Me and anaesthesia department

Assalamualaikum guyss,,,

How are you doing? As usual, I will only update my blog once in a blue moon hihi. So this gonna be a looonggg post.......

Macam mimpi je sekarang aku MO kat anaesthesia department. Bila ingat balik, my very first intubation actually when I was a medical student in anaesthesia posting at Hospital Taiping. I forgot already what operation was it but I persuaded the anaesthetist to let me intubate and I succeeded with one attempt! Nevertheless, never in my mind that I wanted to pursue in anaesthesia. In fact, I really like medical department when I was a medical student.

During my early housemanship period at Sg Buloh, to be frank, I hated anaesth MOs especially when I was in my first posting but towards my subsequent postings I was pretty excited to see them or refer cases to them as they look so cool handling very sick patients. Apart from that, I was always envious to the anaesth team when I had to assist surgeries in OT during my surgical, O&G and ortho postings. (p/s: anaesth team doesn't have to assist surgery and I don't like to assist surgery too). Before I finish my fifth posting, my best friend Kama suggested that we choose anaesthesia as our final posting. We even wrote letter to hospital director so that he places us in anaesthesia department. However, Kama changed her mind in the very last minute as she chose to be in emergency department thereafter. Whereas, me and my unnie Fiffy reported duty at anaesth department together and we worked together in the department, many times so happily haha~~

Anaesthesia Sg Buloh provides a really good training (if you are diligent and want to learn) and HOs is trained with oncall system, not shift. We have superb intensivists and they are one of the reasons why I like to be in anaesth (they are tooooooo ADORABLE!!!) Sebenarnya aku takut nak join anaesth dept ni memula sebab MOs ramai macam garang and tak friendly. Jangkaan meleset, rupanya diorang ni macam angel je dengan anaesth HO, dengan department lain memang tegas and garang sikit hahah. They are really sweet and kind. I still remember Dr R let me intubate a patient in OT two attempts (usually other MO will give only one chance to HO); Dr A let me intubate patient in ICU (my first intubation as anaesth HO and it was successful); Dr T always be my alibi and taught me to insert IJV central venous catheter (CVL); Dr C always let me do procedures, taught me to do subclavian CVL and ECHO; Dr W always let me give spinal block even for emergency obstetric case (not fetal bradycardia); Dr F let me do all 7 CVLs without supervision as it was really jonah oncall day; Dr SG likes to crack jokes and very supportive; Dr S still really nice like when I first encounter him in surgical dept and etc. All in all, these lovely experiences have caused me to be so interested in anaesth. There was one incident on Aug 15th (I was about to finish the posting early September) where I was accused of MIA by this one obnoxious MO as I wasn't in his OT but with my specialist. Because I was so devastated, I applied to not be a floating MO in anaesth. But my application was rejected and my specialists who knows me so well, being so nice to me as she didn't put me to work with the obnoxious MO throughout my floating time. Hahaha, that's the bittersweet experience in anaesth HSgB. Until now, I still miss the anaesth team, the sisters, nurses, MOs and ofcourse the specialists.

Thank you everyone for the best experience throughout my housemanship <3

When I get posted to Sarawak, I asked for anaesthesia department however the post was full in Kuching. As I want to work only in Kuching area, I chose cardiology department in Sarawak Heart Center which is still near Kuching area. Everyday when I came to work at CCU, I will look at the anaesth oncall room's door while feeling really wants to be back in anaesth. It was not easy for me to go back to anaesth department. I approached anaesth HOD in Sarawak General Hospital (SGH) somewhere early December and gave her recommendation letter from my anaesth HOD in HSgB. I was jubilant when she said she'll help to arrange my placement but on Dec 13th she told me that MO anaesth placement in SGH is full. Being optimistic, I was just keep praying although I was upset by that news. On the very next day,  I received text from her to contact anaesth HOD in PJS. To my surprise, the HOD said he is gonna recruit me as anaesth MO in PJS. (P/s: they don't have their own anaesth MO in PJS so I became pioneer againnnnn hehe).

Alhamdulillah, I started working in anaesth dept since January where I did my tag call for one month in SGH. Alhamdulillah, I am very grateful that I opted to do what I like rather than staying in my previous department. Actually I am more grateful that I got to work as cardio MO for almost 2 months before I'm back to anaesthesia. At least I got to familiarise with the hospital and people in cardio dept. After 3months in anaesthesia department PJS, I really like the bosses and the working environment. Awesomeness!

After-work selfie. Haha XD

Because here is heart centre, we do not have general medical or obstetric or orthopaedic or neurosurgical patients hence I'm lacking of some anaesthesia skills on handling those cases. Looking at the bright side, I'm fortunate that we still have urology, geriatric and some peadiatric patients here therefore I still able to perform spinal block for the urology patients going for surgery and intubate peadiatric patients.

After the lengthy post, the take home message here is to do what you like and go for what you really want to do because you will enjoy it. Choose a job you love, you'll never work a day in your life.

Thank you for reading!

Troubleshoot should I quit housemanship

Assalamualaikum and hi there!

This time I'll write on a more serious topic as per the title. Based on stories I heard from those who studied medicine abroad, I can say that housemanship in Malaysia is kinda tough. But at least nowadays housemen working schedule is in shift system, no more oncall system. Mind you certain hospital still using oncall system and in Sg Buloh, anaes department also trained all the HOs to work in oncall system. Being a houseman is really not easy as it is a transition from an enjoyable student lifestyle to an unimaginable hectic working life.

It is normal to feel so overwhelmed, down and wanting to quit housemanship especially those who are very new to this job. For the first posters, you must be shocked, emotionally and physically tired after at least 14 days of working for more than 15hours per day. Plus, you are adapting with the new environment, new people e.g. senior HO, MOs, specialists, nurses etc as well as coping with the working system (review patients, familiarise with writting notes in PC or on papers and taking bloods).

Me being a houseman for 722days already (I have to be exact as I'm counting days to finish really soon hewhewhew), I observed so many trends and behaviours of my housemanship colleagues. Some really work so efficiently and diligently, some work smartly (do work fast & go back home early), some just likes to take their own sweet time to finish carry out plan and dont mind getting home late at night. I am all of the above, it really depends on my mood though hiksss! Not forgetting those with attitude problem MIA and not doing work properly, I can just pray they change to be better.

Lemme stop making this entry so lengthy and just straight to the point. Here are questions I prepared to help determine whether you should or should not quit housemanship:

1. Is medicine is your choice or your family's?
- if it is your choice , add 1 point
- if its your family's, minus 1 point

2. Do you have some liking in this field?
- if yes, add 1 point
- if no, minus 1 point

3. Can you stand with humiliation, scoldings and working without seeing sunlight for at least 2 weeks?
- if you think you can, add 1 point
- if no, minus 1 point

4. Are you afraid to quit because of yourself or your family?
- if its because of yourself, add 2 points
- if its because of your family, minus 1 point
- if you are not sure, add 1 point

5. After start working for 14days, are you surviving well means you dont have to fake illness or take mc or el?
- if yes, add 3 points
- if no, minus 3 points

6. Do yo always feel afraid to go to work until you have to take mc or el?
- if yes, minus 1 point
- if no, add 1 point

After all the above questions, if your mark is negative, you should rethink about being in this profession. If you get positive marks, you should just continue this housemanship journey. Its just for a short time, once you become more senior you will be able to cope better.
Below are additional questions to help you decide.

7. Do you think you can cope with this kind of no-life life?
- if your answer is no and you are really not happy, my advice is you should consider quitting and do something you like. Dont torcher yourself to achieve your family's ambition because you deserve to be happy and achieve your own ambition.
- if you are not sure or your answer is yes, go to the next question.

8. Do you feel happy saving people and make other's smile after they recover from their illness?
- if yes, please do not quit. This is your ambition and your passion. You can survive this. Be strong!
- if no or you are not sure, go to next question.

9. Is being a doctor is your ambition?
- if yes, STRICTLY DO NOT QUIT!!!
- if no and you have other things to do in your mind, you should just quit and do what you like.

These are rough guidelines to help you make decision. After answering these questions you still not sure of your decision, do istikarah prayer and ask around-your colleagues, batchmate, family and even the bosses. Their opinions are really helpful.

I think that is all for now. If you decide to continue being a doctor, do not settle for average, do your very best and serve the patients the best you can. Because if the patient is you or your family, you would choose to be treated from a good doctor right?

Toodles peeps... xoxo

Me as senior house officer: Medical Dept

Asslamualaikum semua...

Aku masuk medical department as a fifth poster. Still remember when I was still tagging (day 1 in department), one of the patients desaturated but the PM shift HO is a junior poster. He did not know what to do hence I helped him managing the patient while waiting for oncall MO to arrive. Remember peeps, if patient desaturated ke ape ke, just use ABCD approach k, baru la tak lupa nak buat apa.

On my day 2 of tagging, after 4pm ada patient kat PKKN ni persistent tachycardia pulak. Terus suruh nurse buat ECG and I reviewed with my friend looks like sinus tachycardia. Patient looks dry as well and complain of pain kat tangan. So aku suruh run fluids and prescribed pain killer. The very next morning round dengan MO review balik ECG, still we are convinced it's sinus tachycardia. Kebetulan konsultan aka HOD lalu wad so MO panggil bos nak tanya opinion. Bos cakap it's SVT then mengamuk habis sebab aku tak passover kes tu to the oncall doctor semalam. Itu lah second time aku kena marah teruk sejak housemanship ni. The patient was sent to CCU immediately and discharged well after few days.

In medical, specialists and MOs are like friends. We work and eat together. Hewhewhew~

Since my 2nd week in medical, I was assign to be ward leader hence I was incharge of HO roster. Therefore, it's easy for me to arrange my schedule but it was so difficult to handle HOs yang suka EL. Pernah aku kena kerja 24hours kat medical ni sebab ganti orang EL. Totally unplanned and unprepared but I survived, alhamdulilah.

Paling happy kat medical ni ialah waktu viva department, dapat full marks. Dr J and Dr S claimed they never gave full marks to anyone before and asked me to join them in medical. Of course the safe answer I gave " Errrrr, I will consider it". Haha. The best part is waktu hospital viva, my HOD said "I still remember you in PKKN before, but you did so well throughout the posting. Dr J is really stingy to give marks but you got full marks. Well done". Malu I olls dia puji depan HOD department lain and timbalan pengarah hospital. >.<

Sebab bos semua baik sangat, aku struggle pegi beli kek ni dan ajak kawan2 buat farewell party the week we were leaving the department. TQ medical team for the bitter sweet memories.

All in all, the take home messages here are to always passover smartly to the oncall person and expect the unexpected. Anything abnormal, inform je bos awal2, lantaklah kalau kena marah sebab inform simple thing pun.

Thanks for reading!

"I am stronger because I had to be, smarter because of my mistakes, happier because of the sadness I have known and now wiser because I learned."

My housemanship summary: Senior year

Assalamualaikum,

Ha, baru ade mood nak update blog.. Six month apart pulak tu. LOL. My life is still the same. I still work as a doctor in the same hospital. Yup, my work means my life. I love my job now. I faced with love-hate relationship with my job before but now I really love my job. Dulu setiap minggu mesti mesej mak cakap nak quit la, dah penat la, nak quit and quit and quit. But I didn't because I don't have plan B which is what I'm going to do next if I quit. Being a rational person, I didn't quit but faced all the struggles instead. Now I'm glad I didn't quit. After being so long in the stormy days, I now found the rainbow. Ceewah =)

Allah dah takdirkan aku dapat posting yang banyak dugaan dulu dan pergi ke posting yang makin mudah kemudiannya. Orthopedics -- Paediatrics -- O&G -- Surgical -- Medical -- Anaethesiology. Ortho tu ko orang takyah tanya memang banyak drama. Somehow I missed the dramas. LOL. I enjoyed the drama actually especially during radiology conference; cuma aku punya adrenaline rush waktu grand ward round setiap hari Isnin tu memang paling aku tak suka. Anak Dato' pun boleh kena halau keluar wad tau waktu round kalau ko salah bagi simple info like patient tu ade diabetes dah 10 tahun tapi ko cakap dua tahun. Nasib baik aku tak pernah kena HAHAHAHA. Bila fikir balik, sebenarnya orthoLIFE training ni the best training. Ajar semua HO tentang love, integrity, fun and endurance. Bila HOD strict sikit baru la takde orang nak EL je kejenya. Yes, aku memang pembenci orang yang EL/ malas kerja ni.

Paeds busy tapi takde drama. Aku paling suka HOD paeds antara semua HOD, baik and sporting habis (HOD anaes pun best). Last week aku terjumpa Dr V, supervisor kat paeds dulu. Tak sangka dia ingat aku lagi dan suruh aku join paeds. Waktu dia cakap, "What do you want to do next? Oh you are considering paeds right. Come join us after this", I was like "errr  I'm not sure yet, I'm still considering paeds". Ok jawapan selamat. =B

O&G best jugak. Siap turun padang main bola jaring dengan bosses lagi. Tapi sebab hari tu aku postcall, aku rasa baiklah aku tengok je tak main. Huhu. Surgical pun best. Aku agak jonah kat surgical. Ade je patient hematemesis tengah2 malam waktu aku shift PM. Padahal patient tu KIV discharge coming morning kot. Urghhhh. Paling best surgical ni banyak cuti. Aku cuti 2 minggu ok untuk EOP!! Yeayyyyy

Nampak sangat muka postcall di situ! Heh

My 5th posting is medical. Memang posting yang the best lah! Orang kata save the best for the last kan. So memang 2 posting terakhir aku ni paling best. Medical ni busy dan ade drama sikit kalau kat wad PKKN tapi bosses dia baik nak mamp. Aku sayang gila kat MOs and specialists medical ni. Ade la sorang MO and sorang specialist aku tak suka tapi aku tak kerja bawah diorang sangat pun.

Aku suka buat scan untuk patients yang datang kat early pregnancy unit (EPAU). Heee~

Thanks for reading!

1 year housemanship experience

Assalamualaikum... This just a random talk about my experience so far.

I'm a houseman for 1 year 2 months already now. Currently I'm in my fourth posting which is surgical. I went through orthopaedic, paediatric and O&G before. During my first posting, I learnt a lot about people and working life. I had a not-really-nice experience during the first posting. But I kinda miss my first posting though; I missed the teamwork I had during the posting. I worked with superb colleagues (but some are annoying) and also the nurses!!! I love the sister and nurses. They helped me a lot and gave strength to me to cope with the department cultures. Yeah, the department had some weird cultures and MOs wasn't so friendly that time. They just make a big fuss about anything during rounds and they won't help to present any single case during rounds. There's one day, left me alone in ward during morning round and I have to present all the cases. In ortho, you cannot refer to any notes while presenting case during rounds. Of course I couldn't remember every details of all 28 cases in ward hence I got screamed at. Haha. My memory wasn't so great though. >.<

My mentor in ortho, the best and kindest specialist in the department. I still remember how I cried in front of him. Haha. Hope he's in best health and be blessed always.

Then I went to paeds. I had a bit of culture shock with the bosses. Many of the MOs and specialist are so nice which unlike the previous posting. I enjoyed being in paeds except when I have to take blood from the NNJ babies. I love babies and children but I don't like to poke them especially those with hard-to-get veins. On my last day in the department, my supervisor asked me to join paeds and of course I'd love too however the thing that made me still thinking about joining paeds is how to deal with the needing to poke the babies????

How can you have heart to poke these too cute babies? I still remember how I cried together with the babies when I took their blood. So heart-breaking you know?!

My O&G posting is also a great experience for me. I love working at labour room but it's usually so tiring especially when its a jonah day. I love doing procedures in labour room but you know sometimes it's like a war zone there which made you feel overwhelmed. Nevertheless, I wont pursue into this field. For me, O&G is equal to medicolegal department. So many medicolegal issues the department encountered. Perhaps, patients like to sue O&G doctors for any slightest mistake. So, it's a nay for O&G.

Me and colleagues during episiotomy suturing workshop.

Now I'm in surgery. Initially I hated this department. So far I will hate which ever department I going through during tagging time. Hiks! Now I kinda like it. The specialists are so cute like really cute. Some likes to shout during ward rounds (I found this cute too), some are just having serious facial expression all the time, some dressed up so nicely with pretty lipstick colour and high heels and some are just super nice, teaching during rounds and likes houseman to involve in deciding management for patient. I know all of them having a kind heart. I just know it from how they devoted their time for patients. They went back so late at night like at 11pm as they faced with difficult surgery which took hoursss to finish and if they are post call, they still works the next day as usual. They are so workaholic. May Allah bless all my surgeons!

As far as now, I met a very super super nice doctors and badas one. I kept questioning myself, how can this particular doctor, Dr S be so patient, talk so softly and teach anyone so nicely whereas another particular doctor so sarcastic, scream next to your ear and asked for explaination letter without checking properly into the matter. Surely I wants to be like Dr S but you know I got some temper sometimes. LOL

Now my concern is to finish my housemanship and get into any specialty. Somehow, I still do not know what specialty I should take. I really can't decide now as yet.

That's all for now peeps. Thanks for reading!

Professional examination OSCE for medical student

Olla peeps. It's been a year since I updated my blog. It's because I was coping with housemanship thingy as well as I forgotten my password to assess my blog. Just recently able to figure out the password. Haha..

So here, I just wanna share regarding my OSCE questions during my professional examination. Hope this can benefit anyone. Here you go...

LONG CASE: PP type 3 posterior

Causes uterine irritability

- braxton hicks contraction

- labour contraction

- uterine hyperstimulation by IOL

- abruptio placenta (usually hard uterus)

Methods use to detect fundus

- lateral grip

- fundal grip

- what else???

What can really determine uterus larger or smaller than date

- based on clinical fundal height more than 4 discrepancies not SFH

Possible causes of breech presentation for this patient

- Prematurity

- Placenta previa

- Congenital anomaly e.g. Neural tube defect (meningomyelocoele)

Other

- Polyhydramnios

- Multiple pregnancy

- Hydrocephalus

- Previous pregnancy with breech

- Abnormal uterus

Investigation to do

1. Full blood count- to check for anemia and maintain Hb > 10g/dL

2. GSH- if necessary, blood bank only hold pt’s GSH for 48hrs only

3. Fetal surveillance- CTG, US

When to transfuse blood

Women at or above 34 weeks gestation with haemoglobin less than 7 g/dL

Management: You’ve been called by a nurse informing that the pt develop bleeding. What are you going to do?

1. Attend pt immediately

2. Check amount of blood loss- might bleed a bit only

3. Put on CTG to monitor fetal heart activity and sign of labour (increase contraction)

4. Prepare patient for emergency lower segment caeseran section

  

SHORT CASES

1. Hand examination

- Present findings: pt has tenderness over distal radial side of wrist & +ve finkelstein test

- Dx: De quervain tenosynovitis

- Ddx: fracture of carpal bone

- Mx: rest, splinting, anti-inflammatory medication, injection of corticosteroid, surgical release of tendon sheath (rarely do)

- Cx steroid injection: tendon rupture, skin atrophy

2. Abdomen examination (obstetric)

- Calculate EDD and POA (at 40 w POA)

- Present your abdominal findings: scar, clinical FH 34w, SFH 35cm which is smaller than date

- Dx: Uterus smaller than date

- Causes: wrong date, oligohydramnios, congenital anomaly (renal agenesis)

- Questions u want to ask pt: ask whether she is sure of LNMP, does she has benefit of early dating scan, any hx gush of fluid (leaking liquor)

- Mx: to confirm date, to do VE in order to check any pooling of amniotic fluid, test fluid with litmus paper & nitralazine test and check bishop score. Give antibiotic to cover any infection.

- Bishop 4/10, what to do? – because cervix not yet favourable, IOL with prostin

3. History taking (psychiatry)

- Dx: OCD

- Ddx: GAD, panic disorder (pt has no symptoms to suggest MDD)

- Why panic disorder? – she has some symptoms of panic attack e.g. SOB, palpitation

- What organic cause could be for the symptoms? - hyperthyroidism

- What specific obsession she has: checking obsession

- How to mx? – give antidepressant such as SSRI, TCA and examples are fluoxetine, clomipramine

4. Examine motor & sensory of UL & LL

- Positive findings: reduced sensation over peripheral area

- What pt has? - Peripheral neuropathy

- Dx: peripheral neuropathy 2⁰ diabetes

- Ddx: peripheral neuropathy 2⁰ alcohol

These are simpler version of what I went through. Kindly read more about those topics and aim for distinction okayy?!

Best of luck all future doctors!!! ^^

Survived for 32days

Assalamualaikum

It's been 1 month since I started my first posting in Orthopaedic Department Hospital Sungai Buloh. All these while Allah helped me so much. Been a first poster, there's so many things I did not know. I absolutely agree that study medicine and work as a doctor has significant difference. Somehow I miss being medical student. Hukhukhuk~

Anyhow, I just would like emphasize on important tips to survive during the housemanship which is always be close to our creator, Allah SWT. Ask help from Him every seconds. Alhamdulillah, I'm so thankful that He always hear my prayers and gave what I asked for. Trust Him all your heart and don't forget that everything happens with His will. Next to it is that we must NEVER EVER EVER GIVE UP!!!

Remember, you are as strong as your next move. How hard life and people try to bring you down, you must ask Him to shield you from falling. There's 89 days for me to finish this posting. Every morning I woke up, adrenaline rush would be there and I hope I can stand with this until end of this posting,

26th Sept was my awesome day since been in this posting. I'm blessed with this mentor mentee group. :')

#prayforme
#mayAllahease
#tobethebestdoctor
#lillahitaala

Thanks for reading. May Allah bless us and please pray for my success!