Hi! My name is Daniel Lim Jhao Jian. Here is where I share my experience, knowledge and ideas. You are welcome to leave comments and follow my blog. You are free to copy anything from this blog. Please recommend this blog to your friends.

Friday 25 March 2022

22 September 2021: An extremely stressful day

22 September 2021 has to be my most stressful day in 2021 and my most stressful day throughout my housemanship so far. It was during the 3rd week after I started working as a House Officer (HO).

A day earlier on 21 September, I had failed the off-tag assessment which made me very upset. Not only was that quite embarrassing for me, it also meant I had to continue working the tagging hours from 7AM to 10PM every day, which is significantly longer than the normal work hours.

On 22 September, I was in charge of the acute cubicle in the Medical ward. Patients in that cubicle were generally very ill and they required morning, afternoon and evening reviews every day. At that time, I was still really bad at blood taking, where more than 80% of my blood taking attempts failed. A specialist ordered a blood culture for a patient whose blood was very difficult to get, even though another specialist had decided that it wasn't necessary earlier.

Taking a blood culture is a complicated procedure as it requires a large amount of blood and has to be done in a sterile manner. I couldn't even get a single drop of blood from that patient, how could I possibly get the large amount of blood needed? My colleagues and the MOs couldn't help me as they were so busy, so I gave up on the blood culture entirely. Shortly afterwards, the patient had to be admitted to the ICU. As he was intubated, I was required to accompany him there.

After arriving the ICU, an MO there asked me several questions regarding the patient's history and I couldn't answer at all. The patient's notes was several hundreds of pages long and I didn't know how I should read them. The MO was very nice and didn't scold me, but he emphasised the need for me to know the full history of a patient before accompanying them to the ICU in the future. Right after that, I had to accompany another intubated patient for a CT scan. Accompanying the 2 patients used up 2 hours of my time, while I still had a lot of pending work in the ward.

When I returned to the ward, an MO was doing the afternoon review of my patients and I had to join her. Although the MO is very nice, she was really thorough in her reviews which took a very long time. Later, a nurse was chasing me to complete the domiciliary care form for a patient who had been discharged a few days ago. The form had to be filled up in 3 copies. Then, one of the patients had a fever and I had to review him. After that, I could finally start doing the work which had been pending for a long time. Before I was done with all the work, it was time for me to do the evening review of my patients.

Suddenly, an MO came and scolded me for not arranging a Covid RTK-Ag test for a patient's wife who would be coming to learn nursing care. I had no idea that the RTK-Ag test was required. Then, a nurse told me that a patient required an IV cannula. Soon afterwards, I had to join the evening ward rounds by the specialist which lasted more than an hour. Much to my dismay, the specialist ordered a blood culture for a patient. The night-shift HO had arrived at that time, but blood cultures cannot be passed over to night-shift HOs which meant that I had to take it.

Seeing that I was so stressed, a senior HO helped me prepare all the equipment for taking the blood culture. I tried taking the blood culture but I wasn't successful. Then, I tried inserting the IV cannula for the patient who required it but I failed in that as well. The senior HO agreed to help me take the blood culture and insert the IV cannula, while emphasising that I needed to practice more and improve. I still had quite some work pending and my colleagues gave me some help.

I managed to finish all the work only at 10:45PM. That was the first time where I had to work overtime and I was truly exhausted. Combined with my failure in the off-tag assessment just a day earlier, I surely was having a very difficult time. At that time, the only thoughts in my mind was that I wanted to quit housemanship. I had applied for UK Foundation Programme 2022 as a backup option, and I felt that I really should go for it.

On the next day 23 September, I travelled to Johor Bahru to receive my 2nd dose of AstraZeneca Covid vaccine. I used that opportunity to go to EcoBotanic to taste some of the food there which I missed so much. At EcoBotanic, I kept reminiscing the good times in the past when I was working as a Teaching Fellow, where I truly enjoyed work and had so little stress. I really wished I could just keep working as a Teaching Fellow for the rest of my life.

On that night after returning to Kluang, I started feeling very tired which was a side effect of the vaccine. I had to take 2 days of sick leave, which gave me a much needed break from work. Thankfully, on 26 September I was allowed to off-tag and start working the normal work hours, which was 2 days of 7AM to 5PM shifts, 2 days of 7AM to 9PM shifts and 1 day of night shift every week.

After working my first night shift, my blood taking skills improved by a lot. Since then, I have been coping well with my housemanship. I am glad that I persevered and didn't actually quit housemanship.