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High School Teaches Only One Life Skill. Driving

Out of all the academic things I learned in high school, the only thing I can recall actually still using today is driving. I learned to drive at the age of 15 in my junior year of high school. Driving class was probably the only class anyone wanted to voluntarily sign up for. The class being full and hardly anyone missing it gave a good indication that everyone wanted to take it. After all, it's the class that will allow you freedom to drive to Prom yourself, hang out with your friends […]

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High School Teaches Only One Life Skill. Driving

Out of all the academic things I learned in high school, the only thing I can recall actually still using today is driving. I learned to drive at the age of 15 in my junior year of high school. Dri…

Eve in The City🗽

The Theoretical Doctor Feb 9

The Wards In The Surgical Department | Sarawak General Hospital

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The main General Surgery wards in this hospital is located on the 7th floor of the main building which are Male Surgical Ward (MSW) and Female Surgical Ward (FSW).

I entered my General Surgery Posting during a time whereby there were no House Officers being allocated into sub-specialities. The only so-called “sub-specialities” that were available were “Vascular” and “Hepatobiliary Team – HPB”. Both of which are added under General Surgery.

Other teams such as Neurosurgery, Plastics, Urology and Paeds Surgery did not have House Officers. It wasn’t till towards the end of my service in this Posting that it was reintroduced.

Thus, our exposure towards the wards in General Surgery were limited but also made it pretty easy for us to manage.

1. Male Surgical Ward, MSW

Located on the 7th floor of the main building, it is considered the ward which is feared and avoided by many but is also where I’ve spent most of my time while being in this posting.

As the name suggests, it is mainly for male patients with underlying surgical issues or at least being managed by Surgical as the primary team.

This ward is usually avoided by many due to the overwhelming amount of patients which is twice the amount in Female Surgical Ward.

Twice the amount usually meant twice the amount of drama as well as the usual chaos.

My journey in General Surgery ended with my service in this particular ward.

2. Female Surgical Ward, FSW

This ward is also situated on the 7th floor of the main building and it is opposite the Male Surgical Ward, MSW.

As per its namesake, it mainly consists of female patients with underlying surgical issues or at least being managed by surgical team as the primary team.

Albeit it being a “Female” Surgical Ward, there would occasionally be male patients being treated there as the beds in the other wards are usually filled, causing an overflow of patients into this ward.

I started my tagging days in this particular ward and I would consider this ward relatively chiller and laid back compared to the other.

3. Vascular Ward

The Vascular Ward is located on Level 3 of the main building.

If you have done the Paediatrics Posting, it is situated in the same location as “Paeds Nursery Level 1″.

The ward is essentially divided into two, catering to both the Paediatrics Team as well as the Vascular Team.

4. Vascular Extension Ward

The Vascular Ward could only cater to at most, 10 patients. Thus, if there were any more patients to be managed under the Vascular Team, they would be placed in the Vascular Extension Ward or in the main surgical wards.

The Vascular Extension is located on the second floor of the main building, inside the Urology Ward which is situated opposite the emergency department, ETD.

During my service period in General Surgery, I have paid a few visits to the Vascular Ward and Vascular Extension Ward. However, I have never served my time there as I was not allocated to be the House Officer in the Vascular Team and also because it was a team I was avoiding.

Upon my exit from this posting, the sub-specialities were reintroduced again and House Officers were being allocated to other teams.

Thus, if you are due to experience the General Surgery Posting, I hope that you will find it as enjoyable as I did especially while working in the Male Surgical Ward.

It is indeed hectic and busy and going home on time is almost unheard of. Albeit MSW being an extremely busy ward, the medical officers I worked with as well as the specialists were kind, helpful and willing to teach.

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My First Day In General Surgery – Tagging Day 1

An article regarding my first day in General Surgery in the Female Surgical Ward as a House Officer.

The Theoretical Doctor

The Theoretical Doctor Feb 8

My First Day In General Surgery – Tagging Day 1

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My “Day 1 of life” in the Surgical Department commenced on the 4th of July 2024 which fell on a Thursday.

I was allocated to work in the side room of Female Surgical Ward (FSW) with a fellow colleague whom I’ve worked previously in the night shift in Paediatrics.

I left home around 5.45am and arrived at almost 6am and started reviewing as usual. I took some time as I read through the previous entries and used it as a guide to write my morning reviews.

Upon reviewing around 4 patients, a fellow medical officer arrived and automatically, I greeted him and followed him. It has become a reflex of mine as in other postings, we had to be like that, which is a good practice.

He was friendly and had a kind demeanour. Thus, I followed him, not knowing that he is actually the medical officer in charge of the HPB (Hepatobiliary) patients.

Usually, there will be a house officer in the ward in charge of the HPB patients, which I did not know of course, considering that it is my first day. Thankfully, I had a partner who followed the “GS – General Surgery” rounds with the other medical officer instead.

As usual, rounds with medical officers followed by rounds with specialists in the morning and as House Officers, we are their assistant and scribe. The morning rounds ended and we proceeded with tracing the joblists for each patients in our allocated cubicles and updating it in the “MOHO” group as well as proceeded to complete the active job-lists.

This is then followed by afternoon reviews, afternoon rounds with medical officers and specialists followed by the completion of the active joblists and finally starting with on-call reviews and preparing our handover lists.

Considering that I am still tagging, I had to stay till at least 10pm. After completion of the on-call reviews, we followed the on-call rounds and HPB (oncall rounds), clerked and transferred in the new patients, completion of the active joblists before finally heading home.

Overall, my first day in Surgery was surprisingly good and calm. The medical officers and specialists seemed rather kind and patient. Thus, giving me the encouragement to continue despite having heard that this particular posting seemed like a rather toxic one which only serve to instil fear in me prior to joining this department.

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The Theoretical Doctor Feb 6

I Ordered A Chest X-Ray For The Wrong Patient | Housemanship Diaries

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It was during my tagging period in the Surgical Posting and I was a Female Surgical Ward.

It was my first day being in charge of the acute beds and side room. I recalled one of the patients being a Urology patient. Usually, if the patient is from other departments, we are not required to review them. This patient in particular was intubated and sent to our ward to be placed in one of the acute beds for further monitoring from the Urology ward.

Upon transfer into the ward, the patient required a portable CXR for post-intubation. I did not screen through the casenote since it was from another team. The nurse in charge informed me of a new case but did not tell that the patient needed a CXR. Hence, my reply was “it’s not our patient, it is from a different team. They will review later.”

Hence, the Urology Medical Officer on call came after a while and reviewed the patient. He went to check the system and was confused as to why the chest x-ray was not done for the patient. The nurse immediately informed that I did not want to do it considering the patient is from another team.

At that time, afternoon rounds with the Surgeon was currently ongoing and I was disturbed from writing my reviews. I immediately proceeded to fill the form and had it sent to the Radiology Department to request for a portable chest x-ray.

Amidst the rush, I had wrongly written for another patient instead.

I only realised it when the radiographer came and did an x-ray on two patients at the acute beds. One, the intubated patient from another department and another which is a patient of ours.

I realised my mistake and rushed back to check the form and was met with a very angry daughter of the patient.

I admitted my mistake and was yelled at. After such a tiring week and a hectic day on top of tagging itself, I could not contain myself any longer and tears started streaming down my eyes uncontrollably.

Thankfully enough, it was just a mere chest x-ray and nothing more or a wrong operation done. Since the patient is under the colorectal team, the surgeon in charge and the medical officers in charge will proceed with their rounds again and I could not contain myself again and tears started to stream down my face again.

The medical officer in charge noticed and asked me to go to toilet, understanding that I needed some time for myself to recollect myself again. Hence, I excused myself.

After a while, I went out and rejoined the rounds and admitted my mistake to the medical officer in charge to which she laughed and said “well she has a free x-ray now and were there any changes as compared to the previous one?” To which I answered none.

She was amused considering that it was over a mere x-ray which was requested for the wrong patient that I started breaking down.

Thankfully, it was just an x-ray.

The lesson learnt here was for me to be extra careful in the future because it could have been worse and become medicolegal.

Please try to avoid doing anything out of rush or pressure and always slow down for a bit and reconfirm the patient and procedures to avoid or minimise errors.

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My First Surgical ETD / ED Night Shift Experience

An article regarding my first night shift working as a House Officer in the ETD in my fourth posting, The Surgical Department.

The Theoretical Doctor

The Theoretical Doctor Feb 5

My First Surgical ETD / ED Night Shift Experience

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My first ETD “on-night” or night shift in Surgical was with a fellow junior who I considered as my senior in the posting as she was in the department much longer that I was.

Prior to joining the Surgical Posting, I have went through the Orthopaedic Posting as my first posting and people said that the ETD shift is similar to that in the Orthopaedic Posting, except that we would be taking the bloods, requesting necessary scans ourselves and posting the case.

Before I went to the emergency department, I stopped by the ward to steal some forms and stock up my “file”. After that, I went downstairs and received handover from the morning team.

During my first “ETD ON” shift, there were two medical officers as the first call. One is a tagging medical officer as she had just joined the department.

The night was rather cold I would say with minimal referrals, probably less than 10.

Every time there is a new case, we would be asked to clerk the patient first. However, usually the medical officer would be there by then and we would see the cases together.

I remembered it being “cool” enough that night that we even had time to have dinner for a while before proceeding to take our coming mornings and even rest for a while somewhere.

In the morning, we requested scans that were rejected the day before and followed rounds with no surgeon to know the latest plans, handed over to the following morning team and returned home on time.

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My First Night Shift In Surgery | Housemanship Diaries

A reflection regarding my first night shift working in the Surgical Department Ward as a House Officer.

The Theoretical Doctor

The Theoretical Doctor Feb 3

My First Day Back At Work After A 6-Week-Break | Housemanship Diaries

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I officially returned to work on the 2nd of October 2024.

Initially, I was stationed to work the morning shift at ward. However, a colleague of mine decided to take a sick leave on that day when she was initially stationed as the House Officer in the Emergency Department, ETD HO.

Being the Allocation Leader in this department, it is my duty to immediately look for a replacement and to update in the group with the medical officers. Not one person came to mind and I felt bad since it was a friend of mine who took a sick leave or did I feel comfortable dragging another person to cover this shift since it is a shift most people avoided.

Thus, I offered to be the ETD HO myself. It was during an anaemic House Officer period and there were only one House Officer stationed at the Emergency Department.

Hence, I went to work and stocked up my necessary supplies before meeting the post night House Officer in the Emergency Department to receive my handover.

Of all days, it had to be one whereby no coming mornings (bloods) were taken for the patients and there were a lot of active job-lists not being carried out. Not to mention scans to be requested the following morning.

Basically, there were a ton of “shits” being thrown to me and if I do not settle it myself or to push my post night colleague to help me, I would be in a mess for the day.

Imagine having just returned to work to this. Without thinking much, I started identifying the patients who had bloods to be taken and proceeded to take all of them and sent it off. After sending them off, I started preparing for scans and called the radiology medical officer oncall to present my case.

Finally, after I thought I was done, I decided to review the stranded patients.

Normally, the stranded patients should be reviewed around 7am as we would begin our morning rounds around 7:30am till 8am. Thankfully, it was the weekend and rounds began much later.

I went through my list of stranded patients and there were almost 20. 20 stranded patients at various locations.

Would I have the time to review all of them? What about the active joblists or scans? Can I rely on my post night colleague? What if there is a new case?

I remembered it being a rainy day and the referrals were initially from wards and not from the Emergency Department (ETD).

Perhaps it would be a slow day. I thought to myself.

But, I thought too soon.

Soon, referrals started piling up. My medical officer’s phone (MO) was blowing up with calls. Other sub-specialities kept reaching out for me to help them out and at one point, me and my medical officer had to split to ensure we got everything done to the best that we could.

I wished that I could literally divide myself but I couldn’t. On top of that, my right foot started to ache. I just came back from a 6-week-break. I can’t afford to go on anther few weeks. If I do, just when am I going to end this posting?

I recalled it being a terribly hectic day and I felt bad as I was mostly away, having been dragged away by other sub-specialities, escorting patients or carrying out the active job-lists. I could not really be by my medical officer’s (MO) side to see the cases.

Finally, the end of my shift approached. 7pm and my night colleague came for handover.

Despite it being the evening already, the fire was still burning strong, referrals did not stop coming in and I still had tasks to complete or I would be handing over “shits” to my night colleague.

Finally, it was around 8-9pm, I can’t really remember as I was following night rounds with the OT call medical officer and registrar. My medical officer told me to return home since the following day, I would be morning shift.

I remembered returning home that day, somewhat unsatisfied with myself. No doubt that it was a tough day, but I could definitely do better. If only my leg did not slow me. The pain seems to increase with every step I took and with every exertion I made.

However, as I remembered, I was blessed to have an angel as my medical officer oncall for that day. Instead of shaming me or being sarcastic or mentioning that I could do better, she simply thanked me for putting my best effort on the first day back and welcomed me back.

It’s angels like this who makes me want to try to be better the following day.

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The House Officer’s Dilemma | Housemanship Diaries

An article regarding my dilemma on which department or speciality to pursue in after completing my 2-year-journey as a House Officer.

The Theoretical Doctor

The Theoretical Doctor Sep 25, 2024

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While growing up, when I was asked regarding what I looked forward towards in the future, I always had the answer.

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The answer was simply, I wanted to be a Doctor (coz that’s what I knew my whole life and indirectly working towards albeit having other interests).

Thus, from primary school, next would be high school, moving towards science stream in school and pre-university in a course which would serves as a prerequisite into entering medical school.

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In medical school, my focus was always on the exams, completing that particular posting, completing that year, completing preclinicals and moving onto clinicals, studying for the grand finals, completing medical school and graduating.

Upon graduation, applying for housemanship to start practicing. I always knew that I wanted to practice in Sarawak General Hospital. Thus, that didn’t require much thinking. Working my way there, and finally, starting housemanship.

Now that I’m a House Officer, completing each posting, working towards completing a year, now focusing on completing the whole journey.

But after that? I feel lost and aimless.

Previously, when asked regarding my need to have a family, I would brush it off. Not that I didn’t want to but I’ve yet to meet the person that I would want to spend the rest of my life with and build a family.

My aim was mainly catered towards my parents. But they’re doing just fine on their own. Thank God for that. I don’t see my purpose anymore actually.

In regard to post-housemanship, I have no idea of which speciality I would like to dive into. In terms of being surgical based or medical based, the thing I learnt over this past 1 year is that I’m definitely a surgical based person. Though, I have enjoyed paediatrics very much (which I supposed is a very much toned down version of the chaotic medical posting).

I wouldn’t know, as upon writing this article, I’ve yet to complete my medical posting.

The medical field is not just tied to 6 different postings. As a House Officer in Malaysia, we are required to rotate to 6 different postings throughout our 2-year-duration in housemanship which are, Surgery, Medical, Orthopaedics, Obstetrics and Gynaecology and Paediatrics. The sixth posting, we have the privilege to choose among Emergency Department (ETD / ED), Anaesthesia, Klinik Kesihatan (Community Clinics) and Psychiatry.

However, in reality, the clinical field is vast and there are other specialities that we as House Officers have yet to enter. In terms of non-clinical field, it is another vast category.

Which of it am I?

At times I wished that I always knew of what I wanted to be, such as a Cardiologist or a Surgeon but after assisting in the operating theatres and working as a junior doctor, none of it appeals to me 100%. Sure it is interesting but is it something I would want to be doing for the rest of my life?

Having completed a year of housemanship, I thought that the answer would be clear to me by now. Yet, I’m still as unsure as I had been before. I’ve approached multiple seniors, medical officers and specialists and talked to various doctors from different fields regarding their experience. I seem to have the information but my heart was not fully captured by any of it.

Everything seems nice and interesting. I hope that in time to come, the answer would be clearer. The least I could do at the moment is to put my best foot forward in whatever department or sector that I go through.

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https://theoreticaldoctor.com/2024/09/25/the-house-officers-dilemma-housemanship-diaries/

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Reflection of the Paediatrics Posting

An article regarding my overall reflection of my third posting, Paediatrics as a House Officer.

The Theoretical Doctor

The Theoretical Doctor Sep 24, 2024

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Daily writing prompt List your top 5 grocery store items. View all responses

Working as a House Officer, I do not go out to eat much. Mainly because our days are mainly occupied with work and after work, we would be drained. Well, most of the time.

Thus, if I were to really go out, it would be during my long breaks which is when I apply for leaves.

In terms of acquiring groceries, I rarely go to the grocery store myself as I do not have a car of my own in Sarawak. I am extremely dependent on Grab and overtime can be expensive as well.

Hence, I make do with the convenience store downstairs at my apartment which doesn’t really have much in terms of fresh foods or ordering online.

Here are my Top 5 must haves in my grocery list which is available in the convenience store if I were to just shop there.

1. Coffee

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As I mentioned in some of my previous articles before. It is a must have drug in my system. Personally I think I have grown rather immune to the effects of caffeine over the years from overconsumption. Thus, if I’m unable to get my grounded coffee beans, usually I’ll make do with some freeze dried coffee or a regular black coffee powder.

2. Oats

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I replace rice for rolled oats when I’m living alone. Back at home, my mother would always cook rice as my parents love rice. However, I noticed that I easily crash or get sleepy easily after consuming rice. Thus, I substitute it for rolled oats and usually I would cook soups or curries and pour the oats over it and consume it just like regular rice.

3. Eggs

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It is easily available. When there is nothing else stored in my pantry and everything else is closed, eggs go about well with almost everything.

4. Noodles

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Well, I’m not exactly healthy per se all the time, and I do enjoy my occasional instant noodles. Especially after work and not having a meal the whole day, I’ll just whip up a quick dish of curry instant noodles with eggs.

5. Sausages

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Personally, I prefer chicken over sausages and as mentioned before, I rarely go out for my groceries. Hence, I’d go for sausage since it is easily available at the convenience store downstairs. In addition to that, I can be versatile with cooking them.

Thus, if I had to list 5 of the hat, these are my top 5 that I would shop for in any grocery stores amidst working as a House Officer.

Again, sadly, it lacks nutrition. But, oh well.

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The Theoretical Doctor

The Theoretical Doctor Sep 22, 2024

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I tagged for almost a month here.

The tagging timing in the Surgical Posting is from 7am till 10pm which is same as with other postings, except Obstetrics & Gynaecology (O&G).

In the Surgical Posting, we all have to complete a compulsory 14-Day-Tagging period irregardless of having “off-tagged”. Entering the Surgical Department as a senior or fourth poster, we are allocated to special shifts such as night shifts in ward or night shifts in ethe emergency department (ETD).

This serves as an advantage to us seniors as we do not have to work the morning shift for one week straight prior to having an off day. It is also better as it allows us to recuperate in between by not having to go to work extremely early.

However, the disadvantage is that our tagging period is somewhat extended.

As I mentioned before, we are required to complete a 14-Day-Tagging period. The night shift is not counted. Hence, the tagging duration can go up to 3 weeks.

For me, it extended up to 4 weeks due to my medical leaves (MC).

During my first week of tagging, I took a day of medical leave due to extreme fatigue and in the second week, I took 3 days of medical leaves due to extreme fatigue and COVID-19.

At the time of writing this article, I am on a 6 weeks medical leave due to my ATFL injury.

Sometimes I wonder, if I will ever exit this posting and proceed with my last which is medical.

Back to the tagging part, thus my tagging period lasted for a month.

Going to work as a tagger, I would leave home around 5:45am – 6am. Partly because I’m just tired and felt like I needed more rest because there will always be an active issue in ward and I am only able to return home at 10pm.

In the evening around 7pm, I would go for dinner after handing over to the night colleagues and completing my tasks and on-call reviews for the day. Most of the time, it would be our first meal of the day.

Some days, we would be done by 8-9pm and on some days, earlier. Most of us, upon completing, would head for dinner and head home or to just head home straightaway.

This is wrong of course but we were simply exhausted and burnt-out during the tagging period. Thus, we grab the opportunity while we could.

Towards the end of my tagging period, I started bringing packed dinner boxes and reheating them as work prior going back.

Surviving the tagging period in the Surgical Posting was hard and tiring but eventually, it did came to an end.

Thus, if you have yet to enter the Surgical Posting, the tagging period is indeed tiring as with any posting. However, try to learn as much as you can and take comfort in the fact that it does come to an end.

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Appreciation Towards The Medical Officers (MOs) – Housemanship Diaries

An article expressing my appreciation towards the Medical Officers who have gone above and beyond in ensuring that we as House Officers are taught well on the job as well as those who were there to…

The Theoretical Doctor

The Theoretical Doctor Sep 20, 2024

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Do you or your family make any special dishes for the holidays?

I am half-Filipino. My mother is from the Philippines and my father, a Malaysian, like me.

Growing up, I was neither close to my mother’s or father’s side. However, between these two, I am somewhat culturally inclined towards my mother’s side through some of her simple heartwarming dishes that she cooked growing up as well as some of the Filipino songs she would play or the Tagalog words she would incorporate in her daily conversations.

Two of the simple dish my mother would prepare would be pasta or bolognese spaghetti and Buko salad.

1. Spaghetti

Originally, spaghetti is a form of pasta and a staple food of traditional Italian cuisine.

However, it also serves as one of the staple Filipino dishes.

My mother would usually make a batch of bolognese spaghetti occasionally and on New Year’s Eve, as that is what my maternal grandmother used to do while she was growing up.

It is rather simple and easy as well and she would go crazy with the cheddar cheese topping. Over the years, as she started to dwell into vegetarianism and eventually become one for a lifetime, she created her own variation of a vegetarian version.

2. Buko Salad

Adapted from https://www.kawalingpinoy.com/buko-salad/

“Buko” salad is a form of Filipino fruit salad.

“Buko” refers to a young coconut fruit and “Buko” salad consists of the young coconut itself.

It is a simple dish which has many variations.

My mother would usually mix with nata de coco of various colours, avoiding the colourless ones, corn, a huge can of mix fruits and other canned fruits before finally mixing it with evaporated milk, cheddar cheese and “buko”.

She will the separate it into containers and freeze it and have it on New Year’s Eve.

Growing up, my family would be seated at the dining table with other dishes prepared on New Year’s Eve for us to dine in together at midnight and every year, these two dishes remains a staple.

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