Dec 25, 2016

The Hailstorm of Tagging

Back when I was in medical school, I thought I had a pretty good grasp of understanding of what being a houseman is like. I know being a houseman is tough, that you have to have a really thick skin and a really deafened pair of ears to withstand the verbal lashes and the mental attacks coming out from the MOs and the specialists. I knew it all long time ago. I have made numerous mental notes about what to expect and what I should prepare.

And the reality of being a houseman has come to me four days ago as I started doing my tagging.

The tagging experience must be different from one person to person and from one hospital to hospital. Of that I'm sure. I got so used to the hospital when I was studying I had quite a cultural shock coming to this hospital. There they used a computerized system, where housemen will push the cardiac table with the laptop on it around the ward, following the ward rounds. All the clerking reviews and all the investigation results can be traced there and then. Here we used papers that were all compiled into folders called the BHTs (bed head tickets) and the observation charts. 

It is hard to describe how my first day of tagging went by. Firstly, everything seemed alien to me. Rows upon rows of bed with so many patients. Nurses, PPK, sisters going here and there all around the ward, all busy with their work. The BHTs and the observation charts are piling up in mounts at various locations. The big whiteboard at the centre of the ward is actually written in English, but  it might as well written in a foreign language as far as I am concerned because I had absolutely no clue what it is all about.

Secondly, the biggest, suck-iest thing about starting your first ever tagging in your entire life is not knowing about anything. I knowwwwwww everyone says it's normal to be clueless about it the first time, that it's how all human work in general but the feeling is still horrible I tell you. And it is worse when no one is teaching you what to do! Do we start by knowing how to clerk, or how to fill up the blood forms, or writing up the patient reviews, or figuring out where to get the trolley for blood taking and practicing your cannulation, or learning to answer the calls, or making calls to your bosses, or how to present to the MOs during rounds, or how to go to the lab to send and trace blood results?

There is a lot of work a houseman needs to do. You know this by now. But which one should you start getting yourself familiarize first?

This is where the permanent (senior) housemen come into picture. The runner houseman on that day looked into us and taught us what to do in the ward. At first I was feeling all so clueless but the trick is to always ask the houseman in charge of the ward what to do. We all learned how to do patient reviews first. Different wards have different amount of reviews housemen should do everyday. At first, she taught us that we should just copy the previous review entry to get ourselves familiarize with the template and so. I remembered stamping my first ever name stamp with my signature after I did my first ever review. I felt a great deal of accomplishment and pride (seriously? From making one tiny thing??) as that was my first evidence of me being a doctor.

After more reviews done we all slowly getting used to the BHTs and know roughly how to write better. It's no longer copy paste practice. They said it is better to spend a great deal of time studying the whole BHT, getting to know the case inside out. Take time to write the review. No one is going to scold you for doing it slow (because we are newborn taggers) and it is better to be slow but correct instead of rushing and getting it all wrong.

Once you are done with any paperwork, be it patient review or blood form or discharge summary or CTG interpretation (I'm doing O&G), always and always give it to your senior HO for them to check. Once you are comfortable doing it, trust me, your colleagues will start coming to you too for your opinion. Teaching others also can reinforce self learning, so be generous in helping your colleagues. Nanti sampai turn kau diorang tolong balik. Gitu.

Rajin-rajinlah bertanya. I'm sure every ward is different, so there's no point in giving you all specific tips on how to start your tagging. Everyone will learn different things at different paces. I remembered my Ortho lecturer parted us that wisdom. Don't fret at others being able to do things that you can't do well enough yet because eventually you will get it right. Pergi mampuslah kau dah pandai pasang branula dah banyak ambik darah and aku pulak tak reti-reti lagi and asyik failed. I will get it right soon and after that it should be of no concern. *I'm psyching myself after failing to do two  simple FBC blood taking and one branula insertion*

But the whole thing still freaked me out for the first three days of working. Not to mention tiring. The worst part for me is the long standing in the ward. My soles are so sore it was very hard for me to follow the ward rounds. So a word of advise: Invest in a pair of good, comfortable shoes. It will NOT solve this issue, but at least you won't have angry, red blistering feet. This is one of the issues I am still struggling with. Maybe because I am fat hence the pain is greater for me. GRAVITY, YOU SUCK.

Don't skip your breakfast - once you had a breakfast, you can last the day without lunch and dinner. I bring one or two packets of biscuits in my pocket so during doing the paperwork I can casually write my review while munching LOL. Also, drink plenty of water. My favourite places in any ward are 1. Any empty chair for me to sit down 2. The pantry. Oh boy. This is where communication skill comes in. Make friends with the nurses and sisters fast because they will point you to the delicious jug of water in the fridge that we can drink. Once I know I have the permission to drink from the pantry, I frequent that place to rejuvenate myself aplenty.

On a serious note, honestly there are times when I am ashamed with myself. When reality doesn't meet your expectations, it crushes your will a little. It forces you to abandon your ideal picture of what a doctor should be and you molded into a doctor you are forced to be. Not the big things but it's about the smaller details. Like how you want to give the utmost best care to the patients, but the sheer amount of paperwork had forced you to just brushed them aside. Sometimes I don't even see my patients or do examinations. I just copied the vital sign monitoring from the nurse chart then update my patient review.

I know better now. I've learned to spare a few minutes attending to them. Asked them how they are feeling at the moment, if the pain has lessen or whether they can walk to the toilet, if they are eating and drinking well. I take time to give explanations to the patient and their relatives. Care for the patients extended far beyond than just hospital care. I've learnt to apply what I have learnt over the years - treat the patients, not the symptoms. Not for the sake of finishing the paperwork, not for the sake of finishing it before the ward rounds start. But for the sake of the patient themselves. Once you do that, paperwork will not become a burden for you anymore. Even the walk to send the blood to the lab becomes enjoyable. We must learn to take pleasure in the break in between the-ever conforming tasks at work.

When the clock strikes 10 o'clock at night and it is time to go, I no longer rushed to go back to my room. In the short span of four days tagging, I opted to slow down instead. No more longing for the bed to rest my deadened sore of my feet and mind, but a walk to the hospital mart sometimes instead, browsing racks of snacks and liquids for me to consume back in my room. My steps now are lighter and merrier now. I look around when I walk, looking people straight into their eyes and searching for the dimple smiles and the twinkles in the eyes. I may get yelled at by the specialist one day, or being thoroughly humiliated in front of the patients any time soon, but as of right now, I am good.


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