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My First Night Shift In Emergency & Trauma | Housemanship Diaries

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Remember when I mentioned that I love the night shifts?

No? Well, here are the articles advocating my love for that shift:

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My first night shift in this department was in the Red Zone and I was terrified.

Thankfully, it was with a fellow Registrar who is rather patient, kind and one who loves to teach.

The scary part however was that it is the Red Zone after all and on my first night!

The Red Zone basically caters to patients who are unstable be it haemodynamically or in terms of their vital signs or that they are in a state of severe acidosis, on the verge of collapsing, you name it. Basically, how severe of a state a person must be in to end up in that zone.

The night started off smoothly with cases coming in one at a time. Alright, I kept repeating to myself, “attend them, transfer them to another bed, vital signs, bloods, fill out forms, clerk and basically just listen to your superiors”.

The night eventually turned into midnight and into the wee hours of the morning and finally the sun has risen. Before I knew it, it was 7am and the AM shift House Officer has arrived. I am not alone again.

Time to prepare for handover rounds at 7:45am.

It was better after that, having another person with me as it felt less intimidating.

At 10am, I took off and headed home. Not a bad experience for the first night shift.

The good thing about the night shift in the Emergency and Trauma is that we are not alone. There is always a team or at least your superiors are always there.

However, I don’t quite prefer the night shift in this posting. Having actually completed this posting, at the time of writing this article, the daytime shift is definitely better.

Nonetheless, in all the night shifts, albeit that it could be a terrifying one especially prior to the start of your shift, always remember that you are never completely alone even if it feels like it and that help is always nearby.

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Life After Offtag In Emergency & Trauma | Housemanship Diaries

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The tagging hours in the Department of Emergency & Trauma is from 7am till 10pm, for a total of 10 days and one off day per week. There are no assessments required to off-tag, only hours required to cash in.

During our tagging season, we were not allocated for night shifts as well.

For me, tagging in this posting felt like an eternity. I remembered counting down my days before I would finally “offtag” and be switched to regular working hours. I also remembered being extremely exhausted at the end of my shift, wondering how did my fellow colleagues managed to pull through.

Tagging in this posting as compared to the other postings was considered less stressful as we were not required to arrive early for morning rounds. We merely had to arrive on time and upon the end of our shift, we leave, as compared to other postings where we would stay back almost every time, cash in “unpaid overtimes.”

Finally after 10 days of tagging, I officially “off-tagged“.

So how was life after that?

Much better. Thankfully.

Regular hours in the Emergency & Trauma Department meant working a 12-hours shift per day with an off day per week and a single night shift.

Basically, we had to ensure that in total, we had to meet the total 60-hours shift per week.

Thus are the timings for our respective shifts:

AM Shift: 7am – 7pm
PM Shift: 10am – 10pm
Night Shift: 10pm – 10am

If you have read my articles on “The Joy Of Working The Night Shift As A House Officer” as well as “My Favourite Time Of The Day At Work“, I mentioned that I absolutely love the night shift. The disadvantage of working the night shift is that we are usually alone and the night shift can be rather unpredictable.

However, it is not the same for me in this posting. Out of the shifts listed above, my favourite is the AM shift, 7am till 7pm. Initially, getting up for work at 7am is tough especially after working the PM shifts back-to-back. But after the initial morning sleepiness wears off, the day proceeds as usual and we return home at 7pm which is nice.

Life after offtag in this department ensured that I had adequate rest prior to my shift starting. No doubt, it is a 12-hours shift every time, we usually arrive and leave work on time as compared to other postings.

Nonetheless, I was still exhausted after every shift. Perhaps it was due to the accumulated mental and physical stress throughout the previous five postings that when I am finally blessed with extra rest, I am still tired.

If you are still in the tagging phase, be it in this department or others, please stay strong. Remember that it doesn’t last forever, it is merely over a certain span of days or weeks.

Keep showing up, keep doing the good work to the best of your strength and abilities and keep moving forward.

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Day 1 Of My Final Posting – Day 647 Of Housemanship

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My first day of my final posting, The Emergency & Trauma Department, commenced on the 11th of April 2025.

Day 647, finally. Finally! I’ve pulled through and entered the last pit stop of my journey as a House Officer.

In every posting, I have always looked forward to this posting. Prior to joining, I’ve always had mixed feelings and initially wanted to join Anaesthesiology. However, a few weeks prior to entering, the other postings such as Psychiatry, Klinik Kesihatan and Anaesthesiology were removed from our options and everyone had to rotate in the Emergency and Trauma Department.

This is good. This meant more manpower.

However, just as the previous postings, prior to joining any new department, I’ve always had this fear and mixed feelings because it is after a new environment.

My fear was stumbling too badly on my first day. Thus, of course, I did my research and questioned the people I knew who were already in the posting.

My First Day began on a Friday in the “Yellow Respi Zone“.

The Yellow Respi Zone consists of patients who are unable to saturate well under room air, usually less than 90%. Having just completed the Medical Posting, the patients allocated there are primarily Medical patients or in particular, having respiratory issues such as patients developing acute pulmonary oedema or fluid overload secondary to non-compliance to their fluid restriction.

Thankfully, I have just completed Medical. Thus, I am able to apply my knowledge learnt which was still fresh at that time.

I arrived a little before 7am since the tagging shift is from 7am till 10pm, introduced myself to the medical officers and talked to a fellow friend who arrived and would be working in the same zone as well. I went through the triages and casenotes of the patients to see if there were any active cases or cases that were due tracing of bloods or referrals.

The day started off rather quietly and it was manageable. I followed the morning handover rounds at 7:45am and after that attended to any new patients or refer if needed.

Basically, when a patient comes in, especially to this zone where the patients’ chief complaint is “shortness of breath“, the first person who attends would usually auscultate or “listen” to the lungs and check the vital sigs prior to taking blood or doing a “full clerking” such as obtaining their past medical history or history of presenting illness.

The next person that steps in usually helps with the bloods and fills the forms.

Everyone worked together as a team and somehow indirectly we were communicating with one another without actually voicing it out. It seemed almost like a dance, or a workout.

Afternoon came and afternoon handovers started at 2:45pm. I met a lovely medical officer who is a junior herself but one who was extremely upbeat and more than happy to guide me.

I learnt a lot during my first day with her. She even encouraged me to consider joining this department during my floating period.

The evenings became extremely busy to which I did not really realise. Maybe because it was my first day or maybe because I have just completed my Medical Posting (and it was much busier over there), or perhaps because I simply enjoyed working with my superior or team on that day.

The day ended at 10pm and I walked back home. Thankfully, I lived within walking distance thus I saved time and did not have to worry regarding transportation or parking issues.

My first day in my last posting or rotation started off well which is something I’m more than thankful for.

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Jobs That I’ve Had

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What jobs have you had?

Teacher

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My first job that I’ve ever had was as a Teacher.

I had just completed my STPM which is a form of pre-university course in Malaysia, equivalent to that of the UK A-Levels and I was waiting for my results.

At that time, I was on a holiday with my parents and was perusing through Facebook when I came across an advertisement on a job offer at a nearby language centre, looking for an English Language teacher.

Without any expectations, I applied for it. At least, I’d have some exposure and regularity prior to entering Medical School in September that year.

Shortly after I returned home, I received a call and an email responding to my application. I went for the interview session and was soon called back and offered a job to which I accepted.

Barista

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My second job, I was a barista at a coffee shop as well as worked at the cash register of a store, both at the same time during my first and second year of medical school after which I stopped and subsequently used to work as a waitress for an F&B company. That was my third job. My second and third jobs were jobs mainly to earn extra cash after classes amidst my free time.

Looking back, I probably should’ve just focused on my writing.

Junior Doctor

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My fourth and current job is working as a junior doctor at Sarawak General Hospital. I still am one since I started practicing in 2023 and is currently going through my sixth and final rotation (at the time of writing this article) before finally receiving my full APC or license to practice independently both in government or private sector.

Am I ready for it? Certainly not.

However, somehow I haven’t quit and I kept pushing through. I don’t know how or why and before I knew it, 2 years has flown by.

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Preparing For My Exit From The Medical Posting As A House Officer | Housemanship Diaries

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Medical. My Fifth rotation.

While I was in Medical School, my favourite rotation was the Medical Posting and I’ve always imagined myself being a Medical Officer in Medical.

Thus, upon entering my Housemanship Journey, I did not choose to rotate in Medical as my first posting. Many people said that the Medical Posting is the most difficult posting of all the postings due to the patient load as well as the workload.

Thus, I began in Orthopaedics and placed Medical as my Fifth Posting. Mainly, because I wanted to “enjoy” it. Enjoy it in the sense that I already knew the basics and knew how to function as a House Officer and would be able to learn how to manage the patients.

However, albeit being a senior poster, some old habits retain. In the Medical posting, we were required to hand in our logbooks 2 weeks prior our End of Posting Date.

However, I approached my mentor 5 weeks prior my exit. Unfortunately, my assigned mentor at that time was not available and asked me to approach my Specialist-in-charge of House Officers at that time to request for a new Mentor.

I approached the Specialist-in-charge and was assigned a new mentor which happened to be someone I worked with multiple times while I was in Medical 3.

The following week was a rather tensed week for me as I tried my best to cram as much as I could.

I finally had my assessment with my first mentor who is a Medical Officer that Sunday. Thankfully, I passed.

2 days later, I went for my assessment with my second mentor, my reassigned specialist, who passed me as well.

The issue next was the completion of my 12 CMEs. CME stands for Continuous Medical Education which occurs once a week on Tuesdays. In other postings, only 5 CMEs were required in order to pass. Sadly, it is not the same for the Medical Posting.

Unfortunately, CMEs done online were not acceptable even if there are certificate of attendance.

Luckily, I had attended a Hospital CME some time ago and I was only looking for ONE more CME prior to my exit of this posting.

Thus, I used that to my advantage and finally, I was able to hand in my logbook and officially exit the posting.

Sadly, a few days prior to my exit, something occurred that led to the demise of a patient. But, that is a story for another article. Thankfully, that did not affect my exit from this posting and I exited, on time.

If you are due to finish the Medical Posting or any posting in general, take it as a lesson from me and approach your assessors much earlier.

Otherwise, all the very best!

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My Next 6 Months (Post Housemanship)

What is the biggest challenge you will face in the next six months?

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At the time of writing this article, it is the 8th of April 2025, Day 644 of my Housemanship Journey. I have just completed my Fifth Posting in Medical and is currently on leave as well as due to begin my 6th and Final Posting in Emergency Medicine on the 11th of April 2025.

One posting or rotation lasts for a total of 4 months if there is no extension, for House Officers.

Thus, it’s safe to say that for the upcoming 4 months, my focus would be on leaving and enjoying my final posting and the challenges I would most probably face then would be the completion of my logbook, preparing my presentation for CME and preparing for my end of posting assessments.

But how about for the subsequent 2 months after that?

That’s a grey area for me.

First of all, I do not know myself on the department that I would want to serve in as a Medical Officer as I enjoyed every posting that I have ever rotated in.

Next, the state or hospital that I would be interested in practicing in for at least the next few years. Currently, I am practicing in Hospital Umum Sarawak, otherwise known as Sarawak General Hospital or “SGH”, in Kuching, Sarawak.

Personally, I would like to stay back over here and serve here rather than to go back as I absolutely love it here and feel like this is where I am meant to be.

However, things might change in the future considering that I would want to get married and my partner is living in Peninsular Malaysia. That’s one as well as the consideration of my parents, having grown up as an only child.

Thus, a grey area for me, nevertheless. Me, being comfortable with procrastination has pushed this thought to the back of my head and refused to entertain since I have to submit my full MMC application by the 13th of April 2025.

This means, I have to set my mind on a department as well as my choice of state (location) or hospitals of choice.

Oh dear…

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Part 1 – Life As A Peri Medical House Officer In Hospital Umum Sarawak | The Emergency Department

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Upon entering the Medical Posting, I was stationed into the “Peri-Medical Pool”. My “birthplace”, so-called.

Prior to entering the Medical Posting, many of my colleagues commented that the Peri-Medical pool is probably one of the worst place to enter considering that it is rather hectic, busy and messy, not to mention the joblist is never ending.

The working shift for a Medical House Officer is as such:

Short Day (SD): 7am till 6pm
Long Day (LD): 7am till 10pm
Night Shift (ON): 8pm till 9am

The Emergency Department in Hospital Umum Sarawak is rather huge and consists of:

Green Zone
EDAU
CSSD
Yellow Zone
Yellow Respi Zone
Green Yellow Zone
Red Zone I
Res Zone II
Decon

Usually a House Officer is allocated to take care of more than one zones.

For example:

Green Zone / EDAY / CSSD
Yellow Zone / Green Yellow Zone
Red Zone I / Red Zone II / Yellow Respi Zone

When the amount of manpower is high, the job gets done quickly and keeping track of the patients is easier.

However, in days where we are stretched thin it is rather difficult.

The Day Shift

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Since I entered the Peri Medical Pool on my Day 1 of tagging in the Medical Posting, my working hours were from 7am till 10pm every day till I offtagged.

I begin my day by first tracing the casenotes of the patients in the zone I am allocated to, snap pictures of the chest x-rays, any relevant radiological reports as well as to trace their bloods.

If bloods were not taken or not in the system, we would then proceed to “summon” the post-night team for help with their bloods.

After all the patients have been traced and the Google Lists have been updated (this is to aid us during our rounds as well as following up on their location later, to ensure that they are not being missed), then I would proceed with my morning reviews.

The morning reviews are just as usual as any morning ward reviews, rounds with the Medical Officer and Specialists and finally carrying out any active joblists.

Since we are in the emergency department, there is usually no afternoon reviews. It depends on the medical officer. Most of the time, rounds are just once daily.

After we are done with our morning joblists, we have to actively screen through the patients in our allocated zones as there is constant movement of the patients in both in and out of the emergency department.

Thus, this means assisting the current on-call team for the day with any STAT bloods or STAT radiological requests as well as updating their progress.

On most days, it is manageable despite the chaos. However, on days where we are lacking in manpower, the difficulty sets in.

The Night Shift

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The night shift begins at 8pm till 9am the following day or until we are done with our “summons”.

I was blessed enough to have gone through perimedical with a partner. Thus, there were two House Officers allocated for the night shift.

As night House Officers in Peri-Medical. We are expected to continue screening through all the casenotes for any new joblist or patients in all the zones in the Emergency Department as well as to assist in any procedures, take STAT bloods or request STAT radiological procedures.

In addition to that, we also have to cover the main building and the side building. This means, if there are any medical patients lodging in non-medical wards, we are in charge of them as well. Most of the time, it is just new transfer ins, sometimes, it is attending to any acute issues.

This is then followed by taking the “coming mornings” or bloods of the stranded patients in the Emergency Department of the lodging patients.

The amount of patients in the Medical Department is extremely high and thus, the medical patients can be stranded up to days in the Emergency Department which can even last till they are being discharged.

Thus, this ensures that the patients are being continued on their treatment irregardless of their location within the hospital.

The night shift as a perimedical house officer can get rather hectic if there are back-to-back influx of new patients in the Emergency Department, tons of coming mornings as well as acute issues in the ward.

In the morning, the “summoned” list can get rather extensive and chaotic as well and can be rather endless.

Hence, on top of the constant walking about the whole hospital, it can get rather tiring. But like I said, it is doable and manageable.

In fact, I enjoyed life as a perimedical house officer a lot.

If you are due to join Peri-Medical, fret not. Keep yourselves equipped with necessary forms and just work quick and as fast as you can.

On some days, one might get lost in the sea of chaos. However, stay strong and know that help is always within reach and that you are not alone.

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My Evening Routine In The Medical Posting | Housemanship Diaries

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On most days in the Medical Posting, at least in the hospital that I’m practicing in, we are allocated to work the “Short Day” or “SD” shifts.

“Short Days” last till 6pm. Occasionally, we would have to work the “Long Day” shift or “LD” which lasts till 10pm or “on-night” which is the night shift.

On days where I’m allocated to work the short day shift, I try to leave work by 6pm. Most of the time, it is feasible while on some days, it is not so.

However, my evening routine is pretty much the same upon returning home irregardless of the time I leave work.

1. Preparing My Dinner

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I love to cook. However, considering I live alone, the meals that I prepare are usually many for one person. Thus, I would keep the extra, rendering me an extra meal prepped for a day or two.

Depending on my mood as well, should I be working the morning shift the following morning and I’m just too exhausted after work and there is no food, I would go for my regular comfort food, instant noodles.

My version of instant noodles involves sautéing chopped onions, curry leaves, mushrooms and diced chilli before adding the water and mixing the instant sachet powders into the broth. I usually add additional curry powder as I like the broth of my instant noodles to be extra soupy and not dry. Once it has come to a boil, I would crack two eggs into the gravy and boil it for a minute or two before adding “half” of the instant noodles and finally topping with some leafy vegetables.

Yes, that’s right, I only consume half. My instant noodles are extra soupy and has less noodles.

Partly because I love adding rolled oats into my broth, thus the whole meal would be too heavy for me if I were to eat all the noodles.

What do I do with the other half of the uncooked noodles?

I keep it and usually comes in handy if I were to cook stir fried noodles.

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Then, there are evenings where I’m filled with energy and the following day happened to be an allocated off day or my night shift, allowing me to cook something different.

Nevertheless, irregardless of my dish of choice for the evening, I would always prepare a set of chopped tofu and mushrooms which I would marinade with some oil, salt, crushed black peppers, diced chilli, slides garlic, curry leaves and some curry powder or chilli powder prior to air frying it.

Thus, by the end of 10 minutes, my dinner would usually be ready.

2. Resetting My Room

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I don’t go through a major spring cleaning in the evenings, just simple tiny actions to reset my room back to an “acceptable” state.

This includes folding my clothes and keeping them back in my cupboard and their designated places, taking out the trash and vacuuming.

Considering I wash my hair every morning prior going to work, there would be strands of hairs on the floor after drying my hair and dusts and tiny debris begins to gather. Thus, I would vacuum almost every evening.

Since I live in a studio apartment, this action is merely a 5 minute job.

3. Preparation For The Next Day

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“Your morning begins the night before.”

I’ve forgotten where I’ve heard this but it’s what I’ve been practicing since I was a kid. Usually the night before, I would know of the set of clothes that I would be wearing the following day.

Next, I would prepare my jars of cold coffee. I usually save up spaghetti glass bottles or jam bottles to keep my tea or coffees or sometimes to be even used as drinking glasses.

I usually carry two 1.5L of flasks to work, one of it contains green tea and the other, my special prepped coffee.

After all of that is done, next would be…

4. Unwinding for the Day

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This begins with me pampering myself with a hot long bath to wash myself of the stench and tiredness of the day, followed by donning myself in a soft, flowy night dress and going about my self-care nighttime routine.

Only after that would I have dinner as I usually fall into a state of food coma after eating.

This is then followed by me clearing the dishes for the last time and finally, heading to bed, which on some days, would be as early as 8pm. However, on average, it is usually around 9-10pm.

This is my evening routine in my Fifth Posting, the Department of Medical, as a House Officer thus far.

I often get questioned by my fellow colleagues as to why I would even consider cooking considering that there are a lot of steps or effort that goes into the process.

However, I do not find it tiring at all as it is my version of de-stressing.

Nothing calms my mind more than listening to music or putting a good show on Netflix while going about my dinner preparations with my phone in “Do Not Disturb” or “Sleep” mode.

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Working on New Year’s Day (2025)

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This will be the second year in a row that I’ve chosen to work on New Year’s Day. If you’ve read my previous similar article last year, I’ve mentioned how my father has this tradition of working on New Year’s Day every year, ever since he started working at the age of 18. It is something that I’ve adapted as well.

This year, I began my year in the Department of Medical which is my Fifth Posting in my Housemanship Journey. I entered this department on the 11th of December last year.

Having just off-tagged the week before, I was still allocated in my first pool which is the Perimedical Pool.

Looking back as it is currently April 2025, at the time of writing this article, I do not quite remember where I was allocated to. I think that I was most probably taking care of the stranded Medical patients in the main building.

Thankfully, I remembered it not being a hectic day and I was allocated the “short day” shift, meaning that I had the opportunity to return home at 6pm.

Considering it was New Year’s Day which is a Public Holiday here, things were rather slow and tuned down.

Thus, it was a rather slowed down and uneventful day, ending with me returning home on time and unwinding early.

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Surviving Tagging And Finally Celebrating Christmas In The Medical Posting – Housemanship Diaries

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In the Medical Posting, seniors were required to tag for a minimum of 10 days prior to off-tag while juniors had to tag for a full 14 days.

I was due to have my off-tag assessment and in the Medical Posting, we were required to off-tag with Physicians, meaning the specialists.

Tagging everyday in the Medical Posting was rather annoying for me since we had to stay until 10pm and being a regular early riser, I would start feeling sleepy around 8pm as that is the time I start to unwind and go to bed.

However, I can’t because I am still tagging. On top of that, since I am tagging, I would be too exhausted by the time I reach home to even consider studying. I had to prioritise my sleep more or I would crash.

Thus, I tagged for a total of 12 days which consisted of two off days. Thus, in reality, I only actually tagged for 10 full days.

In order to officially off-tag, I had to have my logbook signed by the physician who assessed me as well as to have each procedure filled and countersigned by the medical officers.

Long story short, I finally off-tagged on Christmas Eve and did not realised that I have been allocated an off day on the 25th of December.

This was perfect as my parents flew in on the 24th night. Thus, upon having officially off-tagged, I left and started getting ready to travel to the airport to meet my parents.

The following day of course was Christmas which was well spent with my parents.

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My First Day In Medical Posting – Tagging Day 1 | Housemanship Diaries

Tell us about your first day at something — school, work, as a parent, etc.

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Finally, my much awaited posting… Medical!

Ever since I was a first poster, I have always looked forward towards the Medical Posting but one I decided to keep as my last as I wanted to “learn“ and understand the posting rather than just “float” through.

This served as a disadvantage in other postings as when it came to simple management of hyperkalemia or hypokalemia, I wouldn’t know, neither hypoglycaemia or hyperglycaemia.

Instead, I simply memorised my way in terms of the simple management and “referred to Medical” rather than actually learning to correct them myself in other postings.

Thus, I went complex and complicated first prior to building my way up.

My first day in this much awaited posting was on the 11th of December 2024. I had just completed the Surgical Posting and was on a 5-days-break.

On my first day, I was allocated into the “Perimedical Pool”. Deemed as probably the “worst place” to be allocated in. Thus, as usual, the fear starts creeping in.

I started asking around in regards to my job scope as well as the superiors.

Most of them advised to just arrive on time, which I did, at 7am sharp.

That morning, I was allocated to handle the “Yellow Respi” zone of the Emergency Department.

Thankfully, I had a good friend who was my partner for the day.

We began with tracing x-rays of the patients as well as their blood investigations.

After we have gone through all of the patients, we began with our morning reviews while awaiting our medical officer and specialist.

The medical officer arrived and started reviewing the patients with my friend. Here I was, on Day 1, extremely blur.

I introduced myself to the medical officer and he proceeded to tell me to go about my own reviews while he assessed the other patients with my friend.

Alright, here we go again, just like in every posting. Just how and what am I going to review?

Soon, the specialist came and I proceeded to follow the rounds as I was used to in the Surgical Posting where we all followed the grand rounds.

Instead, I was again asked to proceed with reviewing the other patients in the other cubicle while they go about their rounds.

Feeling quite lost and left out, I proceeded as such. Before I knew it, I reviewed all the patients in that particular cubicle just in time when the medical officer and the specialist came.

Thus, I started presenting and writing, still being tuned to the work culture in the Surgical Posting.

Just like rounds in the other postings, we presented, followed, write and after rounds, proceeded with discharges and carrying out the active joblists.

Surprisingly, I had time for lunch.

Afternoon rounds started at 2pm with just the medical officer and my superior was more than kind enough to start explaining and teaching me as to why certain things are as such.

After the PM rounds, I proceeded to screen through the casenotes and update the list of patients in my zone as well as to take any STAT bloods. Before 6pm, I went for my early dinner.

Considering I was tagging, I had to stay till 10pm whereas the rest who are “Short Day” or “SD” went home by 6pm. Thus, from 6pm till 10pm, I was actively screening through the casenotes in the Yellow Zone, Yellow Respi Zone, Red Zone, Red Zone 2, CSSD, EDOU, Green Yellow Zone and updating the list as well as to take any needed STAT bloods which mainly included blood cultures.

A little before 10pm, I approached one of the medical officers to get my signature for the day and went home.

That concludes my first day of tagging in the Medical Posting which surprisingly turned out rather well. For the first day at least.

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My Morning Routine Being A House Officer Leader In The Surgical Posting | Housemanship Diaries

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There are three main leaders in the Surgical Posting. One is in charge of curating the weekly schedule, the other, in charge of ward and cubicle / bed allocations as well as to reallocate if there are any people who took emergency leaves or medical leaves and the third one, in charge of our attendance at work.

I was the daily allocator. Being the “allocator”, I would be in charge of designating the house officers to the selected cubicles of both the male and female surgical wards (MSW and FSW), the Peri, EMOT and ETD as well as to look for substitutes if there are any last minute changes or leaves.

Usually, I will prep my allocation in advance after the schedule leader has done the schedule and make necessary changes along the way. The leader in charge of the schedule usually determines which person works the night shift and when as well as to approve any leaves. Usually, the house officers will be divided into their respective wards.

The night before, I usually run through the suggested allocation in the “Leaders Group” with the medical officers in charge of the House Officers to screen through.

After receiving the green light from them or making necessary adjustments, I would then upload the list in the House Officer’s group. Thus, they would then know where they would be covering.

The list is usually sent in the “MOHO” group, meaning the group containing the House Officers and Medical Officers at 6:30 a.m.

Thus, I would wake up and be on standby at 5am everyday, even on my off days as I would wait for any messages should anybody take medical leaves or emergency leaves and make the necessary adjustments needed.

At 6:30 a.m sharp, I forward the daily allocation into the “MOHO” group.

If I happened to be working on that day, I would pause in between work just to send and then go about my work.

However, if I happened to be on leave or having my off days, I would then return to sleep or go about my other activities after 6:30 a.m.

It was an interesting experience having had the privilege to hold the position as one of the posting leaders.

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Reflection Of The Surgical Posting | Housemanship Diaries

Can you share a positive example of where you’ve felt loved?

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As you can see based on the prompt that I would be answering, Surgical Posting is definitely the place where the environment among the superiors felt more like a family to me and I’ve always felt the love and care towards one another and the patients in the whole team.

Prior to entering this department, I’ve always had my doubts and fear considering that I’ve heard numerous negative comments in regard to the department. Mostly, the department was deemed “toxic”.

However, upon entering there during my first day, I was guided and encouraged to follow rounds even when I seemed rather lost. I was not reprimanded or shouted at but instead I was guided and taught.

No doubt it is a tiring posting and after having completed my tagging period in all of the 5 major postings (Orthopaedics, Paediatrics, Obstetrics & Gynaecology, Surgical and Medical), the tagging period in the Surgical Posting is the most tiring for me.

This posting sort of reminds me of Orthopaedics except the amount of patients are full-blown, never ending with random or common surgical-related issues and the patients are even more unstable.

The thing about being in this posting is that usually when an order is given by our superiors, it is expected to be carried out STAT, meaning immediately and they will usually keep checking in to know the progress and status of the patient which is both good and also annoying. Good because it keeps you on our toes and ensure things are being carried out. Bad as the day could be burning with multiple issues and joblists and there is lack of manpower and you barely had time to sit or even had a drink and next, you’re being summoned again.

However, looking back, I definitely enjoyed every bit of my journey over there. Eventually, I was given the responsibility of being one of the leaders in this department, the daily allocator to be exact, by my friend.

This unknowingly deepens my relationship among my superiors as we would constantly reach out to each other.

Along the way, I made friends with the nurses at Male Surgical Ward and I will always be grateful for their help.

The Surgical Posting also made me realise how much I enjoy Surgical-based and that I am one. Despite my initial interest in Medical upon entering my housemanship journey, I realised that I love hands-on more and I need to “see” the issue. For example, if a patient complaints of abdominal pain, assess the patient, send some blood workups which might help and in your direction of care as well as scans.

Most of the time, the issue is identified through the scan with the blood workup being highly suggestive. Thus we move on from there.

I can’t quite explain. Somehow it just make sense to me just like when I was previously in the Orthopaedics Department.

This posting is also where I spent the longest time. I entered the posting on the 4th of July 2024, which is around 5 months as I took a break in between due to my injury.

The Surgical Posting definitely holds a dear place in my heart. Upon bumping into my old superiors, I still greet them with joy and a smile, reminiscing my good times within the department.

If you are due to join the Surgical Posting, please prepare yourself both mentally and physically.

In my opinion, the Surgical Posting is a physically tiring and not as bad as it seems despite the multiple negative remarks. Perhaps, it was a different experience for others but in my humble opinion, it is NOT a toxic department. At least at the place that I am practicing in.

Have faith, hang in there and try your ultimate best everyday in both your work as well as in trying to learn the most you can out of this posting and journey.

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My Experience as A Plastics House Officer | Housemanship Diaries

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When I entered the Surgical Posting, we initially did not have the privilege of experiencing subspecialities like other batches.

This was due to the fact that there were lack of house officers.

However, mid-Nov, there was redirection of House Officer allocation and suddenly, the posting was overflowed with House Officers.

Hence, subspecialities were reintroduced. The subspecialities reintroduced are neurosurgical, plastics and urology.

Ever since my first posting in Orthopeaedics, I’ve always wanted to experience being in Plastics after assisting my medical officer at that time with SSG.

Thus, during my final weeks, I was given the priviledge.

The Burn Ward is located at Level 3 of the Main Building, and is able to host at most, 10 patients, with each patient having their own room/cubicle.

Usually the burnt patients are kept at Burn Ward whereas other patients who are admitted for AVF creation or SSG are placed at Surgical Ward.

The timing for us House Officers is from 7am till 6pm, Sunday till Friday with an off day on Saturday.

During my time in Plastics, I would usually arrive on time at 7am and proceed to trace the bloods first. After all the bloods have been traced, I would proceed to help out with morning reviews.

Morning reviews are usually done by the postcall medical officer. This is then followed by rounds with the surgeons, usually starting with the acute or rather, the intubated patients followed by the rest.

Rounds at Burn Ward is only once daily. After morning rounds, we would gather at the “Handover Room” whereby the patients who are not in the Burn Ward but is being seen by Plastics as another team or as a primary team are being handed over in terms of case and progress as well as the newly admitted ones.

Next, we will proceed to follow the “Peri rounds” and change dressings if needed. Usually after the Peri rounds is when us House Officers go about our joblists in terms of posting case, referrals or bloodtakings or imaging request.

The rest of the day could be pretty chill if there is nothing going on but usually, there would be new patients to be transferred in, take blood or any post-op patients to be reviewed.

Sometimes there are cases being called and we are more than welcome to join the operation. In between, there are arterial blood gases (ABGs) to be take in between or bloods to be sent.

Finally, in the evening, prior to leaving at the end of our shift, we would prep the coming mornings and leave them nearby before informing in our Surgical House Officer’s group in regards to the “coming mornings”.

My time in Plastics was rather short-lived and I felt that there was so much more to be learnt. But my time spent there was extremely wonderful and the medical officers and surgeons were more than helpful and welcoming towards the new people into their team.

Definitely, a department that I would want to return to.

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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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The Worst Morning Shift In General Surgery | Housemanship Diaries

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I can’t really remember when as at the time of writing this article, I am about to cross into the second week of 2025.

Perhaps it was somewhere in October last year or early November.

It happened to be the day shift on a weekday and we were lack of manpower. 3 House Officers in the Male Surgical Ward, 2 House Officers in the Female Surgical Ward. Out of the 5 of us, I am the senior and the rest are first posters, three of which are only Day 3 into their housemanship life.

Oh dear…

We all know how busy Surgical can get and being the only senior that day surrounded by newbies, it was as good as being alone as they were not familiar with the system or the work or the procedures.

Learning does take time.

The day started with me taking care of the acute beds. The acute beds in the ward is considered the most unstable, hence it only made sense to allocate the senior, which is myself there, followed by the subacute cubicles.

The front cubicles and back cubicles are relatively stable patients. Hence, I allocated my juniors there. Usually for first posters in their first week of life, I would not allocate them independently to take care of a cubicle. However, we were desperately short staffed that day and taking care of the front or back cubicles are not easy either especially if you’ve just entered.

The day was busy enough. Started with me following rounds at acute and subacute with my medical officers and again with the ward surgeon, only to leave midway as the Hepatobiliary Team (HPB) had their own separate rounds and I was the HPB house officer for that day.

After rounds, it is the completion of the joblists. Amidst trying to complete the joblists, we had to transfer in new patients, take and send off the bloods of patients who have just entered as well as attending to any acute issues.

On that day, I had to assist with the front and back cubicles as well and in the afternoon, the juniors left for their Operating Theatre (OT) orientation.

My phone literally rang non-stop that day and the nurses kept haunting me down for everything. If only, I had the ability to clone myself…

Suddenly my phone rang and I had to assist a registrar to help tend to a visiting outpatient, attend the female surgical ward acute issues because the medical officer on-call called me as well as attend a virtual meeting.

Time flew by rather quickly, one minute I was escorting a patient, next was being called upon by this and that medical officer or registrar or nurses. To the point, my post-call registrar stayed back to assist me.

As the evening progressed, most of my patients desaturated. The annoying thing about Surgery, we had to update the whole story properly in the oncall WhatsApp Group for the day.

If only it were as easy as that.

We couldn’t just take a picture of our entry and update. Instead, we had to properly type the whole summary or stay.

I finally completed my task for the day at 10pm. It was an extremely exhausting and tiring day. One which I have no interest in relieving again.

That was probably the worst morning shift I’ve ever experienced.

However, looking back at what I’ve written, it doesn’t do justice to what I actually felt that day.

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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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My First Surgical ETD / ED Night Shift Experience

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My first ETD “on-night” or night shift in Surgical was with a fellow junior who I considered as my senior in the posting as she was in the department much longer that I was.

Prior to joining the Surgical Posting, I have went through the Orthopaedic Posting as my first posting and people said that the ETD shift is similar to that in the Orthopaedic Posting, except that we would be taking the bloods, requesting necessary scans ourselves and posting the case.

Before I went to the emergency department, I stopped by the ward to steal some forms and stock up my “file”. After that, I went downstairs and received handover from the morning team.

During my first “ETD ON” shift, there were two medical officers as the first call. One is a tagging medical officer as she had just joined the department.

The night was rather cold I would say with minimal referrals, probably less than 10.

Every time there is a new case, we would be asked to clerk the patient first. However, usually the medical officer would be there by then and we would see the cases together.

I remembered it being “cool” enough that night that we even had time to have dinner for a while before proceeding to take our coming mornings and even rest for a while somewhere.

In the morning, we requested scans that were rejected the day before and followed rounds with no surgeon to know the latest plans, handed over to the following morning team and returned home on time.

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My First Night Shift In Surgery | Housemanship Diaries

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My first “ON” or “On-night” or night shift in General Surgery was in the Female Surgical Ward with a friend whom I’ve known since around my first posting but have yet to be in the same posting together till our fourth posting in General Surgery.

We were blessed enough to have at least 2 people per ward for the night shift.

Our shift as “on-night” in Surgery began from 7pm and will usually last till all the discharges are done the following morning.

Upon my arrival to the ward, I was informed that one patient in particular had no urine in her CBD (urinary catheter) bag and that she felt like urinating but was unable to void. Considering that she had a urinary catheter in-situ, voiding should not have been an issue.

I attended STAT and assessed her. She had a mass over her abdomen which was hard, non-mobile but had smooth edges, around 15cm by 10cm, a rather large one which I assumed was a tumour, probably pressing onto her urinary bladder as well.

It did not occur to me to check if the patient was previously passing urine, it also did not occur to me to check her intake and output chart. All I could think of at that time was, she felt like voiding, she is in pain, there is no urine flowing into her urine bag.

Thus, I prepped the trolley to reinsert a new CBD. I donned my plastic apron and prepped my materials needed and proceeded to clean the patient’s vagina and reinsert a new urinary catheter in as probably as sterile as I could, bedside.

Upon insertion of the new urinary catheter, there was no urine outflow. Thinking that I may have blocked it or inserted not all the way in, totally abandoning my theoretical principles learnt, I proceeded to reinsert about 3 times and each time was met with no urinary outflow but there were bloodstains from the urethra.

I called my partner for help and he proceeded to help me in informing in the oncall group and referred to Urology medical officer oncall who was rather grumpy.

It was during his referral that I realised that the patient had been anuric (not passing any urine) for sometime now. Clearly, she would not have any urine output and although she felt the need to void, it would not have been an issue considering there is a urinary catheter in-situ.

I had unnecessarily caused trauma and I felt foolish for acting prior performing a thorough examination and understanding her case.

The Urology medical officer came and reinserted a CBD to which she asked us not to remove and to request for an ultrasound the following day for assessment as she suspected that the tumour over her abdomen had infiltrated into her urinary bladder or urinary system.

That was settled but definitely ate up a huge amount of our time because of my mistake.

Subsequently I was rather slow and there were a few post-operative patients and new patients admitted into the ward. Hence, I proceeded to do the needful. By the time I was done, my partner had completed taking the blood for the whole ward and at that time, it was around 3am. I could sense the back-to-back disappointment I have caused him and at that point, I have given up on apologising.

We then proceeded to complete our planned discharges of the patients and by 6am, started tracing the blood results of the patients before retiring into the house officer’s room for a break.

In the morning, as usual as in other postings, we would be “summoned” in the group to take any bloods or to start our discharges.

We returned home around 11am and our post-night shift was followed by an off day.

Personally, I felt that I could’ve done a lot better as I was rather slow that night. However, for a first night shift in Surgical, it was not as bad as it seems.

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My First Day Back At Work After A 6-Week-Break | Housemanship Diaries

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I officially returned to work on the 2nd of October 2024.

Initially, I was stationed to work the morning shift at ward. However, a colleague of mine decided to take a sick leave on that day when she was initially stationed as the House Officer in the Emergency Department, ETD HO.

Being the Allocation Leader in this department, it is my duty to immediately look for a replacement and to update in the group with the medical officers. Not one person came to mind and I felt bad since it was a friend of mine who took a sick leave or did I feel comfortable dragging another person to cover this shift since it is a shift most people avoided.

Thus, I offered to be the ETD HO myself. It was during an anaemic House Officer period and there were only one House Officer stationed at the Emergency Department.

Hence, I went to work and stocked up my necessary supplies before meeting the post night House Officer in the Emergency Department to receive my handover.

Of all days, it had to be one whereby no coming mornings (bloods) were taken for the patients and there were a lot of active job-lists not being carried out. Not to mention scans to be requested the following morning.

Basically, there were a ton of “shits” being thrown to me and if I do not settle it myself or to push my post night colleague to help me, I would be in a mess for the day.

Imagine having just returned to work to this. Without thinking much, I started identifying the patients who had bloods to be taken and proceeded to take all of them and sent it off. After sending them off, I started preparing for scans and called the radiology medical officer oncall to present my case.

Finally, after I thought I was done, I decided to review the stranded patients.

Normally, the stranded patients should be reviewed around 7am as we would begin our morning rounds around 7:30am till 8am. Thankfully, it was the weekend and rounds began much later.

I went through my list of stranded patients and there were almost 20. 20 stranded patients at various locations.

Would I have the time to review all of them? What about the active joblists or scans? Can I rely on my post night colleague? What if there is a new case?

I remembered it being a rainy day and the referrals were initially from wards and not from the Emergency Department (ETD).

Perhaps it would be a slow day. I thought to myself.

But, I thought too soon.

Soon, referrals started piling up. My medical officer’s phone (MO) was blowing up with calls. Other sub-specialities kept reaching out for me to help them out and at one point, me and my medical officer had to split to ensure we got everything done to the best that we could.

I wished that I could literally divide myself but I couldn’t. On top of that, my right foot started to ache. I just came back from a 6-week-break. I can’t afford to go on anther few weeks. If I do, just when am I going to end this posting?

I recalled it being a terribly hectic day and I felt bad as I was mostly away, having been dragged away by other sub-specialities, escorting patients or carrying out the active job-lists. I could not really be by my medical officer’s (MO) side to see the cases.

Finally, the end of my shift approached. 7pm and my night colleague came for handover.

Despite it being the evening already, the fire was still burning strong, referrals did not stop coming in and I still had tasks to complete or I would be handing over “shits” to my night colleague.

Finally, it was around 8-9pm, I can’t really remember as I was following night rounds with the OT call medical officer and registrar. My medical officer told me to return home since the following day, I would be morning shift.

I remembered returning home that day, somewhat unsatisfied with myself. No doubt that it was a tough day, but I could definitely do better. If only my leg did not slow me. The pain seems to increase with every step I took and with every exertion I made.

However, as I remembered, I was blessed to have an angel as my medical officer oncall for that day. Instead of shaming me or being sarcastic or mentioning that I could do better, she simply thanked me for putting my best effort on the first day back and welcomed me back.

It’s angels like this who makes me want to try to be better the following day.

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