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The Theoretical Doctor @[email protected] · 2026-01-15 · 01:00 UTC

My New Year’s Eve – 2025

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31st December 2025. I was NOT oncall.

It was a Wednesday and it was a normal working day. Hence, at 7:45am, I left to work as usual and was there by 8am. It was the New Year’s Eve. I thought that maybe, just maybe, there would be less patients in the clinic.

The day started off smoothly. Surprisingly, there were many patients who came for their follow up followed by additional patients (the defaulters and walk-ins) but it was manageable. We went about our day, seeing each patient and when lunch time came, we went for our lunch break.

At 2pm, we went about our work, seeing patients as usual and I was taking my time with each patient. The patient load in the afternoon shift was lower compared to the morning shift and both my colleagues were done with their patient load.

Suddenly, a staff nurse barged into my room saying that there is a massive accident that just occurred nearby, 2 patients were already brought in and 2 more were on their way. They called in all available doctors (which were only the three of us) to help out.

I told my colleagues to head out and help out first while I rushed through the consultation of my final patient. After that, I rushed to the tiny Emergency Room of the clinic. My colleague who was oncall on that day was already attending to a child. I went over to the other patient, an old lady and did my primary survey and fast scan.

She was desaturating badly under room air and needed oxygen support. She had an open skull fracture, multiple abrasion and laceration wounds over her face, upper and lower limbs as well as rib fractures and on top of that, her left leg appears shortened and she has a closed fracture over her right lower limb.

I didn’t think that we should proceed with an x-ray at our clinic even if we had the facility at that time, the best would be to send them straight away to the hospital because she could deteriorate further any time. Thankfully, her GCS (Glasgow Coma Scale) was full.

I was focused on my patient, stabilising while referring her to the specialists of various specialities as well as the emergency physician that when I finally got ready to transfer her out that I noticed the child that my other colleague was attending to. The child’s right arm was crushed and the distal limb of his right arm was pale and his right lung was obvious till mid-chest.

Just how in the world is he still awake? The poor child was crying out in pain…

Judging by the state of his and my patient’s injuries, it was definitely high impact.

The story was, the whole family were travelling back from Miri to Kuching. Both the parents were sitting in front and the father was driving whilst the two children and their grandmother were sitting at the back.

The father claimed that he was not speeding but as he was about to make a u-turn at a junction, he claimed to have hit the curb and the car turned many times into the other lane before finally stopping and the grandmother and one of the child were thrown out of the car.

It sounded like a very high impact collision. Thankfully, the parents and the other child were well and unscathed.

We had to transfer both patients in two separate ambulances to the Red Zone of the Emergency Department at Hospital Bintulu as one ambulance could only transport one patient at a time.

Upon arriving, I met my colleague and friend at the Red Zone of the hospital. After we have handed over to the medical officers and specialist in the Emergency Department, we headed back together. However, upon reaching back, there was another patient who came in who was extremely tachypnoiec.

Oh, here we go again… Another Red Zone referral…

We stabilised the patient and referred her to hospital again. The clock was already showing 10pm when we left. The journey to the hospital takes about 45 minutes to an hour for each journey and the both of us have yet to have our dinner. This time, I choose to accompany her for the referral, mainly for emotional support and also in hopes of stopping by McDonald’s to get a takeout.

Yes, we did stop by McDonalds after sending the patient safely to the hospital and yes, we used the ambulance and went through drive-through.

By the time we left, it was already 11pm. The journey takes around 45 minutes to an hour and it was raining heavily. At this point, I was wondering if we would end up celebrating New Year’s in the ambulance.

Me and my friend ate in the ambulance on the way back while we joked and exchange oncall stories. Thankfully, we reached a little before midnight. The day was completely unexpected, not to mention tiring but it was nice to have spent it with a friend.

It’s still the beginning of 2026, so if I’m not too late, Happy New Year!

If you are travelling anytime soon or in the future, do drive safely, stay within speed limits especially if it is raining. Remember to get your car and tyres checked before any long distance journey and NEVER drive under the influence.

Stay safe always!

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The Theoretical Doctor @[email protected] · 2026-01-13 · 01:00 UTC

Lazy Days As A Medical Officer

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Do lazy days make you feel rested or unproductive?

While I’m at work, I’d be looking forward to returning home or towards my off day. In contrary, while I’m at home or on my off day, I’d be thinking about returning to work.

Do you feel the same way?

Previously, as a House Officer, I’m used to the “one off day per week”. Whereas, as a Medical Officer, weekends and public holidays are granted off days, except if you’re well… oncall and that depends on your current department as well as some departments require you to put in a half day shift during weekends or public holidays.

I’d say for me, considering I live alone and I don’t even own a car here in Sarawak, I’m pretty much lazy and unproductive to the point I get restless sometimes.

That’s counter productive as rest days are meant to make you feel… rested, right?

Thus, on my off days, since I’m an early riser, I try not to disturb my circadian rhythm by getting up at the same time as usual every morning, partly because I forgot to off the alarm or somehow, my body clock just wakes me up every time.

To feel so-called “productive”, I’d do some studying with my morning coffee till I well, lose my focus, then I start wondering about lunch and start cooking, handwash my clothes because I’m too lazy to walk downstairs with a bag of clothes and finally doze off for my afternoon nap.

I’d then wake up in the evening to have dinner and pack my essentials and bag for work the following day before finally, retiring to bed early.

I really need to be more productive during my off days.

Even me writing this just sounds too depressing.

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The Theoretical Doctor @[email protected] · 2026-01-12 · 01:00 UTC

Reflection: 2 Months As A Floating Medical Officer

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At the time of writing this article, I’m on leave which I took from the 1st of October till 15th of October, which my Head of Department (HOD) was more than kind enough to allow.

I needed the break, perhaps it was an adjustment disorder on my side but I was struggling. Physically, I caught up, I showed up and I was there but mentally, I felt left behind and lost and on most days, I was low.

Perhaps, it was out of tiredness as I have just recently off-tagged and in combination with my low mood, I felt demotivated and in general, felt that I have lost my love for medicine. I decided then that clinical life in the hospital was not for me. True, we were lacking doctors in various departments and hospitals in general across Malaysia. However, during that time, even if there enough manpower, I don’t think I would still want to continue.

I tried looking on the bright side, tiny things as well as the positive aspects of things to help me to get through the day.

Firstly, I’m thankful to be in a subspeciality department instead of the bigger and more hectic departments, I think I would have broken down within the first week itself. Secondly, I was in the department with the sweetest and kindest bosses who were more than happy to teach or lend a helping hand when needed. We are small in number, yes. But it felt like being part of a family.

I was happy, the environment was good, kind and non-toxic. However, mentally, I knew that this is not my place.

This further saddens me as I have always looked forward to being part of this lovely department. Yet, I knew, it’s just a matter of time before I slip and broke down. My body knew that I wouldn’t last long here nor do I foresee myself handling the complex and complicated cases here. If my interest is not here, how would I even make it through to specialise?

Amidst the business and my mind and body trying to keep up with the steep learning curve place before me, I was unable to view my options or to consider other departments.

I was just done in general and sadly, I wouldn’t be able to fulfil my quote in my medical school yearbook, I feel myself losing my will every single day nor do I find the strength within myself to serve.

Sadly,“sometimes what we like is not necessarily what is suited for us”, a fellow colleague told me and that hit me hard. I had no interest in other departments either or practicing in general at that point. All I could think of at that point was to quit and to hand in my resignation letter. After all, I have successfully completed my 2 years of internship / housemanship training. I can still locum if I wanted to. But of course, I didn’t enjoy it either. All I was ever passionate of was to teach. Thus, I considered changing my field and entering university as a lecturer did not sound appealing either as I did not like research at all.

Thus, after much contemplation, I approached my Head of Department (HOD) to validate my 30-day-resignation letter. My HOD is another kind soul who enquired to know what prompted me to come to such a decision. She signed my papers but advised me to consider changing departments instead of quitting.

However, at that time and at that current state of mind, I was fixed on my decision. Hence, the following week on a Monday, I submitted my 30-Days-Notice of Resignation, only to have it retracted the following day. Although I have handed in my 30-Days-Notice, a part of me felt a tinge of regret and sadness. Somehow, some part of me did not want to leave but I could not see any way out of this virtual box that I appear to be caged in.

My colleague and my parents played an important role in my decision to retract my resignation. Instead, despite my limited amount of leaves left for the rest of the year, I chose to take some time of work. Perhaps it was due to tiredness that contributed to my rash and impulsive decision.

On the 1st of October 2025, I took the first flight out and then throughout my leaves, I locummed at several General Practitioners. Remember when I said that I did not like locum either? This time, I decided to give it a second try and to keep an open mind.

The first GP I locummed at was a rather chill one with only 3 cases being seen throughout the whole day. The subsequent GPs were hectic and had multiple procedures, literally from the beginning of my shift till the end. In all of those times, I was the only doctor in the clinic. In my previous experiences, I have locummed at clinics which had 2-3 resident doctors.

Honestly, I don’t know how I managed to pull it off. Despite the hecticness and the patient load, I found myself looking forward to return and I enjoyed talking, listening and consulting the patients. It was fun. Slowly, I found myself enjoying and falling back in love with medicine and practicing medicine and thinking on how I could improve myself to serve better.

Then, I realised, perhaps venturing into family medicine might not be such a bad thing. True, there is abundant of family medicine doctors now and lack of doctors practicing in the hospital but that doesn’t mean that they are still not needed. Sadly, as much as I want to force myself to carry on and stay practicing in the hospital, I knew that it is not meant for me in the long haul or for me to last for even a year.

The opportunity to specialise is there but how can I continue if I can’t even see myself as one, or even have the inspiration?

Suddenly, the plan and my pathway seems clearer and I’m more than ecstatic to embark on my next journey. It was definitely the rest that I needed. To think and to reflect. If I were to stick to this journey, how can I do so for the long haul and at the same time, enjoy it?

I hope that in months or years to come, the decision to stay is the right choice. Perhaps, I still need time to discover my interest in this vast field. At times, I wish that it can be simple and that I would know what or which department I’m fitted to or destined to specialise in.

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The Theoretical Doctor @[email protected] · 2026-01-10 · 01:00 UTC

My FIRST SOLO Oncall Shift As A Floating Medical Officer

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My first solo oncall shift was on the 17th of August 2025 a few days after I have completed my tagging period.

I had a passive oncall on standby just in case things got out of hand, which is a good thing. However, I was adamant to try to survive on my own as if I only had myself and the specialist. Thankfully as well, it was on a weekday which meant I was able to reach out and ask for help if needed and the others would be able to assist if needed or advice me.

As usual, morning rounds, followed by peri rounds. The role as an oncall medical officer of the day is to update the progress of the patients in the specialist’s WhatsApp group as well as to upload any latest wound pictures, if any.

The day was rather busy with rounds and in between I would receive calls from Klinik Kesihatan (Community Clinics), usually requesting a clinic date. Thankfully, no referrals yet.

After rounds, I headed back to the ward to complete any pending joblists before heading into the operating theatre (OT) for a patient that was awaiting her call to OT.

During that operation, there was a referral from the Emergency and Trauma (ETD) Department, referring a case of laceration wound over the forehead for a 3 year old boy.

The medical officer at the ETD was kind enough to assist in taking the bloods as well as admitting the patient. My colleague on the other hand came to check in on me after her day in the clinic and attended to this kid.

After the first operation, the following case was called which was the 3-year-old kid. I have always enjoyed being in the operating theatre, or any hands on procedures.

Despite knowing that I should be conserving energy, instead, I proceeded to carry on and after the second op, I entered an ongoing flap operation next door to assist.

Another referral came for a laceration wound over the forehead for an Orthopaedic patient who was post-operative and transferred to ICU. Apparently, it was missed when the patient arrived at the Emergency Department as he suffered multiple opened fracture and was posted for operation immediately. Thankfully, he was intubated and sedated and I was able to perform a bedside toilet and suturing for him.

By the time I was done, it was midnight. I went back to the oncall room to shower and change for the night. I would usually change into scrubs again if I were to be oncall, just to be on standby in case I was needed immediately.

I did not sleep that night, it just felt wrong as the flap operation was still ongoing since 8am.

I went in again to check in on them, however, I was not needed at that time. Thus, I kept a fellow colleague company.

At 2am, I returned back to ward to complete the planned discharge of a patient and started my morning review. Thankfully, I did. In between, I was referred a new case of another kid who suffered another laceration wound at his right eyebrow. Thus, counselled the parents, obtained consent and admitted the patient.

After that, I was requested to collect bloods or bags packed cell for the patient who was still ongoing operation. When the commotion was done, I returned to continue my early morning reviews.

By 4am, I went back inside the operating theatre to check in on the ongoing operation. Technically, still far from done. Scrubbed in to assist with harvesting the skin for split thickness skin graft and refashioning of the affected limb.

At 8am, we were finally done. The operation officially lasted for 24 hours. All of us scrubbed out and I changed out of my attire to return to ward and follow rounds.

During peri rounds, a patient was called to OT and I entered organ as I dislike peri rounds. After the OT, all of us were just beyond tired and I went home for the day.

No doubt, it was my first “solo oncall”, it did not feel lonely at all as since there was an ongoing operation, physically, I felt comforted knowing that there were people nearby and felt more like a slumber party instead.

And the most important part… I survived it!

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The Theoretical Doctor @[email protected] · 2026-01-09 · 01:00 UTC

I SURVIVED My First Month Of Tagging As A Floating Medical Officer

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Thank God. Seriously.

I started my journey on the 21st of August 2025 and officially off-tag on the 14th of September 2025 after my last tagging oncall shift.

Technically, it was not a month but 3 weeks. Nevertheless, a very tiring 3 weeks with every other day oncalls and one sick leave in between.

The tagging oncalls were every other day (EOD), this meant an oncall shift followed by postcall and the following day is an office hour shift only to be followed by oncall again.

Overall, it was a mixture of fun and tiredness. My sleeping schedule was definitely off as I am usually disturbed in the middle of the night as the time I am usually able to sleep peacefully is during my postcall shifts.

Thankfully, I always had a senior with me to guide me. Thus, every referral I received, I would discuss on the management plan with them. It was mentally challenging as well as the learning curve is extremely steep for a junior medical officer such as myself.

Having completed my tagging period, I am still at lost in terms of management especially for extremely complicated cases. Thus, I find myself running to any of my seniors or the specialists.

Am I confident now though?

Not really. Less terrified and yes somewhat a tad bit confident than when I initially begun. However, just a tad.

The fear is still there as I just do not know what to expect on the types of referrals I will receive during my call.

Some things just don’t change. The fear that I felt during my House Officer days are still there and at times, I wish that I could just simply disappear run away from the issue but doing so, does not help.

Thus, the only solution for me is to dive head on into the issue and call for help whenever needed.

If any of you are experiencing this, just know that you are not alone and sometimes the feelings felt internally just can’t be expressed properly either via words or verbally.

If you are showing up everyday despite feeling this way, you are doing a good job. Take comfort in that as it is not an easy thing to just do. Sometimes, showing up daily in itself is a hard task.

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The Theoretical Doctor @[email protected] · 2026-01-07 · 01:00 UTC

My First Day As A Medical Officer In KKM

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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 @[email protected] · 2026-01-05 · 01:00 UTC

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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Inside the Red Head's Head @[email protected] · 2024-01-26 · 12:53 UTC

Bloganuary writing prompt Write about a few of your favorite family traditions. View all responses

Nope. I don’t think I want to.

Well… okay… I’ll give a couple of holiday season things that I know I’ve written about before, just for the spirit of the thing. I’m having a weird morning and I’m not in a sharing mood so I’ll stick to public-ish info, m’kay?

Both of these little traditions come from my beloved wife Jen’s family, long before I came into the picture. The first happens at midnight on New Year’s Eve. Just after the clock strikes 12:00am to start the new year, one of us opens up one of the doors to the house to let the old year out and someone else opens another door to let the new year in. Cool, huh? I like that one. It’s little and silly but it’s us.

The other tradition I’ll mention is the xmas eve party. When I first started dating Jen her family had an annual xmas eve party at her mother’s house. When we bought our house in 2010 the party moved from there to here. Everything was fine and on schedule until Covid messed it up. Once things calmed down we got sort of back on track. With the kids living in Vermont right now we moved it back to Jen’s mother’s. This year it also moved to the day after xmas due to some busy holiday schedules. It still happened though and it was just as fun as always.

There you have it. Two little family traditions that are not little at all. They are both wonderful. I write this all the time, but I am so grateful and happy that Jen and the kids and the extended family have welcomed me and allowed me to be one of them. It’s one of the things in life that makes me happier than I could ever describe.

https://robertjames1971.blog/2024/01/26/family-traditions/

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