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  • Writer's pictureVincent Chuah


#This is an old post in 2017 from the blog Standing Alone

Hello everyone, it's been a while since we last connected. How is everyone doing? So far, so good? Has anyone ever regretted choosing HSIJB as a house officer training ground? Well, nobody has informed me yet.

I hope all of you who have been following my blog are doing well in your current postings. I believe everyone always looks exhausted, with poor GCS (Glasgow Coma Scale) and experiencing urinary retention during the working period. IV caffeine and CBD STAT!

Life is fantastic, but not so much as a medical doctor. Hahaha...

Reflecting back on my anesth posting (which was about a year ago), it was relatively chill and relaxing compared to other departments. Once you're in anesth, say goodbye to hunger and hello to a fatty abdomen. You end up eating five meals per day (breakfast, lunch, tea break, dinner, and supper). WTH!

You had to undergo three different rotations:

1. Acute Pain Service (APS)

2. Operating Theater (OT)

3. Intensive Care Unit (ICU)

Each rotation teaches you different things. Let me give you a brief overview. As for which rotation comes first, nobody knows as the specialists decide your rotation. Eventually, you will experience all three rotations by the end of the posting. Everyone starts in OT for a two-week tagging, and then you rotate to APS/ICU or remain in OT. In the last two weeks, you return to OT. Each rotation takes about a month or more.

I started my rotation in ICU first. ICU is the best place to provide critical care to critically ill patients. It has the best continuous vital signs monitoring and is well-equipped with advanced items like ventilators. In ICU, you learn how to insert arterial lines, perform USG-guided CVL insertions and fluid resuscitation, manage critical ill patients, and more. My favorite intensivist, Dr. Axxx, was there to provide guidance. You get to set up a ventilator and understand the principles of respiratory mechanics. It's amazing! In the ICU, your responsibilities are limited because MOs and specialists are in charge of the patients. Your job is to assist them, and the SNs in ICU directly inform the specialist/MO if anything goes wrong.

The second rotation was OT. In OT, you learn how to intubate patients, deal with difficult ventilation, perform fluid resuscitation, work with different types of ETTs (Endotracheal Tubes), perform RSI (Rapid Sequence Intubation), spinal analgesia, and more. You have to seize opportunities to fight for intubation experiences with new MOs. If you stay quiet, nobody will give you a chance to intubate patients. I fought with MOs to gain enough intubation experience. We also get a chance to administer spinal analgesia, and I think I've done it more than ten times during my anesth posting. Doing a night shift in OT is like visiting the North Pole; you need to wear warm clothing to avoid getting cold easily.

The third rotation was APS. In APS, you learn how to reduce patients' pain scores by employing multiple modalities, treating chronic pain, implementing morphine protocols, converting IV medications to oral forms, diluting medications, and more. You work with APS nurses in HSIJB who have a wealth of experience in APS, and they were the pioneers in establishing APS with Dr. Exxxx. You need to seek their advice and opinions on various matters. You become a first poster again and treat them as your bosses. Show them respect, follow their commands, and help each other. I got along well with them, and some even wanted to introduce other nurses to me as potential girlfriends. Hahaha... The key is to be hardworking, humble, and willing to learn. Overall, I liked them as a team, but I didn't particularly enjoy this rotation because it involved dealing with pain all the time. Some patients who were overly sensitive would constantly complain of pain. But after this rotation, I felt more comfortable administering morphine, tramadol, or fentanyl.

In each rotation, you need to present a CME (Continuing Medical Education). At the end of the posting, you have a viva with two specialists and one pain specialist. The questions are tough, but I believe that if you work well with them, they will pass you easily. Many anesth MOs tried to persuade me to choose anesth as my future job, but I refused because I couldn't just sit there and watch people perform operations. I wanted to be involved in the operations too.

Next up: pediatric posting (when I became a 100m runner!)

Still, things may have changed. Be positive. Life is fantansy.

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