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Tagline: “Hourly Toilet Break”

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If humans had taglines, what would yours be?

Those who have worked with me know that I have such thing called “The Hourly Toilet Break”.

Firstly, because I consume lots of fluids and secondly, that is how I ensure I do get the break once in a while on a busy day or maybe, the day is quite slow and I am just, bored.

Of course when the day is rather busy and hectic, time just flies and that I do not even realise the time passing by. By the time I actually do complete my task and take the opportunity to just rest for a while, 2-3 hours have gone by.

How Did The Hourly Toilet Break Started?

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I didn’t actually planned for such thing at work. Obviously.

At home, I do frequently go for my toilet breaks as I’m forever consuming green teas or black coffees or water. All of which contributes to the filling of my bladder, in addition to the fluids being diuretics.

It wasn’t until I started my tagging in my sixth rotation, the Emergency & Trauma Department that I reinforced this so-called “hourly toilet break”.

The tagging hours in the Emergency & Trauma Department is long, just as in other postings whereby we had to work from 7am til 10pm everyday with an off day each week for 10 days straight.

Thus, it helped me in ensuring that I either get to sit and recollect myself during hectic days or to make the hours pass during slow days.

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22nd August 2025

Daily Dose, Housemanship Diaries, Sixth Posting (Emergency & Trauma)

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My First Night Shift In Emergency & Trauma | Housemanship Diaries
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Remember when I mentioned that I love the night shifts?

No? Well, here are the articles advocating my love for that shift:
- The Joy Of Working The Night Shift As A House Officer
- My Favourite Time Of The Day At Work
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My first night shift in this department was in the Red Zone and I was terrified.

Thankfully, it was with a fellow Registrar who is rather patient, kind and one who loves to teach.

The scary part however was that it is the Red Zone after all and on my first night!

The Red Zone basically caters to patients who are unstable be it haemodynamically or in terms of their vital signs or that they are in a state of severe acidosis, on the verge of collapsing, you name it. Basically, how severe of a state a person must be in to end up in that zone.

The night started off smoothly with cases coming in one at a time. Alright, I kept repeating to myself, “attend them, transfer them to another bed, vital signs, bloods, fill out forms, clerk and basically just listen to your superiors”.

The night eventually turned into midnight and into the wee hours of the morning and finally the sun has risen. Before I knew it, it was 7am and the AM shift House Officer has arrived. I am not alone again.

Time to prepare for handover rounds at 7:45am.

It was better after that, having another person with me as it felt less intimidating.

At 10am, I took off and headed home. Not a bad experience for the first night shift.

The good thing about the night shift in the Emergency and Trauma is that we are not alone. There is always a team or at least your superiors are always there.

However, I don’t quite prefer the night shift in this posting. Having actually completed this posting, at the time of writing this article, the daytime shift is definitely better.

Nonetheless, in all the night shifts, albeit that it could be a terrifying one especially prior to the start of your shift, always remember that you are never completely alone even if it feels like it and that help is always nearby.

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21st August 2025

Articles, Housemanship Diaries, Sixth Posting (Emergency & Trauma)

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Life After Offtag In Emergency & Trauma | Housemanship Diaries
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The tagging hours in the Department of Emergency & Trauma is from 7am till 10pm, for a total of 10 days and one off day per week. There are no assessments required to off-tag, only hours required to cash in.

During our tagging season, we were not allocated for night shifts as well.

For me, tagging in this posting felt like an eternity. I remembered counting down my days before I would finally “offtag” and be switched to regular working hours. I also remembered being extremely exhausted at the end of my shift, wondering how did my fellow colleagues managed to pull through.

Tagging in this posting as compared to the other postings was considered less stressful as we were not required to arrive early for morning rounds. We merely had to arrive on time and upon the end of our shift, we leave, as compared to other postings where we would stay back almost every time, cash in “unpaid overtimes.”

Finally after 10 days of tagging, I officially “off-tagged“.

So how was life after that?

Much better. Thankfully.

Regular hours in the Emergency & Trauma Department meant working a 12-hours shift per day with an off day per week and a single night shift.

Basically, we had to ensure that in total, we had to meet the total 60-hours shift per week.

Thus are the timings for our respective shifts:
- AM Shift: 7am – 7pm
- PM Shift: 10am – 10pm
- Night Shift: 10pm – 10am
If you have read my articles on “The Joy Of Working The Night Shift As A House Officer” as well as “My Favourite Time Of The Day At Work“, I mentioned that I absolutely love the night shift. The disadvantage of working the night shift is that we are usually alone and the night shift can be rather unpredictable.

However, it is not the same for me in this posting. Out of the shifts listed above, my favourite is the AM shift, 7am till 7pm. Initially, getting up for work at 7am is tough especially after working the PM shifts back-to-back. But after the initial morning sleepiness wears off, the day proceeds as usual and we return home at 7pm which is nice.

Life after offtag in this department ensured that I had adequate rest prior to my shift starting. No doubt, it is a 12-hours shift every time, we usually arrive and leave work on time as compared to other postings.

Nonetheless, I was still exhausted after every shift. Perhaps it was due to the accumulated mental and physical stress throughout the previous five postings that when I am finally blessed with extra rest, I am still tired.

If you are still in the tagging phase, be it in this department or others, please stay strong. Remember that it doesn’t last forever, it is merely over a certain span of days or weeks.

Keep showing up, keep doing the good work to the best of your strength and abilities and keep moving forward.

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20th August 2025

Articles, Housemanship Diaries, Sixth Posting (Emergency & Trauma)

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Day 1 Of My Final Posting – Day 647 Of Housemanship
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My first day of my final posting, The Emergency & Trauma Department, commenced on the 11th of April 2025.

Day 647, finally. Finally! I’ve pulled through and entered the last pit stop of my journey as a House Officer.

In every posting, I have always looked forward to this posting. Prior to joining, I’ve always had mixed feelings and initially wanted to join Anaesthesiology. However, a few weeks prior to entering, the other postings such as Psychiatry, Klinik Kesihatan and Anaesthesiology were removed from our options and everyone had to rotate in the Emergency and Trauma Department.

This is good. This meant more manpower.

However, just as the previous postings, prior to joining any new department, I’ve always had this fear and mixed feelings because it is after a new environment.

My fear was stumbling too badly on my first day. Thus, of course, I did my research and questioned the people I knew who were already in the posting.

My First Day began on a Friday in the “Yellow Respi Zone“.

The Yellow Respi Zone consists of patients who are unable to saturate well under room air, usually less than 90%. Having just completed the Medical Posting, the patients allocated there are primarily Medical patients or in particular, having respiratory issues such as patients developing acute pulmonary oedema or fluid overload secondary to non-compliance to their fluid restriction.

Thankfully, I have just completed Medical. Thus, I am able to apply my knowledge learnt which was still fresh at that time.

I arrived a little before 7am since the tagging shift is from 7am till 10pm, introduced myself to the medical officers and talked to a fellow friend who arrived and would be working in the same zone as well. I went through the triages and casenotes of the patients to see if there were any active cases or cases that were due tracing of bloods or referrals.

The day started off rather quietly and it was manageable. I followed the morning handover rounds at 7:45am and after that attended to any new patients or refer if needed.

Basically, when a patient comes in, especially to this zone where the patients’ chief complaint is “shortness of breath“, the first person who attends would usually auscultate or “listen” to the lungs and check the vital sigs prior to taking blood or doing a “full clerking” such as obtaining their past medical history or history of presenting illness.

The next person that steps in usually helps with the bloods and fills the forms.

Everyone worked together as a team and somehow indirectly we were communicating with one another without actually voicing it out. It seemed almost like a dance, or a workout.

Afternoon came and afternoon handovers started at 2:45pm. I met a lovely medical officer who is a junior herself but one who was extremely upbeat and more than happy to guide me.

I learnt a lot during my first day with her. She even encouraged me to consider joining this department during my floating period.

The evenings became extremely busy to which I did not really realise. Maybe because it was my first day or maybe because I have just completed my Medical Posting (and it was much busier over there), or perhaps because I simply enjoyed working with my superior or team on that day.

The day ended at 10pm and I walked back home. Thankfully, I lived within walking distance thus I saved time and did not have to worry regarding transportation or parking issues.

My first day in my last posting or rotation started off well which is something I’m more than thankful for.

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19th August 2025

Articles, Housemanship Diaries, Sixth Posting (Emergency & Trauma)

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Surviving 10 Days Of Tagging | Emergency & Trauma Department
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My tagging days in my sixth and final rotation, Emergency and Trauma Department, lasted for a total of 10 days which was from the 11th of April till the 23rd of April 2025. This is excluding our one “off day” for the week.

Did I manage to last throughout the tagging days?

Not quite.

I did take a sick leave during my second week of tagging. The reason was that I was just extremely tired.

Photo by Pixabay on Pexels.com

The tagging hours in the Emergency and Trauma Department is from 7 am till 10pm, just in other postings.

The good thing about this department is that we do not need to do morning reviews. Thus, coming way early prior to our shift is unheard of. We merely come and leave on time.

However, considering that it is the Emergency Department, things are unpredictable whereby things could be quiet one moment and hectic the next.

Hence, on days which burn, it can be extremely tiring. But, completing these tagging days are a must and so on slow days where the hours seem to pass by really slowly, I make it a point to have an “hourly toilet break“. On busy days, it may be the only time that I am given a chance to sit and breathe.

On top of that, I made sure I took my lunch and dinner break. Not because I was hungry as I was used to having my meal for the day after work. It was merely my way of spending my time during my tagging days.

At 10pm, the shift is over and I leave, even if the floor is busy because the following day my shift begins at 7am again.

Finally after 10 days of “tagging“, I have finally off-tagged and shifted to “shift hours“.

Photo by Andrey Grushnikov on Pexels.com

There are no assessments in order to off-tag. as there were in other postings, which is a good thing. However, tagging in this posting felt long and seem to went on forever for me. Perhaps, this was because I was mainly tagging alone as I entered a month later than my fellow peers.

Nonetheless, I was glad to be done with this schedule and shift back to a regular 12-hours shift.

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18th August 2025

Articles, Housemanship Diaries, Sixth Posting (Emergency & Trauma)

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Overcoming My Fear To Refer A Case I DO NOT KNOW | Housemanship Diaries

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What fears have you overcome and how?

At the moment of writing this article, I am in my sixth and final rotation which is in the Department of Emergency Medicine, pushing into my third month.

One might think that as we become more senior in our current job, it gets easier or the fear fades.

Well, the anxiety certainly reduces but that does not mean that it disappears.

For me, the fear is still there as to who I would be working with or who I would be referring to and most of all, referring a case that I not know.

I’m sure we’ve all been there before. Especially upon arrival to work and to be absolutely clueless about the patient and their case and progress and to not have anyone handover the case to you.

Not that we won’t take the time to understand. It is just that, we will or at least I would take the time to digest the initial presentation, clinical examination and findings followed by the initial management of the patient and other teams as well as the current progress.

Once I have finally understood the issue of the patient from A to Z, then I can confidently refer the patient for a simple thing.

That’ll usually take me about 5-10 minutes, especially if there is just one too many writing. To others that may seem like an eternity.

The thing is they will somewhat give me a template of what to say in regards to the patient but I am still absolutely clueless and wishes to kindly absorb the pages and information about the patient before I walk into the battlefield.

This is because, one too many times, I will be asked about things totally irrelevant to the case of the patient which will take me some time and if I’m not so lucky, ended up being shouted at. I mean, that’s the worst that can happen right? Certainly reminds me of my early days of housemanship.

Maybe it’s a form of childhood trauma or maybe not, but I need to at least have a reason to defend myself and the patient.

It’s like a debate or a business deal which I find that I may need to fib or exaggerate myself in order to get a test approved or to refer, all for the sake of the patient or sometimes the superiors.

It’s alright but at times it can be rather annoying especially when they want it done in a minutes time.

The next that I have to actually open my mouth and communicate. Being an introvert, I can easily talk to people but I dislike being in groups, small talks or actually talking at times.

I find it exhausting and thus upon the end of my shift, I just need time to recuperate.

However, back to the question of this article, my fear, to refer to other departments, especially, if it is a case I do not know and to a tiger of a person who loves finding any fault just to reject the case is still present to this day and what have I done to overcome it? Nothing, really, just extreme patience.

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17th August 2025

Daily Dose, Housemanship Diaries, Sixth Posting (Emergency & Trauma)

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My Last Shift As A House Officer in Medical | Housemanship Diaries
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At the time of writing this article, I am no longer in my Fifth Rotation, Medical but already in my Sixth Rotation, The Emergency and Trauma Department and at the same time, due for my last shift in my Sixth rotation as well as being a House Officer.

Looking back, my last shift in the Medical Department seemed ages ago.

However, I remembered that I was night shift at that time and was at Male Medical Ward (MMW).

My duration working in this ward was around 3 weeks. However, it was my least favourite as compared to Medical 3, Medical 4, the Infectious Disease (ID) Ward or being part of the Perimedical team. The superiors were alright but it was the vibe of the ward in general that I found unsettling that I can’t quite place my fingers on.

The night shift in Medical is from 8pm till 9am. However, on that day, I recalled leaving home at 6:30pm to go to work as we were not allocated any “long day” shifts.

“Long Day” or “LD” are those who work from 7am till 10pm. Thus from 6pm till 8pm, prior to the night shift person coming, there is a 2 hours gap which is filled by them.

On that week, there were no “Long Day’s” and everyone had the opportunity to return home at 6pm. However, who would fill in the “2-hours gap”?

Thus, I remembered me and my colleagues at that time coming into a mutual agreement and compromise that one person would stay till 7pm and the night shift person would arrive an hour earlier at 7pm.

It was a good compromise except there would be nobody to accompany us till 10pm and usually their help is valuable. Those hours till 10pm can get rather hectic at times.

I remembered arriving around 6:45pm and started receiving handover from the AM teams and was cautioned to lookout for a particular patient in the acute cubicle who was rather unstable.

Upon finishing our handover, the Medical Officer on-call for that ward arrived and things started to go hectic.

I can’t exactly remember what happened but I was on my feet the whole time and did not begin my “coming mornings” till 3am.

Thankfully, I was still able to complete them before 5am and the morning bloods were out in the system on time.

That morning during my post night shift, I was “summoned” for minimal bloods which I completed immediately. Usually during my post night shift, I would remain within the sights of the “AM team” and offer to help out where I could.

But I remembered at that time that I was completely spent. I decided to rest in the House Officer’s room and take any bloods a little later prior to my shift ending, if there were any.

Surprisingly there were none after that. I recalled seeing a junior taking the blood of a patient as I was exiting the ward and asked him as to why he did not just ask me.

He claimed that upon arriving for his morning shift, I looked rather spent and after I left to take a short break in the House Officer’s room, he just did not want to disturb me. After all, he said, it was only one patient.

I was touched and grateful. It was a small gesture. However, it’s small, simple things that sometimes touches you.

After that, I clocked out for the last time as a House Officer in the Medical Department.

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16th August 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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Jobs That I’ve Had

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What jobs have you had?

Teacher

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My first job that I’ve ever had was as a Teacher.

I had just completed my STPM which is a form of pre-university course in Malaysia, equivalent to that of the UK A-Levels and I was waiting for my results.

At that time, I was on a holiday with my parents and was perusing through Facebook when I came across an advertisement on a job offer at a nearby language centre, looking for an English Language teacher.

Without any expectations, I applied for it. At least, I’d have some exposure and regularity prior to entering Medical School in September that year.

Shortly after I returned home, I received a call and an email responding to my application. I went for the interview session and was soon called back and offered a job to which I accepted.

Barista

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My second job, I was a barista at a coffee shop as well as worked at the cash register of a store, both at the same time during my first and second year of medical school after which I stopped and subsequently used to work as a waitress for an F&B company. That was my third job. My second and third jobs were jobs mainly to earn extra cash after classes amidst my free time.

Looking back, I probably should’ve just focused on my writing.

Junior Doctor

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My fourth and current job is working as a junior doctor at Sarawak General Hospital. I still am one since I started practicing in 2023 and is currently going through my sixth and final rotation (at the time of writing this article) before finally receiving my full APC or license to practice independently both in government or private sector.

Am I ready for it? Certainly not.

However, somehow I haven’t quit and I kept pushing through. I don’t know how or why and before I knew it, 2 years has flown by.

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15th August 2025

Daily Dose, Housemanship Diaries, Sixth Posting (Emergency & Trauma)

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Reflection – After Almost 2 Years Of Practicing As A Junior Doctor

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“Would you want to return back to medical school?”

No.

I enjoyed my 5 years of medical school very much and I appreciate the memories formed throughout those years.

However, after working as a junior doctor for 2 years, I would not consider turning back time, just to go through medical school all over again. I enjoyed studying and it was equally tough and fun. Besides that, I had the best study group, “The Impostors”.

Going through the COVID-19 Pandemic season of social distancing and online classes made the journey easier. I remembered staying back in Kuala Lumpur and waking up in the morning prior to starting class just to set up my laptop and my connecting screen, sending the link earlier to the group, sharing the slides if needed and while the classes are on-going, I would go about cooking, cleaning or folding clothes.

My coffee and tea would be on standby and everything was prim and proper. Besides that, breakfast, lunch and dinner would always be prepped by me, for me or my friend who lives upstairs. After that, I would proceed to study during the wee hours.

I think the time I managed to complete reading various textbooks were during the COVID pandemic.

Then, I graduated and started my housemanship. It was extremely tough at first and it’s still difficult now at times but I’ve grown to accept the fact that there will be difficult days as well as good days.

Three months later after starting my housemanship journey, my first pay was banked in and subsequently, every month I received my monthly pay.

Eventually as I become more and more senior, things became more and more familiar and easier and some things or procedures became a reflex, even the management plans.

Thus, considering, the things that I’m doing now which I think is much easier as compared to my medical school days, would I want to turn back time?

Nope. Medical school is important and equally tough. On top of that, I’m not getting paid. Instead, my parents had to pay for my medical school fees.

So, no. I cherished those days as I said. But I certainly do not want to relieve them again.

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14th August 2025

Daily Dose, Housemanship Diaries

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Preparing For My Exit From The Medical Posting As A House Officer | Housemanship Diaries
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Medical. My Fifth rotation.

While I was in Medical School, my favourite rotation was the Medical Posting and I’ve always imagined myself being a Medical Officer in Medical.

Thus, upon entering my Housemanship Journey, I did not choose to rotate in Medical as my first posting. Many people said that the Medical Posting is the most difficult posting of all the postings due to the patient load as well as the workload.

Thus, I began in Orthopaedics and placed Medical as my Fifth Posting. Mainly, because I wanted to “enjoy” it. Enjoy it in the sense that I already knew the basics and knew how to function as a House Officer and would be able to learn how to manage the patients.

However, albeit being a senior poster, some old habits retain. In the Medical posting, we were required to hand in our logbooks 2 weeks prior our End of Posting Date.

However, I approached my mentor 5 weeks prior my exit. Unfortunately, my assigned mentor at that time was not available and asked me to approach my Specialist-in-charge of House Officers at that time to request for a new Mentor.

I approached the Specialist-in-charge and was assigned a new mentor which happened to be someone I worked with multiple times while I was in Medical 3.

The following week was a rather tensed week for me as I tried my best to cram as much as I could.

I finally had my assessment with my first mentor who is a Medical Officer that Sunday. Thankfully, I passed.

2 days later, I went for my assessment with my second mentor, my reassigned specialist, who passed me as well.

The issue next was the completion of my 12 CMEs. CME stands for Continuous Medical Education which occurs once a week on Tuesdays. In other postings, only 5 CMEs were required in order to pass. Sadly, it is not the same for the Medical Posting.

Unfortunately, CMEs done online were not acceptable even if there are certificate of attendance.

Luckily, I had attended a Hospital CME some time ago and I was only looking for ONE more CME prior to my exit of this posting.

Thus, I used that to my advantage and finally, I was able to hand in my logbook and officially exit the posting.

Sadly, a few days prior to my exit, something occurred that led to the demise of a patient. But, that is a story for another article. Thankfully, that did not affect my exit from this posting and I exited, on time.

If you are due to finish the Medical Posting or any posting in general, take it as a lesson from me and approach your assessors much earlier.

Otherwise, all the very best!

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13th August 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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Surviving The Night Shift As A House Officer In Medical 3 | Housemanship Diaries
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The Medical 3 Ward of Hospital Umum Sarawak or “Sarawak General Hospital” is located on the 9th floor of the main building.

Thankfully, being allocated as the Night House Officer, we only had to take care of one ward, unlike being allocated in Medical 4 / Medical 5 / Infectious Disease Ward or being in the Perimedical Team whereby we were always on the go.

The Medical 3 Ward consists of three teams, which are General Medicine, Respiratory and Neuromedical.

During the daytime, we have allocated House Officers for each team. However, during the night shift, we are in charge of the whole ward.

The jobscope of the night shift House Officer in this ward is the same as in other wards and postings which are transferring in of new patients, attending to acute issues and most importantly, coming mornings.

If you have read my previous article on Surviving The Night Shift In The Medical Posting In General, I mentioned that in this posting, upon my arrival to the ward for my night shift, I would begin taking my coming mornings.

The same goes for Medical 3. However, unlike the night shift in Perimedical, I do not take my arterial blood gases with my coming mornings.

I begin from the Respiratory cubicles which is located at the back of the ward and then move to the front cubicles before finally continuing at subacute and acute cubicles which are the beds located in the middle of the ward, in front of the nursing counter.

If I were late for my coming mornings, then I would proceed with taking the arterial blood gases together. But if I finished early, I would take the blood gases much later.

By 5:30am – 6am, I would start running my blood gases and paste them in the casenotes of the patients. Around 6am – 7am is when the morning team starts arriving to trace the bloods as well as begin their morning reviews.

Thus, I wait to be summoned for my bloodtaking or certests.

Finally, at 9am, I return home from my shift.

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2nd August 2025

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Surviving The Night Shift In The Medical Posting In General | Housemanship Diaries
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The shift that I have always dreaded but enjoyed the most were the night shifts. I dreaded it because I knew that I would be alone most of the time and afraid that I would not be able to cope with the adrenaline rush or anxiety or the craziness that might ensue. However, I enjoyed it because that meant that I will be able to sleep in prior to going for my shift and the following day at 7am, the morning team will start arriving and I am not alone anymore.

The Medical posting in general is a “heavy” posting because of the patient load. Almost all of the patients are so-called “Medical” patients once Surgical, Orthopaedic, Psychiatric or other causes have been ruled out, and it could stem from something as simple as electrolyte imbalance to myocardial infarction or stroke.

Thus, imagine the amount of coming mornings.

Prior to entering this posting, I’ve always enquired and listened to my fellow colleagues’ input and experiences. Most of them would say that “In the Medical posting, the rule of thumb for surviving the night shift is to start taking the bloods as soon as you arrive for the night shift”.

True enough. That is something I have practiced since and even in other postings as you do not know just when something may happen and next thing you know, the sun is rising and your coming mornings are late and the morning team have arrived and the bloods are still pending or not in the system or yet to be taken and the medical officers and specialists have arrived.

Sadly, when there is a delay in the blood investigations, there is a delay in management.

Thus, it is a tachycardic moment for me. Prior to entering my shift, I would screen through the coming morning list and upon arriving, I would usually prep my trolley, ensure my coming mornings are divided and arranged according to their cubicles, ensure enough syringes and needles are set aside as well as the alcohol swabs and cotton swabs.

Then, I will begin taking my coming mornings, usually working my way from the back of the ward then towards the front cubicle, subacute cubicle and finally, ending with the acute cubicle.

Usually in between, something will occur, maybe a patient newly admitted into ward or a patient will suddenly be hypotensive or hypertensive or hypoglycaemic or starts throwing up or wants to have a small talk.

Normally, I would not mind entertaining them. However, if I’m still due to complete my coming mornings, I would proceed to complete it and I usually will not rest until I do. At least I’ll be rest assured that should anything occur in between, I would not have to worry about the completion of my coming mornings.

The night shifts can be rather unpredictable as one minute it can seem rather quiet and calm at first and hectic the next. At times, it can get overwhelming as well.

However, have faith and know that help is always nearby and start taking your bloods as early as possible.

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29th July 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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My First Night Shift Covering Medical 4 / Medical 5 / Infectious Disease Ward In Sarawak General Hospital – Housemanship Diaries
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Around my third month in the Department of Medical at Sarawak General Hospital, I was reallocated to Medical 4 which is the “Nephrology Ward” meaning patients who are admitted with newly diagnosed chronic kidney disease or have underlying kidney pathology requiring biopsy or haemodialysis (HD support) but clinically stable as in not requiring oxygen support, not in sepsis or not requiring medications for blood pressure support are admitted here.

I will explain more about that ward in another article.

Anyway, back to the reason for this article, being allocated in this ward meant that I had to cover not just this ward, Medical 4 but also Medical 5 as well as the Infectious Disease Ward during my night shift.

In the Department of Medical, the night shift is from 8pm till 10am the following day.

While I was allocated here, I was blessed enough to have a few taggers in the ward and tagging is from 7am till 10pm.

Thus, upon heading down at 8pm, there are usually a few people in Medical 4 till 10pm. Thus, upon entering my shift, I would first head over to Level 9 to place my bags, pop into Medical 4, for a while and then head over to Medical 5 to take the coming morning bloods.

Upon completion, I would then head over to Medical 4 and begin my coming mornings there. Usually while I’m taking my coming mornings, new patients will come in and thus I would transfer in at the same time.

Upon completion of my coming mornings in Medical 4, I would usually send my bloods at around 2am and then head over to the Infectious Disease Ward to take the coming mornings.

In between I would be free but sometimes I would receive call for new transfer ins at Medical 4 and Medical 5.

At 5-6am, I start running the blood gases. Usually when I take the coming mornings bloods, I would take the blood gases as well and keep it in a separate syringe in the cooler.

Surviving the night shift initially was intimidating as I have yet to experience it and Medical 4 and Medical 5 were located far apart from each other.

My main concern was if something were to occur at both wards at the same time.

Thankfully, my experiences were mostly good and I enjoyed every night shift I’ve experienced thus far in this ward.

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28th July 2025

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The Most Enjoyable and Tiring Day In Medical 3
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I can’t remember which day it was but it was probably during the weekend or a public holiday as I remembered that I was allocated on call who was in charge of this ward.

I was allocated to “General” on that day and was I was alone at that time. I remembered sitting at the other end of the ward at around 11am when one of my colleagues who was allocated to be covering the “Neuro” patients went to have lunch.

The medical officer on call at that time, a rather “happy-go-lucky” and rather jovial person struts into the respiratory cubicle and asked if there were any house officers available?

To which I responded, we’re right here and he came over. He asked for the person who was in charge of the front cubicles which happened to be my colleague who went for lunch. I asked what’s wrong, is there anything I can help with?

He casually replied, nothing much, just walked in and saw a patient’s pulse oximeter reading 70% under room air. Then he laughed.

Me and my friend who happened to be there at that time were shocked and rushed to the patient. True enough, the pulse oximeter reading was 70%, well, 68%. Oddly enough, the patient seemed rather comfortable and not tachypnoeic. In fact, he was surprised as we crowded around his bed, looking concerned.

I asked him if he was having any difficulty breathing which he was not. Thus, our first instinct was probably the machine was faulty and proceeded to check with another vital signs machine.

This time, it was 65%.

I proceeded to take full set of bloods while my medical officer was writing his review and my friend attempted to call my colleague.

I ran his arterial blood gas and it showed Type 1 Respiratory Failure. Considering he did not have a baseline during this admission, we do not know if this was near his baseline or a sudden deterioration.

We called the Peri ICU team and referred the patient for non-invasive ventilatory support (NIV). Imagine, not knowing why this long stay patient was ever here in the first place to summarising the reason for admission down to his current progress. It turns out, he was due to be stepped down to a district hospital for continuation of antibiotics.

Well now, he can’t.

We transferred hum to the acute cubicle for closer monitoring while awaiting the Peri ICU team.

While awaiting, my medical officer decided to check on a patient who was handover to him for afternoon reviews.

This lady was in her 60’s and was admitted for left pleural abscess, meaning there’s pus in her lungs and for this patient, the whole left lung was completely filled. Clinically, she seemed well, speaking in full sentences and laughing to her family members as well in the morning.

In fact. I was even taking her bloods that morning only to have it splashed all over me after attempting to fill the blood culture and sensitivity bottle.

I recalled walking past her as I made my way to the front of the ward and she seemed alright. However, the moment me and my medical officer oncall stood in front of her. She desaturated an started being tachypnoeic.

Well, here’s another one.

There goes the next referral to the Peri ICU team for intubation and also Urology for emergency suprapubic catheter insertion as we attempted to insert a urinary catheter multiple times but failed.

Now, all these events happened very fast but at the same time, time flew by fast. The second patient was intubated and we inserted a femoral venous catheter. My medical officer then wanted to excuse himself to settle the pending discharges in his other ward. However, the first patient wasn’t saturating well under NIV and needed to be intubated.

There goes another intubation as well as another femoral venous catheter insertion. Finally, after all the chaos, things began to finally settle down.

I proceeded to trace my coming mornings, considering that I was the only one in charge of “General” that day and nobody would be helping me. Finally, I proceeded to begin my oncall reviews. This was around 8pm by that time.

After completing my in all reviews with intermittent disturbance in between. I proceeded to aid my friend in preparation of her coming mornings.

It was close to 11pm, I was just clearing my stuffs and getting ready to go when a nurse informed me that a patient seemed rather tachypnoeic.

Annoyed and tired, I attended STAT to find a patient sitting at the side of the bed with his BiPAP machine unlatched and hanging at the side of the bed. The patient beside him then told me, he removed it himself an hour ago.

Boy… Why am I not surprised?

This is another impending intubation.

At this rate, I might as well not leave anymore.

The day was busy enough. I sometimes wonder why is it that we feel guilty to even desire to return home on time? To walk out with the family members watching us finally ecstatic to return home for the day while their family members are stuck in the hospital?

Back to that patient, I didn’t left him gasping on his own of course, I fixed back the BiPAP machine, took an arterial blood gas and alerted my night colleague and medical officer oncall to which they attended STAT.

Thankfully, the following day, I was allocated as night shift. Thus, despite returning home late, I was able to sleep in and recuperate a little before returning back to work that night.

It was a busy day but considerably a rather fun one considering that I happened to work with a rather jovial medical officer oncall and my colleague stayed back to accompany me despite her shift being till 6pm.

Working with certain people definitely helps alleviate some of the pressure of the day.

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10th July 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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A Junior Doctor In Boots

Tell us about your favorite pair of shoes, and where they’ve taken you.

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Prior to having my first pair of boots in 2021 while I was in my third year of medical school, I have always dreamt of wearing boots. Be it short cut or the long ones till mid calf or up till the knee, I loved them all.

I prefer them over heels or flats or slippers.

Partly because I have always imagined myself as a “country girl” in summer dress or jeans, always paired with boots.

However, I’ve never had a pair of boots till I was in my third year of medical school, even that, was given by my aunt. I remembered using it to almost every occasion because it was so comfortable and versatile. The colour was dark green, an ankle length boots with zips on the side. I wore it till one of the shoe had a hole on the side and even then, I was still adamant to wear it till my mom got me a new pair of boots and threw my first pair away.

Since then, I’ve gone through another 2 pair of boots, one pair with heels and another flat. I occasionally wear the one with heels and often use the flat one. The flat one is my go-to everyday boots be it for outing or travelling or a simple trip to the market. However, I rarely use them to work. At work, I have specific types of shoes that I usually wear since I’m on my feet most of the time and these shoes gives me the sole support that I need (if you know what I mean).

But there are days when I’m feeling fancy that I would dress up a little and don a nice blouse over my black leggings to work. Those would be the days when I would wear my favourite regular pair of boots to work, which boosts my self-esteem for the day considering that it is my style, one that I feel brings out the inner-me, the junior doctor-in-boots.

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8th June 2025

Daily Dose

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40 Days Since I’ve Started Being Vegetarian

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Describe one positive change you have made in your life.

The positive change? Being vegetarian. Well, for 40 days then I’m non-vegetarian again.

Why did I even embark on this journey?

Every year during Lent, I would embark on a vegetarian journey, a lacto-ovo-vegetarian journey to be exact and this year, it was from the 5th of March till the 19th of April 2025.

Thus, I went from consuming meat to consuming tofu almost everyday as well as started consuming vegetables again.

Albeit being vegetarian, I try to reduce my rice consumption. Thus, I mainly mixed rolled oats into my dishes.

I started shopping for groceries even more (which may not be such a good thing) but I was surprised at the number of items I could buy and only spend minimal.

Well, vegetables are cheap, which is good.

Changing my diet in combination with my usual routine at work and ensuring I reach my daily steps of 10,000 steps, I started losing weight.

Not much. However, I’ve been struggling with losing the weight that I have gained during my time off in the Surgical Posting.

Now that I’m non-vegetarian again, obtaining food is easier and I actually miss being vegetarian.

Perhaps soon I will embark on this journey again.

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3rd June 2025

Daily Dose

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My Next 6 Months (Post Housemanship)
What is the biggest challenge you will face in the next six months?

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At the time of writing this article, it is the 8th of April 2025, Day 644 of my Housemanship Journey. I have just completed my Fifth Posting in Medical and is currently on leave as well as due to begin my 6th and Final Posting in Emergency Medicine on the 11th of April 2025.

One posting or rotation lasts for a total of 4 months if there is no extension, for House Officers.

Thus, it’s safe to say that for the upcoming 4 months, my focus would be on leaving and enjoying my final posting and the challenges I would most probably face then would be the completion of my logbook, preparing my presentation for CME and preparing for my end of posting assessments.

But how about for the subsequent 2 months after that?

That’s a grey area for me.

First of all, I do not know myself on the department that I would want to serve in as a Medical Officer as I enjoyed every posting that I have ever rotated in.

Next, the state or hospital that I would be interested in practicing in for at least the next few years. Currently, I am practicing in Hospital Umum Sarawak, otherwise known as Sarawak General Hospital or “SGH”, in Kuching, Sarawak.

Personally, I would like to stay back over here and serve here rather than to go back as I absolutely love it here and feel like this is where I am meant to be.

However, things might change in the future considering that I would want to get married and my partner is living in Peninsular Malaysia. That’s one as well as the consideration of my parents, having grown up as an only child.

Thus, a grey area for me, nevertheless. Me, being comfortable with procrastination has pushed this thought to the back of my head and refused to entertain since I have to submit my full MMC application by the 13th of April 2025.

This means, I have to set my mind on a department as well as my choice of state (location) or hospitals of choice.

Oh dear…

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20th May 2025

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Laughing – A Way To Destress

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What makes you laugh?

Laughing – A form of de-stressing activity. To which some may find “distressing”?

Or perhaps I’m just a little unbalanced.

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However, back to the prompt, I would laugh at almost anything actually.

Many would ask me on why do I laugh so easily or on almost anything. Honestly, I have no proper answer for it. Perhaps, the easily justifiable answer would be that it has become a form of my default reaction towards answering people.

Firstly, it softens my expression, thus making myself seem more approachable (or so I think). Sadly, that also means that sometimes people would not take me seriously. Next, it lightens the situation and prevents a tensed situation from escalating. However, it may also flip the other way around which may further escalate the situation instead as me laughing may deem that I do not take them seriously.

Sometimes, when I am being thrown an insult, I do react by first laughing about it, as a shield for myself and preventing myself from being hurt or at least giving myself some time before digesting the issues.

Then, there are times, when I am lost in my own world, which is most of the time, I would suddenly remember something funny or find something amusing and start laughing to myself. At times, it may escalate into a hearty laughter to which some might find distressing.

Nevertheless, after a good laugh, I would usually feel better, as they say, it releases endorphins, a “feel good” hormone and thus, “laughter is the best medicine”.

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18th May 2025

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My First Hour Of The Day

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What are your morning rituals? What does the first hour of your day look like?

By default I rise around 4-5am. Perhaps out of habit as I usually take my time in the morning. Sadly, this also happens during my off days even when my alarms are off. My body clock is somehow tuned to waking up at such.

As mentioned, I take my time upon waking up. Thus, upon waking up, the rain sounds which I fall asleep to would be playing in the background and I would sit by the side of my bed and slowly make my way to my kitchen which is just across my bed, since I live in a studio unit and put my kettle to boil.

The kettle is usually filled the night before and hence, one thing less for me to think in the morning. This is then followed by my morning bathroom rituals and brushing my teeth.

Usually by then, I would have been much more awake and proceed to consume my iron tablet, vitamin C and making my morning coffee which is a mixture of 3-in-1 sachet and a teaspoon of black coffee since I prefer an even stronger coffee.

If I were working that morning, I would prepare both of my 1.5L of flasks by filling them with cold coffee which I have brewed a day prior for me to bring to work.

Why 2 flasks? Well, one is not enough.

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There are days when I’m feeling hungry or in the mood, I would prepare myself breakfast. My go-to-regular is frying egg mixed with mushrooms, chopped chilli and curry leaves and adding them to my breakfast sandwich. During my time being vegetarian, I would usually grill or air-fry my premixed tofu which I have marinated with spices, acting as a burger patty and my breakfast sandwich is prepared.

There are days, despite waking up earlier, I would still miss breakfast, thus instead I would pack it for work.

After that is followed by showering and getting ready for work. I usually wash my hair in the mornings daily. Thus, prior leaving for work, I would dry my hair with a hair dryer and style it up in a bun and I’m good to go.

How about if I’m not working on that day or if I’m night shift for that day?

Usually I proceed with my usual cup of coffee or I would go the extra mile by brewing myself a pot of masala or ginger tea with the tv playing in the background of some random YouTube video on productivity, to which I’m usually not listening to and merely keeping it on in the background for some background noise.

Then, I would proceed to prepare my breakfast and start my day with some writing or studying.

Well, that’s my first hour for the day, or perhaps a little more than that.

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16th May 2025

Daily Dose, Housemanship Diaries

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Iced Tea & Cold Brew Coffee

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What is your favorite drink?

As the title entails, it is Iced Tea and Cold Coffee.

1. Iced Tea

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I fell in love with tea, green tea, black tea and oolong tea in particular when I was 14 years old.

At that time, I was looking into drinks to aid my weight loss and I came across green tea and oolong tea being suitable drinks in facilitating weight loss when consumed without sugar.

Thus, I brewed my first proper sugarless green tea and fell in love with the taste. Ever since then, I started drinking it on a regular basis and it has pretty much replaced water for me.

Did it aid with weight loss?

Perhaps in the beginning, eventually, I continued drinking it because I enjoyed the taste be it warm or cold.

As I started working, I would usually prepare cold brew green tea in order for me to bring to work the following day.

Photo by Charlotte May on Pexels.com

Why cold?

The environment that I’m working in can get rather warm and considering I am a person who perspires easily, the temperature of the tea eases me and provides immediate rejuvenation.

Even after a long day at work, nothing refreshes me more than a cold brew green tea served in mason jar and a straw.

2. Cold Coffee

Photo by Marta Dzedyshko on Pexels.com

I am a HUGE fan of coffee, black sugarless coffee in particular.

My love for coffee began since I was in primary school, which I think is a bad thing since children are not supposed to consume coffee.

Back then, my mother would used to prepare coffee for my father and milo for me prior to my father sending me off to school and heading to work.

Me and my father would then switch drinks after he has drank half of his drink.

Then, when I turned 14 years old, I started pulling an all nighter or getting up at midnight just to study.

Eventually, I developed immunity towards coffee and is able to fall asleep even after consuming it. Thus, I merely consume it out of addiction and routine.

As I started working, as mentioned in my explanation for cold tea, the environment is rather warm for me to be consuming hot coffee. Hence, I would prepare my mason jars of coffee the night prior and transfer it into my flask the following day.

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14th May 2025

Daily Dose

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My Grocery List As A Junior Doctor – While I Was In My Vegetarian Phase

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Being a Junior Doctor or a House Officer, we are located the lowest in the hierarchy of medical personnels. That is because we have just started practicing which means there is still a lot for us to learn on top of learning how to be a safe doctor as well as the simple management of the patients’ condition down to their tailored management. Thus, this automatically translates into long hours at work, a mentally and physically tiring journey as well as a reduction in our total night’s sleep.

Are we married to our work? In a way yes and also no.

Not that we want to or that we are workaholics but being in this field, it is an unspoken expectation which seems to have befallen us.

Thus, our so-called “work-life balance” is almost always in disequilibrium and we try our best to destress in whatever way suits us best.

For me, it is cooking and recently, I have embarked on a vegetarian journey for the Lenten season (at the time of writing this article, it was during Lent), as well as a way of trying to be a pinch healthier to my already unhealthy lifestyle.

Since I enjoy making my own meals, I rarely eat outside. Thus, the idea that vegetarian food is a little bit difficult to be obtained or ordered online, does not really bother me.

A bright side to this is that, I’m lacto-ovo-vegetarian, meaning I consume egg amidst being vegetarian as well as dairy products and throughout my vegetarian season, I did not reduce my food portion (which may be bad). Rather, I simply changed my food choices from non-vegetarian to vegetarian and from ordering take-outs to consuming more home prepared meals.

Thus, what are the grocery items that I ensure I stock up on a regular basis?

1. Tofu

Photo by Polina Tankilevitch on Pexels.com

I absolutely CANNOT live without tofu. It is extremely versatile as I could make any kind of dish with it. Most of the time, I would simply dice it and marinade with some spices and air fry it.

At times, when I’m feeling fancy, I would use it as a burger patty as well.

2. Mushrooms

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This is another versatile ingredient. From enoki mushrooms to crab mushrooms, oyster mushrooms or button mushrooms, you name it. I’m a big fan.

I try my best to stock up on fresh mushrooms. However, since I go through it pretty fast, I would usually fall back to dried mushrooms since it is readily available in the mart of my residential area.

3. Eggs

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Luckily, I chose to be lacto-ovo-vegetarian, meaning if I ran out of ingredients, I could pretty much add egg, be it just cracking them into my broth or frying them.

4. Bird’s Eye Chilli

Photo by Anna Nekrashevich on Pexels.com

Bird’s eye chilli or “cili padi” as we call it in Malaysia.

I am a big fan of spicy food and since I go through chilli powder pretty fast, I started incorporating them into my dishes.

Be warned though, if you’re not a fan of spicy dishes, adding one too many may render the dish unconsumable.

5. Rolled Oats

Photo by Karyna Panchenko on Pexels.com

This usually takes some time before it finishes.

Since I am a “heavy eater”, I started substituting my rice with rolled oats instead, which is something I started doing 2 years ago.

I’m not a big fan of having my oats with milk as I find it rather sweet or sometimes just bland for my palate. Instead, I prefer savoury dishes and the oats complements most of the dishes well.

6. Curry Leaves

Photo by Rahul Sonawane on Pexels.com

This does not really serve any purpose except I merely enjoy the aroma emitting when I sizzle it with oil, adding a nice aroma to my dishes.

7. Random Vegetables – Cabbage, Leafy Vegetables, Potatoes, Cabbage

Photo by Mark Stebnicki on Pexels.com

I started eating greens again.

I have always loved eating vegetables. However, it is not easily obtained since I do not have a car, I rarely go out and the nearby residential mart does not sell them.

Thus, I order online, I usually have a few fallback vegetables which I would add to my cart which are cabbages, any leafy vegetables, potatoes and aubergines.

Photo by Laker on Pexels.com

Cabbage is another versatile vegetable as I could add it to my curry dishes and it does not wilt immediately, as an extra ingredient in my stir fried noodles as well as when I cook “okonomiyaki”.

These are my food grocery list by default. I’m not exactly a health conscious person despite being a doctor myself nor do I reduce my food portion. It is merely a step for me to try and be a little bit healthier which is sustainable for me and hopefully in time, it deems fruitful.

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12th May 2025

Daily Dose, Housemanship Diaries

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My Teenage Years

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Describe a phase in life that was difficult to say goodbye to.

Upon reading this prompt, I was reminded of my high school days. The first year of high school was very tough for me in terms of adjusting to a new school, cultures and subjects.

I went from a comfortable place to a different one without any guidance nor advice and I went from being a senior to a freshie all over again, which I did not like.

In addition to that, I had a very bad temper and used to talk back to my seniors which did not aid in my reputation. Well, that was the first year, things started getting better the following year onwards and my grades picked up. I have accustomed myself to the flow.

It was during my teenage years that I met my good friends whom I still keep contact to this day albeit not meeting much.

Looking back, I enjoyed my routine and studying very much. Waking up early was the hardest part of the day, which surprisingly isn’t one for me now, I have transitioned into an early riser.

This is followed by shower, preparing my breakfast and lunch for school, which mostly just includes me grabbing bread or biscuits and stuffing it in my bag and wait for my parents to send me off to school, which is usually my dad. He would send me off prior going to work.

I was truly blessed to have experience that.

In school, it was about attending classes, completing homework or assignments, gossiping with my friends or attending extra-curricular activities. However, the place I truly enjoyed spending my time was in the library. Thus, if I were to bunk class, I would lock myself inside the library and just study or read. The perks of being a librarian. Thankfully, my teacher-in-charge of the library always had my back if I were to be questioned regarding my whereabouts.

After school, my mother would be the one who usually picks me up from school and most of the time, we would eat outside. Occasionally, she does cook at home and as I am writing this reflection, I truly miss these simple heartwarming dishes.

This is then followed by me showering, completing my homework, studying, chilling, going out with my mom and getting ready for tuition or extra classes which are usually in the evenings or on alternate days.

Life was simple and predictable. I remembered attending multiple tuition classes during the week, mainly because I was bored being at home as I was not allowed to simply go out with my friends as I pleased. Thus, I looked forward to those evenings.

Holidays and weekends were the things I looked forward to as well and I enjoyed recuperating or simply helping my parents out with their chores, watching movies or TV shows, studying with music, writing and playing video games.

Surprisingly, what aid me in studying back in high school was due to video games. Perhaps it was the way I “destress” and it drives my mind.

I was not allowed to work during the holidays as my parents feared that once I get the taste of my own earnings, studying will no longer be a priority. However, my pocket money wasn’t great either. But I still got by and occasionally, my dad would slip in some money without my mom knowing just so I could enjoy a nice meal across the road with my friend.

The stress back then were focused on exams and completing homework. Occasionally, life dramas do get in the way, all part and parcel of being a “teenager”, having crushes, jealousy and bullying.

However, for the most part, I enjoyed my teenage years and looking back, I wouldn’t change a thing except to be more disciplined in my studying and to learn more.

Those years flew by rather quickly. Before I knew it, I was a senior and the stress of choosing a major or course and the university applications kicked in. Over the years, I’ve accumulated multiple fond memories with my friends as well which were a mixed of beautiful ones, silly and extremely foolish ones, which we do look back and laugh about during our meet-ups.

If you are reading this, I hope that you did enjoy your teenage years as much as I did too. If you are a teenager, do not fill your time with just studying, immerse yourself in extracurricular activities as well and discover new habits. It is the season of discovering yourself, and hopefully in years to come when you do look back and ponder, it will be filled with sweet memories as well.

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10th May 2025

Daily Dose

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Part 2 – Life As A Peri Medical House Officer In Hospital Umum Sarawak | Main Building, Side Building, Infectious Disease Ward
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The Peri Medical House Officer Team takes care of:
1. The Emergency Department
  - Green zone
  - Yellow zone
  - Yellow respiratory zone
  - Green-Yellow zone
  - Asthma Bay
  - Red Zone I
  - Red Zone II
  - Decon
  - CSSD
  - EDOU
2. Main Building
3. Side Building
4. Infectious Disease Ward
5. SDC (Surgical Daycare)
In this article, I will be sharing my experiences as a Perimedical House Officer covering main building, side building, SDC as well as the Infectious Disease (ID) ward.

As I previously mentioned in my previous article, the work begins from 7am till 6pm (short days), 7am till 10pm (long days) and 8am till 9am (night shifts).

Covering this part of the hospital meant taking care of “stranded patients” which are medical patients who are lodging in other department wards as there are no space or beds available in the main medical wards. Usually, patients like these are somewhat stable enough to be left on their own without constant supervision. Those that do require, are usually left in the Emergency Department or transferred straight to medical wards.

The Main Building

Taking care of the Main Building meant that one would have to cover:
- 2nd floor: Urology Ward
- 3rd floor: Male and Female RTU Wards
- 4th floor: Labour Ward
- 5th floor: Maternity 2 (Antenatal Ward), Maternity 3 (Postnatal Ward)
- 6th floor: Female and Male Orthopaedic Ward
- 7th Floor: Male and Female Surgical Wards
On some days, there would not be any perimedical patients in certain wards. Thus, there are days that we do not have to go to these wards. On bad days, there are perimedical patients on every floor and the patient count will be extremely high.

During my time serving in the main building, I was blessed enough to have a partner. Thus, despite the high volume of patients, it felt manageable.

Upon my arrival, I usually begin from the highest floor and work my way down. Thus, I begin from the 7th floor by checking with the TL or Team Leader to identify new cases and update the list followed by tracing the blood investigations.

This is to ensure that the patients are not missed during rounds.

I proceed with doing this in the wards of every floor till I am done prior to beginning my morning reviews.

Usually by then, the Medical Officers have arrived and are proceeding with their morning reviews.

Sometimes, we join in and sometimes, we are asked to review the other patients and on our own until the specialist arrives.

Upon the specialist’s arrival, we would all meet up at one place to begin out rounds.

Rounds in perimedical is similar to that in the ward. The only difference is that rounds are once daily and the patients are all around the place.

In between, there would be new transfer ins, attending to acute issues of which the nurses from other wards would call or inform the House Officers from other departments.

After that, it is followed by preparation of the coming morning bloods. The wards and bed numbers are labelled on top of the forms and kept in the ETD for the night House Officers to take.

The Side Building

The Side Building is less hectic than main building and that meant we had to cover:
- 3rd floor: Neurosurgical ward / Neurosurgical HDU, ICU extension
- 4th floor: Paediatrics Orthopaedic Ward
- 5th floor: Gynaecology Ward, Ophthalmology Ward
As usual, upon my arrival, I would begin at the topmost floor and check for any new patients as well as to trace the bloods.

After all of it is done, I begin my review in the ICU Extension 2 Ward. The ICU Extension 2 ward consists of unstable, intubated patients of various departments.

Usually by the time I begin my morning review, the specialist would have just arrived and we begin our rounds.

After the ICU Extension 2 is followed by Neurosurgical Ward since they are located at the same place, then Neurosurgical HDU.

Upon completion of morning rounds is followed by carrying out the active joblists, discharges and requesting for radiological scans.

Similar to Main Building, the coming morning bloods are prepped and kept at the Emergency Department for the night house officers to collect.

SDC – Surgical Day Care

SDC is the Surgical Day Care as per the name. Usually patients who are admitted here come in on the day of the procedure itself and is discharged in the evening.

However, when the wards are fully occupied and the Emergency Department is overflowing with stranded patients, the SDC converts temporarily to host the stranded patients.

At max, the patient load is only two cubicles full and the patients being admitted there are usually relatively stable.

Similar to main building and side building, I begin my day with tracing the bloods, x-rays or any relevant radiologist reports before beginning my review and rounds with the medical officer and specialists.

The Infectious Disease Ward

The Infectious Disease Ward or “ID Ward” is located in a building separate from the main or side building.

Previously, it used to be the House Officer’s Accommodation. However, it was subsequently converted into a ward.

The ward consists of two floors with each floor containing 6 isolation rooms for each floor. Upon entering the ward itself, one has to change into the hospital scrubs and prior entering the ward isolation rooms, one has to don apron, shower cap and gloves, the standard PPE.

The casenotes are not allowed to be brought in, thus all reviews are written outside.

What do I do if I were stationed to at the Infectious Disease Ward?

The house officer allocated to the ID ward are those from the Peri Pool, meaning our shift is from 7am till 6pm for short days.

Thus, upon my arrival, I would change into the hospital scrubs. Then, I would proceed to trace the bloods. The bloods sent from the ID ward are usually late. Thus. It would either be pending in the system or yet to be in the system.

Next, I will begin my reviews, first to the newly transferred in patients followed by the rest while awaiting the medical officer.

There is a whiteboard consisting of the names of the patients in the isolation rooms. Usually in the morning prior to entering the isolation rooms, we would have a short round and presentation with the ID consultant with the whiteboard.

Thus, during my time there, I would constantly update and personalise it according to my style which would be easier for me during my presentation with the ward consultant.

After that, we will all proceed to the isolation room. As House Officers, we are the scribe and assistants of the medical officers. Since, we are not allowed to bring the casenotes into the isolation room, thus we will type everything inside our phone and transfer it onto paper after our grand rounds with the patients.

Rounds at the Infectious Disease Ward is only once daily.

After the completion of rounds, just like any ward is the completion of active joblist.

Personally, I enjoyed my time in the Infectious Disease Ward a lot, mainly because I was given the autonomy to customise the board as I liked, present to the consultant myself and was asked multiple questions during rounds and having discussions which I find rather stimulating and enjoyable.

On top of that, I even had time to return home for a quick lunch every time I was stationed at this ward.

In the afternoon, some patients on high oxygen support may need arterial blood gases (ABGs) at certain time. If not, it is the preparation of coming morning bloods and transfer ins of any new patients.

Being in charge of the other places is considerably less hectic than being allocated in the Yellow Zone which can get rather crazy at times as there is massive movement of patients constantly. It actually feels like as if I am at KL Sentral during peak hours.

However, do not fear if you are allocated into the Peri Medical Pool. The workload can get extremely hectic and it can be rather messy. But, always try your best to learn as much as you can during your period serving there and to enjoy your journey.

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8th May 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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Part 1 – Life As A Peri Medical House Officer In Hospital Umum Sarawak | The Emergency Department
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Upon entering the Medical Posting, I was stationed into the “Peri-Medical Pool”. My “birthplace”, so-called.

Prior to entering the Medical Posting, many of my colleagues commented that the Peri-Medical pool is probably one of the worst place to enter considering that it is rather hectic, busy and messy, not to mention the joblist is never ending.

The working shift for a Medical House Officer is as such:
- Short Day (SD): 7am till 6pm
- Long Day (LD): 7am till 10pm
- Night Shift (ON): 8pm till 9am
The Emergency Department in Hospital Umum Sarawak is rather huge and consists of:
- Green Zone
- EDAU
- CSSD
- Yellow Zone
- Yellow Respi Zone
- Green Yellow Zone
- Red Zone I
- Res Zone II
- Decon
Usually a House Officer is allocated to take care of more than one zones.

For example:
- Green Zone / EDAY / CSSD
- Yellow Zone / Green Yellow Zone
- Red Zone I / Red Zone II / Yellow Respi Zone
When the amount of manpower is high, the job gets done quickly and keeping track of the patients is easier.

However, in days where we are stretched thin it is rather difficult.

The Day Shift

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Since I entered the Peri Medical Pool on my Day 1 of tagging in the Medical Posting, my working hours were from 7am till 10pm every day till I offtagged.

I begin my day by first tracing the casenotes of the patients in the zone I am allocated to, snap pictures of the chest x-rays, any relevant radiological reports as well as to trace their bloods.

If bloods were not taken or not in the system, we would then proceed to “summon” the post-night team for help with their bloods.

After all the patients have been traced and the Google Lists have been updated (this is to aid us during our rounds as well as following up on their location later, to ensure that they are not being missed), then I would proceed with my morning reviews.

The morning reviews are just as usual as any morning ward reviews, rounds with the Medical Officer and Specialists and finally carrying out any active joblists.

Since we are in the emergency department, there is usually no afternoon reviews. It depends on the medical officer. Most of the time, rounds are just once daily.

After we are done with our morning joblists, we have to actively screen through the patients in our allocated zones as there is constant movement of the patients in both in and out of the emergency department.

Thus, this means assisting the current on-call team for the day with any STAT bloods or STAT radiological requests as well as updating their progress.

On most days, it is manageable despite the chaos. However, on days where we are lacking in manpower, the difficulty sets in.

The Night Shift

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The night shift begins at 8pm till 9am the following day or until we are done with our “summons”.

I was blessed enough to have gone through perimedical with a partner. Thus, there were two House Officers allocated for the night shift.

As night House Officers in Peri-Medical. We are expected to continue screening through all the casenotes for any new joblist or patients in all the zones in the Emergency Department as well as to assist in any procedures, take STAT bloods or request STAT radiological procedures.

In addition to that, we also have to cover the main building and the side building. This means, if there are any medical patients lodging in non-medical wards, we are in charge of them as well. Most of the time, it is just new transfer ins, sometimes, it is attending to any acute issues.

This is then followed by taking the “coming mornings” or bloods of the stranded patients in the Emergency Department of the lodging patients.

The amount of patients in the Medical Department is extremely high and thus, the medical patients can be stranded up to days in the Emergency Department which can even last till they are being discharged.

Thus, this ensures that the patients are being continued on their treatment irregardless of their location within the hospital.

The night shift as a perimedical house officer can get rather hectic if there are back-to-back influx of new patients in the Emergency Department, tons of coming mornings as well as acute issues in the ward.

In the morning, the “summoned” list can get rather extensive and chaotic as well and can be rather endless.

Hence, on top of the constant walking about the whole hospital, it can get rather tiring. But like I said, it is doable and manageable.

In fact, I enjoyed life as a perimedical house officer a lot.

If you are due to join Peri-Medical, fret not. Keep yourselves equipped with necessary forms and just work quick and as fast as you can.

On some days, one might get lost in the sea of chaos. However, stay strong and know that help is always within reach and that you are not alone.

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28th April 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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My Evening Routine In The Medical Posting | Housemanship Diaries
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On most days in the Medical Posting, at least in the hospital that I’m practicing in, we are allocated to work the “Short Day” or “SD” shifts.

“Short Days” last till 6pm. Occasionally, we would have to work the “Long Day” shift or “LD” which lasts till 10pm or “on-night” which is the night shift.

On days where I’m allocated to work the short day shift, I try to leave work by 6pm. Most of the time, it is feasible while on some days, it is not so.

However, my evening routine is pretty much the same upon returning home irregardless of the time I leave work.

1. Preparing My Dinner

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I love to cook. However, considering I live alone, the meals that I prepare are usually many for one person. Thus, I would keep the extra, rendering me an extra meal prepped for a day or two.

Depending on my mood as well, should I be working the morning shift the following morning and I’m just too exhausted after work and there is no food, I would go for my regular comfort food, instant noodles.

My version of instant noodles involves sautéing chopped onions, curry leaves, mushrooms and diced chilli before adding the water and mixing the instant sachet powders into the broth. I usually add additional curry powder as I like the broth of my instant noodles to be extra soupy and not dry. Once it has come to a boil, I would crack two eggs into the gravy and boil it for a minute or two before adding “half” of the instant noodles and finally topping with some leafy vegetables.

Yes, that’s right, I only consume half. My instant noodles are extra soupy and has less noodles.

Partly because I love adding rolled oats into my broth, thus the whole meal would be too heavy for me if I were to eat all the noodles.

What do I do with the other half of the uncooked noodles?

I keep it and usually comes in handy if I were to cook stir fried noodles.

Photo by Amar Preciado on Pexels.com

Then, there are evenings where I’m filled with energy and the following day happened to be an allocated off day or my night shift, allowing me to cook something different.

Nevertheless, irregardless of my dish of choice for the evening, I would always prepare a set of chopped tofu and mushrooms which I would marinade with some oil, salt, crushed black peppers, diced chilli, slides garlic, curry leaves and some curry powder or chilli powder prior to air frying it.

Thus, by the end of 10 minutes, my dinner would usually be ready.

2. Resetting My Room

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I don’t go through a major spring cleaning in the evenings, just simple tiny actions to reset my room back to an “acceptable” state.

This includes folding my clothes and keeping them back in my cupboard and their designated places, taking out the trash and vacuuming.

Considering I wash my hair every morning prior going to work, there would be strands of hairs on the floor after drying my hair and dusts and tiny debris begins to gather. Thus, I would vacuum almost every evening.

Since I live in a studio apartment, this action is merely a 5 minute job.

3. Preparation For The Next Day

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“Your morning begins the night before.”

I’ve forgotten where I’ve heard this but it’s what I’ve been practicing since I was a kid. Usually the night before, I would know of the set of clothes that I would be wearing the following day.

Next, I would prepare my jars of cold coffee. I usually save up spaghetti glass bottles or jam bottles to keep my tea or coffees or sometimes to be even used as drinking glasses.

I usually carry two 1.5L of flasks to work, one of it contains green tea and the other, my special prepped coffee.

After all of that is done, next would be…

4. Unwinding for the Day

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This begins with me pampering myself with a hot long bath to wash myself of the stench and tiredness of the day, followed by donning myself in a soft, flowy night dress and going about my self-care nighttime routine.

Only after that would I have dinner as I usually fall into a state of food coma after eating.

This is then followed by me clearing the dishes for the last time and finally, heading to bed, which on some days, would be as early as 8pm. However, on average, it is usually around 9-10pm.

This is my evening routine in my Fifth Posting, the Department of Medical, as a House Officer thus far.

I often get questioned by my fellow colleagues as to why I would even consider cooking considering that there are a lot of steps or effort that goes into the process.

However, I do not find it tiring at all as it is my version of de-stressing.

Nothing calms my mind more than listening to music or putting a good show on Netflix while going about my dinner preparations with my phone in “Do Not Disturb” or “Sleep” mode.

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13th April 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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Working on New Year’s Day (2025)
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This will be the second year in a row that I’ve chosen to work on New Year’s Day. If you’ve read my previous similar article last year, I’ve mentioned how my father has this tradition of working on New Year’s Day every year, ever since he started working at the age of 18. It is something that I’ve adapted as well.

This year, I began my year in the Department of Medical which is my Fifth Posting in my Housemanship Journey. I entered this department on the 11th of December last year.

Having just off-tagged the week before, I was still allocated in my first pool which is the Perimedical Pool.

Looking back as it is currently April 2025, at the time of writing this article, I do not quite remember where I was allocated to. I think that I was most probably taking care of the stranded Medical patients in the main building.

Thankfully, I remembered it not being a hectic day and I was allocated the “short day” shift, meaning that I had the opportunity to return home at 6pm.

Considering it was New Year’s Day which is a Public Holiday here, things were rather slow and tuned down.

Thus, it was a rather slowed down and uneventful day, ending with me returning home on time and unwinding early.

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11th April 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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My Reflection of 2024
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Albeit it being March 2025, at the time of writing this article, let’s take a walk down memory lane.

2024 started with me being in the Obstetrics & Gynaecology (O&G) Department and ended with me being in the Medical Department.

Each department has its own sweet memory of which I shall cherish when I reflect upon my days as a House Officer.

2024 was also the year I took a 6-week-break from my journey as a House Officer, unintentionally, while I was in the Surgical Posting which was a good break indeed. It felt more like a school holiday and I returned home and was being pampered by my family and loved ones.

Sadly, it was also the time I regained all my weight that I have successfully lost along my journey as a House Officer and have more or less kept it on since then.

The struggle to lose weight has returned and amidst the busyness, I still somehow managed to eat which certainly did not help with my weight management.

2024 was also the year I met my partner and best friend as well as his family. My circle of loved ones have been expanded of which I am truly grateful and blessed. Despite being in a long distance relationship, we both try our best to make time for each other everyday which was not at all hard and leaned onto each other for moral support. It made my journey even easier and lovelier.

In short, 2024 flew by rather quickly just like every year. But, it was a beautiful year, one that’s filled with love and multiple odd and funny experiences as well as important ones.

There were challenges as well. The year would not be complete or interesting without it. However, I pulled through or else I would not be writing this reflection today.

As for 2025?

I’m hopeful and I know , it’s going to be another interesting and beautiful year.

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9th April 2025

Articles

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My First Day In Medical Posting – Tagging Day 1 | Housemanship Diaries
Tell us about your first day at something — school, work, as a parent, etc.

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Finally, my much awaited posting… Medical!

Ever since I was a first poster, I have always looked forward towards the Medical Posting but one I decided to keep as my last as I wanted to “learn“ and understand the posting rather than just “float” through.

This served as a disadvantage in other postings as when it came to simple management of hyperkalemia or hypokalemia, I wouldn’t know, neither hypoglycaemia or hyperglycaemia.

Instead, I simply memorised my way in terms of the simple management and “referred to Medical” rather than actually learning to correct them myself in other postings.

Thus, I went complex and complicated first prior to building my way up.

My first day in this much awaited posting was on the 11th of December 2024. I had just completed the Surgical Posting and was on a 5-days-break.

On my first day, I was allocated into the “Perimedical Pool”. Deemed as probably the “worst place” to be allocated in. Thus, as usual, the fear starts creeping in.

I started asking around in regards to my job scope as well as the superiors.

Most of them advised to just arrive on time, which I did, at 7am sharp.

That morning, I was allocated to handle the “Yellow Respi” zone of the Emergency Department.

Thankfully, I had a good friend who was my partner for the day.

We began with tracing x-rays of the patients as well as their blood investigations.

After we have gone through all of the patients, we began with our morning reviews while awaiting our medical officer and specialist.

The medical officer arrived and started reviewing the patients with my friend. Here I was, on Day 1, extremely blur.

I introduced myself to the medical officer and he proceeded to tell me to go about my own reviews while he assessed the other patients with my friend.

Alright, here we go again, just like in every posting. Just how and what am I going to review?

Soon, the specialist came and I proceeded to follow the rounds as I was used to in the Surgical Posting where we all followed the grand rounds.

Instead, I was again asked to proceed with reviewing the other patients in the other cubicle while they go about their rounds.

Feeling quite lost and left out, I proceeded as such. Before I knew it, I reviewed all the patients in that particular cubicle just in time when the medical officer and the specialist came.

Thus, I started presenting and writing, still being tuned to the work culture in the Surgical Posting.

Just like rounds in the other postings, we presented, followed, write and after rounds, proceeded with discharges and carrying out the active joblists.

Surprisingly, I had time for lunch.

Afternoon rounds started at 2pm with just the medical officer and my superior was more than kind enough to start explaining and teaching me as to why certain things are as such.

After the PM rounds, I proceeded to screen through the casenotes and update the list of patients in my zone as well as to take any STAT bloods. Before 6pm, I went for my early dinner.

Considering I was tagging, I had to stay till 10pm whereas the rest who are “Short Day” or “SD” went home by 6pm. Thus, from 6pm till 10pm, I was actively screening through the casenotes in the Yellow Zone, Yellow Respi Zone, Red Zone, Red Zone 2, CSSD, EDOU, Green Yellow Zone and updating the list as well as to take any needed STAT bloods which mainly included blood cultures.

A little before 10pm, I approached one of the medical officers to get my signature for the day and went home.

That concludes my first day of tagging in the Medical Posting which surprisingly turned out rather well. For the first day at least.

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22nd March 2025

Articles, Fifth Posting (Medical), Housemanship Diaries

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My Morning Routine Being A House Officer Leader In The Surgical Posting | Housemanship Diaries
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There are three main leaders in the Surgical Posting. One is in charge of curating the weekly schedule, the other, in charge of ward and cubicle / bed allocations as well as to reallocate if there are any people who took emergency leaves or medical leaves and the third one, in charge of our attendance at work.

I was the daily allocator. Being the “allocator”, I would be in charge of designating the house officers to the selected cubicles of both the male and female surgical wards (MSW and FSW), the Peri, EMOT and ETD as well as to look for substitutes if there are any last minute changes or leaves.

Usually, I will prep my allocation in advance after the schedule leader has done the schedule and make necessary changes along the way. The leader in charge of the schedule usually determines which person works the night shift and when as well as to approve any leaves. Usually, the house officers will be divided into their respective wards.

The night before, I usually run through the suggested allocation in the “Leaders Group” with the medical officers in charge of the House Officers to screen through.

After receiving the green light from them or making necessary adjustments, I would then upload the list in the House Officer’s group. Thus, they would then know where they would be covering.

The list is usually sent in the “MOHO” group, meaning the group containing the House Officers and Medical Officers at 6:30 a.m.

Thus, I would wake up and be on standby at 5am everyday, even on my off days as I would wait for any messages should anybody take medical leaves or emergency leaves and make the necessary adjustments needed.

At 6:30 a.m sharp, I forward the daily allocation into the “MOHO” group.

If I happened to be working on that day, I would pause in between work just to send and then go about my work.

However, if I happened to be on leave or having my off days, I would then return to sleep or go about my other activities after 6:30 a.m.

It was an interesting experience having had the privilege to hold the position as one of the posting leaders.

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20th March 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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Reflection Of The Surgical Posting | Housemanship Diaries
Can you share a positive example of where you’ve felt loved?

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As you can see based on the prompt that I would be answering, Surgical Posting is definitely the place where the environment among the superiors felt more like a family to me and I’ve always felt the love and care towards one another and the patients in the whole team.

Prior to entering this department, I’ve always had my doubts and fear considering that I’ve heard numerous negative comments in regard to the department. Mostly, the department was deemed “toxic”.

However, upon entering there during my first day, I was guided and encouraged to follow rounds even when I seemed rather lost. I was not reprimanded or shouted at but instead I was guided and taught.

No doubt it is a tiring posting and after having completed my tagging period in all of the 5 major postings (Orthopaedics, Paediatrics, Obstetrics & Gynaecology, Surgical and Medical), the tagging period in the Surgical Posting is the most tiring for me.

This posting sort of reminds me of Orthopaedics except the amount of patients are full-blown, never ending with random or common surgical-related issues and the patients are even more unstable.

The thing about being in this posting is that usually when an order is given by our superiors, it is expected to be carried out STAT, meaning immediately and they will usually keep checking in to know the progress and status of the patient which is both good and also annoying. Good because it keeps you on our toes and ensure things are being carried out. Bad as the day could be burning with multiple issues and joblists and there is lack of manpower and you barely had time to sit or even had a drink and next, you’re being summoned again.

However, looking back, I definitely enjoyed every bit of my journey over there. Eventually, I was given the responsibility of being one of the leaders in this department, the daily allocator to be exact, by my friend.

This unknowingly deepens my relationship among my superiors as we would constantly reach out to each other.

Along the way, I made friends with the nurses at Male Surgical Ward and I will always be grateful for their help.

The Surgical Posting also made me realise how much I enjoy Surgical-based and that I am one. Despite my initial interest in Medical upon entering my housemanship journey, I realised that I love hands-on more and I need to “see” the issue. For example, if a patient complaints of abdominal pain, assess the patient, send some blood workups which might help and in your direction of care as well as scans.

Most of the time, the issue is identified through the scan with the blood workup being highly suggestive. Thus we move on from there.

I can’t quite explain. Somehow it just make sense to me just like when I was previously in the Orthopaedics Department.

This posting is also where I spent the longest time. I entered the posting on the 4th of July 2024, which is around 5 months as I took a break in between due to my injury.

The Surgical Posting definitely holds a dear place in my heart. Upon bumping into my old superiors, I still greet them with joy and a smile, reminiscing my good times within the department.

If you are due to join the Surgical Posting, please prepare yourself both mentally and physically.

In my opinion, the Surgical Posting is a physically tiring and not as bad as it seems despite the multiple negative remarks. Perhaps, it was a different experience for others but in my humble opinion, it is NOT a toxic department. At least at the place that I am practicing in.

Have faith, hang in there and try your ultimate best everyday in both your work as well as in trying to learn the most you can out of this posting and journey.

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18th March 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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My Experience as A Plastics House Officer | Housemanship Diaries
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When I entered the Surgical Posting, we initially did not have the privilege of experiencing subspecialities like other batches.

This was due to the fact that there were lack of house officers.

However, mid-Nov, there was redirection of House Officer allocation and suddenly, the posting was overflowed with House Officers.

Hence, subspecialities were reintroduced. The subspecialities reintroduced are neurosurgical, plastics and urology.

Ever since my first posting in Orthopeaedics, I’ve always wanted to experience being in Plastics after assisting my medical officer at that time with SSG.

Thus, during my final weeks, I was given the priviledge.

The Burn Ward is located at Level 3 of the Main Building, and is able to host at most, 10 patients, with each patient having their own room/cubicle.

Usually the burnt patients are kept at Burn Ward whereas other patients who are admitted for AVF creation or SSG are placed at Surgical Ward.

The timing for us House Officers is from 7am till 6pm, Sunday till Friday with an off day on Saturday.

During my time in Plastics, I would usually arrive on time at 7am and proceed to trace the bloods first. After all the bloods have been traced, I would proceed to help out with morning reviews.

Morning reviews are usually done by the postcall medical officer. This is then followed by rounds with the surgeons, usually starting with the acute or rather, the intubated patients followed by the rest.

Rounds at Burn Ward is only once daily. After morning rounds, we would gather at the “Handover Room” whereby the patients who are not in the Burn Ward but is being seen by Plastics as another team or as a primary team are being handed over in terms of case and progress as well as the newly admitted ones.

Next, we will proceed to follow the “Peri rounds” and change dressings if needed. Usually after the Peri rounds is when us House Officers go about our joblists in terms of posting case, referrals or bloodtakings or imaging request.

The rest of the day could be pretty chill if there is nothing going on but usually, there would be new patients to be transferred in, take blood or any post-op patients to be reviewed.

Sometimes there are cases being called and we are more than welcome to join the operation. In between, there are arterial blood gases (ABGs) to be take in between or bloods to be sent.

Finally, in the evening, prior to leaving at the end of our shift, we would prep the coming mornings and leave them nearby before informing in our Surgical House Officer’s group in regards to the “coming mornings”.

My time in Plastics was rather short-lived and I felt that there was so much more to be learnt. But my time spent there was extremely wonderful and the medical officers and surgeons were more than helpful and welcoming towards the new people into their team.

Definitely, a department that I would want to return to.

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16th March 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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The Wards In The Surgical Department | Sarawak General Hospital
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The main General Surgery wards in this hospital is located on the 7th floor of the main building which are Male Surgical Ward (MSW) and Female Surgical Ward (FSW).

I entered my General Surgery Posting during a time whereby there were no House Officers being allocated into sub-specialities. The only so-called “sub-specialities” that were available were “Vascular” and “Hepatobiliary Team – HPB”. Both of which are added under General Surgery.

Other teams such as Neurosurgery, Plastics, Urology and Paeds Surgery did not have House Officers. It wasn’t till towards the end of my service in this Posting that it was reintroduced.

Thus, our exposure towards the wards in General Surgery were limited but also made it pretty easy for us to manage.

1. Male Surgical Ward, MSW

Located on the 7th floor of the main building, it is considered the ward which is feared and avoided by many but is also where I’ve spent most of my time while being in this posting.

As the name suggests, it is mainly for male patients with underlying surgical issues or at least being managed by Surgical as the primary team.

This ward is usually avoided by many due to the overwhelming amount of patients which is twice the amount in Female Surgical Ward.

Twice the amount usually meant twice the amount of drama as well as the usual chaos.

My journey in General Surgery ended with my service in this particular ward.

2. Female Surgical Ward, FSW

This ward is also situated on the 7th floor of the main building and it is opposite the Male Surgical Ward, MSW.

As per its namesake, it mainly consists of female patients with underlying surgical issues or at least being managed by surgical team as the primary team.

Albeit it being a “Female” Surgical Ward, there would occasionally be male patients being treated there as the beds in the other wards are usually filled, causing an overflow of patients into this ward.

I started my tagging days in this particular ward and I would consider this ward relatively chiller and laid back compared to the other.

3. Vascular Ward

The Vascular Ward is located on Level 3 of the main building.

If you have done the Paediatrics Posting, it is situated in the same location as “Paeds Nursery Level 1″.

The ward is essentially divided into two, catering to both the Paediatrics Team as well as the Vascular Team.

4. Vascular Extension Ward

The Vascular Ward could only cater to at most, 10 patients. Thus, if there were any more patients to be managed under the Vascular Team, they would be placed in the Vascular Extension Ward or in the main surgical wards.

The Vascular Extension is located on the second floor of the main building, inside the Urology Ward which is situated opposite the emergency department, ETD.

During my service period in General Surgery, I have paid a few visits to the Vascular Ward and Vascular Extension Ward. However, I have never served my time there as I was not allocated to be the House Officer in the Vascular Team and also because it was a team I was avoiding.

Upon my exit from this posting, the sub-specialities were reintroduced again and House Officers were being allocated to other teams.

Thus, if you are due to experience the General Surgery Posting, I hope that you will find it as enjoyable as I did especially while working in the Male Surgical Ward.

It is indeed hectic and busy and going home on time is almost unheard of. Albeit MSW being an extremely busy ward, the medical officers I worked with as well as the specialists were kind, helpful and willing to teach.

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9th February 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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My First Day In General Surgery – Tagging Day 1
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My “Day 1 of life” in the Surgical Department commenced on the 4th of July 2024 which fell on a Thursday.

I was allocated to work in the side room of Female Surgical Ward (FSW) with a fellow colleague whom I’ve worked previously in the night shift in Paediatrics.

I left home around 5.45am and arrived at almost 6am and started reviewing as usual. I took some time as I read through the previous entries and used it as a guide to write my morning reviews.

Upon reviewing around 4 patients, a fellow medical officer arrived and automatically, I greeted him and followed him. It has become a reflex of mine as in other postings, we had to be like that, which is a good practice.

He was friendly and had a kind demeanour. Thus, I followed him, not knowing that he is actually the medical officer in charge of the HPB (Hepatobiliary) patients.

Usually, there will be a house officer in the ward in charge of the HPB patients, which I did not know of course, considering that it is my first day. Thankfully, I had a partner who followed the “GS – General Surgery” rounds with the other medical officer instead.

As usual, rounds with medical officers followed by rounds with specialists in the morning and as House Officers, we are their assistant and scribe. The morning rounds ended and we proceeded with tracing the joblists for each patients in our allocated cubicles and updating it in the “MOHO” group as well as proceeded to complete the active job-lists.

This is then followed by afternoon reviews, afternoon rounds with medical officers and specialists followed by the completion of the active joblists and finally starting with on-call reviews and preparing our handover lists.

Considering that I am still tagging, I had to stay till at least 10pm. After completion of the on-call reviews, we followed the on-call rounds and HPB (oncall rounds), clerked and transferred in the new patients, completion of the active joblists before finally heading home.

Overall, my first day in Surgery was surprisingly good and calm. The medical officers and specialists seemed rather kind and patient. Thus, giving me the encouragement to continue despite having heard that this particular posting seemed like a rather toxic one which only serve to instil fear in me prior to joining this department.

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8th February 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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The Worst Morning Shift In General Surgery | Housemanship Diaries
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I can’t really remember when as at the time of writing this article, I am about to cross into the second week of 2025.

Perhaps it was somewhere in October last year or early November.

It happened to be the day shift on a weekday and we were lack of manpower. 3 House Officers in the Male Surgical Ward, 2 House Officers in the Female Surgical Ward. Out of the 5 of us, I am the senior and the rest are first posters, three of which are only Day 3 into their housemanship life.

Oh dear…

We all know how busy Surgical can get and being the only senior that day surrounded by newbies, it was as good as being alone as they were not familiar with the system or the work or the procedures.

Learning does take time.

The day started with me taking care of the acute beds. The acute beds in the ward is considered the most unstable, hence it only made sense to allocate the senior, which is myself there, followed by the subacute cubicles.

The front cubicles and back cubicles are relatively stable patients. Hence, I allocated my juniors there. Usually for first posters in their first week of life, I would not allocate them independently to take care of a cubicle. However, we were desperately short staffed that day and taking care of the front or back cubicles are not easy either especially if you’ve just entered.

The day was busy enough. Started with me following rounds at acute and subacute with my medical officers and again with the ward surgeon, only to leave midway as the Hepatobiliary Team (HPB) had their own separate rounds and I was the HPB house officer for that day.

After rounds, it is the completion of the joblists. Amidst trying to complete the joblists, we had to transfer in new patients, take and send off the bloods of patients who have just entered as well as attending to any acute issues.

On that day, I had to assist with the front and back cubicles as well and in the afternoon, the juniors left for their Operating Theatre (OT) orientation.

My phone literally rang non-stop that day and the nurses kept haunting me down for everything. If only, I had the ability to clone myself…

Suddenly my phone rang and I had to assist a registrar to help tend to a visiting outpatient, attend the female surgical ward acute issues because the medical officer on-call called me as well as attend a virtual meeting.

Time flew by rather quickly, one minute I was escorting a patient, next was being called upon by this and that medical officer or registrar or nurses. To the point, my post-call registrar stayed back to assist me.

As the evening progressed, most of my patients desaturated. The annoying thing about Surgery, we had to update the whole story properly in the oncall WhatsApp Group for the day.

If only it were as easy as that.

We couldn’t just take a picture of our entry and update. Instead, we had to properly type the whole summary or stay.

I finally completed my task for the day at 10pm. It was an extremely exhausting and tiring day. One which I have no interest in relieving again.

That was probably the worst morning shift I’ve ever experienced.

However, looking back at what I’ve written, it doesn’t do justice to what I actually felt that day.

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7th February 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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I Ordered A Chest X-Ray For The Wrong Patient | Housemanship Diaries
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It was during my tagging period in the Surgical Posting and I was a Female Surgical Ward.

It was my first day being in charge of the acute beds and side room. I recalled one of the patients being a Urology patient. Usually, if the patient is from other departments, we are not required to review them. This patient in particular was intubated and sent to our ward to be placed in one of the acute beds for further monitoring from the Urology ward.

Upon transfer into the ward, the patient required a portable CXR for post-intubation. I did not screen through the casenote since it was from another team. The nurse in charge informed me of a new case but did not tell that the patient needed a CXR. Hence, my reply was “it’s not our patient, it is from a different team. They will review later.”

Hence, the Urology Medical Officer on call came after a while and reviewed the patient. He went to check the system and was confused as to why the chest x-ray was not done for the patient. The nurse immediately informed that I did not want to do it considering the patient is from another team.

At that time, afternoon rounds with the Surgeon was currently ongoing and I was disturbed from writing my reviews. I immediately proceeded to fill the form and had it sent to the Radiology Department to request for a portable chest x-ray.

Amidst the rush, I had wrongly written for another patient instead.

I only realised it when the radiographer came and did an x-ray on two patients at the acute beds. One, the intubated patient from another department and another which is a patient of ours.

I realised my mistake and rushed back to check the form and was met with a very angry daughter of the patient.

I admitted my mistake and was yelled at. After such a tiring week and a hectic day on top of tagging itself, I could not contain myself any longer and tears started streaming down my eyes uncontrollably.

Thankfully enough, it was just a mere chest x-ray and nothing more or a wrong operation done. Since the patient is under the colorectal team, the surgeon in charge and the medical officers in charge will proceed with their rounds again and I could not contain myself again and tears started to stream down my face again.

The medical officer in charge noticed and asked me to go to toilet, understanding that I needed some time for myself to recollect myself again. Hence, I excused myself.

After a while, I went out and rejoined the rounds and admitted my mistake to the medical officer in charge to which she laughed and said “well she has a free x-ray now and were there any changes as compared to the previous one?” To which I answered none.

She was amused considering that it was over a mere x-ray which was requested for the wrong patient that I started breaking down.

Thankfully, it was just an x-ray.

The lesson learnt here was for me to be extra careful in the future because it could have been worse and become medicolegal.

Please try to avoid doing anything out of rush or pressure and always slow down for a bit and reconfirm the patient and procedures to avoid or minimise errors.

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6th February 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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My First Surgical ETD / ED Night Shift Experience
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My first ETD “on-night” or night shift in Surgical was with a fellow junior who I considered as my senior in the posting as she was in the department much longer that I was.

Prior to joining the Surgical Posting, I have went through the Orthopaedic Posting as my first posting and people said that the ETD shift is similar to that in the Orthopaedic Posting, except that we would be taking the bloods, requesting necessary scans ourselves and posting the case.

Before I went to the emergency department, I stopped by the ward to steal some forms and stock up my “file”. After that, I went downstairs and received handover from the morning team.

During my first “ETD ON” shift, there were two medical officers as the first call. One is a tagging medical officer as she had just joined the department.

The night was rather cold I would say with minimal referrals, probably less than 10.

Every time there is a new case, we would be asked to clerk the patient first. However, usually the medical officer would be there by then and we would see the cases together.

I remembered it being “cool” enough that night that we even had time to have dinner for a while before proceeding to take our coming mornings and even rest for a while somewhere.

In the morning, we requested scans that were rejected the day before and followed rounds with no surgeon to know the latest plans, handed over to the following morning team and returned home on time.

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5th February 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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My First Night Shift In Surgery | Housemanship Diaries
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My first “ON” or “On-night” or night shift in General Surgery was in the Female Surgical Ward with a friend whom I’ve known since around my first posting but have yet to be in the same posting together till our fourth posting in General Surgery.

We were blessed enough to have at least 2 people per ward for the night shift.

Our shift as “on-night” in Surgery began from 7pm and will usually last till all the discharges are done the following morning.

Upon my arrival to the ward, I was informed that one patient in particular had no urine in her CBD (urinary catheter) bag and that she felt like urinating but was unable to void. Considering that she had a urinary catheter in-situ, voiding should not have been an issue.

I attended STAT and assessed her. She had a mass over her abdomen which was hard, non-mobile but had smooth edges, around 15cm by 10cm, a rather large one which I assumed was a tumour, probably pressing onto her urinary bladder as well.

It did not occur to me to check if the patient was previously passing urine, it also did not occur to me to check her intake and output chart. All I could think of at that time was, she felt like voiding, she is in pain, there is no urine flowing into her urine bag.

Thus, I prepped the trolley to reinsert a new CBD. I donned my plastic apron and prepped my materials needed and proceeded to clean the patient’s vagina and reinsert a new urinary catheter in as probably as sterile as I could, bedside.

Upon insertion of the new urinary catheter, there was no urine outflow. Thinking that I may have blocked it or inserted not all the way in, totally abandoning my theoretical principles learnt, I proceeded to reinsert about 3 times and each time was met with no urinary outflow but there were bloodstains from the urethra.

I called my partner for help and he proceeded to help me in informing in the oncall group and referred to Urology medical officer oncall who was rather grumpy.

It was during his referral that I realised that the patient had been anuric (not passing any urine) for sometime now. Clearly, she would not have any urine output and although she felt the need to void, it would not have been an issue considering there is a urinary catheter in-situ.

I had unnecessarily caused trauma and I felt foolish for acting prior performing a thorough examination and understanding her case.

The Urology medical officer came and reinserted a CBD to which she asked us not to remove and to request for an ultrasound the following day for assessment as she suspected that the tumour over her abdomen had infiltrated into her urinary bladder or urinary system.

That was settled but definitely ate up a huge amount of our time because of my mistake.

Subsequently I was rather slow and there were a few post-operative patients and new patients admitted into the ward. Hence, I proceeded to do the needful. By the time I was done, my partner had completed taking the blood for the whole ward and at that time, it was around 3am. I could sense the back-to-back disappointment I have caused him and at that point, I have given up on apologising.

We then proceeded to complete our planned discharges of the patients and by 6am, started tracing the blood results of the patients before retiring into the house officer’s room for a break.

In the morning, as usual as in other postings, we would be “summoned” in the group to take any bloods or to start our discharges.

We returned home around 11am and our post-night shift was followed by an off day.

Personally, I felt that I could’ve done a lot better as I was rather slow that night. However, for a first night shift in Surgical, it was not as bad as it seems.

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4th February 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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My First Day Back At Work After A 6-Week-Break | Housemanship Diaries
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I officially returned to work on the 2nd of October 2024.

Initially, I was stationed to work the morning shift at ward. However, a colleague of mine decided to take a sick leave on that day when she was initially stationed as the House Officer in the Emergency Department, ETD HO.

Being the Allocation Leader in this department, it is my duty to immediately look for a replacement and to update in the group with the medical officers. Not one person came to mind and I felt bad since it was a friend of mine who took a sick leave or did I feel comfortable dragging another person to cover this shift since it is a shift most people avoided.

Thus, I offered to be the ETD HO myself. It was during an anaemic House Officer period and there were only one House Officer stationed at the Emergency Department.

Hence, I went to work and stocked up my necessary supplies before meeting the post night House Officer in the Emergency Department to receive my handover.

Of all days, it had to be one whereby no coming mornings (bloods) were taken for the patients and there were a lot of active job-lists not being carried out. Not to mention scans to be requested the following morning.

Basically, there were a ton of “shits” being thrown to me and if I do not settle it myself or to push my post night colleague to help me, I would be in a mess for the day.

Imagine having just returned to work to this. Without thinking much, I started identifying the patients who had bloods to be taken and proceeded to take all of them and sent it off. After sending them off, I started preparing for scans and called the radiology medical officer oncall to present my case.

Finally, after I thought I was done, I decided to review the stranded patients.

Normally, the stranded patients should be reviewed around 7am as we would begin our morning rounds around 7:30am till 8am. Thankfully, it was the weekend and rounds began much later.

I went through my list of stranded patients and there were almost 20. 20 stranded patients at various locations.

Would I have the time to review all of them? What about the active joblists or scans? Can I rely on my post night colleague? What if there is a new case?

I remembered it being a rainy day and the referrals were initially from wards and not from the Emergency Department (ETD).

Perhaps it would be a slow day. I thought to myself.

But, I thought too soon.

Soon, referrals started piling up. My medical officer’s phone (MO) was blowing up with calls. Other sub-specialities kept reaching out for me to help them out and at one point, me and my medical officer had to split to ensure we got everything done to the best that we could.

I wished that I could literally divide myself but I couldn’t. On top of that, my right foot started to ache. I just came back from a 6-week-break. I can’t afford to go on anther few weeks. If I do, just when am I going to end this posting?

I recalled it being a terribly hectic day and I felt bad as I was mostly away, having been dragged away by other sub-specialities, escorting patients or carrying out the active job-lists. I could not really be by my medical officer’s (MO) side to see the cases.

Finally, the end of my shift approached. 7pm and my night colleague came for handover.

Despite it being the evening already, the fire was still burning strong, referrals did not stop coming in and I still had tasks to complete or I would be handing over “shits” to my night colleague.

Finally, it was around 8-9pm, I can’t really remember as I was following night rounds with the OT call medical officer and registrar. My medical officer told me to return home since the following day, I would be morning shift.

I remembered returning home that day, somewhat unsatisfied with myself. No doubt that it was a tough day, but I could definitely do better. If only my leg did not slow me. The pain seems to increase with every step I took and with every exertion I made.

However, as I remembered, I was blessed to have an angel as my medical officer oncall for that day. Instead of shaming me or being sarcastic or mentioning that I could do better, she simply thanked me for putting my best effort on the first day back and welcomed me back.

It’s angels like this who makes me want to try to be better the following day.

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3rd February 2025

Articles, Fourth Posting (Surgery), Housemanship Diaries

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Writing After A Long Time

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Day 496 of my housemanship journey, a the time of writing this article.

A few months ago, I took a sweet 6-week-long break after having just completed my first year of practicing as a junior doctor.

It was unplanned and definitely a blessing in disguise.

However, that rendered me to overshoot my allocated amount of leaves within a posting . Thus, I was extended in my fourth posting, Surgery.

Ever since I came back to work on the 2nd of October, it has been a tough 1 and a half month. My body was shocked back to work and it was a tough season as there were many people leaving the department.

Working the morning shift was even more tiring than working the night shift. Hence, in order to survive without collapsing out of exhaustion, I chose to work during the night shift consecutively for days.

Looking back, only a month and a half flew by but it felt like months have gone by instead.

However, today, I am able to write after what feels like a really long time. I feel that I can slow down at least for the next month at least and enjoy my work instead as we transition into a good season in this department.

A huge batch of house officers has been allocated into this department and this morning, there are 17 junior doctors in charge of a single ward as compared to previously when there were only 3 – 4 junior doctors.

Is that a good thing?

For those who have been in the department for some time like me, we definitely appreciate this break. However, a part of me also question if they will be able to learn as much as we did?

If you are currently struggling with bad days at work, just remember that it is these days that teaches us and makes us grow and that good days are definitely coming.

For when it does arrive, it allows us to appreciate the moment.

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2nd February 2025

Daily Dose, Fourth Posting (Surgery), Housemanship Diaries

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Controlling My Food Choices and Portion

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Daily writing prompt
What details of your life could you pay more attention to?
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I’ve always been a foodie.

I enjoy my going on food trips with my family or friends. If I’m bored or sleepy, I would look for a snack, which again is well, food.

Thus, over the years, the weight started piling up and towards the end of primary school, I noticed that my weight posed an issue. As a child, I was overweight.

I recalled visiting the doctor once when I was in primary school coz I was unwell and he made me stand on the weighing scale and perhaps he did say more but at a young age, all I remembered was him yelling “Your child is FAT. FAT. FAT. FAT. F-A-T, FAT!”, all throughout my checkup and as I was leaving his office with my mom.

It felt like as if I had committed a felony. When in reality, he was trying to point out on how unhealthy it is for me, somehow in a rather direct way.

Over the years, I’ve struggled with my weight. It was never constant and always up and down. I’ve tried various diets which didn’t stuck long.

The only time I properly lost weight was when I started my housemanship journey. Amidst me eating at the wrong time, somehow the weight just magically went off. Firstly, perhaps I was too occupied with work to eat properly, hence, unknowingly I tend to practice intermittent fasting almost everyday and secondly, my movements have increased dramatically. Walking above 15k steps per day was a norm.

However, as I progressed throughout my postings, I learnt how to fit eating back into my busy schedule and the weight started piling back slowly.

I brought the matter up to a dear friend and she mentioned that perhaps, I could try controlling my food portion. I reflected and realised that all these while, I’ve been consuming food in the usual portion which didn’t had an effect on me previously as I was constantly on the move.

Thus, if there is something I seriously need to pay more attention to, it would be my food choices as well as the portion. Food is extremely delicious and good. Sadly, I would say that I fall into the category of “Live to Eat” rather than “Eat to Live”.

Hence, it’s time for me to take charge and make a change towards my food choices and start my journey towards a healthier life.

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26th September 2024

Daily Dose

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The House Officer’s Dilemma | Housemanship Diaries
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While growing up, when I was asked regarding what I looked forward towards in the future, I always had the answer.

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The answer was simply, I wanted to be a Doctor (coz that’s what I knew my whole life and indirectly working towards albeit having other interests).

Thus, from primary school, next would be high school, moving towards science stream in school and pre-university in a course which would serves as a prerequisite into entering medical school.

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In medical school, my focus was always on the exams, completing that particular posting, completing that year, completing preclinicals and moving onto clinicals, studying for the grand finals, completing medical school and graduating.

Upon graduation, applying for housemanship to start practicing. I always knew that I wanted to practice in Sarawak General Hospital. Thus, that didn’t require much thinking. Working my way there, and finally, starting housemanship.

Now that I’m a House Officer, completing each posting, working towards completing a year, now focusing on completing the whole journey.

But after that? I feel lost and aimless.

Previously, when asked regarding my need to have a family, I would brush it off. Not that I didn’t want to but I’ve yet to meet the person that I would want to spend the rest of my life with and build a family.

My aim was mainly catered towards my parents. But they’re doing just fine on their own. Thank God for that. I don’t see my purpose anymore actually.

In regard to post-housemanship, I have no idea of which speciality I would like to dive into. In terms of being surgical based or medical based, the thing I learnt over this past 1 year is that I’m definitely a surgical based person. Though, I have enjoyed paediatrics very much (which I supposed is a very much toned down version of the chaotic medical posting).

I wouldn’t know, as upon writing this article, I’ve yet to complete my medical posting.

The medical field is not just tied to 6 different postings. As a House Officer in Malaysia, we are required to rotate to 6 different postings throughout our 2-year-duration in housemanship which are, Surgery, Medical, Orthopaedics, Obstetrics and Gynaecology and Paediatrics. The sixth posting, we have the privilege to choose among Emergency Department (ETD / ED), Anaesthesia, Klinik Kesihatan (Community Clinics) and Psychiatry.

However, in reality, the clinical field is vast and there are other specialities that we as House Officers have yet to enter. In terms of non-clinical field, it is another vast category.

Which of it am I?

At times I wished that I always knew of what I wanted to be, such as a Cardiologist or a Surgeon but after assisting in the operating theatres and working as a junior doctor, none of it appeals to me 100%. Sure it is interesting but is it something I would want to be doing for the rest of my life?

Having completed a year of housemanship, I thought that the answer would be clear to me by now. Yet, I’m still as unsure as I had been before. I’ve approached multiple seniors, medical officers and specialists and talked to various doctors from different fields regarding their experience. I seem to have the information but my heart was not fully captured by any of it.

Everything seems nice and interesting. I hope that in time to come, the answer would be clearer. The least I could do at the moment is to put my best foot forward in whatever department or sector that I go through.

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25th September 2024

Articles, Fourth Posting (Surgery), Housemanship Diaries

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My Top 5 Grocery Store Items

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Daily writing prompt
List your top 5 grocery store items.
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Working as a House Officer, I do not go out to eat much. Mainly because our days are mainly occupied with work and after work, we would be drained. Well, most of the time.

Thus, if I were to really go out, it would be during my long breaks which is when I apply for leaves.

In terms of acquiring groceries, I rarely go to the grocery store myself as I do not have a car of my own in Sarawak. I am extremely dependent on Grab and overtime can be expensive as well.

Hence, I make do with the convenience store downstairs at my apartment which doesn’t really have much in terms of fresh foods or ordering online.

Here are my Top 5 must haves in my grocery list which is available in the convenience store if I were to just shop there.

1. Coffee

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As I mentioned in some of my previous articles before. It is a must have drug in my system. Personally I think I have grown rather immune to the effects of caffeine over the years from overconsumption. Thus, if I’m unable to get my grounded coffee beans, usually I’ll make do with some freeze dried coffee or a regular black coffee powder.

2. Oats

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I replace rice for rolled oats when I’m living alone. Back at home, my mother would always cook rice as my parents love rice. However, I noticed that I easily crash or get sleepy easily after consuming rice. Thus, I substitute it for rolled oats and usually I would cook soups or curries and pour the oats over it and consume it just like regular rice.

3. Eggs

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It is easily available. When there is nothing else stored in my pantry and everything else is closed, eggs go about well with almost everything.

4. Noodles

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Well, I’m not exactly healthy per se all the time, and I do enjoy my occasional instant noodles. Especially after work and not having a meal the whole day, I’ll just whip up a quick dish of curry instant noodles with eggs.

5. Sausages

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Personally, I prefer chicken over sausages and as mentioned before, I rarely go out for my groceries. Hence, I’d go for sausage since it is easily available at the convenience store downstairs. In addition to that, I can be versatile with cooking them.

Thus, if I had to list 5 of the hat, these are my top 5 that I would shop for in any grocery stores amidst working as a House Officer.

Again, sadly, it lacks nutrition. But, oh well.

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24th September 2024

Daily Dose

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Reflection of the Paediatrics Posting
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Paediatrics Posting. The posting of tiny human beings.

Looking back, I feared entering into the Paediatrics posting. I think I say that for almost every posting.

However, it was one that I fell in love with before I even off-tagged, as mentioned in one of my articles previously.

The stress level was not as bad as it was in other postings mainly because we were dealing with children. Not to say that treating them is easier, in fact it isn’t as they tend to fight back, scream or cry a lot.

I mean they’re just children.

But perhaps when I do come to work, the smile on their cute faces were enough to alleviate some of the stress and checking them clinically involves a skill as they are easily triggered.

I would find myself playing with them or calming them down. Most of the time if I were to auscultate them, they would either start playing with it, swat it away or start crying.

The Paediatrics posting is the place I started eating again amidst the stress. Irregardless of the amount of patients and work to do, there is always time for lunch or at least our superiors will make sure of that.

It was also the place where I enjoyed the long rounds in the morning and afternoon as well as I would present to specialists.

I made a good friend with a medical officer who I still keep contact with albeit having left the posting. I enjoyed the days where I would be allocated to work with him.

Having worked both in the general ward and nursery ward, the experiences were different but enjoyable nonetheless.

If there is a posting I wouldn’t mind repeating, it is the Paediatric Posting and I hope you do or will or had enjoyed this posting just as much as I did.

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23rd September 2024

Articles, Housemanship Diaries, Third Posting (Paediatrics)

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Surviving A Month Of Tagging In My Fourth Posting – Surgery | Housemanship Diaries
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I tagged for almost a month here.

The tagging timing in the Surgical Posting is from 7am till 10pm which is same as with other postings, except Obstetrics & Gynaecology (O&G).

In the Surgical Posting, we all have to complete a compulsory 14-Day-Tagging period irregardless of having “off-tagged”. Entering the Surgical Department as a senior or fourth poster, we are allocated to special shifts such as night shifts in ward or night shifts in ethe emergency department (ETD).

This serves as an advantage to us seniors as we do not have to work the morning shift for one week straight prior to having an off day. It is also better as it allows us to recuperate in between by not having to go to work extremely early.

However, the disadvantage is that our tagging period is somewhat extended.

As I mentioned before, we are required to complete a 14-Day-Tagging period. The night shift is not counted. Hence, the tagging duration can go up to 3 weeks.

For me, it extended up to 4 weeks due to my medical leaves (MC).

During my first week of tagging, I took a day of medical leave due to extreme fatigue and in the second week, I took 3 days of medical leaves due to extreme fatigue and COVID-19.

At the time of writing this article, I am on a 6 weeks medical leave due to my ATFL injury.

Sometimes I wonder, if I will ever exit this posting and proceed with my last which is medical.

Back to the tagging part, thus my tagging period lasted for a month.

Going to work as a tagger, I would leave home around 5:45am – 6am. Partly because I’m just tired and felt like I needed more rest because there will always be an active issue in ward and I am only able to return home at 10pm.

In the evening around 7pm, I would go for dinner after handing over to the night colleagues and completing my tasks and on-call reviews for the day. Most of the time, it would be our first meal of the day.

Some days, we would be done by 8-9pm and on some days, earlier. Most of us, upon completing, would head for dinner and head home or to just head home straightaway.

This is wrong of course but we were simply exhausted and burnt-out during the tagging period. Thus, we grab the opportunity while we could.

Towards the end of my tagging period, I started bringing packed dinner boxes and reheating them as work prior going back.

Surviving the tagging period in the Surgical Posting was hard and tiring but eventually, it did came to an end.

Thus, if you have yet to enter the Surgical Posting, the tagging period is indeed tiring as with any posting. However, try to learn as much as you can and take comfort in the fact that it does come to an end.

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22nd September 2024

Articles, Fourth Posting (Surgery), Housemanship Diaries

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Ending My Articles On A Good Note

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Sometime ago, I wrote about “The Small Change I Hope My Blog Would Make“, whereby I mentioned that with every article written and uploaded on this website would spread some form of comfort and positivity, especially within the community of junior doctors.

Perhaps I’m just simply being optimistic. I have to. That keeps me going, even on difficult days to the point it has become a default reflex for me.

Nonetheless, I love to write and sometimes I do get lost that I tend to deviate from the topic at times and divert back to the main topic at hand.

Living in this world which has its flaws and problems at every corner, I try to see the good aspect of things and thus, I try to end my articles on a good note or some encouragement, which is mainly directed at me actually. However, I never know who may be reading my written articles and perhaps just need some encouragement and kind words at the moment.

It serves as a “happy ending” just like a fairytale in which I escape in one too many times.

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21st September 2024

Daily Dose

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Spaghetti & Buko Salad

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Do you or your family make any special dishes for the holidays?

I am half-Filipino. My mother is from the Philippines and my father, a Malaysian, like me.

Growing up, I was neither close to my mother’s or father’s side. However, between these two, I am somewhat culturally inclined towards my mother’s side through some of her simple heartwarming dishes that she cooked growing up as well as some of the Filipino songs she would play or the Tagalog words she would incorporate in her daily conversations.

Two of the simple dish my mother would prepare would be pasta or bolognese spaghetti and Buko salad.

1. Spaghetti

Originally, spaghetti is a form of pasta and a staple food of traditional Italian cuisine.

However, it also serves as one of the staple Filipino dishes.

My mother would usually make a batch of bolognese spaghetti occasionally and on New Year’s Eve, as that is what my maternal grandmother used to do while she was growing up.

It is rather simple and easy as well and she would go crazy with the cheddar cheese topping. Over the years, as she started to dwell into vegetarianism and eventually become one for a lifetime, she created her own variation of a vegetarian version.

2. Buko Salad

Adapted from https://www.kawalingpinoy.com/buko-salad/

“Buko” salad is a form of Filipino fruit salad.

“Buko” refers to a young coconut fruit and “Buko” salad consists of the young coconut itself.

It is a simple dish which has many variations.

My mother would usually mix with nata de coco of various colours, avoiding the colourless ones, corn, a huge can of mix fruits and other canned fruits before finally mixing it with evaporated milk, cheddar cheese and “buko”.

She will the separate it into containers and freeze it and have it on New Year’s Eve.

Growing up, my family would be seated at the dining table with other dishes prepared on New Year’s Eve for us to dine in together at midnight and every year, these two dishes remains a staple.

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20th September 2024

Daily Dose

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Studying With Music

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Daily writing prompt
What would your life be like without music?
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Utterly boring.

As far as I could recall, I have always associated studying with music.

Perhaps it is because while growing up, my mom had always filled the house with music and made me sit at a corner to study whether I liked it or not, I had to study.

Eventually, I’ve grown used to, to studying with music or reading with music.

In high school, I discovered the kind of music that I like as well as the suitable time for me to study.

Thus, music and studying goes hand-in-hand or I will not be able to focus.

Eventually, I shift to Podcasts and Audiobooks while I am going about doing my chores or cooking, I am either listening to these or music.

Even my daily morning writing has jazz or lo-fi playing in the background.

There are days of course when I do not feel like listening to my music or is simply not in the mood for other musics.

Thus, “lo-fi” or “jazz” are my go-to. Still musical nevertheless.

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19th September 2024

Daily Dose

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The Energy Boosters

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Daily writing prompt
What things give you energy?
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Working in the hospital, I wished that I had endless amount of energy. This is due to the never ending amount of patients as well as the lack of manpower.

Despite having completed your side of work, you just wished that you could help out. However, once you are done for the day, the thought of even going out is too tiring, upon returning home.

Thus, the evenings after work are usually spent recuperating and resting before going to bed to repeat the whole thing again the following day.

These are what keeps me going throughout the day.

1. Coffee

I need to have my morning coffee. I just absolutely have to.

My morning is not complete without my morning coffee as my body will feel sluggish and tired. I’m somewhat also more irritable and unable to think or move fast.

Perhaps it is the caffeine addiction speaking.

After I have had my black coffee to start the day and packed my necessary coffee flasks for work, it is then that I am ready to walk out the door and head to work.

2. Chrysanthemum Tea

I have built a liking towards cold chrysanthemum tea.

Personally, I enjoy the sugarless chrysanthemum tea. However, the ones available at work are only those in the can and has sugar in it.

Nevertheless, I still make do with it. Besides it is affordable too. Sipping that cold soothes my soul and reenergises me.

3. Cold Green Tea

In addition to cold chrysanthemum tea, I would usually prepare a jug of green tea and store it in the fridge.

This is for me to enjoy upon returning home and also serves as a healthier alternative to chrysanthemum tea which is packed with sugar.

Thus, the things that energises me are not food but simply drinks.

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18th September 2024

Daily Dose

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Appreciation Towards The Medical Officers (MOs) – Housemanship Diaries
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“You Guys Are Angels”

This may be a biased statement and it differs according to the individual’s experience. Thus, although I do know of the controversies I may ignite. I am merely saying this out of my own firsthand experiences and as mentioned before, each person’s experience differs greatly.

MOs, short for Medical Officers.

First of all, I don’t know how do you guys (medical officers) do it, pulling through an oncall shift, just to return for another oncall duty the following day after postcall. Perhaps it is because during my current batch, we have shifted fully to the “shift system”. Thus, we have yet to experience the “oncall” system which was experienced by the older house officer batches.

I am in awe and I appreciate the determination and discipline that goes with it. Most of the time when an oncall medical officer is on duty, they solely handle the referrals from emergency or ward and sometimes both. This goes on from the start of that day till the following morning and after which they would have to help out in clinics during their postcall, wards or even in operating theatres (OT).

Most of the time, they are alone unless they are lucky enough to have a “tagger”. Thus it is them, the house officer, the registrar and the specialist that forms the oncall team.

That is if they are oncall. In the wards, they rely on the house officers to carry out the active joblists, to take the bloods, request necessary scans, to resuscitate the patient first and inform if there are any acute issues and to carry out the morning, evening and oncall reviews while they are in the clinics or operating theatres or helping out in other places.

I used to think that once we have completed housemanship, life will be better. However, after observing my medical officers and registrars, it does not actually get better, the stress is on another level, the responsibilities increases yet they pull through it with jokes and smiles. I used to think that, perhaps they have gotten used to it. On the other hand, I’m still struggling.

Medical Officers are in charge of the House Officers as well. Thus, if any pitfalls were to occur, of course we do get scolded but they are the ones who get reprimanded as well. I’ve lost count of the times when the medical officers have backed me up. Although I do know that, that is their duty but albeit the responsibilities and the stress, I’ve experienced it first hand multiple times when they would take the fall instead when it comes to answering the specialists.

There are times when I do feel their anger were uncalled for. However, most of the time I understand that it mainly stems from tiredness. The patience really wears thin and snaps easily when there is lack of proper rest.

A lot is expected of them from the specialists and on top of that, taking care of us, House Officers too and teaching us what we do not know while trusting the patient’s care into our hands while they are off to help out in a different place. They are always a call away even if we are placed in the night shift. Thus, should there be any issues, they are always nearby and there.

Yet, after work, after the tiring day and issues that occur in ward, they return home to their families and loved ones and try to go about their life, only to return and repeat it again the following day.

Some might say, well, it is their duty isn’t it? I’ve heard it before.

It is true and personally I feel that we as House Officers, although we are tired, and on top of that being tested emotionally, they are even more tired.

Thus, if there is anything at all that stems from this article, it is my deep and heartfelt gratitude and appreciation towards the Medical Officers, which are rarely said.

My dear readers, if you are beginning your journey as a House Officer or is currently going through your housemanship or internship journey, have faith, patience and to always remember to be kind. Remember that as House Officers, we serve to ease the burdens of the Medical Officers on top of learning on the job, for we will one day take their place.

A fellow colleague always mentions this sentence while I’m in my Surgical Posting, “Don’t do unto others what you don’t want them to do unto you”.

This wise line by Confucius has a special place in my heart and I hope it does for you as well. As you become more senior and familiar with the work at hand as well as build good relationships with your superiors, always remember to be humble and kind.

Do not let cockiness overcome you nor be easily angered when a fellow junior makes a mistake or asks for guidance.

We were all once in their shoes as well.

Always remember to take care of yourselves first, so you can serve others best.

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17th September 2024

Articles, Fourth Posting (Surgery), Housemanship Diaries

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Being The ANSC (Antenatal Specialist Clinic) House Officer – Housemanship Diaries
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In my previous article, I have talked about my experience as an EPAU (Early Pregnancy Assessment Unit) House Officer.

The ANSC (Antenatal Specialist Clinic) is a separate clinic of its own. Usually patients with other underlying issues comes in for follow up here and most of the time, it is combined with the Medical team. The operating hours are on weekdays from 9am till 12pm and 2pm till 5pm.

The joblists for ANSC is similar to that of EPAU. The patients over here will come in for scan and the medical officers are in charge of screening and scanning the patients. After which, the patients will go to their allocated specialists.

The job of the House Officer?

Our job is merely to record down scan findings or to call the patients or to take their blood or fill up blood requests forms if needed. There are instances whereby we need to request certain radiological tests or to get an outpatient appointment.

But that’s about it actually. The good thing about EPAU and ANSC is that we do get lunch breaks. Thus, it is something I always looked forward to.

Usually in the afternoon, it is a different clinic. Most of the time I would stay behind. Mainly because once we are done with the clinics, we are expected to return to Labour Ward and help out since our working hours are till 7pm. Thus, I try my best to delay my return to the labour ward for as long as possible.

My experience as a House Officer in both the EPAU and ANSC were both enjoyable and fun.

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3rd June 2024

Daily Dose, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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Being the EPAU (Early Pregnancy Assessment Unit) House Officer – Housemanship Diaries
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EPAU of the Early Pregnancy Assessment Unit is like working in a clinic. Before I begin, allow me to express how much I absolutely love it when I am allocated as the “EPAU House Officer” for the day.

The hospital that I am practicing in is Hospital Umum Sarawak otherwise known as Sarawak General Hospital.

The working hours as an EPAU HO is from 8am till 5pm, with a lunch break from 12pm till 2pm. This is then followed by the continuation of work from 2pm till about 5pm.

Most of the cases seen here are patients who go for follow up most likely due to foetal growth restriction (FGR) or cases referred from Klinik Kesihatan. There are some cases whereby the gestation is yet to be seen in utero likely because it is too early but the pregnancy test appears positive, hence they are on follow up for scan of gestational viability after a week or two. In terms of gynae cases, most of the patients that come in are impending miscarriages or patients who have miscarriage but are on follow up to check on their B-hCG.

As an EPAU house officer, our duty is to first screen through the cases that comes in. As I mentioned before, some cases are referred while some are on follow-up.

Thus, we will screen through by writing their age followed by their gestation and parity and finally, any relevant antenatal history.

After we are done screening, we help out with writing the scan findings, calling the patients or helping to take bloods.

There’s not much that needs to be done actually but on certain days whereby the patient load is tremendous, it can get extremely busy.

However, being an EPAU house officer is a good experience and a good change of scene especially if you’ve been allocated to the ward always.

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2nd June 2024

Daily Dose, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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Reflection of The Obstetric and Gynaecology Posting
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Upon writing this article, I am now in the third posting. So far, I have completed the Orthopaedics posting and Obstetric and Gynaecology (O&G) posting and currently I am in Paediatrics posting, Day 280 of my housemanship journey. Very soon, I would have completed a year of my House Officer training.

Time certainly does fly by rather quickly. However, if there is any posting that I am very glad to be done with, it is the O&G Posting.

Entering the O&G Department came by a total surprise as I initially applied for Medical posting. Somehow, I was the only one out of my group of friends to have gone down a different road. Was it a blessing in disguise? Perhaps.

During my tagging period in O&G, we had no off days. However, the good side of it was that we only worked from 7am till 7pm for AM shift and 7pm till 7am for PM or night shift.

I entered the posting rather hopeful and enthusiastic as I would be closer to my dear good friend, Wei Shern. However, since it is a new department, it took me some time to get used to.

The nurses in the O&G Department were mostly friendly and I find myself closer to the nurses compared to the others. They were kind, helpful and my partners in crime.

There were also multiple other medical officers and specialists who were extremely kind and patient in terms of showing me the ropes. This is something that I will be forever thankful for. Most of the time, I held onto them, mainly to protect myself and if I knew that it would be a good day, despite the place flooding with patients.

However, amidst all that, this was also the posting where I had little interest in studying. Going back from work was all I looked forward to at work and I dreaded going to work in the morning. Hence, my efforts were always the bare minimum.

Sadly, it is a posting that I do not desire to repeat. The environment did not feel suitable for me despite having a number of good, kind and encouraging bosses around.

Surprisingly, I exited the posting on time because I was behind on my assessment and logbook. Ironically, it was a posting that I was disinterested in and yet somehow, I took my time in completing my logbook and assessment.

Thankfully, I exited on time.

The Obstetric and Gynaecology (O&G) posting was interesting and personally, I partly wished that I had more interest to know more and had pushed myself to learn and read more rather than just doing the bare minimum. However, there is also a part of me that is relieved and glad to be through with this short journey in this posting.

If you are due to experience the O&G posting, my only advise is to stay strong and positive. On most days, it will be difficult but try to tune out the noises and actions that hurt you and hold onto your friends and kind souls.

You’ll be over it soon. But who knows? For you may even enjoy it yourself.

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1st June 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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My First Ever Explanation Letter
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Perhaps I had been lucky? Perhaps I have been “let off the hook” multiple times (which I know is true). But I have made multiple mistakes and if there is one thing I know, I am still not competent enough but I take pride in the fact that I’ve tried and I am still pushing forth through the journey.

My first every explanation letter occurred while I was in the Obstetric and Gynaecology Posting. I forfeited my off day on that day and was called back to assist in Maternity 2 as one house officer took emergency leave and there were lack of house officers on duty.

The job scope of Maternity 2 involves monitoring the foetal heart condition on the CTG (cardiotocograph), attending to any acute cases such as patients complaining of contraction pain or spontaneous rupture of membrane (SROM) or in short “their water broke”.

I was towards the end of my shift, around 6:55pm when a staff nurse informed me that there is a deceleration on the CTG monitoring.

I attended STAT. To my surprise, there were significant episodes of decelerations on the CTG and I proceeded to check the opening of her cervix. It was only 3cm. The criteria was for the cervix to be at least 5cm before calling labour ward to send the patient downstairs.

I immediately took picture of the CTG monitoring, took the case note and rushed downstairs to find any medical officer on call to present my case. However, there were no other medical officers present at that time except for the Registrar who was writing her review. Considering that the patient’s baby is in acute foetal distress, I explained to her that I had to present this case.

Upon presenting my review, I was asked a few questions regarding her admission which I did not know and proceeded to flip the case note to answer her.

She then commented on my lack of insight on the patient’s case and inability to document my findings first before referring. I agree. I should’ve documented first.

However, I have a tendency to act first before thinking, thus, my first instinct was to run and inform STAT before digesting her antenatal issues and progress in the ward.

I was saved from the continuation of her comment by another fellow medical officer, the very same one who was with me when I experienced a case of cord prolapse during my night shift in Maternity 2.

Upon reviewing the patient, the patient mentioned that her water broke around 4pm.

Now, this was a real mistake on my part. At 4pm, the staff nurse informed me that this particular patient informed that her water broke to which I attended STAT.

Upon my assessment, there were no leaking liquor, cough impulse was also negative and her bedsheet was not wet. However, I did not document it down.

Thus, when she was assessed by the medical officer, that was when her water broke, there was obvious flooding and the medical officer proceeded to check for any entry at 4pm. She then called the Registrar to inform regarding this case and told that initially at 4pm, the patient complained of leaking liquor to which I claimed there wasn’t. However, there was no documentation.

I was then asked to hand in an explanation letter by 8am the following morning to which I did by that night shift.

Documentation is extremely important because should a case be brought to court in the future, the documentation serves to save myself as the patient’s case note serves as a legal document.

Thus, if you are having trouble like me in terms of documenting prior to acting, I totally understand. However, just document first if you can!

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31st May 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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My Last Day In The Department of Obstetrics And Gynaecology
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I ended my time in O&G by being the “on-night” house officer in Maternity 2.

Thankfully, it was a rather cold night with few issues. I was able to have supper, talk to the nurses and sleep for a bit. I was not on my feet as much.

The following day, I had to help out with rounds as it was during a period where there were shortage of house officers. Thus, in the morning, I will be allocated to a team and review the patients in that following team.

That morning, I reviewed the patients in blue team and was rounding with a lovely as well as one of the nicest medical officers in this posting. On top of that, I was rounding with a kind specialist as well. Both of them are serial jokers and hence, rounding with them was always filled with giggles and laughter amidst the stressful environment.

After the rounds, I aided the medical officer in foley’s catheter insertion. This is done to augment the labour of the patients, prepped a few discharges and went home.

My Obstetric and Gynaecology posting ended on a good note which I am extremely grateful for.

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30th May 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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Surviving On-Night In The Gynaecology Ward As A House Officer In Sarawak General Hospital – Housemanship Diaries
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Finally, the last of the “On-night” shift in the Department of Obstetrics and Gynaecology, Sarawak General Hospital.

The Gynaecology ward is situated in a separate building, quite a distance from the maternity wards and the labour ward and is also the ward where my seniors mentioned that we are able to sleep throughout the night once everything settles down.

Sadly, that was not the case for me. I did my rotation in Gynaecology during my last days in the O&G Department. I was allocated there for two weeks there before they switched me back into the Maternity pool. However, I did a number of night shifts in Gynaecology.

The “ON shift” in Gynaecology is the same as the night shift in Maternity which is from 7pm till 9am the following day. Similarly, upon our arrival to the Gynaecology ward, we are expected to take picture of the admission board and upload it in the “MO-HO” WhatsApp group as well as the total patient count. This is then followed by receiving handover from the “Long-day” house officers and to start reviewing.

The beds that we would review are usually beds situated in the acute bay, patients who are admitted and yet to be seen by the medical officers in the Emergency Department or Labour Ward.

Next, we will wait for the medical officers to come and do their on-call review. Just like in the Maternity ward, we usually do not review the patients again with the specialists unless specifically asked by the specialists.

For the rest of the night onwards would be helping out with “Plan D” of the patients which are planned discharges. Some patients would require the “Plan D” to be typed as they are long staying patients or their case is rather complicated.

This is followed by taking of the coming morning bloods as well as attending to any acute issues.

Usually the amount of “coming morning” bloods in Gynaecology ward is extremely less or sometimes none. Thus, when all necessary plans are completed, most of us would proceed to sleep.

Sounds good, right? That is of course an “ideal” night.

However, things may not necessary go according to plan. As I mentioned earlier, this was during my senior’s time.

My experience as a “Gynae ON” was different as we experienced a shortage of house officers during that time. It was the transition period for certain batches of house officers. Thus, many applied for leaves towards the end of the posting.

There were only a total of 4 house officers during the night shift. 1 allocated to Maternity 1 / Maternity 3, 1 to Maternity 2, 1 to Labour Ward who will be in charge of PAC as well.

Thus, who will be the OT (Operating Theatre) house officer? The Gynae ward house officer.

A typical night for me in the Gynae Ward would be me going to the Gynae ward to update the patient count on WhatsApp and to leave my bag followed by rushing into the Maternity OT or Main OT to scrub in and assist in any caesarean cases or operating cases.

In between, I would go out to the OT and return to Gynae ward if there are no cases being called only to have myself called again.

Thus, what about the oncall reviews?

I do not complete it. The patients will definitely be seen by the oncall Medical Officer but without a house officer. I would only return to complete the active joblists if any or to help update. If I am unable to, the staff nurses would contact Labour Ward directly.

This will continue until morning around 7am. Then, as usual, I will be “summoned” in the group to help with any discharges or STAT bloods or simple referrals such as pharmacy referrals or physiotherapist referrals.

Finally, at 9am, I return home.

Personally, I did not really prefer the Gynaecology ward. However, the thing that I did enjoy was being able to assist in the Operating Theatre which I would choose any day over being in the Labour Ward.

What I did not prefer was having to change every time, from OT and back to ward and vice versa. I prefer to remain statically in charge of just one place. Nonetheless, it was a good experience.

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29th May 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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Surviving On-Night In The Postnatal Ward (Maternity 1 & 3) As A House Officer In Sarawak General Hospital – Housemanship Diaries
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Perhaps you have read about my experience in Maternity 2 as the oncall house officer. Maternity 2 which is also known as the antenatal ward.

Maternity 1 and Maternity 3 is where the postnatal patients go to right after delivery. Be it from normal delivery, assisted delivery or post lower segment caesarean section.

Maternity 1 and Maternity 3 are the places I was allocated to in the early days of my post tagging period. During my time as a house officer in the Department of Obstetrics and Gynaecology in the hospital I am practicing in, we were experiencing a shortage in house officers. Hence, only one house officer would be allocated per ward and if you are allocated to be in charge of Maternity 3, this means that you would need to handle both Maternity 1 and 3, at night.

Thus, how do I go about my night shift in these places?

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Arriving 10-30 minutes prior to the start of my shift.

My shift begins at 7pm and ends at 9am. Similar to Maternity 2, I would arrive around 10-30 minutes earlier prior to the start of my shift and receive handover from the morning / AM team in Maternity 1 and Maternity 3.

This is followed by taking pictures of the patients’ allocation board and posting it in the “MO-HO” group. The patient count needs to be updated in the group every 7pm and 5am.

Next, I would start reviewing the acute beds in Maternity 3 followed by the post lower segment caesarean section (LSCS) patients who have been transferred in but yet to be seen by medical officers or those who are still on intravenous drips (IVD) and urinary catheter.

Next, while awaiting the medical officers on-call to come for rounds, I would settle the transfer ins of new patients.

Usually, patients who are transferred in requires “Plan D” which are prepped discharges as most post spontaneous vertex delivery patients otherwise known as patients who gave birth normally would usually be discharged the following day.

After rounds, I would go about the same joblists which are transfer-ins of new patients, doing the “Plan D” in both Maternity 1 and Maternity 3 as well as attending to acute cases. Usually the acute cases seen in Maternity 1 and 3 would be hypertensive patients and postpartum haemorrhage. Hypertensive crises patients are quite common and usually the control is more stricter postpartum. Postpartum haemorrhage occurring in ward is a rare case and usually if there is, the patients would have been managed and stabilised in labour ward prior to transferring out.

What used to irk me the most was the fact that I needed a medical officer to countersign my prescriptions prior to the nurses serving them. This serves a real issue as the post-caesarean section patients would be in pain and in order for me to manage the patients, I had to complete the transfer in review, find a medical officer who is free, present my case and then only get a countersign when I would very much prefer to just serve the analgesics immediately.

This of course continues on until the morning team comes for their review which is around 6am.

On good days, one thing happens at a time, meaning in Maternity 3 followed by Maternity 1. Sometimes there would be less transfer ins. On bad days, everything occurs simultaneously at once and I would be rushing between both wards continuously.

After the morning team arrives, it is time to complete the duties after being “summoned”. Most of the time, it is pharmacist referrals for injection technique for post caesarean section patient as they would be on subcutaneous clexane or social worker referrals, physiotherapy referrals or to prepare prepped discharges also known as “Plan D” for certain patients who are due to be discharged but the discharges are yet to be prepped till 9am.

Personally, I prefer Maternity 2 as compared to Maternity 1 and Maternity 3. As I mentioned in my previous article, on good days, it is extremely cold in the sense that when there is no active issues, we are able to sit for a bit and rest and perhaps even eat. However, on bad days, the ward could be burning with multiple issues as well.

Personally, it was an experience to be handling Maternity 1 and Maternity 3, provided that you work with good bosses of course, which may not always be the case.

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28th May 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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Surviving On-Night In The Antenatal Ward (Maternity 2) As A House Officer In Sarawak General Hospital – Housemanship Diaries
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Maternity 2. The Antenatal Ward.

Maternity 2 is a rather intimidating ward to work in as a house officer during the night shift. When all goes well, it will be a good night yet the next thing you know, a CTG (cardiotocograph) turns up suspicious or even worse a clear cut pathological CTG and you would have to refer the patient to any medical officers oncall and prep for emergency caesarean section.

On top of this, patients will be complaining of contraction pain here and there as well as the feeling of bearing down and you have to attend immediately to check the opening of the os. If they are 5cm or more, this warrants them to be sent to the labour ward. Besides that, there would be spontaneous rupture of membrane, SROM, to which you have to attend STAT as well and do a per speculum to assess if there is pooling of liquor as well as the presence of positive cough impulse.

As a house officer, we are required to work from 7pm till 9am the following day.

What do I do upon arrival?

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I would usually arrive 10 to 30 minutes before the start of my shift and snap picture of the board of patients as they need to be updated in the “MO-HO” group every 7pm and 5am.

This is followed by receiving any handover from the morning team. In Maternity 2, the patients which are put on prostin, inserted foleys, acute bay patients and those whose names were sent for augmentation of labour will need to be reviewed during oncall rounds if they have yet to be called and still remain in the ward at that time.

Hence, there are days when the numbers of patients of such being handed over are less and then there are days when almost the whole ward needs to be reviewed.

Reviewing The Patients

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Thus, I always begin with the acute bay patients first followed by the front and moving my way backwards for the foley / prostin / patients for augmentation.

On days when there are too many patients to be reviewed, I would usually only manage to complete about 70% before an issue creeps up or the oncall medical officer arrives and thus I would end up reviewing the patients together with the medical officer on call.

Acute Issues that I have faced so far?

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One that I will never forget is the case of a cord prolapse.

It had to happen during the wee hours of 3am. A patient complained that their water broke and she was induced with foley’s catheter. Having just started my night shift in that ward, I do not know how I should go about, which is either to remove the foley’s first, then report to the medical officer or to report to the medical officer first then remove the foley’s. Being extremely blur, I asked the staff nurse to start the patient on CTG (cardiotocograph) monitoring and excused myself to the toilet.

While in the toilet, I received a call from the staff nurse asking me to check the CTG of that particular patient, explaining that there was a deceleration noted. Having looked through multiple CTGs, usually what is deemed a deceleration is usually not and not something to be worried about. Thus, I calmly told the nurse that I will attend to it soon, right after I am done.

Thus, I went and by that time, there had been multiple episodes of deceleration in just 10 minutes. The foetus was in a clear cut distress state. I proceeded to take picture of the CTG and ran downstairs to find any medical officer who could help me.

A particular medical officer spotted me and I showed her the picture. She calmly told me to go upstairs and that she would be up in a minute.

Upon her arrival, she removed the foley’s catheter followed by inserting her fingers to estimate the cervical opening. But upon inserting her fingers, she never pulled it out and asked me to call the registrar on call immediately. It was a case of cord prolapse. He came and everyone prepped the patient for emergency lower segment caesarean section, the case was posted and everything cooled down.

Next, a lady complained of contraction pain and when I checked the opening, it was fully dilated and the baby’s head was crowning, thus, the delivery was conducted bedside.

Other issues would be non-reassuring CTG or hypertensive crisis. Most of the time, it is contraction pain or spontaneous rupture of membrane (SROM) which essentially means “the water broke”.

What do I do after all these incidents?

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Proceed with my coming morning bloods if any and send them followed by tracing any pending investigations.

Meanwhile, the morning team arrives around 5-6am and basically I would just wait to be “summoned” in the group by the morning team to complete certain simple tasks such as taking blood or helping to trace certain investigations, to post a case or to prep “Plan D”. “Plan D” are discharges which are prepped and awaiting the medical officer’s chop and signature.

Although, Maternity 2 can seem like a rather scary place to be in, it was less daunting and tiring for me than working in the labour ward. Perhaps it is due to the fact that we have extra autonomy on the patients’ management plan.

If it is your first time in the antenatal ward, fear not for it is the learning process. It is true that it can be somewhat scary but during the good days, it is extremely chill. Hence, all the very best, do have faith in yourself and always put your best foot forward!

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27th May 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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The Types Of Wards In The O&G Department Of Sarawak General Hospital – Housemanship Diaries
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The Obstetric and Gynaecology Department in Sarawak General Hospital consists of five wards in total. Four of which are situated in the main building while one, which is the Gynaecology ward is situated in the side building.

1. Labour Ward / LW

The labour ward and PAC (Pregnancy Assessment Centre) is located on the fourth floor of the main building.

Pregnant mothers who are stable and came in presenting with gynaecological issues are referred to the PAC first. It is basically the emergency department solely catering to mothers and women with gynaecological issues.

The labour ward is situated on the same floor as the PAC but situated at the back of PAC. Women in active phase of labour, requiring augmentation of labour or who are unstable requiring close monitoring are usually placed here.

2. Maternity 1 and High Dependancy Unit (HDU)

The High Dependancy Unit (HDU) is located within the Maternity 1 ward and it is situated on Level 3 of the main building.

Postpartum mothers are usually transferred here upon delivery. Patients who are transferred to the high dependancy unit are usually postoperative patients requiring completion of magnesium sulphate over 24 hours or postoperative patients who have bled more than 1L intraoperatively. Besides that, patients who have undergone classical caesarean section or hysterectomy are being monitored here as well.

3. Maternity 2

The antenatal ward.

Mothers who are admitted from PAC but yet to be in active phase of labour or perhaps electively admitted are monitored here.

This ward can be a rather intimidating place to work in. Mainly because should there be any acute emergencies on the cardiotocograph monitoring, the medical officers or the oncall team are not there since they are in the labour ward and as house officers, it is our duty to monitor the CTG and to inform immediately for any issues besides attending to other issues such as spontaneous rupture of membrane, as well as checking the os opening of the patients should they complain of strong contraction pain and the feeling of bearing down.

4. Maternity 3

Similar to Maternity 1, this ward is also known as the “postpartum ward”.

Post operative patients who have underwent lower segment caesarean section (LSCS), post spontaneous delivery patients or post vacuum assisted delivery patients are usually transferred here, if not to Maternity 1.

It is a ward that can get rather busy during mornings since the rate of patient turnover is extremely high as post SVD patients are usually discharged the following day itself if they are stable.

5. Gynaecology Ward

This is the last and final ward in the O&G Department.

This ward is located on Level 5 of the side building.

As the name suggests, patients with gynaecological issues such as miscarriages, stillbirth, abnormal uterine bleeding and gynaecological-oncology related issues are being monitored here.

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26th May 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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Being An O&G Operating Theatre House Officer – Housemanship Diaries
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If there is any place I would rather be in this whole department, it is in the operating theatre. Just like in my previous posting, Orthopaedic, the operating theatre is where I feel alive the most.

As a house officer, it is our duty to ensure the antibiotics are prepared beforehand. For almost all the patients, it is “IV Cefazolin 2g STAT”, unless they were given other antibiotics prior to their transfer into the OT.

Thus, I would usually “smuggle” a few boxes of Cefazolin bottles prior to entering the operating theatre.

Next, we have to fill up the board of information regarding the patient’s name, gestation and parity, antenatal issues, location of operation as well as the operation.

Most of the time, being in Obstetric and Gynaecology Department, the operation done is lower segment caesarean section (LSCS), bilateral tubal ligation (BTL) and occasionally classical caesarean section or hysterectomy.

After the patient has been transferred onto the table and has been administered anaesthesia block, it is time to scrub in with the surgeon!

In O&G, it is important to learn how to drape the patient which is relatively easy and repetitive once you know how to. This is then followed by “time-out”, testing of the incision site by the surgeon and finally, cutting.

During LSCS, most of the time, the medical officers work extremely fast to get the baby out since most of the time, the mother is posted for caesarean section due to acute foetal distress, presumed foetal compromise or foetal bradycardia.

Of course, that is not the case, there are times when a mother is posted due to prolonged second stage of labour, failed induction of labour, chorioamnionitis, refused trial of labour after caesarean (TOLAC) or electively admitted for LSCS.

Personally, the interesting part is during “fundal” when the surgeon finally grabs hold of the baby’s head and as the first assistant, we are required to press the abdomen of the mother to help push the baby out.

After the baby is born, the surgeon would usually wait for a minute before clamping and cutting the umbilical cord and handing the baby to the Paediatrics resuscitation team for neonatal resuscitation.

This is then followed by closing up of the uterus and abdomen in layers and finally scrubbing out to type out the post operative notes.

The speciality of the O&G Department is that they have their own operating theatre in the labour ward known as the “maternity operating theatre”.

However, should there be another emergency case posted while another case is ongoing, the case will be shifted to the main operating theatre.

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23rd May 2024

Articles, Housemanship Diaries, Second Posting (Obstetrics & Gynaecology)

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