Surviving Medicine

This story is about surviving medicine.  Let’s see if you can survive reading this till the end.

It all begins with the first step. You decided to read medicine.

It’s not something simple like deciding which condiment to go with your nasi lemak – rendang beef or sambal sotong? No my friend, it has to be from within.

It’s a big step. You need to give up life as you imagined when you were young.
It’s not as simple as cough and cold, say a-a-a-a. It’s about hard work, lots of reading, burning the midnight oil, sleepless nights – yes everything you heard is true.

The first few years will be all about learning theory, lots of reading and memorizing.
You need to know the bones, the muscles, the veins, the nerves, the organs – the names there are so many of them! We also start cutting up the cadavers…the stench of formalin, the bodies in the morgue…some may not handle it.
And then you need to figure out the biochemistry, and biophysics, lots of drawing and math. If you are in a foreign country, you need to learn the language as well. Not only that, there’s sociology, hygiene, histology, Biology, MIRCObiology – all the parasites and life cycle and eggs; the bacterias, viruses and fungi.
Wait there’s more – pharmacology, all the drugs and their groups and thousand names!
We have modules and viva exams where you need to study countless topics (sometimes almost the whole book) and pour out answers to the lecturers. During the whole course we only had 2 major MCQ papers, the rest were oral viva exams. Countless one-on-one exams!

The next years, physiology, the normal bodily functions, pathophysiology the abnormal – diseases in adults, respiratory, cardiology, endocrinology, gastro, dermatology, orthopedics.. and oh wait for children too in pediatrics. And next, how to treat this and that disease. Then theres surgery, gynaecology, opthalmology, infectious diseases, children infectious diseases, pathological anatomy, nursing and my favourite forensic medicine – autopsies, we open up fresh corpses to study their organs… we learn the names of hundreds of instruments… (if you are still reading until this part – Bravo!)

Next, the clinical years – we start moving to hospitals. We talk to patients, we try to diagnose them, and figure out treatment plans. We learn xrays, ultrasounds, emergencies, delivering babies, surgeries… there will be some exams along the way too.

Finally comes the FINAL year. You will have to sit for exams, exams and exams. You will be asked everything, from year 1. You will be expected to apply your knowledge to interview, diagnose and treat patients.

And finally, you’ve graduated! It’s all over! I survived! I’m a doctor! YES! Let’s celebrate!

NO. It’s not over. In fact, it’s just the beginning. HOUSEMANSHIP comes next.

It’s real life. Yes, for real! Theory is over. Maybe even life is over as you know it.

For at least the next TWO years, your life is not yours. You dedicate it to medicine. You may miss your meals. You may not get enough sleep. You work at night when people are asleep. You will miss your friend’s wedding. You may even get belittled, shouted at, bullied, shamed in front of colleagues. You may even want to quit.

I graduated from Ukraine, a place looked-down upon due to many political reasons.
And I had to work harder. I had to proof them wrong. I spent time writing guides as a way to revise and better myself. Eventually, house officers guide was born, to help all of you survive this a little easier.  But remember this – nobody graduates and knows everything about medicine. You all start from scratch and are all equal.

So grab a book and start reading, that’s all medicine is about.

If you didn’t manage to finish this article, perhaps medicine just isn’t for you.
Please remember and do not give up halfway. You have been warned.

I’m a survivor.

 

Primary Care QR

Dear friends,

I have been trying to work on a “Primary Care Guide”, however my original files have gone missing since moving back from Miri to KL.

What remains is a “Algoritm” in which I compiled useful notes from our Malaysian CPG for your everyday practice as a Primary Care Medical Officer.

I hope it helps! Meanwhile I will try to rewrite the guide again.

Cheers

The Algorithm (Primary Care QR notes)
by Dr Gerard Loh

KKIA Guide

Dear friends,

I have left the government service.  I was serving in the KKIA (mother and child clinic) before resigning and here are some notes that I wish to share. I made a check list to summarize the main points to look out for during antenatal follow up visits.

MCH notes 2017
-compiled by my colleagues at KKIA MIRI
Many thanks to Dr Jody Yii, Dr Wong Wang Ming, Dr Fatimah Azmi

1st RME CHECKLIST
– compiled by yours truly, Dr Gerard

I have truly enjoyed my 5 years stint as a Primary Care Medical Officer and will always miss the lovely town Miri.

Coming soon: Quit Smoking Guide

Acknowledgements

Some of you may be wondering what are these meaningless phrases at the bottom of the guide covers

Well, if you look closely the capital letters are actually names of people who made a deep impression during the HO postings…

BOBOIBOY = code name for someone aka “The Cat”..he wasnt always around but this codename always made me chuckle

LOWGOR = Dr Low WH, affectionately called ” Low Gor “, hard on the outside but caring and supportive deep inside..

MS NOR AISHAH = the name says it all, one of the best HOD you will ever work for

NORA = Dr Nora, medical physician, I will never forget you…supportive during my hard times..

B.PRIYA = One of my favourite Pediatricians who was always nice, caring and loved to teach the HOs

These people made me who I am today, and I dedicate my work to them… Thank you

 

Key summary of Saturday Teach-in Difficult Dengue 13/9/14

Especially for those who missed this, Download me =)

Key Summary – Saturday Teach-in Difficult Dengue

The Promise

This is a story about my mentor

My second posting was one I dreaded the most – O&G

I remember it quite vividly.

It was my first day reporting for duty at the O&G department. Having just came back from a long CNY break, I wasn’t upbeat about this.

The steps were similar, first find the department’s PA, fill in forms…and ooh wait, something different. This time, we were assigned MENTORS.

Ofcourse, prior to the posting, we would ask friends who had passed the posting. How is it like? Who’s the fiercest MO? Who to watch out for? It was always exciting to join a new department.

One by one our names were called. And then came my turn.  I got Dr R.  And yes, she was one of the most feared ones. Gulp!

Tagging in O&G was different. There was a list of things you had to do and a viva with your mentor to pass – including delivering 10 babies.

There were about 10 of us new HOs. So the rat race began. I was never the outspoken HO, and didnt like racing with the rest, so I was quite left behind.

I didnt have the best luck in O&G. While waiting for my potential victims to complete my list, they usually ended up going for a EMLSCS…or a Vacuum delivery! That’s when I met my mentor the first time. She performed the VAD, and I stood there starring at her.  Is this the right time to say hello? Looking at her, she had that aura too..

Suddenly she turned around and looked at me, with those stern, fiery and experienced eyes….and then ignored me, and called for another senior HO to assist.
That’s it lah- I thought. Gone…

Needless to say, I did not dare to approach her as the days gone by..Alas it was time for my assessment…with my mentor.

I gathered all my strength and nervously went up to her – Hello Dr, errr…we are your mentees…(me and wife)…
What came next was something I wish to forget. The thing I call the HAIR DRYER. It was dreadful. I never looked at her face, but I assume it was full of fire and anger.
She stormed off after giving me a piece of her mind, and left us with a certain “promise”.

I was at fault. I admit it. I had waited till assessment day to introduce myself to my mentor! A week after starting at the dept.  I was terrified at the sight of her, what more to approach her.

Eventually, Dr R cooled down, and was REALLY a cool mentor. All of my first times were with her…my first caesar, ectopic…what a coincidence, no?
O&G was the most eventful and disastrous posting for me, but I took comfort in my mentor, and she defended me, and guided me to the finish line. She may have a fiery temper, but deep inside, I saw a confident and caring lady.  She was always approachable and I discovered the funny side of her.

She never really fulfilled her “promise”, and in fact it was the complete opposite.

 

Ever since then, I always remembered the important lesson.  Always introduce yourself to your bosses, and mentor!

 

 

Thank you Dr R, my mentor, my friend.  This is for you

 

The Malignant

I remember my first day vividly.

It was a fine day in October. Having successfully appealed my choice of hospital, I was quite upbeat, and a little nervous.
This is the day we have been waiting for ever since reading medicine. Am I ready for this? No.

We first assembled at the Jabatan Pentadbiran office, and were soon directed to a small meeting room. There were about 30 of us new House Officers.
Some of them happened to be my university mates, how wonderful.

After the usual filling in forms and other materials, the question was finally dropped upon us. Which department do you want to begin your journey?

Which department? Hmm..Some of them started chattering – Oh, I must start with medical first, then I have the basics for the remaining postings. Oh I want Surgical first, because I love Greys Anatomy….and things like that.

Me? Absolutely no idea. I was never someone who planned anything. Eventually, it came down to lucky draws. My gosh, at that moment, all I was hoping for was not to be separated with my girl (wife now, eventually we completed all the postings together 🙂 ).

Alas, we drew the lots, tabled the results. Orthopaedics it was! And the same for my girl and uni mates. Here we go!

So we left the office and were instructed to head to our respective departments – The Pejabat Pakar.
Finding our way to the office, I saw photos of previous housemen, pictures of our future Bosses, it was intense.
After meeting the PA and filling more forms, we headed to the wards to meet the House Officer Captain. (The usual steps when moving to a new dept)

At the ward, we met the house captains. Dr Annuar and Rina. He welcomed us and gave an interesting briefing – the proper attire, what time we start, and that we are all colleagues, no need to call each other by Dr___ , simple things like that.  Next came another revelation. He had to divide us into 2 groups. He needed 4 brave people to join him at the female ward, while the rest, to the male ward. The thing was, there was a certain Doctor let’s call her DR L. She was the scariest Medical Officer in the department. Oh sh*t. I heard these stories before…bosses giving the hair dryer treatment and all. But somehow, I ended up volunteering along with my 3 uni mates.

So off we trotted to ward 5C. Looking left and right, we saw them, the patients..some with weird equipment stuck to their foot, some with no limbs!  Some with rotten hands, and what was that smell??

And then there she was, Dr L, putting on a stern, black face and starring at each one of us. I could feel the aura. OMG, she looked like she wanted to eat us up.
After a nervy Hello~ from us, she put on a forced smile, and then looked away without a word. Oh sh*t what did I get myself into.

The rest of the day was about following rounds, and learning to use the computer system,  attempting our first procedures. It wasnt easy!  We started tagging – working from 7am till 10pm everyday, for 2 weeks. Deprieved of sleep and proper meals, we strived and struggled, trying to read thick text books. There were no guidelines for us new “taggers”.

At last, we passed our first assessment and started the full time HO job. Fortunately, we had very friendly and helpful senior HOs – Annuar, Rita, Vijay, Sheng, Munira, Hidir, Adilia, Syed…just to name a few.

 

Months went on, there were interesting encounters, Grand ward rounds, interesting cases, assessments, VIVA…I started writing notes for HOs …and then came the end of the posting.

We had a farewell party, and plenty of fun. When the last portion of chicken briyani was eaten and the last sirap drunk, then came a funny question for all of us.

Who was your favourite MO?

Looking back on the first day, and then today, there was no doubt, my answer was Dr L!
Ofcourse we were terrified at the sight of her at first, eventually she softened and became my favourite MO, and friend.

 

That’s it. My first day and first posting

It has always been my favourite moments in my HO life.  The pace at orthopedics was perfect for newcomers like us to practise basic procedures.
The medical officers and specialist were always approachable and helpful.

But it wasn’t easy at first. That’s when I decided to compile notes for the newcomers.

I was never the brilliant HO, but as I completed my postings, I always left them with a piece of my heart – the HO guide.

 

How was your first day? Your first encounter with the fierce MO?

 

 

NEW – TBCP Guide

DOWNLOAD : TBCP guide

Dear friend and colleagues,

I’ve just uploaded my latest work, the TBCP guide. This guide is intended for Medical Officers working in Klinik Kesihatan with TBCP. Managing TB or Leprosy cases especially for the first time can be confusing and time consuming to read up. This guide includes important points and simple tables to aid your everyday work at the TBCP.

Remember, always refer to your TB CPG for official guidelines as TB management changes from time to time.

Incomplete A&E guide

Dear friends,
Thank you for following our blog. As you all know, I will be leaving for Sarawak to continue my service as a medical officer there.

I’ve been working on the ED guide, however I had to put it on hiatus as I was trying to appeal my posting, which in the end was not so fruitful.

Well, so far I have done some short notes for Triage, Trauma, Basic USG, log roll…

Ofcourse there’s so much more to write but as I am leaving for Sarawak tmr, I hope this first few chapters will help you adapt in your new posting.

ED GUIDE (Trauma)

Don’t count so much on this version, it’s INCOMPLETE, will finish the guide once I have settled down in Sarawak.

All the best, dear new HOs, have a great service.

Yours trully.

Gerard

New peds HO guide

Dear friends,

I have completed my latest peds HO Guide. Again, it is an early version which requires proof reading. Kindly assist me in this and correct me if I am wrong.

May this collection help you in your pediatrics posting. Will add on more topics when time permits in the near future. Right now, I’m off to A and E! Cheers

Additional notes by Dr Goh Kiam Seong