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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