Life as a labour room houseman

Somehow the horrors of the previous housemen seem exaggerated. The night was fun with little tension, and thanks to an overdose of coffee, I messed around more than sleep/worked. Initially I did get a little confused, but take a breath and the nrp training kicks in. The mo on-call will be there most of the time anyway. The nurses are-as always, extremely helpful.

Like I said before, labour room rocks. Still, i've only done the night shift so far, and my night shifts are almost always free. And now it's even better as I'm provided with my own room.

What do I do as the paediatric houseman on standby?

Obviously we are on standby round the clock for resuscitation of any and all deliveries. Babies with high risks/probability of needing resuscitation are singled out and attended to by the mo on call and extra personnel if needed i.e. the houseman.

Some cases at risk of needing resuscitation include a gestation of less than 35w,>

To be on standby you need to have successfully completed the newborn resuscitation programme (NRP) and at least a month's experience at the neonatal ward or NICU or both.

It's scary but that's what makes it exciting. The labour room is always like that. Like the job itself, you'll either like it or hate it.

assessment

well, my assessment was finally over..i didnt really study but experience in the dept was enough i guess..although i did lose sleep, my ex-roomates would vouch for how i could spent sleepless nights worrying but still manage to NOT study..any basic knowledge they asked was easily answered..hopefully my fourth assessment has proven the credibility of me and my university once again..really the only person i need approval from is myself...i could care less about any ignorant jerks who still doubts the fact that i am a certified and capable doctor if they died in their ignorant bliss. First posters will do dumb things, no matter how 'prestigious' a university they come from. I know I'm being a little biased..there are really people who IMO reallly need to buck up, mentally, knowledge-wise, and rationally. They might get extended, and maybe they deserve it. Some things are actually too basic not to know...unless you've been enjoying yourself too much after spm..even though I still think you forget a lot of the stuff you try to cram in during those long med student years...


After medical, I had always acknowledged the possibility of being extended as long as I am labelled as a HO, no matter how hard I try. Although I still thought the extension in my first posting was one biased, unjustified decision that will leave a scar in me that seems to never heal. Another guy I know got extended in medical for the simplest and probably a stupid reason - he was accused of taking another patient's blood sample for a blood transfusion and mislabelling it with another patient's blood. A serious offence if it was true, but did they really check? because he adamantly denies it, and they kept him another 2 months for a mistake that he might have made..come on, in O+G I was faced with the same situation, a patient's blood group came up as B+ when in 2007 it was A+...I personally went with the blood MO to check the patient's blood group, and I was in the right all along. A dumb HO in 2007 who probably is a happy MO somewhere, oblivious to what he did, was in the wrong, and we have no idea who it was.

Some new guys are just annoying, telling me stuff I already know, to do things I already did, correcting mistakes I never did, and even telling the MOs about it..when I did my job correctly in the first place. This was 2 months ago, and I'm good with them now, as we got along later and they understood how I work,and how to work in itself..i dont blame them anyway, they started their job with some people who really liked to fire up the littlest mistakes into something big for the bosses to see, so they could look good.
personally i hate people who kiss ass too much..they are just big sissies who think they are better because they can find little mistakes other people make, and cover their own mistakes nicely. of course, i dont really go on an all-out war with them, unless they make me look bad, which occassionally do happen.most of the time I've had a good work relationship with almost everyone I met

So did some superiors, who initially were somewhat hostile, but later trusted this houseman..winning these little battles are actually pretty rewarding in itself..

holiday-ing

Day 3 of holiday, i came back from kampung with my family for a cousin's wedding, and am currently in bangi...
tomorrow should be going to penang to see the chaps up yonder.

I'm the coolest person on earth (if I'm the only one there)

it's time for my 'newest insecurities' post..
If anyone ever bothers reading this crap, they'll notice some personal issues being broadcast out into the light...all intentional i assure you, however direct or poorly expressed they were, it was part of the blog that i thought should be there, to remind myself that i'm not here to show off or anything, and i dont really care if anyone reads this or not, and I'm confident enough to tell about myself that way and not feel like a self concious idiot, or some crazy dude people would shun. But I've always believed that we should live by a conscience through which we define ourselves, in every situation and changes we encounter, certain credos just above the tabula rasa from which we evolved into the adults we are. This just sounds deep but is actually getting crappier the more I try to explain.
insecurity no 1)
my 4th posting, but I'm still scared about my assessment in a few days..I guess it never gets easier, especially when the threat of consequences after a failure is real
2) I'm suddenly feeling pretty lost, like I dont really know myself anymore
3) I havent let go of some things I should have, and I feel that I have yet to accomplish anything in my life

positive consequences:
by acknowledging my weaknesses, I will try to get rid of them, and I now have a goal I can materialize and strive for

I might actually seriously study for the assessment if i get scared enough
the "need to accomplish" might make me do stuff other than work, read stuff, read manga, and stare at the computer screen for hours before dozing off
i dont know much about losing my "selfness" ...maybe it's just a transient feeling.maybe i should get a pet or a girlfriend or something, but I like my privacy, free time (albeit limited) and self-indulgement days right now

my latest pic

i was minding my own business, making insensible comments on facebook, when it became blurry...
and poof!


sebab komen dalam facebook, kene sumpah jadi gardenia?

Down's

Sometimes the best moments in your working day, where you learn the most, is at the end of it...well, at least that’s my reason for going back a bit late today although I was post call.

My friend doing newborn screening downstairs kept passing up babies with hypoglycaemia to the neonatal ward ( I changed wards about 2 ½ weeks ago). Being the kind to do so, he went up to check up on the babies he admitted, I was just about to go home when i saw him. Another friend was clerking a new case. While casually looking at the baby, the friend from downstairs suddenly commented – hey, doesnt that look like a Down’s baby? – no way, but hey there are single transverse palmar creases on both hands. We searched around a bit and found a bit more – low set ears, upward slanting of eyebrows, flat nasal bridge, sandal gap deformities bilaterally..

We called the MO who had also seen the baby for hypoglycaemia. Initially sceptic, he finally concurred with our findings. The more we looked, the more signs we saw.. the flat facial profile, incurved fifth finger etc. Fortunately the tone was normal, and no murmurs can be heard, yet. We decided to document our findings but not diagnose the baby yet.

Then we called our ward specialist, who had also seen the case and was ready to go home. Surprise, surprise, her opinion echoed ours and she ordered for chromosomal studies, an echo, and to counsel the parents on the possible diagnosis and prognosis. Unexpectedly, the baby had passed through 4 doctors of different levels, but everyone was more concerned on the hypoglycaemia, which was the most urgent matter anyway, but it was the one who initially admitted the baby who noticed first. It's pretty exciting when you find something your superiors missed, isn't it.

Since all was well, my friend from downstairs continued on his was to find his baby, only to come back since the one we were examining all this while was the baby he was looking for!

Even the best can miss a thing or two sometimes..hehe

*a few days back, the same specialist told us that if we did learn anything from our stay in the neonatal ward, she wants us to at least be able to diagnose a Down's Syndrome baby

where should I go?

InsyaAllah, my housemanship will end some day, and i'll keep my spirits up till then.
My senior, kak sal, is actually an mo in my kampung's hospital, it was pretty cool since i heard my relatives talk about this dr salina, then i found out about it a few months ago when i chatted with her on facebook.
Tomorrow i'll be going to pahang again with my siblings for aidiladha with our extended family (i have a few days off)
long term plans seem to bug me these past few weeks, starting my fourth posting made me think again about what i want to do when i finish my housemanship...
What would you guys think? So far i've gone through medical, o+g, and ortho..
I thought medical was not meant for me for a certain personal reason, but the past few weeks working in the general paediatrics wards, and a question by my specialist about what i wanted to do made me realise my curiousity of how things work, and joy in getting to the diagnosis might be suited for a ward like in the medical department. Also an mo i know (who i think initially hated me) also asked the same question, and when i asked him whether the dept itself would accept me, he said why not?, i guess i'm as eligible as the next houseman in the hospital at least.
So far paediatrics is great too, the workload (for housemen now, at least) is a lot lesser than our medical wards, the kids are cute, and i might have a certain affinity to them, and most of the discharges are all smiles and happy faces..of course, this is not always the case with the nicu and phdu...
O+g has a strict dept policy, not unlike peads, probably due to the medicolegal issues, but again, here, almost all cases are just normal happy people having a baby or two. The workload is a bit tough, but i might like that, just like the labour room, where the adrenaline rush makes you like it or hate it.and i'm not hating it. Again i'm not denying the general medicine department also has this rush.
I always thought I wanted to end up in a surgical area of expertise, as you can get to do something with your hands, and I like the OT environment since the first day I set foot on that tiled floor during my medical student years – again , I think it’s the adrenaline rush – the things that make you or break you. And probably coz it sounds cool... I bet a lot of you can say the same thing right?

I even asked around the Mos’ opinion if I could actually join orthopaedics. They gave the same answers, they find nothing that seems to stop me from asking the HOD to put my name there if I’m really interested. In the end I still didn’t ask the HOD..

There was a time when I got really interested in anaesthesia. At that time I spent a lot of time in the OT. I would talk with the anaesth MO or specialist, and got to see what their job was like, from getting the consent to managing the patients at the recovery bay. They even taught me how to intubate a few times, correcting my techniques, a specialist also encouraged me to join when i finish my housemanship, as they were short.

Another option is A & E. There are no calls, which means you can be at peak performance throughout your shifts, and the diagnosis there is really a challenge. Also, you will be the first to meet the acute presentations.I heard a lot of stuff about the A+E in Malaysia, but my friend is an MO there, and it’s the individual who makes all the difference.

In the meantime, I’ll just enjoy my Housemanship while it lasts, there are risks, the calls are as bad as you think it is, and you have to work 7 days a week. But who says being an MO solves everything? Your responsibilities are higher, you are expected to know more, your workload (currently) is actually more, and your calls are worse. Also, I wont have a good reason not to worry about my career as I’m not still stuck doing my housemanship. At least an MO’s working hours are less and you get weekends and public holidays off. I guess it’s just the job, being a doctor and all..

me assisting an amputation in my student years