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?
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.
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