Mastodawn

2026 – The Beginning

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First of all, Happy New Year! I hope you have had a great start to this year and if you have any New Year’s Resolutions planned, I hope that you will be able to stick throughout the year.

I did not have any New Year’s Resolutions planned as I usually did the previous years. Mainly because I have just moved to a new place, settling in with things still pending in Kuching, trying to adapt to my working environment as well as picking up on new skills.

Thus, New Year’s Resolution? It’ll come as the year progresses.

My New Year’s Eve was spent at work and mainly in the ambulance with a dear friend as well as work colleague, however, that is a separate post for another time.

As usual, since I’ve started working as a doctor in 2023, I’ve always made it a point to work on New Year’s Day, a habit which I’ve adapted from my dad ever since he has started working at the age of 18.

However, New Year’s Day is a public holiday here in Sarawak. Thus, I was allocated as the oncall medical officer on the 1st of January as well as on the 2nd of January. Per oncall shift is from 8am on that day till 8am the following day (which means, mine ended at 8am on the 3rd of January).

My first case began with a case of wound breakdown over the right wrist, which the patient chose not to seek hospital treatment followed by another case of upper gastrointestinal bleed which was sent to hospital. This was then followed by another case of possible acute appendicitis which the patient and family decided to “discharge against medical advice” because they wanted to seek treatment in their hometown considering they were travelling and happened to be in the same area.

Upon returning home, I was called back for a case of breakthrough seizure likely secondary to under-dosage of medications. The patient had three episodes of seizure that day followed by a regular 1-2 monthly episodes. Hence, referred and sent to hospital.

Finally, I can return home. Time to get some rest since I would be working the next day. Shortly after, I was called back, a patient sustained laceration wound over the medial aspect of his antecubital fossa. Mechanism of injury? Unknown and he was in an extremely drunken state.

Otherwise, he was stable. Sadly, my medical assistant at that time could not be contacted to escort the patient to hospital and the family members did not have their own transportation.

If only, he was fully awake, I would have triaged him to green zone. However, transportation issues… Thankfully, the patient’s family has an uncle who was willing to send. The only thing was he needed some time to arrive due to the heavy rain and slippery roads.

I didn’t feel good leaving the patient behind although he was stable. Thus, I stayed till 4am until his uncle came and the patient himself had woken up.

After that, I went back home and straight away gotten ready for work since it’s a working day and I am still oncall.

The following day on the 2nd of January, went by smoothly during office hours with referrals here and there but it was manageable.

In the afternoon, another patient came in for symptomatic anaemia secondary to abnormal uterine bleeding with newly diagnosed cervical carcinoma. Her haemoglobin level was 5, who again, refused hospital referral claiming she visited the clinic for fever and not for her anaemic symptoms. After much convincing and discussion with my specialist, the patient still opted to “discharge against medical advice”.

Which makes me wonder… Why in the world?…

This was followed by dinner with my friend. I remembered thinking to myself that evening that maybe… just maybe… I would have a cold night. Enough of referrals.

However, at 11:30pm on the 2nd of January 2026, I received a call from my medical assistant that a patient presented to the clinic breathless with an SpO2 of 50% under room air, started on high flow mask and at best, it is only 90%.

Sounds like an impending intubation and CPR case.

I called up my friend immediately as I rushed to the car as she lives closer to the clinic. I needed all the help I could get for this patient. The roads were slippery and it was a rainy night. Yet, I sped. Thankfully, my friend had already arrived before me.

The patient?

I remembered seeing this patient on the 23rd of December 2025. At that time, his lungs already had crepitations with reduced air entry over the right side and yet he chose to “discharge against medical advice”. I remembered telling him that he would collapse if he didn’t go and true enough, here he was… sitting up, gasping for air.

His vitals? Blood pressure was sky high, lungs filled with crepitations but no pedal oedema, lines were set, no ECG done but we didn’t have time to waste…

I called up the Emergency Physician in the nearest hospital (which is an hour away), presented shortly and informed that we had to proceed with intubation because he was too tachypnoeic.

We prepared for intubation, informed the family members as well as explained the risk of CPR and death. The family understood and agreed.

Intubation… This was a difficult intubation for the guy was a very large guy with hardly any neck visible.

But before we could start, his GCS dropped and so did his heart rate, I started CPR while my friend attempted to crash intubate. We attempted to crash intubate and both times, it failed… I called up the Emergency Physician again and told her that we were 30 minutes into the CPR, she told me to call off after the current cycle.

My first death at a new workplace and on the third day of the year at 0027H, 3rd of January 2026.

Then, I proceeded to complete my notes for the family members to bring to the police station to lodge a police report and broke the news to the family. I was calm and so were the patients’ family. After that, I called up the Emergency Physician to thank her and then, I broke down.

I broke down because had he gone on the 23rd itself, he wouldn’t have to gone through this.. He lives alone and his so-called family members aren’t even his biological family members but neighbours and friends… I broke down because I also felt defeated… We tried our best with such limited resources and manpower…

Yet, I couldn’t save him…

If you have YET to come up with a New Year’s Resolution… At least consider this, adhere to your regular check-ups if you have any… Stay compliant to your medications, diet restrictions or any fluid restrictions if you do have…

And if something is off or not right, please RUSH to the nearest clinic or better, the hospital… Because there is only so much that we can do with such limited resources in a community clinic.

Otherwise, I wish that you have a Blessed 2026 filled with love, beautiful memories and wonderful opportunities.

Remember to have fun and do enjoy it but please do so, responsibly.

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The Theoretical Doctor Aug 15, 2025

My Last Shift As A House Officer in Medical | Housemanship Diaries

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At the time of writing this article, I am no longer in my Fifth Rotation, Medical but already in my Sixth Rotation, The Emergency and Trauma Department and at the same time, due for my last shift in my Sixth rotation as well as being a House Officer.

Looking back, my last shift in the Medical Department seemed ages ago.

However, I remembered that I was night shift at that time and was at Male Medical Ward (MMW).

My duration working in this ward was around 3 weeks. However, it was my least favourite as compared to Medical 3, Medical 4, the Infectious Disease (ID) Ward or being part of the Perimedical team. The superiors were alright but it was the vibe of the ward in general that I found unsettling that I can’t quite place my fingers on.

The night shift in Medical is from 8pm till 9am. However, on that day, I recalled leaving home at 6:30pm to go to work as we were not allocated any “long day” shifts.

“Long Day” or “LD” are those who work from 7am till 10pm. Thus from 6pm till 8pm, prior to the night shift person coming, there is a 2 hours gap which is filled by them.

On that week, there were no “Long Day’s” and everyone had the opportunity to return home at 6pm. However, who would fill in the “2-hours gap”?

Thus, I remembered me and my colleagues at that time coming into a mutual agreement and compromise that one person would stay till 7pm and the night shift person would arrive an hour earlier at 7pm.

It was a good compromise except there would be nobody to accompany us till 10pm and usually their help is valuable. Those hours till 10pm can get rather hectic at times.

I remembered arriving around 6:45pm and started receiving handover from the AM teams and was cautioned to lookout for a particular patient in the acute cubicle who was rather unstable.

Upon finishing our handover, the Medical Officer on-call for that ward arrived and things started to go hectic.

I can’t exactly remember what happened but I was on my feet the whole time and did not begin my “coming mornings” till 3am.

Thankfully, I was still able to complete them before 5am and the morning bloods were out in the system on time.

That morning during my post night shift, I was “summoned” for minimal bloods which I completed immediately. Usually during my post night shift, I would remain within the sights of the “AM team” and offer to help out where I could.

But I remembered at that time that I was completely spent. I decided to rest in the House Officer’s room and take any bloods a little later prior to my shift ending, if there were any.

Surprisingly there were none after that. I recalled seeing a junior taking the blood of a patient as I was exiting the ward and asked him as to why he did not just ask me.

He claimed that upon arriving for his morning shift, I looked rather spent and after I left to take a short break in the House Officer’s room, he just did not want to disturb me. After all, he said, it was only one patient.

I was touched and grateful. It was a small gesture. However, it’s small, simple things that sometimes touches you.

After that, I clocked out for the last time as a House Officer in the Medical Department.

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The Theoretical Doctor Aug 13, 2025

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, 2025

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 28, 2025

My First Night Shift Covering Medical 4 / Medical 5 / Infectious Disease Ward In Sarawak General Hospital – Housemanship Diaries

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Around my third month in the Department of Medical at Sarawak General Hospital, I was reallocated to Medical 4 which is the “Nephrology Ward” meaning patients who are admitted with newly diagnosed chronic kidney disease or have underlying kidney pathology requiring biopsy or haemodialysis (HD support) but clinically stable as in not requiring oxygen support, not in sepsis or not requiring medications for blood pressure support are admitted here.

I will explain more about that ward in another article.

Anyway, back to the reason for this article, being allocated in this ward meant that I had to cover not just this ward, Medical 4 but also Medical 5 as well as the Infectious Disease Ward during my night shift.

In the Department of Medical, the night shift is from 8pm till 10am the following day.

While I was allocated here, I was blessed enough to have a few taggers in the ward and tagging is from 7am till 10pm.

Thus, upon heading down at 8pm, there are usually a few people in Medical 4 till 10pm. Thus, upon entering my shift, I would first head over to Level 9 to place my bags, pop into Medical 4, for a while and then head over to Medical 5 to take the coming morning bloods.

Upon completion, I would then head over to Medical 4 and begin my coming mornings there. Usually while I’m taking my coming mornings, new patients will come in and thus I would transfer in at the same time.

Upon completion of my coming mornings in Medical 4, I would usually send my bloods at around 2am and then head over to the Infectious Disease Ward to take the coming mornings.

In between I would be free but sometimes I would receive call for new transfer ins at Medical 4 and Medical 5.

At 5-6am, I start running the blood gases. Usually when I take the coming mornings bloods, I would take the blood gases as well and keep it in a separate syringe in the cooler.

Surviving the night shift initially was intimidating as I have yet to experience it and Medical 4 and Medical 5 were located far apart from each other.

My main concern was if something were to occur at both wards at the same time.

Thankfully, my experiences were mostly good and I enjoyed every night shift I’ve experienced thus far in this ward.

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The Theoretical Doctor Jul 10, 2025

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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novaTopFlex Jun 2, 2025

Barriers to a Good Life

Daily writing promptWhat are the most important things needed to live a good life?View all responses The most important things to live a good life are abidance to all applicable laws and policies, of course, but also advocacy for a more ethical future and remembering the mistakes of the past. To live a good life, as I am doing now, one must avoid encouraging violations, including systematic violations, in any way. For a more literal definition of a “good life,” unfortunately, under […]

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Barriers to a Good Life

Daily writing promptWhat are the most important things needed to live a good life?View all responses The most important things to live a good life are abidance to all applicable laws and policies, …

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The Theoretical Doctor May 18, 2025

Laughing – A Way To Destress

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What makes you laugh?

Laughing – A form of de-stressing activity. To which some may find “distressing”?

Or perhaps I’m just a little unbalanced.

Photo by ROMAN ODINTSOV on Pexels.com

However, back to the prompt, I would laugh at almost anything actually.

Many would ask me on why do I laugh so easily or on almost anything. Honestly, I have no proper answer for it. Perhaps, the easily justifiable answer would be that it has become a form of my default reaction towards answering people.

Firstly, it softens my expression, thus making myself seem more approachable (or so I think). Sadly, that also means that sometimes people would not take me seriously. Next, it lightens the situation and prevents a tensed situation from escalating. However, it may also flip the other way around which may further escalate the situation instead as me laughing may deem that I do not take them seriously.

Sometimes, when I am being thrown an insult, I do react by first laughing about it, as a shield for myself and preventing myself from being hurt or at least giving myself some time before digesting the issues.

Then, there are times, when I am lost in my own world, which is most of the time, I would suddenly remember something funny or find something amusing and start laughing to myself. At times, it may escalate into a hearty laughter to which some might find distressing.

Nevertheless, after a good laugh, I would usually feel better, as they say, it releases endorphins, a “feel good” hormone and thus, “laughter is the best medicine”.

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The Theoretical Doctor

The Theoretical Doctor May 10, 2025

My Teenage Years

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Describe a phase in life that was difficult to say goodbye to.

Upon reading this prompt, I was reminded of my high school days. The first year of high school was very tough for me in terms of adjusting to a new school, cultures and subjects.

I went from a comfortable place to a different one without any guidance nor advice and I went from being a senior to a freshie all over again, which I did not like.

In addition to that, I had a very bad temper and used to talk back to my seniors which did not aid in my reputation. Well, that was the first year, things started getting better the following year onwards and my grades picked up. I have accustomed myself to the flow.

It was during my teenage years that I met my good friends whom I still keep contact to this day albeit not meeting much.

Looking back, I enjoyed my routine and studying very much. Waking up early was the hardest part of the day, which surprisingly isn’t one for me now, I have transitioned into an early riser.

This is followed by shower, preparing my breakfast and lunch for school, which mostly just includes me grabbing bread or biscuits and stuffing it in my bag and wait for my parents to send me off to school, which is usually my dad. He would send me off prior going to work.

I was truly blessed to have experience that.

In school, it was about attending classes, completing homework or assignments, gossiping with my friends or attending extra-curricular activities. However, the place I truly enjoyed spending my time was in the library. Thus, if I were to bunk class, I would lock myself inside the library and just study or read. The perks of being a librarian. Thankfully, my teacher-in-charge of the library always had my back if I were to be questioned regarding my whereabouts.

After school, my mother would be the one who usually picks me up from school and most of the time, we would eat outside. Occasionally, she does cook at home and as I am writing this reflection, I truly miss these simple heartwarming dishes.

This is then followed by me showering, completing my homework, studying, chilling, going out with my mom and getting ready for tuition or extra classes which are usually in the evenings or on alternate days.

Life was simple and predictable. I remembered attending multiple tuition classes during the week, mainly because I was bored being at home as I was not allowed to simply go out with my friends as I pleased. Thus, I looked forward to those evenings.

Holidays and weekends were the things I looked forward to as well and I enjoyed recuperating or simply helping my parents out with their chores, watching movies or TV shows, studying with music, writing and playing video games.

Surprisingly, what aid me in studying back in high school was due to video games. Perhaps it was the way I “destress” and it drives my mind.

I was not allowed to work during the holidays as my parents feared that once I get the taste of my own earnings, studying will no longer be a priority. However, my pocket money wasn’t great either. But I still got by and occasionally, my dad would slip in some money without my mom knowing just so I could enjoy a nice meal across the road with my friend.

The stress back then were focused on exams and completing homework. Occasionally, life dramas do get in the way, all part and parcel of being a “teenager”, having crushes, jealousy and bullying.

However, for the most part, I enjoyed my teenage years and looking back, I wouldn’t change a thing except to be more disciplined in my studying and to learn more.

Those years flew by rather quickly. Before I knew it, I was a senior and the stress of choosing a major or course and the university applications kicked in. Over the years, I’ve accumulated multiple fond memories with my friends as well which were a mixed of beautiful ones, silly and extremely foolish ones, which we do look back and laugh about during our meet-ups.

If you are reading this, I hope that you did enjoy your teenage years as much as I did too. If you are a teenager, do not fill your time with just studying, immerse yourself in extracurricular activities as well and discover new habits. It is the season of discovering yourself, and hopefully in years to come when you do look back and ponder, it will be filled with sweet memories as well.

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The Theoretical Doctor

The Theoretical Doctor May 8, 2025

Part 2 – Life As A Peri Medical House Officer In Hospital Umum Sarawak | Main Building, Side Building, Infectious Disease Ward

Related Posts:

The Peri Medical House Officer Team takes care of:

The Emergency Department

Green zone
Yellow zone
Yellow respiratory zone
Green-Yellow zone
Asthma Bay
Red Zone I
Red Zone II
Decon
CSSD
EDOU

Main Building

Side Building

Infectious Disease Ward

SDC (Surgical Daycare)

In this article, I will be sharing my experiences as a Perimedical House Officer covering main building, side building, SDC as well as the Infectious Disease (ID) ward.

As I previously mentioned in my previous article, the work begins from 7am till 6pm (short days), 7am till 10pm (long days) and 8am till 9am (night shifts).

Covering this part of the hospital meant taking care of “stranded patients” which are medical patients who are lodging in other department wards as there are no space or beds available in the main medical wards. Usually, patients like these are somewhat stable enough to be left on their own without constant supervision. Those that do require, are usually left in the Emergency Department or transferred straight to medical wards.

The Main Building

Taking care of the Main Building meant that one would have to cover:

2nd floor: Urology Ward
3rd floor: Male and Female RTU Wards
4th floor: Labour Ward
5th floor: Maternity 2 (Antenatal Ward), Maternity 3 (Postnatal Ward)
6th floor: Female and Male Orthopaedic Ward
7th Floor: Male and Female Surgical Wards

On some days, there would not be any perimedical patients in certain wards. Thus, there are days that we do not have to go to these wards. On bad days, there are perimedical patients on every floor and the patient count will be extremely high.

During my time serving in the main building, I was blessed enough to have a partner. Thus, despite the high volume of patients, it felt manageable.

Upon my arrival, I usually begin from the highest floor and work my way down. Thus, I begin from the 7th floor by checking with the TL or Team Leader to identify new cases and update the list followed by tracing the blood investigations.

This is to ensure that the patients are not missed during rounds.

I proceed with doing this in the wards of every floor till I am done prior to beginning my morning reviews.

Usually by then, the Medical Officers have arrived and are proceeding with their morning reviews.

Sometimes, we join in and sometimes, we are asked to review the other patients and on our own until the specialist arrives.

Upon the specialist’s arrival, we would all meet up at one place to begin out rounds.

Rounds in perimedical is similar to that in the ward. The only difference is that rounds are once daily and the patients are all around the place.

In between, there would be new transfer ins, attending to acute issues of which the nurses from other wards would call or inform the House Officers from other departments.

After that, it is followed by preparation of the coming morning bloods. The wards and bed numbers are labelled on top of the forms and kept in the ETD for the night House Officers to take.

The Side Building

The Side Building is less hectic than main building and that meant we had to cover:

3rd floor: Neurosurgical ward / Neurosurgical HDU, ICU extension
4th floor: Paediatrics Orthopaedic Ward
5th floor: Gynaecology Ward, Ophthalmology Ward

As usual, upon my arrival, I would begin at the topmost floor and check for any new patients as well as to trace the bloods.

After all of it is done, I begin my review in the ICU Extension 2 Ward. The ICU Extension 2 ward consists of unstable, intubated patients of various departments.

Usually by the time I begin my morning review, the specialist would have just arrived and we begin our rounds.

After the ICU Extension 2 is followed by Neurosurgical Ward since they are located at the same place, then Neurosurgical HDU.

Upon completion of morning rounds is followed by carrying out the active joblists, discharges and requesting for radiological scans.

Similar to Main Building, the coming morning bloods are prepped and kept at the Emergency Department for the night house officers to collect.

SDC – Surgical Day Care

SDC is the Surgical Day Care as per the name. Usually patients who are admitted here come in on the day of the procedure itself and is discharged in the evening.

However, when the wards are fully occupied and the Emergency Department is overflowing with stranded patients, the SDC converts temporarily to host the stranded patients.

At max, the patient load is only two cubicles full and the patients being admitted there are usually relatively stable.

Similar to main building and side building, I begin my day with tracing the bloods, x-rays or any relevant radiologist reports before beginning my review and rounds with the medical officer and specialists.

The Infectious Disease Ward

The Infectious Disease Ward or “ID Ward” is located in a building separate from the main or side building.

Previously, it used to be the House Officer’s Accommodation. However, it was subsequently converted into a ward.

The ward consists of two floors with each floor containing 6 isolation rooms for each floor. Upon entering the ward itself, one has to change into the hospital scrubs and prior entering the ward isolation rooms, one has to don apron, shower cap and gloves, the standard PPE.

The casenotes are not allowed to be brought in, thus all reviews are written outside.

What do I do if I were stationed to at the Infectious Disease Ward?

The house officer allocated to the ID ward are those from the Peri Pool, meaning our shift is from 7am till 6pm for short days.

Thus, upon my arrival, I would change into the hospital scrubs. Then, I would proceed to trace the bloods. The bloods sent from the ID ward are usually late. Thus. It would either be pending in the system or yet to be in the system.

Next, I will begin my reviews, first to the newly transferred in patients followed by the rest while awaiting the medical officer.

There is a whiteboard consisting of the names of the patients in the isolation rooms. Usually in the morning prior to entering the isolation rooms, we would have a short round and presentation with the ID consultant with the whiteboard.

Thus, during my time there, I would constantly update and personalise it according to my style which would be easier for me during my presentation with the ward consultant.

After that, we will all proceed to the isolation room. As House Officers, we are the scribe and assistants of the medical officers. Since, we are not allowed to bring the casenotes into the isolation room, thus we will type everything inside our phone and transfer it onto paper after our grand rounds with the patients.

Rounds at the Infectious Disease Ward is only once daily.

After the completion of rounds, just like any ward is the completion of active joblist.

Personally, I enjoyed my time in the Infectious Disease Ward a lot, mainly because I was given the autonomy to customise the board as I liked, present to the consultant myself and was asked multiple questions during rounds and having discussions which I find rather stimulating and enjoyable.

On top of that, I even had time to return home for a quick lunch every time I was stationed at this ward.

In the afternoon, some patients on high oxygen support may need arterial blood gases (ABGs) at certain time. If not, it is the preparation of coming morning bloods and transfer ins of any new patients.

Being in charge of the other places is considerably less hectic than being allocated in the Yellow Zone which can get rather crazy at times as there is massive movement of patients constantly. It actually feels like as if I am at KL Sentral during peak hours.

However, do not fear if you are allocated into the Peri Medical Pool. The workload can get extremely hectic and it can be rather messy. But, always try your best to learn as much as you can during your period serving there and to enjoy your journey.

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Part 1 – Life As A Peri Medical House Officer In Hospital Umum Sarawak | The Emergency Department

An article regarding my life as a Peri-Medical House Officer in my Fifth Posting, The Medical Department (Part 1).

The Theoretical Doctor