Useless Rambling

Sometimes I feel like I am stuck in my current job.

If I had studied accountancy and I don't like being an accountant, I can at the very least change to a different company.

If I studied business, I can apply for so many different jobs out there.

I will never get the chance to open up the classified section and look for jobs.

I mean, I can, if I want to - but then the 6 years of my life spent in Russia would be a waste.

It's not as if I dislike my current job.

It is OK.
It is not great.
It is not horrible.
It is OK.

But then, sometimes, I feel inadequate.

I feel ...... (I can't think of a word to describe my feelings).

Maybe I am just not meant to be a doctor.

There are so many things I don't know.

I can't even do simple procedures like blood taking properly.

I wonder what I studied for 6 years.

Do I really know more than what I knew 6-7 years ago?

But then I can't complain cos this job is what I wanted.

This was my ambition.

I wasn't forced to do it so I can't blame anyone for it.

But then again, as I said before, it's not like I hate the job.

Argh...what am I writing..
My past few entries have been full of useless ramblings.
Maybe 'cos it's past my bed time.

Good night....

Home Sweet Home

I am back home!
Finally, after almost 2 months, I am back home!

I am kind of happy - mainly because I don't have to go to work tomorrow and can sleep in.
It's been such a long time since I woke up without an alarm.
Unfortunately, I still have to use an alarm tomorrow because I have some things that I have to get done early tomorrow. But then, at least I don't have to wake up at 6.15am.

I have been in PICU (Pediatric ICU) for the past 2 days. I will be there for the whole of next week. There are not that many patients there and there are a few MOs around, so our (HOs) job is a little less, but then it is a bit boring at times because we just don't know what to do. But then again maybe that's just because the ward is a little empty for now. God knows what it would be like next week.

I don't get it sometimes. There are times when the ward is extremely full with patients overflowing into other wards, and there are times that the ward is extremely empty that we keep patients for one more day just for observation. So, does this mean the ward is too small or too big? Do we need another ward or is what we have sufficient?

I don't seem able to think properly for now - kind of sleepy already..hopefully I will have something less crappy to write tomorrow.

Good night!

Cause And Effect

Day 1: Left ankle slightly painful. Ignore. Continue work as usual.

Day 2: Left ankle more painful. Limp a little. Work. Pain worse at night.

Day 3: Left ankle very painful. Take MC. By evening, pain almost gone, still limping a little, go for oncall.

Day 4: Developed a small swelling over left knee – didn’t hit anywhere, don’t think got bitten by any insect. Unable to bend knee without feeling terrible pain, so most of weight beared by right leg. See doctor – given antibiotics.

Day 5: Knee pain improving. Minimal limp. Slight pain over right ankle, probably due to the extra burden it had to endure the day before.

Day 6: Right ankle painful in the morning, got better as the day progressed. Limping (weight now more on left leg). At night, pain worsened – took Papase, took Voltaren, bandaged ankle, slept.

Day 7: Right ankle less painful in the morning, but as day progressed, pain got a little bit worse. For now, leg is bandaged. Hope that it will be better tomorrow.

Conclusion: My body is trying to tell me something. Lose weight, perhaps?

09.01.09

The Russian Patient vs The Malaysian Patient

I don’t know whether or not I have ever written an entry about this topic (I can’t even check since I do not have an internet connection right now). I know I’ve thought of writing about this matter before, but then I’m not sure whether I actually did it or not. But then I figured out that it didn’t matter – if I can’t remember whether or not I’ve written about it, people most probably can’t remember reading it as well (you like my logic?).

Although all patients have 1 thing in common – they are sick (duh!), there are still significant differences between one patient and another.
Some like to talk.
Some only answer questions that you ask them.
Some want to know about their disease.
Some actually read up about their disease if they have a chance to do so.
Some couldn’t care less what you give them or do to them as long as they get better.
Some patients co-operate.
Some are compliant to their medications and treatments.
Some just want to get out of the hospital as fast as they can.
Some run to the hospital for the slightest hint of flu.
Some wait until they are half dead before actually seeking help.

There is one thing that I have noticed about most Malaysian patients (as opposed to those in Russia) that I am not very pleased about. Here’s a typical question and answer session:

Question : What medication were you given?
Malaysian patient 1: The white medicine with the letter KKM.
Malaysian patient 2: fever medicine, cough medicine, antibiotic – pink in colour.
Russian patient: Paracetamol, propanolol, nifedipine.

Do you see the difference? Most Malaysian patients don’t really care what medication they are given. They just take them without bothering to ask what is it they are given, as long as they get better. I am not just talking about those who are less learned or older generation – even those in their 20s who are proffesionals don’t know what medicine they are taking. All they know – antibiotic. There are SO MANY DIFFERENT TYPES OF ANTIBIOTICS!!

Russian patients (at least what I have seen) know their medications or at least write down the name of their medication somewhere so that they can show it to the doctor if they are asked about it. I have seen a Russian patient who didn’t know what medication she was on, and after about a day in the hospital, took the effort to remember all the medications that she is being treated with. I am talking about 80 year old Russian ladies! If they can rememeber their medication, why can’t you?

It is important for a doctor to know what medication you are on. Let’s say you are a patient with hypertension – only if the doctor knows what medication and what dosage of the medication you are taking now, can they adjust it according to your needs.

Here’s another reason why it would be beneficial to you to know your medication:
You have been having fever, cough and flu for almost a week. You went to the clinic and were given an antibiotic. You finished the whole course and did not get better. You then went to the hospital. The doctor wants to start you on antibiotics but you don’t know which antibiotic you took earlier. Obviously the first antibiotic you took did not work, but then, since the doctor doesn’t know which antibiotic you were given, he/she will give you the antibiotic which they think might be the most helpful, which might even be the same one as you had taken previously. Once again, your condition doesn’t improve and then they change your antibiotics to a different kind and you get better. Wouldn’t it have been better to just have remembered which antibiotics you took earlier so that you could have been given a different kind the 2nd time around?

I’m sure all the doctors in Malaysia would agree with me regarding this matter. Please try to know what medication you are taking. If your doctor doesn’t tell you the name, ask for the name. You don’t have to memorize all the names – write it down somewhere and just bring the sheet of paper along the next time you go see a doctor. It will definitely help the doctor in doing his/her job.

Having said that, there is another thing that I would just like to say – antibiotics are NOT the answer to all diseases. Do not take antibiotics before consulting your doctor. Same symptoms does not mean same disease. Not everyone needs antibiotics. Let your doctor decide your medication.

Better still, stay healthy!! :)

09.01.09

My First Leave Application

I am EXCITED!
I have 2 reasons to be excited.

One is a secret.

The other one is ‘cos my cousin brother is getting married!

Why am I excited?
‘Cos the last family wedding I attended was more than 2 years ago.

I have attended a couple of weddings since I graduated, but then family weddings are different from non-family weddings.

I have applied for my leave, and most probably it will be approved since I have not heard anything about it not being approved yet. (As you can see from the title of this post, this is the first time I am applying for leave)

The wedding and the dinner will be held on the same day, and I am planning to tie sarees for both the function and of course I can’t tie the same saree twice. I have already decided which sarees to wear (I have at least 4 new sarees never worn before); all I need to do is sew the blouses.

You know what’s exciting about family weddings?
- You know quite a number of people who are there.
- You get to catch up with family members whom you have not met for a long time.
- You get a reason to dress up.
- You have a few people to join you in commenting about another person’s attire.
- You can take as many sweets or door gifts as you want ‘cos the person giving them away is your relative anyway.
- You know there will be non-vegetarian food being served.
- You know what the bride/groom look like in real life (without makeup).

Can’t think of anymore reasons.
It’s late, maybe that’s why.
I’m on call tomorrow. I pray for no admissions and an uneventful night.
Friday, I finish work at 1.
I have applied for the weekend off (I am entitled to 1 weekend off per month).
Looking forward to the loooong weekend.

07.01.09

Instant Mi Goreng Recipe

I have decided to share with everyone my secret in making delicious, easy to make instant Mi Goreng (generous, aren’t I?). Try it once, and if you don’t like it, don’t try it again.

Ingredients:

1. 1 packet of Mi Goreng – I’ve tried Mamee Mi Poh (red packet) and Maggi Goreng (Blue Packet). Both are equally nice, but the blue packet is a bit saltier and I personally prefer Mi Poh. I think there is another Mi Goreng by Maggi, ‘Pedas’ or something like that – quite nice too.

2. Bawang goreng (fried onion) – can get it from any supermarket or grocery shops

3. Chilli sauce (the spicier the better)

4. Thick soy sauce (warning – might make dish salty)

5. 1 bowl, 1 plate, 1 fork, 1 spoon (:P)

6. Kettle and water (:P :P)

Method:

1. Boil water.

2. While waiting for water to boil, put the noodles in the bowl and the ‘perencah’ (spices) given into the plate.

3. Add into the plate a little bit of thick soy sauce and as much chilli sauce as you like (too much will make the dish wet). Mix all the sauces and spices together with spoon.

4. Once water has boiled, pour it into the bowl and wait for some time. For those who are concerned about wax, you can pour off the first round of water (from the bowl) and pour another round of hot water, but then that will make the noodles soft and soggy, so I don’t do that.

5. When noodles seem kinda cooked to a consistency that you like, either pour off the water or use fork and remove noodles from the bowl (you can seive the noodles if you wish, especially the small ‘pieces’). Make sure you shake off excessive water or else the dish will become wet.

6. Add in as much bawang goreng as you like.

7. Mix the noodles, bawang goreng and the sauce and spice.

8. Your dish is now ready to eat!

*of course it would always taste better if you could eat it with fried eggs or sausages or chicken or whatever else you like to eat with your Mi Goreng.

p/s leave a comment ONLY IF you find the recipe USEFUL or TASTY. It would break my heart to know that people don’t like my recipe. No comments are also acceptable.

07.01.09

What To Eat?

Life here can be pretty boring.

Today I finished work by 5.00pm.

I don’t know what to eat for dinner.

I don’t know whom to eat dinner with.

I am bored of eating the same food everyday.

But I don’t know that many shops in Ipoh.

And my parking skills are next to none.

If I go somewhere and find something that I would like to eat and there is no place to park, I will just move on anyway.

And even if I buy something to eat, I don’t know what to do while I eat.

I don’t want to eat all by myself in the shop..I tried that once and it is quite depressing.

Even if I tapau, there is nothing to do while I eat except read study books (not very appetizing, is it?).

In the end, today, I just came back home without buying anything.

Now, I am hungry.

I have chocolate, biscuits and Maggi.

Biscuits are for breakfast.

Chocolate or Maggi?

Yes, I know..sad isn’t it, to have to eat Maggi in Malaysia?

I really don’t feel like going out now to get dinner.

It’s not like I know what to buy anyway….

Maggi it is!

Time to boil water (no, I don’t have a stove).

Bon appétit everyone!

07.01.09

Rules And Regulations Of The Paediatric Ward

1. No wearing long-sleeves. If you do wear long sleeves, then the sleeve has to be folded up to the elbow.

2. No wearing bangles, watches, rings or anything else on fingers and wrist.

3. When you enter the ward (even if you just went out for lunch), you have to wash your hands up to your wrists using a handwash technique.

4. Before touching a patient, you have to wash you hands with a special alcohol splash (will be everywhere around the ward). After each patient, before touching another patient, you have to wash your hands with the alcohol splash again.

5. You are not allowed to wear labcoats (white coat that doctors/pharmacist/cleaners in Russia/butchers in Russia wear).

6. You must carry with you a pen, a drug dosage book, a calculator (to calculate the drug dosage) and a pen torch. Thus, you can see everyone walking around with a pouch or sling bag to keep all their stuff.

7. You are allowed to use your own stethoscope in the Paediatric ward, but you have to wipe it with an alcohol swab (provided in the hospital) before you use it on a patient.

8. In the Neonatal ward (children below 1 year of age), you use the stethoscope provided by the hospital, and even then, have to wipe it with the alcohol swab before using it for a patient.

9. You have to wash your hands before and after each blood taking procedure.

10. No wearing anything that hangs (i.e. name tags). Name tags are to be pinned or clipped to your shirt. Ties have to be stuffed into your shirt.

All for the sake of effective infection control.

04.01.09

Abbrevations

Some commonly used short forms in my current department:
(try guessing what it means before reading the explaination)

- HTN – hypertension
- D (with a circle around it) – discharge
- Rpt – repeat
- TR – tricuspid regurgitation
- d/w – discussed with
- IEM – inborn error of metabolism
- TRO – to rule out
- M with a circle around it – Mother
- F with a circle around it – Father
- S with a circle around it – specialist or surfactant (depending on situation)
- s/t – spoken to
- D 4 OL – Day 4 of life
- 1/7 – 1 day
- 1/52 – 1 week
- 1/12 – 1 month
- TF – total fluid
- FTSVD – full term, spontaneous vaginal delivery
- EMLSCS – emergency lower segment c-section
- ELLSCS – elective lower segment c-section
- DM – diabetes
- TCA – to come again – the patient has to come to the clinic/hospital for follow up treatment
- G & D – growth and development
- MPC – morning paeds clinic
- BF – breast feeding
- Prem- premature
- T/O – transfer out (usually from one ward to another)
- r/v – review
- S/B – seen by (usually MO or Specialist)
- BW – birth weight
- CW – current weight
- COH – circumference of head
- DOA – date of admission
- A/S – Apgar score
- K/C/O – known case of
- DRNM – dual rhythm, no murmur (means the heart sound is normal)
- NKDA – no known drug allergy
- a/w – associated with

There are many more, but right now I just can’t seem to think about them. Try guessing what this means – rpt cm in LC (answer below..and no, there are no medical terms)





Rpt cm in LC – repeat coming morning in local clicic, which means the test is to be repeated in any nearby clinics the next day. Bet you couldn’t guess it, huh?

04.01.09

Tagging

For the first 2 weeks for work, I was tagging. The tagging period is a period of time given for a HO to get used to whichever department that he/she is placed in. All departments of all hospitals have the tagging system. However, the duration varies. The average duration for tagging is 2 weeks. If you are competent enough, then the HOD or whoever is incharge can allow you to complete your tagging faster, or they can extend your tagging until they think you are capable of doing your job without supervision.

The worst part about tagging is the working hours. You have to work from 7.30am to 11pm everyday – 7 days a week. However, some departments (e.g. Paeds in Ipoh) is kind enough to give us about an hour lunch break and 2 hours dinner break, provided we complete whatever work we are supposed to do before leaving for our breaks. We are also give breaks from 12pm-6pm during weekends, so life wasn’t too bad. You are not allowed to do oncalls while tagging.

Once you are off-tag, your working hours is from 7.30am to 5pm on weekdays or 7.30am to 1pm on weekends and public holidays. However, being off-tag means you can be given oncalls.

What does being oncall mean? For a HO, it means staying and taking care of a particular ward all by yourself. If there is any problems, then you can contact the MO oncall who will be incharge of a few wards. Oncall hours are from 5pm to 7am (the next day) on weekdays and 1pm to 7am (the next day) on weekends and public holidays. The plus point of being on call? You get to go back at about 1pm the next day.

Life right now is not as bad as I imagined it to be. But then, as I told you in my previous post, Paeds is supposed to be the ‘chillest’ department of all. I just hope that I can cope up with the job when I am trasferred to the other departments. Even now, I feel like I don’t know many things. I KNOW that I don’t know many things. I know that I have lots to learn. I hope I can be a good doctor. I hope I don’t get extended. I hope I don’t make major mistakes and cause someone their lives. It’s almost 11pm now and I am sleepy. Got to wake up early tomorrow for work. Good night!

03.01.09

My Day At Work

Let me tell you the basics about my job.

I can’t quite believe it yet.
MY JOB!
I am actually working!

No more a student.
Earning my own money (although I haven’t actually got my first pay yet).
Living away from home.
Driving to and from work, myself.
Eating out.
Actually doing something that is supposed to make a difference in someone else’s life.
No more a student.

I find it weird – 2 months ago I was doing nothing, sitting at home; 1 month ago I was in induksi and BTN attending lectures and now I am going to work everyday and supposedly making money.

Anyway, I am currently working as a/an (not too sure) Houseman (HO) in the Pediatric Department of Ipoh Hospital. It is supposed to be the easiest and ‘chillest’ department of all, but even then, I cannot say that I am not having problems adapting to work. I will be working in Ipoh Hospital for 2 years in 6 different departments (Paeds, O & G – obstetrics and gynaecology, Medical, Surgery, A & E – accident and emergency, and Orthopedics). After I complete the two years (providing I don’t get extended), I will be a/an Medical Officer (MO), and maybe be transferred out to anywhere in Perak. I can, however, request to be transferred out of Perak, providing I have a good enough reason to give.

My relatives and friends keep telling me that Ipoh is a nice place to work and the hospital is a good hospital. For me, I don’t really care. No matter where I work, I know that I am going to be busy and not have that much time. The only difference is that now I have to send my clothes for laundry and I have to eat out (as opposed to having my Mum do the laundry and eating home cooked food). I sound cruel, don’t I? Actually, I am quite a nice person; deep down inside.

How am I adapting to my life here? Quite well, I think. I wake up at about 6-6.15 and get to work at about 7. I and my fellow HOs will start with our morning reviews and rounds. Then the MOs come and we (HOs) will do rounds with them. After that, the speacialist will come and do another round, and we follow them as well.

After the specialist rounds, usually we HOs will have discharges to do as well as other investigations and blood takings. By the time that is done, it will be time for the afternoon rounds. Sometimes there are also new admissions to take care off. Afternoon rounds only involve the acute (really sick) patients and new cases not seen by the MO yet.

By 5.00, HOs are allowed to leave, unless you are on call or you are tagging (will explain about tagging in another post). If you are on call, there will be another review to be done at about 7pm followed by MO rounds and specialist rounds, but also involving only acute patients and new cases. Once that it over with, you just do whatever blood takings that have not been done yet or handle new cases. If there are no new admissions, then you can sleep and wake up the next morning in time for morning reviews.

Work doesn’t sound that complicated, does it? There is a lot more to work than what I just told, but then I will explain that in subsequent posts. This post is already long enough as it is. As I told you in my previous post, most of my entries are going to revolve around my work, because that is the only thing going on in my life right now. That is what my whole day is about. I hope I don’t bore you too much though. That would defeat the whole purpose of writing an entry, right?

03.01.08

Retrospective Blog Entries

No, I still haven’t got my internet connection yet. Sad, isn’t it. I thought that one of the first things I should get after I start work is an internet connection and till now, almost one month after I started work, I still don’t have one. The reason – it is too expensive.

I do have a few choices – streamyx, Maxis broadband, Celcom broadband or the dial-up tmnet thing. All these choices are either too expensive or do not provide proper service at the place that I live. I am still exploring my choices, but then I decided that I have left my blog for too long and have come to a solution.

I am going to blog at my own time in my hostel, then pass it along to KR or Rajiv, whoever comes and visits me, and tell them to post it up on my blog. I will try to write as many as possible so that there will be more posts to be posted up, but then for now it is just a plan, so let’s see how it works out. However, this means that all my posts will be retrospective entries. Hopefully I will get my internet soon enough to be able to post entries up by myself and check my mail and check my facebook and friendster account and read the papers and study (although I doubt that much of my time online will be spent studying).

Anyway, for those who don’t know it yet, I am currently an official employee of the Ipoh Hospital. I think you can expect most of my posts from now onwards to be about work and the people I meet at work. I guess many of you have heard about patient-doctor confidentiality, but then I don’t really know what I am allowed to and not allowed to talk about. I will try my best to not talk too much about my patients or even if I do, I will not use their names – so I guess its ok, right?

I think this is enough for this post. Have fun online-ing!

03.01.09