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.

.  .  .  .  .

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?

.  .  .  .  .