Night shift

I am writing this at 4 am in the morning. 

Because?

My night shift will start at 11pm, the first night of four-in-a-row. 

Night shift is a mix bag of coffee-induced wakefulness in an artificially-lit building that can range from quiet (rare of course) to crazy. Resource is always limited, hospital staff are somewhat tired and the cafe is non-existent. 

With 3+ years experience of doing monthly runs of 3-4 night shifts in a row, I present you my top tips of surviving nights as a junior doctor. 

Pre-nights

1. Plan ahead

Knowing that you'll have nights in the next 2-3 weeks will help you mentally and physically prepare for it. If you're working in the wards, your colleagues will love you if you have prepped the discharge summaries of those long-term patients expecting to be discharged during your nights. Preparation also applies to petty things like getting snacks-to-share when they are cheap...

2. Know what you're covering and the resources available

Which ward? Do I have to cover extra wards? Where and when is handover? Who will you get if you call the Medical Emergency Team? How to make a MET call? Do we have 24-hour xray/bloods/CT or do we have to call them in to do it? Working in a provincial hospital for 2 years with only on-call xray service for serious conditions only and CTs for life-threatening/time critical conditions really change the way you manage patients. 

3. The day before

I try to teach my body to 'prepare' for nights with this regime (day 0 is the first nights)

Day -1

Skip morning coffee > tire myself with exercise (haha) > sleep in the afternoon > late evening coffee > if I can't resist it, sleep early say 10pm > try to wake up at 2am day 0 > sleep again from 9am of Day 0

Day 0

Continuation of above. Wake up in the afternoon for zohor prayers > do not drink coffee > sleep after Asar or Maghrib (late afternoon) > wake up 1.5-2hrs before the shift depending on travel time > COFFEE! > Showtime!

Nights

1. Minimise error

Humans are not nocturnal species and everybody who have actually done nights can vouch that nights can just be brain-numbing. 

Hence, have a set of go-to medical calculators/websites/cheat sheets that you can jog your memory when charting that medicine to check the dosing or contraindications, or just double-check on other life-threatening condition before you discharge that patient with what sounds like mechanical back pain.. 

My list includes

MdCalc - medical calculator including scoring guides
NZ Formulary - doses, indications and contraindications of drugs
Life In The Fast Lane - ECG reviews and basic management of ED presentations
Don't Forget The Bubbles - Paeds stuff
EM cases - Reviews of ED cases' management

2. Triage

If you're working in the wards, nurses will page you asking for more pain relief, laxatives, fluids etc.. By all means be nice to them (because if you work long enough, you'll know that nurses run the hospital, just saying....) but pay attention to the distress call or vague 'I don't know what's wrong but this patient doesn't look right despite normal obs'. Uh oh... But don't panic, see next step. 

3. Notes, leads and bloods

If you're still a while away to see this 'vaguely not-right' patient, ask the nurses to have the notes by the bedside, do an ECG and send basic bloods. If when you arrive the patient does look sick... 

4. People die in alphabetical order - so A, B, C is priority!

I expect my nursing colleagues to ring the emergency bell/call sooner/sounds panicky if Airway and Breathing is ever a problem and so far, the expectation has been met. Trickier bit is the Circulation and Disability (neurological deterioration) which can be more difficult to recognise and even harder to assess. If you can't get past Airway.... 

5. Basic is best

Basic and Advance Life Support are designed to be simple. Follow it. Simple airway adjuncts like chin lift goes a long way... 

6. GET HELP EARLY

Can't stress this enough. Get senior help, mobilise your resources (eg call the xray/CT person earlier) because help might come in person in the next 15 minutes... which is a LONG time if you have a sick patient in front of you. 

Post-nights

1. The day after the first night shift

Sleep regime should be individualised - trial and error helps. For a Muslim like me, I have to include performing the Zuhur (afternoon), Asar (mid/late afternoon) and Maghrib (early evening) prayers into my sleep regime. 

What I usually do is 'delay' my Zuhur prayer towards the end usually around 4pm to maximise my sleep. And sleep again after Maghrib. 

2. Travel

Driving after a night shift feeling sleepy is dangerous. 

Do not risk it. People have actually died. 

Have a back up plan. Find a place around the hospital where you can 'crash' for a few hours of sleep. Ask around. If all else fails, just sleep in the car with the windows winded down.. Much safer than drowsy driving. 

There you go. Hopefully it helps!

Astaghfirullah

Astaghfirullah 

Ya Allah, Ya Rahman, Ya Rahim. 

Alhamdulillah

All praise be to Allah, the Creator, the Owner, the Sustainer of the heaven and the earth. 

With His provisions, His guidance, His permission - I am now a junior doctor.

Astaghfirullah, Alhamdulillah. 

Alhamdulillah- He showered me with blessings every single day. 

Astaghfirullah because I know I haven't thanked Him enough. 

Now is the time to use these ni'mah to good use. 

Ya Allah guide me. 

Running those runs... Part 1

Salam to all.

Wow, the last post was in 2012! Time sure flies.

What I intend to share today are some of my thoughts and also the things I picked up during my first year of clinical medicine. 

So here goes:

1. Choosing the run sequence

The way I see it, there are three main ways in choosing run sequence. 

First, put the hardest one first. Reasons: first few weeks, students are still in the 'accommodation' phase, not expected to know as much therefore less expectation from the consultants/registrars (regs) and hopefully a more lenient assessment. The downside? Well, it took me around 2 weeks to get over the excitement of starting clinical years get my head around the hospital grounds, learn the lingo, know the people etc.... So that 2 weeks wasn't really used to work on the run. Luckily I still have another 4 weeks... 

Second, put the hardest one last. This gives you more time to learn stuff over the year, to get your mind and heart to beat synchronously with the constant beep of the anaesthetic machine and also to get some valuable tips from your buddies on how to cruise the run. You are however, expected to know a wee bit more than your early-year counterparts. 

Third, enjoy the holidays!! Got to be the maid-of-honour for your best friend's wedding during winter break? Awesome!! Just make sure that your holiday falls during that period because as you may find out already, our holidays are now different from the majority of other undergrads in Uni; ours are shorter and quite randomly placed throughout the year. Well, you can try asking for a few days off from your consultant... but I haven't tried that so I'm not sure how it'll turn out.. Also, look at the different holiday combination. I prefer a more widely-scattered holidays Eg. 1 week in March, 2 weeks in August, 1 week in October. Some prefer a more 'concentrated' holiday of 3 straight weeks in June... 

2. 'Hardest run' - my definition

The one with the most unfamiliar things to learn plus assignments/OSCEs/sign-offs to be completed within the shortest period of time. Eg. General Medicine aka GenMed. 4 case reports each with different requirements, 10 patients to clerk, 6 grand rounds to attend and 1 mini-CEX/mini-OSCE to be completed in 6 weeks. Compare this with Speciality Medicine aka SpecMed. 4 case reports and 1 mini-CEX also in 6 weeks. 

Progress test/exams scheduled sometime during the run is also a factor. Ask someone from the years above you regarding the run with the most workload. Better yet, ask them everything... seriously... 

Again, that's my personal view on what defines a hard run. Yours could be totally different. 

...
...

Okay, so maybe after reading the first two points, you're thinking, God, I'm screwed. I have Progress Test and end-of-year OSCE right in the middle of my GenMed!! Not to mention the international medical student conference halfway across the world, which I've already bought non-refundable flight tickets to!!

Err.. I'm not sure if it could get that complicated... but anyway, take a deep breath and read point No 3. 

3. Get an overview of the whole year. 

Get the year's diary/planner, preferably a big one-sided wall planner so you could see better. Note the run's start date, end date, lecture weeks, exams/OSCEs and most importantly : holidays! Why holidays are the most important? Well, it keeps you sane. And motivated ;) *also excellent to catch up on some sleep reading... 

And when you get the specific details of each run's assessment hand-in dates (usually the school will provide you with this on the first day of the run) write it on the wall planner!

Now embrace it.  

Take a deep breath and think like a Military General. You have your battles laid out in front of you. Strategise your plan of attack and work on it!!! :D

To be continued insyaAllah. 

Have to learn it still

Salam to all.

How are you today? Alhamdulillah for everything ey?

Yup, again, easier said than done.

Alhamdulillah. Alhamdulillah. Alhamdulillah (All Praise is to Allah).

Just got my 303 (Repro) test marks. What can I say? hmmm.. not exactly what I've hoped it would be. It's just one mark higher than my 313 (brain) test marks although it's waaaay easier than 313. I thought I could answer it well but if marks is the determinant, then I was wrong. 

What am I feeling at the moment? 

I don't know. Shocked is definitely one of them. Sad? A little bit. Whether the time I spent studying was useless? Nauzubillah min zalik (may Allah protect us from that).

It's just so hard to remind and keep reminding myself that for a Muslim, Effort is NOT equal to Result. Result is something that's been pre-determined by Allah. And only Doa (prayers) can change that with the permission of Allah. 

First clinical skill :)

Salam to all.

It's exactly 0000, 23rd March.

In 9 hours, I have to be in Robb and hopefully insyaAllah listen to the lecture about cell injury. InsyaAllah I'll like it, I've already liked writing about liking it.

Please ignore.

Anyhow, I spent 3 hours doing the Auckland Day Out poster. Something I kinda enjoy but I wish I could do it faster next time.

What happened today was it's my first clinical skills practice!

Yeayyyyy!

Learnt some cool stuff like taking a pulse, checking thyroid, taking BP, listening to heartbeat, body fat measurement and checking temperature. There are other stations as well (hand washing, patient history taking, BMI calculation~~) but let's just say I like the earlier ones better ;)

And I had the annual flu vaccination. The rate of the doctor jabbing the patient was something like 25 people per half an hour? Well, that's what he had to do to jab all med and nursing students in 2 days.

Tried fish burger at M@G. Okay la. The fish is the normal fish and chips, cut in half and sandwiched between burger bread. For just $5.90, that's pretty sweet~~~ :D

Everyday $5.90~ 1 week = $29.50, 1 month = $118.

Ngahahaha!

Oh, lapar balik :p

Must.. hafal... vitamins.... Must... eat... Must... do... test... next.. Thursday...

Seriously, I need a life other than books and Umsa events =.='

Thank you for waiting

Salam to all.

Yes, I do miss blogging and sometimes I do write in my head.

Haha, you miss me? Cut the crap :P

Anyway, since the last post, a LOT of things happen. But I guess they're mostly not Drama-dom material.

Where I am now?

Well, I'm currently sitting in my quite-comfortable chair with wheels, looking out to my window, which is sadly-but-I-must-be-grateful facing another apartment. Yes, I must stop complaining about not having direct sunlight into my room!!

I'm the one who willingly agree to take this room, the one used for storage during summer break. Oh, I must stop this self-sacrificial nonsense things!!

Just so you know, currently MJ and Akon's Hold My Hand is playing.

And I guess that's what I need lately. Alhamdulillah Romeo, my giant teddy bear, arrived 2 days ago. At least I have something to hug. :')

So what happened today?

Spent $10 for gym. 17 minutes on the bike and another 17 on the treadmill+hand jog item.

Then came home and studiedddd. Hahaha, I guess that's the first time when I'm really studying. 1 and a half hour of concentrated studying. If there is such word. Haha.

And now it's Fearless. 

Lately it's sorta a bit bumpy. I get frustrated easily and I tend to think the worst of any situation. I get impatient and irrational and it's just unfair coz I tend to crack at the wrong person. Hopefully she doesn't really notice. 

Now it's Elevator, which is a bit of a love-hate coz I am using the song as my Alarm. Haha.

Yesterday, I found out that it's POSSIBLE to get ALL A's throughout FIRST and SECOND year.

Ahhhhhhhhhhhhhhhhhhhhhhhhhhh.

I got two conflicting responses.

One, I feel happy and motivated to know that it IS possible.

Two, I feel lousy coz my result last year wasn't that good, passed the Medic requirement but still~

This brings forth the issue of Usaha and Tawakkal.

Yes, if you were to ask me if I studied for my Sem 2 final exam, yes, I studiedddddddd.

Medsci was crazy giler susahhhhhhhhhh. Lots and lots of blank pages. Arghhhhhhhhhhhhh!!
Expected a C or lower but alhamdulillah got a B.

Pop 102 was honestly much much better. I couldn't stop writing for the whole 2 hours coz Alhamdulillah the ideas keep flowing. I didn't miss any question though there was one or two sub-question I couldn't get through. I expected an A+ but got a B instead.
I'm quite sure I should ask for a recount of marks but somehow I didn't do it. Regret? I try not to.

Econs and Health Psych came out B+.

Alhamdulillah.

I'm still having problem with Tawakkal. Help me please?

I miss playing futsal. A lot.

Hopefully kak Zati can organise futsal again.

So that I can let them play with their new geng without feeling jealous that I'm not a guy.

Arghhhhhhhhhhhhhhh

I need the positive vibe.

Currently playing is Get it Right, Glee.

Spot on.

I miss Langkawi. Again.

The last of Benjamin :(

Salam to all.

Last lecture for pop 102. :(

Really enjoyed the subject, an eye-opener indeed.

But then again, 2 assignments costs me my beauty sleep. =.='

Just submitted the assignment 2. Slept for only half an hour between 10pm and now, which is 12.21pm. Whoa, boleh la start training utk jadi TI lagi 5 thn! <---adeyh.. lambat lagi laa..


Sangat bersyukur Allah beri peluang ini. :)

I'm sooooooooo gonna miss lecture!