviewed and take investigations before they come, so being in-charged in one cubicle, I came around 5 – 5.30 a.m. just to make sure things are done before MOs and specialists came.
  
  If you see cases that you don’t know about, read up. Learning doesn’t stop when you graduate. You will feel that the more cases you see, the ‘dumber’ you feel. Learn from your mistakes. Learn how to de-stress and cope with stress. Work smart.
  
  I generally take 6 months to adapt so only during the later part of my second posting was I able to actually enjoy working as a doctor.
• To be scolded is NORMAL during housemanship: We don’t scold you for no reason. Learn from mistakes. IF you still don’t know what you did wrong, ASK. We expect you to learn fast; we don’t care from which university you came from or if you’re a Dean’s List or Mumtaz students but we DO CARE for you to be functional. If we order investigations in the morning, of course we expect to see the results by afternoon round. If we ask to refer STAT or take blood and send STAT of course we expect it to be done urgently. If a patients need close monitoring and be informed if deteriorates, of course we expect to be called if patients collapsed. If we ask you about the disease and you don’t know, read up and if we ask you to read up, do read up and be expected to be asked again in the future AND be able to answer.
  
  Kena marah tu benda biasa masa houseman- ambil ape yang baik, and belajar dari situ; benda tak baik tu masuk telinga kanan, keluar telinga kiri- this is what I usually tell my junior colleagues.
  
  This is where your support system comes- have friends or colleagues, who share the same interest or are in the same boat to rant and ‘luahkan perasaan’, go to gym, go see movies, go eat, read Quran, seek comfort from families- pendek cerita, know how to de-stress and learn how to cope with stress.
  
  Reciting Quran and solat sunat was a way to calm myself down during tagging. Later, I found friends to hang with and we actually formed ‘Geng Makan2’ who’d eat out together after work and went bowling and watched movies.
• Give a good first impression: Contrary to the saying ‘don’t judge a book by it’s cover’, first impression DO COUNT. People talk and people observe. Words about how good or how bad you are as a house officer might travel around especially in a small hospital, so yes, do give good impression and have the right attitude towards everyone.

In conclusion, at the end of the day, you are expected to be functional, responsible, reliable and safe houseman. Medical profession is tough and tiring and stressful. You may not be able to eat properly, sleep properly and yet are expected to function normally. So at the end of the day, correct your intention and remind yourself why you choose to be a doctor and what can motivate you to stay in the field?

IMAM/PPIM ( IMAM Malaysia ) organizes Houseman Preparatory Course at regular interval and they have fb group. Prepare yourself mentally. If you are reading this as a student overseas, when you’re doing attachment at local hospital during your clinical year time, observe how patients are, try to clerk cases, attach yourself with the HO and explore the job the scope, follow rounds and see how they present, ask if you can observe or do some simple procedure. Have a feel of how working in Malaysia is.

It also helps to have goals too. While you’re doing your housemanship, explore your interest: medical-based or surgical-based? Or are you interested in admin job, or lab jobs or teaching jobs? Find out various ways to do specialty programmes. IMAM also has Post-Graduate Preparatory Course every year. Learn as much during housemanship, because once you enter MO-ship, you will be accountable for every decision and management you make.

And while it is scary to embark into medical world, it is fun! To be honest, there’s no other job that gives this kind of satisfaction when patients you treat improve greatly and when they say thank you. It also reminds you how small you are and how humble you are and how great His plan is.

Wallahualam bissawab.

Tagging & Expectations [1]

Salam...
Continuing from the previous post...

Tagging
Once you enter a department, you will be doing ‘tagging’ which usually last for 2 weeks for most departments, especially for a first poster. Working hours for a houseman generally starts at 7 a.m.. During tagging it’s usually from 7 a.m. to 10 or 11 p.m. everyday until you’ve been given off-tag.
So what do you have to do during tagging?

1. On the first day or the day before your first day into the department, go and introduce yourself to the Head of Department, and then to the ward’s Sister so that they know you’re coming.

2. Clerk as many patients as you can. Clerking means to get full history from the patients, do full examinations, come to a diagnosis and different diagnoses, plan and take related investigations and do your own plan of management for that particular patient. The more cases you see, the more familiar and comfortable you are with taking history & doing examinations. The more variety of cases you see, the easier it is to remember the management. Usually every cases will be seen by an MO after you finish clerking- learn to present properly, fluently and with confidence.

3. Learn and practice how to do procedures- basic procedures such as venupuncture, inserting branula, taking blood C&S using aseptic technique, inserting urinary catheter, inserting Ryle’s tube are all things that you are expected to be able to do by the end of your tagging. Paediatrics may be a little different; and some department also require you to be able to insert central venous long line, do peritoneal dialysis, wound debridement, inserting tibial/calcaneal pin etc.

4. Learn what form to fill for which investigation and which bottle to fill in. Learn how to trace the results. Learn to to refer cases and write referrals.

5. If you are in O&G, surgical or orthopaedic, learn to book/post cases for operation, how to fill in the form etc. Find out from your senior colleagues if there are special/extra requirements that you need to complete to be off-tag. This depends of the department and hospital you’re working in. For example, if you’re in O&G, you may need to conduct 10 deliveries and assist 5 C-sec to off-tag.

Expectations (Part 1)

Not in order of priority/importance, I’m writing this part as a fellow senior houseman who has passed her housemanship:

• Niat: Please correct your intention of working in medical field. We are doing service-based job so we deal a lot with people with different attitude, expectations and behaviour. This can be very stressful but in the end there are only two things: we’re trying to help patients and we seek to find barakah in our job. My previous Dean of Medicine gave us this du’a and most of my colleagues and I recite this in our prayers: "O' Allah, please let us be the tool of Your Mercy in serving the humanity regardless of race, creeds and religions"

• Able to clerk cases and present: You have 3-4 years of clinical years to practice this. By the time you graduated, you ARE expected to be able to get the chief complaint(s) and rule out differential diagnoses and summarise the case.

• Able to recognize signs and findings in examination: Of course, this will help you in your diagnosis. So the more patients you see, the more signs you’ll find, the better you are at recognizing things. Do know basic stuff like normal vital signs values, heart sounds and murmur, different sounds during lung auscultations, neurological abnormalities etc. We need you to be able to elicit signs from patients.

• Attitude: Which is sometimes a major headache to senior colleagues, MOs and specialists. Do have the right attitude: be polite and humble. Don’t be arrogant. Basic rules as a houseman is "jangan berlagak terlalu pandai, jangan jadi bodoh sombong" or so to say. 'Menjawab balik', giving excuses and justifying yourself are all different- know who you are dealing with. If you don’t know, ask, ask and ask. Do NOT assume. Be polite to ALL patients and relatives even if you are tired and hungry- they don’t know that. Respect everyone including the cleaners, staff nurse, MAs, your colleagues, MOs, specialists, consultants. Sometimes it’s not easy when you meet colleagues who are not cooperative and not of exemplary behaviour- just recognizes who they are and avoid having that kind of attitude. Be friendly.

• Be a team-player: Know who your houseman leader, follow rules set by the department and be a team-player. If you have finished with your task, help your friends in need. If everyone help each other, you can finish ward work faster and everyone can go and eat lunch or rest earlier. Also, when you see your MOs doing round and are still around, even if your shift finishes at 5, wait till they say you can go home or something along that line, in case there are still works to be done. How can you go home earlier than your MOs/Specialist? -.-; The same goes if there are still a lot of ward work to be done and it’s already 5 p.m.... Finish your work first then you can go home with eased heart. Pass over if you need to know learn what kind of cases that need to be passed over

To be continued...
Next (final entry): Expectations [2]

Taking that first step...

Salam...
I wrote this a while ago for my younger brother who's reading Medicine in Egypt, just as a sneak peak into housemanship- just some tips and tricks working as a junior officer in medical field. This will be posted in 2 or 3 entries since the actual draft is quite long. I hope it'll give a rough overview of what's to come for those who will be joining the medical fraternity soon.

Before that, let me wish you Happy New Year! Let's pray 2014 will be more meaningful & beneficial :)

Before I give the overview, just to let you know that to each houseman his or her own experience; everyone faces different things and there are a lot of factors that need to be considered so what I’m writing is solely based on what I have experienced in my 2-years of housemanship. Be informed that I’m jotting this as someone who initially was doing medicine in Australia for a bit then came home to a local private university to graduate- so I am fortunate enough to be given sneak-peak of how a HO life would be during my clinical years and I do understand the anxiety that overseas grads are facing.

Second of all, I’m also jotting this down from a medical officer point of view; just to give a feedback what are some of the expectation of a ‘functional house officer’. I have no intention of scaring any of you but I’d like to prime you on the current situation of a houseman life so that mentally you are prepared of what to expect when you come home.

After you have graduated, you will have roughly 2 to 3 months before you’ll be called to work. Choose wisely of what you want to do during this time because the coming 2 years (if you’re not being extended in any department) will be... kind of gruelling.

Choosing a hospital

First of all, where you choose your housemanship is important. Factors that you need to consider is distant from home, support system & how well you can adapt to new environment, what you expect to achieve by the end of 2 years and what you expect to experience. For the last 2 points, it basically means that, do you want to go to a district or a tertiary/referral centres? Or do you want to go to hospital with computer-based or using BHT/patient’s file. Generally speaking district hospitals have less patients, limited investigations and no sub-specialty- so basically you will have to learn to do investigations within limited resources and need to refer to hospital with facilities or with subspecialties if you encountered patients that needed to be referred.

For example I was doing my housemanship in Batu Pahat Hospital, a district hospital- quite a busy hospital with common cases. Our radiology department have up to CT-scan machine so studies like MRI, barium studies, MCUG all needed to be referred out. If we receive cases like ICB, intussusceptions, coronary artery diseases, oncology cases, these need to be referred to tertiary centers such as HSAJB, HKL, Selayang, IJN and so forth.

If you choose a tertiary centre, sometimes you probably find yourself managing high-profile or rare cases. Your ward may be very busy but you may learn a lot of things. Some hospitals used computer so you have to familiarize yourself on how to clerk with laptops, how to find results via the computer and so forth; the good thing is you don’t have to run to the lab to fetch the results and you can trace patient’s past record easier.

If you choose to go to Sabah and Sarawak, be prepared to learn new dialects. The advantages of going to West Malaysia, you’ll probably be more skilled in terms of procedures i.e. vacuum delivery, Caesarean-section, appendicectomy etc. Once you are allocated a hospital, you will need to report to the hospital right after the induction week finished, and then to Jabatan Kesihatan Negeri. Usually they will be a few days of hospital orientation after you report duty.

Next: Tagging