Conflicts & Harmony~

Once Jinjang was over, it was back to Hospital. Oh my GaGa, I was to work in IPD once I'm back to Hospital. To be frank, I actually tried to convert my 2-week IPD to Clinical when I was in DIS. One reason is due to my love for Clinical, and I felt that I had only 7 weeks to appreciate Clinical which is not enough for me. This could be considered unusual among us housemen since Clinical is one of the most disliked unit of all. But I felt that it was unfair that the 2 extra weeks available was given to IPD. Also, I realised that during this time, many housemen were stationed in IPD, so I would not be needed that much. However, nothing was done because all of us knew that it was a little difficult to do so unless this issue was brought up to the Chief.

I was unhappy, but it was my duty to work in IPD. So, what to do? Back to old IPD times. Basically, I'd prefer doing screening, so I did. At least the unit showed some improvement and order, but it still sucks. I still came early to clear off what was accumulated the day before and to do check-and-founds for dangerous drugs. Many said I'm HARDWORKING, but at the same time FOOLISH to do such things. I can remember clearly an OPD lady commenting that, and another OPD lady scolding me for this and that.

Well, that's what others say. Enough of what others were saying. This is what I AM going to SAY: I'm NOT hardworking, and neither am I foolish. I know my own limits and ability. While I'm in that unit serving that unit, I shall do my best to make the unit flow smooth and keep the unit safe from harm. I'm not a manager, nor am I a senior. I cannot order people around me to do this or do that. I'm at the bottom, at the base of the hierarchy. Of course I have to settle them myself. I'm just doing my part to do what's best for my unit. Is it because the appreciation is not there that people don't wish to make the department better? Or that there's no appreciation shown? If so, why hasn't the unit leader realise this? And if the leader does, why has nothing been done to handle it?

Thanks to the weekend and public holiday shifts, my off hours accumulated to a total of 51 hours, and still coming. Time to claim some off after Hari Raya festival. Went to see the almighty Lady Guna for off, both my colleague and I (48 hrs & 51 hrs respectively). Well, I really needed the off since my research was crashing (we had to redo nearly everything in like 1 week), but my colleague was afraid that with my competition, she wouldn't be able to claim her off, saying that that was the only chance for her to claim off, and never again she could claim thereafter. As if I had any chance to claim off after that, and mine was obviously more than hers.

The way she put it was as if it was the end of the world for her, so when we asked for of, I didn't mention anything about my research thing, and was just trying my luck (with no hope of getting it). Lady Guna was reluctant to approve our time off despite having 8 housemen around that time, saying that it was too short a notice for her. I got quite irritated with her statement. There was once in April that I actually asked off/leave from her a month in advance. She was reluctant to approve it, or even acknowledge it, saying that it was too far ahead for her to decide. Thus I waited another fortnight and followed up with her. Guess what she said? "Oh, I'll not be around this time, so you should seek my second-in-command for it."

My colleague was adamant in claiming her off, but Lady Guna was still reluctant, saying that she shall see if she'll be able to release her the coming evening. I thus placed my leave file back to the cupboard, and Lady Guna made a statement that sounded like, "Hey, do you not want your off?"

"I want it, but it's alright Madam," I replied showing that I've lost faith in my expression.

"Then put your leave file on my desk!" she said.

Of course I felt it on her desk even though we all knew that the answer would be "no" as putting my file into the cupboard would show disrespect and defiance. In the end, she approved my colleague's off for 3 hours, and froze my off, apologising to me saying that she couldn't give me any off. I told her that it was fine only because I already knew that there's no way that I could get any off from her, and that my heart was already prepared for it. My colleague even taunted me saying that I could actually keep my file without any off claimed. What can I do? Continue with life.

It was thus the toughest phase of my Housemanship where research and work clashed. Research was important but work does not come second. It was very difficult as we had to reconstruct our research objective, results, and discussion in one short week. I needed a miracle. My research partner was eager to help but she couldn't help much since she knew only a little regarding our research and how it should be, despite her being the one who discussed with our Deputy Chief and research supervisor (well, I had to cover for screening that time, couldn't leave the other houseman alone). Well, I couldn't cover and complete everything in time, so I ORDERED her to redo the Introduction part as well as to update and edit the Results part. She gave me more work instead. Of course I showed my dissatisfaction.

Please understand, I didn't sleep for 2 working nights doing just the slides, I had to take up the Results and Discussion part because she just couldn't handle it. Hence, of course I would delegate the Introduction through Methodology part for her to do, and expect an improved version. To my dismay, it needs great editing - because of what? Language. However, at least she was there all time along to help out, which is a lot better than someone else who wasn't even there for you at all. The presentation was a joke. I hated one of the judge's guts, but I was glad it was over. I got a good sleep right after the presentation even while I was in the hall. I didn't care anymore.

Oh my, I totally forgot that I was in Clinical. Being one of the only 2 housemen in Clinical, we gotta do bedside dispensing for 6 Clinical Wards, if not, the IPD housemen would have to do it for us. I've been in IPD before and I really felt how it was like. Workload was already a lot, so I do not think that it would be a good idea to let them do all the dispensing though I had to do CP1 clerking. What could I do? Ward rounds during the morning, dispensing during the afternoon, and CP1 clerking after work in the evening. That was how I ended up finish keying in everything at 10 pm.

I had to. I had no choice. I had not even done one CP2 at all. What was more fascinating, Pn. Fad, my preceptor for that week, had to go for TDM course and I was to be up in the ward rounding with doctors alone. Scary. The female medical ward was one of the most pleasant wards around, with much friendly nurses around. Most of the house officers were pleasant, except one. Medical officers, cool, except one. Specialists, I've only experienced with one. Nonetheless, I did whatever I could for the good of my unit, and I'm proud to do it for Clinical since it is the love of my life.


So this is what you meant
When you said that you were spent?
And now it's time to build from the bottom of the pit right to the top
Don't hold back
Packing my bags and giving the Academy a rain check

I don't ever wanna let you down
I don't ever wanna leave this town
'Cause after all this city never sleeps at night

It's time to begin, isn't it?
I get a little bit bigger but then I'll admit
I'm just the same as I was
Now don't you understand?
I'm never changing who I am

This road never looked so lonely
This house doesn't burn down slowly
To ashes! 
To ashes! 

It's time to begin, isn't it?
I get a little bit bigger but then I'll admit
I'm just the same as I was
Now don't you understand?
I'm never changing who I am

It's time to begin, isn't it?
I get a little bit bigger but then I'll admit
I'm just the same as I was
Now don't you understand?
I'm never changing who I am

Suffering in Heaven~

Once TDM was over, it was OPD again for 2 weeks, then I was off to Klinik Kesihatan Jinjang. It was definitely a total different experience in Jinjang. My colleagues told me that it would be Heaven in Jinjang, but on the contrary, I was kinda suffering in Heaven. Patients there were ... ... (can I not describe please?). Food there was definitely better, but the community is a little poor. The environment in PJ or SJ would be better than Jinjang or Kepong, sorry to say. Nonetheless, learnt a few things in Jinjang - Mandarin, Central Hokkien, Cantonese, and how to write in Chinese.

I made new friends in Jinjang as well, some expected, some unexpected. Since they taught me stuff, I thought it would be fair for me to share my life experiences as well. After all, I dislike hiding who I truly am unnecessarily.

Attachment in KK Jinjang gave a little break for me to meet up with old pals. Stole some time to celebrate Dr. Machine Lim's & NiNi Global Neo's birthdays, and went to Malacca for a spontaneous weekend gathering with Pussy Keat and some of my classmates. I'll let the pictures do the talking~

Glory in Hell~

Ahh, so we meet again! Let me see where I last left. Oh yes, it was in the month of April 2012 when I thought the worst was over as a major part of my attachment in the In-Patient Department (IPD) was completed. I've gotta admit that I disliked IPD very much compared to the Out-Patient Department (OPD). Though I hate the Aseptic Unit more than IPD, I still cannot come to terms to be in love with IPD.

When I last wrote in this familiar site, I just went into the Galenical Unit. Life in Galenical was serene but at times, boring. It was as if I was baking cakes, bancuh-ing syrups and coloured drinks, and packing icings. Nonetheless, it was definitely a place to relax and to have a break from the idiotic IPD lifestyle. Wait, what's happening in Galenical? Oh my, new family members. They're so cute!!

However, time in Galenical was short. More terrifying units awaited me. Come end of April, it was scheduled that I should be in the Drug Information Service (DIS) Unit. Initially it was a little tough to get through as the Unit Head was stern and at times came with fiery anger. Rarely had people ever escaped her web of rage. Even I got entangled in her web despite trying my best to evade. Atrocious it seemed she might had been, but it came with balance. She was one of the best Leaders around that is worthy of genuine respect. Her works were excellent, incomparable, and I guess it is safe to say that they were second to none; and if I were wrong, then at par with others.

Initially it was tough for me to go through DIS, but as the days went by, I began to learn how things were and should be. I came to understand her better too. She believed in good management and self-discipline. She was one of the bosses that would actually allow her subordinates to take leave or time off NO MATTER HOW BUSY the unit may be if the applicant has an ACCEPTABLE reason (acceptable, not necessarily be good or desperate). Hence, with her excellent management skills, the outcome of her works or the unit's works were always good if not, better.

In DIS, the amount of knowledge I gained about drugs was the most compared to other units. Other units were just focused on perfection of work, less of education and knowledge. Oh well, more preparation for me to face Clinical I suppose. One of the best thing I felt being in this unit is appreciation and understanding. Unlike leaders from other units, no matter how much you've done, no appreciation came from them; some gave you more problems. I was quite happy with what I did for this unit, even though my output wasn't at its best - i.e. re-organising the drug catalogue, assisting in the preparation of MERS talk, and compiling/editing the pharmacy bulletin. A little self credit I should have for myself maybe (OMG, I'm so into self-indulgence suddenly xD) since this bulletin was the first to be sent out to other hospitals after some time (perhaps, a year maybe?).

After a month in the much feared DIS unit, came one of the most terrifying unit of all - TDM!! Therapeutic Drug Monitoring, or Clinical Pharmacokinetics. I had to admit that I suck in TDM during my Uni years. Who would had known that I would fall in love with Clinical Pharmacokinetics when I'm actually practicing it. I did not have exposure to all drugs but at least I'd experienced one of the least common cases in my hospital - phenytoin, valproate, theophylline, aminophylline, and digoxin; all together in one concise case. During my time, there was not much of vancomycin cases, so I was stronger in aminoglycosides instead. But attachment in this unit was fun, especially when you get a fun partner. With her, my secret life is revealed.

Clinical Pharmacokinetics wasn't smooth all the time. Ajaran sesats are always around and idiots always come with them. Once there was a house officer who showed zer0 respect for us. Mother eff!! Everybody makes mistakes, so please, we never disrespect you, for what reason should you look down on us? Another idiot is a traitor of our own kind. Well, she must be better than everyone else. In this context, she is always correct, even though she is wrong, she is still correct.

Sometimes it is very sick to get trapped between two Sesaters. Alright, I may not be as experienced nor talented as any of you out there but at least I did my homework. I called up a few other hospitals to get datas on aminoglycoside monitoring. I am aware that different indications had different target levels. There was once an evil day when my rival gave me a gentamicin initiation case for infective endocarditis. I wasn't happy about what my rival did to me but I had to do it since at that time, it was my teammate's first day, and she wasn't accustomed to the calculations.

The case was from a medical ward, and I was told by my rival that the clinical pharmacist estimated that the dose of gentamicin for this patient should be 160 mg BD. Of course, I called up the ward to ask for the patient's body weight, and it was only 46 kg. For infective endocarditis, the peak level for gentamicin in synergism with C-pen, should be between 3 to 5 μg/ml, and it should be a TDS dosing. Using the patient's body weight, no matter how I adjusted, I couldn't get 160 mg BD, not even targeting 10 μg/ml could I get it. From the clinical pharmacist's recommended dosing, I realise that she wanted a BD dosing for convenience and accuracy of gentamicin administration, but I had no idea why would she target 10 μg/ml. Nevertheless, I adjusted the dose to 100 mg BD. When I got back to my rival, I told him that I suggested 100 mg BD. My rival playfully hit me on my tummy and mocked me whether I had already discussed with the clinical pharmacist or not. I got angry and shouted at my rival and stormed to see the clinical pharmacist in charge of that ward.

"I've done the calculations, and I found that 100 mg BD is enough," I told the clinical pharmacist.

"Why 100 mg BD?" she asked in return.

"Then why 160?" I asked back.

"Why 100?" she challenged.

"I based it on the patient's body weight, and his weight is only 46 kg," I replied.

"He's a full-grown man, how can he be 46?" she snapped with a frown upon her face, then she took me to the central screening counter, asking a guy. "How heavy are you?"

"65," replied the guy.

"How heavy are you?" she turned the question to me.

"63," I replied.

"I am 55," said a pregnant lady out of thin air, and everyone laughed, making a fool out of me.

"See," said the clinical pharmacist with pride in her eyes, implying that she I was proved wrong.

"So, you want it to be 160 mg BD is it?" I asked her.

"I don't know ah, I didn't suggest anything ah," was the reply I get from her along with her innocent fake Hello Kitty imitated face.

I could only go back to my counter and recalculate everything using her 60 kg estimation to get around 160 mg BD, targeting 10 μg/ml which is double the recommended peak level. 160 mg BD it was that I suggested to the doctor. Then the phone rang, and it was from that witch.

"Yeah, I took the patient to weight, and he's really 46 only," she said as if nothing happened.

SWEAT!! What was worse, when the TDM pharmacist queried us why he was given such a high dose, guess what that witch said?

"No offense ah," the witch looked at me before continuing, facing the TDM pharmacist. "HE overestimated the patient's body weight... .. ..."

I was like, what the fish!! You were the one who overestimated the patient's weight and now you wanna throw all the blame to me? I kept quiet only because I'm a houseman, you're my senior, and I'm your mentee. I respected you all these while even though you're younger than I am, and this was how you treated me?!!


♪ So what happens now? Where am I going to? ♫