A House Officer in a Teaching Hospital: Week 2

Monday

Don't remember what happened on Monday. Probably nothing significant. A group of 10 final year medical students came to join us in the ward. Their job is to make me happy. I am their boss. I am so grateful they are here. Dr Andrea gave me a pen and a notebook (to write down my jobs) - that's very nice of her and I am grateful for the presents (hope I won't lose them because of the past few days I nearly had).

Monday night to Tuesday morning I was oncall. It was horrible. Luckily the two MOs were kind enough to help me out. I was so slow to do everything. Bloods that needed to be taken, cannulas that were to be inserted, patients that needed to be clerked in were only done, on average, two hours after they were supposed to be done. One major delaying factor was that I had to go down to MR scan 3 times to sedate this lady, which was a scary experience on its own. When clerking patients, it's such a pain when you cannot read the previous person's clerking, and having to ask around the nurses. The nurses... what shall I say... were just not being supportive during the night. I felt so useless not knowing how to manage anything and having to phone my MO for everything. Call call call coming non-stop. The lady gaga ringtone of my phone got more and more irritating as the night went, and I thought for a few moments that I was having auditory hallucination of the sweet romance ringtone. I need to revise my medical emergencies management and learn how to priorities better.

Tuesday

I was so tired post call that all I could think was can I please go to sleep stat? All I could recall was a really long teaching ward round which lasted until 3pm. The peak of my sleepiness came about during the discussion of renal tubular acidosis in a young patient. I don't care how interesting the physiology of the disease is. I want to get this over with and go home and sleep. I ended up doing discharges until 11pm that night. Working continuously for 42 hours in hospital. Can you imagine my exhaustion?  

Wednesday

I made a patient cry today because I have poked her too many times for ABG. I really cannot understand - this is the second patient that I have encountered that I just simply cannot get any ABG. I did it the usual way which I can proudly say, yield rather good success rate. I tried for about 10x before giving up.

I suddenly had a sense of how meaningful my job is. There's this patient whom I really wish not see everyday. He has chronic renal failure and pulmonary oedema, and it is my job to take blood from him everyday. Unfortunately, he pulls up a 'tak-nak tak-nak' show every single morning. Come on... I haven't got time for this: I have 27 other bloods to do! What I normally do is to leave him alone for a while and come back after I have finished everyone, by then he would normally be in a better mood for me to poke around. I had a really important job today, which was to sort out his social welfare. His son and his life has been in a mess for years but no one had bothered to properly get the necessary help for him. The registrar had assigned this important job for me. I helped him write support letter, get the social worker to see him, get help for dialysis etc. I was proud that I was able to put aside my vengeance on how he has made my life difficult every morning and rise above to understand that he's only acting like that because he is ill. I am really determined to do this part of my job well.

Thursday

I really hate relatives surrounding the patient when I am trying to take blood or put in cannula. It's ok if it is easy and requires only one shot. But if I have to try 5/10 times before I get it, I feel the pressure as the relatives get distressed for seeing the patient getting distress. Normal people are just not emotionally numb to patient in pain like doctors are. I am considering if I should ask the relatives to go away while I do these next time.

Dr Andrea made everyone wear pink today. We took a group picture. That was really sweet.

Dr Yusniza, my registrar gave me two of her white coats today. Aghr.... now I have no excuse for not wearing it anymore. 

Untraumatic radiology scans requests today. HAHAHA!!!

Friday

Started the day with one of my patients collapsed. Thank goodness she was found before I arrived in hospital, or else I'd be clueless on what to do. Abi, who was oncall, dealt with it impressively. I did my first successful femoral stab for her (with all the surrounding nurses cheering). Unfortunately, we arrested not long after, and we did CPR for 50 minutes - unfortunately she did not survive. Quite sad.

There's another reason for me to be proud of myself today. One of the patient needs cannula for blood transfusion. She's been ill for so long already, she's literally skin and bone. She needs a pink one, but all her veins were of the blue size. The medical students and I had tried so many times - left hand, right hand, left leg, right leg - nothing went in. I was already on the verge of giving up when I thought I felt a small vein on the leg. Went for it, and hurray - it's in. I'm so proud that I persisted and did not go asking for help without trying my best. (at the expense of the patient suffering of course).  

Saturday

Dr Andrea gave me a day off. Will grab the opportunity to study.

Sunday 

It started ok. 4 discharges. Before my ward round finished, my already getting calls. It was only a tidy bit better than my on-call last time. I still haven't finishes the discharge by 8pm. Luckily there was a very very kind medical student to help me with 2 discharges, or else I'll be stuck with discharge and delay the rest of my on-call work by another 2 hours. 

I have still not learnt the art of prioritizing yet. There's new patients from emergency and admitted electively to be clerked in - supposed to be seen as soon as they arrive in ward (take history, examine, take blood, and prescribe medication so the nurses can give them out asap as a minimum) . Also in patient who suddenly has problem like shortness of breath, chest pain - some of which, obviously I need to drop everything and go as soon as they call as it could be a matter of life and death. Finally, there's petty jobs like take blood, insert cannula - not unimportant either because the patients who usually need blood have dengue or electrolyte imbalance who need regular monitoring, and patients who need cannula would have needed it for IV antibiotic or blood transfusion. Many a times when I'm trying to sit down and do something, I get called to do something else, which fragments my job. So 10 jobs becomes 30 jobs because I have to go back and forth 3 times to complete the unfinished work. Of all the jobs amassed during my oncall, only about 50% have been done. I feel so bad because the patient don't get the treatment they need. I've also really not been having time to document everything I've done - this could well come back and bite me in the future (really, of so many jobs I have during oncall, documenting is the least of my priority. But I need to make it the priority to cover my ass). So far, my MOs (more senior doctors) had been very supportive, but I feel the support has gone to the point of burden. Like last time oncall, I skipped lunch, dinner, breakfast and lunch next day just because all these were not my priority compared to clerking new patients and attending to acutely ill patients. Was absolutely totally exhausted. Didn't finish oncall work until 9am next day.

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A House Officer in a Teaching Hospital: Week 1

Day 1

Reported to the hospital at 9:30am. A big pile of forms to fill in. Met another new house officer (HO), Sara. We were supposed to go to another four places to settle the admin stuff: the department of medcine, general admin, security and white coat. Didn't manage to do the latter three because our head of department wasn't around on that day, whose signature is required to complete the latter three things. Allocated to the department of medicine.

Met Abi, the house officer leader. She was so happy to see us because medicine has been very short of HO that she was working oncall every 2 days. I was allocated to work for ward Med5 with Abi, while Sara will be working next door with another HO, Izni. 

I tagged Abi until 10pm that day. Oncall is crazy. Say I am oncall for monday, I will come to work as usual on 7am monday, start oncall at 5pm until 7am the next day, then resume ward work from 7am until 5pm - 36 hours non stop. Jobs include clerking new admission which could be up to 28 overnight, covering the 6 medical wards, cardiac care unit, cardiac rehab unit, high dependency unit and a semiprivate ward all on our own. 

Day 2

Already given half a ward to be in-charged of. Aren't we supposed to be just shadowing on the first week? So scary to be on my own. The routine is we take blood, ward round, request scan, make referral and prepare discharge summaries. Luckily the medical students were around to help out with the jobs - such angels. I was particularly anxious of having to request for scan and make referrals over the phone because my medicine has really gone a little rusty and I don't know the patients well thus didn't always know why the scan was requested. 

Didn't tag oncall but still stayed until 10pm to prepare the next day's discharge so I would have less work tomorrow. Unfortunately it would benefit someone else tomorrow.

Day 3

There was a crisis today. One of the medical HO did not turn up for work and wouldn't answer his phone. Abi said he's been depressed for a while because of the job. So I had to go upstairs to ward Med1 to cover for him. What an experience being the only HO in the ward. With no medical students and another HO to help out, I spent the entire day taking blood. I felt so useless taking such a long time, like a headless chicken going back and forth the trolley. And to make it worse, Abi still wanted me to go downstairs and manage half of the ward. I did go down for a while but was sent back upstairs by the specialist again. 

I have fallen in love the team upstairs here. The specialist is called Dr Andrea. She's amazing. She said there's no hierarchy in this ward, that I can ask anyone anything. Finishing blood so late, by the time I started the discharges it was already 4-5pm already. She and the MO sat down to help me do the discharges - I was so moved! (The first three days were a bit of a shock and I was constantly feeling emotional, I really could have shed the happy tears). It turned out that I needed to call her mobile at 9pm about some discharges and she was happy to help me out. 

My first acutely ill ward patient today. This lady who was suppose to be discharged suddenly complained of shortness of breath. I forgot to think ABC, but I briefly asked the patient some question and examined her, then asked the nurse to do a set of obs and called the MO straightaway. In the mean time she didn't look too unwell so I carried on doing discharges while waiting for the MO. A repeated set of obs was done in 20 minutes - the heart rate had shot up to 133! Just as I began having palpitation and cold sweat, the MO arrived. She asked me what's wrong, and I said I wasn't sure. Then she asked me for differential diagnosis for shortness of breath. That's easy - pulmonary oedema, MI, PE, pneumonia, pneumothorax, asthma etc etc. She said if I knew why didn't I work out the problem myself? Why indeed? Busy panicking perhaps? Then she reminded me that I'm a doctor not a clerk, and taught be how to deal with problems like this in the future. Opps, nearly forgot about that. A good lesson. 

Didn't have time to go to admin.

Day 4

Back to the downstairs ward with Abi. Today I had a strict MO - no mistake allowed. I very quickly get taught how to run the ward round and I learnt quite quickly. There were quite a few jobs to do but I was getting much more organized and was actually finished before 8pm. I then helped out Abi who was oncall again with blood. I spent an hour in high dependency with two very poorly and veinless patients.

Abi broke a bad news to me: said I won't be working in Med5 with her anymore. It was because Sara, the new HO, who was sent to cover the ward Med1 upstairs today could not cope alone, and Dr Andrea was more comfortable with me (I'm so flattered). Abi was quite upset that I was going. I was too. :(

Still didn't have time to go to admin.

Day 5

Yes! Back in Med1. Came at 6:30am today as I don't want to spend the entire day taking blood for the whole ward like the other day. It all went well as planned until about 9am the high dependency kept calling me over to do bloods, cannula, consenting their patients, interrupting my organization. 

The evil plan was that there were 9 discharges today! Luckily the team of my seniors was kind enough to help me with 6, or else I would be staying in hospital overnight. Well, nearly... I finished everything and went home at 11pm.

Still didn't have time to go to admin.

Day 6

Sadly, Malaysian doctors of all levels, from house officers to specialists have to work on weekend. Maybe I did push myself too far yesterday. Felt completely drained, was so slow to do the blood and kept missing when I normally wouldn't. I informed Dr Andrea and Aida about the 2 impossible patient who needed cannula. Today I saw how brutal and heartless doctors with many years of hard training are. In each patient, we poked about 20 unsuccessful cannulae before giving up, ignorant to the patient's moaning, involuntary jerks etc. I am not that cruel yet - I would try up to only 5-6 times before stopping. Again, I'm so moved that they are willing to help me do these house officer's jobs. They inserted proper central lines in them eventually. Managed to escape just before dusk today. Yeah!!!

Day 7

My best day yet. Came in at 6:45, managed to finish blood round by 8:30, even had time to read about the new patients and update the blood results. Joined the round properly for the first time in Med1. It was fun actually. They taught me how to write and I picked up very quickly. Not very dissimilar to the UK, I've been writing round notes since third year. Dr Aida, my MO was such an efficient partner - while I write, she went around doing all the jobs, so they'd be no jobs left for after the round (apart from bloods, cannula, discharge, in other words my job). Dr Andrea complained that I wasn't wearing white coat today. I have to wash and I only have one... And then she said she would give me hers. No no no please forget it. And then she said she would give me hers. No no no please forget it. It's so filthy, people coughing TB, Strep and all sorts at me everyday. Now I am having some cough now. Hope I don't have to take MC. Another fun thing was that my cannulae all went in the first time round! Satisfying. 

Dr Andrea told me that from tomorrow I would have a group of medical students to help me out. In fact, they were already here today to clerk in their patients. Asian medical students are so hardworking - they come in at 7am, weekends and does overnight oncall. I love medical students. 

Went home at 5:30. Bliss.

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This week I am so grateful for my colleagues for giving me the support I need - my specialist, registrar, MO and fellow house officer for giving second opinions on cannulae, helping and training me up for the job, attending to my calls about sick patients, answering my query at 10 o'clock or simply asking if I am coping alright - meant so much. Says who that junior doctors in Malaysia do not get support?

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