“1 month down, 23 months to go, but hey, who’s counting?”

- To quote T(ex-)R’s status.

I’ve come a little way from when I hated housemanship so much that I told everyone to call me Dr. Toyat, rather than Dr. Sheena, because I didn’t want my work to have anything AT ALL to do my life, including the name by which my friends call me.

I have to reluctantly concede Pravin is right:
I would actually rather people called me Sheena. Mind you, this was a VERY recent development, though.

I hate work less now that I’m on the wards. The workload is the same, if not more, compared to the labour room, but working in an environment where people are so much nicer, and more co-operative, and so much less snide goes a long way towards lessening my hatred of O&G work.

And that’s one thing I’ve learnt about myself: I don’t get stressed out so much by work per se; if the people around me are unpleasant, even if I don’t have a lot of work/responsibility at the time, I still get pretty edgy.

I’ve settled into a routine of sorts. In my first week, when a senior house-officer told me we had to look after 26 patients on the wards, my reaction was, “So few? In the UK, we had more than that, and lodgers, too.”

Looking back, my naïveté is pretty funny.

Unlike the UK, where the house-officers do the rounds together with the seniors & just scribe, under the Malaysian system, house-officers have to complete the rounds BEFORE the seniors arrive, and then, do the rounds AGAIN together with them when they do arrive. Plus, house-officers in Malaysia also do an afternoon round – something that wouldn’t normally be done in the UK – again, before the seniors arrive, and then do the afternoon rounds AGAIN with them.

Which doesn’t leave you with a great deal of time to do all the other clerical work all house-officers, both in the UK & in Malaysia, tend to get saddled with.

By the way, forms are the BANE of my life. To discharge 1 post-natal patient, I have to do a discharge summary, prepare a prescription for discharge medication, sign 2 medical certificates, fill in the baby-book, 2 forms and a neonatal clerking sheet. Provided the mother did not have any problems antenatally. If she did have problems, then there are MORE forms I have to fill in.

If there’s anything I’d like to introduce in Malaysia, it would be for the house-officers to do a paper-round, as they do - over breakfast, too - in Southampton General Hospital to divvy up the jobs equally

- OMG, did I actually quote SGH as an example of something GOOD?? -

‘cos I don’t see how my being the more junior house-officer – by 2 months – means that I review & sort out 11 patients while the more senior house-officer only has to review 4.

To be able to complete rounds before the registrars come to do their rounds, I turn up at work between 6:00am to 6:30am. I take short-cuts with my more stable patients; rather than seeing each one individually, I occasionally take to standing in the middle of the ward, where I can see all 3 placenta praevia patients, and ask at one-shot, “Semua OK?” “Ya, doktor.” “Ya, doktor.” “Ya, doktor.” “OK, bagus.”

Again, it’s funny, but it’s sad, too, because I want to spend time with my patients. And patients want to spend time with their doctors.

It was my turn to do my stint in the labour room and the labour room high-dependency unit (HDU). I’d just come on that morning, and a colleague from the ward called the HDU to transfer to me the case of a primigravida at 30 weeks, who was due to go for an emergency Caesarean section in 20 mins. time for threatened pre-term labour, and could I please sort out the OT, anaesthetist, surgeon, neonatal ICU, and consent the patient?

So, I sorted out the OT, anaesthetist, the surgeon had spoken to her that morning, confirmed there was a ventilator available in the NICU, then brought the yellow consent form to the patient for her to sign.

“Surgeon sudah terangkan, pasal operation ini?”
“Sudah.”
She puts my pen to the paper. I’m thinking, “OK, after she signs, I need to confirm that we can push her to OT, then call the surgeon again to tell him she’s on the way…” She signs. Then looks up.

“Sudah ada ventilatorkah, untuk anak saya nanti?”

And I am shocked out of my task-listing, task-ticking. This poor woman had been thinking, had signed a consent form thinking, that the doctors were going to deliver her baby without making sure all measures were in place to keep her baby alive & healthy. And I have a rush of pity for how worried she must be.

“Surgeon pagi tadi tak cakapkah? Kita memang sudah ada ventilator untuk anak kamu.”
“Adakah? Saya tidak tahu. Doktor tak cakap.”
“Memang ada ventilator. Kita memang tak akan operate sehingga kita pastikan ada ventilator. Saya baru telefon wad kanak-kanak tadi, memang ada ventilator untuk anak kamu. Itulah sebab kita nak operate sekarang. Jangan risau.”

And she looks up gratefully.
“Terima kasih, doktor.”
I clasp her hand, and turn to move on to the next item on my list, but she still hasn’t let go of my hand. I turn back inquiringly.

“Hari ini, hari jadi saya, doktor.”

How many doctors & nurses have seen her to prepare her for this emergency C-section, but who has she had a chance to tell this morning that it’s her birthday today?

I’m sorry I can’t spend more time with you.

“Puan, jangan risau. Ventilator sudah ada, surgeon pun sudah panggil. Nampaknya, selepas operation nanti, kamu dengan anak kamu boleh kongsi hari jadi yang samalah.”

11 working hours in a day. 14 hours on-call on a weekday. 24 hours on-call on a weekend. Will it ever be enough for all I need to do & all the patients I need to see?

From the fear of suffering rebukes.

I have spent the greater part of my time b*tching to all & sundry about the people I have to deal with at work, because I’m desperate for support, for sympathy from any quarter, for all the cr*p/cr*ppy people I have to deal with at work. For someone to empathise with the fear I feel every time I open my mouth at work that I am potentially subjecting myself to yet another rude & hurtful put-down.

Because, more than the truth of whether or not I was in the wrong, I need someone to assure me that I was/am in the right

- whether or not I actually was –

that I am better than everyone else at work

- whether or not I actually am –

because I can’t carry on going in to work, facing that perpetual barrage of (seemingly) personal attacks thinking that no one is “on my side.”

So, when I turn to the One who is supposedly my Rock & my Refuge, the one to whom I can pour my heart out, hoping that He, too, will sympathise with me, but end up being rebuked instead, it feels like a slap in the face.

“There is nothing concealed that will not be disclosed, or hidden that will not be made known. What you have said in the dark will be heard in the daylight, and what you have whispered in the ear in the inner rooms will be proclaimed from the roofs.”

- Luke 12: 2-3, Friday’s daily reading.

“You, therefore, have no excuse, you who pass judgment on someone else, for at whatever point you judge the other, you are condemning yourself, because you who pass judgment do the same things. Now we know that God’s judgment against those who do such things is based on truth. So when you, a mere man, pass judgment on them and yet do the same things, do you think you will escape God’s judgment? Or do you show contempt for the riches of his kindness, tolerance and patience, not realizing that God’s kindness leads you toward repentance?

But because of your stubbornness and your unrepentant heart, you are storing up wrath against yourself for the day of God’s wrath, when his righteous judgment will be revealed. God “will give to each person according to what he has done.” To those who by persistence in doing good seek glory, honor and immortality, he will give eternal life. But for those who are self-seeking and who reject the truth and follow evil, there will be wrath and anger. There will be trouble and distress for every human being who does evil: first for the Jew, then for the Gentile; but glory, honor and peace for everyone who does good: first for the Jew, then for the Gentile. For God does not show favouritism.”

- Romans 2:1-11, Wednesday’s daily reading.

I know He has rebuked me because He loves me, and because He has made me to serve Him better than the way I’m serving now, but it’s HARD, because all I want right now is just for someone to agree with me that everyone else at work is cr*p. And the last thing I want right now is to be told that I am not better than the people I have blogged/b*tched about.

Because I’m not strong enough to cope with being told that I am in the wrong, or to cope with being challenged to grow.

“O Jesus, meek and humble of heart,
Hear me.

From the desire of being esteemed,
Deliver me, O Jesus.
From the desire of being loved,
Deliver me, O Jesus.
From the desire of being extolled,
Deliver me, O Jesus.
From the desire of being honoured,
Deliver me, O Jesus.
From the desire of being praised,
Deliver me, O Jesus.
From the desire of being preferred to others,
Deliver me, O Jesus.
From the desire of being consulted,
Deliver me, O Jesus.
From the desire of being approved,
Deliver me, O Jesus.

From the fear of being humiliated,
Deliver me, O Jesus.
From the fear of being despised,
Deliver me, O Jesus.
From the fear of suffering rebukes,
Deliver me, O Jesus.
From the fear of being calumniated,
Deliver me, O Jesus.
From the fear of being forgotten,
Deliver me, O Jesus.
From the fear of being ridiculed,
Deliver me, O Jesus.
From the fear of being wronged,
Deliver me, O Jesus.
From the fear of being suspected,
Deliver me, O Jesus.

That others may be loved more than I,
Jesus, grant me the grace to desire it.
That others may be esteemed more than I,
Jesus, grant me the grace to desire it.
That, in the opinion of the world,
others may increase and I may decrease,
Jesus, grant me the grace to desire it.
That others may be chosen and I set aside,
Jesus, grant me the grace to desire it.
That others may be praised and I go unnoticed,
Jesus, grant me the grace to desire it.
That others may be preferred to me in everything,
Jesus, grant me the grace to desire it.
That others may become holier than I,
provided that I may become as holy as I should,
Jesus, grant me the grace to desire it.
Our Lady of Humility, pray for us.”

- Cardinal Raphael Merry’s prayer.

A huge thank you to my little sister, who told me all about this prayer.

2nd week of housemanship.

And already SICK of the pettiness.

Yep. It wasn’t just because it was my final-year, or because of the medical school. I just plain DO NOT LIKE, in fact, HEARTILY DISLIKE, Obstetrics & Gynaecology.

And it’s all because of what Stephen, fellow O&G-disliker, describes as the “vibe” coming from mostly-female staff.

You do have a few nice nurses, and a few nice midwives, but the ones I’ve encountered in Malaysia have mostly been infuriatingly rude & inconsiderate. When they’re not being downright lazy & absurd.

Just today, I wrote my clerking on a fresh continuation sheet; reason I used a fresh continuation sheet being that the nurse/midwife was hogging the patient notes. After I’d completed writing everything, the nurse/midwife proceeds to tell me off loudly & rudely – in front of the patient – for not having written immediately after her entry. ‘cos now, that would mean she would have to – horror of horrors – cross through one side of the continuation sheet if she were to include my fresh sheet in the notes, and because - gasp - I have wasted one sheet.

She then proceeded to go to the nurses’ station to complain (deliberately) in my earshot to the other nurses about how incompetent I was, to vigorous agreeement from all the other nurses, one of whom advised her (also in my earshot), “Tengkinglah. Tengkinglah dengan doctor.” (Shout at the doctor.)

I keep my cool, keep my head down, and proceed to re-write my entire clerking below her entry

- since you know, that saves more paper AND takes less time than her just striking 1 line diagonally across the page –

only to then have her say – not to my face, mind you, but still within earshot – “Lagging-lah, doktor nie. Tengok, saya pun tak dapat buat kerja sebab doktor ambil masa lama sangat.” (So slow this doctor. See I can’t even do my work because of how much time she’s taking.)

It’s a special kind of pettiness, this. I don’t know if males can be this petty. Unless maybe if they were gay.

What is it, that has happened to them, that had made them so so angry, and so spiteful? Is it the herd mentality that makes them so confident they can treat their colleagues this way, and not have to worry about any repercussions? I mean, so confidently COWARDLY? You have anything to say, say it to my freakin’ face! B*tch.

And it’s not just the nurses/midwives, too. It’s the female doctors, as well. Or rather, Malaysian-trained female doctors. Also today, I was trying to get ahold of a neonatal ventilator for a primigravida patient at 28 weeks with severe & worsening pre-eclampsia. I’d already called all the hospitals in the Klang Valley, but I hadn’t called any hospitals outside of the Klang Valley on express instructions from my senior. So, again, also on instruction from my senior, I then called our own neonatal ICU, and spoke with – presumably – a medical officer or registrar there:

“You don’t know, is it? Our ventilators are all fully-booked!”
(Patiently explain I know they are fully-booked, just that this case was quite urgent, and if she delivered before the other patients on the list, was it possible for her to have priority.)

“I think you should work harder and call other hospitals. You need to work harder!”
(Thanks for passing judgment; I’d only just called like 10 hospitals earlier, ie. all the hospitals I was asked to call, slacker that I am, tsk, tsk.
Explain again I have called, and that was why I was subsequently instructed to call them.)

“You want to come to our NICU and see for yourself? All the ventilators are used! You don’t believe me, is it? Why don’t you come over and see for yourself?”

Why YOU so sarcas & so emo? You’re a doctor, for goodness’ sake. I’ve been nothing but unfailingly polite & soft-spoken to you. Get a grip!

I can foresee people commenting, “This is nothing. I’ve had worse. This is how working in Malaysia is like.”

I will accept being taught. I will accept being reprimanded when I’m in the wrong. Heck, I will accept being bullied, and being made to do scut work; I am, after all, kilometres down the hierarchy in the labour ward.

What I see no reason in having to accept is this kind of uncalled-for rudeness. It’s just so, unnecessary. You CAN teach without having to be mean & nasty. Does it achieve anything? Do you think you’re really “teaching” people anything, treating others like how you were treated?

People trained in Malaysia allergic to being polite, is it? I’ve met consultants in the UK, who are way more qualified, way more skilled, way more experienced, AND kilometres up the hierarchy, who don’t find it THAT huge an effort to treat their lowers, including that lowest of the low, the medical student creature, like human beings.

“True character of a person is measured not from how you treat your superiors, but from how you treat your inferiors.”

They didn’t see a need to belittle other people in order to pump up their fragile ego.

7 days of tagging left.
Let’s see how much longer I can put up with this 3rd-class mentality, ie. this pointless cr*p before I snap. Gee, wow, that phrase even rhymes.

My new wallpaper makes me smile.