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And the journey continues…

So to recap what’s my progress in the 4 years of living in Langkawi : –
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After a year of service in primary health care

I totally forgot that I have a blog until recently a student told me about reading it.

So I was sent to continue my service in heath clinic (Klinik Kesihatan aka KK) eventhough I asked for an allocation in the hospital. Well, I accepted it because the main aim is to improve the health of the population and to prevent disease progression at an early stage.

The first day of me working in the KK, I could not adapt to it because it was all handwritten and involved a lot of paper work and seeing patients as fast as possible.
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Shipping off to Langkawi

Personal items all packed, loaded, awaiting shipment.

Drove all the way from Sungai Petani to Kuala Kedah, Alor Star to the shipping company to ship my car loaded with personal useful stuff to Langkawi before beginning my new sort of life as MO.
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My life as a houseman in Hospital Sultan Abdul Halim

Can’t believe that it’s already been 2 years since I’ve started my life as a doctor.

Much have I learnt during this 2 long years after started in a blurred, what’s-going-on innocent manner.

Frankly, it’s a dog-eat-dog world. You gotta be really tough to handle the situation. Especially when one is a Russian grad doctor who works in Malaysia like me.

I was quite blessed to start my medical career in Hospital Sultan Abdul Halim, Sungai Petani where it’s neither a big nor a small hospital. Equipped with some of the most up-to-date devices and facilities like the pneumatic system and total hospital information system (THIS), it’s a good hospital to start with. We have scary specialists too, but if compared with what I’ve heard from other hospitals, they’re not very scary after all. Well…….maybe just one (if you’re working in HSAH, you know who).

Speaking of pneumatic system, we no longer have to rely on PPK to send specimens or be the messenger to send stuff intrahospitally. Just put the specimens into the tubes provided, stuff it into the pneumatic transfer box, and with pressure the tube will be sucked to the desired destination. But when it’s faulty it could create a huge mess, that happens when there’s a “traffic jam” in the system. So there are pros and cons too.

We used computers and laptops to do most of the stuff. From clerking to tracing investigation results to discharge, everything through THIS. The admin was (still is) trying to create a paperless hospital. But we were still using papers in most wards. The only downside of THIS is that there’s no privacy in patients’ data because we mostly could have access to all patients’ database in the hospital.

And when it comes to referrals to specific disciplines, housemen get to send patients in the ambulance to tertiary centres. That means resting time! But not for the ill patient who needs constant monitoring. We usually send cases out to General Hospital Penang or Alor Star. Sometimes even Kuala Lumpur (but thank god I didn’t send any cases to KL). Resting for a short time in the ambulance is fine, but it’s definitely not the quietest and comfy to sleep at.

Houseman needs to go through 6 postings during internship.

  1. Medical
  2. Surgery
  3. Paediatrics
  4. Orthopedics
  5. O&G
  6. A&E or Anaesthesiology

So my life as a doctor began with :

1. Orthopedics posting

My least favourite subject in med school. I did not know what I learn, I did not know what they want. But thankfully it’s a rather relaxing posting to start with where workload is half the one in medical or surgical postings. So I started from zero. It involves both surgical skills and medical diagnostics. Luckily I met with a Russian grad who was in her final posting. She was kinda fierce at first, I was kinda frightened. She guided me throughout the posting until she left when I was more a competent houseman, but still a fresh poster. Thus I was even bullied and scolded by my medical officers for my incompetency. Lucky for me I made a bunch of close friends who brought joy and laughter during my darkest period in the 4 months. I still remember I would give them a treat when I was scolded by a particular medical officer. And they wish that the particular medical officer can scold me more so that they can get free dinner. However time passes by, I became a senior in the posting and somehow gained trust from my medical officers, even the HOD after I’ve been introduced by a friend to help him with his work. So I’ve learnt the most basic things eg procedures, operating THIS, seeing patients in clinic and made some very close friends in my first posting before I went into my 2nd posting.

2. Medical posting

The scariest department in the hospital. Again I went back to zero, knowing that I must do twice as much as my previous posting, I’ve gotta keep up with the others. This is the real dog-eat-dog world where people try to cover up their asses to not get into trouble. There’s a reason behind it, and the reason is that the HOD is a scary lady. She’s not big, not ugly, she looks elegant, but her eyes and her voice when she scolds, pierce right through your heart and shatter your soul. She has her spies in the whole department and we might not know who is and who’s not. Everybody who works in the department treats her as their ultimate fear factor. Everybody trembles when talking to her. And when she walks into a ward, it’s like a red carpet walk with escorts. When she makes round, everything must be in order. All charts (eg investigations, vital signs) and consents must be on the left side of the folder. The arrangement on the right side must be right in order (ECG -> referral letter -> admission form -> houseman clerking sheet -> medical officer first review -> specialist review -> progress notes….). Yep she’s that serious. Doctors must not push the laptop carts because it’s the nurses’ job. Every houseman has to know in and out regarding all patient’s details. One short moment of silence if she asked something and nobody knew, the consequence is rather heavy. Ranging from being punished for doing all the discharge summaries for the whole ward, to clerking all ward admissions, to reclerking all the patients in the ward, to no weekend off, and nobody is allowed to help, period. Fortunately internal medicine was kinda my forte. So I just need to catch up with the local knowledge that I wasn’t taught back in Nizhny Novgorod. But I remember I suffered from a scary scolding from the HOD when I forgot to draw a patient’s blood in the first class ward. So she brought me and the whole team which followed her round into a room. Asked everyone to sit down and she deliberately asked me to look at her when I was at my most petrified moment. Then she asked a very nice and kind medical officer to ask me why I didn’t take the patient’s blood. So the MO with his nice voice was asking me why, and she wasn’t happy and asked the MO to be more firm and fierce while asking me that. So the nice MO raised his tone a little and asked me back the same question. At that point I guess she had already no time to ask him to ask me more fiercely. So she had to ask the question herself

“TELL ME WHY YOU DID NOT TAKE THE PATIENT’S BLOOD?”

*Awkward silence moment……*

“DON’T KEEP QUIET, I EXPECT AN ANSWER, TELL ME WHY????!!!”

“sorry boss I forgot”

“YOU DON’T TELL ME YOU FORGOT, DO YOU FORGET TO EAT? DO YOU FORGET TO SLEEP? DO YOU FORGET TO WEAR YOUR SHIRT TO WORK?”

“no boss I remember to wear my shirt to work”

“THEN TELL ME WHY??!! YOU’RE LAZY IZZIT?? HUH?? LAZY IZZIT??!!!”

“sorry boss I was lazy”

“YOU GO OUT AND APOLOGIZE TO THE PATIENT, NOW!!!!!!”

*I left the room and heard a loud laugh from her at the back*

And that became my legend in the department for admitting I was lazy to the HOD. But back then when I was in the room, I was truly petrified, I was a trembling little puppy. But after that lesson, I became stronger, knowing how to protect myself, and how to avoid contact with her. But somehow I became rather neutral than becoming her target or her favourite pet. So less scolding from her henceforth. In medical posting, it was really really tough with lack of sleep, but with the EOD calls we had, we were rich because we didn’t have time to spend the money. It was a training ground for all housemen who worked in this hospital. So by the time one left medical posting, every other posting would trust our work efficiency. Except for those lazy bums and who were the HOD’s pets. They were really bad colleagues to work with. So after 4 months of training in medical posting, I moved on to my 3rd posting.

3. Surgery posting

So back to surgical base. One thing I already sick of was scrubbing in and out of the OT. It just ruined my hair everytime. Nothing much to say about this posting. A lot of retractions, and retractions, and more retractions. Ward work was manageable if working with the right colleagues. Partially done my first appendicectomy which ended up as a macerated appendix where the base was unable to be identified until a senior MO came for the rescue. Inserted my first chest tube, inserted 2 successful PICC after failed attempts previously. 4 months, boom, passed. Surgical was not my forte, but I don’t hate it in general (except the scrubbing in part).

4. O&G posting

Came to a posting I thought I love, but it wasn’t my favourite. Many medicolegal stuff going on. But I admit that I preferred the obstetrics part than the gynae part. The reason why I preferred obstetrics was because there’s a lot of hands-on procedures to be done. I like suturing episiotomy wounds, I love conducting deliveries, I like doing antenatal scans, I love artificial rupturing of amniotic membrane etc. Things that I didn’t like was clerking patients in PAC, they just kept coming *faint*, and examining newborns before they’re allowed to be discharged to mother or to be admitted to paediatrics ward. Then came to scrubbing into OT for operations, again ruined my hair. Gynae ward was just boring and sad. So many abortions, so many painful PV bleed, so many agonizing terminal cancer patients. Some of the MOs were really nice and kind. Keeping in good terms with the specialists was crucial. 1 specialist even let me perform my very first ventouse delivery, though it was a failed ventouse, hehe *shame*. Though I did not like this posting very much, I seriously think that I’ve learnt a lot in this posting.

5. Paediatrics posting

Children’s germs were dangerously fierce. Very easy to fall ill in paeds ward. I wasn’t really performing well in this posting because mood was majorly affected by babies’ and children’s cry and yelling and the parents’ complaints (ergh~).  But I did my job as ordered. MOs were nice and helpful as friends. 1 MO even gave me an advice of choosing A&E posting over anaes posting. She told me there’s nothing much to learn or to do in anaes posting. Unless I wanted to stay and continue my career as an anaesthetist. I took her word and went for A&E posting.

6. A&E posting

Final posting after 20 months of internship. This posting was about clinical applications of all knowledge that I’ve gained in all previous postings into one. The first day in A&E department was already a normal working day as a energizer bunny instead of tagging here and there. It’s busy and hectic as hell. By the time I joined the club, we had shortage of housemen. From 8-10 HO per shift to 2-4 HO per shift. But we struggled and survived. Though busy, we had the most angelic MOs in the world (except a few). They were helpful, forgiving, kind, and showed empathy when we’re so busy. There were 3 very chronic MOs who were just in charge of supervising HO doing stuff. 2 of them were forgivable because they’re still seeing patients as usual, but limited and very few. The other one was super-duper chronic MO as bad as a terminal cancer can be, she’s good for nothing. She came to work, asking any HO to go and clear the green (OPD) zone, while she went missing or checking if the garbage bin is clear or is there trashes on the table etc like a housewife. She’s a really bad example, and I did not respect her at all. The medical assistants and the staff nurses were very intelligent in helping doctors too. But all in all, I learnt how to screen patients as the primary team, diagnose and see if they’re fit for discharge/home treatment or to be admitted for further interventions, prioritize matters, decision making for life saving interventions, ECHO, EFAST, ultrasound guided procedures etc. This posting brushed me up to becoming a more competent doctor. I’m very happy when I heard my MOs telling me how much they appreciated me and my friends for our competency in working.

So 24 months of internship ended. I’m officially a medical officer now. I hope I can provide a good service to the civilians, and try my best in helping them to solve their health problems.

Next stop : PKD Langkawi (as I’ve requested).

 

Looking forward for a better life there as a medical officer.

PS : Don’t come asking me for MC. I can only give you chocolates or liqueur (I’m sorry~)i

Orientation before tagging in hospital

There were 5 of us going through the orientation. Jo, Nicole, Revathy were from the same induction camp in Hotel Midah, KL. Fakhrud was from the camp in Bagan Lalang, I don’t know where is that, but it’s in Malaysia.

So the first day after reporting ourselves to the State Health Department of Kedah (JKNK), we rushed back to Hospital Sultan Abdul Halim (HSAH) to report duty.

The hospital director gave us a warm welcome and had given us some info regarding the hospital. We filled in more forms, it’s slowly develop the phobia of writing my name, IC number, address, and my occupation and its grade. So after the orientation, we went back home.

The next 2 days, we had a crash course on IT regarding the operating system in the hospital as it’s fully computerized. It’s not paperless though, but it’s definitely less paper. I was late to the class as I was taking the driving test for my driver’s license. So I was like 30 minutes late to the class. But it was quite okay as I’m catching up fast on computers. We have to know how to use the so-called eHIS system. We can record patients’ information in it, amend it, order drugs, order and schedule OT etc etc with it. To make a conclusion of mine to it, it’s TROUBLESOME. Then we also had a talk about handling the medical records in the archive and the coding on files.

The following 2 days were devoted to pathology. We went to blood bank and learnt things about blood transfusion, its components, indications, contraindications, criteria to blood donation etc. It was quite an intense session because we were asked questions. So we ended up going to library to seek for answers. Then we also went to the Histopathological department to learn what’s to what’s not, how to prepare a slide from a specimen. Next was Cytological department, which technically is in the same department like the histopath, but they don’t entertain each other, kinda ironic. We were taught about gynae, non-gynae, and FNA procedures which are tested by cytology. After that we went to microbiology lab. Same things were told, like what’s to what’s not, introduction, what reasons the specimens got rejected. We also were taught how to prepare thick and thin blood film for malaria parasites. And yes, it has to be done by the HOs. The last thing we’ve done was introduction to infection control practice and standard precautions like washing hands, wearing masks, wearing gloves, wearing shoecovers (бахили) etc. The best mask is called N95, very relatable isn’t it? LOL

So how are the slides for histopathology prepared?
1. Samples taken must be soaked in 10-20% formalin to preserve the structure and preventing cells from disintegrating.
2. Samples are wash and fixed with alot of alcohol, then xylene to remove the alcohol then waxed. The whole process could take 15 hours to get done. So we were advised to not rush the pathologists to get the samples prepared. Smaller samples are put in a block then are soaked in wax until it’s solidified.
4. The samples were frozen in the fridge.
5. Samples were taken to the microtome to get sliced to get a good sample for a slide.
6. Samples were sliced into thin films, then put on top of water and get “scooped” up on a slide.
7. Slides are put on top of a heater to melt and vaporise the wax.
8. Slides are sent for staining and covered.

Induction

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Induction was on the 11th of October, in Hotel Midah, KL. Dad and bro-in-law decided to drive along with me to KL. Papago was with us in case if we got lost and raped in KL. We went there on 10th of October.

Dad and bro-in-law went to KL for a business meeting with their suppliers. The good thing I went with them was I didn’t have to pay a single penny for food. It’s all on their suppliers’ bill. And the food was not cheap!!!!!!!!!

So this is the 29th batch of Induction course. During induction, we’ve been sorted into groups. My group is team 7, there were 10 of us and one of us is the prettiest girl in the whole induction course. I was so happy~ LOL We were given a task. It’s a scenario that we had to act out on the 4th day of induction. All things went well, my team mates were cooperative, so we got the scene right on the day itself. My room mate was a student graduated from Edinburgh, UK. Nice person indeed, kinda crazy, definitely alot is going on with him. Very knowledgeable and very friendly. Glad to have him as my room mate for 4 nights.

We had seminars about the Department of Human Resources, Corporate Culture, Ethics, Constitutional Bureau(BTN), psychology, discipline, money matters etc etc. Some were interesting, some were plain boring, one was brutal. Some were well-learnt, some were spent on FB and daydreaming.

BTN was the most brutal seminar. It raised up racial issue that we could not even question them. The nonBumiputra were told about the privilege of the Malays, and basically telling us to blame our ancestors. Hahahaha. It’s like this, in 1951 in return of the Malays accepting us as citizens, our ancestors had to agree to give the premium privilege to the Malays.

We spent most of our time inside the hotel, more or less like prisoners. The food in the hotel was nice for the first day, 2nd day, but it’s too much and boring from the 3rd day onwards. But some of us managed to get out with friends, cruised around KL, eating out, got lost on monorail, buying drinks from Petaling Street. Willy’s brother, William brought me and Shu Yu to eat Hokkien Mee(Hokkien Char) in a nearby place. It was taaaaaaaaaaaaaaaaassstyy~~.

After 5 days of nothingness, we had to go back to our states to report ourselves to the State Health Department before reporting ourselves to the hospital.

I got my first choice, which was Hospital Sultan Abdul Halim in Sungai Petani. I had no regrets choosing it because I live just 5 minutes drive outside the hospital area.

 

The wait

The waiting process is not flattering. I’m bored with what I’m doing everyday.

I have a flat ass waiting for the induction!

So what was I doing?

TAKING CARE OF BABY CHERRAINE!!!

Gosh, baby Cherraine loves to cry and it’s torturing. What’s wrong? Babies are supposed to eat, sleep, and poop!!!!!

Smirk

You know I rule ya'll

TAKING PHOTOS OF THE HEAVY RAIN CLOUDS AND RUN-AWAY CARS

The weather was so brutal and when it’s about to rain, the dark clouds are so thick and dark and looking horrendous. So the cars were speeding up to avoid the rain. It once struck me thinking that hurricane is coming and destroy this small town.

The hungry clouds

Run away car

I don’t know what else I’ve been doing……but I’m really bored!!!!!