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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 10

The Most Enjoyable and Tiring Day In Medical 3

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I can’t remember which day it was but it was probably during the weekend or a public holiday as I remembered that I was allocated on call who was in charge of this ward.

I was allocated to “General” on that day and was I was alone at that time. I remembered sitting at the other end of the ward at around 11am when one of my colleagues who was allocated to be covering the “Neuro” patients went to have lunch.

The medical officer on call at that time, a rather “happy-go-lucky” and rather jovial person struts into the respiratory cubicle and asked if there were any house officers available?

To which I responded, we’re right here and he came over. He asked for the person who was in charge of the front cubicles which happened to be my colleague who went for lunch. I asked what’s wrong, is there anything I can help with?

He casually replied, nothing much, just walked in and saw a patient’s pulse oximeter reading 70% under room air. Then he laughed.

Me and my friend who happened to be there at that time were shocked and rushed to the patient. True enough, the pulse oximeter reading was 70%, well, 68%. Oddly enough, the patient seemed rather comfortable and not tachypnoeic. In fact, he was surprised as we crowded around his bed, looking concerned.

I asked him if he was having any difficulty breathing which he was not. Thus, our first instinct was probably the machine was faulty and proceeded to check with another vital signs machine.

This time, it was 65%.

I proceeded to take full set of bloods while my medical officer was writing his review and my friend attempted to call my colleague.

I ran his arterial blood gas and it showed Type 1 Respiratory Failure. Considering he did not have a baseline during this admission, we do not know if this was near his baseline or a sudden deterioration.

We called the Peri ICU team and referred the patient for non-invasive ventilatory support (NIV). Imagine, not knowing why this long stay patient was ever here in the first place to summarising the reason for admission down to his current progress. It turns out, he was due to be stepped down to a district hospital for continuation of antibiotics.

Well now, he can’t.

We transferred hum to the acute cubicle for closer monitoring while awaiting the Peri ICU team.

While awaiting, my medical officer decided to check on a patient who was handover to him for afternoon reviews.

This lady was in her 60’s and was admitted for left pleural abscess, meaning there’s pus in her lungs and for this patient, the whole left lung was completely filled. Clinically, she seemed well, speaking in full sentences and laughing to her family members as well in the morning.

In fact. I was even taking her bloods that morning only to have it splashed all over me after attempting to fill the blood culture and sensitivity bottle.

I recalled walking past her as I made my way to the front of the ward and she seemed alright. However, the moment me and my medical officer oncall stood in front of her. She desaturated an started being tachypnoeic.

Well, here’s another one.

There goes the next referral to the Peri ICU team for intubation and also Urology for emergency suprapubic catheter insertion as we attempted to insert a urinary catheter multiple times but failed.

Now, all these events happened very fast but at the same time, time flew by fast. The second patient was intubated and we inserted a femoral venous catheter. My medical officer then wanted to excuse himself to settle the pending discharges in his other ward. However, the first patient wasn’t saturating well under NIV and needed to be intubated.

There goes another intubation as well as another femoral venous catheter insertion. Finally, after all the chaos, things began to finally settle down.

I proceeded to trace my coming mornings, considering that I was the only one in charge of “General” that day and nobody would be helping me. Finally, I proceeded to begin my oncall reviews. This was around 8pm by that time.

After completing my in all reviews with intermittent disturbance in between. I proceeded to aid my friend in preparation of her coming mornings.

It was close to 11pm, I was just clearing my stuffs and getting ready to go when a nurse informed me that a patient seemed rather tachypnoeic.

Annoyed and tired, I attended STAT to find a patient sitting at the side of the bed with his BiPAP machine unlatched and hanging at the side of the bed. The patient beside him then told me, he removed it himself an hour ago.

Boy… Why am I not surprised?

This is another impending intubation.

At this rate, I might as well not leave anymore.

The day was busy enough. I sometimes wonder why is it that we feel guilty to even desire to return home on time? To walk out with the family members watching us finally ecstatic to return home for the day while their family members are stuck in the hospital?

Back to that patient, I didn’t left him gasping on his own of course, I fixed back the BiPAP machine, took an arterial blood gas and alerted my night colleague and medical officer oncall to which they attended STAT.

Thankfully, the following day, I was allocated as night shift. Thus, despite returning home late, I was able to sleep in and recuperate a little before returning back to work that night.

It was a busy day but considerably a rather fun one considering that I happened to work with a rather jovial medical officer oncall and my colleague stayed back to accompany me despite her shift being till 6pm.

Working with certain people definitely helps alleviate some of the pressure of the day.

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ELBLOG DE LAS CURIOSIDADES May 8

🤔 ¿Eres líder o seguidor? La pregunta del día

Sugerencia de escritura del día ¿Eres líder o seguidor? Ver todas las respuestas Retrato artístico de una niña con piel pecosa y mirada profunda, acompañada de un gato negro.

En redes, en la escuela, en el trabajo, en los grupos… siempre hay alguien que lidera y alguien que sigue. Pero, ¿y tú? ¿Eres líder o seguidor? 🧠✨

👣 Todos somos líderes y seguidores en diferentes momentos

La verdad es que no se puede ser un buen líder sin antes haber sido un buen seguidor. En algún punto de la vida todos hemos estado en ambos roles. A veces tomamos decisiones, guiamos a otros, y otras veces seguimos el camino que alguien más abrió.

Ser seguidor no significa ser débil ni tener pensamiento limitado. Significa saber observar, aprender y apoyar hasta estar listos para dar un paso al frente.

🧭 Un líder real también sabe escuchar

Un líder que vale la pena no es el que manda por mandar. Es el que escucha, aprende, se adapta y recibe críticas constructivas. El que acepta que el feedback no es una amenaza, sino una herramienta para crecer en equipo. 🌱🤝

Pero hay una línea peligrosa…

⚠️ Cuando ser seguidor se convierte en sumisión

Si estás en un grupo donde no se puede opinar, cuestionar o simplemente tener otra perspectiva, ¡ojo! 🔥 Eso no es liderazgo, eso es control.

Muchos grupos sectarios o de coerción emocional disfrazan su liderazgo de «orden» o «unidad», pero en realidad te obligan a callar, a seguir sin pensar, a apagar tu voz. Y eso no está bien. 😶🚫

🚪 Si estás en un espacio así… sal de ahí

La libertad de pensamiento no es negociable. Si te hacen sentir mal por cuestionar, si no puedes hablar con libertad, si todo se basa en obedecer sin razón… ¡corre! 💨

No viniste a este mundo para ser un robot. Viniste para pensar, sentir, crecer y aportar.

¿Y tú qué opinas? 🗣️
¿Has sido más líder o más seguidor últimamente?
Déjalo en los comentarios 👇 ¡Hablemos de esto!

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The Theoretical Doctor Sep 26, 2024

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Daily writing prompt What details of your life could you pay more attention to? View all responses

I’ve always been a foodie.

I enjoy my going on food trips with my family or friends. If I’m bored or sleepy, I would look for a snack, which again is well, food.

Thus, over the years, the weight started piling up and towards the end of primary school, I noticed that my weight posed an issue. As a child, I was overweight.

I recalled visiting the doctor once when I was in primary school coz I was unwell and he made me stand on the weighing scale and perhaps he did say more but at a young age, all I remembered was him yelling “Your child is FAT. FAT. FAT. FAT. F-A-T, FAT!”, all throughout my checkup and as I was leaving his office with my mom.

It felt like as if I had committed a felony. When in reality, he was trying to point out on how unhealthy it is for me, somehow in a rather direct way.

Over the years, I’ve struggled with my weight. It was never constant and always up and down. I’ve tried various diets which didn’t stuck long.

The only time I properly lost weight was when I started my housemanship journey. Amidst me eating at the wrong time, somehow the weight just magically went off. Firstly, perhaps I was too occupied with work to eat properly, hence, unknowingly I tend to practice intermittent fasting almost everyday and secondly, my movements have increased dramatically. Walking above 15k steps per day was a norm.

However, as I progressed throughout my postings, I learnt how to fit eating back into my busy schedule and the weight started piling back slowly.

I brought the matter up to a dear friend and she mentioned that perhaps, I could try controlling my food portion. I reflected and realised that all these while, I’ve been consuming food in the usual portion which didn’t had an effect on me previously as I was constantly on the move.

Thus, if there is something I seriously need to pay more attention to, it would be my food choices as well as the portion. Food is extremely delicious and good. Sadly, I would say that I fall into the category of “Live to Eat” rather than “Eat to Live”.

Hence, it’s time for me to take charge and make a change towards my food choices and start my journey towards a healthier life.

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The Theoretical Doctor

The Theoretical Doctor Sep 19, 2024

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Daily writing prompt What would your life be like without music? View all responses

Utterly boring.

As far as I could recall, I have always associated studying with music.

Perhaps it is because while growing up, my mom had always filled the house with music and made me sit at a corner to study whether I liked it or not, I had to study.

Eventually, I’ve grown used to, to studying with music or reading with music.

In high school, I discovered the kind of music that I like as well as the suitable time for me to study.

Thus, music and studying goes hand-in-hand or I will not be able to focus.

Eventually, I shift to Podcasts and Audiobooks while I am going about doing my chores or cooking, I am either listening to these or music.

Even my daily morning writing has jazz or lo-fi playing in the background.

There are days of course when I do not feel like listening to my music or is simply not in the mood for other musics.

Thus, “lo-fi” or “jazz” are my go-to. Still musical nevertheless.

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The Theoretical Doctor

Inside the Red Head's Head May 15, 2024

Daily writing prompt Are you a leader or a follower? View all responses

I have thought long and hard about how to answer this question (we’re talking at least five minutes of internal debate here) and I think the best way for me to answer it is:

Yes.

Am I a leader or a follower? Yes, yes I am.

I am a supervisor at work with a small staff reporting to me. I have to be a leader for them or else I’m not going to be terribly good at my job. Outside of work I feel much more comfortable letting other people take the lead so I can just follow along. I would like to think that in my relationship with my wife we are both leading some of the time and following at other times, but I suspect that I do a lot more following than leading. I suppose I could be a leader in the cover band, but I prefer to let other people take the reigns and just go along for the ride. I feel like I am playing that leadership role more today than I used to before our singer left, but I suspect as time rolls on I will step back again. We’ll see.

So there you have it. Am I a leader? Yeah, sometimes. Am I a follower? Yeah, sometimes.

Yes, yes I am.

https://robertjames1971.blog/2024/05/15/yes-4/

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