Life as a medical student #8 My First Oncall Experience

For many housemen, on call is daunting. The rest of the world is asleep - their consultants, most of their peers, and in many cases even their supervising medical officers will be asleep. But not them. They need to stay up and be alert at the time when they are physiologically programmed to be asleep. They are responsible for admitting new patients and managing emergency cases in the middle of night. I've always wondered how it's like to be on call. So to take self-torture to another level, I volunteered to be the only medical student who was on call in Ward 18B last Thursday night. It was an impromptu one - I didn't even have enough sleep the night before, or at least had some preparation - I was working in the ward and soon when I realised it was already 10 o'clock at night so I thought I would just stay in the ward. Truth to be told, medical students are not obliged to on call, but to have a taste of it, I stayed.

Hospitals have a different character at night, so quiet you could have heard a pin drop. I was lucky to have Dr Chan and Dr Wong together with me for the night. They are the most dedicated housemen I have seen. Starting from 8 o'clock at night phone calls kept coming in. A lot of new patients were admitted and both of them were on haywire. Hence I offered my help to clerk some of the new patients. It was exciting - to assess patients first hand - because normally when we clerk patients, we would have already know what the patients were presented with by looking at their charts. (Yes we play cheat like that) Clerking new patients give me a chance to implement my own management plans and deciding my differential diagnosis. Also good for me to practise my history taking skills. 

I also got to perform procedures I might not otherwise get to do during day time, for instance, blood taking. Now this is one of the things I have mastered in these few weeks. ....Okay la maybe not 100%. Success rate 80% la kay. Still need more practice. There were so much else in the ward to learn and do. The big shock was that the majority of the job was administrative rather than practical and academic. I learnt where the lab forms were kept, how to label the blood samples, and how to send bloods I had taken. Nonetheless, I enjoyed being the housemen's assistant by helping them in and out. Well, all because I would be happy to have medical students to help me out one day when I am a houseman? :)

It was about four or five in the morning when I started to get tired. I had been up all day. I opened my patient's charts and tried to read and digest the information in it. But my eyelids felt as though they were attached to lead weights. My body went into shutdown mode. Weren't there moments when you said to yourself, what have I got myself into here?

The next morning, ward rounds with the specialists and consultants started at 8 o'clock as usual in the morning. I cleaned myself up a little and contiued to join the rounds. After having my early morning caffeine fixed, I tried hard to pull myself together until the end of the day. So this was how my first on call experience was like - I was in the hospital for a total of 30 hours.

I was so tired that all I wanted to do was to crawl into my comfortable pyjamas, plopped into my bed and hit the sack.

Life as a medical student #6 Just a touch of a hand

Dear Mrs E,

We didn't know each other well. You might recognize my face from ward rounds, I was the girl in the corner holding my books, looking at the ground or out the window. I occasionally asked you how you were, and you always told me the same thing - pain, so much pain. I didn't know what to do. I wanted to hold your hand and tell you you will be okay, but something held me back. Because there is nothing I can do to cure you. I am just a medical student, and even if I was a doctor, there is no medicine to make you better. We can give you pills and injections and fluids. But they can only prolong your life. All they gave you was just more and more pain.

I was there when your family was told the news. I saw how they reacted to your prognosis, did you see it? Did you see the pain they were in? Did you realize just how loved you have been. I looked at them, unsure of what to say, knowing that no words could take away their sadness and their grief.

As your condition deteriorated, you couldn't even tell me that you were in pain. I still went to your bed every morning and asked you how you were. But you could only stare at me, mouth wide open, no words coming out from your mouth. You started to lose appetite, you didn't even have a look at the food they served. Your son, who is a great chef who owns a restaurant brought you your favourite food. But yet, you turned your head away.

My heart aches for you.

Finally it was my last day in Ward 23. I came to your bed and said good morning to you. And as usual I asked you how you were. You looked at me, as if you knew that I won't be there with you anymore starting from tomorrow. You reached out your hand to me. I thought you wanted to tell me something so I bent down. Your fingertips found my skin, then you touched my face, gently.

Until today I don't know what it means. But I wish for a miracle - that this illness which haunts you will be gone one day. Stay strong.

Life as a medical student #5 What I learnt from Ward 23

Two weeks in Ward 23, Hospital Kuala Lumpur.

I wish I could tell you stories about an impressive tracheostomy, or how I performed chest compression on a patient and brought her back to life. Nahhh. But I can't. All I can tell you is the little things that happened - what Ward 23 has taught me.

In Ward 23 we have our General Medicine rotation. Patients are from diverse cultural backgrounds and have different life circumstances. Some have been relatively healthy and it was their first hospital admission. Others were chronic disease patients who probably have twenty years of long standing hypertension and diabetes. This is my first opportunity to meet real patients in a hospital setting - it is a much less structured learning environment than I have experienced up until now. A lot of self-directed in my learning is needed, which is a challenge for me as I am used to be spoon-fed -  we all are. On the first few days, I entered the ward and not knowing what to do or who to speak to. All I did was standing there watching the specialists and doctors discussing cases which I don't understand. The busy environment was intimidating, I almost started doubting my decision of becoming a doctor again.

But as I started to talk to some of the patients, things changed. I remember one woman in particular. I was walking from one bed to another, reading their charts. Then she started to make sounds. I knew she was trying to gain my attention. So I closed my files and walked towards her.

''Kenapa mak cik? Mak cik okey?''

She started to complain to me about her calf pain and how it affected her sleep. She frowned talking about the pain like a little kid. She told me how she hated staying in the hospital and her children never came to visit her. I looked at her lunch plate and realised she only ate the fruits. I asked why didn't she eat the porridge, the vegetables and the chicken. She said she had no appetite. And that she only likes fruits, especially the watermelon selling at the cafeteria downstairs. But she is wheel-chair bound and it is difficult for her to go down to the cafeteria. So I offered to buy her the watermelon. 

She was all happy when she saw me coming back with the watermelon. She had one bite and told me the watermelon was sweet. The juice of the watermelon was dripping everywhere on her neck and shirt. I helped her to wipe them away.

I made a promise to myself to always remember the sparks that she had in her eyes and the smile on her face when someone in the ward finally willing to listen to her and satisfy her wish.

Ward 23 taught me something -  that patients are always our best teachers. I am grateful for patients who are happy to let me talk to and examine them. Thank you for seeing me as a member of the medical profession - although I am just a medical student. It reminds me to behave in a professional manner at all times. I know that my rotations will have even more to offer me in terms of interactive, hands-on learning. Finding real life connections between the diseases I learned and the presentations I saw in my patients is interesting. But it is going beyond the disease presentations of my patients and getting a glimpse into their lives that really are the heart of medicine. Thank you, Ward 23.

"Medicine is learned at the bedside and not in the classroom”

Sir William Osler (1849 - 1919)