pampered for a closure

Remember during those high school days. where we/d be scared by seniors who said that additional mathematics are super hard? to a point where single digit marks in exam seems acceptable. and failing is a norm. to a point where  you start questioning yourself, is it that hard? is it that scary? but when you actually go through it, its just like any other subject. you put effort to it. its actually doable. pretty sure the teacher wondered the same back then. haha..

and that is probably the easiest example i could give to express on how i felt regarding entering the emergency department (ED) . most of those entering this department, entered as a final poster. the last pit stop before the housemanship era ends. but for some of us, we entered as the second last pitstop. making us a bit vulnerable and inferior in terms of exposure. and seeing how the seniors relentlessly complain about the lifeless life in emergency department made me wonder on how to survive in such a high intense, adrenaline pumping situation kind of place.

but hey. Im a believer. always remind my feeble self,
in every cloud there's a silver lining
Allah puts you in the hardship that you are now not to show you your capped limit, but to show what you are capable of, and if you believe in so, maybe you were meant for more right?

the gloomy clouds..

all the previous places during working in the ward had an organised working flow. you settle the patient's issue in the ward, once they get well enough. they're allowed to go back, and we can arrange for another patient to be admitted in the ward and the cycle continues. with the limited beds and extra temporary beds allocated, we could roughly estimate what needs to be done and by when the 'chores' would be done. and to make things easier, the works are well distributed accordingly among colleagues, nurses, bosses and everyone understands and knows which work is theirs and which is another. a cog in a well lubricated clock, moving at its own expected pace, sometimes it gets a little rough. sometimes. but the job ends when the day ends.

but the emergency department proved that work ward is not comparable. showing the true nature of what this field has to offer. its a messy and chaotic place. people just keeps on coming in regardless the time. some are on the verge of dying. some are on the verge of anger, some are just there because of the sick leaves they wish to apply on the following days. to make things worst, many cant go up to the ward because of the ward is already full, hence they're stranded in the emergency department. an you take care of them as how you have to take care of them in the ward, in addition to the work you already have.

theres no such thing as fully occupied emergency department. everyone is entitled to healthcare. hence we have to accept all the patient. 3-4 patients will come in every 1 hour. (too bad patients dont get sick only during office hours)and you still have to see all of them and make sure they are all treated equally, and on time. in addition to that, the number of patient sometimes, can exceed more than the number of the total bed an chairs we have in the department. i feel bad for the patients who can only sit because of we dont have enough bed. i feel bad at times when a mother brings a sick baby, but no privacy for breastfeeding. and most of all i feel bad for myself for neglecting my basic needs for time to pray, eat, and family because of what im doing.

staffwise?

the ratio is obviously inappropriate. due to understaffed, sometimes you have to do all the works yourself most of the time. this includes the nurse's job, the PPK's work an etc. in short, youre responsible for everything to keep the place running. what ever 'systematic distributive flow' you knew in the ward means nothing in the emergency department. an ironically, should anything goes wrong, youre held responsible and the blame cannot be shifted to other personnel. how wonderful. and to certain family members of patient thinks that its like a nursery, where they drop off their parents, "orders" us to take care of them, and should anything go wrong, tax payers has every right to complaint later on. oh well.

the hippocratic oath,
finishing medical school we took the oath of " do not harm " and to treat as must. and this oath haunts us in everything we do, knowing everything that we do may affect the quality of life of a patient, and the death or cure of a person can sometimes makes us stutter and doubt our own mind.Not to mention, forcing to make decisions with an overworked brain in long stretched working hours, an empty stomach, on a daily basis makes more room for error that could affect a person's life or death matter.

patients?

ill be lucky to have a patient who understands whats happening in the department. those who actually knows that what we are doing there, are what we are supposed to do. and on very special occasions, and if im lucky enough, ill get patients who actually thank us for our effort. but most of the time. Everyone that comes to the hospital thinks they are the most sick person that requires immediate treatment and every second attention. and seeing so many other patients in there, they could casually ask us questions that could test our patience, repetitively.

"doc, bila saya bole balek?" ( auntie you just came, i just took a few blood of of yours,process takes time )

"doc, bila saya bole naik ward? sudah satu jam saya tunggu: ( pakcik, org lain ada tunggu 2 hari tak naik naik. )

"doc, knpa xray lama sangat tunggu? kaki saya lama dah sakit ni ( theres only 1 x ray room, and theyre doing xrays for unconcious, and more fragile patients, is it not obvious who is priority?)

"doc, pakcik saya apa cerita? ( so now i have to tell everything to EACH family member, and you cannot discuss among yourself? as if i dont have other things to do )

"doc, tolong tukar kan pampers ayah saya, dia dah berak: ( and changing diapers are not part of the healthcare system as i recalled? wew )

"doc, saya batuk dah 3 hari, nak mc boleh?" ( and you decided to come at 3am for this?) 

If only the patients and their family knows, we are doing what we could. If only they know we treat everyone the same because everyone matters. just because you have a certain person in higher hierarchy above us, it doesnt change your privileges in the emergency department, simply saying, just because you pay taxes, the place doesnt change from a hospital to a hotel.

let me try to explain one thing that i think, most of the community failed to understand. and that is the rationale and how the emergency department functions, Its called emergency for a reason, it is something that you have due to emergency problems. up until today i cannot understand why people still come because of something that has happened last week. but regardless, if you come, we will treat you accordingly. part of the system's job is to identify which zone youre supposed to be in , green, yellow or red. each with different waiting time. and to allocate the patient, is not the patient's decision but the ED's staff. everyone will claim they're be the most sick person to get attention. my guess is that if we do entertain them, then its not fair for those who really need more critical attention right?

imagine, 1 person comes, and after asking the necessary questions an we took a few bloods and other investigations, it should take time before all of the results came out and in the mean time, the medications and treatment that can be given has already been given. though after the blood results came out, there may be additional medications and further workups must be done. then afterwards, doctors from the ward may need to see the patient to see if the patient should need to be in the ward or can be treated at home. and when theres an indication for admission, then the patient must await his/her turn until there is an empty bed in the ward. in the meantime anything can happen. a stable patient may deteriorate. suddenly a patient's conciousness can drop, or other complains from the patient may require urgent attention.
for 1 person that comes to ED may be processed within 15-20 minutes, things aint that swifty when 2-3 patient comes every 15 freaking minutes.

after all of this day in day out. im lucky enough if i get to pray ( luckier if able to pray ontime ), maybe ill get something to munch in between, maybe ill get to sit once awhile. maybe ill get to end my daily 12 hours shift on time. but here i am, compensating all of that. as long as all of the patients we treat, doesnt die, as long as theyre unharmed by incompetency and sub-treatment.

some people break at some point. some required extra time to adjust. some throws a white flag and decides" i dont care, i cannot care anymore "




But the silver lining is somehow, worth the menace and trouble.

 through all the troubles i went through, i didnt went through it alone. i went through it together with other people whom has been through with me since day 1 of working. in other words, we have each other to get things around easily and help each other. non are a stranger, and non is a foe at work. and most importantly, the essence of ' lets get this done and move on to another' felt more approachable  when you're working with friends, instead of colleagues whom youd probably known and worked with ever since you started doing this kind of jobs 1 year ago. the comfort zone that understands how painful it was not being able to adjust accordingly to the pressure of work, and how it gets better when you go through it together,.

and this train of thought was similar to the ambient that the bosses try to provide. knowing how stress wok can be. the bosses adjust accordingly to try and minimise the daily punishing mind games. cut the nonsense crap of scolding, and embrace the teaching part. we did mistakes because of something we dont know, not because of negligence. and for that the cure is to teach, and to tell instead of scrutinise.

and experience, it comes from a lot of other place if you let it. and this kind ambience indirectly says to you " its a messy place. but we could all work together to keep the good vibes and survive another day" sometimes in the deepest stress your having during the day, a good vibe and a person to come to you and say "its okay, we'll do this together" is all that you need to hear to keep you on track.

and of course, the best way to beat the stress is to get out of it once in awhile. The understanding, and flexibility of the schedule allows you to take a breath outside, reconcile and enjoy the moment. The best part of it is able to do it together. By the Grace of God i was able to travel, the best part was not about the destination, but the company. i could not have asked for more.

but the past of a journey is always the take home message that you could gain.

so often a phrase is popped out in my head everytime i get pissed of something.
" every decision that you express during anger, will always end up in shame. "
and i learnt it in the hard way.
as how i recall it, i remembered that i was in a pressured place and time, as a few patient that needed consultation in a time. then comes an old man asking me, " dokter, saya kene tunggu berape lama lg ye??"
and i raised my voice while replying to him;
" encik, kalau semua orang lain boleh tunggu, encik boleh tak tunggu kejap? sampai masa saya akan panggil encik, ok?"
" oh, ye ke, baiklah, maaf dokter, saya bukan apa, saya datang dari teluk intan naik teksi, teksi masih tunggu. saya dah takde duit nk balek kalau lmbt sebab tambang teksi sekarang mahal. " and this conversation occurred in front of everyone in which the conversation ended up with a glaring of stares from everyone to me.

at that time it struck me awhile. i know ive seen insensible people who would just ask us to see them fast because they just hate waiting. and most of the time they think  that the doctors are just sitting and not doing anything.
but this guy is actually needing me because of something  that is troublesome to him. of all the people for me to snap to, i ended up snapping to the wrong person. probably Allah just wanted to remind me one thing. be tolerable, be understanding, as you know you also would want the same if youre on the other end. hence, everytime i almost snap, ill try to find 1001 reasons not to. and believe me, once you realise how to keep the temper cool, you'd thank everyone for being a part of the journey. it was not easy. and maybe at some point requires all the help you could get from your surrounding.

and for all the mentioned reasons, ill say that i was pampered with what has been bestowed upon me, during and after work.. i see the blessings of what time was able to provide despite the hectic schedule.to a point ill say to myself, " trust the process, and trust God with His plans more than you trust your plan. and see how miracle unfolds. "

So if theres anything important that i could take note from this year is, to keep an open mind. everyone can define what is happening to themself and reflect their understanding to you. but that should not affect your judgement as you have your own conscious and surely you hold no accountability towards their opinion, a steady conscious with a right mindset is possibly all you need to keep on going even if the whole world is possibly saying no to you.

for all the blessings i had towards the end of 2019,
i hope that i may be more understanding towards other people, give chances, and listen to people. some of them just needs a set of ears just to be heard.
i hope ill be able to retain all the good values that has been reflected towards me. and not let it rot with whatever bitterness that the world tries to pollute me with in the future. people learn to adapt to a point they think they matter more than other people. such toxicity. such disgrace.

and last but not least, I hope i can pray 5 times a day and prioritise what is needed to, and realise there are things that you need to do, and what you want to do. if you keep doing what you need to do, the end the process of what you are doing is not a journey. but an expected routine.

lets go beyond, lets go for more shall we? :)

(P/s: sharing a few pictures during the 4 months of of working. happy pictures only, pictures during work can spoil the mood xD)