Tuesday, December 23, 2014

Finger Fashionista

In orthopaedics, we usually get called down to do a finger refashioning at the emergency department. Just like manicure, finger refashioning makes the fingers look better, except that instead of cutting the nails short, we cut the whole finger short. Our intentions were good though, these fingers were already cut in the first place. We make them look nicer and less prone to infection. A typical mechanism of injury would be that of fingers stuck in factory machines. These fingers look horrible before being refashioned, depending on which machines they were stuck in. Sometimes they are crushed by stamp print machines, shredded by paper shredder machines, lacerated by grass cutter machines, rolled flat by paper roller machines, but the worst one I have seen are the ones stuck in sugarcane machines. They are crushed and shredded at the same time.

Usual patients are the migrant workers, because they are the ones working in factories to operate machines. It is sad to think that these people came here to Malaysia in search of a better future for their family but ended up losing a few fingers. So one day, I had a call to do a finger refashioning for a factory worker who got his fingers cut at a wood cutting factory . The poor guy was a Burmese, must be in his 30s. He was accompanied by a young man in neat corporate uniform, his supervisor. I learned from the supervisor that he just came from Myanmar and did not speak a word of Malay, and just a little bit of English. When saw him, he was in pain and had his right hand covered by a piece of cloth that was already half-soaked with blood. Slowly, I removed the piece of cloth and from the supervisor's story, what I saw was expected: the index finger was nearly total amputated. It was just dangling there, the only thing holding it in place is a layer of skin. The bone was totally crushed. But what bothers me is that the thumb was crushed as well. Of all the fingers of our hands, the thumb is the most that affect hand function. The level of amputation determines the extent of the functional deficit. I knew I had to take extra precaution to preserve the thumb length.

So I asked the supervisor to wait outside while I do what needed to be done. To tell the truth, I liked being called to do finger refashioning. When I am in the sterile scrubs, in the silent procedure room with just the medical assistant and the patient, I feel at ease as the frantic noise of the ED department outside drowns out. I get to escape from the hectic wards for a while. I feel a sense of calm and focus as I start to wield the blade. In experienced hands, finger refashioning should take just about 30 minutes. I took a tad bit longer, but in moments of intense focus, you barely notice the time pass. The fingers were still oozing blood. In a nutshell, I gave anaesthetics to make the fingers feel numb and insensitive to pain, stopped the bleeding, crushed the bones to make it shorter than the surrounding skin, trimmed the ragged edge of the remaining skin and soft tissue to make it look smoother, at the same time creating a skin flap to close the gaping hole, and sew the opposing skin together. Convinced that the bleeding was secured, I covered it with topical antibiotic gel, and then with a white cotton gauze.

I was satisfied with my finger work I did that day. I explained that he needs to take antibiotics as to prevent infection to the injured finger, and has to come to the local health clinic to get it cleaned up daily, and come again to our clinic to get the stitch removed and reassess the wound. I tried my best to explain to him in the simplest form of language. At the end of my explanation, I looked at him. He was looking at me with a blank stare. I looked at him, he looked at me. I was looking at him, he looked at me.

Okay that's it, this guy does not understand a word I said.

Exhausted of all effort to communicate near the end of my work shift, I showed him the 'thumbs up' sign, and said "Okeh?". Although in pain, but perhaps still numbed by the local anaesthetic I gave him, he looked at his thumb, now made shorter, covered with white gauze, lifted it up, trying his best to show me a 'thumbs up', and said:

"Bagus!" (Good!)

With his other hand, he gave pat on my shoulders.

Well, that was unexpected.

I called the supervisor in. I explained the same thing to him, hoping that he will have a way to communicate my instruction to this employee of his. I also mentioned to the supervisor that I had already explained to him, but I don't think he understood, and gave a quick remark that he understands the word "bagus" though. 

But the supervisor said "Uh, I don't think he understands the word, I think he was just imitating my boss".

"What do you mean?" I asked curiously.

"You see, at the factory, at the end of the day our boss will give a thumbs up to those who worked well, before they end their shift, and will give them a pat at the shoulders. They then will happily go punch out their attendance card at the punching machine".

I laughed out loud, and the supervisor had no idea why. The Burmese guy was still smiling, I wonder if he understood what was the conversation about. So he was merely imitating his boss at the factory, guessing that "bagus" with a thumbs up is a sign of appreciation. Oh well at least I know it means I did good job.

I looked at my watch and realized it was way pass my working hours. So after being told 'bagus!' and given that pat on the shoulders, I happily go punch out my attendance card at the punching machine, similar to what factory workers do every working day. In some way or another, we are all the same. I am a cogwheel in a white coat in this machinery called the Malaysian health care system.

Friday, December 19, 2014

Superhero the Musical - The Story of the PPR Kids

"The art of theatre humanises the human race" - Samad, main character in 'Superhero'

After more than 2 hours watching the musical theatre "Superhero" at the National Museum's Auditorium, I still could not believe such a beautiful and lively performance come from the PPR kids of Kuala Lumpur. PPR, which stands for 'Projek Perumahan Rakyat' (People's Housing Project) is an effort by the government to relocate squatters to live in permanent homes with more "comfortable, relaxed and healthier environment". However, "comfortable, relaxed and healthier environment" is not easily achieved when their living space is cramped with limited number of rooms, air ventilation and space to move around. 

With increasing family size, it is easy to feel suffocated living in such small spaces, which why children and teenagers who live in these places often spend most of their time outside their houses and explore the world on their own. While it is a good thing to explore the world, it can also be a risky business for kids when they are out and about without the supervision of their parents. Especially in this city of Kuala Lumpur. Kids can either find good inspiration outdoors and do something good with their lives, or make friends with the wrong people and end up getting involved with unhealthy activities, skip school and worse of all, commit crimes.

On a couple of occasions, I gave talks to these PPR kids in programs that are organized by myHarapan (the Youth Trust Foundation). I was supposed to motivate them, but even before giving these talks, I knew I to had to crack my head on how to get these kids interested. I mean, come on, I talked to those people at myHarapan and they say it is hard enough for teachers to get attention of these kids in school. Why would they want to listen to some stranger coming to give so called 'motivation'? So I decided to scrape all my old scripts and decided to tell a different story. Unlike the speech I gave at MRSMs or high schools, I didn't focus on them to be successful just academically, but on being successful in doing anything that they are interested in. I know there are PPR kids who are academically brilliant, but for the majority of them who secretly have inborn talent, I encouraged them not to be afraid to do what they like, do their best in it, and make it productive. I told them the story of my good friend Jimmy, a chef with no academic qualifications, not even PMR or SPM, who ended up working as a sushi chef in Switzerland. My talk was about going all out in whatever you do. To my relief, I saw their gleaming eyes as they relate to my story, and I know I had their attention when one of them shouted "Mak saya jual laksa!", when I asked them if theu know anything about the food business. Best of all, I saw hope in their eyes.

"Hanya perlu percaya!" (Just need to believe), shouted one of the character during the play. It became a theme of the musical theatre, that if you believe, anyone can become a hero. What send tears down many of the audiences is that these characters, they are not fictional. These kids are playing out what happens to be their own lives living as a PPR kid. They share their story of happiness and sadness, the hard life of their parents to make ends meet, the difficulties they face at school and much more. This musical theatre is organized by myHarapan and Revolution Stage. Through this project, the PPR kids undergo basic theatre workshops. The workshop is divided into 3 stages, and this musical performance is the 3rd stage. I cannot emphasise enough that this effort my myHarapan and Revolution Stage really bring out the best in these kids. I had a chance to talk to some of the kids and the organizers after the show. One of them pointed out how they can see with their own eyes the change in these kids as they go through the workshop. At first they weren't very involved, didn't talk much and were very shy onstage. Now, the audience can see first hand how confident these kids are on stage. With them being so young, there is no doubt that this kind of confidence will take them far in life. The kids told how life has changed for them ever since joining this project. Previously spending time loitering around with friends, smoking and 'rempit'ing around, they now have a productive outlet for their energy and creativity.

It is hard not to believe in the theme "hanya perlu percaya" after the show ended, because you can see in front of you that these kids made it here to become so good in acting because they just believed. I admit I haven't seen that much theatrical plays in my life, but I can tell you that it was an awe-inspiring experience and I would not hesitate to recommend it to all of you loooking for a good way to spend your day. 

The show is still happening until this weekend, 21st December 2014. Details is as in the poster below. Do come, and remember that the ticket sales will also go to this project's funds to enable them to do bigger projects and involve more PPR kids. With your help, more and more of these kids will become 'Superheroes' and lead them to better lives ahead 

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.

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