Welche Speisen würdest du gerne zubereiten?
Obwohl wir täglich mehrmals essen, kann die Frage “Was koche ich heute?” oder “Welche Speisen würdest du gerne zubereiten?” zu einer echten Herausforderung werden. Viele von uns stehen vor dieser Entscheidung und suchen nach einfachen und zeitsparenden Lösungen, um den kulinarischen Alltag zu bereichern. Es ist daher nicht überraschend, dass […]
Cocina «Lasaña casera de verduras»
Buenos días, amigos y amigas, pues hoy me apetecería cocinar un plato sano y muy rico, una combinación ideal para disfrutar de la comida, hoy vamos con una lasaña casera de verduras.
La lasaña casera de verduras es una versión saludable, colorida y sabrosa de la clásica lasaña italiana. Se compone de capas de pasta intercaladas con un sofrito de diferentes verduras, salsa de tomate y bechamel, que luego se gratina con queso para obtener un acabado dorado y apetitoso236.
Ingredientes principales
Preparación básica
Consejos y variaciones
Esta lasaña de verduras es perfecta como plato único principal, apta para vegetarianos (si eliges quesos sin cuajo animal) y muy adaptable a lo que tengas en la nevera245.
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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 Worst Morning Shift In General Surgery | Housemanship Diaries
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I can’t really remember when as at the time of writing this article, I am about to cross into the second week of 2025.
Perhaps it was somewhere in October last year or early November.
It happened to be the day shift on a weekday and we were lack of manpower. 3 House Officers in the Male Surgical Ward, 2 House Officers in the Female Surgical Ward. Out of the 5 of us, I am the senior and the rest are first posters, three of which are only Day 3 into their housemanship life.
Oh dear…
We all know how busy Surgical can get and being the only senior that day surrounded by newbies, it was as good as being alone as they were not familiar with the system or the work or the procedures.
The day started with me taking care of the acute beds. The acute beds in the ward is considered the most unstable, hence it only made sense to allocate the senior, which is myself there, followed by the subacute cubicles.
The front cubicles and back cubicles are relatively stable patients. Hence, I allocated my juniors there. Usually for first posters in their first week of life, I would not allocate them independently to take care of a cubicle. However, we were desperately short staffed that day and taking care of the front or back cubicles are not easy either especially if you’ve just entered.
The day was busy enough. Started with me following rounds at acute and subacute with my medical officers and again with the ward surgeon, only to leave midway as the Hepatobiliary Team (HPB) had their own separate rounds and I was the HPB house officer for that day.
After rounds, it is the completion of the joblists. Amidst trying to complete the joblists, we had to transfer in new patients, take and send off the bloods of patients who have just entered as well as attending to any acute issues.
On that day, I had to assist with the front and back cubicles as well and in the afternoon, the juniors left for their Operating Theatre (OT) orientation.
My phone literally rang non-stop that day and the nurses kept haunting me down for everything. If only, I had the ability to clone myself…
Suddenly my phone rang and I had to assist a registrar to help tend to a visiting outpatient, attend the female surgical ward acute issues because the medical officer on-call called me as well as attend a virtual meeting.
Time flew by rather quickly, one minute I was escorting a patient, next was being called upon by this and that medical officer or registrar or nurses. To the point, my post-call registrar stayed back to assist me.
As the evening progressed, most of my patients desaturated. The annoying thing about Surgery, we had to update the whole story properly in the oncall WhatsApp Group for the day.
If only it were as easy as that.
We couldn’t just take a picture of our entry and update. Instead, we had to properly type the whole summary or stay.
I finally completed my task for the day at 10pm. It was an extremely exhausting and tiring day. One which I have no interest in relieving again.
That was probably the worst morning shift I’ve ever experienced.
However, looking back at what I’ve written, it doesn’t do justice to what I actually felt that day.
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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
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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
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My first “ON” or “On-night” or night shift in General Surgery was in the Female Surgical Ward with a friend whom I’ve known since around my first posting but have yet to be in the same posting together till our fourth posting in General Surgery.
We were blessed enough to have at least 2 people per ward for the night shift.
Our shift as “on-night” in Surgery began from 7pm and will usually last till all the discharges are done the following morning.
Upon my arrival to the ward, I was informed that one patient in particular had no urine in her CBD (urinary catheter) bag and that she felt like urinating but was unable to void. Considering that she had a urinary catheter in-situ, voiding should not have been an issue.
I attended STAT and assessed her. She had a mass over her abdomen which was hard, non-mobile but had smooth edges, around 15cm by 10cm, a rather large one which I assumed was a tumour, probably pressing onto her urinary bladder as well.
It did not occur to me to check if the patient was previously passing urine, it also did not occur to me to check her intake and output chart. All I could think of at that time was, she felt like voiding, she is in pain, there is no urine flowing into her urine bag.
Thus, I prepped the trolley to reinsert a new CBD. I donned my plastic apron and prepped my materials needed and proceeded to clean the patient’s vagina and reinsert a new urinary catheter in as probably as sterile as I could, bedside.
Upon insertion of the new urinary catheter, there was no urine outflow. Thinking that I may have blocked it or inserted not all the way in, totally abandoning my theoretical principles learnt, I proceeded to reinsert about 3 times and each time was met with no urinary outflow but there were bloodstains from the urethra.
I called my partner for help and he proceeded to help me in informing in the oncall group and referred to Urology medical officer oncall who was rather grumpy.
It was during his referral that I realised that the patient had been anuric (not passing any urine) for sometime now. Clearly, she would not have any urine output and although she felt the need to void, it would not have been an issue considering there is a urinary catheter in-situ.
I had unnecessarily caused trauma and I felt foolish for acting prior performing a thorough examination and understanding her case.
The Urology medical officer came and reinserted a CBD to which she asked us not to remove and to request for an ultrasound the following day for assessment as she suspected that the tumour over her abdomen had infiltrated into her urinary bladder or urinary system.
That was settled but definitely ate up a huge amount of our time because of my mistake.
Subsequently I was rather slow and there were a few post-operative patients and new patients admitted into the ward. Hence, I proceeded to do the needful. By the time I was done, my partner had completed taking the blood for the whole ward and at that time, it was around 3am. I could sense the back-to-back disappointment I have caused him and at that point, I have given up on apologising.
We then proceeded to complete our planned discharges of the patients and by 6am, started tracing the blood results of the patients before retiring into the house officer’s room for a break.
In the morning, as usual as in other postings, we would be “summoned” in the group to take any bloods or to start our discharges.
We returned home around 11am and our post-night shift was followed by an off day.
Personally, I felt that I could’ve done a lot better as I was rather slow that night. However, for a first night shift in Surgical, it was not as bad as it seems.
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Writing After A Long Time
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Day 496 of my housemanship journey, a the time of writing this article.
A few months ago, I took a sweet 6-week-long break after having just completed my first year of practicing as a junior doctor.
It was unplanned and definitely a blessing in disguise.
However, that rendered me to overshoot my allocated amount of leaves within a posting . Thus, I was extended in my fourth posting, Surgery.
Ever since I came back to work on the 2nd of October, it has been a tough 1 and a half month. My body was shocked back to work and it was a tough season as there were many people leaving the department.
Working the morning shift was even more tiring than working the night shift. Hence, in order to survive without collapsing out of exhaustion, I chose to work during the night shift consecutively for days.
Looking back, only a month and a half flew by but it felt like months have gone by instead.
However, today, I am able to write after what feels like a really long time. I feel that I can slow down at least for the next month at least and enjoy my work instead as we transition into a good season in this department.
A huge batch of house officers has been allocated into this department and this morning, there are 17 junior doctors in charge of a single ward as compared to previously when there were only 3 – 4 junior doctors.
Is that a good thing?
For those who have been in the department for some time like me, we definitely appreciate this break. However, a part of me also question if they will be able to learn as much as we did?
If you are currently struggling with bad days at work, just remember that it is these days that teaches us and makes us grow and that good days are definitely coming.
For when it does arrive, it allows us to appreciate the moment.
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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.
Photo by Derek Finch on Pexels.comThe 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.
Photo by Tara Winstead on Pexels.comIn 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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Eric
El Mundo de Óscar
The Theoretical Doctor
