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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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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 21, 2024

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Sometime ago, I wrote about “The Small Change I Hope My Blog Would Make“, whereby I mentioned that with every article written and uploaded on this website would spread some form of comfort and positivity, especially within the community of junior doctors.

Perhaps I’m just simply being optimistic. I have to. That keeps me going, even on difficult days to the point it has become a default reflex for me.

Nonetheless, I love to write and sometimes I do get lost that I tend to deviate from the topic at times and divert back to the main topic at hand.

Living in this world which has its flaws and problems at every corner, I try to see the good aspect of things and thus, I try to end my articles on a good note or some encouragement, which is mainly directed at me actually. However, I never know who may be reading my written articles and perhaps just need some encouragement and kind words at the moment.

It serves as a “happy ending” just like a fairytale in which I escape in one too many times.

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The Theoretical Doctor

The Theoretical Doctor Sep 18, 2024

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Daily writing prompt What things give you energy? View all responses

Working in the hospital, I wished that I had endless amount of energy. This is due to the never ending amount of patients as well as the lack of manpower.

Despite having completed your side of work, you just wished that you could help out. However, once you are done for the day, the thought of even going out is too tiring, upon returning home.

Thus, the evenings after work are usually spent recuperating and resting before going to bed to repeat the whole thing again the following day.

These are what keeps me going throughout the day.

1. Coffee

I need to have my morning coffee. I just absolutely have to.

My morning is not complete without my morning coffee as my body will feel sluggish and tired. I’m somewhat also more irritable and unable to think or move fast.

Perhaps it is the caffeine addiction speaking.

After I have had my black coffee to start the day and packed my necessary coffee flasks for work, it is then that I am ready to walk out the door and head to work.

2. Chrysanthemum Tea

I have built a liking towards cold chrysanthemum tea.

Personally, I enjoy the sugarless chrysanthemum tea. However, the ones available at work are only those in the can and has sugar in it.

Nevertheless, I still make do with it. Besides it is affordable too. Sipping that cold soothes my soul and reenergises me.

3. Cold Green Tea

In addition to cold chrysanthemum tea, I would usually prepare a jug of green tea and store it in the fridge.

This is for me to enjoy upon returning home and also serves as a healthier alternative to chrysanthemum tea which is packed with sugar.

Thus, the things that energises me are not food but simply drinks.

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The Theoretical Doctor

The Theoretical Doctor Sep 16, 2024

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Sunday, 30th of June 2024. I was allocated to work as the morning shift house officer at Paediatric Isolation Ward 3A. It was a Sunday.

At the time of writing this article, it is September and currently in my fourth posting which is Surgery. I should be pushing into my third month in Surgery but considering my recent injury in August, I have been on 6-weeks medical leave.

Looking back, my last day in Paediatrics was extremely lovely.

Working during the weekend in General Paediatrics especially Paeds 3A meant that there is only one medical officer who will do the morning rounds, which is usually the oncall medical officer and grand rounds with specialist is only once which is in the morning.

Prior to my arrival that morning, I knew that there were only two allocated house officers on duty in the ward that day. Me and a colleague of mine.

However, my colleague was on medical leave and was unable to come to work. I started off with morning reviews at the acute cubicle as usual and continued to the next cubicle while awaiting another house officer to be reallocated.

Considering that we were tight on manpower during that day, we each reviewed the patients on our own and directly presented to the specialists.

A lovely person was reallocated and I enjoyed every bit working with her. We completed morning rounds at almost 2pm and proceeded to complete our morning discharges and take any STAT bloods.

Then, we went for lunch and proceeded with acute bay reviews and continued with our afternoon discharges.

Upon completion, we spent time talking and joking. The hours were filled with giggles and laughter till it was finally time to return home.

We returned home on time that day at 6pm.

My third posting ended on a good note as well and it was one filled with tons of fond memories. It is one of the posting that I would not mind repeating.

If you are due to commence the Paediatric posting, I sincerely hope that you will enjoy it as much as I did.

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The Theoretical Doctor Sep 15, 2024

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Pushing into my third month in Paediatrics Posting, I was allocated to the Nursery Ward, after successfully completing my Neonatal Resuscitation Program (NRP).

I was rather fearful and hesitant. I heard that the hours are a killer and working the night shift and being the post night is even worse. However, I was mainly worried about being a resuscitator.

Prior to joining the Nursery Ward, I have had a few experiences working in the ward itself. Not as a resuscitator but merely covering the morning rounds, going a out reviewing as well as settling the job lists.

Thankfully, I had a few experiences covering for the Nursery Ward. Thus, I was not completely blur upon entering the ward. Except this time, I had to serve the night shift as well as to resuscitate.

The Morning Shift

On paper, the morning shift is from 7am till 7pm.

However, most of us would arrive at latest at 6am. This is because the “coming mornings” were taken by the morning shift and not the night shift.

Usually the day or night before which is before the morning shift here to return home for the day, they would have to prep the “coming morning bloods”, which is a normal thing we would do in other postings. This includes preparing the forms and tubes or in this case, name stickers for the tubes and to update in the coming morning list in the house officer’s group. The list merely serves as a guide for the team for the following day to refer once they arrive to take blood. Once all the bloods from their allocated cubicles have been taken, we are expected to help the others out if there are anymore bloods to be taken followed by sending it first to the lab before joining the medical officers for morning reviews or rounds.

In the Nursery Ward, the medical officers arrive by 7am and the specialists begins their rounds around 9am. Thus, upon their arrival, they will proceed with their morning reviews first while us house officers are taking the coming morning bloods.

After we are done taking the coming morning bloods for our allocated cubicles, we will then proceed to help the others with their coming morning bloods if it is not done and send it all first prior to joining the medical officers and specialists for rounds.

After rounds, just like in other wards, it is followed by the completion of active job lists such as requesting scans, referrals or any other STAT bloods, tracing of bloods and updating as well as clerking new cases.

Usually by 12pm, we would be done and have a short break for lunch.

If it is during the weekdays, we would then proceed with afternoon reviews and wait to do rounds with the medical officers and specialists.

The rounds would end around 3pm to 4pm. Just like in the mornings, it is then followed by completion of the active job lists. However, since the rounds end late, usually things starts to slow down.

Then, we will start prepping forms on the observation chart such as the “Day of Life”, diagnosis or any planned discharges, as well as the preparation of coming morning bloods before heading home at 7pm.

This is if you are allocated purely to the Nursery Ward of course.

The Resuscitator

My favourite part of working in the Nursery Ward.

During the morning or night shift, we have an allocated resuscitator on duty. A resuscitator is “on-call” during their shift and has to accept referrals from the Labour Ward or Maternity Ward.

Upon the start of our shift, we will introduce ourselves in a designated group which consists of the House Officers from both the Paediatrics and Obstetrics & Gynaecology (O&G) teams, that we are the resuscitators on duty for that day.

On good days, the referrals are coming in, one at a time but on bad days, they would come in bulk, happening all at the same time. The thing is that you would wish that you could divide yourself.

The cases which are referred are usually meconium-stained liquor – SMSL, MMSL, TMSL, mothers going for lower segment caesarean section, vacuum-assisted delivery and mothers diagnosed with chorioamnionitis (just to name a few).

Not all referrals requires the medical officers to be on standby and supervise us. However, upon receiving the call, we are expected to first go to the mothers and clerk the mother’s condition as well as the indication of referral.

This is then proceeded by presenting the case to the medical officers if they are required to be on “stand-by” or to inform regarding the likelihood for admission upon delivery.

Prior to being a resuscitator, we are required to have completed the “Neonatal Resuscitation Program – NRP” which would then deem us competent for being a resuscitator.

Being the allocated resuscitator can be daunting at times especially if it is the very first time as the cases can sometimes be dire and the calls received are unpredictable.

However, fear not. It is extremely daunting at first but have faith and know that help is always nearby should you need it.

The Night Shift

The Night Shift in the Nursery Ward is from 7pm till 7am, on paper. The reality is that if you are working the night shift in the Nursery Ward, we usually return home around 11am – 12pm the following day.

There are only two House Officers allocated in the Nursery Ward at night. One is usually in charge of the ward in terms of carrying out the active job lists, taking time sensitive bloods, tracing bloods and clerking new cases while the other will be the main resuscitator, attending to cases, similar to the one from the morning shift.

At 7am, we will handover any pending cases from the night before and proceed to Maternity 1 and Maternity 3.

Upon arriving to Maternity 1 and Maternity 3, we will collect all the “baby books” from the babies’ cot and proceed to trace the cord TSH (cTSH), G6PD status or any pending bloods or serum bilirubin in the system.

After completion of tracing, we will proceed to start our baby check and should any baby appear clinically jaundiced, we will check their bilirubin through a TCB machine and start phototherapy or to take “Day 1 Jaundice” workup if needed.

All the babies in Maternity 1 and Maternity 3 will be checked even if they have already been done the day before.

Upon completion of our baby checks with the medical officers, we will then go about carrying out any necessary job lists such as transferring out babies from the Maternity ward to the Nursery ward, taking bloods, tracing bloods, referrals or sending the babies down to Nursery Ward for any scans.

If you are due to enter the Paediatrics Department or to work in the Nursery Ward, fear not, it can seem daunting at first but my experience working in the Nursery Ward for 4 weeks were fruitful and I enjoyed every moment of it.

Remember to always be of good support to your colleagues be it in terms of helping out with their workload or just merely being of good moral support.

Lastly, remember to enjoy the journey and every bit of the moment.