Saturday, May 14, 2011

HOusemen Story

JMO --> Medical Officer

Life couldn't have been any better when I'm finally given the position of Medical Officer-ship whereby I can get the weekends off and go back earlier on weekdays. After having experienced my housemanship and JMO-ship for 15 months, I'm grateful to have survived it through and through and finally, appreciate more on the weekends. As a doctor practicing in Malaysia as a house officer, and I could probably generalize this to other parts of the world, one has to carry out not only clinical work but all the other secretarial work to the core; yet the other term of office-clinical boy. And if I could reminisce on the past that I have so long endured, and why house officers should be allowed a better pay... here goes:-

(i) Work 7 days a week, fortunately the concept of 7-11 is not applied here, or we would be dead

(ii) No clocking out at 5 pm on weekdays or 12 pm on weekends, unless if you have finished your work, and in our setting, you usually clock out 3-4 hours after the stated time

(iii) You are expected to do calls at least 3 times per week depending on the amount of house officers available

(iv) Work more than 100 hours per week, my record was 118 hours in a week

(v) Take all the bloods, set all the lines, do all the ancillary procedures like central venous lines, chest tube insertions, pleural or peritoneal tapping, catheterization, peritoneal dialysis, clerk all the cases, memorize the patient's progression, remember all the investigation results, attend to emergencies as front-liners, document all the trivial things, do most of the things first-hand despite having no idea what you are doing

(vi) Refer all the cases and most of the time not really knowing what the purpose is for

(vii) Getting hammered for not knowing what you are referring and not including enough data

(viii) Run all over the hospital to get the blood results, rush for the blood, then run to the theater to send the blood, run back to the ward as your staff may have forgotten the preoperative antibiotics, and run to the radiological department to get the CT scans your surgeons want to have a look at before operating (this did happen to me before)

(ix) Be the scapegoat most of the time during ward rounds, everything goes wrong is because of the house officer forgetting or can't recall

(x) In each mortality presentation, the house officer will in any way, be nailed for something he did, be it documentation or examination

(xi) Be ridiculed for the meager amount of knowledge he or she has, sometimes in front of the patients

(xii) Overworked and underpaid, people do come to you and ask you why the heck is your face so gloomy, and that you look like a piece of garbage with unidentified stench emanating from goodness knows where

(xiii) Expect the unexpected as difficult patients pose you a tough time just because they know someone up the ladder who happens to be your most nastiest boss, and so that you should treat them extra extra nice, or else you face extension (aaahh... this happens so often I couldn't even count it with my ten fingers)

(xiv) Having been overworked, you are expected to display a compassionate look and portray your patience to patients despite knowing for the fact that you can see up to more than 50 patients in a day (both in or outpatients); and that's only see, what about the procedures and the secretarial work that comes with it? 24 hours in a day is simply never enough, and I recalled that every moment when I am the only house officer in a ward managing all the things from head to toe

To have survived this drafty period of hard-core work, as many would have proclaim, would make the better out of you, would make you stronger and make you more durable. Yet, seemingly, with all of these ongoing grill, I found myself being admitted 3 times in the ward and multiple times in the casualty bed; and I don't literally find that as a very comforting thought.

Falling ill is common as one fights his way through housemanship. Yet, the way paved for a house officer is not at all encouraging. When a house officer falls sick, there is no such thing as a medical certificate. It is not applicable to them as they have to repay back the sick leave that they take for an extension on their 4-month long duration. And to add things worse, they are counted into the annual leave, despite having true certification on how sick you are and that you are admitted to their ward. Anyway, I was fortunate to have additional leave to my pocket to spare even after I spent the most of it hanging dry in the hospital bed. The process may be cruel in its own sense, and it couldn't have been made more nasty with certain individuals who are slightly higher in rank who are the least in their mind, thoughtful or caring.

But all of that changes when I went into the Paediatrics posting. I was appreciated for the work that I do, and to put on the sugar and spice, I was continuously showered with words of encouragement and support for my skills in computer. The staff nurses in the ward that I work in commented on the speed of my work which made everyone's life a comfort zone, and the head of department together with her underlings actually cared for once, about my welfare. Never had I been to a posting so far in my year in housemanship whereby the head of department would actually call me (a nobody) up on my handphone to discuss matters pertaining to my welfare. They cared so much that they were the true apple of my eye. Aside from the long hours in working and the amount of workmanship poured into the posting which is as vast as the ocean, one could possibly work tirelessly in view of the ongoing support and care that they will give you. Though there are times that certain rules ought to be altered for the sake of some other's welfare, there are also the certain tacts of simplicities when you can approach the big boss and discuss issues. This occasion occurred towards the end of my Paediatrics posting, and that alone made me think twice with regards on staying onwards as a Paediatrics MO or to wait for the tide to sweep me to another place.

I was certain through some words shared by the boss that I should give it a try as I have no idea what I wanted to do; and as well as the other piece of advice that I should at the same time follow the tide as it will bring us to places that otherwise, we will never have a chance to see or experience for ourselves. I gave in to the last piece of advice as I have already have other things in my mind. You see, becoming a clinician is a rough and grueling process to which many would think of it as something general. There are so many specialists and consultants nowadays that to become another specialist is equivalent to just another freshly passed out house officer. One has to dig in deeper to earn his respect, and the new breed of subspecialties are breeding everywhere. Things like Cardiology, Cardiothoracic Surgery, Respiratory, Urology were once the subspecialties that many would take a jog on and carve a name and a fame for themselves. But the demands are getting greater that no soon enough, we'd probably have a specialist on just Heart Attacks all by themselves, and Congenital Heart Disease specialist all by themselves.

The tide has turned, the future is yet but coming, and the demands are taking a toll on everyone that the clinicians are wondering whether should they continue to upgrade themselves or just stay on the same track which probably would put them off the radar. Glad to say, I am comfortable to stay on track with what comes and what goes, and staying in Cardiology for now would be something afresh and perhaps grant me the opportunity to grasp whatever knowledge that I can before I venture on another totally different dimension.

Back to the current position that I am in, I am still enjoying the luxury that comes with the promotion to MO status. Aside from accumulating more knowledge from the books, journals and updates that I am now obligated to; I get to enjoy at the same time the weekends off, reporting to work later than a house officer, having the laurels to go back earlier, and having people to work under me. Of course, with the higher position, comes greater responsibilities and I have to now depend on my cerebral rather than my spinal efforts to get things done. That worries me, well most of the time when a decision comes to point and whereby making a wrong one would yield disaster. Tagging thereby becomes a vital point, getting to see fresh cases as it comes to casualty and discussing with a senior colleague on what to do as a first-hand experience.

One, especially me, begins to now see a different light of dimension as I take a seat on the medical officer's chair and assumes its backbone of relinquishing and relegating responsibilities to house officers (within their realm of knowledge and capabilities) while at the same time, ensure the stability of the patient before handing it over to the underlings to manage it. Anything wrong goes to your head but knowing at the same time, learning is a curve filled with many sharp corners and that leaning onto one may be painful at first but it soon will stick into your mind as hard as it could to make you feel the importance of it. But... setting that aside for a while, as I will soon begin my tagging later; I am for once, after 15 months getting to finally enjoy my first weekend break. It is a relatively good change as I can now look forward to more trips back to Penang over the weekends and more relaxation period for me as I can now concentrate more on accumulating knowledge on ECGs and Cardiology cases so that I will not look dumb when people (even patients) start asking me about things in relation to the heart.

Somehow, God is gracious, and I am grateful to be posted into Cardiology. It was my first love as I started that similar posting when we all moved to the new hospital. The coronary care staff nurses were very well-trained and kind and helpful in many ways. And I could still recall the close friendships that we had when I was a first-poster house officer. Even then, I was respected as a doctor in making decision and being the front-line decision maker in the absence of my superiors. I handled myself well and I am glad that I was granted that life-changing event to which gave me the opportunity to like General Internal Medicine. But, I guess, things change as time goes by, and having tread my sole onto O/G, General Surgery and Paediatrics as a house officer, the stress in life has peaked and to earn that same love again for the posting that I enjoyed so much, that would probably take a longer duration than one could possibly fathom.

Suffice to say, my stress level seems to be taking a downward trend as I am now granted the comfort of doing the things that I enjoy. As I completed the last day of my housemanship, and walked back home with the thought at the back of my mind that seemed to linger on the whole day, the words "It is over" were all painted in all the corners of my brain. I was glad to close the chapter that I have no intention of reopening it. I am in no favor at any single time to discuss its occasions of austerity to any others, the practical rigidity that I was imbued with for all these past one year. The stringent kowtows and fear of being extended or put up as a scapegoat is no longer a picture to experience and for once, I could live a better life and breathe the clean air, while exhaling, through my mouth. The past life of swallowing all the unhealthy air and only have the toilet bowl to complain my rants and grunts to are finally over. I could finally, for once voice my opinion and let them be heard; but of course, that don't mean that I should go looking for troubles.

Right about now, prior to me starting my real tagging calls, I guess I should take a long desired break, which explained how early I collapse last night and how late I am finally able to wake up to today. That luxury had escaped me for the past 15 months, and now, I am glad to have it back by my side.


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