housemanship journey so far

It's good to be back. I used to blog a lot back then. Feels so old enough. This time I'm going to express myself again after so long living in the cave. Okay, lets get started. 

I'm going to share with your my housemanship stories. 

Tomorrow marks my 9th month of being a house officer. As what been told by who've been gone through this phase that housemanship is kinda hell. I would like to agree and disagree on that. The fact that I'm still surviving makes me believe this too shall pass. Survival of the fittest. There are days that is full of shit making you started to regret your decision choosing this path and some days you feels like I'm good being a doctor, especially when you've done a good job, patients thanking you, and your superiors praising you. 

I started off with medical department, the hellest of all, its what people had been saying. There are tons of ward works, blood takings, assisting procedures like lumbar puncture, peritoneal/ pleural tapping, some days there's bone marrow aspiration, femoral catheters, ijvc are like bread and butter when dealing with nephro patients, seeing patient get intubated and CPR is a like usual scene in medical. Every day there is active and passive wards. Active ward means when there is new case from ED, the patient will directly admit to the ward. It will be the busiest ward of all, the discharge rate is the same of new cases rate. We as a house officer need to settle discharge as soon as possible, and clerking the new cases at the same time. I started my housemanship during active day. Can you imagine that? 

It was my first day. I woke up early as I was nervous to death. At 530 am I already in the ward. I was assigned to cube 5, consisted of chronic cases like End Stage Renal Failure, Fluid Overload secondary to Congestive Cardiac Failure. Even before housemanship I went to Pre Housemanship Courses, they taught about how to review patients and presenting cases during round, when it came to the real scenario, I went blank. It took me 3 hours to reviewed 8 patients before morning round. 3 hours man. Damn slow. And this continued for few weeks. Only after 2 months in medical, Ive become confident enough. 

During rounds, specialist will order blood investigations, radio imaging  like ultrasound, CT Scan or MRI and this thing houseman need to spoken to radiologist, unlike other department where MOs is the one going down to request. On my first day of life, I need to request fro MRI Brain. Cant you imagine that? Glad I have a good senior, he went down with me, showing me how to request. Okay here's the list of what are the usual things that the bosses would order during rounds: 

- blood takings: from routine blood investigation like FBC/ RP/ LFT to fancy one like ceruloplasmin, tumor markers, young hypertensive workout and the list goes on. 

- radio imaging 

- medications to endorse 

- refer patient to other departments/ units. For example like patient with underlying Diabetes Mellitus, we refer to dietician, stroke patients to physiotherapist, patient with anemia ? upper gastrointestinal bleed to surgical team 

- procedures like pleural tapping, IJVC insertion. this one we need to assist MOs, once already senior enough can volunteer to do it under MO supervision 

- discharge patient; this requires lot of time writing and documenting especially in medical phew glad I already discharge from medical luls 

This all things you need to carry out by your own. Now imagine having 16 patients with all these plans. Yup surely there's no time to rest or even eat. Sometimes I even hold myself from pissing. Yup I once have a bladder of steel ha-ha. Okay now imagine having all these during active days and then taking care of dengue patients requiring FBC QID. Damn busy! Really need to be fast and know which one need to be settled first. 

First thing first is the imaging because boss would like to see the report in the evening. This will effect the management of patients. Yaaass obviously everything we do to patients will effect the managements as a whole. No need to mentioned that ha-ha. Here is the order that can ease your work things that you need to do first and later after rounds. 

1) request imaging 

2) endorse medications

3) blood STAT! STAT means urgent 

4) refer patients 

5) preparing procedures then assist MOs 

6) discharge patients 

Discharging patients will always be the last one until there's this one patient being impatient and started to curse you for delaying their time to go back home or maybe the relatives being impatient and started to viral you on the internet. Like hello can you just be patient for once! Please. When we say okay uncle you can go back today, doesnt mean you can just go home in a minute. We need to settle other important things first. Can discharge home means the patient is stable enough. There are other patients in the ward that are unstable requiring more medical attention. Please know that before you go posting your harsh words cursing us in the facebook. What a keyboard warrior. Heh. 

You cant go back unless you have settled all your works. During my tagging period, there was time I went back at 2 am. Like I said there were shitty days that makes you went home late in the night and the next day by hook or by crook you need to start afresh and go to work. 

I think I cannot go thru housemanship without endless support from my family T.T 

I would be mental without them. 

Wow it's nearly 9 pm and I still got lots to say, but... need to study for my NRP - neonatal resuscitation protocol - next week. I will continue writing another time. 

Bye.