Essential from one's prespective

Many hoped that it was going to be an April fools joke including myself but it's here finally - Goods and Service Tax.

There were many reassurances given by ministers that essential items will not be taxed. However, I wondered if there were any ladies in that committee deciding the list.

The thing that really irritates me is that sanitary pads are subjected to the 6% GST! What nonsense is this? It's like we're punished for this normal menstrual cycle that allowed mankind to repopulate. If we can't afford to keep ourselves hygienic during our monthly cycle with sanitary pads, what are we suppose to use?

Those who are savvy and rich enough would have stocked up on their supply. But sooner or later we'll run out and can't escape from this GST. Those of you who have light and short duration of period can start counting how much money you would have saved. Times have just gotten tougher to be a girl.

I propose that there should be a regular review of the items included in the taxation. I hope that Malaysian women will get their voices heard and not be bullied with this new taxation system.

Conscientious

Too little conscientiousness. That's what happening at our workplaces nowadays. Add in the assumptions. Now that's the best recipe to kill off any respect.

When I received the invitation letter as a speaker today, not only was my marital status changed but a new surname (which also implied that my religion was changed too) was given to me. I really salute the effort put into creating a whole new identity. Maybe I should just let this imaginary speaker do all the hard work.

People's reaction? Some started laughing, some got angry. I can understand that because such an absurd thing can happen. Maybe if there wasn't that much fear or religious polarisation going on, I would have been amused. Yet I felt insulted and feared that rumours will start.

It isn't hard to be conscientious. My full name isn't a secret. All it takes is a little extra effort.

Frustrated and shocked

What will you feel if suddenly you realised that your senior is not competent at all and that you're left all alone to save a patient's life?

Seriously, I can't believe that this happened. I was suddenly called by the nurse while I was struggling with a difficult cannula as the visiting registrar was looking for me, plus it sounded urgent. So, I somehow managed to quickly put in the cannula and went over. He told me patient suddenly stopped breathing and just stood one side while I rushed to the patient ordering the nurses to take down the vital signs, give oxygen and bring the crash trolley.

Throughout the whole resuscitation up till me bagging the patient, he just stood there and do nothing! I mean, at least he could have ordered oxygen when the patient turned blue in front of him but he just stood there. My nurse even had to get another lecturer to come over to help me. I seriously couldn't believe that there's qualified physicians of this standard in this era. This was hopeless. I was already trying desperately to cope alone as there were no other houseman sent to help me while my partner was on long medical leave and there's still unqualified senior around. I felt like I was seriously in the deepest end of the sea drowning and there's no one there who can help me. By the time my lecturer arrived, the patient had already stabilised and was transferred to the acute bay.

I thought that the drama was over but in the afternoon, when I finally had the opportunity to go down to the radiology department to beg for urgent scans, I received an urgent call from my staff nurse that another patient collapsed. Great, I ran all the way back as fluid resuscitation couldn't be given as her hand with the cannula was already swollen. Usually I don't panic when these things happen, but knowing that all my other seniors are in clinic that afternoon and there's only me looking after the ward while I was trying desperately to set another cannula in an oedematous patient doesn't help with confidence at all. At least my staff nurse tried helping me but desperate times require desperate measures. I managed to set my first external jugular venous access.

To cut a long story short, my 2nd patient who crashed that day survived. Haih......At least my lecturer ran back from clinic just in time when I've already done what I could for her.

I hate working alone. I dread going to work these days. I need a break before I go crazy.

Random ramblings

How I wish that I can make time stop and then I'll be able to sleep a little longer, play a little more, just so that I have had enough mental preparation to face the responsibilities of tomorrow.

The ability to be able to go back in time would be great too, reliving those carefree moments, re-experiencing the joys of yesterdays.

Recently, I've been having these worries that I'm nearing the tipping point of giving up. The temptation to just forget all responsibilities and walk out on my job is so great. All this is caused by the lack of job satisfaction, pressure at work, seeing so much injustice going on, unequal distribution of responsibilities. Can I not go to work tomorrow??? What if I'd chosen a different profession? Would I have earned more and experienced a better quality of life? It'll be so depressing if that were the case.

I hate this part of me where I don't adapt to change that well. One thing bad about work at the moment is that we get rotated every so often. I do take a long time to settle down in a routine, getting to know the team that I work with. Once I'd established my comfort zone, suddenly, I'm due to change over to a totally different environment and team. Haih.......

Enough of these ramblings. I guess I just need to get it off my chest. Still, the disinhibition tendency is brewing inside of me.

Finally, the start of the shift system

Last Friday, our team leader gathered some of us to decide on the working hours that we would like to be implemented when the shift system officially starts in September. Hooray!!! Finally, after all that complaint and sufferings we went through. We'll officially be humans working as doctors and not robots.

One major issue faced in UMMC is that we have not enough manpower for the shift system to go smoothly. It'll be so unfair if we were forced to do double shifts and not get paid overtime or oncall allowance due to lack of houseman. Each rotation will require at least 15 more houseman for this to go smoothly, that's not even taking into consideration if some had to take emergency leave or would like to go on annual leave. I seriously don't know how will it go. It's going to be chaotic for the first few weeks, but hopefully things will fall into place.

Another issue that I'm worried is that colleagues from the previous shift will pass over a mountain of work to the next houseman taking over due to laziness, incompetency, you name it. With the current oncall system, we're still facing it, so, I don't think there'll be any difference.

At the moment, I'm losing motivation to work. I'm not as enthusiastic, not as keen, not as generous as I would like myself to be, as there are colleagues who get away with such irresponsibility and both of us still get the same pay. So, why should I do more increasing my chances of making mistakes in the process and risk more lives? I hate people who are already so slow, lazy and good in skiving but is still so calculative. Maybe I should start being as calculative. I am going to be a lazy and stupid houseman from now on thus ending up with less responsibilities and life will be peaceful.

4am - the most dangerous time of the day

Yup, I somehow is still surviving this inhumane 36+ hours oncall system and yesterday, the worst thing happened to me, or should I say, the innocent ECG machine.

I don't get it. I've already assessed the patient and deemed that he just needed some chest physiotherapy and suction to help with his breathing and as soon as I stepped into the oncall room for less than 2 minutes, the nurse calls me saying that MO's orders were to take an ABG, order chest xray and do an ECG for the same patient. Ok, ABG was fine, at least I was successful at the first attempt.

ECG was another issue. I just don't understand why on earth that house officers at UMMC are made to do ECGs for patients. This is damn stupid. As if the machine could electrocute the patient or something. Well, the ECG machine was more dangerous than it seemed. It has the potential to fracture a bone or two.

I was waiting for the ECG machine to print, but then somehow, it's ink finished and I couldn't get a clear picture. So, I politely asked the nurse if they could get another ECG machine which was returned by verbal directions to where the other ECG machine was hidden. Ok, fine, I had to go find the machine myself.

First warning sign that something was about to happen...... I started wheeling it and the extension plug resting on the wall dropped. So, I unplugged it and started moving it again.........

This time, the whole machine came crashing down while doing a somersault in mid air just before it landed a few millimeters from my foot with a big 'thud' as there was another power cable connected to another power point which I'd didn't realise after removing the first one at 4am in the morning.

Yes, it died and was beyond salvageable and at that point in time, I just couldn't be bothered. I think I woke the whole ward up and nurses were threatening me that I needed to pay compensation for it. Whatever......I'd never learned how to handle ECG machines gently plus is it our job to do ECGs? This is just ridiculous. What a waste of resources and I've caused more wastage.

Never get a doctor for whatever reasons at inhumane hours of the night. We pose a dangerous threat not only to the patients but also to ourselves. Why do doctors need to work inhumane hours for the benefit of mankind? Aren't we humans too? If someone starts collecting data on the number and types of mistakes made by doctors working inhumane hours, it will be appalling.

I'm still wondering if I have the right to refuse to manually ventilate a patient in the CT scan room as I'm unhappy with the amount of radiation that I'm exposed to. Well, I don't even have the basic human right to practice safe working hours, what more avoidance of risks of cancer. Can we get compensated if we develop brain tumours or Alzheimers in future? Who knows what are the long term effects of constant exposure of high doses of xrays. My memory is getting poorer, thanks to the constant dying brain cells and mutations from all those beams.

I hate doing ECGs. I hate giving IV drugs. I feel that we should be learning more to be doctors rather than doing jobs which doesn't require 5 years of medical training to carry out. I rather learn when is appropriate to order ECG and then interpret that ECG.

When will be the time where all Malaysian doctors practice safe working hours? When will be the time where people start making changes for the better of the future generation rather than using examples from the 'good old days' to shut us up?

Who thinks that little things doesn't matter?

You'll be surprised how little things which started off as just an annoyance can occur one after another and their accumulative effect can be so great that it just mounts up to the tipping point.

It's scary but I think I understand how anger and despair pushes someone to kill.

Unprofessional

Was told off by a lecturer for not recording down what was discussed in front of the lift about one patient that was jointly managed by both our teams. Can I record what was said and play it back?

Hmmmmm....maybe I should record down what's been discussed at the cafeteria next time.

Can I not get the coffee?

Picture this:

After doing the balancing act of carrying at least 10 cups of coffee from Secret Recipe on the ground floor, squeeze into the crowded lift while guarding the coffee with your life up to the 9th floor, used one foot to kick the conference door open as no one is gentleman enough to get up from their seats to hold the door, felt the great relieve that balancing on one foot with 10 coffees in hand is still possible, the tachycardia and adrenaline rush immediately resolve as the coffee hit the table just in time for the pre-op discussion.

Now, not even having the chance to breath the sigh of relieve, got told off straight away by the secretary that the Prof will only take Latte so remember to get a cup for the next meeting while she conveniently just sits there.

I went to 5 years of medical school so that I could get the whole team coffee single-handedly once a week. I want to use my cert to wrap Nasi Lemak already.

Secretaries are just too posh or wearing heels too high to be carrying coffees around. I miss those days where consultants show appreciation by treating us to coffee and not waste human talents like this.

I really hate

patients who can be so selfish that not only they don't treasure their own life, they don't even care about the risks they bring to their loved ones. Go to hell!!!

Frustrated

There's just too many people out there in this world who will manipulate the situation for their own benefits in the expense of others. I've learned that it doesn't pay to be nice. So, if I cannot win them, join them and be as selfish.

Suffering in silence will never be appreciated and some may even take advantage of it. Always try to get something in return for favours asked. Never be as stupid as me.

I never went looking for change but change came looking for me and now my heart is infected. I've turned cold.

Exam for docs won’t cause brain drain

Exam for docs won’t cause brain drain

I'm sure I'm not the first one who wished that this exam was implemented earlier. Such a big potential loophole for scholars who do not wish to do their housemanship in Malaysia after graduation. We can choose to fail this examination in the act of free will and thus deem incompetent to practice in our homeland. Just joking. There are many reasons why we choose to come back instead of serving in a foreign land.

Change of topic.

Almost 3 months into my training and I'm still grumbling and complaining every single day. I blame tiredness for sucking away each and every passion I have for medicine and helping mankind. There are still occasions where I'd reached my breaking point and almost walk away from whatever cruel act that I was carrying out on screaming and crying children or some who are too weak to even make a sound. There are also times when I'd just turned cold blooded and went ahead without caring about their pleas to finish the job so that I can go home postcall. Seriously, I don't know how long inhumane working hours can provide optimum training for house officers. Most of the time, nothing gets absorbed by the organ sitting between the ears.

House officers are not distributed evenly in Malaysia. Seriously, they're not. I hear others boasting about only 4 calls a month, having time to play football, never covering a ward alone. I can only say that the grass is always greener on the other side. I should start accepting my own fate and stop complaining. Our seniors had it worse. I wished that there is a labour law in Malaysia safe guarding sufficient resting time. With the numbers of HOs now, I'm sure we have the capacity to implement safer working hours.

I wonder how many patients realised the dangers of overworked doctors and some even complained that we switch on the lights in the middle of the night while administering IV drugs and even on our technique of drugs giving. Am I supposed to administer drugs in the dark? I almost encourage the father of a patient to lodge an official complaint when he said, 'If you don't know how to administer IV drugs, then don't administer!' when I accidentally caused some backflow into the 3-way tap. Well, I can guarantee that none of the house officers has had proper training in IV drugs administration prior to any of our oncalls. We learnt it from each other. Another thing about some nurses, they're not supportive at all. Some don't even carry out their jobs properly and yet they start criticising you for minor mistakes, even scold you for wrong techniques and worse of all, when you ask them for help, they complain first and then reluctantly drag themselves over to help. That's counted lucky, try walking over to the nurses station to ask for a hand and end up not getting any thus patient's mother had to help out instead. Hmmmmmm......that's professionalism for you.

I was really angry at one occasion when I was asked to remove a umbilical artery catheter from a few days old infant during my oncall and the nurse told me that usually the house officer removes it. I'd never done one before but was pushed (or you can say coerced) by the nurse to do it. Only advice that she gave me when I asked where was the appropriate place to start cutting she said 'Just cut lah!'. Great, whatever happens to this poor baby will be my fault and I wonder who was the super enthusiastic doctor who tied so many knots. When I face the blade toward the catheter, the nurse started scolding me cause I might cut the catheter but it was impossible to even get in between the thread, so when I asked her how else should I cut, she couldn't even suggest anything. Luckily, my oncall MO came to the rescue in the end when I gave up and looked for him for help. Even then, no one taught me the right way of removing until today!!!!! I love my ward's MOs cause they're so helpful and they teach you the correct method before setting you off into the wild. That should be the way. It's only then I felt glad ending up at Paeds ICU ward despite all the stress and long working hours. Will make the best of my placement there.

I'm apologising to all my patients as I am forced to make you my guinea pigs most of the time due to poor training provided for housemans.

The last 3 days of the year

Started with oncall from Wednesday into Thursday. Luckily it wasn't that eventful. Managed to catch 2 hours of sleep which was not too bad. Most sleep I got was 3 hours.

Was woken up at 4am cause there was a new admission. Naughty 2 year old put a small dice up her nose. Initially it was still visible in the right nostril but after she struggled so much while doing the head x-ray, the dice went in further and was not visible even on x-ray. ENT tried to dig it out but failed. In the end, admitted to the ward that I was covering for endoscopic removal under general anaestetics. Had to insert a cannula into a strong, struggling child with a dice somewhere inside her oropharynx which might have gone in even further after I stressed her out even more. Listened to her chest after....no stridor. So, all is still well. Sent her off for chest-x-ray. Might have seen some white shadow around the level just below her chin. Hmmm....it's gone in quite far. Had a really bad stomachache cause had my dinner too late at night when food has already gone bad but was too tired to think of my own health and just swallowed it down within 5 minutes cause new admission had arrived at midnight. Regretted that terribly.

Struggled to stay awake the whole of Thursday. I still don't understand why my energy level keeps on falling after each call no matter how much I rest. Found out during passover round that there was going to be an exchange transfusion that night. Made my friend promise to call me when it has started. Went back to my room, ate, showered, waited for call but fell asleep. Woken up around midnight....found out that exchange transfusion was going on, went back to the ward to observe and learn something. Went home around 2am.

Got called by friend who was oncall at 5.55am to ask for help to take 6am bloods. So, went back to ward, took first patient's blood and suddenly was called to sedate patient for reintubation as patient pulled out endotrachael tube. Struggled to sedate for almost an hour. Continued with the morning bloods and ward round. Couldn't be bothered to do much as was seriously too tired. Doctors in Malaysia don't get any public holidays, but at least I got a half day. Was at the verge of tears when had to take at least 6 mls of blood from a patient for some stupid research which HOs must carry out under orders from research assistants (which get paid to collect data and they by right should collect the bloods themselves) but we don't get any extra pay or recognition and patients lose more blood. Was asked to give up on my attempts at getting blood from a meningitis patient as I was ruining all the available veins. At this point, I couldn't care less for the patient. Will attack him again tomorrow for the sake of research. I'm so glad that today is the last day of this research.

Stayed back to complete a transfer summary for a patient who had been in PICU for the past 2 months. Made it super duper brief and packed my bags and disappeared from the wards before I was asked to do something else.

Counting down to New Year in my room after hibernating. Going to continue hibernation. Will go to wards by 6.30am to help oncall houseman to take bloods. Fingers crossed that my life will be smooth sailing for year 2011.

Happy New Year!!!!

Why the double standards?

Other government servants get public holidays and weekends off. Why can't doctors get the same? Both are human but one lives like one and the other had no human rights to rest in the name of saving mankind.

Learning to live with it

I can live with being scolded for my own fault but to be scolded by 2 different people for 2 different reasons which are not my fault.

So, I started meditating, 'They're scolding someone else, not me. They're scolding someone else, not me'. Put on the never ending loop like a spoiled cassette player till the noise pollution dies down.

As guinea pigs, if we're not eaten alive by any one of the predators, we will still escape with bruises and injuries. Wait, I think my situation is worse than that, I cannot even run. We're just planktons. Haih.....no wonder people said that HOs are of the lowest of the lowest class followed by the medical students, the cleaners, the hospital attendants, etc.

Wrong timing

Why don't you sleep when I'm trying to sedate you. After giving you maximum doses of 2 medication plus another dose of undisclosed medication, you finally gave your last struggle and fell into a deep sleep.

Now I want to discharge you but you're sleeping like a log. How can you treat me like this?

Note: At last, my patient was fully awake before I left home and was safely discharged from hospital.

While waiting.....

for the letter of doom, which I'm informed that it'll arrive after the 8th bringing news about the start of my misery from the 18th. I've been keeping myself occupied with...

2 AGMs

E&O AGM- Went there, no door gift, drank a cup of tea, then went back to.....

Maybank AGM - where I had a good laugh at some of the questions and comments from the floor and witnessed how Malaysians rush for food when the doors to the buffet opened like there's a long famine going on in the country. I was really hard hit by the fact that I'm back in Malaysia. Queues weren't followed, people pushing and fighting to get the plates and dishes. Some even came with plastic bags and Tupperware to take away when not everyone has taken their share yet. Welcome to uncivilised Malaysia! When will it be a time when I can proudly say that I'm a Malaysian?

ECM Libra 4Q10 Investment talk:

It was held at Equatorial Hotel in KL and the breakfast was delicious!

This programme is highly recommended as it gives a very good insight to the direction of the Malaysian share market and also recommends stocks to watch out for.

Right after that, I rushed off to trader's club meeting at ChartNexus. Phew, only managed to have lunch at almost 4 in the afternoon. Training for HO.

I found out that many of my friends have received their induction letter which will be held next week. I myself was allocated to the following week's group so I'll have an extra week off. Feel a bit left out but at least I can polish up my skills in investment in the meantime.

After all these years, I'm leaving with a bad experience

Warning! A lot of grumbling and complaining ahead

I've been staying at St Andrews Gardens for the last 2 years of my student life in Liverpool. The reason that I chose this place in the first place was because of the good location (my bus stop for my hospitals are just across the road) and good reviews from friends who have been staying there for more than 3 years.

I loved the place. Not only I had good memories of the times we had open house for Hari Raya, the bbqs on the patch of green in the middle of the semi-circular building. The friendly and helpful staff who makes the effort to know you added the finishing touches.

Then, the recession came in last year. St Andrews Gardens was bought over by Mansion Properties. That was shortly after we've moved in at the beginning of our new contract.

Here lies the problem. The new management is trying to squeeze as much profit or cut as much losses from the existing tenants who has already paid and signed the contract. They can't change the rental fees so they do that by cutting down on essential maintenance even though we've paid our rent, some of us in full.

The lifts which were used to be repaired within a week at most when they broke down stopped totally. We've been climbing the stairs for almost a year now. That wasn't too bad as we were just carrying our body weight up. The thing is, they are making everyone move out at the end of the contract, without even considering our constant pleas to repair the lifts for just a day so that we can move out!

I've just moved my boxes for shipping from the 4th floor down via stairs which is just ridiculous! I don't understand why do they want to delay replacing the lifts earlier on as they will have to repair the lifts at some point. It's not like they're going to disrupt current tenants by repairing lifts as we are not even using them! They're going to renovate the whole place in preparation for the new term so that they can increase the rent, but the builders will definitely need a mode of transportation of heavy items up 5 floors right? Isn't there a possibility of maybe using one of the lifts as a cargo lift? If the current management can treat existing tenants that poorly, I don't think they're any better when the new ones move in. In the process, they're already creating a bad name for themselves as the current tenant, including myself are already discouraging potential tenants from staying here. I'm even blogging about this.

J, one of the porter was kind enough to help me carrry up all the empty shipping boxes which I'd ordered. From that day on, I was already dreading the worse and yet, the worse was not the worst that I'd imagined.

Carrying down the last box, which was the smallest one and one of the lightest, I think I'd become too careless and the lighting at the top flight of stairs wasn't the brightest, I missed the last step and fell spraining my ankle and dropping my box in the process. Haih.....just right after my dad told me to be careful and not hurt myself. I don't know if this is some sort of premonition that he has or something, every time somebody advises you to be careful, something is bound to happen. Papa, sorry for not listening.

I should have retired for the night after carrying those 5 huge boxes to M's flat whose lift was still working so that I wouldn't have to suffer too much tomorrow, rather than stupidly persevering on with the last 2.

I seriously hope that my ankle doesn't swell up tomorrow as I'll need to transport them over to the loading place for shipping. Wish my luck. I still need my ankles for tomorrow.

To pack or not to pack, that is the question

Here I am, reading the latest updates of flights, the current activity of Eyjafjallajokull volcano (please don't make me pronounce the name), refreshing Ryanair's website at least once every hour, wondering if I should pack my bag or not. Haih......

What will be my fate on Monday? Will the skies be clear? Will the airports be packed with travelers again? Will the planes take off? What if I manage to fly out of the UK but not back in again? Skip a few days of term? That doesn't sound too bad.

Any suggestions for Plan B? Road trip around the UK instead? Alton towers? Cornwall? Go down to London to watch Phantom of the Opera?

Maybe I'll end up with Plan C: 1 week hibernation

Mother nature, why of all times, of all volcanoes, of all wind directions?

Hang on, just hang in there

I am going to conclude that January is my unlucky month. Started on A&E rotation which is practically killing me slowly already. First time in my life, failed an MCQ test by 3 marks and I'll have to re-read that thick ALS book again. Not only that, I'll have to rearrange to resit it some other time.

Today, I found out that I forgot to update my calendar on my computer, so, ended up missing a module which I was supposed to attend (after they canceled the initial time that I signed up for and I totally forgot about the rescheduled date) yesterday. And that was the last module arranged for this rotation. What if there are no more available modules in the next rotation? What if I can't complete it before my portfolio is due? What if...... I just want to kick myself for forgetting about it.

Just now, one nurse asked me if I'd inserted the cannula into a patient's hand, which I did but I don't know why I kept on interpreting that she was asking if I'd catheterised the patient, so I answered 'no' twice. Finally, I realised what she was getting at and she reminded me to record down that I was the one who inserted the cannula. Haih....brain already shutdown.

Why are there so many patients who are only able to understand and speak Cantonese? And why are there no other doctors around who can speak the dialect? Why am I always called to handle them? My Cantonese is horrible, and I don't even know any medical terms not mentioning the name of parts of the body. No one will say Kidneys or Intestines in daily conversation, do they? I only picked up Cantonese through watching TVB dramas, and rarely I hear them mention any medical terms. Haih.....

Cases....need to get 18 of that, prepare 2 presentations, all before I can complete this module without fail. By the time I get home, I'm already half dead and without any motivation to even read anything medically related. I need something to inspire me. In these dark moments, I just wonder did I make the right choice in doing medicine? Have I gotten any joy from practicing medicine? How did I end up suffering like this? What's the point? I still get patients who are pissed at you cause you don't follow what they want you to do for them. Remind me somebody, why on earth am I becoming a doctor? Maybe I should just change my profession.

Enough of all the ramblings......I'm so not looking forward to the 36 hours oncall in Malaysia. I don't think I can handle it. I'll end up killing a few patients due to extreme tiredness. The existence of the the long oncalls just bewilders me cause there's an excess of housemans in Malaysia at the moment. I hope that they abolish it soon.