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The Wards In The Surgical Department | Sarawak General Hospital

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The main General Surgery wards in this hospital is located on the 7th floor of the main building which are Male Surgical Ward (MSW) and Female Surgical Ward (FSW).

I entered my General Surgery Posting during a time whereby there were no House Officers being allocated into sub-specialities. The only so-called “sub-specialities” that were available were “Vascular” and “Hepatobiliary Team – HPB”. Both of which are added under General Surgery.

Other teams such as Neurosurgery, Plastics, Urology and Paeds Surgery did not have House Officers. It wasn’t till towards the end of my service in this Posting that it was reintroduced.

Thus, our exposure towards the wards in General Surgery were limited but also made it pretty easy for us to manage.

1. Male Surgical Ward, MSW

Located on the 7th floor of the main building, it is considered the ward which is feared and avoided by many but is also where I’ve spent most of my time while being in this posting.

As the name suggests, it is mainly for male patients with underlying surgical issues or at least being managed by Surgical as the primary team.

This ward is usually avoided by many due to the overwhelming amount of patients which is twice the amount in Female Surgical Ward.

Twice the amount usually meant twice the amount of drama as well as the usual chaos.

My journey in General Surgery ended with my service in this particular ward.

2. Female Surgical Ward, FSW

This ward is also situated on the 7th floor of the main building and it is opposite the Male Surgical Ward, MSW.

As per its namesake, it mainly consists of female patients with underlying surgical issues or at least being managed by surgical team as the primary team.

Albeit it being a “Female” Surgical Ward, there would occasionally be male patients being treated there as the beds in the other wards are usually filled, causing an overflow of patients into this ward.

I started my tagging days in this particular ward and I would consider this ward relatively chiller and laid back compared to the other.

3. Vascular Ward

The Vascular Ward is located on Level 3 of the main building.

If you have done the Paediatrics Posting, it is situated in the same location as “Paeds Nursery Level 1″.

The ward is essentially divided into two, catering to both the Paediatrics Team as well as the Vascular Team.

4. Vascular Extension Ward

The Vascular Ward could only cater to at most, 10 patients. Thus, if there were any more patients to be managed under the Vascular Team, they would be placed in the Vascular Extension Ward or in the main surgical wards.

The Vascular Extension is located on the second floor of the main building, inside the Urology Ward which is situated opposite the emergency department, ETD.

During my service period in General Surgery, I have paid a few visits to the Vascular Ward and Vascular Extension Ward. However, I have never served my time there as I was not allocated to be the House Officer in the Vascular Team and also because it was a team I was avoiding.

Upon my exit from this posting, the sub-specialities were reintroduced again and House Officers were being allocated to other teams.

Thus, if you are due to experience the General Surgery Posting, I hope that you will find it as enjoyable as I did especially while working in the Male Surgical Ward.

It is indeed hectic and busy and going home on time is almost unheard of. Albeit MSW being an extremely busy ward, the medical officers I worked with as well as the specialists were kind, helpful and willing to teach.

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I Ordered A Chest X-Ray For The Wrong Patient | Housemanship Diaries

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It was during my tagging period in the Surgical Posting and I was a Female Surgical Ward.

It was my first day being in charge of the acute beds and side room. I recalled one of the patients being a Urology patient. Usually, if the patient is from other departments, we are not required to review them. This patient in particular was intubated and sent to our ward to be placed in one of the acute beds for further monitoring from the Urology ward.

Upon transfer into the ward, the patient required a portable CXR for post-intubation. I did not screen through the casenote since it was from another team. The nurse in charge informed me of a new case but did not tell that the patient needed a CXR. Hence, my reply was “it’s not our patient, it is from a different team. They will review later.”

Hence, the Urology Medical Officer on call came after a while and reviewed the patient. He went to check the system and was confused as to why the chest x-ray was not done for the patient. The nurse immediately informed that I did not want to do it considering the patient is from another team.

At that time, afternoon rounds with the Surgeon was currently ongoing and I was disturbed from writing my reviews. I immediately proceeded to fill the form and had it sent to the Radiology Department to request for a portable chest x-ray.

Amidst the rush, I had wrongly written for another patient instead.

I only realised it when the radiographer came and did an x-ray on two patients at the acute beds. One, the intubated patient from another department and another which is a patient of ours.

I realised my mistake and rushed back to check the form and was met with a very angry daughter of the patient.

I admitted my mistake and was yelled at. After such a tiring week and a hectic day on top of tagging itself, I could not contain myself any longer and tears started streaming down my eyes uncontrollably.

Thankfully enough, it was just a mere chest x-ray and nothing more or a wrong operation done. Since the patient is under the colorectal team, the surgeon in charge and the medical officers in charge will proceed with their rounds again and I could not contain myself again and tears started to stream down my face again.

The medical officer in charge noticed and asked me to go to toilet, understanding that I needed some time for myself to recollect myself again. Hence, I excused myself.

After a while, I went out and rejoined the rounds and admitted my mistake to the medical officer in charge to which she laughed and said “well she has a free x-ray now and were there any changes as compared to the previous one?” To which I answered none.

She was amused considering that it was over a mere x-ray which was requested for the wrong patient that I started breaking down.

Thankfully, it was just an x-ray.

The lesson learnt here was for me to be extra careful in the future because it could have been worse and become medicolegal.

Please try to avoid doing anything out of rush or pressure and always slow down for a bit and reconfirm the patient and procedures to avoid or minimise errors.

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Daily writing prompt What details of your life could you pay more attention to? View all responses

I’ve always been a foodie.

I enjoy my going on food trips with my family or friends. If I’m bored or sleepy, I would look for a snack, which again is well, food.

Thus, over the years, the weight started piling up and towards the end of primary school, I noticed that my weight posed an issue. As a child, I was overweight.

I recalled visiting the doctor once when I was in primary school coz I was unwell and he made me stand on the weighing scale and perhaps he did say more but at a young age, all I remembered was him yelling “Your child is FAT. FAT. FAT. FAT. F-A-T, FAT!”, all throughout my checkup and as I was leaving his office with my mom.

It felt like as if I had committed a felony. When in reality, he was trying to point out on how unhealthy it is for me, somehow in a rather direct way.

Over the years, I’ve struggled with my weight. It was never constant and always up and down. I’ve tried various diets which didn’t stuck long.

The only time I properly lost weight was when I started my housemanship journey. Amidst me eating at the wrong time, somehow the weight just magically went off. Firstly, perhaps I was too occupied with work to eat properly, hence, unknowingly I tend to practice intermittent fasting almost everyday and secondly, my movements have increased dramatically. Walking above 15k steps per day was a norm.

However, as I progressed throughout my postings, I learnt how to fit eating back into my busy schedule and the weight started piling back slowly.

I brought the matter up to a dear friend and she mentioned that perhaps, I could try controlling my food portion. I reflected and realised that all these while, I’ve been consuming food in the usual portion which didn’t had an effect on me previously as I was constantly on the move.

Thus, if there is something I seriously need to pay more attention to, it would be my food choices as well as the portion. Food is extremely delicious and good. Sadly, I would say that I fall into the category of “Live to Eat” rather than “Eat to Live”.

Hence, it’s time for me to take charge and make a change towards my food choices and start my journey towards a healthier life.

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Daily writing prompt List your top 5 grocery store items. View all responses

Working as a House Officer, I do not go out to eat much. Mainly because our days are mainly occupied with work and after work, we would be drained. Well, most of the time.

Thus, if I were to really go out, it would be during my long breaks which is when I apply for leaves.

In terms of acquiring groceries, I rarely go to the grocery store myself as I do not have a car of my own in Sarawak. I am extremely dependent on Grab and overtime can be expensive as well.

Hence, I make do with the convenience store downstairs at my apartment which doesn’t really have much in terms of fresh foods or ordering online.

Here are my Top 5 must haves in my grocery list which is available in the convenience store if I were to just shop there.

1. Coffee

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As I mentioned in some of my previous articles before. It is a must have drug in my system. Personally I think I have grown rather immune to the effects of caffeine over the years from overconsumption. Thus, if I’m unable to get my grounded coffee beans, usually I’ll make do with some freeze dried coffee or a regular black coffee powder.

2. Oats

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I replace rice for rolled oats when I’m living alone. Back at home, my mother would always cook rice as my parents love rice. However, I noticed that I easily crash or get sleepy easily after consuming rice. Thus, I substitute it for rolled oats and usually I would cook soups or curries and pour the oats over it and consume it just like regular rice.

3. Eggs

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It is easily available. When there is nothing else stored in my pantry and everything else is closed, eggs go about well with almost everything.

4. Noodles

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Well, I’m not exactly healthy per se all the time, and I do enjoy my occasional instant noodles. Especially after work and not having a meal the whole day, I’ll just whip up a quick dish of curry instant noodles with eggs.

5. Sausages

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Personally, I prefer chicken over sausages and as mentioned before, I rarely go out for my groceries. Hence, I’d go for sausage since it is easily available at the convenience store downstairs. In addition to that, I can be versatile with cooking them.

Thus, if I had to list 5 of the hat, these are my top 5 that I would shop for in any grocery stores amidst working as a House Officer.

Again, sadly, it lacks nutrition. But, oh well.

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I tagged for almost a month here.

The tagging timing in the Surgical Posting is from 7am till 10pm which is same as with other postings, except Obstetrics & Gynaecology (O&G).

In the Surgical Posting, we all have to complete a compulsory 14-Day-Tagging period irregardless of having “off-tagged”. Entering the Surgical Department as a senior or fourth poster, we are allocated to special shifts such as night shifts in ward or night shifts in ethe emergency department (ETD).

This serves as an advantage to us seniors as we do not have to work the morning shift for one week straight prior to having an off day. It is also better as it allows us to recuperate in between by not having to go to work extremely early.

However, the disadvantage is that our tagging period is somewhat extended.

As I mentioned before, we are required to complete a 14-Day-Tagging period. The night shift is not counted. Hence, the tagging duration can go up to 3 weeks.

For me, it extended up to 4 weeks due to my medical leaves (MC).

During my first week of tagging, I took a day of medical leave due to extreme fatigue and in the second week, I took 3 days of medical leaves due to extreme fatigue and COVID-19.

At the time of writing this article, I am on a 6 weeks medical leave due to my ATFL injury.

Sometimes I wonder, if I will ever exit this posting and proceed with my last which is medical.

Back to the tagging part, thus my tagging period lasted for a month.

Going to work as a tagger, I would leave home around 5:45am – 6am. Partly because I’m just tired and felt like I needed more rest because there will always be an active issue in ward and I am only able to return home at 10pm.

In the evening around 7pm, I would go for dinner after handing over to the night colleagues and completing my tasks and on-call reviews for the day. Most of the time, it would be our first meal of the day.

Some days, we would be done by 8-9pm and on some days, earlier. Most of us, upon completing, would head for dinner and head home or to just head home straightaway.

This is wrong of course but we were simply exhausted and burnt-out during the tagging period. Thus, we grab the opportunity while we could.

Towards the end of my tagging period, I started bringing packed dinner boxes and reheating them as work prior going back.

Surviving the tagging period in the Surgical Posting was hard and tiring but eventually, it did came to an end.

Thus, if you have yet to enter the Surgical Posting, the tagging period is indeed tiring as with any posting. However, try to learn as much as you can and take comfort in the fact that it does come to an end.

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“You Guys Are Angels”

This may be a biased statement and it differs according to the individual’s experience. Thus, although I do know of the controversies I may ignite. I am merely saying this out of my own firsthand experiences and as mentioned before, each person’s experience differs greatly.

MOs, short for Medical Officers.

First of all, I don’t know how do you guys (medical officers) do it, pulling through an oncall shift, just to return for another oncall duty the following day after postcall. Perhaps it is because during my current batch, we have shifted fully to the “shift system”. Thus, we have yet to experience the “oncall” system which was experienced by the older house officer batches.

I am in awe and I appreciate the determination and discipline that goes with it. Most of the time when an oncall medical officer is on duty, they solely handle the referrals from emergency or ward and sometimes both. This goes on from the start of that day till the following morning and after which they would have to help out in clinics during their postcall, wards or even in operating theatres (OT).

Most of the time, they are alone unless they are lucky enough to have a “tagger”. Thus it is them, the house officer, the registrar and the specialist that forms the oncall team.

That is if they are oncall. In the wards, they rely on the house officers to carry out the active joblists, to take the bloods, request necessary scans, to resuscitate the patient first and inform if there are any acute issues and to carry out the morning, evening and oncall reviews while they are in the clinics or operating theatres or helping out in other places.

I used to think that once we have completed housemanship, life will be better. However, after observing my medical officers and registrars, it does not actually get better, the stress is on another level, the responsibilities increases yet they pull through it with jokes and smiles. I used to think that, perhaps they have gotten used to it. On the other hand, I’m still struggling.

Medical Officers are in charge of the House Officers as well. Thus, if any pitfalls were to occur, of course we do get scolded but they are the ones who get reprimanded as well. I’ve lost count of the times when the medical officers have backed me up. Although I do know that, that is their duty but albeit the responsibilities and the stress, I’ve experienced it first hand multiple times when they would take the fall instead when it comes to answering the specialists.

There are times when I do feel their anger were uncalled for. However, most of the time I understand that it mainly stems from tiredness. The patience really wears thin and snaps easily when there is lack of proper rest.

A lot is expected of them from the specialists and on top of that, taking care of us, House Officers too and teaching us what we do not know while trusting the patient’s care into our hands while they are off to help out in a different place. They are always a call away even if we are placed in the night shift. Thus, should there be any issues, they are always nearby and there.

Yet, after work, after the tiring day and issues that occur in ward, they return home to their families and loved ones and try to go about their life, only to return and repeat it again the following day.

Some might say, well, it is their duty isn’t it? I’ve heard it before.

It is true and personally I feel that we as House Officers, although we are tired, and on top of that being tested emotionally, they are even more tired.

Thus, if there is anything at all that stems from this article, it is my deep and heartfelt gratitude and appreciation towards the Medical Officers, which are rarely said.

My dear readers, if you are beginning your journey as a House Officer or is currently going through your housemanship or internship journey, have faith, patience and to always remember to be kind. Remember that as House Officers, we serve to ease the burdens of the Medical Officers on top of learning on the job, for we will one day take their place.

A fellow colleague always mentions this sentence while I’m in my Surgical Posting, “Don’t do unto others what you don’t want them to do unto you”.

This wise line by Confucius has a special place in my heart and I hope it does for you as well. As you become more senior and familiar with the work at hand as well as build good relationships with your superiors, always remember to be humble and kind.

Do not let cockiness overcome you nor be easily angered when a fellow junior makes a mistake or asks for guidance.

We were all once in their shoes as well.

Always remember to take care of yourselves first, so you can serve others best.

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Working In The Nursery Ward – Housemanship Diaries

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Pushing into my third month in Paediatrics Posting, I was allocated to the Nursery Ward, after successfully completing my Neonatal Resuscitation Program (NRP).

I was rather fearful and hesitant. I heard that the hours are a killer and working the night shift and being the post night is even worse. However, I was mainly worried about being a resuscitator.

Prior to joining the Nursery Ward, I have had a few experiences working in the ward itself. Not as a resuscitator but merely covering the morning rounds, going a out reviewing as well as settling the job lists.

Thankfully, I had a few experiences covering for the Nursery Ward. Thus, I was not completely blur upon entering the ward. Except this time, I had to serve the night shift as well as to resuscitate.

The Morning Shift

On paper, the morning shift is from 7am till 7pm.

However, most of us would arrive at latest at 6am. This is because the “coming mornings” were taken by the morning shift and not the night shift.

Usually the day or night before which is before the morning shift were to return home for the day, they would have to prep the “coming morning bloods”, which is a normal thing we would do in other postings. This includes preparing the forms and tubes or in this case, name stickers for the tubes and to update in the coming morning list in the house officer’s group. The list merely serves as a guide for the team for the following day to refer once they arrive to take blood. Once all the bloods from their allocated cubicles have been taken, we are expected to help the others out if there are anymore bloods to be taken followed by sending it first to the lab before joining the medical officers for morning reviews or rounds.

In the Nursery Ward, the medical officers arrive by 7am and the specialists begins their rounds around 9am. Thus, upon their arrival, they will proceed with their morning reviews first while us house officers are taking the coming morning bloods.

After we are done taking the coming morning bloods for our allocated cubicles, we will then proceed to help the others with their coming morning bloods if it is not done and send it all first prior to joining the medical officers and specialists for rounds.

After rounds, just like in other wards, it is followed by the completion of active job lists such as requesting scans, referrals or any other STAT bloods, tracing of bloods and updating as well as clerking new cases.

Usually by 12pm, we would be done and have a short break for lunch.

If it is during the weekdays, we would then proceed with afternoon reviews and wait to do rounds with the medical officers and specialists.

The rounds would end around 3pm to 4pm. Just like in the mornings, it is then followed by completion of the active job lists. However, since the rounds end late, usually things starts to slow down.

Then, we will start prepping forms on the observation chart such as the “Day of Life”, diagnosis or any planned discharges, as well as the preparation of coming morning bloods before heading home at 7pm.

This is if you are allocated purely to the Nursery Ward of course.

The Resuscitator

My favourite part of working in the Nursery Ward.

During the morning or night shift, we have an allocated resuscitator on duty. A resuscitator is “on-call” during their shift and has to accept referrals from the Labour Ward or Maternity Ward.

Upon the start of our shift, we will introduce ourselves in a designated group which consists of the House Officers from both the Paediatrics and Obstetrics & Gynaecology (O&G) teams, that we are the resuscitators on duty for that day.

On good days, the referrals are coming in, one at a time but on bad days, they would come in bulk, happening all at the same time. The thing is that you would wish that you could divide yourself.

The cases which are referred are usually meconium-stained liquor – SMSL, MMSL, TMSL, mothers going for lower segment caesarean section, vacuum-assisted delivery and mothers diagnosed with chorioamnionitis (just to name a few).

Not all referrals requires the medical officers to be on standby and supervise us. However, upon receiving the call, we are expected to first go to the mothers and clerk the mother’s condition as well as the indication of referral.

This is then proceeded by presenting the case to the medical officers if they are required to be on “stand-by” or to inform regarding the likelihood for admission upon delivery.

Prior to being a resuscitator, we are required to have completed the “Neonatal Resuscitation Program – NRP” which would then deem us competent for being a resuscitator.

Being the allocated resuscitator can be daunting at times especially if it is the very first time as the cases can sometimes be dire and the calls received are unpredictable.

However, fear not. It is extremely daunting at first but have faith and know that help is always nearby should you need it.

The Night Shift

The Night Shift in the Nursery Ward is from 7pm till 7am, on paper. The reality is that if you are working the night shift in the Nursery Ward, we usually return home around 11am – 12pm the following day.

There are only two House Officers allocated in the Nursery Ward at night. One is usually in charge of the ward in terms of carrying out the active job lists, taking time sensitive bloods, tracing bloods and clerking new cases while the other will be the main resuscitator, attending to cases, similar to the one from the morning shift.

At 7am, we will handover any pending cases from the night before and proceed to Maternity 1 and Maternity 3.

Upon arriving to Maternity 1 and Maternity 3, we will collect all the “baby books” from the babies’ cot and proceed to trace the cord TSH (cTSH), G6PD status or any pending bloods or serum bilirubin in the system.

After completion of tracing, we will proceed to start our baby check and should any baby appear clinically jaundiced, we will check their bilirubin through a TCB machine and start phototherapy or to take “Day 1 Jaundice” workup if needed.

All the babies in Maternity 1 and Maternity 3 will be checked even if they have already been done the day before.

Upon completion of our baby checks with the medical officers, we will then go about carrying out any necessary job lists such as transferring out babies from the Maternity ward to the Nursery ward, taking bloods, tracing bloods, referrals or sending the babies down to Nursery Ward for any scans.

If you are due to enter the Paediatrics Department or to work in the Nursery Ward, fear not, it can seem daunting at first but my experience working in the Nursery Ward for 4 weeks were fruitful and I enjoyed every moment of it.

Remember to always be of good support to your colleagues be it in terms of helping out with their workload or just merely being of good moral support.

Lastly, remember to enjoy the journey and every bit of the moment.

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Daily writing prompt What is your favorite restaurant? View all responses

My favorite restaurant doesn’t exist anymore. The franchise does but my favorite location does not. It was The Border Cafe in Harvard Square in Cambridge, MA. I am not sure if I remember the timeline right or not. They had a fire in the kitchen and had to close down. Then during the pandemic (I think) they gave up the effort and shut down for good. There is still a branch in Burlington, MA which was the one I had been going to almost exclusively for years even though I preferred Cambridge, and I think there is still one in Saugus, MA too. There were a couple in New Jersey somewhere with the same menu and decor but a different name.

We started going back when I was in my early 20’s. Harvard Square is generally THE place to be, and The Border Cafe had the best food and the best vibe. Their buffalo chicken sauce is to die for, really. Unfortunately, Cambridge is kind of a pain to drive to if you don’t live in metro Boston, so when the Burlington branch opened (much, much closer to home and really easy to get to) we sort of planted our flag there. It was never as good, but it was definitely good enough.

When Jen and I started dating we took the kids there. Neither of them liked it, and little four year old Harry actually felt sick afterwards. Jen and I still went pretty often but never with the kids. Also, we haven’t been there since the Pandemic. Four years. Now, having written this, I am kinda jonesing for their boneless buffalo chicken.

https://robertjames1971.blog/2024/04/14/the-border-cafe-2/

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