Somehow i have managed to pass through the year of 2008 and without knowing it, now already is 2009. i didnt get to celebrate the countdown, maybe that's why :P last week of the last year have been busy doing call duties in hospital.

anyway, a very happy new year to everybody. n now i'm looking forward for my long holiday for chinese new year. i felt regret for missing my friendSSSSS' wedding (in total 2) n seriously, cant say anything to defend myself. Su, so sorry to u again. n alvin also :P tht's y in return i'm going to take long leave for CNY as revenge.

have just finished another few call duties for january... there're still 4 more calls left. counting my fingers now.

probably for new year resolution, i've decided to end this blog and start another one in blogspot. http://sushijin.blogspot.com it's easier to manipulate and more flexible and colorful. so please be updated :)

now i'm really home sick. :P

House officer in malaysia work in general hospitals after they graduate for training to prepare themselves to work independently after their traineeship. therefore, depend on which hospital they go to, generally they went through a few posting before becoming a full fledged medical officer that we all r seeing outside. major postings include medicine, surgery and obs&gynae, followed by orthopedic and pediatric. we have just include accident&emergency in the latest freshgraduate training programme. now, new house officers will have to undergo full 2 years of training before confirmed as medical officer and serve the health industry.

so we have 2 years to divide among the 5 (or 6) postings, which give around few months (4mths) in each posting to learn what is essential n needed to work in future. we have medical officers and specialists to guide them during their postings, tht's the purpose of teaching hospitals we have here in m'sia. house officers should come early in the morning n review patients, update their progression and look for new problem or pts' complaints. then medical officers will do round with them, n they have the opportunity to learn what should be done, what's not discovered yet, n any change of diagnosis. then finally we have input from specialists also when they come n do rounds (again, :) ) HO learned the most during rounds with MO and specialist. after rounds, they will have to carry out the job list or ward work. this largely train their clinical skills, how to set intravenous access, calculate drip for patients, prescribe antibiotic and pain killers for patients, clerk new admission and diagnose patient's problem, order the necessary investigations, n most importantly, inform their superior for any emergency arises in the ward. although HO is the lowest at the hirearki in medical field, they r the first hand staffs come into contact with patients.

normal working hours for HO (practically) usually is around from 6 till 6, including they finish all the work being ordered by medical officer and specialist, with no guarentee for lunch time or even lunch break. sometimes u have to stay back n finish the work if there r alot of patients (s/time u skip ur dinner). N dun forget about on calls also, means after office hours, if needed u have to stay in the ward for the night, unable to go back for clothes change or meal time, till the next day n work till 6 pm again. round the clock, u have 36 hours non stop working. from this massive amount of time, HO learn, train, n practice under supervision

so, imagine our HO work in shift, say around 8 hours per shift, one to two shift per day, with no on call system, they will have roughly 1/3 of 4 months(!!!) to come contact into patient, n even less time to learn n practice, n therefore less skill n knowledge being imparted.

unfortunately our medical field does not practice the western style programme, in which their HO (internship) train straight in the programme (surgery, medicine, pediatric etc etc) they interested in n no need to run the hassle to go through other discipline. so they have years ahead of them to train n gain knowledge from tht department. with that, shift system is practical to ensure they have enough rest. in our setting, we see new rotation of HO changing posting in 4 months time n they will not repeat their posting unless they come back as medical officer for tht particular discipline. here, shift system does not seem beneficial to HO (from my point of view :P )

HO is years of hardship n mental challenge. if u can go through it, u can go through future stress and responsibility in thie field (coz u will be better equipped) it's always wrong impression things will get easier after medical students years. things will just worsen the longer u stay in the medical field. stress and hardship rise skyhigh the higher level u go through (MO, specialist, consultant, head of department, hospital director)

i'm so into this topic today coz there's a specialist want to promote HO to work in shift system, which i strongly against it. i n few of my close friends went the traditional method of training have agreed that we learnt the most from our training years (1 and half year), not from our books. :) efficiency in work depends mostly on clinical skills, n knowledge can bring us to further study.

last week i witnessed a patient was being resuscitated in casualty for sudden worsening of consciousness and suspected intra-abdominal bleeding and at the end he didnt make it for the surgery. before he was sent to operating theatre for emergency surgery, i was asked by my senior to let the family know patient's condition and counseled them regarding the poor prognosis.

they didn't seem to understand at first when i mentioned patient was bleeding heavily inside the abdomen and we need to do emergency surgery on him and prognosis is poor. then it struck me a second or two that i need to say it more bluntly: patient has high chance of dying during surgery and will not make it if surgery is not done.  the wife and daughter were very shocked and started crying immediately. patient's whole bunch of family was waiting outside. he has another two children not more than 14 years old, all wailing in pain when they saw their father and son being pushed into the ambulance for transport to operating theatre, with breathing tube down his throat and bags of blood and fluid attaching to his limbs and neck. it's heartbreaking to hear those cry.

all can be done is done, but patient didnt make it. he passed away even before we start cutting the abdomen. post mortem revealed he suffered from severe major organS injury that cause the ongoing bleed inside the abdomen. even the surgery was done, i doubt we can do much better for him.

he came to us fully conscious and alert and left his family forever within hours after that. life can be so unpredictable. yet another time, i felt unsure how i can keep my loved ones and friends close to me. they may leave me, or i may leave some day, and that day may not as far away as i thought. like before, i felt uneasy and a bit heartbreak when this thought came to me, n have to force myself to attend to some other things.

we need to cherish every moment we have, either with ourselves or our loved ones. every moment we have with each other does not happen for granted.

days since beginning of une have been quite twisting and tiring for me. i did not get to be assigned to periphery or district clinic as i hoped for less hectic and steady working hours, but stayed on in Hospital Taiping, my first training ground for my doctor career, as Medical Officer. the next thing i did was trying to get myself into the department i wanted. after much consideration, i decided i wanted to give surgery a try. i've been very motivated to work during my posting in surgery n there r so much more i want to know n not able to learn in the limited time of posting. however, our director had posted me to Anaesthesiolgy department despite knowing my interest and request. then i decided to start working out interest into this department. who knows? maybe i will like this as well. i have never in this department (they have no house officer in this department)

i started my tagging period to learn the basic skill n train my knowledge in anaes, n after 3 weeks of tagging (every other day from daytime till midnight) my hospital director called up again n asked whether i'm still interested in surgery n she can take me out of anaes anytime n put me in surgery any time i want. i was so shocked n not able to give an immediate answer to her. yes, i'm still interested in switching posting, but then i have to restart my tagging period back from day 1! :P

but within a week, i found out another of my colleague got posted to surgery which was depressing for her. she had already made up her mind that surgical-based work is not for her, n she was very eager in finding a way out from her posting. after days of mind-breaking thinking n talking to friends, i switched posting with her and ended up here in surgery. i finally got what i wanted, but already half-dead from exhaustion. haha...

but working in surgical field made me realized even more that i wanted to work as surgical MO. i enjoyed seeing the apparent difference we made for patient after our management in ward, n i get to like doing simple procedures and operations on patients who need them in order to get well. i like seeing patients get well and go home walking out the door.colleagues and specialist are nice and always look out for each other. work is always hectic but there's so much things i can learn n do. although half-beaten from tagging period now, but i'm looking forward my working days here in surgical department. at least i'll be here for another year. :)

now i'm officially medical officer in Department of Aneaethesiology Hospital Taiping. I already started my tagging period, er, something like orientation period since Monday, and it will be for 2 months. then i should be able to go solo as full-fledged MO Anaes.

cant really comment whether i'm sad or relieved when i get to know my assigned post. i was hoping to go periphery in clinic setting for a change of pace, but staying back in hospital made a lot of things easier and save me alot of trouble. first of all, there's no need for moving house/room. i have never stayed in one place for long since i started my second half of medical course, n seems like i'm getting further and further from home for longer and longer period of time. i already have a room here in taiping and gotten accustomed to lifestyle here ( slow and steady, haha). my housemate built in internet connection, which make life more lively now. and due to the confirmation of assigned post, i bought myself a brand new air-conditioner. cool air always now. colleagues and specialists within the department are also nice and willing to share knowledge, n i think i can enjoy the working environment here. although initially i expressed my concern to go into surgical department, but i think it's unlikely that i'll appeal again to change posting, since i have not decided to go further for any master/postgraduate program yet (whether for surgery or anaes) i shall stay on in taiping and continue working, n see how things end up. so far, no definite plan yet in future.

guess what? i'm finally in my last posting in Hospital Taiping: Pediatric posting.  i finished my surgical posting which lasted for 3 months, too short to master my appendicectomy surgical posting was very busy but fun at the same time. one thing working in hospital in this medical field is that the colleagues that u worked with is very important. depend on what kind of ppl they are, ur work actually get better or worse.

although many colleagues have commented how nice being in peds posting here, i dun find the posting particularly enjoying, it's not as stressful, as in medicine, n neither it is so busy, like surgery n med or obs & gynae, but i just dun like it. think the main reason is the patients are either babies or children,

here mortality is really serious thing. of course, no one will expect dire situation and complication from children esp babies to happen and usually unless clear cut bad prognosis, it's not suppose to happen. this is similar to obs & gynae posting.
one nice thing in this posting is that we can have our afternoon off the next day after our on call, so we get enough rest even though we have on cal every other day.
next month i can foresee tight scedule for on calls, coz many ppl taking leave in turns n some actually leaving the posting for good.
i already applied for periphery placement, meaning they will notify me where i have to go to work after i finish my housemanship in hospital taiping, n although we have forms to fill in our choice (1 choice only !) basically its really up to them where they want to put us. some of my colleagues get kicked to up north when he's from KL, n there's alot of examples ppl's placement got switched with other ppl out of short notice, or they were just told to work elsewhere (different from the place assigned previously) on the day they report in. so basically, i wont know where i'll work till the day i go there to work.

i hope i get to work in klinik kesihatan, hectic only seeing patients as outpatient, n ideally no need on call.

my boyfriend already posted to klinik kesihatan kuala kurau, far from what he wanted in the first place. n things will get a bit lonely here than usual. hope i can get leave next month to come back KL. miss my home now...

work been getting even tighter when ppl going on leave for raya, luckily we dun have many muslim colleageus, but now mostly there's only 1 houseman in charge of 1 ward, including me. n so unfortunate i've been elected to be in charge of HO on call list, ward roster, clinic roster n HO teaching topics. sigh.... :P

there's still one n half month left to finish medicine n most likely next posting would be surgery.

another main event recently would be my trip to langkawi. a dating trip for 3 days. went to visit few places. the waterfall - i hate the stairs but i love the lake for boat paddling; underwater world - so sad the big fishes were poisoned; bird n wildlife park - heard the taiping zoo has better varities than them, i dunno; island hopping - the boat travelling was like roller coaster; cable car - noticed i really have phobia against height, more than on-water roller coaster, but the scenary on top was excellent :) ; restaurants have nice seafood, not bad for those near awana hotel. anyway, i never been to langkawi before so it seem a very nice trip to me. i know others have been there like on regular basis, n maybe nothing much surprises for them. but it's really a fantastic holiday, till i felt depressed when i have to be on call on my first day after work here in hospital. what to do? no pain no gain. :)

next holiday would be mid nov when i have to go back KL. really missed home... never been home for more than 2 months... first time in my career in taiping. already missed the dim sum in restaurant six happiness (luk fuk) :P argh.... so hungry...

i'm on call today again. hope ppl dun come to hosptial n just go for raya holiday.

another weekend here in hosp taiping.

hehe... sorry for throwing the bomb to my friends just like tht, but really, didnt get the right chance to tell when u all came to taiping to visit me.  anyway, things r going smoothly here n we'll just see how in future k? now it's still work, hostel, work, hostel plus dating dinner if both of us not on call. i have even less time for my video game. is it s/thing good or bad?

still in ortho posting still, another one n half month to go before entering the hell of medicine posting. really dun want to go to that posting. for now, i'm enjoying my second call, which usually is less busy compared to first call, excluding the part i need to assist operation past midnight if there's cases. plus next week, i'll be in charge in clinic which mean i no need to go to ward to do rounds. but if someone else ask me to cover i'm obliged to agree since i'll be the most free houseman available.

yesterday gang of friends came to taiping to stay overnight. it's really good to gather around like this since i have not seen them in ages.  too bad i cant join their night safari trip coz on call tonight. (thus can online today. haha!!)

life in ortho not as bad as O&G but it really is more tiring. but recently i find it more bearable now, n in fact starting to enjoy e/day's work here. dunno whether it has anything to do with meeting someone here.  still in progress, but i think both of us will work out well.

now awaiting staff nurse to bring me tools to do procedure on a patient in ward. so far so good... (shh... touch wood...)

may i have a good call.

cant believe i actually was cut off from outside world for total of 1 1/2 months...

life has been like hell since i came back to work since CNY break. i've been EOD calls ever since from the break... meaning i start work on monday, start on call on tues, then thurs, then sat then mon then wed .... n on n on n on... n the whole month of march i've done 15 calls (out of 30 days). it was miracle tht i didnt fall sick n still manage to hang on n not skipping calls... though i thought of just leave the hospital n quit the job n go back home. :P

n finally i finished my O&G posting in end of march. i started into orthopaedics, which has cool wards (like the one i'm in now) n they have computers tht can access internet!!! Hooray!!! i'm happy enough just to get online, never mind abt msn working or not...

ortho is not as easy as i think initially... many procedures need to be learnt n i have to able to do them effectively alone... on calls in orthos r tiring, running everywhere in the hospital coz the wards were scattered all around, plus have to cover patients referred from other units, mostly from surgical or medical wards. still need to find time to study though... specialists here like to 'teach'. :D

but stucked in taiping for too long (only two trips to ipoh till now) made me feel a bit sick. i missed the movie 300, n dun think i can watch spiderman 3 or transformer or harry potter if things keep this way up... luckily i got leave next week from thursday till sunday n i shooting back to KL straight away on thurs morning after on call. :D

gonna pick up the news n entertainment soon enough... :) think i'll stop for now... actually i'm on call now in hospital... till next entry then.