Mastodawn

Tagline: “Hourly Toilet Break”

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If humans had taglines, what would yours be?

Those who have worked with me know that I have such thing called “The Hourly Toilet Break”.

Firstly, because I consume lots of fluids and secondly, that is how I ensure I do get the break once in a while on a busy day or maybe, the day is quite slow and I am just, bored.

Of course when the day is rather busy and hectic, time just flies and that I do not even realise the time passing by. By the time I actually do complete my task and take the opportunity to just rest for a while, 2-3 hours have gone by.

How Did The Hourly Toilet Break Started?

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I didn’t actually planned for such thing at work. Obviously.

At home, I do frequently go for my toilet breaks as I’m forever consuming green teas or black coffees or water. All of which contributes to the filling of my bladder, in addition to the fluids being diuretics.

It wasn’t until I started my tagging in my sixth rotation, the Emergency & Trauma Department that I reinforced this so-called “hourly toilet break”.

The tagging hours in the Emergency & Trauma Department is long, just as in other postings whereby we had to work from 7am til 10pm everyday with an off day each week for 10 days straight.

Thus, it helped me in ensuring that I either get to sit and recollect myself during hectic days or to make the hours pass during slow days.

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The Theoretical Doctor Aug 21

My First Night Shift In Emergency & Trauma | Housemanship Diaries

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Remember when I mentioned that I love the night shifts?

No? Well, here are the articles advocating my love for that shift:

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My first night shift in this department was in the Red Zone and I was terrified.

Thankfully, it was with a fellow Registrar who is rather patient, kind and one who loves to teach.

The scary part however was that it is the Red Zone after all and on my first night!

The Red Zone basically caters to patients who are unstable be it haemodynamically or in terms of their vital signs or that they are in a state of severe acidosis, on the verge of collapsing, you name it. Basically, how severe of a state a person must be in to end up in that zone.

The night started off smoothly with cases coming in one at a time. Alright, I kept repeating to myself, “attend them, transfer them to another bed, vital signs, bloods, fill out forms, clerk and basically just listen to your superiors”.

The night eventually turned into midnight and into the wee hours of the morning and finally the sun has risen. Before I knew it, it was 7am and the AM shift House Officer has arrived. I am not alone again.

Time to prepare for handover rounds at 7:45am.

It was better after that, having another person with me as it felt less intimidating.

At 10am, I took off and headed home. Not a bad experience for the first night shift.

The good thing about the night shift in the Emergency and Trauma is that we are not alone. There is always a team or at least your superiors are always there.

However, I don’t quite prefer the night shift in this posting. Having actually completed this posting, at the time of writing this article, the daytime shift is definitely better.

Nonetheless, in all the night shifts, albeit that it could be a terrifying one especially prior to the start of your shift, always remember that you are never completely alone even if it feels like it and that help is always nearby.

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The Theoretical Doctor Aug 20

Life After Offtag In Emergency & Trauma | Housemanship Diaries

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The tagging hours in the Department of Emergency & Trauma is from 7am till 10pm, for a total of 10 days and one off day per week. There are no assessments required to off-tag, only hours required to cash in.

During our tagging season, we were not allocated for night shifts as well.

For me, tagging in this posting felt like an eternity. I remembered counting down my days before I would finally “offtag” and be switched to regular working hours. I also remembered being extremely exhausted at the end of my shift, wondering how did my fellow colleagues managed to pull through.

Tagging in this posting as compared to the other postings was considered less stressful as we were not required to arrive early for morning rounds. We merely had to arrive on time and upon the end of our shift, we leave, as compared to other postings where we would stay back almost every time, cash in “unpaid overtimes.”

Finally after 10 days of tagging, I officially “off-tagged“.

So how was life after that?

Much better. Thankfully.

Regular hours in the Emergency & Trauma Department meant working a 12-hours shift per day with an off day per week and a single night shift.

Basically, we had to ensure that in total, we had to meet the total 60-hours shift per week.

Thus are the timings for our respective shifts:

AM Shift: 7am – 7pm
PM Shift: 10am – 10pm
Night Shift: 10pm – 10am

If you have read my articles on “The Joy Of Working The Night Shift As A House Officer” as well as “My Favourite Time Of The Day At Work“, I mentioned that I absolutely love the night shift. The disadvantage of working the night shift is that we are usually alone and the night shift can be rather unpredictable.

However, it is not the same for me in this posting. Out of the shifts listed above, my favourite is the AM shift, 7am till 7pm. Initially, getting up for work at 7am is tough especially after working the PM shifts back-to-back. But after the initial morning sleepiness wears off, the day proceeds as usual and we return home at 7pm which is nice.

Life after offtag in this department ensured that I had adequate rest prior to my shift starting. No doubt, it is a 12-hours shift every time, we usually arrive and leave work on time as compared to other postings.

Nonetheless, I was still exhausted after every shift. Perhaps it was due to the accumulated mental and physical stress throughout the previous five postings that when I am finally blessed with extra rest, I am still tired.

If you are still in the tagging phase, be it in this department or others, please stay strong. Remember that it doesn’t last forever, it is merely over a certain span of days or weeks.

Keep showing up, keep doing the good work to the best of your strength and abilities and keep moving forward.

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The Theoretical Doctor Aug 18

Surviving 10 Days Of Tagging | Emergency & Trauma Department

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My tagging days in my sixth and final rotation, Emergency and Trauma Department, lasted for a total of 10 days which was from the 11th of April till the 23rd of April 2025. This is excluding our one “off day” for the week.

Did I manage to last throughout the tagging days?

Not quite.

I did take a sick leave during my second week of tagging. The reason was that I was just extremely tired.

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The tagging hours in the Emergency and Trauma Department is from 7 am till 10pm, just in other postings.

The good thing about this department is that we do not need to do morning reviews. Thus, coming way early prior to our shift is unheard of. We merely come and leave on time.

However, considering that it is the Emergency Department, things are unpredictable whereby things could be quiet one moment and hectic the next.

Hence, on days which burn, it can be extremely tiring. But, completing these tagging days are a must and so on slow days where the hours seem to pass by really slowly, I make it a point to have an “hourly toilet break“. On busy days, it may be the only time that I am given a chance to sit and breathe.

On top of that, I made sure I took my lunch and dinner break. Not because I was hungry as I was used to having my meal for the day after work. It was merely my way of spending my time during my tagging days.

At 10pm, the shift is over and I leave, even if the floor is busy because the following day my shift begins at 7am again.

Finally after 10 days of “tagging“, I have finally off-tagged and shifted to “shift hours“.

Photo by Andrey Grushnikov on Pexels.com

There are no assessments in order to off-tag. as there were in other postings, which is a good thing. However, tagging in this posting felt long and seem to went on forever for me. Perhaps, this was because I was mainly tagging alone as I entered a month later than my fellow peers.

Nonetheless, I was glad to be done with this schedule and shift back to a regular 12-hours shift.

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The Theoretical Doctor Aug 17

Overcoming My Fear To Refer A Case I DO NOT KNOW | Housemanship Diaries

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What fears have you overcome and how?

At the moment of writing this article, I am in my sixth and final rotation which is in the Department of Emergency Medicine, pushing into my third month.

One might think that as we become more senior in our current job, it gets easier or the fear fades.

Well, the anxiety certainly reduces but that does not mean that it disappears.

For me, the fear is still there as to who I would be working with or who I would be referring to and most of all, referring a case that I not know.

I’m sure we’ve all been there before. Especially upon arrival to work and to be absolutely clueless about the patient and their case and progress and to not have anyone handover the case to you.

Not that we won’t take the time to understand. It is just that, we will or at least I would take the time to digest the initial presentation, clinical examination and findings followed by the initial management of the patient and other teams as well as the current progress.

Once I have finally understood the issue of the patient from A to Z, then I can confidently refer the patient for a simple thing.

That’ll usually take me about 5-10 minutes, especially if there is just one too many writing. To others that may seem like an eternity.

The thing is they will somewhat give me a template of what to say in regards to the patient but I am still absolutely clueless and wishes to kindly absorb the pages and information about the patient before I walk into the battlefield.

This is because, one too many times, I will be asked about things totally irrelevant to the case of the patient which will take me some time and if I’m not so lucky, ended up being shouted at. I mean, that’s the worst that can happen right? Certainly reminds me of my early days of housemanship.

Maybe it’s a form of childhood trauma or maybe not, but I need to at least have a reason to defend myself and the patient.

It’s like a debate or a business deal which I find that I may need to fib or exaggerate myself in order to get a test approved or to refer, all for the sake of the patient or sometimes the superiors.

It’s alright but at times it can be rather annoying especially when they want it done in a minutes time.

The next that I have to actually open my mouth and communicate. Being an introvert, I can easily talk to people but I dislike being in groups, small talks or actually talking at times.

I find it exhausting and thus upon the end of my shift, I just need time to recuperate.

However, back to the question of this article, my fear, to refer to other departments, especially, if it is a case I do not know and to a tiger of a person who loves finding any fault just to reject the case is still present to this day and what have I done to overcome it? Nothing, really, just extreme patience.

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The Theoretical Doctor Aug 14

Reflection – After Almost 2 Years Of Practicing As A Junior Doctor

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“Would you want to return back to medical school?”

No.

I enjoyed my 5 years of medical school very much and I appreciate the memories formed throughout those years.

However, after working as a junior doctor for 2 years, I would not consider turning back time, just to go through medical school all over again. I enjoyed studying and it was equally tough and fun. Besides that, I had the best study group, “The Impostors”.

Going through the COVID-19 Pandemic season of social distancing and online classes made the journey easier. I remembered staying back in Kuala Lumpur and waking up in the morning prior to starting class just to set up my laptop and my connecting screen, sending the link earlier to the group, sharing the slides if needed and while the classes are on-going, I would go about cooking, cleaning or folding clothes.

My coffee and tea would be on standby and everything was prim and proper. Besides that, breakfast, lunch and dinner would always be prepped by me, for me or my friend who lives upstairs. After that, I would proceed to study during the wee hours.

I think the time I managed to complete reading various textbooks were during the COVID pandemic.

Then, I graduated and started my housemanship. It was extremely tough at first and it’s still difficult now at times but I’ve grown to accept the fact that there will be difficult days as well as good days.

Three months later after starting my housemanship journey, my first pay was banked in and subsequently, every month I received my monthly pay.

Eventually as I become more and more senior, things became more and more familiar and easier and some things or procedures became a reflex, even the management plans.

Thus, considering, the things that I’m doing now which I think is much easier as compared to my medical school days, would I want to turn back time?

Nope. Medical school is important and equally tough. On top of that, I’m not getting paid. Instead, my parents had to pay for my medical school fees.

So, no. I cherished those days as I said. But I certainly do not want to relieve them again.

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The Theoretical Doctor Aug 13

Preparing For My Exit From The Medical Posting As A House Officer | Housemanship Diaries

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Medical. My Fifth rotation.

While I was in Medical School, my favourite rotation was the Medical Posting and I’ve always imagined myself being a Medical Officer in Medical.

Thus, upon entering my Housemanship Journey, I did not choose to rotate in Medical as my first posting. Many people said that the Medical Posting is the most difficult posting of all the postings due to the patient load as well as the workload.

Thus, I began in Orthopaedics and placed Medical as my Fifth Posting. Mainly, because I wanted to “enjoy” it. Enjoy it in the sense that I already knew the basics and knew how to function as a House Officer and would be able to learn how to manage the patients.

However, albeit being a senior poster, some old habits retain. In the Medical posting, we were required to hand in our logbooks 2 weeks prior our End of Posting Date.

However, I approached my mentor 5 weeks prior my exit. Unfortunately, my assigned mentor at that time was not available and asked me to approach my Specialist-in-charge of House Officers at that time to request for a new Mentor.

I approached the Specialist-in-charge and was assigned a new mentor which happened to be someone I worked with multiple times while I was in Medical 3.

The following week was a rather tensed week for me as I tried my best to cram as much as I could.

I finally had my assessment with my first mentor who is a Medical Officer that Sunday. Thankfully, I passed.

2 days later, I went for my assessment with my second mentor, my reassigned specialist, who passed me as well.

The issue next was the completion of my 12 CMEs. CME stands for Continuous Medical Education which occurs once a week on Tuesdays. In other postings, only 5 CMEs were required in order to pass. Sadly, it is not the same for the Medical Posting.

Unfortunately, CMEs done online were not acceptable even if there are certificate of attendance.

Luckily, I had attended a Hospital CME some time ago and I was only looking for ONE more CME prior to my exit of this posting.

Thus, I used that to my advantage and finally, I was able to hand in my logbook and officially exit the posting.

Sadly, a few days prior to my exit, something occurred that led to the demise of a patient. But, that is a story for another article. Thankfully, that did not affect my exit from this posting and I exited, on time.

If you are due to finish the Medical Posting or any posting in general, take it as a lesson from me and approach your assessors much earlier.

Otherwise, all the very best!

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The Theoretical Doctor Aug 2

Surviving The Night Shift As A House Officer In Medical 3 | Housemanship Diaries

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The Medical 3 Ward of Hospital Umum Sarawak or “Sarawak General Hospital” is located on the 9th floor of the main building.

Thankfully, being allocated as the Night House Officer, we only had to take care of one ward, unlike being allocated in Medical 4 / Medical 5 / Infectious Disease Ward or being in the Perimedical Team whereby we were always on the go.

The Medical 3 Ward consists of three teams, which are General Medicine, Respiratory and Neuromedical.

During the daytime, we have allocated House Officers for each team. However, during the night shift, we are in charge of the whole ward.

The jobscope of the night shift House Officer in this ward is the same as in other wards and postings which are transferring in of new patients, attending to acute issues and most importantly, coming mornings.

If you have read my previous article on Surviving The Night Shift In The Medical Posting In General, I mentioned that in this posting, upon my arrival to the ward for my night shift, I would begin taking my coming mornings.

The same goes for Medical 3. However, unlike the night shift in Perimedical, I do not take my arterial blood gases with my coming mornings.

I begin from the Respiratory cubicles which is located at the back of the ward and then move to the front cubicles before finally continuing at subacute and acute cubicles which are the beds located in the middle of the ward, in front of the nursing counter.

If I were late for my coming mornings, then I would proceed with taking the arterial blood gases together. But if I finished early, I would take the blood gases much later.

By 5:30am – 6am, I would start running my blood gases and paste them in the casenotes of the patients. Around 6am – 7am is when the morning team starts arriving to trace the bloods as well as begin their morning reviews.

Thus, I wait to be summoned for my bloodtaking or certests.

Finally, at 9am, I return home from my shift.

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The Theoretical Doctor Jul 29

Surviving The Night Shift In The Medical Posting In General | Housemanship Diaries

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The shift that I have always dreaded but enjoyed the most were the night shifts. I dreaded it because I knew that I would be alone most of the time and afraid that I would not be able to cope with the adrenaline rush or anxiety or the craziness that might ensue. However, I enjoyed it because that meant that I will be able to sleep in prior to going for my shift and the following day at 7am, the morning team will start arriving and I am not alone anymore.

The Medical posting in general is a “heavy” posting because of the patient load. Almost all of the patients are so-called “Medical” patients once Surgical, Orthopaedic, Psychiatric or other causes have been ruled out, and it could stem from something as simple as electrolyte imbalance to myocardial infarction or stroke.

Thus, imagine the amount of coming mornings.

Prior to entering this posting, I’ve always enquired and listened to my fellow colleagues’ input and experiences. Most of them would say that “In the Medical posting, the rule of thumb for surviving the night shift is to start taking the bloods as soon as you arrive for the night shift”.

True enough. That is something I have practiced since and even in other postings as you do not know just when something may happen and next thing you know, the sun is rising and your coming mornings are late and the morning team have arrived and the bloods are still pending or not in the system or yet to be taken and the medical officers and specialists have arrived.

Sadly, when there is a delay in the blood investigations, there is a delay in management.

Thus, it is a tachycardic moment for me. Prior to entering my shift, I would screen through the coming morning list and upon arriving, I would usually prep my trolley, ensure my coming mornings are divided and arranged according to their cubicles, ensure enough syringes and needles are set aside as well as the alcohol swabs and cotton swabs.

Then, I will begin taking my coming mornings, usually working my way from the back of the ward then towards the front cubicle, subacute cubicle and finally, ending with the acute cubicle.

Usually in between, something will occur, maybe a patient newly admitted into ward or a patient will suddenly be hypotensive or hypertensive or hypoglycaemic or starts throwing up or wants to have a small talk.

Normally, I would not mind entertaining them. However, if I’m still due to complete my coming mornings, I would proceed to complete it and I usually will not rest until I do. At least I’ll be rest assured that should anything occur in between, I would not have to worry about the completion of my coming mornings.

The night shifts can be rather unpredictable as one minute it can seem rather quiet and calm at first and hectic the next. At times, it can get overwhelming as well.

However, have faith and know that help is always nearby and start taking your bloods as early as possible.

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The Theoretical Doctor May 16

My First Hour Of The Day

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What are your morning rituals? What does the first hour of your day look like?

By default I rise around 4-5am. Perhaps out of habit as I usually take my time in the morning. Sadly, this also happens during my off days even when my alarms are off. My body clock is somehow tuned to waking up at such.

As mentioned, I take my time upon waking up. Thus, upon waking up, the rain sounds which I fall asleep to would be playing in the background and I would sit by the side of my bed and slowly make my way to my kitchen which is just across my bed, since I live in a studio unit and put my kettle to boil.

The kettle is usually filled the night before and hence, one thing less for me to think in the morning. This is then followed by my morning bathroom rituals and brushing my teeth.

Usually by then, I would have been much more awake and proceed to consume my iron tablet, vitamin C and making my morning coffee which is a mixture of 3-in-1 sachet and a teaspoon of black coffee since I prefer an even stronger coffee.

If I were working that morning, I would prepare both of my 1.5L of flasks by filling them with cold coffee which I have brewed a day prior for me to bring to work.

Why 2 flasks? Well, one is not enough.

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There are days when I’m feeling hungry or in the mood, I would prepare myself breakfast. My go-to-regular is frying egg mixed with mushrooms, chopped chilli and curry leaves and adding them to my breakfast sandwich. During my time being vegetarian, I would usually grill or air-fry my premixed tofu which I have marinated with spices, acting as a burger patty and my breakfast sandwich is prepared.

There are days, despite waking up earlier, I would still miss breakfast, thus instead I would pack it for work.

After that is followed by showering and getting ready for work. I usually wash my hair in the mornings daily. Thus, prior leaving for work, I would dry my hair with a hair dryer and style it up in a bun and I’m good to go.

How about if I’m not working on that day or if I’m night shift for that day?

Usually I proceed with my usual cup of coffee or I would go the extra mile by brewing myself a pot of masala or ginger tea with the tv playing in the background of some random YouTube video on productivity, to which I’m usually not listening to and merely keeping it on in the background for some background noise.

Then, I would proceed to prepare my breakfast and start my day with some writing or studying.

Well, that’s my first hour for the day, or perhaps a little more than that.

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