Wednesday, December 10, 2014

Idiot's Guide to Surviving Housemanship

What's with all this ruckus about houseman complaining about their housemanship training in the press, and MOs and specialists complaining about houseman in return? I admit housemanship can be challenging, especially for those who just started. I also admit that during my first posting even I harbor the thoughts of quitting. But I didn't, and I have never regretted the decision to stay on while some of my colleagues resigned. Almost half-way though my housemanship journey, I think I'd like to share a few things I've learned for the past one year. I call it the ' Idiot's Guide to Surviving Housemanship', inspired by the 'Idiot's Guide to' series:

1. Don't take negative comments and scoldings personally.
You see, we live in an age where houseman are in excess. Every time a specialist or an MO scolds you, chances are, you are not the first one and unlikely to be the last one. Imagine, nowadays there can be up to 30 to 40 houseman in a certain department at a particular time. Without extension, every houseman will rotate in each department every 4 months. A specialist or an MO on average have to deal with on average 120 houseman per year. So there is a very high chance that whatever mistake you did has already been done by another houseman before, and the scolding is nothing directed solely for you. They just want you to improve, just like others who made it before you. So don't take things personal, they might have repeated the same comment and scolding for the 100th time. So don't go missing in action (MIA) everytime you get a bad scolding. It's nothing personal.

2. MOs and specialist are not out there 'to get you'.
Sometimes when we get real bad scoldings, we tend to think the MO or specialist has this certain mission to wipe us off this earth. We have this feeling that every time they feel our presence, they are there to get us, and when we are not around, they think of ways to make our life miserable. The truth is, specialists and MOs are human with their own personal life too. When we couldn't sleep at night thinking about how this particular MO will mess around with us during tomorrow's ward round, he or she might just be thinking about their next holiday destination, about their Master's application, or about their wedding plans. They don't have time to think about how to mess around with you. There are just better things to think about before bedtime. So don't waste your time at home worrying about tomorrow, instead be happy and spend time with your family and friends, like what your MO is doing.

3. Forget that you were ever on the Dean's list, a 4-flat student or a batch leader during your medical school days
While your achievements are good for motivation, as a houseman, you have to forget about all those because you start your journey just like everybody else, no more, no less. Because no matter how good you were, housemanship is a process of learning, and sooner or later you will tend to make mistakes. What matters is whether you learn from it or not. Many straight-A, 4-flat students just could not take housemanship and quit because they are not used to or have never tasted failure before. They are more vulnerable when faced with harsh scoldings, because they used to be so perfect in medical school. The less smarter ones are the resilient and tough ones because they have faced so many failures and scoldings during medical school that they feel like it is just another day in the life of a medical profession. So no matter how good or bad you were in medical school, forget about all that and start anew. An MD and MBBS is just a starting point. Now you are as dumb as everyone else and everyone else is as smart as you

4. Time is gold, steal it
Don't be an idiot and hold your pee when things get too busy. Volunteer to send the bloods to the laboratory, and on the way back, stop by the loo. Contrary to public belief, doctors are not THAT busy all the time. There are always time when patients are less, workload is low, long interval in between patients. Learn to take a nap wherever you are, just make sure your phone is on full-blast volume. Learn to sleep anywhere EXCEPT where there is no line reception. The most important thing is to make yourself reachable. You're considered MIA when your colleagues and staff nurses couldn't reach you. I know many would not agree on taking a nap during working hours, but personally I think that if I really have no work to do, it is better to take a refreshing power nap than being physically and mentally exhausted, endangering the lives of patients.

5. Your colleague will exaggerate everything
Sometimes when you did a mistake, and then the next thing you have your colleague texting you asking "Hey what happened today, I heard this specialist was furious at you for bla bla bla". Unless you heard from the specialist yourself, usually the story is exaggerated as it goes through the grapevine from one person to another. Things are not always as bad as people tell you. This is another case of 'nothing is personal'. Others might have done a worse mistake than you, and what matters is not giving up, going MIA, but instead take it as a lesson learned.

6. Everybody has their own problems to remember
One of the worst thing that could happen to a houseman is a public scolding, in front of your colleagues, patients, staff nurses, MA, Radicare people, lol. But that, too, shall pass with time. Don't get too depressed and go MIA, because everybody gets their own dose of scoldings and no one has the time to remember yours. Don't believe me? Try telling one of your colleagues: "Man, I still feel really bad for the stupid thing I dad in the OT last month". Chances are, they will reply with "Uh, which stupid thing again?". "You know, when I threw the fibreoptic scope into the yellow bin and the surgeon was so furious I had to go down to Radicare and literally scourge through the piles of waste to retrieve it?". "Oh, that one!". Point is, no matter how stupid your mistake is, in a month you will have to trigger others to remember it. So just learn from mistakes, and don't worry about what others think. In the medical profession, everybody has their own problems to think of, they won't remember yours.

7. You don't get extended because your boss hates you
In the extreme case of being extended, don't feel so down too. You don't get extended because your superior hates you. If they really do hate you, they would have let you pass as soon as possible because they want you out of the department and never want to see your face again. An extension really means that they feel that there is something inadequate in you, and you might need more time to learn it.
So fellow houseman, these are my 50 cents. Just remember, there are thousands of us, each and everyone with our own struggles, and we are all in this together. You are not alone. So cheer up, stop complaining too much, to the press especially, and may us all be great doctors for the better health care of our nation.

Sunday, November 30, 2014

Chichen Itza

My favorite destinations when traveling in a foreign country are either beautiful nature or archeological sites. Both will make you rethink about your existence in this world, make you feel small, but at the same time calling you to do things bigger than yourself. In Mexico, I took a 2-hour journey from Cancun to the state of Yucatan to visit one of the most famous archeological sites in the world, dubbed one of the new 7 wonders of the world: Chichen Itza.

Remember all the havoc back in 2012, propagated by Hollywood that the world is going to end? It stems from here, Chichen Itza, built by the Mayans, where their numbered calendar ends at the year 2012. But according to our guide, the Mayans never said the world was going to end in 2012. For them, 2012 marks the end of an era.

The Chichen Itza was most probably built around 7th century AD, during the golden age of Mayan culture. At the height of their civilization, the Mayans must have thought that their civilization would last until 2012, which then a new era will arrive. But it is a mystery to both them and us, how, having created the most unique written language, sophisticated art, architecture, mathematical and astronomical systems, the civilization disappear without a trace.

As an example of the Mayan's extraordinary mathematical, astronomical and architectural feat, the four faces of the temple of Kukulkan have stairways with 91 steps each, which makes 364 steps total. Combined with a base platform on top of the pyramid that unites all four stairways, it comes to 365, the exact number of days in a solar year. Then At about 3 pm on March 20th and September 22nd the sunlight casts a series of shadows against the western balustrade of the main stairway, which creates an optical illusion of a 37-meter-long snake that follows the sun "slithering" down to its own head carved at the base of the staircase.

When the Spanish conquerors came to discover this ancient site, and came in contact with the surviving Mayan people around the area who seem so humble and shows no evidence of sophisticated mathematical, astronomical or architectural knowledge, the first thing that came to their mind was that the Romans or Egyptians must have been here. For them, it is impossible for these people who seem to know nothing to build such a magnificent architectural masterpiece.

Our tour guide went on to explain that the enemy of the Mayans are Mayans themselves. The Mayans divide themselves into different settlements, and there was no effort to unite them all. Fighting off each other might be the reason how they perished. He also mentioned that the decay in society might also be the cause, political tremors, greed, lust for power, etc, which today's society are also guilty of. Sometimes we are so proud of our achievements, but look at how our society is decaying? Chichen Itza serves as an evidence of how no achievements lasts in this world, even the most advanced civilization of an era. Everything is beautifully summed up in the Holy Quran, Surah As-Sajdah, Verse 26:

Has it not become clear to them how many generations We destroyed before them, [as] they walk among their dwellings? Indeed in that are signs; then do they not hear?

The people of the great Mayan civilization may have perished, but what lives on is their knowledge, passed down to generations until it is still used today. Perhaps knowledge is something which we humans are bound to discover and carry on from one generation to another. It is from our Creator, and never belongs to someone or a particular civilization. That is why I love traveling to places like this. It reminds us that no matter how smart we think we are, every single knowledge never belongs to us. So never be too proud, but keep on advancing knowledge. In the words of a Sufi poet, never let success go too much into your head, but don't let failure go too much into your heart.

Saturday, November 15, 2014

In Defense Of The Humble Doctors

"Mak Cik cek kejap ye".

This is not the first time I heard a doctor calling herself 'mak cik' when dealing with a patient, but every time I hear it, it is none other than from a Family Medicine doctor. Family Medicine is a medical specialty provides health care for the individuals based on knowledge of the patient in the context of the family and the community, disease prevention and health promotion.

They are the doctors that we first meet at the local Klinik Kesihatan, before we are referred to the hospitals, if necessary. They are the "gatekeepers" as what the medical fraternity likes to call, the ones who holds the dam to prevent a flood of patients to tertiary hospitals. Through emphasis on disease prevention and health promotion, they not only treat individuals but also the whole community. Family Medicine is an arm of medicine that is indispensable, but sadly are the heroes that are unsung.

Since Family Medicine doctors are the first to see patients, they can deal with any diseases under the sun. Hence in their training, they are required to do rotations for a couple of months in each department at tertiary hospitals. That is when I get to work with one of them, in the Paediatrics department, during one fine Saturday morning rounds:

"Mak Cik cek kejap ye"

She said again when dealing with a child. For some may argue it sounds unprofessional, lacks formality and all.

But I think to a child, it doesn't matter.

There is nothing wrong with it, and I think what is wrong is when a doctor is arrogant enough to be irritated when someone calls them 'Encik' or 'Puan'. She took time to talk with the mother, asking about the family, how they are supporting the child, socially and financially, in a very friendly and humble manner, like really talking to a 'mak cik'.
Being a doctor is a demanding job, I admit. The hospital can consume us and make us think that the wards, clinic and operation theatres are the only thing there is to life. Last week I was scrolling through the Facebook feed a post by a friend of mine caught my attention. It is about one surgeon, allegedly from my hospital, a tertiary centre, arrogantly bashing a Family Medicine doctor, labelling them as dumb and resistant to teachings.

It is quite common, when you spend too much time in the same place, with the same people, to develop an inflated sense of importance, putting yourself in the centre and thinking the world revolves around you, ignoring the fact that the outside world is bigger than what you see. Everyone is good at something, but not everything. It is not wise to judge that a chimpanzee is better than a dolphin based on a race to climb trees.

Respect must be earned, not forced. For many people, the more title you get, the more Dato' Dr, Professor Dr, and all sorts, the more respect you will earn. But for me, I can respect a doctor who is not a little bit annoyed when someone calls them 'Pak Cik'. I would hate it if I spend too much time inside that 4-walls of the hospital and develop this very false sense of self importance for myself. A way that I have found effective is to spend more time on the ground with the community through volunteer work, and secondly through traveling the world. That is how I think Family Medicine and Public Health doctors do it. It is a way to see that the world is wide, and what we do is just a speck of dust in this huge universe.

During my last call there was a death of a baby, which we failed to resuscitate after being exhausted of all efforts, and also a birth in the O&G ward, a premature, which we successfully resuscitated. It happened so spontaneously that the mother did not even make it to the labor room.

Moments of intense pressure makes time move so fast, you barely notice the clock ticking, during evening calls you come in when the sun is setting, go back when it's near noon the next day and punch in when the sun is setting again. I do enjoy the work, it made time felt worthwhile, but the most important thing is that it doesn't end there. It further values and add meaning to the moment when I am free to do what means most to me: treating the community and traveling the world.

Volunteer work and traveling should humble you. I am nonchalant when talking about my NGO trying to build a hospital in Cambodia because I went to South Africa and saw a kid of 17 years old who opened a school, and giving scholarships to people older than him. What I do is just 10% of what a 17 year old kid did. If that doesn't humble you, I don't know what does. We don't see this when we stay for too long in the same place with the same kind of people. Hence I always promise myself to use my free time for my NGO and for travel. It fights off arrogance. It makes me perfectly fine when people don't address me as 'doctor'. Call me "Pak Cik", I wouldn't mind. Because in front of the Creator, I am just a slave

Thursday, October 30, 2014

Welcome To Life, Baby

"Premature baby in room 4, os full!"

I heard someone shout as I was attending a case in the labor room nursery. From the footsteps, I fathom someone running nearer and nearer towards me.

"Doctor, you're from paediatrics, are you?"

"Uh yes"

"There's a premature in labor, os full! We've tried to call your medical officer but couldn't get to her"

My heart started to race. Like a reflex, I reached for my phone and tried to call my medical officer. I cannot be attending a premature baby by myself. I was not trained to. A baby born premature can be born with so many complications and the first few minutes after they are born are the critical period that could determine life and death of a baby.

"Sorry, the number you have dialed cannot be reached". My heart starts to beat faster and faster.

"They are calling you doctor!". I had no choice but to run towards the labor room.

"Is paediatrics here?, baby's coming out!", I heard the obstetrician shout.

"Yes, yes, here he is! Don't worry!"

'What the heck', I thought. Don't worry? This is just my 3rd day in paediatrics, I am still tagging and the only newborn resuscitation I know was my crash-course study before my final exams in medical school. The O&G houseman are still trying to call my Medical officer, but to no avail

"Oh, heck" I thought and wore the gloves anyway.

"Paeds, standby, baby's coming out!"

I saw the head emerging as the mother continues to push. Swiftly, after a few seconds the obstetrician delivered the baby out. But something was wrong. The baby was not crying. Hastily, they showed the newborn to the mother, exposing the genitalia.

"Ma'am tell us if it's a boy or a girl? Now!"

Either the mother was too exhausted or she couldn't comprehend the obstetrician's question, she went silent.

"MA'AM IS THIS A BOY OR A GIRL?"

The mother still looked confused.

"Oh whatever, it's a boy!" said the obstetrician. "Baby's not crying, let paediatrics take over!"

"Oh boy" I whispered under my breath. They still couldn't contact my superior. They handed me the baby, and I rushed the baby towards the open hood warmer where all the neonatal resuscitation equipment are.

It is true that in the moment of intense pressure, memories of knowledge you never thought you had in your brain came to emerge out of nowhere. Utilizing everything I know from medical school, after a a minute or two, the baby started to cry. Loudly. His skin turned from bluish to pink. I have never felt so relieved to hear a cry so loud.

It was an intense moment. 3rd day in paediatrics. What a start. Later I learned that the mother was actually unmarried, it was a case of unplanned pregnancy, and hence left the baby fatherless. Sadly, the mother is actualy a Malay Muslim. The nurses told me that I should recite the azan to the newborn baby. So I did,

"Allahu Akbar, Allahu Akbar
(Allah is the greatest, Allah is the greatest)

Allahu Akbar, Allahu Akbar
(Allah is the greatest, Allah is the greatest)

Ashadu An La Illaha Illallah
(I witness that there is no god but Allah)

Ashadu An La Illaha Illallah
(I witness that there is no god but Allah)

Ashadu Anna Muhammad-ar-Rasool-ul-Allah
(I witness that Muhammad is prophet of Allah)

Ashadu Anna Muhammad-ar-Rasool-ul-Allah
(I witness that Muhammad is the prophet of Allah)

Hayya 'Alas Salat
(Come towards the prayers)

Hayya 'Alas Salat
(Come towards the prayers)

Hayya 'Alal Falah
(Come towards the success)

Hayya 'Alal Falah
(Come towards the success)

Allahu Akbar, Allahu Akbar
(Allah is the greatest, Allah is the greatest)

La Illaha Illaallah
(There is no god but Allah)

The baby that was just now crying was silent as I recited the azan. His eyes are wide open, as if listening intently to the words.

With the words of Allah, we welcome you to life

Tuesday, July 29, 2014

As a Humanitarian, I Support Hamas

Most Malaysians are well aware of the whole Palestinian-Israeli conflict, but friends outside the country often asked me about my opinion and are surprised when I told them I support what Hamas is doing. Most are still misled by mainstream media which portray Hamas as a terrorist group organization, and they think that seeing me as who talks about health care and do humanitarian work, supporting Hamas is contradicting what I do. Here is my take on why as a so-called 'humanitarian', I support Hamas:

This war is not just about stopping missiles and prevent death from missiles. Ceasefire has been done every now and then, dozens of time, but when there is no death by missiles, Israel moves on to kill Palestinians by slow, painful death: blockade of land, sea and air, cutting off supply of food, medicine, electricity and materials for shelter. The biggest hospital in Gaza is still running on equipment that you might thought came out from medical museums. Gaza is trapped, nothing can go in, Gazans are not free to go out. Palestinians has tried to negotiate this with Israel for 40 years to end the blockade and let Palestinians be free to live, trade and travel freely. But after 40 damn years, Israel still won't compromise. How long more can they stand it? Negotiations don't work. Hamas don't attack for no reason, they want Israel to lift the blockage of land, sea and air. They won't stop until they have that basic freedom to live. They want basic health. The definition of health by the WHO is Health is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". What is the use of another ceasefire, when they know they will still be killed by Israelis by a slow and painful death?


What's with counter-attacking with attacking schools, playground and hospitals? "Targeting the command and control center of Hamas" they say. Is it possible that playgrounds and beaches are a "command and contol centre" of Hamas? Do they hide weapons in sandboxes? In the beach sand? Are little kids playing with their friends in sandboxes a threat to Israel? How about the United Nations school? Do you think the UN would let Hamas hide weapons in their school? 

To my international friends who knows me as a humanitarian, you might think it is ironic for me to support Hamas and the Al-Qassam brigade. But I do support them, because their demand to lift off the blockade is for them to live a safe and healthy lives for their people. How would you feel when you are cut off supply from food, medicine and shelter in your own damn country? Hamas has to retaliate because the UN can't do much. Some of you has been with me in Geneva, and you know how the talks go. They come out with resolutions and resolutions, but in the end, the ones who decides to comply or not are the respective governments in the countries themselves. They can talk all they want, but Israel feel that they have no obligation to comply to these resolutions.

It is tiring to write things like this every year, then it dies out when ceasefire is reached, and Palestinians continue to die of inadequate nutrition and healthcare. Supporting Hamas does not contradict with what I do, in fact it is in line with my belief that everybody deserves good health. Not just people in Africa who has to walk miles to fetch water, not just people in South America who live in Shantytowns with holes in their roof, not just people in India who has to travel far to see a doctor. This is Gaza, water supplies are cut off, their roofs are full of holes made by Israeli missiles, and traveling to see a doctor? I'm sorry the hospital has just been bombed