Monday, October 13, 2014

Pregnant before marriage

Most people do not want to talk about this.  Some even try to deny the subject,  imagining a perfection in the society.  We are living in a muslim community and as a Muslim community we are perfect. 

They are not wrong but they are not completely right.  It's happening and we are no perfect than any other society.  In fact we could be worse if nobody address the issue.
I have seen a lot of pregnancy before marriage in my practice. No, not non muslim, they were muslim.  In fact half of them I non Muslim and half of them are muslim..

What religion have to do with this?  For me religion only play a small role in prevention of this subject but in reality and statically speaking they are no difference at all whether you are muslim or not.

The issue rises due to lack of education.  I'm not saying sexual education alone but all other education factor play important role here.  Even education in religion would help reducing the number of premarital pregnancy.  I m not going to talk about sexual education here.  Just want to highlight the issue so that everyone can realize the reality here.

I would not talk about prevention,  let other people talk about that.  As a medical officer working in hospital, I am more interested in addressing the management after this thing happen.  I am not supposed to tell this mother that she will go to hell for her zin in premarital sex,  or tell this mother that she has no future after this,  or cancel her wedding ceremony plan to be done soon.  I want to do best for them so that they can live as other mother would be.

So,  these mother deserve emotional and physical support ( blaming her for her sin would not change the situation). These mother deserve the same hospital care as other mother.  For me there is no different between them and any other mother. Or perhaps I don't care.

I could not say pregnancy before marriage is ok or vice versa.  I just treat them the best I can.

However,  those women out there who are planning to get married,  and you are having a regular o occasion sexual activity with your partner,  these also goes to those male,  you have to think and plan about the pregnancy first.  Pregnancy should not be an accidental one.  You will not be a good mother or provide a good care for your children if you are not ready yet.  It is a big thing.  A big decision in life to make. 

You need to have a good wedding ceremony for you and your partner to remember until the end of time and child also came with a good memory like that.  It is not memorable if you are rushing a ceremony just because you are pregnant or your partner is pregnant. 

Having a child is not as easy as having a dog or a cat.

So,  I still not supporting pregnancy before marriage. Unless you decide to do that after discussion with your partner.  I believe I am speaking for Muslim side of view so such discussion would not happen.  But please think before you do.  If you can hold sex until marriage like what you are supposed to do anyway,  then do it.  If not,  please protect yourself,  get a contraception.  Think about the future.

As I said,  Islam prohibit premarital sex but the problem is happenings it's real. So other than religious advise I need to address this issue in a different way.  No matter how much time you spent to make people adhere to Islamic teaching,  there must be somebody who will not follow. So for those who did not, get up,  think straight.  Protection first.

Tuesday, October 07, 2014

Sipitang: A Town Of Beauty Or Disease?

The most important thing to prevent diseases is hygiene. A single most important measure to control the spread of infection is by practicing hand hygiene. It is clearly stated from perspective of science and any religion that everyone must keep everything clean to keep germs away.

2 years in Sipitang working as a medical officer, I have witness myself that this town has an ugly side behind the beautiful beach and its culture. Diseases keep spreading even no matter how much medication we dispense from the hospital. Non communicable diseases is a norm everywhere but what bothers me is the infectious diseases that has no ending.

I came to believe that the health system in this town need to be upgraded so that we can reach more people. The more we can reach, the more I realize that infection is still a burden in this district of Sipitang. Where does the infection came from? Is it raining from the sky?

Most medical practitioner will laugh with that sentence. Rarely diseases fall from the sky. Unlike the traditional medicine practitioner who look up to the sky asking for God to chase away the demons, we usually look down to the ground and find what has been causing the illness for our patient.

One ugly truth is the hygiene of this town is totally down to 10 percent ( if there is scale for that. I am sure there is). Everywhere I can see mice running around, I can see stray dog lying around the corner, bird poops, stray cats, and the litter everywhere.

If someone still remember when a celebrity name Aizat came to perform in Sipitang, he made a controversial statement saying that this town is dirty. Not to my surprise most of respond from the internet do agree with him. This means that Sipitang community know about this problem.

This make thing more difficult. For a group of people who acknowledge that their town is dirty will cause a headache. Its better if they deny it so that someone can prove it and change them. Or just keep silence and fix themselves. But once a community agree with that statement mean that they know their town is dirty and why they did not fix from the beginning?

Nevertheless, this also show that Sipitang people are not stubborn. By acknowledging that statement, it is much easier to make a step to fix the problem.

I came to understand that the younger generation of Sipitang is quite educated and all of them want their town to change. to be more clean and free of diseases. The old generation usually will have to agree on this. I believe all the native in Sipitang will make sure their town is clean all the time. However, in my recent observation, I still can see rubbish thrown at the side of the road, the drain, at the beach and everywhere. I even saw a routine attitude of driver throwing out can of drink or a cigarettes from their car and drive like nothing has happen. I can still smell cat urine stench the wet market. I still struggle with flies everywhere you go.

Look at the beach for god sake. This town has the one of the most beautiful sunset view from its beach but look at the sea..rubbish floating everywhere!

Its chronic. This town will never make it if no change made. I can see one big poster at Sipitang Wet Market to encourage people to keep their environment clean but down below the big poster or billboard, litters everywhere.

I am an outsider here in Sipitang. Just 2 years in this town but my job permits me to see the ugly side of it. Dengue, Malaria, leptospirosis, food poisoning, all of this diseases can be prevented by keeping our level of hygine high. Maybe people in Sipitang will disagree and perhaps chase me out and ask me to keep out of Sipitang after I write this, but my intention is just to make this town better.


I have an idea to make a charity, a group event just to clean this town. A small group would help. By collecting rubbish voluntarily in maybe one or two place at a time. By those activity we can promote to people to do the same. Just collect the rubbish and put it in a proper place.

I have no idea how to start this. I just hope that some people would have the same thought as I do so that we can make a step on this.



My aim is to keep this town clean and free from diseases..


p/s: contact me at ascap23@gmail.com if you have better idea on how to make this town clean.

Monday, August 11, 2014

Gaza vs Israel : Does not matter who you kill.

Malaysian as always will be the loudest people on the back and the quiet one when in front.

It was proven again when looking into the conflict between Gaza and Israel.

They shout, they cuss, they diss, they even destroy public and private property to show their support to Gaza.

Nevertheless, for non muslim Malaysian, they bash facebook, spam everything talking about how stupid muslim shout, cuss, diss, destroy public and private property and somehow they did not support Gaza entirely and some even support Israel.

Both are typical Malaysian. We will never get out from this mentality, and if someone did, he is a minority and need to be stop and isolated.

My opinion and view, it does not matter who kill who, both are wrong in killing people.

Obviously, Israel are inhuman by killing lot of children and innocence people, and in Gaza part or more to Hamas part, they also have blood in their hand.

What is wrong with Muslim now suddenly becoming like terrorist like what westerner envision before. We say "no we are a religion of peace, we did not support terrorism"..then when the conflict happen we say "kill jews, destroy israel, they did not deserve to live, support al qassam"

That sound like a terrorist supporter for me.

Even when we boycott mcdonald, we vandalized their premise like we are some gang of terrorist or what.

How do we promote peace when we act like this? Are our prayer everyday praying for the death of Israel?

Did they realize Islamophobic people tend to say Koran teach and encourage muslim to kill non muslim? Now those people will smile and say " I told you so, I am not surprise, that is how Islam is"

Shameful.

And for those non muslim malaysian, they believe that they are the right one now. So they post and spam their social media eating Israel product and laughing happily ever after. Muslim boycott these product they make a shout out asking for that product and show the world they are using that product.

Then they started posting the right of Israel to found a country and everything unsupporting their fellow muslim friend.

Yet they said they are promoting peace? Are women and children in Gaza death is a joke for them? Are we boycotting israel because we are muslim and non muslim not oblige to oppose the murder of innocence children?

How sick our society is. Does not matter we are muslim or not, women and children are dying in Gaza.




Stop looking people at their religion and race first, look at them as a human first.

I would not kill a Jew if he is innocence. Who are we to decide other people life.

For me, what Israel have done is totally unacceptable and they need a stern action to be carried out to them for their sin in killing innocence people. They should not be supported. They should not just get away like that after kiling a lot of people.

And for Hamas and Al qassam, they should not be praised as a hero. They are not like what those people said " the soldier of Islam", they are just a soldier. They may fight for their own land but they too should not get away just like that after making their own people suffer.


When Prophet Muhammad lost a war, he retreat to make sure not much casualty to be bear by his army. And this Hamas already losing thoussand of their people life, still proudly call them self the Hero and will cost more casualty until they stop and retreat.


Surrender may make you look like a loser but it will never be certain the other side is a complete winner.



Both Israel and Hamas need to stop now.


We should donate our money to buy food for Gazan and not bullet for Hamas. We should boycott Israel to make sure they realize, we will never support terrorist anyway.



...


For those eagerly want to comment and attack me for not supporting Al Qassam, please do understand, this is my opinion. It is up to you to go and vandalize whatever you want and kill what ever you want. But once you kill, you will never be a hero but a murderer.

Monday, June 02, 2014

Medical Officer Lunch

Ni District version.

Sure I had my lunch when  I became medical officer(MO) myself.  Posted in District,  there must be a hell lot of time to spare.  Or is it. 

Now my blackberry era is over.  My HTC One alarm clock bell rang.  Already snooze it for a few times.  Why is is so hard to wake up in the morning.  It's 6.30 am.  Had my shower,  cold shower.  My house's heater broke.  This old government house build for doctors are poorly maintained.  Perhaps no one stay here before me for quite sometime. That's what they said. 

I'm fully prepared for work by 7.30am.  Life much better now.  I'm staying alone in this lonely house,  my wife will join me here in a few weeks time.  If she came,  maybe she can make me some breakfast. 

I am on call so breakfast would not be a problem.  There will be breakfast prepared by kitchen hospital for oncall MO.  In a few minutes time,  I will arrived in hospital and I will enjoy my breakfast.  A thing that is rare during house officer era. 

Breakfast usually simple,  same as what patient in the ward get.  A naked dinner loaf with hard boiled eggs and a sweet tea or milo,  or fried rice. Literally fried rice,  with no other ingredients inside it except maybe garlic,  salt and pepper.  Who says you will be getting nice food in hospital?  No one.   It's healthy,  edible, but not tasty. 

Had to eat quick.  20 patient waiting for me in my ward.  Yes, 20 patients.  Rub that in your face me in my house officer time.  Work pretty much the same. Reviewing patient is still the same as what HO did but now I have to make decision myself.   The responsibility is mine. Something goes wrong,  I will bare it myself.  None will help to protect me now.  Who ever had been call to state meeting because you fuck up someone's life know what I  talking about.  They will make you cry and regret your life as a doctor. 

So this 20 patient of mine,  I will make sure they are alive no matter what.  We don't have specialist in my small district hospital so I am pretty much the boss when I do my round.  My follower,  is my nurse and occasionally a pharmacist.  I love them hanging around because they were like a walking dictionary of drugs.  If I'm rushing for clinic they even calculate the drug doses for me.  A nurse basically just..  I don't know how to describe it.  You know what a nurse do.  They help me a lot. 

If there is a case that I think need to be refer to specialist,  I will pick up a phone and ask specialist opinion.  This is where I get my 'breakfast' occasionally.  Who said you are mo and nobody scold you anymore? You will be scolded,  but in my place scolded by phone as my specialist is 200km away from my hospital. This is when you realize,  the skill of presenting cases is matter.  When two person talking in phone,  the way you present will determine whether you will be scold or not.   Sometimes I get scolded for no reason.  Because for me that patient condition is that bad but the guy at the other side convince me that it was not that bad.  I am the one who see the patient! Shit happen. 

Wait,  I don't have that much time to drag my round for 1 hour.  I start working at 8am and I have clinic by 9 am.  So i have only 1 hour to see all this patient and document everything inside their case note.  And when there is discharge,  I am still the one who will be doing all the paper work.  Work basically the same as in big hospital but here in my place,  I am the MO,  I am the specialist and I am myself the HO.  No one to bully me and no one for me to bully. 

By 9am no matter what,  as ordered by my director of hospital,  I must run the clinic.  Clinic is the boring part of becoming a doctor.  Basically you are seeing mostly 'healthy'  patient.  They came because it's their appointment date.  They want or not,  they still have to come.,  and I still have to see them.  Basically he don't want to see doctor and I don't want to see him but we will end up in clinic room somehow,  and work goes on. 

A good patient will come and say "doctor I'm feeling well just prescribe my lipitor.  If can,  prescribe longer so I  do not need to come to hospital that frequently".

A bad patient will says " I'm having back pain,  sometime dizzy,  only sometime.  Not now.  Sometime fever,  but rarely....." and the story goes on.  " I think that metformin not good for me so I didn't take it".  Face palm.  Her blood sugar is 23mmol.

A terrible patient will come and says " doctor,  I need Mc."  enough said. 

This classification of patient only valid for my own purpose.  But you can't actually distinguish patient like this.  A talkative patient might be the good one because we can find her illness much easier compare to the one who always claimed he is well and compliance but his diastolic blood pressure is 120mmhg.

Patient who ask for MC,  always be a terrible patient. 

Clinic usually drag until 1 o'clock,  and for a person who is oncall,  it's my bad day.  I can't go out for lunch because at 1pm until 2pm, I have to cover the whole hospital so that non oncall mo can go eat their lunch.  Lunch usually provided for me,  consist of,  not again,  hospital food.  Not tasty, not tasty. 

Now at 1 pm, I have to sit down in casualty and see green zone patient.  Most of the time,  I think people really abusing emergency department.  I am available in my clinic with 2 other mo to see all this common cold and viral fever case and yet at 1 pm,  when other mo go for lunch and only one mo stay in hospital,  they will come to casualty department seeking treatment.  To ask them to wait until 2 pm is out of the question. 

"I cannot wait,  I am busy doctor.  I have to go somewhere after this"

" I'm not well and you ask me to wait in outpatient department? "

" insect went into my ear, you call this not emergency? What kind of Doctor are you? "

There is actually one uncle in acute exacerbation of chronic airway disease inside red zone,  fracture case,  stroke,  and this guy want me to pull out insect from his ear right now?!  Is that thing biting inside your ear?  No.  When does it occur? Last night!  He have like 12 hours to wait to come exactly at 1 pm during lunch time?  What  a sick world we living this day?

So if you are damn fast,  everything will be settle by 2 pm when the primary team arrive back from lunch or if you don't perhaps primary team will come and help you at 2pm. That is rare.  You see,  as a doctor,  everyone is holding so much responsibility for a person life.  No one in the world are doing the same thing in my opinion.  You become an army and you think you are protecting life?  The whole country life?  Yes you are.  You become  pilot,  likely you will have to keep 100 lives inside your plane.  Yes you are. 

Doctors however is not the same like these other job (add other job if you want).  Life and death is really (REALLY!) in our hand.  We are playing God and we always fail.  No other job give you a position to see people dying in front of you and you can't do anything about it but still optimist that you can keep them alive.  Really!  People that are sick will die somehow someway.  A soldier will regret of not killing the enemy who later kill his team mate.  A pilot will regret, if not die together with his passenger.  A doctor, playing God as I mentioned, regret of not saving that patient who have multiple diseases,  a heavy smoker,  and he is 90 years old.  We are fighting God.  The battle that we surely will lose. 

Anyway,  I do believe other occupation have their own stress and responsibility but I cod not think of others   that does what we do every day.

So when the primary team back at 2 pm,  most likely all patients from 1 o'clock have 'tattoo of your name  on their forehead' .  That patient is yours and you better settle it before you go finish other thing such as lunch. 

By 2 pm you already have patient waiting for you in ward for that peritoneal tapping you promised in the morning. Perhaps, an acute appendicitis patient need to be cut, or that case that you need to call radiologist 200km away to get CT scan,  and clinic patient as usual.  And you need to settle that patient with an insect stuck for 12 hours in his ear before hand.

If you are damn lucky,  you will have your lunch at 3pm.  If not so lucky,  you will be eating  a cold nasty dinner at 5 pm,  hospital food,  usually serve at 5-6 pm.  Your lunch already eaten by your medical assistant (MA).

And at 5 pm before you can even take a shower,  you need to start your oncall.  And as usual casualty is your primary base.  As usual,  all those cold cases will come straight to emergency department after 5pm. Common complains are common cold.  Your emergency department will become outpatient starting from 5pm-10pm at night.  Plus the real emergency cases. 

A bad oncall is when a midwife call you telling that this CTG or fetal heart is no good.  Then, trouble begin.  An emergency cesarean is a damn medicolegal case potential.  You don't want to play with it.  So forget that dying young man who involved in car accident,  I need to save a baby first

Your second call will be like a superhero,  always came in the end.  When patient already prep to operating room,  he or she will come and you can settle down a bit, back to saving that car accident guy.  If he still alive. Please God let him SURVIVE!  I don't have time to do post mortem tomorrow.

At night,  weird cases happen.  Husband punch wife,  wife go to hospital,  doctor need to write detail report due to possibility of court case.  A young girl complain dizziness and urine pregnancy test turn out to be positive when she 'never'  had sex with anyone.  She must be damn holy! Finger amputated by chainsaw,  what the hell are you chainsaw-ing at midnight? Horror movie.  A guy who cannot sleep at night,  too much coffee? A youngster brought by friend because he fainted after drinking too much alcohol.  Great,  what alcohol actually do for you by the way? Make you awake and energetic? And lots and lots of illegal immigrants who didn't dare to come at daytime because police might arrest them.  I guess police sleep at night nowadays.  Crime only happen during day time.  No police at night.

As I scan a denying pregnant mother at 4 am,  I was damn tired.  I do get my sleep on and off but that pattern of sleep always gave me a throbbing headache.  Luckily I am a doctor so painkiller like ibuprofen,  aspirin,  would be available for me to ease the pain.  Paracetamol won't work anymore. After explaining to that mother that we need to observe her due to her per vaginal bleeding,  I grab a clerking sheet and start writing her clerking admission when I suddenly realize that she is too, a non resident,  an illegal immigrants.  One thing about them,  they really don't have money to pay for hospital bill.  If i am a billionaire, I would sponsor her so I do not need to counsel her for 1 and half hour to be admitted.  In the end,  I sent her home,  sign  form to go home at her own risk,  and maybe now I can get some sleep. 

It's already 5.30 am.  The cold and quiet dawn.  And again, my MA woke me up,  "someone brought a dead baby to casualty". Great!

It was until 7 am before I get my sleep. Cases after that, hopefully will be referred to 8am MO.  I want to sleep.  I don't care if I woke up at 10 AM.  I need sleep.  I am damn tired of oncall and I want to have some sleep!

Then i started thinking of all patient that is eagerly waiting for me to see.  In their head,  maybe that doctor will sent me home today.  Clinic will be already filling up at 8am.  All patient impatiently waiting for their number to be called.  I can't sleep thinking of this.  No matter how much I hate seeing patient,  I still choose this professional line of work.  I already took an oath to put patient first above anything else.

Do I get lunch as a medical officer?  Yes I do occasionally.  Life is not that bad,  or maybe it is bad but the life before, is worse. The training of constantly hungry and scolded all the time during house officer creates a person who don't care about anything else anymore other than his work treating patient. Those little thing such as having a normal lunch even in rush bring a feeling of accomplishment. 

Life as I said will keep getting better, even better for any other person is not the same as what I feel right now. 

Friday, May 30, 2014

HOUSE OFFICER LUNCH

Can I remember my lunch during house officer time? 

Every morning at 5.30am, my alarm clock from my beloved BlackBerry phone rang( I missed BlackBerry era),  it's time to get up and start working again.  The water feel so cold even when the heater is on.  Taking shower with my eyes closed. 
Put on my shirt,  pray,  lab coat ( when was the last time I wash that coat?).  Not a big problem,  I will change to a new one later at my hospital.

5.50am. Trained to do thing quick in just 20 minutes I'm off to work.  I will have my breakfast later in hospital. Luckily my house just a traffic light and 2 round about away from hospital, i will reach hospital at around 6.00 am. 

Work start at 6.30 am but when you start working at 6.30am, that means you are already late.  The heck to that,  I am off work at 12 midnight last night,  I don't care if  I am late or not in the morning!  Unfortunately,  I do care... With 70 patirents cranked up in the ward with us only  5 house officer,  it could not be worse.   2 house officer are dedicated to acute ward taking care around 10 acute cases.  Oh,  I hope it's my rotation in acute ward!  They sure are busy but we...? How can we see 60 patients in 1 hour? 
Damn it! when one of our team MIA ( missing in action).  Granny die I supposed.  Every week there will be someone's grandmother die.. How is that even possible? So 3 of us now with 60 patients.  

They will be no team meeting or whatsoever,  everyone know what they are doing,  just go and do work.  Doesn't matter what happen,  you need to see this 60 patient.  Prioritize first, the one that need to be seen urgent need to be seen before our medical officer arrived.  See patient does not mean just look at her face and say are u ok? ....  See patient means,  ask them if they have any problem, listen to their weird complain, physical examination, and  write everything in the case note. 

 F--- it when you open the case note and you see last night plan..! 

 FBC BUSE/CREAT CM.

 That's mean you need to withdraw that patient blood for test.  Heck! I only have 30 minutes and another 20 patient to review.  Fock this guy who plan this last night..! That guy is me, myself.  Damn it!  I should have prepare the form for the test, at least, but I am too tired to do so before I went back last night.  Drawing blood means putting your safety precaution gear on,  prepare your needle and syringe,  whatever you need,  then explained to patient what you are going to do...

Suddenly that patient said,  "wait doctor,  I feel tired and nervous.  I'm phobia to needle and blood,  can you wait for a moment?" 

No lady I don't have a moment,  give me your damn hand or I stab your heart with this syringe! I wish I could say that,  but this is professional line of work I am doing.  So,  i will reply with a smile,  jot down her name and bed number,  and I will be back later to entertain her.  I really have no time now.

So,  as usual,  morning end up with a lot of scolding as we did not finish our review ( WTF!  We only left the last cubicle with 6-8 patient inside.  We complete most of our work.  Or, we were scolded due to no blood test were taken! ( I forgot that damn lady who have needle phobia.  I promised to be back but I never did).  Breakfast as usual consist of scolding by our MO.  Our sister and mother name frequently involved,  poor them,  they must be still asleep or having a nice breakfast at this moment.  It's 7.30am.


8.00 am,  if there is department meeting they will be held at this time and if not, specialist will come at around 8am to 8.30am. We We will have our second breakfast at that time.  More scolding by specialist.  Our real breakfast,  we haven't taken it yet. 
Specialist round usually drag till 10 AM, that's clinic time.  The boss need to go to clinic.  Perhaps specialist also rushing in his or her work because they also have so many thing to do.  That's why they always angry... I comfort myself.  It's not me.  It's not me. 


So,  the unfortunate one will stay in ward and complete all the work,  all the order that need to be carry out,  do cpr for that dying patient,  and the lucky one can go to clinic. 

It's not that lucky after all,  there are 300 patient waiting and you will have no time to even shit or pee.  Our work in clinic is pretty simple though,  just clerk patient,  then discuss with our MO or specialist,  she will recheck whatever you have clerk and give plan.  It's pretty simple.  Just that we need to do it fast.  If not,  the clinic will drag until afternoon.  You don't want to do that.  You want to take your lunch.  I've already skipped my breakfast. 

It drag on...   At 3 pm,  only a few people left. Medical officer will discuss where they will take their lunch.  There a few decent restaurant near the hospital.  I love the chicken rice restaurant.  The chicken is tender,  variety of side dish... But wait,  our MO already left...  We house officer,  our place now, is in the ward.  Nobody ask if we already had lunch or perhaps breakfast for God sake! 

With empty stomach,  back to ward.  Afternoon review already completed by the staying HO in ward.  How can she and he finished it?  Well evening round usually a bit more simple. Just update the plan that you have done in the morning.  MO ward round at ongoing around 3pm. Finish if no problem by 4 or 4.30pm. Usually we need bed for new admission so we need to discharge patient.  Usually 20-30 patient discharge after morning round, the time when we enjoyed ourselves in clinic.  The ward HO must be having inflammation with their hand muscle discharging all patient.  Yet they will be another 20-30 admission by lunch time.  So no lunch for them also.  Now the ward is full again,  we are here,  the 5 of us including the MIA HO (finish burying his granny I supposed).  Our job now is to discharge another 20-30 patients as ordered by MO or specialist.

It's 4.30pm. Patient and their relative already lining up in front of the counter.

 "how long do we need to wait?" says says the the angry son of of patient. 

"you all makan gaji buta ka? Buat kerja pun lambat.  Tadi pakar cakap jam 2 sudah boleh balik!! " says another angry son of of patient.  

Yes,  specialist said that at 2pm maybe but she or he is not the one who going to finish the paper work.  We do.  Discharge mean,  summarizing all the notes we have made everyday,  writing a right diagnosis,  write the medication,  sign all forms and blood test result to make sure we did not miss anything.  Then the nurse need to record their name,  get appointment date for them and then double check the case note again if we miss anything then discharge.  This will take around 10-15 minutes.  Sound quick.  Repeat the task for another 30 times and when your case is at the bottom of the stack,  you just need to wait.  Be patient. We won't drag you until morning.  We won't postpone the job to the next day even if we missed our breakfast and lunch.

5 pm,  hopefully everything turn out to be ok.  Discharge almost complete.  Maybe we should take turn and get some food to eat.  Hell no.  I do not know why time like after 5pm, patient choose to Desaturate, to collapse,  and here we go again running here and there.  The drama continues...

It is usually at 7pm,  when our work finished,  check our oncall list and we are not oncall.  Look around and pretend that we did not see that oncall fellow resuscitating a dying person, then we can get out and get some food.  
 
But I just could not let my friend there alone (usually only 1 person oncall per ward) pumping that person chest.  In the end i end up helping him,  owed him when I'm oncall,  he use to stay to help me shock a VF patient.  I need to help him.  A patient doesn't matter anymore when you are tired,  your friend is, because they are the one who are going to help you in need. Honestly though.  I really don't care about that dying patient anymore. He or she wouldn't make it.  But my friend will be there the next day. 

As time goes,  it almost 10 pm,  I am tired.  My hair look like I'm just woke up in morning after getting drunk the previous night.  My unwashed lab coat stained with fresh blood adding to the collection of old stained blood.  The lab coat room already closed so I don't care,  I will use that back tomorrow,  the heck if it's stained with hep B virus.  Who cares? Infection control did.  But why they closed that lab coat room so early.  I will change the lab coat early in the morning tomorrow.

As I drive through the closed restaurant nearby the hospital(that chicken rice place closed at 9.30pm, the only open restaurant is mamak stall selling curry full of germ as they cook that curry in the morning- I will still ate that! ) I have a thought. Is this the dream life you dream before you choose to be a doctor.  Before you click send on that online application form to enter medical school?  

No! I never thought my life would be this hard. 

But i will still do it because I already chose this path.  Why I keep this path?  It's a lie if I said I want to help people,  to help patient.  Patient is the utmost important thing.  I lie if I said that.  I lie if I said I'm in it for the money.  We are overworked and underpaid,  where's the money at?  I lie if I said I'm in for the title doctor.  Calling yourself a doctor will only invite many laughter at you.  Who respect doctor anymore?  Look at the news,  the social media,  doctor is the one to be blamed.  I feel ashamed bearing the title of Doctor with this kind of people nowadays.  Most of the people nowadays!  Nobody trust a doctor anymore. They trust pilot more than a doctor.  A pilot ask not to smoke,  nobody smoke in airplanes.  Doctor ask not to smoke,  patient will ignore like we never say it or we never exist.

Why I'm in this game? It's because of the experience.  The knowledge that I gain with all the experience I had.  The reality I realized when I'm at work.  To see how sick is our society,  literally not just from the illness but the sick mentality they had. The more they deny modern medicine,  deny our advice, the more they will reveal how poor our education are in this country.  The poorest education people usually the one with more knowledge. The one that bring Wikipedia printout or whatever anti vaccine or anti modern medicine site they found over the Internet. 

That is why I keep staying in this game.  And somehow someway I will always keep my oath to save a patient life and you don't need to worry about that,  I will save your family first before seeing my sick baby daughter at home for sure.  This line of work is still professional and it always be professional. 

So...  What is my lunch when I am a house officer?  I could not remember because I rarely had it.