End of housemanship. Or 2011: Year in Review.

I don’t know why today I’m bothering with trying to write a year in review, seeing as I’ve never done so in all the years I’ve kept this blog. Maybe it’s the speed with which a whole era of singlehood in my life is drawing to a close, and with it, the desire to then slow time down & take pictures of the life flashing before your eyes.

I know the metaphor of the life flashing before one’s eyes is reminiscent of impending death, and yes, I am dying. Dying to the single person I was. Hoping, that by God’s grace in loving Aaron, I learn to die to self. That ultimately, it would be no longer I who live, but Christ who lives in me.

Engraved in Aaron’s wedding ring:

“I have been crucified with Christ and I no longer live, but Christ lives in me. The life I live in the body, I live by faith in the Son of God, who loved me and gave himself for me.”
- Galatians 2:20

So, where do I begin?

Work in 2011 was better than 2010.

I started off the year in one of the best rotations I’d ever had: Hand team in orthopaedics. Say what you want about orthopods. – my hand consultants ROCKED. Admittedly, I’ve always been a geek for anatomy, and I LOVE it when the body moves exactly as you’d expect based on the insertion of various tendons. As such, I thoroughly enjoyed the teaching rounds, esp. when the consultants could predict exactly which tendon was cut based on the range of movement of the fingers. Even though I knew it all boiled down to anatomy <3 it still felt a little like magic

Also, my consultant was one of that rare breed: a consultant with a dry sense of humour. It was a shame, though, that not many would get his jokes during rounds.

Orthopaedics was followed by paediatrics, where I had a surprisingly positive experience. Having heard horror stories of MOs ganging up to criticise & demean HOs, I ended up working with MOs, who despite being clearly knowledgeable & skilled in their field, nonetheless treated me with a great deal of respect & showed their appreciation for the work I did.

Stark contrast to my O&G days, where I didn’t want anyone from work to even know my name. Now, I (hope) ‘m actually friends with one of the particularly nice MOs, and actually want to stay in touch.

Then, I had my last posting as a houseman. The posting I had been waiting all these months for.

EMERGENCY DEPARTMENT (ED).

Based on this algorithm or flow-chart on choosing a medical specialty - published in the BMJ, k! - I belonged in ED.

And the 4 months I was there proved it right.

Wasn’t plagued by the occasional urges that used to hit me back in my other postings, to just turn around on the NPE & head on home. (When you’re the only houseman on your team, unfortunately, that option isn’t open to you.)

Even a colleague of mine commented, “Sheena, every time you come to the ED, you look like you’re coming to a playground.”

However, all good things must come to an end, and I had to complete my beloved emergency department posting (& thus, housemanship), and was subsequently posted to KK Lui Muda in Jempol, Negri Sembilan, for my first year of MOship.

When I arrived there, the MOs there were surprised, as they hadn’t expected anyone who’d worked in KL/Selangor to take up the job. After all, there had been 3 MOs from KL/Selangor who’d been posted to Jempol, and all 3 of them had appealed against the posting.

And it WAS tempting to appeal. I mean, I had no idea how to even spell Lui Muda - had to get the assistant to read the name out twice to me over the telephone - let alone where it was. I was due to be married. And I’d grown very comfortable at home in Sunway with my parents & my friends & my malls & my Starbucks…

“Those of us who are educated – especially those educated overseas – owe it to those who have not had that opportunity to come back & share knowledge with them.”

- Fr. Simon Yong

So, I went.

Can’t say I was too thrilled about it; in fact, I was down right depressed the weekend before I was due to start, having gone with Aaron & YK to take in the lay of the land:

But again, as Fr. Simon says, “Your heart will go where your mind goes. It is not your mind that should follow your feelings.”

Never mind the fact that earlier, he & Fr. Michael Chua had been laughing their heads off after trying to googlemap my place.

Fr. Simon: Oh my God, so much green!
Fr. Michael Chua: Look at the number of kampungs you have to pass by in order to get there!

My parents & Aaron came to help me move in, and that helped ease me in a lot.
The other MOs are great, and it’s nice - though slightly weird - to have housemates my age again, who’re all in the same profession.

Plus, there are upsides to being in the kampung:

Free pandan leaves - that as a boss, you can order ask your gardener to help you pick behind your clinic.

Interesting juxtaposition: the tong yin & the green plate from Whittards, UK. (Chewah, snob sial!)

First time I’d ever made tong yin.

Free fruits.

My staff nurse gave me like, this 10kg bag of rambutans to take back home. They know I anti-durian, otherwise sure they would give me durian to angkut all the way in my car back home. *shudders*

Apart from work, had some other things going on in 2011.

Getting proposed to being one of them.

Had YK, Sheena Tiong, Adeline Teo & San2 give me the best engagement present ever: a trip to the UK.

I cried so much during Wicked – even more than YK -’cos I was watching it with her, and she is my BFF, just like Elphaba & Galinda.

Got ready for a wedding, while trying to remember to get ready for marriage..

Celebrated Christmas & New Year’s Eve with family.

Played lasertag for the first time – and totally kicked a**
Can see why Barney Stinson loves the game so much.

And now, it’s 2 hours ’til the end of 2011, and 6 days ’til my wedding.

Happy 2012!

Couldn’t I just have people call me “boss” without having to take over boss duties?

Barely a month out of housemanship, and I’ve already been made the medical officer in-charge of this tiny health clinic. My proper title being YM, short for Yang Menjaga.

*******

“On the 10th day of work, the ministry gave to me…”
(to be sung to the tune of 12 days of Christmas)

3 ambulance drivers, 2 general workers, 1 health attendant…

all of whom under the 2012 government payment scheme will be known as “operation assistants”

- superfluous, really, seeing as I’m hardly going to make my Operation Assistant Ex-Gardener start driving the ambulance despite sharing the same job scope as the Operation Assistant Formerly Known As Ambulance Driver -

as well as 2 medical assistants, 1 nursing sister, 4 staff nurses, 6 community nurses, 2 pharmacy assistants & 1 laboratory assistant.

*******

Some of whom, I have already had occasion to tell off.

Example, one morning, I had to leave my clinic at 8:20am to attend a Kempen Kebersihan (Cleanliness Campaign) at the local Orang Asli settlement…

- Sigh, I’ll explain in a separate blog-post.

Anyway, by the time I left the clinic, my laboratory assistant still hadn’t turned up, so when I came back at noon, this conversation ensued:

“Pukul berape sampai pagi tadi?”
“Er, pukul lapan lebih, kot, doktor…”
“Oh, ye, ke? Agak-agak lapan lebih pukul berape, ye?”
“Er, mungkin lebih kurang lapan suku…”

“Oh, YE, ke? Sebab pagi tadi doktor bertolak dari klinik pada pukul lapan dua puluh, tak perasan pun batang hidung engkau.”
“Hehe, mungkin lebih kurang lapan dua puluh lima, kot, doktor.”

*******

The lab assistant wasn’t the only one who got the sharp edge of my tongue.

There was also one of the ambulance drivers, who used to go MIA from work. The support staff live in quarters behind the clinic, so he had taken to going on-call from his house.

Until I made a personal telephone call to inquire as to whether he would be turning up for work that day.

(You see, he hadn’t known about the change of regime – since he was MIA the day the previous YM handed over duties to me – so my early-morning telephone call was a bolt out of the blue.)

Anyway, after that call, all 3 of the ambulance drivers were actually present in the clinic - looking a little sloppy, but hey, better than nothing - and happened to be in the same room while I handed over a couple of stethoscopes I’d successfully procured for my medical assistant.

One of the ambulance drivers, wanting to be smart, asked, “Doktor, dalam bilik doktor ade tak ambulans spare untuk kite orang?” (Do you have a spare ambulance in your room?)

To which I immediately retorted, “Ambulans tu, susah sikit untuk cari. Yang penting, pemandu tak boleh susah dicari.” (Ambulances are a little hard to find. The important thing is, drivers can’t be hard to find.)

******

As YK pointed out, Yang Menjaga = The Babysitter.

How appropriate.

I mean, I know you’re government servants & so you’ve got tenure, but at your age, I honestly don’t see why you need to me to tell you to turn up for work, or have me stand by the attendance log to ensure you’re present in the clinic from 8am to 5pm…

And after all that unnecessary nagging, STILL be eligible for your year-end bonus.

What a way to demoralise & disincentivise the rest of us to whom the word “bonus” actually means something.

******

Is that a cat in the boot of your car?

Why, yes, it is! It is a Puss in Boot!

Er, yeah… So, why is there a cat in the boot of your car?

That’s because this INFERNAL CAT, after wandering the jungle in front of my clinic, then insists on coming INTO my clinic & snoozing on the weighing scale in the maternal & child health clinic that we use to weigh NEWBORN BABIES.

I booted – that’s figuratively & literally – this cat out of my clinic a few times, but the DRATTED FELINE KEPT COMING BACK, and my staff & community nurses won’t kick it out, because it’s SO CUTE.

I think some cats are cute.

Just NOT in a waiting room full of pregnant mothers, waiting to infect them with Toxoplasmosis Gondii, a cat-borne parasite, putting my gluteus maximus on the line with having to explain at perinatal mortality meetings why their babies DIED, or are DEFORMED or their BABIES’ BRAINS ARE INFESTED WITH PARASITES BECAUSE YOU COULDN’T SHOO THAT ADORABLE PARASITE-CARRYING CAT OUT OF YOUR CLINIC.

Bet you don’t think cats are so cute now, do ya?? DO YA??

So, as any responsible MO would do, I tipped the creature into the boot of my car & bought it a one-way ticket from my clinic in Kampung Lui Muda (Felda) to Bandar Seri Jempol.

******

I also have to attend meetings on a weekly basis, including meetings with the FELDA committee of Lui Muda. Yep, the local doctor is THAT integrated into rural community life.

I feel so Doc Martin.

How on earth did a doctor as uninterested in minutiae as I am, end up seated around seated around a conference table decorated with the typical government loops of cloth in orange & maroon, in the Balai Raya FELDA Lui Muda, listening to:

- what to do with the remaining RM33 left in the account – for the main committee to hang on to it, or for the belia (youths) to take it?

This was a prolonged discussion among the venerable elders, which in the end was resolved when the belia representative said he’d organise a year-end sepak takraw game. Cost of sepak takraw ball = RM20.

Win.

- the UPSR results of the local school, as presented by one of the teachers at the meeting, and why was it that no one got straight As – salah cikgu, ke? ataupun salah PIBG tak cukup melibatkan diri?

Teacher muttering under breath, “Muridlah.”

Again, another prolonged & painful discussion, while the teacher had to explain to these angry committee members why was it their grandchildren didn’t do well in English.

The English teacher had taken maternity leave, then extended her maternity leave, then her replacement had some medical problems, then the replacement of the replacement also had some medical problems…

Uh-huh.

******

Then it was my turn in the hot-seat: they were grousing about a staff nurse, whom they thought was particularly meddlesome & interfering. Apparently, she’d broken up a local engagement, thanks to her officiousness.

I suppose her habit of hawking her Tupperware in the community clinics after weighing babies & checking blood pressures didn’t endear her any either.

******

I know, RIVETING STUFF, RIGHT?

******

And now, starting January of next year, I’ve got to lead senamrobik (aerobic exercises)

- yep, you got that right, SENAMROBIK -

on Friday mornings for the clinic staff & the people in the neighbourhood.

JOY.

KK Lui Muda: Week 1

Monday

Got lost for one and a half hours trying to find my way from the Hospital Jempol quarters to Klinik Kesihatan (KK) Lui Muda (Lui Muda Health Clinic) whilst my Garmin GPS was busy “acquiring satellite location.”

Finally succeeded with the help of sign-posts & a makcik at a roadside stall.

Tuesday

Had my first full day at work. Used to wonder before what an office-job would be like: 8am-5pm, 1-hour break for lunch (+ unscheduled breaks for breakfast, brunch, afternoon tea), spending most of the working-time seated & in front of a computer…

Didn’t think I’d ever get to experience that kind of working life until today. Having wifi at the KK definitely adds to the experience.

I’m bored, yes - there is only so much mail-checking & facebooking one can do in between patients - but at the same time, I’m ashamed to admit that I’M SO GLAD I don’t have to go on-call, or work nights. Or work Saturdays, Sundays or public holidays.

Strange to think that 4 out of 4 or 5 out of 5 weekends in a month will be wholly mine to do as I please.

Wednesday

Put a man in the Coronary Care Unit of Hospital Kuala Pilah with anaphylactic shock (life-threatening allergic reaction) after accidentally prescribing him Voltaren for his costochondritis.

FYI: Naproxen & Voltaren are both NSAIDS. Makes sense if you’re allergic to one, you’d be allergic to the other.

On a lighter note, finished my entire week’s stock of reading (books), so decided to catch up on the 2 years of Xiaxue’s life that I missed out on reading during housemanship.

Thursday

Slightly more exciting morning: Caught an ST-elevation myocardial infarction (heart attack) in an otherwise comfortable patient. Initially couldn’t believe my eyes when I saw the ST-elevations from V1-V4… until I saw the T-inversions from V2-V6.

Later found out from the MO at Hospital Jempol that his creatinine kinase came back as 1005, and he had to be sent to Hospital Seremban.

Friday

HOME TO URBAN CIVILISATION!

Housemanship: A state of perpetual sleep deprivation.

A week or 2 into my housemanship, a friend of mine was in town, and asked me to meet up with him, at 8:30am on Saturday. I’d been doing on-calls every other day (EOD) that week, and I said flat-out, “No, I need to sleep in. I need to catch up on my sleep.” To which he replied, “Forget sleeping in, you will never catch up on your sleep. For these 2 years, you will have no sleep & have no life.”

I thought he was joking.

I wish he was.

There are only 9 house-officers in the whole of my department. At least 3 house-officers need to be on-call per night, which means that we end up doing between 8 to 10 calls per month. When we are on-call, 1 house-officer can cover up to 52 patients (2 wards.) We start work at 6:30am, and finish work the next day at 5pm, ie. a 34-hour working “day”. And you start work the following day again, bright & early, at 6:30am until 5pm, provided you’re not on-call that day as well. None of this half-day or day-off business, contrary to the announcement made by the health minister.

In fact, I’ve had stints where I’ve had to start work on Tuesday at 6:30am, finish on Wednesday at 5:00pm, start work the following day on Thursday at 6:30am, finish on Friday at 5:00pm, start work again on Saturday at 6:30am, finish on Sunday at 1:00pm, start work on Monday at 6:30am, and finish on Tuesday at 5:00pm. This would be known as EOD, or being on-call Every Other Day. Which basically meant I only got to sleep once every other night, and have a shower once every other day.

In theory, I could sleep & shower in the on-call room.

On-call room. As well as the nemesis that stands between the way of a house-officer & a good night's sleep: the on-call room telephone.

Note the absence of a heater. Or shower-head. To produce the icy-cold blast of water designed to jolt house-officers uncomfortably awake.

Only problem is that I’m kept so busy during my calls that I usually don’t have the time to sleep and/or shower. Meaning that I could easily work for 34 hours straight. In the UK, junior doctors are only allowed to work 56 hours in a week. I easily do 56 hours in 4 days.

I’ve been so exhausted at work that I’ve fallen asleep while assisting at operations; this means I’ve scrubbed-in, and have nearly pitched headfirst into a patient’s open abdomen because I’ve nodded off.

When the D-G made the comment that “housemen are not over-worked in hospitals,” my father said, “Sheena, you should write something in response to that.”

Only that I was too exhausted – from work – to write anything.