Quitting Housemanship

Qutting Housemanship

stressed doctorShould I quit housemanship? To be honest, this question has crossed my mind countless times. I came near to my breaking point barely 2 weeks into my HOship in O&G rotation. I can understand too well the stress of being in a completely new environment, feeling like an idiot and having no idea how to function. I know too well the feeling of inadequacy and the anger at myself for having spent 6 years abroad with nothing to show for. If you’re a houseman on the verge of quitting, then I hope my writing would help you decide, if only a little.

Should I Quit Housemanship

That being said, I still think, no, you shouldn’t quit housemanship.

Yes, it is the toughest thing I’ve ever done in my entire life. Slogging 2 years without adequate sleep, enduring harsh criticisms from superiors, having the nagging feeling that you’ve forgotten to do something right – all these is part and parcel of working as a lowly HO in Malaysia.

Yet as I grow older, I saw housemanship as a period where one can achieve tremendous personal growth. Just bear in mind that no other profession gives you the opportunity to develop yourself in such a short period of time. At least, no other profession requires you to perform and not kill somebody at the same time.

The need to perform well under pressure will hone you into someone you’ll barely recognise 2 years down the road. Whether that pressure made you into an amazing healthcare provider or a horrible boss who will just continue the vicious cycle for the younger generation is another matter entirely.

It all boils down to one essential word: grit

Grit

If you haven’t read the book by Angela Duckworth, I highly recommend you to. Her book has opened my eyes on high performance and tenacity. Her research shows that, no you don’t need talent or a high IQ to be successful in life. All you need is the passion and the perseverance to persist to the end.

Yes, housemanship will break you.

You will be driven to the edge of your abilities.

You will be pushed past your limits.

Yet if you persist, if you hold on to that one word, believing that all difficulties will just help you develop that grittiness, then you have the essential quality called The Growth Mindset. It will carry you far in life.

Personally, for me, I held on, and I am forever grateful to my friends and family who helped me through it. I strongly believe the 2 years shaped me into a more mature and courageous person who will not easily take no for an answer. All the harsh treatment only made me develop a kind of mental toughness and tenacity to persevere through the shitty phase in life.

I will spare you the usual arguments defending our current HO training system. I personally think that it has much room to improve. Look past that, however, and you’ll realise that housemanship is a valuable training ground for you to rapidly become a capable adult. All the experience you garner through the period will help you in whatever field you choose, even outside of medicine.

Dear housemen, don’t give up. Fight on. When all else fails, just remember, pain is temporary, but growth is permanent. Everyone has the capacity to grow, and you can too.

 

Housemanship Experience – Part Two

After 2 gruelling years, I have finally completed my compulsory house officer training.

Anyone who has been through it would tell pretty much the same things – shitty working hours, exhausting workload, toxic environment – sometimes to the point of annoying those who are not in this field.

“Yeah yeah we get it. You have been through hell, bla bla bla. What else is new?”

Well before I get into that, let me recount my experience from my last 3 posting. (Click here to read my experience from the first 3 rotations)

Surgery

Surgery was one of the toughest posting for me in terms of workload. Back then there was no off days, so that means puny HOs have to work continuosly without break for 4 months, with only a weekend pass in between (or was it 2? I can’t remember).

Oncalls were terrible affairs as you’d have to work 30 hours, and if you were placed in one of the surgical subspecialties, it stretches to 36 hours straight. I had the pleasure of doing back to back calls for a week, which meant that the only time I went home was every other day just to shower and sleep.

I had no idea how I did it back then.

The only time I enjoyed myself was during my rotation in urology. Bosses were nice there. Other than that, let’s just say I’m glad I don’t have to step into the operating theatre anymore.

Paediatrics

Ah, the dreaded department. The one that invokes a sense of impending doom in the hearts of every puny HO.

To be honest, I quite liked the rotation in paediatrics. I guess it was because it being the 5th rotation, everyone from my batch went into the posting together. So that means friends whom you could count on, and in housemanship, teamwork means everything.

I started off in the nursery, then the general wards, then came the rotation in paediatrics intensive care unit, and finally paeds oncology. Paediatrics was the one department where they hammer the sense of carefulness into you everyday. You have to pay attention to every single tiny little thing. You are dealing with tiny little humans after all. A simple mistake can cost lives.

I was fortunate enough to have had the chance of working under some of the smartest and most dedicated people in paediatrics. My time in PICU was spent just trying to not make any mistakes and trying not to shit my pants as I cower in fear in the shadow of the famous consultant there.

That being said, paediatrics was the one posting that thought me the value of perseverance. It was where I saw first-hand the true meaning of doctors being healers. It was where I saw miracles happen.

Emergency & Trauma

Ah, ED. The jungle.

The chaos in ED would make anyone rip their hair out in frustration. Luckily I went into the department together my batchmates as well, and like I said, teamwork is everything.

I would say I learned the most in this department. It is where one get to integrate everything they’ve learned in previous departments and apply it in real life, and sometimes in hair-raising situations. I’ve lost count the number of CPRs I’ve participated in.

The hours are long and the work is exhausting. Add to that the various shenanigans one has to put up with people who treat the ED as their personal pharmacy/free medical consultation clinic, it’s easy to hate the place. Yet strangely I found comfort in the chaos.

In short, ED was fun, and it was over in a blink of an eye.

Finally it was over

My last night shift in ED was a relatively peaceful one. And before I knew it, 2 years of hell was over.

Pictured here with the other survivors of housemanship

To be honest, it didn’t feel as liberating as I thought it would be. With the completion of housemanship, one becomes a medical officer, and that actually is the scary part.

There’s no one to breathe down your neck anymore, yes, but you’ll have to start being the one who makes decisions that will impact another human being directly. The responsibility is tremendous.

I just hope that when the time comes, I’ll be able to make the right decisions¬† to the best of my ability.

End of Another Year

I cannot believe it’s already the end of 2017, and even more perplexed to find myself struggling to remember what has happened for the past year. Everything seems to be a blur, a life lived as though I wasn’t in control, a life in which things happened before I could comprehend the full magnitude of it all.

All I know is, I have more or less settled into life as a HO in this hospital. The daily grind, the exhaustion, the toxic people I deal with daily at work – all these things have definitely changed me, and I hope for the better. Things don’t seem as difficult as when I first started. I guess that’s what they mean by grit – the more you put yourself into uncomfortable territories, the more you grow and adapt. It doesn’t matter whether you like it or not, what matters is just turning up and getting shit done.

Then there was another life-changing event that happened right at the beginning of the year that seemed to throw a wrench into everything. Yet I know I walked away from it a changed man who has a different worldview now. Alas, life is never a fairy tale. Yet there’s always a silver lining in everything, and when things seem to be darkest, that’s when the slightest sliver of light becomes a ray of life-giving sunshine.

That being said, 2018 represents a new beginning, a chance to wash away all the filth and start on a clean slate. It also represents a major fork in my journey in life since I have to make a career pathway decision pretty soon.

Here’s to another great year, and hopefully it won’t be another blurry, forgettable one. Happy new year folks.

Hospital food chain

House officers are quite literally on the bottom of the hospital food chain.

There are at the consultants and head of departments, the gods of medicine whose mere presence makes everyone scuttle. Pray they won’t ask you questions during ward rounds.

Then there are the specialists who supervise the show in the ward. The ones who make important life or death decisions, the tough clinical judgements.

Then there are the registrars whom we look up to, who are training to become the next generation of specialists, those that the MO’s turn to for guidance.

Then there are the MO’s, those that actually run the show, those that we depend on for our daily instructions.

Then there are the staff nurses, without whom the ward will totally come to a standstill. They are the ones who actually administer medicines, who nurse the patients back to health, who provide tender care to the sick people in need of human touch.

Then there are the JM (jururawat masyarakat) whose job scope I’m still trying to figure out. lol. They help take vital sign measurements, collect blood products, escort patients if needed.

There are the PPK (pembantu perawatan kesihatan) who are vital to ensure smooth running of the wards. They deliver food, send whatever documents need to be sent, collect whatever stuff needs to be collected. They are basically the messengers of the hospital.

And don’t forget the radiographers, the technicians, the cleaners.

So where does a house officer fit in?

Right at the bottom of the food chain.

We are no one.

We work. We get up at 5am and toil until evening everyday. We get screamed at for no reason and swallow our pride, even when the person screaming is not our direct superior. We take the scolding for mistakes we did or did not do (doesn’t matter, it’s always our fault). We try to get a little better everyday.

We are there when the post operation old gentleman needs a little help ambulating. We listen when the old grandmother cries in the middle of the night because her son didn’t visit her that day. We make travel arrangements to make sure the patient from some rural village gets to reach home and not get stranded in the middle of the jungle somewhere. All the while not expecting to get praised for it. Because that’s our job, and everyone expects us to do it.

When the truth sinks in, when you realise medicine is actually more of a lifelong calling and that everyone started off being nobody, that’s when you accept being at the bottom of the food chain isn’t so bad.

Besides, it’s only for 2 years right?

I still wanna quit clinical medicine though. Hahahaha.

Housemanship rants: settle your own shit

It’s no secret that housemen work their asses off doing what we call ‘joblists’ and scurrying around like rats frantically trying to complete what has been planned for the patients before their superiors do their rounds, day in and day out.

Sometimes, one would come across something a task in the joblist that was planned the day before or the shift before that hasn’t been done, and when that happens, one can be forgiven for grumbling and silently cursing the previous HO who didn’t do it. It’s what I call leaving your shit to other people.

Why does uncompleted joblists evoke such a big emotional response? Because the HO in charge for the day would face the consequence even if he or she know nothing about the plan for the patient the day before. No such thing as “not my patient” or “I didn’t review the patient yesterday”. Because ultimately every patient is your patient. So if something wasn’t done, and you have the luck to be the one who’s taking care of said patient, then be prepared to either pull a Superman stunt to do it before rounds or swallow the wrath of the MO’s or specialists.

“Why wasn’t it done?”

Why indeed.

Never mind the fact that we are humans and we can’t duplicate ourselves.

Fact is, leaving shits to other people is a daily occurrence. I have been guilty of it, and I have also been at the receiving end of it. Most of the time I would just do it and not complain. Why? Because why bother getting yourself worked up over something that would take your two or three minutes to settle rather than confront others.

Granted, there are certain species that regularly leave behind nasty excrements for others to clean up, and these people deserve the scolding.

I recently got to know that FY house officers in UK can just handover whatever is left in their joblist to the next shift and go home.

Wow.

Maybe it’s because UK people are generally nicer. Or the fact that its way easier to do things there, everything is computerised etc.

It doesn’t work that way here unfortunately. We still have to send bloods manually by walking to the lab 3 mins away, and trace the results manually ourselves via the only computer and take photos of the result through a glass screen like some kind of Paleolithic age cavemen (at least that’s how it is in SGH).

And whatever happened during your shift, you have to complete everything, even if it means staying beyond your working hours. Never mind the fact that we don’t get overtime pay.

It’s manageable if you have good rapport and have a deep sense of teamwork. When you have teammates or friends that understand you’re exhausted, and they cast the yoke upon themselves and pull the weight together with you, facing the shitstorm together – when it happens, housemanship becomes something quite enjoyable. All because you have friends that do understand what you’re going through, and you’re not alone.

But when you’re working with selfish people who grumble or disappear for no reason and you’re left all alone to settle all the pending jobs, and at the same time getting scolded for not getting things done fast enough, that’s when your morale would drop like a stone, and going to work feels like torture. I’ve been there and it’s not a nice feeling.

Housemanship is a tortuous journey. Everyone is tired. Everyone makes mistakes. Everyone leaves shit for others. But it would be slightly more bearable if everyone sacrifices just a little bit to help their fellow colleagues. Teamwork is key. Life wouldn’t suddenly be a bed of roses, but it wouldn’t suck that bad either.

Housemanship Experience – Part One

I’ve finally completed my third posting of my housemanship. It’s quite amazing to look back and contemplate the journey I’ve been through.

So you might ask, hey, how it’s like being a houseman? Well, I’ll try my best to summarise my experience working here for the past 1 year.

Obstetrics and gynaecology

I started off in O&G. Anybody who’s done O&G as their first posting will tell you that it’s a killer department and many got extended. Imagine being new to this whole field, not knowing how to function and suddenly you’re handling not just one but two lives (the baby and the mother). In the first week I dreaded going to work everyday, and sometimes I’d wake up in the middle of the night in cold sweat, heart racing, frantically trying to remember where I was.

The palpitations were the worst. It’s just sort of a background noise, the subtle sense that something is wrong, and I’d be nervously thinking what did I miss during the day. Truth be told, I broke down within 2 weeks of tagging and seriously considered quitting. But I couldn’t quit, so I soldiered on with the support of my family.

I’ve had my fair share of screaming, scolding, berating from the medical officers. Granted, they were trying to hammer the finer art of OBGYN into me. But it’s definitely not a good feeling when you get shouted profanities at by your medical officer, or being chased out from the cubicle for not being able to write entries in the case notes. I was so clueless back then. One also had to learn through errors and mistakes especially when it comes to assisting the surgeon in the operating theatre. They don’t teach you that in medical school.

Oh AND to top it off, there’s the KKM logbook to fill and our hospital’s O&G department required us to perform a caesarean section under supervision in order to pass the posting. So yeah. Definitely was interesting, but nerve-wrecking.

Miraculously I survived.

Medical

So off I went to my second posting. Medical department is where one learns the art of managing basic medical conditions with the hope that housemen would be able to handle patients safely once they’re on their own, or at least that’s the hope. Truth be told I was still pretty clueless and I didn’t know why certain things were done that way or why certain investigations were ordered. In hindsight, I should’ve asked more.

It was a very hectic department with seemingly endless joblist, and you’d be so busy doing the tasks that there’s not much time left to actually learn how to manage patients. Time were mostly spent doing mundane things like drawing blood, sending bloods, tracing said blood results, requesting imaging like ultrasound, referring cases for interdepartmental consults and so on.

All this probably led to me being more efficient in prioritising importance of tasks and forced me to manage time well. Plus, MO’s are very nice in general, so though the workload is high, it wasn’t that stressful, unless when you’re oncall at night and things could go wrong, which it did in my case. That’s story for another time.

Orthopaedics

Orthopaedics is supposed to be a way more relaxed department, or so everyone says. It was, in a way, except for the fact that we have a slightly, erm, stricter HOD and things can get tense during morning handovers.

Otherwise, there’s actually less joblists to do in the wards, and we get rotated to the emergency department to handle all new orthopaedics referrals. That means having the chance to play around with plaster of paris, applying casts or backslabs ourselves and getting the chance to do manual reduction of fractures in the ETD. For those who are more keen to do things with their hands, orthopaedics would be a very nice place.

By this point in time, third posters were expected to be more functional, and of course you’d get screwed badly too if things don’t go smoothly in the wards. That being said, by the third posting everyone who’s still surviving HOship would’ve developed a unique ability to remain poker-faced, nodding and apologising robotically despite the most vicious remarks by the superiors.

Oh and of course you’d have the chance to enter OT again and assist in some interesting surgeries.

Final thoughts

When I first started HOship, I never expected it to be this tough. I pushed on anyway, and time passed by so quickly and before I know it, one year has already passed. I now look forward to the day I finish my housemanship and being a little less clueless, a little less dangerous and a little bit more useful to those I serve around me.

Click here to read part 2!