Houseman Bingo (Part 2)
June 9, 2020
Let's continue with the next part. :)
This bingo is actually for my own memories, housemanship has its ups and downs, so, I treasure all experiences I had encountered when I was a houseman :) Maybe this post can be helpful for any new house officers trying to read around about housemanship - though there are lots of other people posting everywhere, hehe :)
10. Activate blue or / and red alert.
In the hospital I had practised as a houseman, blue alert means there are some emergencies going on in the hospital involving outpatients, family members or visitors.
Recently, there was a patient brought in to our ED after blue code activated. She was at the outpatient department, to be specific during the process on blood taking for her appointment date when suddenly develop fitting episode. With a known case of epilepsy, she was finally admitted for further management.
Others can be as family member who is taking care of patient in ward suddenly found unconscious. It is not that the ward cannot do anything to him... of course they will especially for basic life support. But the emergency team will be called to attend the patient and bring him to the ED for stabilization :)
While red alert can be found mostly in O&G department, involving pregnant women - eclampsia (sawan), post partum hemorrhage (pendarahan banyak lepas bersalin), should dystocia (bahu tersangkut masa bersalin), cord prolapse (umbilical cord di pintu rahim masa nak bersalin) - all of these cases are emergencies!
11. Send patient for xray by self.
This happened when I was in Orthopaedics. We were planning to get check x ray (means x ray that is done after operation) to see in formality if the operation is successful or not. The patient was put on some case (I can't recall the name) but it was a bit complicated to set it up. The radiographer need to remove the cast/sling first before shooting the x ray, but requested for Ortho team to be there to reset it back after the x ray.
12. Explanation letter.
Need to do this when in Ortho as well for some reason - actually I forgot details of this patient.
-_-'
13. Send specimens to lab by self.
It is a normal routine for housemen, despite we have PPK (pembantu perawatan kesihatan) but they could be doing other stuffs too, like sending patient for xray / to OT, taking food trays from kitchen etc. So, in daily life, sending specimens is our task too - especially in emergency cases in ward, like resuscitating patient.
14. Sleepless oncalls
To be honest, I don't fancy oncalls / night shifts. -_-' maybe that is one of the reasons I prefer myself to float in ED (other than I still can't decide which departments to go as I love all of them huhu). ED practices shift systems.
Oncall usually means, working for at least 24hours plus plus plus, for example going to work at 7am today and punched out at 1pm the next day. For some hospital, it can be up to 5pm the next day. I had no experiences with that shifts, as my previous oncall shift was different.
In O&G - 7am-5pm, go home to come back at 10pm and finish oncall at 1pm the next day - though we can be stucked in the ward / labor room between that 5pm-10pm.
In medical - 7am-12pm, break till 4pm, then continue working till 1pm the next day. The 4 hours break were totally UNPRACTICAL haha as the morning round will finish around 11am plus, and for sure it will be really hard to get all task lists done within 1 hour. Haha.... kalau bertangguh, tahan la telinga kena marah dengan family members sbb tak siapkan lagi surat-surat discharge semua. T_T
15. Meconium bath in LR
Meconium = najis pertama baby. Despite wearing plastic apron, our clothes / shoes can be soaked with the patients' meconium while we are helping the delivery. Meconium can be light / moderate / thick.
Stain in meconium means the baby already pooed inside the womb. This can be a problem later if the baby aspirate the meconium as it can pass through the lungs and cause the baby to have difficulty in breathing upon delivery. This is not a simple case - it can even lead to death!
16. Feed and took selfie with newborn in ward.
I really enjoy the feeding session in NICU (neonatal intensive care unit), you can see how eager some babies react to milk (be in expressed breast milk or formula milk). Usually if the babies need intensive care and monitoring, they will be admitted to NICU where they don't stay with mothers. So, the time for direct breast feeding will be limited and all mothers will be consented for formula milk.
Different situation in post-natal ward or special care nursery (SCN), where the babies can be still under pediatrics team's observation but they are stable enough to be left with mothers. :)
17. Belanja misi food.
Usually after end of posting :) Haha.
18. Mortality summary.
Haaaa, I don't like this one. First, it means our patient had passed away. Next, they need good documentation especially in cases that family members would like to have a formal medical report to claim with insurance company etc.
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Wow, suddenly I missed my housemanship. Haha, but like others, of course I don't want to repeat the phase again. Housemen leave home before sunrise, return long after sunset. Almost daily hehe.
Alhamdulillah. Thank you Allah for helping and guiding me through out the housemanship - with providing me good people around and experiences. :)
SM, Perak, Malaysia
200609
Found this in my phone gallery. Before I delete pictures like these, I feel excited to share it on the blog first. I have 9999+ images more to delete, seems like I have deleted nothing. Hahaha.
For this, I managed to achieve one Bingo. :D
1. No off for 2 weeks.
Yeah, it is possible for some department when you can accumulate two off days consecutively :) As a houseman, you are entitled to get one off day per week.
In my case, it was during surgical posting. We have this 2 weeks rotation for clinic which cover office hours (Monday to Friday, 8am - 5pm). So, you can either have your off day on Saturday or Sunday for each week. Otherwise, you can request to the team leader to allow you to work the whole 2 weeks and claim your 2 days off later.
Housemanship has flexible schedule though. It was hard to plan for holidays, sometimes.
2. Ate hospital food.
We called this - hospital diet. Trust me, almost 99% of the food are delicious! Usually the kitchen will serve different meals for staffs and patients. Even for patients, there are different food too - depends on each requirement, some may have high potassium diet, low potassium diet, low sugar diet, not to forget... we really care about patients' allergies too :)
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| Tomyam ayam |
3. Felt like quiting.
Hehe, I felt this way every time I failed to give my best, or unable to save patients, or unable to recall knowledge that I've learned.
Medicine is a continuous learning, every day is a learning process and we encounters lots of new things every second.
Feeling like quiting is normal, just don't quit before you have really tried your best or have a strong back up plan. Find something to look for everyday. :)
4. Did a vacuum dressing.
There are different types of dressing to the wound. Dressing means technique to cover the wound - some simply with normal saline, some with special liquid, some with iodine. For vacuum dressing, we are basically put some negative pressure / put some suction to the wound, with the aim to remove all exudates (layman terms = air bisa?) and encourage growth of new healthy tissue :)
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| Something like this - source https://www.wjgnet.com/2218-6190/full/v1/i3/13.htm |
5. Failed blood taking x5 on same patient.
It is actually common for patient with difficult blood taking which usually we ended up with taking blood from the artery. I encountered this when I was in medical department, especially when I was doing my solo HO night shift. It was hard to ask for help as others are busy too with their medical wards. T_T
6. Play with newborn in ward.
I enjoyed this especially in O&G department, hehe I called newborns as cookies fresh from oven. :) Their smell is soooo nice, especially after we cleaned them up. After a baby is born, the doctor will need to do basic baby check, to make sure the baby is generally healthy. If the mother has some pregnancy problem, like gestational diabetes mellitus, history of infection, big baby - we eventually will call the paeds team to do the check instead. :)
7. Kena 'buli' senior or MO.
Hmmm, sometimes I don't realised this, until another colleague mentioned to me something like, "Eh, kenapa kau pulak buat benda ni, bukan patutnya XX punya task ke?" Haha.
Bullied by MO, hmmm, not sure.
8. Get to know a supportive MO
There are lots of them to be honest. Get to know them and you will have more opportunity to learn more. :) Every department, I have my favourite MOs whom I found easier to discuss and plan for management as they will ask me back about the reasons behind those management. :)
"Kenapa aku buat macam ni untuk patient ni."
If my answer is "not sure, nanti saya baca part ni." And he/she will give due date to present back to him/her with the answer. Sometimes, even after studying that specific topic, my answer can be wrong. But I love how they were still being patient and explain the reasons.
These kinds of people, may Allah bless.
9. Punch out 4 hours after work.
HAHA.... many times during medical department, especially during postnight shift. You are allowed to go home after 1pm (during that shift system), but, what to do if the morning rounds sometime finished around 11am, and you have lots of task to complete before leaving the ward. Usually what made me stuck there was when I failed to complete my tasks especially the one involving office hours - like sending / receiving fax to / from another tertiary hospital about patients' previous records, requesting urgent radiology appointment, calling another office / klinik kesihatan - where the lunch break usually from 1pm - 2pm plus.
While I still have other pending stuffs to do like settling patients' discharge notes, assisting MO with procedures, urgent blood taking etc. Hahaha.
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Enough with 9 for this post, gonna share the rest in the next one :)
SM, Perak, Malaysia
200609
The Art of Letting God by Mizi Wahid | Book Review
June 6, 2020
I have my eyes on this book for months but keep on postponing because of the
price -_-'. I know RM50 is not that much for a book, to be exact a hard
covered book. But as I have spent hundredssss of ringgit during the previous
Big Bad Wolf, I need to calm myself from buying new books until I read at
least a quarter of books I bought from BBW hehe.
So, here I am!
I managed to grab it at a discounted price during Pesta Buku Iman and I can
say I love it so much! The book arrived just before Ramadhan, so I have spent
the whole Ramadhan reading it, slowly. I even brought it to the hospital and
shared things I read with my colleagues, then we ended up sharing our own
experiences. It was lovely, alhamdulillah.
Title: The Art of Letting God
Author: Mizi Wahid
Pages: 147
Publisher: Iman Publications
Publication Date: March 2019
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Back cover of The Art of Letting God. |
Anyway, while writing this, I realised I don't have much book reviews on
non-fiction (?) Actually I've been known by my family as a person who lacks
fiction imagination haha, so I tried my best to read lots of fiction books to
improve it.
Allow me to share snippets or beautiful verses from this book :)
1. The greatest temptation many of us find most challenging to deal with in life - is the temptation to give up.
This is very true, we have the temptation to quit whatever we are doing, for
various reasons - financial problem, family problem, lost of focus, emotional
attacks etc. But, the moment we managed to overcome this temptation, that's
the beauty of success. It actually can be seen as one point in life, but to be
honest, life is continuous journey so to overcome it needs life long courage
and support.
In this book, the author described more about Prophet Moses (p.b.u.h) who was
not only asking Allah for ease in affairs but strength, wisdom, patience,
ability and support :)
2. Tawakkul is the word used to imply one's act of reliance on God or "trusting in His plan". It is also seen as "perfect trust in God, and complete reliance on Him alone.
Reading this verse, reminds me on previous conversation with a friend of mine
who is an atheist. Medical school was a hard time. To get through each tests
and years, I learned a lot about tawakkal and really, success is not only
about studying smart but the idea of having Allah to rely on after our hard
works.
"Tie your camel first and then put your trust in Allah."
She mentioned to me how stressful she was and asked how do Malaysians can
remain calm. Haha. Only if she could see hurricanes in our hearts :D
"Maybe because most of us are Muslims? We usually leave it to God after we
tried our best during the process of revising."
"Oh, I don't believe in God, but I believe my success will be from my hard
work, that's why I need to study more."
In my heart... no wonder. Penat sebenarnya bila kita terlalu bergantung pada
kemampuan sendiri sebab manusia memang bukan perfect, akan ada kesilapan dan
kelemahan.
3. Believe that nothing just happens. Instead, everything happens for a good reason. And everything happens for you, not against you.
Most of times, we tend to argue about others rizq and complained why such
opportunities do not come to us. And we tend not to realised how much other
rizq have Allah blessed us with. Some may have a good occupation and income,
but he may not have children yet. Some may be blessed with children but having
difficulties in work.
The author also mentioned about the tools and ingredients to success that we
may already have but we don't realised it - so, we ended up to keep wondering
about our unanswered prayers.
"If all of you were to truly have faith in Allah s.w.t. He will
certainly provide you with sustenance, just as He would give to a little
bird, for when it leaves its nest in the morning with an empty stomach,
but returns home in the evening full."
4. Friends, reject the cup of poison. Instead, drink from the fountain of faith, the reservoir of resilience, and the sea of spiritual confidence.
In the book, this part was described as we are exposed to lots of "poison"
which would murder our thoughts and destroy our peace and happiness to its
death.
I believe most of us have our own experiences.
Rejections from other people.
Bad words that push us down.
Refuse that poisons, reject that unproductive comments, go beyond.
5. "How do we know if we've forgiven somebody, and have completely moved on?"
The author listed down few check lists to see where we are and how much
further we need to go to finally achieved the term 'completely moved on'.
- Are we still interested to know about them?
- Do we feel our blood boiling when we hear their name being mentioned in a conversation?
- Do we feel awkward when we bump into the person?
- Are our emotions still at the mercy of our senses being triggered by old memories?
- Do we feel unhappy when someone tells us about the person's happiness?
- Are we secretly stalking them?
I agree with the author with letting Gold be the one to "teach our enemies a
lesson". We don't have to be one as Allah surely know the best lesson to give
with the perfect timing.
"Those who spend in prosperity and in adversity, who suppress anger,
and forgive others, verily, Allah loves those who do good." (Quran
3:134)
Let it go and let God :)
"Experience genuine peace in your life when you learn how to love in
moderation, fear within limits and hate within reason."
6. Each new day, deserves a brand new beginning. Let go of yesterday's hurts, begin the day in the name of Allah. Just as He magnificently heals all of our physical wounds, trust in Him to supernaturally heal our emotional and spiritual wounds too.
I love the part "Never back away from opportunities to help others who are
struggling, by making a positive difference in their lives"
despite having this kind of thought, "But I'm not good enough".
Humans are never perfect.
Humans do make mistakes.
Even the first human Allah created - Prophet Adam, fell with persuasions of
Iblis and eventually being casted out from Paradise, Prophet Adam repented for
his sins and became the first Messenger of ALlah to humanity.
I know we are not prophet, but from this story, we need to believe that humans
make mistake and Allah is always there to forgive us more that we are to
forgive ourselves.
Beautiful :)
SM, Perak, Malaysia
200606
I was scrolling my Quora and came across this question. It is an interesting question if we are trying to answer it from perspective of healthcare workers like me vs riders.
To be honest, I don't have motorcycle license and have no skill to ride it as well. Haha.
And after working in the hospital,
I WILL THINK TWICE BEFORE RIDING ANY MOTORCYCLES. T___T
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| https://www.quora.com/Why-do-people-not-wear-a-helmet-while-riding-a-motorcycle |
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**WARNING - THIS POST CONTAINS WOUND IMAGES**
Let me share with you a recent case I attended in the Emergency Department.
It was the morning of last day of Ramadhan, maybe around 4am. The patient was a 16-year-old boy, if I am not mistaken. He was referred from a klinik kesihatan that was 40km away, with the impression of: To Rule Out Skull Fracture.
Resources in Klinik Kesihatan can be limited, they can do chest xray, but not others. I've experienced a lot of referral to rule fractures from KK and to be honest, skills of doctors and medical assistants in KK are amazing. They are usually the primary team to stabilize patient in areas without hospital.
So, back to this case, he was brought in on a wheelchair, with lots of gauzes covering different parts of all four limbs. He could even walk from the wheelchair to the bed.
Usually, when we attend trauma cases, we use ATLS as guidance.
ATLS - advanced trauma life support.
The PDF itself is almost 500 pages! -_-'
Starting with A - airway + cervical
- Patient able to speak in full sentences, no gurgling or stridor, no foreign bodies in the mouth/ nose, not on cervical collar, range of movement of neck was full.
Proceed with B - breathing + ventilation
- Here, we usually use the acronym IPPA - which means Inspection, Percussion, Palpation, Auscultation
- I - breath spontaneous, not tachypneic, chest rise was equal bilaterally, no chest wound
- P - resonant percussion bilaterally
- P - no clavicle tenderness, no chest tenderness, chest spring negative, no subcutaneous emphysema / crepitus
- A - lung was clear, equal air entry
- Don't forget to check the oxygen saturation too (SpO2)
Then, C - circulation
- check other vital signs - blood pressure, pulse rate
- CCTVR - Color of skin, Capillary refill time (CRT), Temperature of extremities (is it warm/cold), pulse Volume, pulse Rate
- for this patient, it was all normal - pink, CRT <2s, warm peripheries, good pulse volume, pulse rate around 60-70.
- then, we checked the abdomen - soft, non tender, not distended, no abdominal wound.
After that, D - disability
- GCS was full E4 V5 M6, pupils 3mm/3mm equal reactive
Finally E - exposure / environment
- Here, we inspected the whole body from top to bottom, from front to the back.
- This boy has abrasion wound everywhere - shoulder, elbow, hand, shin, foot. But there was no swelling, no limb deformity, no limb tenderness, no limited range of joint movement (means, he can bend all joints normally) - so we don't expect any fractures here.
- There was no spinal tenderness / step deformity during log roll
- But the head was covered with bandage and we could see some blood stain. When we open the bandage, fuhhhhh there was jagged wound, quite big one! the skull was exposed. And there was no skin flap to cover back the skull.
- We gave him antibiotics and painkiller too.
- FAST scan done, no free fluid.
Something like this but smaller around 6cmx6cm size.
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| https://www.slideshare.net/vipinvenugopalnair/free-ld-flap-for-scalp-reconstruction-dr-vipin-v-nair |
Okayy, I know there are LOTS OF MEDICAL TERMS here haha. It is okayyyy, you don't have to understand everything. :D
To make it easy, generally we can say that this patient was stable clinically, vital signs was okay. Just, if there was no jagged wound on his scalp, he didn't even need to be referred to tertiary hospital.
Biasalah orang accident mesti akan calar balar sana-sini. Takde patah, kira alhamdulillah sangat dah. Tapi untuk dia ni, kulit kepala dah terbukak, tengkorak terdedah camtu. Nak jahit kulit kepala pun tak boleh.
We managed to request CT brain in view of the wound was big and skull was exposed - just to rule out any skull fracture or any possible bleeding in the brain (ICB - intracranial bleeding).
Alhamdulillah, turned out CT brain was okay - no ICB, no skull fracture.
So, what we did for his jagged wound - we referred him to Surgical Team so that they can refer the patient to Plastic Team. In big hospital, you can see lots of sub-specialty for Surgery - neurosurgery, plastic surgery, ear-nose-throat, hepatobiliary team etc. But, we don't have such sub-specialties here. There nearest one for that is HRPBI - Hospital Ipoh.
If the wound was a simple laceration like the one below, usually we can suture it ourselves..
| https://www.medicalimages.com/stock-photo-image-image9257585.html |
I feel sad for his father, he looked very tired and when the surgical team informed him that the patient will be transferred to Ipoh, we could see his 'pasrah' face. I believe the importance of parenting, but kids nowadays can be beyond control.
This is one kind of accident that actually can be avoided.
Why?
The boy is underage, without licence, without helmet, went out riding motorcycle with his friends around 12am, speed at least 80km/hour and the mechanism of accident was as I expected - he said "kawan main motor himpit-himpit, saya tak boleh control motor tu yang terbabas"
Rasa sedih bila jumpa kes macam ni.
And there were countless cases like this EVERY SINGLE DAY.
So, if you guys or your family members are motorcycle riders, do remind each other kay.
Always wear helmet.
200530
SM, Perak, Malaysia
Day 10 of May Photo Challenge - Self Care
I Miss...
May 15, 2020
I miss travelling actually, walking around the airport to catch flights.
I miss sitting by the window and watch the beautiful scenery from the top.
I miss the feeling to pass the security control and to have another stamp on my passport.
:)
I was actually planning to have a trip back to Czech after completing my housemanship hehe :D. Usually, after housemanship, we are allowed to use the remaining annual leaves and take a long holiday up to 27 days (if I am not mistaken). But my husband was still working at that time, so I decided to wait for him first to go later together. I went to the office to inform that I would be starting my floating (junior medical officer) soon.
Due to Covid19 outbreak, my friends who decided to take that long holidays were called to start working and our leaves were apparently have been frozen since March.
Ouch.
And I think travelling abroad is going to be tricky after this pandemic, right?
Maybe travelers need to provide supporting documents, health reports - new norms maybe?
Day 9 of May Photo A Day - I Miss...
SM, Perak, Malaysia
200515
The Sky
May 12, 2020
Sunrise from the hospital, to be exact - the Emergency Department. :D
I think this one was taken on my post-night shift around 7am plus.
Sunrise.
Means it is another day.
Another opportunity. Another chance.
For?
Being a better person.
I always wonder, how did I survived housemanship the past 2 years. To be honest, I believe most housemen will have the thought of quitting, but due to every own reasons, most of them survived and still surviving. It was a tough journey. Hanis Amanina who you are seeing now is a lot different than who she was in Czech or before that. Hehe :D
Go with the flow.
Sometimes, I cannot deny that the HOship hurt my heart and feeling a lot. I believe it affects my personality, my attitude and my knowledge. Learning as a medical student is not the same as being a doctor itself. The responsibilities I need to carry every time I do something to the patients, always overwhelm me. Still.
But at the same time, honestly it gave me happiness as well - able to manage patients correctly, able to see patients getting healthy, surrounded with good and helpful colleagues, have the opportunity to say the first Assalamualaikum to newborns. MashaAllah, the feeling was AMAZINGGGG and I will never forget that! :)
I believe the key is not to give up.
Recently I read the The Art of Letting God, at the very first chapter, it shared about the greatest temptation. I agree that the greatest temptation to deal with is the temptation to give up.
"Are these goals truly achievable? Am I being realistic? Am I good enough? Am I worthy of such achievements? Or is it simple better for me to just give up?"
In the book, it mentioned about dealing with it is by asking help from Allah. When we looked back the story of Prophet Moses (peace be upon him), despite only asking for ease, he also asked for strength, wisdom, patience, ability and support.
I have shared a post about DOA PENERANG HATI when I was still a medical student. At that time, I was having difficulties adapting with Czech's exam system where almost all exams were done orally. T_T It was a struggle to speak medical stuffs or answer medical questions confidently in the exam because once you said something wrong, the examiner will directly know you are lacking something there and suddenly he will go deeper on something that you are not confident with.
But Alhamdulillah, that phase has passed. :)
Housemanship tooooo :)
Alhamdulillah alhamdulillah.
Anyway, still remember my collections of sky over 2014? Can't believe 6 years have passed. WOWWW. MashAllah :)
Day 8 of May Photo A Day - The Sky
SM, Perak, Malaysia
200512
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