Life being a Doctor in Malaysia Hospital？？ Part 1, it is all about housemanship

Some people got curious on how a doctor’s life is recently and I received some messages on that, especially after the COVID war started. Well, there are some negative comments and questions in between, which I don’t quite understand why. Anyway, 'm going to share my experience of being a house officer in a Malaysian Hospital for the past 2 years today, which was pretty much a roller coaster in my life.

I started my career since May 2017, in a public hospital in the northern region. I belong to the 3^rd cohort of contract medical doctors under the Ministry of Health Malaysia (KKM). Before we reported ourselves to the government, I had a long hiatus for almost a year since my graduation in June 2016 . Yes, ’'m a public university graduate by the way, so the long hiatus is not tied to factors such as race, being a local or overseas graduate; basically, everyone faces the same problem.

What did I do during the long hiatus, or rather, during the  gap year? Well I travelled to a lot of places during the break, and this includes spending a month in Taiwan, joining some volunteer programmes, and working in a office in between. As to the question of why  did I notget myself involved  in some medical related job scope, Well we are prohibited from that actually. I’m considered lucky to get a job in an office, as many of my friends had to work as a grab driver, or even a cleaner to support their life. Most of us did not come from a wealthy family and we struggled to live for the past 1 year.

In November 2016, we went for our interview in respective our states,had our portfolio ready, brushed up our knowledge, in hope of creating agood impression on the interviewers. After the interview and another long wait, we received our official placement email from the government, and was instructed to start our service from May 2017. Before the reporting date, we went for a week long programme of ‘ Program Transformasi Minda’ , and basically had our last honeymoon before the hell like 2 years for housemanship began.

So now, what did I go though for the past 2 years for housemanship??
It is a mixture of tear and blood,cheer, gains and losses. I almost gave up in the beginning part, as it was so tough and so pressuring that I felt suffocated. But trust me, be determined to go through this, as all the training  made me a better doctor to survive in this field.

As part of the government requirements, we have to complete 2 years housemanship with 6 rotations in order to become a medical officer. The mandatory ones are orthopaedics, medical, paediatrics, obstetrics and gynaecology and generalsurgery. We then have options for emergency medicine, anaesthesiology and intensive care medicine, community medicine and psychiatryas the electives and I chose to go on with anaesthesiology. Please be mindful that the elective option is hospital based.

I started my housemanship journey with medical -> obstetrics and gynaecology -> orthopaedics -> paediatrics -> surgery -> anaesthesiology. After my completion of housemanship, I joined paediatrics, which was the department I love the most ( still loving it till now). Before I started my work, I always wished to be a surgeon, as I love the feeling of saving livesfrom the operation theatres ( too much of drama and movie I guess). I studied for MRCS and I even bought a set of basic suture set myself. But things didn’ go with what I wished, as I found myself hating the life in the operation theatre for long hours andthe toxic working environment. I had a bad time honestly.

So my tips? Don set your target too fast before you join the department, many of my friends wished to be a neurosurgeon, a cardiothoracic surgeon, a gynaecologist in the beginning, but they ended up something totally unrelated and yet they are successful on that. Enjoy the life of housemanship, and explore the different fields. Pick one that suits you the most during the end of housemanship and go for it.

I made up my mind for paediatrics after I joined as a fourth poster. To be honest, I got so much influence from my seniors in this field, and  they have guided me a lot, in building up my confidence in this field since housemanship. The starting point wasn’t easy at all, to pass the tagging process inf paediatrics, we have to complete the Direct Observed Procedure with 2 assessments. I failed my neonatal assessment during the first attempt, and I could not master the peripheral cannula insertion skill. The babies are so tiny and their veins are so fragile, and as a houseman, only 2 poke attempts are allowed and the department was very strict on this. I was one of the poor performing ones in the beginning.

The tagging was 7 days in arow for paediatrics, with a break of one day, then another 7 days consecutively in the Neonatal Intensive Care Unit (NICU) or Special Care Nursery (SCN) for neonatal rotation. It was physically and mentally torturing andI would say it was the worst tagging period among the 6 postings. Paediatric is a busy department, we don’t get regular lunch and dinner time partly due to  endless cases withlengthy clerking. Everything hase to be precise, and there is no standard practice or dosing for each baby, everything is fully  customised. I worked from 6am-10pm for 14 days and it was really exhausting. Failure to pass my tagging assessment almost made me suffered an emotional breakdown.

Forutnately, my medical officer detected my problem, and she counselled me. I got another off day as a break, so I could really cool myself down. I cant really recall back the days that I had, it was awful, the training was tough. But, all these nightmares made me a capable paediatric officer today Although I wouldn’t say I’m an excellent one, I still have a long way to go but I able to carry out my job scope competently nowadays. Im not an obsessive-compulsive personality type of person but I will make sure all the little kiddos under my care get appropriate treatment.  I love to play with them. Their bright smiles and cheerful laughters during discharge are my biggest achievement.

 And I am really thankful to my family and my teammates to go through this with me, colleagues such as Iylia, Feena, Wahidah and Nina. We formed a strong team, and we get good feedback from the medical officers, specialists and consultants. My seniors colleagues still label us as the “strongest team” despite us having left the department for more than a year haha. I built my confidence in paediatrics in the middle of theposting, which I was given a chance to perform“ in- out Survanta”, to standby independently before a senior attending arrives and many more. At the end of my posting, I had a conversation with my specialists and consultants, and they encouraged me to join this field.

I was a bit nervous to make a decision at that moment,as I still hold on my wish to be a surgeon. Until I did my surgical posting, things changed. Although it was my passion in the beginning, it turned out to become a nightmare during my housemanship posting. Long hours of operation theatre, humiliation from the seniors are among the reasons that I have decided to quit my dream as a surgeon . As a senior in the posting, I was given high expectation and I really enjoyed it when I was given the  task to take care of appointed patients. In  mid posting, I was transferred to another district hospital as “ attachment house officer”to learn on palliative care, and to be in charged of pre operation carefor 5 weeks. It was the happiest moment during my housemanship.

After the 5 weeks posting I got transferred back and joined the team to take care of patients in the intensive care unit. Well I guess I was too high profile back then, and things deteriorated to the point where I was backstabbed by some irresponsible people, with non existential, baseless ill intent accusations. I was being judged immediately, without a chance to defend myself. Those medical officers who worked with my previously, decided not to stand up for me at that moment. I was barred from some surgical procedures back then.  It was demotivating and I will never forget what that person had done. Guess who was the one who brought me back to my feet back in the end? She was a senior medical officer, Dr F, who was labelled as a “malignant” medical officer from Obstetric and Gynaecology department. We had a short conversation when we met in the operation theatre that time, and I felt thankful for that. My seniors from paediatric back me up at the same time. It doesn’t stop my path just here.

I finally decided my path during the end of my 5^th posting in surgery andtook my MRCPCH 1A and 1B exam during my 6^th posting as an anaesthesiology house officer. Thankfully my supervisor in anaesthesia was very considerate on my situation and she listed me in the operational theatre schedule for 2 weeks during my preparation for the exam, so I could have enough time for study and preparation. Couldn’t imagine if I was scheduled for intensive care unit (ICU) rotation that time, with that heavy workload and high pressure working environment, I probably will have gottenmad. Don’t get it wrong, I love my ICU rotation at the same time. I learnt on ventilator settings, intubation skills, brushed up my cannula insertion skill and the other invasive procedures undersupervision at the same time, spinal anaesthesia etc during the posting. Saving life after cardiopulmonary resuscitation, along wiht the adrenaline rush as we try to bring back life to a patient on the verge of death gave a huge satisfaction.

My medical officers encouraged me to stay back for anaesthesiology posting that time, but I decided to go with paediatrics. Did I pass my exam? Yes I did, and I managed to attempt for my part 2A during my floating period, although I failed it in the end. The reason why I choose not to be a anaesthesiology although I enjoy the process? Well I have a very negative mindset when I manage adult patients, which I think it is not fair to some of them when comes to treatment.  Most of the cases we got were fluid overload due to noncompliance to fluid restriction, disease complication form missed medications, and midnight motor vehicles trauma cases. I get very upset to treat them when they did not take good care of themselves at the first place, and it really affected my judgement. But being a doctor, we shouldn’t judge the patient, we should save lives regardless. That is the reason why I gaveup to pursue adult medicine, and got myself into paediatrics, to save the lives of the little angels.

It is a bit lengthy here but these are part of my life during my housemanship. I Will try to recall back my experience during my 1^st, 2^nd and 3^rd posting next time.

In short, be firm on what you wish to be, and do not quit if you still hold on to that passion in themedical field.