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The Theoretical Doctor

My First Tagging On-Call Shift As A Floating Medical Officer

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My first tagging oncall shift was on a Sunday with a fellow medical officer I knew when I was a House Officer in General Surgery. Back then, he was having his attachment in General Surgery.

Just like a House Officer, we had to undergo a period of “tagging“.

In the Department of Plastics and Reconstructive Surgery at Sarawak General Hospital, I had to undergo a tagging period of one month, every other day (EOD). This is because, I am a newborn medical officer with no previous experience in General Surgery (as a Medical Officer).

This is an advantage as I would be able to learn as much as I could within a span of 1 month. However, it was also a disadvantage as I’m afraid, I would be burnt out mentally and physically considering the on-calls were on every other day (EOD).

“I can do it. If others could, I could too.” , I repeated this mantra to myself but the learning curve is going to be an extremely steep one.

During my first tagging oncall, thankfully, it was with a fellow senior colleague who I was rather comfortable with.

We started with our morning ward rounds followed by passover and peri-rounds. After we were done, we went back to the ward to settle our pending job-lists followed by lunch.

As a tagging on-call medical officer, the first call would be to me for referrals. After which, I would discuss with my senior and proceed to see the referred patient together. After reviewing our newly electively admitted patients, pre-op rounds with surgeon and demarcating the op site and pre-op meeting, we went back home in the evening and returned at night together for our night reviews which we updated in the Department’s WhatsApp Group on the progress of certain patients. Incidentally, a patient whom we were awaiting for op was called into the operating theatre and the operation ended at 2am. Finally, we returned home for the night.

I was nervous of course as I usually get anxious easily. However, I took my shower and headed to bed.

My phone was kept beside me in case I were to receive calls or referrals. At 6am, I returned to the ward and started our morning reviews as well as prepared for our morning rounds.

Since, it was a Monday, it was morning ward rounds, handover and peri rounds as usual. However, since I was still tagging, I was expected to stay till 5pm or to join the ongoing surgeries.

Thus, my first postcall was spent in the operating theatre assisting till 6pm. However, despite the ongoing operation, I excused myself to return home and rest.

The following day will be another one, thankfully, not oncall but within office hours.

Thankfully, it was a good call with a fellow senior that I was comfortable with in terms of approaching in regards to my doubts which was undoubtedly, many.

I can only hope that I would be able to survive this whole month of tagging.

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The Theoretical Doctor

My First Day As A Medical Officer In KKM

My First Day Of Locum And As A Medical Officer.Article written by Dr. Jewel Nambiar.

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Housemanship or Internship for Doctors in Malaysia lasts for a duration of 2 years, upon completion of our medical school journey.

For some, they began shortly upon graduation whilst for others, they took a gap year.

I submitted my application to pursue my internship in the Ministry of Health, Malaysia (Kementerian Kesihatan Malaysia, KKM) shortly after my graduation but did not actually begin till 6 months later in 2023. Two years later, thankfully, I’ve completed and fully registered with the Malaysian Medical Council (MMC) and possess a valid Annual Practicing Certificate (APC).

Post housemanship, I went on a 3-weeks-break and on the 21st of August 2025, I reported for duty as a Medical Officer.

Upon my completion of housemanship, one would have to go through a “floating period” of maximum 6 months prior to receiving their placement in whichever department, hospital or state of choice. Usually, the floating period occurs in the same hospital that one had completed their housemanship or internship in.

Thankfully, I was offered to float in the Department of Plastic and Reconstructive Surgery. However, I was diving into the world of Surgery with no experience or knowledge in basic suturing.

During my first day, I reported for duty at the Hospital Director’s Office to receive my “floating” placement letter, checked my remaining leaves and proceeded to Burn Ward of Sarawak General Hospital.

The Burn Ward.

I’ve had good memories previously as a House Officer here and I was beyond ecstatic as well as relieved to be accepted into this department which is filled with understanding and helpful bosses.

I was then given orientation by one of the medical officers, clerked a burn patient that was just admitted and spent most of my time accompanying a fellow friend who thankfully is in the same department. Considering it was my first day and a rather slow one, I was able to return home at 5pm.

There’s just so much more that I have yet to learn. Hopefully, I’ll have both the mental and physical strength to push through.

Thankfully, the environment is one that is filled with love and encouragement.

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The Theoretical Doctor

My First Day Of Locum And As A Medical Officer

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A locum or locum tenens, is a person who temporarily fulfils the duties of another; the term is especially used for physicians or clergy.
– Wikipedia.

The first time I ever tasted or ventured into locum or a so-called “part-time doctor” was on the 3rd of August 2025.

At that time, I was back in my hometown and on a 3-weeks-break post housemanship / internship at a small private clinic, yet to officially begin as a Medical Officer.

While I was in medical school, I would occasionally hear this term “locum” from my fellow seniors or batch mates, lecturers, parents or even friends of my parents. However, in order to locum, one would need to be fully registered with the Malaysian Medical Council (MMC) and possess a valid Annual Practicing Certificate (APC). In short, I had to graduate medical school, finish my internship or housemanship first, then only am I able to dive into this.

Thus, upon acquiring my full MMC and APC licence, I was looking forward to locum. Looking forward to it as well as nervous to dive into this. Thankfully, I had just completed my final rotation in the Emergency and Trauma Department.

In the Emergency and Trauma Department, there are various zones in which the patients would be triaged into in terms of presenting complaints, severity and their vital signs. The least critical in severity would be triaged into Green zone. The Green zone is similar to a clinic setting, thus, it gave me some idea on the type of cases I would be expecting.

My first locum was just 3 hours long, from 7pm till 10pm. I figured that since I am just starting at that time, it would be better to start with minimal hours in order to get used to it and also.. if I would enjoy it.

The clinic was quaint and small but equipped with basic necessities and a scan machine. The only thing that it did not have, was an x-ray facility. The moment I sat down, the patients kept coming back-to-back. As soon as I was done with one, another came.

For a first-timer, I felt it was equivalent to the Green Zone in General Hospital whereby the cases were always there but the patient load was manageable.

However, I was extremely scared.

Mainly afraid that I might accidentally jeopardise the patient’s safety in terms of mismanagement. Thankfully, by 9:30 pm, the clinic assistant stopped accepting new patients and prepared to close the clinic.

For a first experience, it was a good one despite it being rather terrifying for me.

But, we all have to start somewhere and build our confidence, don’t we?

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The Theoretical Doctor

2026 – The Beginning

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First of all, Happy New Year! I hope you have had a great start to this year and if you have any New Year’s Resolutions planned, I hope that you will be able to stick throughout the year.

I did not have any New Year’s Resolutions planned as I usually did the previous years. Mainly because I have just moved to a new place, settling in with things still pending in Kuching, trying to adapt to my working environment as well as picking up on new skills.

Thus, New Year’s Resolution? It’ll come as the year progresses.

My New Year’s Eve was spent at work and mainly in the ambulance with a dear friend as well as work colleague, however, that is a separate post for another time.

As usual, since I’ve started working as a doctor in 2023, I’ve always made it a point to work on New Year’s Day, a habit which I’ve adapted from my dad ever since he has started working at the age of 18.

However, New Year’s Day is a public holiday here in Sarawak. Thus, I was allocated as the oncall medical officer on the 1st of January as well as on the 2nd of January. Per oncall shift is from 8am on that day till 8am the following day (which means, mine ended at 8am on the 3rd of January).

My first case began with a case of wound breakdown over the right wrist, which the patient chose not to seek hospital treatment followed by another case of upper gastrointestinal bleed which was sent to hospital. This was then followed by another case of possible acute appendicitis which the patient and family decided to “discharge against medical advice” because they wanted to seek treatment in their hometown considering they were travelling and happened to be in the same area.

Upon returning home, I was called back for a case of breakthrough seizure likely secondary to under-dosage of medications. The patient had three episodes of seizure that day followed by a regular 1-2 monthly episodes. Hence, referred and sent to hospital.

Finally, I can return home. Time to get some rest since I would be working the next day. Shortly after, I was called back, a patient sustained laceration wound over the medial aspect of his antecubital fossa. Mechanism of injury? Unknown and he was in an extremely drunken state.

Otherwise, he was stable. Sadly, my medical assistant at that time could not be contacted to escort the patient to hospital and the family members did not have their own transportation.

If only, he was fully awake, I would have triaged him to green zone. However, transportation issues… Thankfully, the patient’s family has an uncle who was willing to send. The only thing was he needed some time to arrive due to the heavy rain and slippery roads.

I didn’t feel good leaving the patient behind although he was stable. Thus, I stayed till 4am until his uncle came and the patient himself had woken up.

After that, I went back home and straight away gotten ready for work since it’s a working day and I am still oncall.

The following day on the 2nd of January, went by smoothly during office hours with referrals here and there but it was manageable.

In the afternoon, another patient came in for symptomatic anaemia secondary to abnormal uterine bleeding with newly diagnosed cervical carcinoma. Her haemoglobin level was 5, who again, refused hospital referral claiming she visited the clinic for fever and not for her anaemic symptoms. After much convincing and discussion with my specialist, the patient still opted to “discharge against medical advice”.

Which makes me wonder… Why in the world?…

This was followed by dinner with my friend. I remembered thinking to myself that evening that maybe… just maybe… I would have a cold night. Enough of referrals.

However, at 11:30pm on the 2nd of January 2026, I received a call from my medical assistant that a patient presented to the clinic breathless with an SpO2 of 50% under room air, started on high flow mask and at best, it is only 90%.

Sounds like an impending intubation and CPR case.

I called up my friend immediately as I rushed to the car as she lives closer to the clinic. I needed all the help I could get for this patient. The roads were slippery and it was a rainy night. Yet, I sped. Thankfully, my friend had already arrived before me.

The patient?

I remembered seeing this patient on the 23rd of December 2025. At that time, his lungs already had crepitations with reduced air entry over the right side and yet he chose to “discharge against medical advice”. I remembered telling him that he would collapse if he didn’t go and true enough, here he was… sitting up, gasping for air.

His vitals? Blood pressure was sky high, lungs filled with crepitations but no pedal oedema, lines were set, no ECG done but we didn’t have time to waste…

I called up the Emergency Physician in the nearest hospital (which is an hour away), presented shortly and informed that we had to proceed with intubation because he was too tachypnoeic.

We prepared for intubation, informed the family members as well as explained the risk of CPR and death. The family understood and agreed.

Intubation… This was a difficult intubation for the guy was a very large guy with hardly any neck visible.

But before we could start, his GCS dropped and so did his heart rate, I started CPR while my friend attempted to crash intubate. We attempted to crash intubate and both times, it failed… I called up the Emergency Physician again and told her that we were 30 minutes into the CPR, she told me to call off after the current cycle.

My first death at a new workplace and on the third day of the year at 0027H, 3rd of January 2026.

Then, I proceeded to complete my notes for the family members to bring to the police station to lodge a police report and broke the news to the family. I was calm and so were the patients’ family. After that, I called up the Emergency Physician to thank her and then, I broke down.

I broke down because had he gone on the 23rd itself, he wouldn’t have to gone through this.. He lives alone and his so-called family members aren’t even his biological family members but neighbours and friends… I broke down because I also felt defeated… We tried our best with such limited resources and manpower…

Yet, I couldn’t save him…

If you have YET to come up with a New Year’s Resolution… At least consider this, adhere to your regular check-ups if you have any… Stay compliant to your medications, diet restrictions or any fluid restrictions if you do have…

And if something is off or not right, please RUSH to the nearest clinic or better, the hospital… Because there is only so much that we can do with such limited resources in a community clinic.

Otherwise, I wish that you have a Blessed 2026 filled with love, beautiful memories and wonderful opportunities.

Remember to have fun and do enjoy it but please do so, responsibly.

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