Surviving Housemanship in Malaysia~ An article by Dr Eugene Low

First of all, special thanks to my housemanship war mate + 15 years BFF for writing a great article and featuring in my blog!!!
He was the top houseman during our training, and now he makes a great achievement in his career.

So, lets get started 😎

This post will probably be odd in a travel blog but I guess medicine has always been close to our heart – thank you Dr Celine for the invitation to contribute a non-travel related article.

Surviving housemanship in Malaysia – We’ve all been there
It wasn’t that long ago that I, like so many before and after me sat in front of the computer nervously waiting for e-houseman to open its portal. It was many moments of intense wait – as your fate for the next two year hangs in the balance of a few clicks, and your internet speed. Mine crashed, due to the sheer volume of people logging in at the same time and before I knew it there were only two far away hospitals available.
My heart sank. However, a few emails and many frantic calls later to KKM (and I believe I was not the only one) they decided to reopen the hospital selection and with a bit of luck, I got what I always wanted – Hospital Seberang Jaya.
Make no mistake housemanship is intense. The stories are true, but not all. It was demanding, exhausting, unrelenting, yet, it was also rewarding, interesting and at times, even fun. It was the best of times, it was the worst of times.
As it is, the hours are considerably more than what normal people would work for, but conditions are improving.

Be humble, learn always.
“You don’t know everything. And a few years from now when you are on your first day of work, remember that.” My Year 2 psychology professor once said.   
In housemanship, there will always be help if you ask for it. I admit struggling during my first rotation – the job demand, the emergencies, the hours, the new environment. And it wasn’t just me, over time I’ve seen so many people caved in to pressure. It could get so busy that because you just weren’t efficient enough, you tend to lose pace and before you knew it, you’d skip meals, stay back just to complete your work. I lost weight, but not the determination. “Do you not rest? I saw you yesterday night and today you’re here again” a patient once asked innocently. I smiled wryly. Yet, despite everything so many people have helped me pull through. It was something through the stark reality of life’s morbidity that we learned many lessons. Textbooks can only teach you so much because it’s very different when you witness a real patient collapse right in front of you. “Sp02 not picking up, BP undetectable, get help, get the crash cart!” and I remember first time being part of the resuscitation team. “I can’t get the blood!” a senior had to take over. It was extremely disappointing – but you keep on doing, learning until you excel. In the midst of all the emergency chaos there was always a certain rhythm of order, as everyone played their part in saving the patient. And you learn from everyone in the team. In paediatrics, the senior nurses helped with cannula insertion in difficult patients when we failed. As our surgical Head of Department likes to emphasize during his grand rounds “Knowledge is important but attitude is so much more”.
Be humble always.

Good Support goes a long way
Tagging period means 6 days of continuous 15 hour shifts with a day’s rest for 2 weeks to help you adapt to a new department. It’s always stressful to start a new department – new things to read, new protocol, new department routine. It’s meant for new people to be able to function during night shifts as a competent house officer, often being the first to attend to patients when needed.

 “come down to the foyer later we’ll deliver you dinner”
Random text messages like these were the best surprises and my family has been extremely supportive throughout. During the long periods of tagging where apart from work all you did was to go home to sleep, getting home cook food was very heartwarming. I agree not everyone enjoyed this luxury especially those that work far from their hometown, but family support on many levels, is so important! Then of course there were the friends you made – we used to occasionally deliver goodies – bubble tea, food etc for those working extended shifts. I’ve met so many incredible people throughout the two years and it’s not just among house officers - over time some of the perceived “fiercest” bosses in a department were actually very nice and towards the end of every postings it’s always makan-makan celebration with everyone! What best binds us all Malaysians together if not food?
I’ve always had an interest in internal medicine. “Go for it, pay now or never!” It wasn’t even the first day of the exams application but my senior texted me to tell me to register for the Royal Colleges first part exam because extra slots were allocated! It was a giant leap of faith because I just wasn’t ready but I locked in anyway for a slot in Singapore. “I’ll see you there!” Then help poured in from my other friends and department medical officers/specialists who gave me materials and tips on preparing. It was busy, busy, busy days of balancing work and study. But by then I was into my fourth posting and had a firm grip on routine work and duties as a house officer. I was in fact in paediatrics tagging and the HOD was very supportive and allowed me leaves for the exam. A month later - Click, Click, Click …..we passed! The tears of joy! If you’re determined and ready, go for it. I’ve known friends who passed their UK Royal Colleges exams, USMLE exams, AMC exams during housemanship. Aim to pass but prepare to fail. It’s not impossible, but nothing short of a hard challenge.

All work and no fun is boring.
Nyendol. Ah  joining in a couple of sessions with this bunch of Obgyn colleagues and MOs for a good foodie session was always so good. By then I’d begun to gain weight again. Then there was the Obgyn Night with our performances and a department dinner. It was a lot of good banter really and everyone had a good laugh. Good days to reminisce! Suddenly ward rounds were a lot more fun as everyone got closer. Then there were the hiking and beach outings!
We all get about 8 or 9 days of leaves every rotation and depending on manpower availability some departments allow people to take a long stretch. Many of my friends saved up for a good vacation towards the end of a posting while some took the chance to go back home in another state. It’s revitalizing! “Come with us to our Tibet trip!” I didn’t join because I was saving up leaves and money for exams but it’s all about balancing your time and finances!
Always take a step back and take a self-check on your mental health. Am I okay? You deserve a good rest every now and then!
Never overwork yourself, because a good day’s work is about efficiency and finishing everything in a good and timely manner. KPI means aiming to finish on time! Never leave your work for others to complete also just to go home on time – unless you want to lose marks and friends!
Strong basics , knowledge matters
Whatever you’ve learned, matters. Always find out what core knowledge is relevant to the posting.
 “Warning signs of dengue! How do you manage DKA?”
 “What to do in cord prolapse?!”
“How do you recognize and manage UGIB?”
I find it useful to revise just before a new posting because once tagging starts you’ll be so exhausted to study, and before you know it off tag exam looms ahead.
“How do you expect me to have time for study if all we do is work long hours?! It’s not fair” I remember one of the medical officers was taken aback when a rather audacious house officer retaliated with that question after failing the off tag exam – almost as if it served as an excuse for poor knowledge.
No, busy tagging hours does not exempt you from equipping yourself with core basic knowledge to function as a house officer. The job scope is fairly clear – first line clerking, learn the skills to manage and escalate, call for help if necessary. There will always be subjects we are better or worse at – it just means putting more effort beforehand to ask, study, learn, prepare.
Then as you observe how medicine from the text book is applied onto real live scenarios, it can be quite exciting. And by the end of four long months, you’ll be surprise how confident you will become at managing some of the common cases seen in that specialty. 

Finding your own way there
Nobody will know how hard it is except you and people who have gone through it” someone once told me. “Ah you’re joining the service, welcome but be ready, be prepared, it’s going to be very very tough” said the doctor who certified me fit for work shortly before commencement. Ah yes, back when I was that optimistic medical graduate ready to take on the challenge!
Sure, ask anyone who’ve been through it and see their eyes light up – Ah during my days………
by Eugene Low
17 July 2020

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