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Behold… your two best friends when you are in Medical posting in Malaysia. Sarawak Handbook of Medical Emergencies is a book all HO (and budding HOs) should have when in Medical posting. Concise info regarding most common things you’ll be encountering in the posting, with management of said things. Of course, reading alone will never be enough until you really get to deal and manage said illness, but it’s really a good guide. And specialists and MOs will expect you to have it to for reference to things they’ll ask during rounds, so it’s a good way to learn too. And Oxford Clinical Medicine is another investment for HOs too, if you haven’t bought it when you’re a student.

While in O&G I simply used my book which I used during my student life. I think Impey’s O&G is a great book for O&G basics. Students in UK use this book if I’m not mistaken; my folks were told so when they bought me this book in Arab, and fellow HOs who studied in UK and Ireland pretty much confirmed it too. In fact, when I was in Russia, my O&G lecturer loved this book so much that she asked me to scan the diagrams in this book, burned them in CDs, and made this my semester’s course work instead of having to present a topic in class. As for the other book you see there, it’s Oncall O&G by Saunders, which I also think is a great book. I bought it prior to starting my O&G posting, feeling that I need a book that would fit my labcoat’s pocket. True to its namesake, it was my faithful companion during O&G oncall and now it lays in the cupboard, collecting dust until today when I decided to snap a pic of the book.

For Ortho, I don’t have the book with me right now, but most of us here used Pocketbook of Orthopaedics and Fractures by Ronald McRae as a guide. It’s good enough for reference, for HO level. And for my Paeds posting I used the ‘Malaysian Paeds protocol book’ which I photocopied from a fellow HO’s photocopied book - because our specialists there told us that we only needed that book to go through our Paeds posting. It’s kind of like the Sarawak Handbook, for Paeds. Didn’t have it with me now as someone borrowed the book and dah perapkan buku tu jadi etanol agaknye….sebab tak pulangkan balik. And worse, I don’t even remember who borrowed the book. Ah well… just ask any local medical student/graduate and chances are they have the book.

….. No, I don’t get paid for this little ‘advertorial’, which is not an advertorial at all. As you can see I’m lame with adverts. Naw…just some tips on what to have during your postings, and for me to update my blog before it begins to collect dust! I’ll update again soon with more HO stuffs… now excuse me while I enjoy my Sunday off day, away from suicidal patients who claimed not to be suicidal. Haha.

P/S: Thanks Efenem for the link to the blog. No wonder this blog suddenly gets a burst of traffic. :D. And it’s quite an honor. Never thought that my ramblings about HO life can be useful. Now I’ll make a point to write more HO stuffs in future.

Well, that was some bits of what my posting is all about right now. I’m in the Medical posting, by far considered the most challenging posting of all. I have done Pediatrics, Orthopedics and Obstetrics and Gynaecology. Those didn’t prepare me enough for Medical posting. I really need to read up more, more, more and MORE. Where have those info I learned from med-school gone to?

The first time I had my oncall, it was a relatively uneventful one in which I managed to get a couple of hours worth of sleep. That was good enough. I was oncall in the female ward, and cases that came in were mostly hyponatremia (less salt in the body), and suicidal (claimed not to be) attempts. Really, those overdose cases really annoyed the hell out of me. And how was it NOT intentional when they swallowed stuffs like, let’s say, paraquat, pestisides, and….forgive me if I laughed this out loud, but… MOSQUITO COILS? Oh my god I nearly died laughing in private when I heard of that. Most of the overdose patients wanted to seek attention from their husband or boyfriend, and swallowed lots and lots of medicines. Most of the times they took lots of Paracetamols. Some other time, the no-known-medical-illness patient came in due to poisoning due to ingestion of anti-diabetics and anti-hypertensives which belonged to another sibling. I really can’t sympthatize with these patients. I don’t know why they are so foolish. Sometimes, mulut laser je cakap, “Tahu tak boleh mati kalau ter overdose lebih sikit je ubat ni?” or “nanti siang nanti saya kena refer awak dekat doktor sakit jiwa okay. Procedure hospital.” And if I get a reply in the vein of, “Tapi saya tak gila, doktor.” I just simply gave a look which translated such as, “Like I care? You tried killing yourself, sounds crazy enough to me.”

Oncall in the male ward however, I saw that most cases are actually serious cases or chronic cases. Most of them due to unhealthy lifestyles during their young ages which ended up costing them when they are old. Fine. That is actually quite okay. Here I can practice some neutralism and professionalism. Although I lost a bit of temper with one Nepalese patient who suddenly acted crazy one night and grabbed the nurses’ butts when they were trying to restrain him on the bed, pulling their tudungs and brooches and nametags, pulled out the branula IV line set on him, attempted to pull out the catheter out of his penis (and squirmed and yelled in the process…really, that catheter has a small balloon inflated inside your thing, silly patient). When I attended to him he tried to pull my nametag and stethoscope and my reflex was to slap away his hands. Guess it shocked him, made him jumped out of the bed, hid under the bed and sobbed. Uggh. I thought this was another Psychiatric case until I saw the diagnosis: meningoencephalitis. Layman = brain infection. No wonder. Asked the PPK and guards to restrain the patient on bed - the last thing I wanted was him to jump out of the window (although I bet the other patients were just itching to open the window and his strains - he caused mayhem the whole night by crying, yelling and NOT sleeping).

I am most sympathetic however when oncall in Dengue ward. Where what ever happened to the patients was entirely not their fault (blame those little demon spawns of satans called Aedes instead - rhymed with Hades). Imagine a quarter of the ward full of all dengue cases, with 3x daily bloodtakings. Really trained me to be quick in taking blood. 30 seconds per patient is the way to go. Heh. Nasib baik veins senang jumpa.

All in all, I’m learning a lot. But it’s stressful too. I’m most stressed here I know it’s showing on my face. I have to re-study everything back, but that’s okay. I was seldom so stressed up like this when I was in my previous three postings - the usual times I’d be stressed was during oncalls. Here, even normal days riled me up. Haissh. Oh Allah, give me strength and the endurance to do this.

P/S: Being in Medical posting however, gives me a real eye-opener to the reason why in Islam some things are not meant for us to do. Forbidden, even. Really made me think. Perhaps this is His way to guide me. InsyaAllah.

Well….it has been a while. December is a rather busy month in 2009 for me as I approached the end of my Obstetrics and Gynaecology posting.

1/12/09 — 8/12/09 - Last Moment in O&G

My logbook was due to be sent and I had to be prepared to be assessed by the specialists there. Waiting for that time to come was nerve-wrecking, although thankfully throughout the end of my posting I was placed in the operation theater, where all I did was assist my MO in Caesarean sections. That for four days in a week where they were elective cases to be done. And come Friday, all I had to worry was emergency CS cases, which so happen to be NONE at all so I was just sitting around, fretting much. And the oncalls…in order to at least be fair to other HOs in the department when I took the one week break stretch, I’d have to do more calls. So I was doing Every-Other-Day calls on Wednesday, Friday and Sunday. And thankfully, for Friday and Sunday calls I actually managed to sleep during those uneventful calls. Monday came and I was assessed. And the most nerve-wrecking part was that I didn’t know whether I’d passed or not, my specialists simply told me to enjoy my holiday and to come on the very last day where I was supposed to finish my posting.

And in between all those, I had to go to KL after work almost everyday to get my visa to Saudi Arabia settled, as I really wanted to go to Saudi. At first the sheer pressure of having to multitask between work and settling the visa nearly got to me but after reconsidering it and of course, by Allah’s will, I managed to get it done. Bought the ticket on the 5th December, for me to fly back to Saudi on the 9th, and it was all done! Pheww.

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Prelude: In which I talk about work and tie it with a past experience, and I think this post is much more fitting of its title from a previous post with the same name. But no matter. Work, experience and humor for your complete wholesome meal today. And I don’t know why I never blog about this earlier. Guess O&G gave me enough creative juices for me to blog again…

There are a sudden of influx of foreigners coming to the government hospitals to seek treatment for whatever ailment there is. In my case, foreigners come to the department where I am currently posted in to deliver babies. Okay…acceptable.

But then, when they come in with zero knowledge in conversing in Malay or English, I’d have to take a deep breath and try sign languages. However, as patient as I can ever be (and nurses say that I do have that, no matter how frustrated I look) I still could not resist the urge to strangle those who came in at the dead of the night when I’m oncall with zero BM / English and expect me to know what the current problem is. I’d wonder, “Why me, why this is happening when I’m oncall, why isn’t there ferocious thunderstorms when I’m oncall…” Really…doctors are many things but psychic we are not. But at least, come experience, I could now hazard some guesses to why they are coming to the Patient Assessment Center… they are of course could either be, 1) having passage of show - that’s blood + mucus, or 2) contractions pain, or 3) leakage of liquor, or 4) two or three of those I mentioned earlier together, and the award-winning reason, 5) THE BABY IS COMING OUT!!

I really should probably consider learning Burmese as there are a lot of Burmese patients coming in. There was once when I was working - during office hour - when a Burmese couple came to PAC. It has become quite a normalcy if the patient does not speak a word of BM (they will gain the ability to at least say “sakit”, “ubat” or “baby” once the baby is out) but when the husband also knows zilch of the language then I knew we were having a situation. I was about to consider talking in ducks-and-chickens language when suddenly at the corner of my eyes I saw my lovable Burmese fellow houseman colleague (we were posted together in Orthopedics once, and when I was spirited away to O&G she went to do Paeds) walking past me. Quickly I grabbed her and requested a favor for her to do a quick interview to the patient. Luckily she was quite free and obliged and phew, one problem settled. The situation however got me into thinking.

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Prelude: My Obstetrics and Gynaecology assessment coming up this 30th! Whatever happen, pray that I don’t get extended…so far so good (I hope). So in this post, not only will I relegade to you my experience in going to one of Siti Nurhaliza’s many performances, I will also ‘ulangkaji’ with some things O&G.

Way back since last month, my MO has invited me to tag along with her to a function which will have one very special guest star: Dato’ Siti Nurhaliza. While I am a so-so fan of her, I do admire Siti as she is indeed a superb entertainer, so I said yes. Besides it would be fun, I hoped, and a chance for me to once again test my camera to its limit. The function will be held at Stadium Malawati Shah Alam on 15/11/09, so I’d get a chance to test my camera in a dark indoors, and if I’m lucky I’d be able to snap some close up pics of Siti live on stage.

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The travelogue continues…and this is just part one of what day 4 was all about. Since I went to two places on that day, might as well do two separate entries. Prior to coming to Melbourne, St Kilda is one of the places which I had in mind to visit, and I actually was planning to do so on my very first day in Melbourne. However, since I was post-call and all and had to pack and fly to the Down Under, I actually slept off half the journey inside the free tram that took us around the city. I decided to go there on another day instead. Luck be with me that after touring the Great Ocean Roads and seeing the wondrous Twelve Apostles and also spending a day petting (or trying to) the many animal natives of Australia, Naz asked me what else I wanted to go/see on the day before my last day here. I thought of St Kilda and the Sovereign Mountain (which will be in the 2nd part of Day 4 entry) so off we went to these two places.

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