How did I eventually off-tag?

A tragic and triumphant tale about a first poster in surgery who tagged for 53 days during housemanship. How, and why did this happen?

This question pains me a little bit, but I think running away from it any longer will cause unnecessary scarring, so let me just tell you. I suppose by this point, I feel I no longer need to explain what housemanship/ tagging is, but if you don’t know, please refer to my earlier posts or videos.

To "tag" means to learn what needs to be done to work in the department. To "off tag" means that you now know what to do, and how to handle what you don’t know how to do. This period shouldn’t last more than 14 days, but mine lasted a whopping 53. Why?

In every department of housemanship, there is one medical officer in charge of the well-being of all the house officers, and one specialist. It’s the medical officer that decides whether or not you off-tag, based on whether or not you’ve completed the few criteria as stated in your logbook. In surgery, we are supposed to do three things;

  1. Enter the operation theaters six times to collect an array of experiences i.e. 2x major, 2x minor, 2x open appendicectomy.
  2. Pass an off-tag assessment with a 2nd or 3rd call medical officer.
  3. Complete our logbook (where we log the procedures we observed/ assisted/ performed, cases clerked, operations participated in, different working zones oriented to etc.)

By day 20, I had done everything I needed to off-tag, but it seemed that luck was not on my side. Every time the medical officer who had the off-tag trident was around, I found new ways to mess up. Maybe it was nerves, maybe it was the unintentional sabotage by my seniors, or other medical officers combined with my own naivete cum incompetence, maybe it was fate playing with me… But on one fine morning, they entered the cube I was assigned to, and started rounds with the last patient I had left to review. “You haven’t even finished reviewing your patients by 8am?”, they asked.

Talk about bad timing...

My excuses, valid as they were (really), fell to deaf ears. About a half hour later, they broadcasted to the WhatsApp group they're in with all the house officers that a fellow colleague of mine was allowed to off-tag. It was with this particular colleague that I was working closely with to off-tag together. They wrote, “The rest of you can continue tagging until you have a sense of how to work.”

Sure, I felt dejected, but not quite defeated. There was nothing to be done except to work harder, and not take what they said personally, because I did have a sense of how to work. I made many mistakes, but took responsibility for them, and learned something new about how to function every single day. I wasn’t about to quit just because this “mentor” only knew how to teach by berating us, and rubbing our failures in our faces (and everyone else's) on a daily basis.

This went on for a few more weeks. I approached some seniors for advice, and their response was a bizarre concoction of consolation and gaslighting, and ultimately that I should just keep texting Lord of the Off-tag. With the desperation of a drunken ex, I sent text messages every other day, and greeted them whenever I saw them. Nine times out of ten I was blatantly ignored, and as I approached the two month mark, I just gave up.

So what if I was tagging for the entire length of the department? So what if I worked 40 hours more than everyone else every single week, but still got paid the same miserable salary? So what if I never got to experience a single night shift?

With the weight I lost, and my raccoon eyes, I tried not to burst into tears every time a medical officer or senior asked me the dreaded question, “Why haven’t you off-tagged?”, because no matter how hard I tried, I didn’t know the magical answer that would make it happen.

Because I’m not good enough/ trying hard enough/ enough

These were the answers that I started to believe to be true, but I always ended up shrugging my shoulders, or changing the subject altogether. I went into a kind of survival mode really, and tried to take every day as it came. Internally, I chanted the advice from Randy Pausch (the guy who got on Oprah for his book/ tenure talk, The Last Lecture after being diagnosed with terminal cancer) like an ancient mantra that would keep the body going where the spirit had ceased to exist: “Don’t complain, just work harder.”

So I did. I just worked to the best of my abilities every single day, and fought every suicidal thought that came my way, because this was my bed. I chose this life, I am committed to finishing what I started, and I know that I am working towards something more meaningful that I can properly comprehend at this moment. But that still begs the question, how did I eventually off-tag?

With our fourth-poster seniors who ran the show leaving the department, new ones came to replace them. Some of them, though their first impression with me was abysmal, were people I found myself able to talk to, and here’s the thing: They listened, offered me feedback, encouragement, and better-than-fortune-cookie advice. They told me I was too proud, and it was my ego that was prolonging my suffering, not my perceived inability to cannulate veins. Even though I ended up doing the same thing their predecessors had asked me to (harass the mentor until they yielded), the fervor behind it was different.

This wasn’t about me asking for permission to be allowed to off-tag, despite the pathetic text messages sounding exactly like that. This was about demanding respect against their harrowing attempts to demolish my self-worth, and insist that I be treated fairly.

The pinnacle of maximum functionality in any department in housemanship is when you yourself can offer advice to new taggers on how to off-tag. After many more shameless texts, they finally replied with a resounding, “Ok offtag”, and just like that, I was freed from the shackles of sixteen hour shifts, six days a week.

And they lived happily ever after... Not.

Though this post was meant to be a triumphant tale of good prevailing over evil (or as we say in our business: malignant), I am deeply saddened by the way in which we have to learn how to practice medicine in Malaysia. I wonder if other countries experience this too. Mind games, internal politics, and endless drama… Are these really the bedrock of a budding doctor? It’s exhausting to constantly be reprimanded on the grounds that that was how things were done when you were in housemanship wherever, and however many eons ago that was.

Trying to learn in an environment that normalizes acceptable forms of bullying and verbal abuse is just as big a paradox as trying to find a life partner if you happen to have grown up in a household where physical beatings and passive aggression are commonplace.

I can never understand the logic behind upholding traditions that ultimately traumatize. "My parents were beaten, and therefore so was I," is a justification I've heard from friends all too often growing up in Malaysia, and now a similar thought process fuels the horror stories we hear during housemanship. It’s 2022, and I feel like bringing up constructive communication in my workplace will get me crucified. Just because your parents or mentors abused the living light out of you then, doesn’t mean we need to inherit those practices now.

Don’t feel bad for me, okay?

Whenever I see my mentor now, I feel for them, because even though the way they went about mentoring me is far from a model teaching approach, I have emerged stronger as a result of it. Yet I wonder if one day my resilience will return the favor to young house officers with equal agony, or if I will break the chain, and find gentler ways to teach them the art of practicing medicine. Whoever thinks being a good doctor is all about patient interaction is wrong. It should be just as much about everyone else you practice medicine with.

If you want to read my musings more frequently

I am counting down to the end of surgery with workplace selfies @sthgvndrj

If you want to put a face (and voice) to my stories

My most recent upload recounts five teachings after three months in surgery.

P.S. Happy New Year, Happy Thaipusam, and Happy Chinese New Year too.

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