An Update and Hopefully More to Come

Yep, it's been a while.

So my last post was almost 6 months ago (and coincidentally on my birthday too!) and you might be wondering what moved me to finally start writing in this blog again? Well, in my search for looking for student experiences in sitting for the Professional and Linguistic Assessments Board (PLAB) exam, which is requirement for international medical graduates (IMG) interested in working in the United Kingdom (UK), I came across a blog by one of my super seniors blog and decided to write again. It's also because I write long-ass sentences like that which make are difficult to comprehend. I want to say I've been extremely busy and haven't been able to do stuff like writing in this blog but that was only true for the earlier part of the year. Currently, I'm in my fourth year of medical school (self-pat on the back for surviving) and in my Psychiatry posting. Not much has happened this year except for the fact that I am now unsure about whether I want to pursue a career in paediatrics or obstetrics and gynaecology. I also spent a majority of my time focusing on trying to apply to the UK for their horsemanship program, better known as the UK Foundation Programme (UKFP). My involvements in extra-curricular and research has taken a slight back-seat this year as I needed time to not be extremely busy with a million-and-one commitments in my life and learn to "chill". Admittedly, "chilling" has been one of the greatest things I've been able to achieve these days and I believe had I not stopped to take a breath, I would be spiralling my way to a horrible final year experience. I'm not exactly sure, what happened or what clicked for me to realise that "Yea, that's enough chilling, time to game up" but those are the thoughts that come to mind these days. It could also be the fact that I'm in psychiatry now and have all the time in the world. Welp, there'd be too much to share in this post if I really wanted to so the remainder of this article will be me ruminating on my experience in obstetrics (which happened to be one of the best thing's this year for me) and why I love it so much!

O&G: More fun than I expected!

Obstetrics and Gynaecology (O&G) was the first posting of my fourth year in medical school. It would also be the first posting in which my batch would actually have a "full physical" clinical posting after a year of half-baked clinical year during a pandemic (not to any fault of the many lectures and tutors who really tried to make the most of it despite all limitations but let's be real, how much of clinical medicine can you really learn online and with so many restrictions in the clinical setting). The transition from only being able to go to the wards during certain hours and for certain limits and being able to do very few procedures to suddenly being expected to be in the wards from 7:30 a.m. to 5 p.m. and having 24 hour on calls (which would be followed by a whole day of lectures and clinicals) was shocking to say the least. Compounded with the fact that O&G is a subspecialty field and we only had 2-3 weeks of O&G lectures in pre-clinical years, basically it was starting medical school all over again. Learning schedules for clinics and practices in clinics, learning ward work and how to take bloods, order and label them, learning the nuances of the labour ward and every emergency possible in preparation for it to happen and so many others. I honestly thought I was going to hate O&G, one because it was gonna be so touch and two because I always thought only women should be doing O&G because if I were a girl, I would not be keen for some man to be handling any part of my hoo-haas. Then, I started my rotations in the Antenatal clinic. To say I was dumb would be an understatement but despite my lack of knowledge or exposure, it was an extremely enjoyable experience to have. I enjoyed clerking the mothers and listening to them enthusiastically answer all the questions we had for them, I enjoyed hearing the consults from the obstetricians-to-be and hearing their advices and mums listening eagerly and taking notes, I enjoyed hearing the sound of the Daptones picking up the baby's heartbeat and the apparent smiles (note we're still wearing masks at this point in time) at hearing that sound. It was only my first day and I found myself really loving obstetrics! My time in obstetrics was only made better the more weeks I spent going to clinics and doing on-calls in the labour ward. I was able to do many Pap Smear's and speculum examinations thanks to my super-kind and super-good-at-teaching medical officers, MO's (big shoutout to Dr Nabila, Dr Nad K and Dr Asmahani for letting me do my first speculums and vaginal examinations on actual patients). During my on-calls, that was the first time I got to catheterise actual patients and my first ever intravenous cannulation was on a mum in labour (I was so bad that her bedside literally looked like a scene from Jason-TQ Dr Aqwa and Dr Nad for being patient and not screaming at me even though it was 3am in the morning). I got to assist in a lot of deliveries (my biggest regret is not being able to conduct one myself) and had a chance to put in a few stitches in a perineal repair. It sounds like I enjoyed the posting mainly becasue of all the procedures I could finally do, but I genuinely loved how beautifully simple and enjoyable the subject matter of O&G was. I loved reading about obstetrics and all parts of it from prenatal, intra-partum and post-natal care (I even spend time outside of this posting reading more about O&G because I love it sooooo soooo much). I love going to the antenatal ward and clerking the mums and then proceeding to just chat with them about their potential baby names, and what concerns they had. I even had a patient I saw in the ward who remembered me during my End of Posting exam (EOP) and told one of the examiners that she loved how I did my obstetric exams (unfortunately she wasn't my patient during my exams but she spoke of me even when she didn't see me during that day, didn't even feel like I left that much of an impression on her in the wards but hearing that was like so uplifting!). 

Dr Syeda! Literally the reason I knew so much stuff in O&G!

A picture with the legend herself, Dr Rahmah!

Us post-episiotomy repair classes, you can guess what those emoji's are hiding.

Ultrasounds galore!

Me and Wan Chien after successfully watching over a mum during labour 

In a small corner you can see a section for medical students so we don't skip out

The partogram before being filled out.

When I look back on it, I loved obstetrics because the patients were just so lovable. I loved how enthusiastic they were about their health and what was to happen, I loved how particular and detailed we were seeing to mums because mostly the prognosis of patients here were good and good outcomes were the norm so we worked out absolute-best to prevent those horrible bad outcomes (I'm not saying fields like medical and all have patients who are not as enthusiastic but every once-in-a-while you get those uncles who don't take their meds and up in the hospital with a hyperglycaemic emergency or with rotten feet). At my school, we're expected to be in the labour ward for the whole 24 hours we're on call unless we have classes so we would literally just be sitting in the rooms with the mums carefully plotting their partograms (a chart to monitor her labour) and seeing to her needs (catheterising mums, giving them relevant medications, etc) and of course helping out in the labour process. Most of my peers don't remember their on-calls as fondly as I do but my on-calls in the Labour Ward were one the best times I've had in medical school. I had so many meaningful conversations with the mums and sometimes their husbands and it may sound obnoxious but the "Thank you" you get when the mum gets transferred from the Labour Ward to the Post-Natal Ward is something no amount of money can buy. I also had some great teachers during my time in Obstetrics, the medical officers we would see day-to-day were literally some of the best doctors I have had the chance to learn under (Big shoutout to Dr Aishah, Dr Ashikin, Dr Asma, Dr  Nad K, Dr Nabilah, Dr Shamaa, Dr Liana, Dr Aqwa, Dr Risha and Dr Sakinah!). I also had a chance to learn under the absolutely amazing Dr Syeda whose rounds are something I would say everyone in my medical school should get to experience at least once, we would round on patients and for every level of trainee there (medical student, HO, MO) she would make at least one patient a meaningful teaching moment either by long case, short case or viva. I learnt so much during her rounds and I literally would wake up mornings super excited anticipating her rounds, even going as far as to sacrifice my Chinese New Year Holidays to get more time in O&G! I hope that if I ever get into academia or teaching, I would be able to emulate her style of teaching and doing rounds because it was so enjoyable and I learnt so so much! Of course, not forgetting my supervisor Dr Rahmah who taught me more than just the theory and clinical aspects of O&G but things that made me a better doctor and a person. The first question she asked me when I met her was "So you're on call today right, what's the name of the ward sister in charge and who were the HO on call today?". I was of course left dumbfounded, I had prepared by reading about the basics of an obstetric history and exam or common conditions in labour but she asked me that instead. She spent a while stressing to me and my friends the importance of knowing the team and at the very least their names so from that day onwards, I became known as the medical student who would ask everyone their name (which is surprisingly a fairly uncommon act in our Malaysian healthcare setting, we just call everyone adik, Abang, kakak or doctor!). You'd be surprised what difference knowing someone's name does to your clinical setting, I had PPK's (Penolong Pegawai Kesihatan') recommend me cases in the clinic to clerk, nurses offering to teach me about common medications in the labour ward, houseman literally going across the entire ward looking for me to teach me how to catheterise. Previously, I use to just skirt around them and try to not get in their way but now I actually felt part of the team. After a few weeks of adjusting I actually was able to pull my weight and help out more, and even become known as quite a reliable medical student. Even 'till the last few days of my posting I even took extra days to be on-call in the labour while others wanted to focus on exams, experiences I don't regret gaining! 

Fetoscopes! Difficult to use but preferred doing this over my gynaecology rounds haha

Now this was my O&G posting, and you definitely see a lot of O's and almost no G's here. Well, to say I love gynaecology as much as obstetrics would be a far stretch from the truth but I did have some good times in gynaecology too. Clinics would be super fun to look forward too (aside from being kicked out of the room when the occasional patient who wasn't comfortable with males came along) but I got to do quite a few speculum examinations and even had a go at doing a trans-abdominal ultrasound (it's actually way harder than it looks!). In O&G, our centre works in different teams (A, B, C, D) and each team would usually specialise in one thing, so some teams would see more cervical cancer cases, some would see more uterine pathologies and mine would see most of the urogynaecology cases. So mostly, my clinics were patients with Pelvic Organ Prolapse (POP) which is basically their uterus (or other parts of their genitourinary tract) dropping out of their vagina's (at least for the more severe cases). Now POP's were fun and by the end of the posting, I was pretty well versed in the assessment and management of POP's but POP's were not medical student level conditions and I had seen very few cases of cervical cancer (I actually only saw my first cone biopsy a week after finishing O&G during my Anaesthesia rotation in the OT). A lot of my team cases in the wards were miscarriages or things like hyperemesis gravidarum with the occasional fibroid or adenomyosis. There were also mostly fertility cases so OT would be a lot of salphigograms or tubal procedures which were also super cool but not my cup of tea. Admittedly, perhaps I did spend too much time in the obstetrics side but I was still able to get through the gynaecology part of EOP so I suppose I did enough. 

At one point, I even reconsidered my devotion to pursuing paediatrics for further training and those who know me would also know that I am a die-hard paediatric fan! Welp, it's now a few postings on from O&G and I do still reminisce on my time in O&G and absolutely love it when the current students in O&G discuss their cases or questions with me (when I probably should have been reading more orthopaedic and psychiatry stuff). A few experiences in the paediatric orthopaedic clinic and now currently in the Child Psychiatry Clinic, my love and passion for paediatrics has been reignited but who know's what the future will bring. I even tried to apply to do my clinical elective in obstetrics but alas I couldn't find a supervisor so instead I am now on the road to doing my electives in Neonatology (which I feel is a great blend between obstetrics and paediatrics) so I am super looking forward to that. Well until I get the urge to write again, but I probably will want to write about my experiences in wanting to apply for the UKFP, my experiences in psychiatry (especially in the Child Psychiatry Clinic) as well as my overall experience in fourth year when I finish so hopefully it won't be too long 'till I write again! Till then, take care and thanks for reading! 

Stuck between wanting to be a Mommy Doctor or a Kid Doctor.

*Link to the super seniors blog:

http://poissonandme.blogspot.com