My housemanship journey - Part 1

Even before starting to work as a doctor, you'd hear rumors and horror stories of what it's like to be a houseman in Malaysia. When I was in medical school, I remember reading articles that were published in newspapers by parents and other relatives of then house officers of how they were being mistreated and bullied, etc. It can be demotivating to read and hear such news, especially before experiencing it first hand. Was is all true? Is housemanship really as bad as what people say it is?

To shed a bit of light to future doctors, I'd like to share my experience of housemanship and my hope is that the story will be able to help you in your own journey as you join our fraternity.

I did housemanship in Hospital Tengku Ampuan Rahimah, Klang. Back then during orientation, we were asked to list out 3 hospitals we wanted to go to, and HTAR Klang was definitely not in my choice. Excited to begin my career as a doctor (and not knowing any better), I decided to just go with it anyway. There were nine of us who were sent to HTAR on the 2nd of October, 2012. Following the administrative paperwork, I was given my first rotation, General Surgery.

Clinical work is very different from medical school. To succeed in medical school, all you had to do was know about your patient and talk arbitrarily to cook up some random management plan you don't even really know about. In the real world, you can't talk your patient back to life. Someone's actually gotta take the investigations, set up the cannula for intravenous medications, post the patient's case for surgery, and make things run. That someone is you, and boy was the learning curve steep. The analogy would be like putting a baby who has barely learned how to walk onto a 30 year old treadmill that's not stopped running since it was built.

Day three of life - I had a near miss incident and I was reprimanded by my surgeon and shouted at by my ward sister. The surgeon said these words and I remember it now as if he just said it yesterday, "You! If I had a knife with me now I would use it to cut you open!". I could feel my heart sink into my stomach. Following that the ward sister told me that I'd probably be extended for being the incident. Looking back now, I don't blame the surgeon and sister for saying those things. But I did feel like I was set up by the system to fail - who would ask a third day freshie to check blood products for transfusion? And is this the way the seniors guide the newcomers?

Welcome to the real world. That was the day I realized that no one owes it to you to teach you how the system works. No one is gonna coddle you the way your mum does when you screw up. No one is gonna say "Hey man, good job" even if you think you deserve it. If you want to learn something from somebody, it's up to you to convince the other person to share his insight with you. If you make a mistake, it is your responsibility to own up to it and rectify the situation.

I didn't bounce back from that incident immediately. I went back home that day and stared at the wall. I asked God if this was what He really wanted me to do, and if it was, why did He allow me to make such a stupid mistake. I contemplated quitting. (Retrospectively I just didn't want to take responsibility for my mistakes and be humiliated by others anymore). Then I realized I had a huge study loan to pay and quitting was out of the question so I sucked it up and went to bed.

As the days progressed, I found that I liked my job more and more. It was not always smooth sailing. I had patients scolding me for not getting the IV line in. One elderly gentleman almost punched me in the face when I attempted venepuncture on him. This other surgeon Mr. L was known for being salacious and I was not spared from his lewd comments. But I realized that what I did matter. Following ward rounds, the surgeons and MOs will leave the ward for other work and the only ones left behind were us HOs. We had to run whatever plans that were given for each of the patients and those plans made a difference. For instance, something as simple as tracing a blood investigation and correcting whatever minute abnormality meant that the patient could get his surgery done. We were the ones the staff nurses would call upon when there were new admissions or if a patient develops any problems, and they looked to us for plans and direction. That said, don't be a hero and know your limits. Anytime you've got something bigger than you, you should probably get a senior involved.

One of the things I learn as a fresh intern was that there are particular ways to conduct yourself in a particular rotation. In surgery, anyone above your pay grade was "Boss". Sometimes, even the PPK (or porter) was also called "Boss". Then, you refer a case to the medical team and call the doctor "Boss", and he says "I'm not your boss. You can call me Dr so and so". You end up scratching your head and wonder.. To boss or not to boss?"

Surgical housemen worked in 2 shifts, I think those posted to ED had another separate shift. I can't remember the exact hours. Say what you want, working anything longer than 12 hours straight is physically and mentally draining. Alternating between day and night shifts takes a toll on your circadian rhythm and sleep cycle. Night shifts were particularly challenging for me as you had much less manpower and the responsibility of the wards fell on your shoulders. While it may not be as crazy as working 36 hours every other day, it's still a challenging feat. I'm grateful that we do get better hours for rest and time to study in between.

Well, four months whizzed by without me realizing it. At the end of the rotation, I didn't get extended. I made good friends and I learned how to function as a house officer. Did I like the rotation? Yes, my surgeons and MOs were all good in what they did and very nice to us. It was a good introduction to the life of a doctor and it helped set up the momentum for the following 20 months to come. Also, I met the love of my life in this posting and we now have 4 beautiful children together. That's a story for another day.

Talking about quitting housemanship

There's a post going viral regarding a house officer quitting and how it was the best decision that she'd made. 7700 shares and 10000 likes go on to show that many people concur with the points made by the writer.

I'd be lying if I said the thought never crossed my mind. Being a house officer was physically and mentally exhausting. I was lucky (or unlucky) enough to be working in the shift system, but certain departments arranged the shifts in a way that you end up working everyday anyway. Take medical department for example, we worked long day shift, short day shift, night shift, and our post night was considered our off day; rinse and repeat. Most of the time, the post night would be spent on random work stuff anyway like venepuncture, settling discharges and summaries, attending CMEs to ensure you achieve the minimum required to pass the posting. etc. Night shifts were particularly scary because sometimes you'd have to work alone. You never know how many admissions there'd be and how many patients were gonna need resuscitation.

Most of the time, your work goes unnoticed. That means that it doesn't really matter if you did a good job or you made a huge blunder. It's not good either way because in one case it's demotivating, while in the other you won't know how bad things could be until the situation actually does spiral out of control.

Was it a toxic environment? It felt that way, and it still feels that way. There'll always be people who think that they're superior and better than you, and they talk down to you or talk at you rather than talk to you. Sometimes, it does feel like the superiors forgotten what it's like to be a house officer, or they choose not to care anymore. BUT, there'll also always be people who encourage you and inspire you to be a better doctor and more importantly a better person than you were yesterday. There will be superiors and colleagues who take the time to sit beside you, listen to you and offer sound practical advice, or even just be there.

(Of course, there are also those cartoons who are existing just because. You don't really understand what role they play in the hospital or in your life).

So what am I trying to say? If you're feeling burned out and you think you want to quit housemanship, I'd like to share what my thoughts and hopefully it would be able to help you come to a conclusion with the matter.

1) Housemanship will pass before you know it. Medical school took you six years of your time, what's another two? Not completing housemanship is like preparing all the gear you need for the run but calling it a day before even starting the marathon. If you're sure it's not your cup of tea after two years, it wouldn't be too late to consider something else then.

2) It is a thankless job and most people won't know or acknowledge the work that you do. And well, who cares? It doesn't really matter. At the end of the day, you're in this line of work because you wanna do some good and whether anyone else sees it or not is besides the point.

3) There will be good and bad days. Sometimes a string of the latter will happen before something good finally comes. That one rare moment a patient thanks you (Yes, you, a house officer) for taking good care of him and he gets to walk out of the ward alive? That is gold. I did say it doesn't matter (point 2), but it still feels pretty good to be appreciated. We're human after all.

4) There'll be toxic and malignant people everywhere, not just the medical fraternity. If you can't tolerate two years of internship whereby you're not directly responsible for your patient, will you be able to tolerate the other hardships anyway that come with a new job? Quitting housemanship shouldn't be about the external factors. It's about you realizing healing and comforting the sick is not what you want to do.

5) If you do want to quit though, be very sure of what your long term plan is. Hey, I'm not saying the salary's great but it pays the bills.

6) There were times I felt like quitting myself. I just wanted to share with whoever it is out there that feels like you can't carry on anymore, you are NOT alone in this. Everyone who has gone before you probably thought about it one time or the other, regardless of how strong or courageous they seem to be right now. There is absolutely nothing wrong with feeling stressed, defeated and discouraged - especially given the limitations of the system and workplace we're in. Get help. Talk to somebody. There's always someone who's willing to listen, and it gets better.

To the original author who penned about quitting and her points for it, kudos to her for speaking up and initiating discussions to the local healthcare working environment.