The Worst Is Over

Salam everyone.

It’s been ages since I last updated! A lot of things have taken place since then but the best of them are:

1)I officially graduated from med school on the 31st of April. (pictures in facebook everyone!)

2)I have graduated from O+G department on 16th of May…and is now starting on my one week holiday until I have to go to the next department (hopefully medical or surgical)

I was told by many people that O+G is the worst department in this hospital. Once you’ve gone through O+G you woud have gone through the climax…you’ll be okay. Say them.

Ye ke?

I beg to differ.

It’s the present that counts. What I am presently going through will always be worse than what I have left behind. Regardless of how I felt about it at that time! Regardless!

But rather than worrying about the uncertainties of the future, I much rather enjoy my holiday at the moment. Satu posting dah habis! And that’s all that matters.

The Good Things about O+G:

-You are part of something wonderful, i.e the birth of babies and thus our hope of the future. You get to play with adorable little babies while doing the baby checks.  You know, honing your motherly/fatherly instinct; practicing how to hold babies the correct way; how to wrap them up nicely and all that.

-Some of the MOs are really nice. And some of the specialists are also very nice. (I carefully use the word ‘some’ and I am very accurate in choosing my words. For example, there are reasons why I don’t use ‘most’. Got it?)

-You gained lots of experience on how to handle what is after all a physiological state. Being pregnant is not a disease. Being pregnant is a normal state rather than a disease-state; so you are really actually learning how to handle life’s situation; the situation of being pregnant. It’s more like general knowledge (ehem…plus pitocin, syntometrine, hydration, CTG monitoring, IV drip, perineal suturing and episiotomies and caesarean section).

The bad things about O+G:

It’s not O&G perse. Well, it IS O&G that makes 4 months of my life feels like four hundred thousand LIGHT years but it’s also the whole health system in Malaysia.

And I would like to dedicate one whole post to talk about our health system. But now let’s just focus on O&G.

The bad things about O&G can be listed in this order:

1) The Department is made up of women, in the most.

-And is that bad?, I can hear you asking. Well other than the lack of  young and cute male MOs to flirt with, it can’t be that bad to work with female MOs, right?, you further question.

Trust me, working with women is fine. Working with fussy backbiters and gossipmongers and nitpickers (regardless of gender) is what I am having problem with. I am not used to this. I encountered better behaviours overseas (where most people are non-Muslims) than here, where even the religiously-attired and self-proclaimed good muslimah can behave like they are afflicted with 24hours, all-year-round PMS.  Trust me, not fun! And imagine having one particular PMS-afflicted MALE boss in the department too! Double whammy of misery okay!

Female Behaviour # 1: Exaggeration

You could be making the smallest of mistake but they decide to see that small mole under the assistance of  x 10000000 lens microscope until its size becomes at par with Mount Everest (you know female behaviours: exaggeration!). 

Look, I am female myself. I exaggerate too! But I don’t do that about others! Only about myself!

Female Behaviour # 2: Backbiting

Not only they enlarge that mistake into cosmic proportions, they also decide to spread them around until everyone knows.

I am a first-poster. What do I know about how O+G compares to other departments? But according to my 5th poster friend, O+G is bad because they are made up of female backbiters. They may not see it as mengumpat; I suppose they might see it as simply exchanging information, maybe? But it certainly IS mengumpat. One small mistake that you make, when only that MO involved should know about it, the whole department will know.

And they will aim you.

Female Behaviour # 3: Contradictory

One day, they say one thing. The next day, they change their mind 360 degrees!

“I expect all HOs to inform their MOs when the partogram shows that it is beyond the alert line. Don’t take responsibility, you are just a HO. You should always inform your MO.” That was the female specialist instruction.

So the HO then informed the MO about how the partogram has gone beyond the alert line already. And this is what the MO said:

“Oii hang ni! Partogram macam ni biasalah! CTG dia elok! Dia kan primigravida, bagilah dia masa!”

WE KNOW THAT! ALL HOs would love not having to inform their MOs about the partogram once it crosses even the ACTION line, as long as the CTG is okay….but what does the specialist say?

“Kenapa partogram macam ni hangpa tak inform sesiapa pun? Ada inform MO?”

“Saya tak inform MO. CTG dia elok.”

“Kalau CTG elok pun, partogram ni dah action line dah! Kenapa kamu tak inform?”

Nanti MO marah! Sebab tu kami tak inform. Nanti MO akan cakap, macam ni pun kamu nak inform? Kamu ni doktor ke staff nurse….asyik nak inform saja? (tapi of coursela kami tak berani nak jawab macam tu kat specialist kan! Lagi kena aim dengan MO sebab mengadu kat specialist.)

Tapi bila kami tak inform, and turns out something bad happen that no one could have foreseen, kami akan kena sebab tak inform.

Pergi kanan pun salah. Pergi kiri pun salah!

I don’t mind if I get scolded for informing something important that they then decide as insignificant….but I do mind knowing that the MO will then spread the incident of ‘budak ni sikit-sikit pun nak inform’ to her other MO friends and thus making me having a bad reputation. And then they aim you! Towards you, they will behave like everything you do is wrong. To others, they turn a blind eye even though the others make the exact same mistake that you have done.

What I got from O&G:

1)To inform your MO about something…and then it turns out as nothing…..is a crime! (Hang ni! Benda macam ni pun nak habaq kat aku?)

2)Not informing your MO about something….and then it turns out to be something bad….is a crime too!

3)To inform your MO about something…and then it turns out as something really bad…. is also a crime under the O&G law in the section of  ‘The HO should have informed sooner.”

4)Not informing your MO about something….and then pray that nothing bad will happen, and then nothing really did happen…..only then, you are not a criminal.

How is that a safe working style? I don’t know!

You have no idea how ANY patient will turn out to be! And as you can see, it doesn’t matter how any patient turns out to be, you are only crime-free if the only thing they know about the patient is the patient is well after labour  (even though the CTG before was looking pretty worrying; it’s only God has answered your prayer to keep the patient well because if the patient turns out bad, you will surely ‘kena’ sebab x inform!).

That is labour room contradictory situation!

One concerned staff nurse feels very sorry for us, especially when that particular MO is on-call. “Macam mana HO nak buat kerja kalau MO garang macam ni. Nak inform pun takut!”

*shrugs*. Tak tahu lahhh! Memang ini laa dilema terbesar HO….to inform or not to inform, that is the question.

For the record, not many MOs  behave in that manner. So far, only two MOs who seem to always be in constant state of PMS. But we know that they spread rumours…and our reputation will be in tatters. So, it scared us into not informing even the kind MOs about anything suspicious, as long as we feel like we can manage it ourselves. God has protected me, so far. Nothing bad has ever happened to any patients that I haven’t informed on. But were I extended in O+G for a further 4 months, I could not guarantee how far my good luck will persist. Again I can only thank God for saving me from being extended in O+G.

Female Behaviour # 4: Out-of-point, unnecessary,unrelated scolding

If I make one mistake, scold me for that mistake. Don’t drag other issues into an unrelated incident. I can give so many examples of this…one that happened to me, and many others that happened to other HOs.

Some examples:

“Kamu ni present elok-elok sikt. Awat? Kamu ingat kamu handsome dengan rambut terpacak-pacak macam tu, saya teringin kat kamu ke? Kamu ingat kamu ni handsome sangat?” (what the hell? Apa kaitan tak reti present dengan muka dia handsome ke tak? And apsal tiba-tiba ko nak introduce the topic of whether or not ko teringin kat dia? Ke ko teringin betul ni?)

“You arrr…always make the same mistake all over again. You orang Islam kan? You ada anak kan? Daripada you kerja kat sini, baik you berhenti saja jaga anak you kat rumah tu; Biar dapat pahala. Daripada you pergi kerja buat benda bodoh macam ni, pahala pun tak dapat kan! Lepas tu you tinggal pula anak kat rumah pun, lagi you tak dapat pahala. Apsal? Suami you takkan tak mampu tanggung you?” (again what the hell a NON-MUSLIM MO mulut macam ****nak masuk campur urusan pahala orang Islam and then nak cakap pasal rumahtangga orang ni apahal?)

“You arrr, please okay. Kalau tak tahu, tanya nurse! You jangan ingat sebab you doctor, you lebih tinggi daripada nurse. They know more than you do. You with your UK slang, tak payah nak berlagak kat sini.” (At that time, my only mistake was not asking the nurse about which button to press while using the electronic BP measurement. She got irritated because I was slow. But I don’t understand why she has to assume that my not asking the nurse is equivalent to my thinking that they are below than me. I am the daughter of  a long-serving retired nurse. I am the last person to think nurses are beneath me.  And she thought I was from Newcastle UK…so she said I had a UK slang padahal mana aku ada slang pun! Ngok! Ada-ada saja idea dia nak cakap aku berlagak. Jaki sangat sebab aku balik dari oversea ke?)

Were I to enumerate all the incidences that we as O&G HO had to go through when it comes to this specific female behaviour, this post will never end. RAaaamaaaiiiii dah cakap pasal mulut seorang dua MO yang macam tu. Satu dua MO macam tu, rosak susu sebelanga! Padahal MO lain ok jer….kalau berleter pun, mostly in a joking manner. Tapi sebab sorang dua MO yang macam ni lebih dominant, habis satu O&G department!

Okey, example ni lagi best. This one was done by a female specialist to my friend:

The background story: My friend forgot to punch her card….so she simply wrote the time la…basically beyond 5 pm already. Besides, how in God’s name can anyone cheat the time they went home? We have sooo much work we always end up going back after five anyway! You can never get away with going out early because 1) you have to finish your work, and it doesn’t finish before five 2)you have to pass-over your patients to the HO on call. And the on call people never arrive on time; you have to wait anyway 3)if you are in the habit of taking off early, people will know and they will mark you. So, you really don’t have the motivation nor the opportunity to cheat pun!

Besides, she only forgot to punch her card once. Just ONCE.

So after submitting her punch card for on-call claims, she got called up:

“I takkan luluskan oncall claim you! You tak punch card betul-betul, you tulis macam ni saja, you cuba nak menipu kah? Hah? Orang Islam apa you ni? Sebab ada orang-orang Islam macam you ni la tak ada non-muslim yang teringin nak masuk Islam! Memalukan agama! I sumpah you, I minta you takkan kahwin sampai bila-bila.”

(Ok…macam tu laa lebih kurang cara specialist ‘alim’ ni cakap. Aku tak tahu sangat macam mana dia jump from how non muslim won’t be interested in Islam  and tiba-tiba cakap pasal kawan aku tak kahwin pulak….tapi dia ada mention those two things yang LANGSUNG TAK ADA KAITAN dengan kesilapan kawan aku tak punch card!)

What the hell, weh? Takkan effect terlupa punch card…menyebabkan orang bukan Islam tak mau masuk Islam? Tak ada kaitan weh! Lain laa kalau kawan aku ni memang jahat, kaki penipu, x buat kerja! My friend may not be jubah-wearing, tudung-labuh-adorning muslimah like her, but my friend is not a cheater. My friend doesn’t need the oncall claim money pun! Dia anak orang kaya! She doesn’t need to cheat for money laa! Pandai cakap pasal akhlak-akhlak Islam….you yourself tak husnuzon kan? Tak bersangka baik sesama Islam. Ok ke perangai macam tu?

Kawan aku sampai menangis balik rumah. Ayah dia macam nak buat surat saja atau nak jumpa saja specialist tu tapi kawan aku tak bagi…takut lagi kena aim teruk!

This particular female behaviour of ‘out-of-topic, unnecessary, unrelated scolding‘ is a form of bullying and ragging, isn’t it? It’s just as ugly as the male form of physical torture!

And the worst part about this is: Even the specialist herself had asked her JM to punch card for her! Many MOs have asked the HOs to punch card for them because they want to go home early after clinic when there’s no more patients! How hypocritical is this!

Okey, habis cerita pasal O+G as a female-populated department. That is the WORST part of being in O&G.

Moving on to what else that makes O+G the worst rotation to us:

2)Obstetric Central aka Continuous CTG Monitoring

In other parts of the world, even in developed countries, there is no indication for CONTINUOUS  ctg monitoring in antenatally uneventful  labouring women. If the women has no hypertension/pre-eclampsia, not post-date and thus no IOL given, no history of unexpected fresh stillbirth…why in God’s name do you want to do continuous CTG monitoring.

Imagine doing a Full Blood Count and Renal Profile or Urinalysis every one hour? Of course you are bound to find something abnormal if you do Investigation that often….and then you panic for nothing!

Part of the reason we HATE the Obs Central sooo much is because:

1)We are obligated to inform the MO if something looks suspicious (even if we think it’s nothing!) And as I have told you before, informing the MO is the hell in O+G. Ask anyone!

2)It doubles our work because Obs central is online! We basically have to document BOTH in the patient’s file and then repeat the whole thing online! How is that time-efficient?

3) Number 1 and Number 2 would not feel so terrible if continuous CTG monitoring is indicated for that patient! But why in God’s name do you want to do coninuous CTG monitoring in perfectly healthy NORMAL labouring women.

It’s like this: I can understand why you want to repeat renal profile every other day for a patient with acute renal failure. But why do you want to do renal profile on random physiologically healthy patients who came to you for repeat prescriptions of OCP? The non-necessity is as bad as that! It only increases the rate of (UNNECESSARY) Caesarean Section without reducing the incidence of perinatal deaths and cerebral palsy!

Let’s hear what the study says HERE:

A Cochrane Collaboration review has shown that use of cardiotocography reduces the rate of seizures in the newborn, but there is no clear benefit in the prevention of cerebral palsy, perinatal death and other complications of labour. In contrast, labour monitored by CTG is slightly more likely to result in instrumental delivery (forceps or vacuum extraction) or Caesarean Section. The false-positive rate of cardiotocography for cerebral palsy is given as high as 99%, meaning that only 1-2 of one hundred babies with non-reassuring patterns will develop cerebral palsy. The introduction of additional methods of intrapartum assessment has given mixed results.

When introduced, this practice was expected to reduce the incidence of fetal demise in labor and make for a reduction in cerebral palsy (CP). Its use became almost universal for hospital births in the US. In recent years there has been some controversy as to the utility of the cardiotocograph in low-risk pregnancies, and the related belief that over-reliance on the test has led to increased misdiagnoses of fetal distress and hence increased (and possibly unnecessary) caesarean deliveries.

Do you know how MUCH Caesarean Section per day that we have in my hospital? It can be up to more than half of the delivery on that day. For example: If total deliveries on that day is 30; 16 of them maybe caesarean section and only 14 of them is spontaneous vaginal delivery.

That’s too much!

In other parts of Malaysia, there’s NO SUCH THING as continuous CTG monitoring! Only in my hospital and in Selayang! Konon canggih la. We become the slave to technology…instead of the other way around. If the technology can decrease our workload, decrease the time needed for documentation, increased the safety of patients…then by all means known to mankind, please bring them in. But if all the technology does is doubling our work of documentation, increasing our worries and anxiety over something as physiological as sleeping CTG, and increasing the rate of unnecessary procedures with long-term side-effects to patients…then baik tak payah!

3)The side-work : The Blasted Audit!

Ask any O&G HO. If they smile broadly and say they absolutely in love with Audit, then make sure you remember her face. Remember that face; the face of a liar through, and through.

We all absolutely loath audit! Part of the reason I am sooo happy to be out of O+G is the blasted AUDIT! Like we don’t have enough work to do.

What is the Audit, you ask!

Well, other than a creative form of torture for the lowly housemen, it is designed to keep tract of how many deliveries on that day, how many ended up with caesars, what are the outcomes for babies and mothers. Are the babies admitted into NICU? Bla-bla-bla.

Look, it IS a good practice to do audit! Of course it is important to know how many of the babies we delivered end up unwell requring NICU admission. The audit IS important. No denying that! But WHO was designed to keep track of all that?

Yup! The HO who was on-call on that day! Imagine this scenario: You have been working non-stop for 36 hours. Yet, you can’t go straight home after five (that is assuming you finish your work by five). Instead you have to stay back and track all those patients that you have delivered (and the ones that you haven’t) and prepare the details. You have to go to NICU, begging the MO in NIIC to allow you to update on the babies. You are post-call…the only physiological thing to do at that moment is to sleep and rest…yet….

Since when does doing the AUDIT is included in our job specs? *shrugs*

The AUDIT is the bane of our existence! Previously, the Audit was done by MOs (mmmhmm….I have nothing more to say).

Actually, as I was going through my O&G posting, there were so many other issues that I was very unsatisfied with. But those that I have mentioned are the main ones laaa. Besides this post is too long already. I might need to continue my babbling in another post.

I would like to clarify that if not for that one or two MOs and that particular specialist, O&G in this hospital would not be so bad. You have to understand that in O&G you are handling normal pregnant ladies. The theory is: No one is supposed to die from childbirth because we are dealing with a physiological condition; not pathological. In medical posting, no one gives a damn if the patient dies. In O&G, you have to go through a lot of inquiries and maternal mortality reviews if a patient dies. High chance of getting sued if the slightest thing went wrong! So the O&G department has perfected the art of assigning blame…and the blame will always get pointed to the HO.

This is the reality! We got blamed if we inform something that they think is insignificant (how would new HOs know what is considered significant and what’s not?). We got blamed if we don’t inform too. And if we have informed, we got blamed for not informing early. The easiest scapegoat is the HO….because the HO won’t get sued; free from responsibility.

But I do believe that O&G would have been more enjoyable without the two MOs in particular. Looking back, I feel sad…I could have enjoyed O&G. I really could have.

But everything ends well. I have passed all my assessments, Alhamdulillah. I am out of there! Out of there! Out of there! I am not turning back!

Good bye O&G.

To all other MOs and specialists, thank you for everything! Thank you for  all the good and all the bad!

*********************************************************************

UPDATED 4/1/12

With regards to the punch card incident, the specialist in question could not remember ever uttering the word ‘sumpah awak takkan kahwin’ to my friend. The topic of her marriageability was raised but the ‘sumpah’ is disputable. After clarifying the issue with BOTH parties, it is more likely that my friend could have interpreted the word differently.

Because I was not there when it happened, I wouldn’t know what had REALLY transpired at that time.

Other than the two persons involved in that incident, only Allah knows what exactly went on then.

For the sake of fairness and justice, I hereby retracted what I had said about the ‘sumpah’. In fact to be on the safe side in the hereafter, I much rather retract what I had said about the whole incident altogether. Regardless of whether or not it happened, it wasn’t my place to say it. And I apologize publicly and sincerely to the specialist in question.

However, the rest of this post remains the same.

 

“O you who believe, stand out firmly for justice, as witnesses to Allah, even though it be AGAINST YOURSELVES, or your parents, or your kin, be he rich or poor, Allah is a better protector to both (than you).So follow not the lusts (of your hearts), lest you avoid justice ; and if you distort your witness or refuse  to give it, verily Allah is Ever Well-Acquainted with what you do.”  ( 4: 135)

 

“O you who believe, stand out firmly for Allah as JUST witnesses, and let not the enmity and hatred of others make you avoid justice. Be Just. That is nearer to piety; and fear Allah. Allah is well acquainted with what you do.” (5:8)

 

May Allah help us all in admitting our respective mistakes and seek forgiveness from those we have hurt, be it intentional or otherwise.

9 thoughts on “The Worst Is Over

  1. congrats on surviving your first rotation! sounds like there’s so many new challenges that come with internship apart from the long hours. how do you find hospitals in m’sia compared to aus? I guess it would be a lot busier. enjoy your short break🙂

    Like

  2. Thanks for dropping by Winnie! How’s your study going?

    Yup, the long hours is only part of the challenges working as a house officer (aka intern) in Malaysia. I will let you know in another post how does Malaysia compare to Australia clinically and systematically. So stay tuned.. lol.

    Good luck in your studies. Remember to enjoy your student days…you’re gonna miss them once you start working.

    Like

  3. EX HO

    salam…..
    well a very negative thinking about the department…..
    but i do think afiza is most negative minded people that i have ever met in my life….
    why afiza u feel like that?

    Like

    1. Wasalam!

      You are so funny! Prove to me that I have ever behaved like a negative thinking person! Have I ever taken any EL at all? Have I ever go missing in action all of a sudden? A negative thinking person would quit a long time ago.

      Right….I have raised so many issues here. You haven’t touched on any of them! Instead it is much easier sweep the issues under the carpet and then pretend that I am a negative thinking person.

      You wouldn’t last long in a debate competition.

      Why Afiza you feel like that, you asked.
      Did you read the post? Or are you the sort of person who like to write comments just for the sake of commenting? I generally don’t like to waste my time on that kind of person.

      Like

  4. Fellow ho

    Salam afiza
    Your posting was hilarious and i believe it was true – d ctg, exageration, audit. Really hate audit n ctg. The CONTINOUS CTG is really pain in d ass n unnecessary. Dont want to give labour in our hosp-pt cant move at all- nnt ctg buruk. Aku stress bb pon stress.

    but during my time there were no irrelevent scolding anymore. N they r really nice.

    I really enjoyed o+g posting n loved it.

    Nway salute to u.

    Like

    1. Wasalam.
      I am glad you had enjoyed OnG; it was something I had wished for myself.
      And Thank Allah there were no irrelevant scolding anymore; taking that out alone is enough to make up for the continuous CTG and the fear of to inform or not to inform.

      Like

  5. ex-ho hsb

    hye…
    saya sgt bersetuju dgn pendapat afiza dlm post ni..
    sy adalah salah sorg mangsa fitnah semasa posting o&g suatu masa dahulu..setiap hari yg saya lalui kat o&g adalh hari yg sedih n menyeksakan..
    hanya Tuhan saja yg tahu apa yg kita rasa..Allah maha mengetahui..
    setiap kejahatan yg derang buat pasti dpt balasan suatu ari nnt..Allah maha adil..biar Tuhan saja yg balas..
    cuma just terpikir..dah beribu2 manusia derg buat dosa..mesti susah derg nk cari balik utk minta maaf bila derg dah insaf suatu hari nnt..

    Like

  6. dude

    hi! i accidentally found your blog and read this post. i TOTALLY AGREE with you. i am a new MO in Selayang hospital who was forced to join this stupid dept. i would say NONE of them in this dept (the consultants, specialists & MOs) are nice person. i feel like vomit out blood most of the time i encounter them. new MOs are mentally & physically tortured.We’ve been treating like HOs (even worse i think). i really wanna chop off their neck if i’m allowed to do so..congratz as u’ve finished ur o&g posting!

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s