Elective Extravaganza: Internal and ED in Malaysia

Here is a little something different for Elective Extravaganza: what happens when you realise you chose the “wrong” thing for your elective? Aziza Aini (a fellow blogger, click on over) is a third year medical student in Malaysia who, during her second year, did an elective in Internal Medicine. Although she enjoyed it, she realised that she much preferred Emergency Medicine. So she innovatively did both.

Aziza’s story is also interesting because she attends a twinning program – essentially, her first two years of medical school is at one institution, and the last years are completed at a different institution. They do an elective in second year to assist with clinical skills development. I enjoyed her views because they remind me of the experiences our second years have when they get their first introduction to clinical medicine – the things they notice, and the things that make an impact on them. It is part of the reason I will always value introducing a student to hospital as early as possible.

Now, I’ll leave Aziza to tell her story:

elective second yr malaysia

Nervously enough, I took a few steps into the secondary triage room with a medical assistant. From there, I entered the waiting area for those who had been sent to the blue zone. I had to pretend like I belonged there or they would know that I didn’t.

I walked on to the green zone and that was when that suffocating urine stench burned my nostrils. I took a few deep breaths and soon became acclimated to the smell. Then I greeted a medical assistant.

“Boleh saya buat ECG untuk patient ni?”

[“Can I perform an ECG for this patient?”]

She stopped and looked at me, “Tahun berapa?” [Which year (are you in)?]

“Second year.”

“Okey. Buatlah.” [Okay, do it then.]

That was the second time I sneaked into the emergency department (ED), this time without my friends who were assigned there.

Aziza on the left. Image provided.
Aziza on the left. Image provided.

I chose Internal Medicine for my elective and spent my mornings in the ward, clerking patients and doing physical examinations. After lunch, I’d usually go home. I love Emergency Medicine but decided to be posted to the Internal Medicine department because of the myriad cases they have there. During my last week of posting I went to the emergency department just to have a feel of it. I might have been in trouble if they found out that I wasn’t supposed to be there – can’t really say since I didn’t get caught.

I loved my experience that day at the ED and so, every single day of my last week I would “hang out” there after lunch. Most cases at the ED were chest pains and MVAs. Because I was just a second year medical student, I couldn’t do much. My job scope was limited to taking vitals, doing ECGs and giving supervised injections.

On one of the days, an old lady was rushed to the yellow zone. She was conscious but was breathing heavily. She looked scared and nervous as the medical assistants and trainee nurses swarmed around her. One was finding a vein on the back of her hand, another placed a probe on her fingertip to get her vitals while others observed. The doctor was on his way. And I stood there quietly, at the cranial end of the bed being a passive onlooker. I looked at her as she turned towards me. I noticed her thin hair, her dry lips with angular stomatitis at the corners and her sad eyes. I gulped nervously and smiled. They poked and prodded her wrinkled hand and left it bruised. They couldn’t find a vein and when they did, it collapsed just as fast. Each time they poked, she’d clench her teeth quietly and turn the other way. I held her hand and softly told her that she’d be okay. I thought she needed to hear that. She looked at me and had a surprised look on her face. But I also sensed a little bit of relief in that look. I smiled again.

Soon a MVA came in. The patient had a long cut on her head but it wasn’t deep. The doctor assessed her, ordered a few tests and left the medical assistants to do the Toilet & Suturing. I was there observing the medical assistant suture her scalp. The area was locally anaesthetised and she confirmed that it was numbed. But she was shaking and he kept telling her to be still. Perhaps the thought that someone’s actually sewing her head was disturbing for her. He signaled me to get to her side and talk to her. I shook my head. What am I supposed to say?

I went anyway. I remembered a scene from ER where Carol would calm a patient. My first few sentences were from that drama. (Yeap, I watch ER over and over again, for motivation.) But then I got the hang of it and started talking with her comfortably. She got distracted, the medical assistant finished his job and everyone was happy.

In my university, communication skills are strongly emphasised. But, unlike medical facts, skills are not something you can teach someone. It comes with observations, practice and mistakes. And as I just mentioned above, watching ER helped me tremendously as they actually show me things from both perspectives; the doctors’ and the patients’. I would say I learnt about understanding patients’ expectations, common mistakes done by medical students or young doctors, how to deal with difficult patients and most importantly, how to talk with patients – all from ER. So now, don’t tell me watching TV is a waste of time *smiles*.

Each person in the ED is as important as everyone else and I liked that. I really love the strong team work atmosphere there. I would definitely want to work in such a place. Of course, there are some grumpy, holier-than-thou kind of doctors who would shout at nurses, medicals assistants and even their own colleagues. I understand that it is the emergency department and that you need to be on your feet at all times and no mistakes can be tolerated but I still can’t see how shouting changes anything.

There were a lot more things that happened and are still fresh in my mind now. My posting was an amazing three weeks and I can’t wait for my clinical phase now.

To those who are about to be placed at hospitals for their elective posting soon, choose wisely. It’s okay to choose the wrong department (we all get confused sometimes), so long as you have the guts to make a plan and make it work. It just takes a little courage to do what you love.


  1. peace says:

    I just got back from Malaysia and I know this is not related: But why is this resturant “secret recipe” so popular and everywhere?

    Good luck in your study and thank you for the post.

    1. I don’t know, maybe Aziza will be able to answer you 🙂
      I myself have never been to Malaysia, but I hope to go there one day soon.

    2. Haha. Can’t really answer either. I love cakes and Secret Recipe is one of the cake shops that serves really good cakes with an affordable price. The cafe is quite classy too, at least the outlets I’ve been to are. 🙂

  2. harveylisam says:

    I love the emergency department, too. It really suits my lack of attention span, haha. Glad Aziza was able to sneak in there for a bit during her elective!

    1. Hah! I have a love-hate relationship with the ED. Some days I love it, some days I want to run as far away from it as possible.

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