It is too easy to feel like an insignificant minion – everyone calls you ‘eh’, ‘houseman’, ‘stethoscope’, ‘Volkman’s retractor’, ‘artery forceps’… Over time a houseman cannot help but feel depersonalised by the daily routines and processes that rob us of our identity and significance.
How did we get reduced to this state? After all, one too many medical students sprang from illustrious roots – top scorers in the national exams, national bowlers, marathon runners. Prolific teens who shook hands with the President at the age of 15, Physics Olympiad Winners, theatre understudies, cause activists. Progeny of a family that sprouted pioneers of various medical fields in the country.
Then we enter medical school – cue hoards of relatives and family friends taking pride in and sharing your limelight (“my mother’s neighbour’s nephew whom I used to play with when I was 3 years old”) – calling you pride of the nation, big bucks wager, smart ass, and the whole works.
After 5 years of labour, the elusive “Dr” prefix finally arrives in our dainty palms, accompanied by hearty handshakes from the Dean of Medicine, topped off with a dinner and dance celebrating your graduating batch in a posh hotel.
And that’s when everything falls apart.
Whoever thought that being a doctor was all about glam ( just like in ER, Grey’s Anatomy or God forbid, House MD), truly deserves to have an awakening smack on the head so hard and vault-shattering, a subdural haemorrhage may be precipitated. For I did not find it glamorous at all when one night, during my night call, a 90-year old delirious old lady, God bless her soul, spewed watery diarrhoea all over herself (could even see the remnants of bean spouts in her expelled matter) and my pants in the Emergency Department. I did not find it amusing when one night, I was setting an IV cannula on my patient, and when he said he felt a wave of fart coming, he really meant gas admixed with an estimated half litre of blood fresh from the rectum. I also found it quite solemn when one has to do CPR on a patient (aah, ain’t CPR cool when it’s confined to TV) who has blood literally spewing out of the abdomen where the fresh midline laparotomy scar was.
And on a daily basis, you tie all loose strings between the patient and defined endpoint – if the defined endpoint is surgery, then the loose ends to fix would be to refer Cardivascular Medicine for pre-operative assessment, fluid restrict the patient so his hyponatremia may resolve. Refer to MSW for financial issues. Occasionally you may even be tasked to find accommodation for a night or two for patients from overseas countries. The other occasion may require you to deliver your bosses’ items from Point A to Point B, say a surgical instrument, or a stack of case files.
Sometimes nurses may scream at you for not coming to attend to a patient who hasn’t peed for 4 hours, when you are in the midst of resuscitating a patient whose blood pressure was 60/38 (yes, mmHg). Sometimes nurses and relatives may call you for answers – answers for questions which you don’t even know, yet you are expected to deliver a satisfactory explanation. Sometimes you may be even tasked to apologise for mistakes you did not do.
And now you are tired, more tired than your body ever knew. You have blood on your Crocs, and a little bit of crusted vomit stain your scrub pants. It’s 3.10am and your phone never stopped ringing since 5pm, despite a dying battery. Answers, answers, answers. Action, action, action. You are thoroughly exhausted. 22 hours of non-stop work, and counting. Last meal was a hurried dinner at 5pm, thereafter intermittent Milo from the office vending machine. Parched throat from all the history taking, talking to relatives, giving orders to nurses, persuading radiologists to give you a scan, dry air of the night contributed by the merciless aircon, etc.
Does anybody ask you whether you have eaten?
Does anyone care if the scolding you got for not seeing an ARU patient because you were resuscitating another, was justified or otherwise?
Even if it was not justified, does said perpetrator apologise for actions?
Does anyone ask if you are tired, or need a break?
No. Because you are a doctor, and therefore you are Superman. So Superman, you can perform a toilet and suture even in your 37th hour of work without flinching.
Nobody calls me by name, il mio nome è nessuno…
Most deject, my spirits worn,
My hair unkempt, my shoes are torn.
The passers by, they all plague me,
For all I smell, is poo and pee.
In 36th the hour passed,
I worry how long I would last?
The faded blue of slavered gowns
Now cloudy grey with furrowed frowns.
How much aghast, my weary mind!
My closing eyes, so much unkind.
Oh how long before the exit rounds?
My feet, they throb; my heart, it pounds.
Yet, as if nature intended for me to be redirected, little things along the way delivered long thoughts in my mind. One day, a simple question of “你好吗” from a consultant drew a weary “such misery!” from myself. Yet his quip sent me thinking for days – he said “But why are you miserable? Medicine is good. Helping others is good.” Such nonchalant words, such spinal words. Said as if such thoughts were second nature to the speaker. I came to the realisation that I have been so blessed to be put in a position where I am able make a difference, to precipitate change, the ability to avert outcomes which may otherwise be disastrous.
Such dreary I deemed my work to be, that I almost forgot the joys of basking in the eventual return of my patients' health, the long handshakes, the appreciative hug from the 51-year old auntie with blonde hair who was admitted for gallstone pancreatitis.
Such insignificance I put to myself that I forgot had I not ordered the scans for that bleeding patient that night, nobody would have figured that his gastric ulcer exploded into bloodbags into the peritoneum, warranting an emergency operation to salvage his life. I also forgot that if there was no houseman to tie up all the loose ends together, there would be no sail, and without a sail, the ship would not steer. With no houseman to piece the little puzzles, there would not be any big picture – and you know how often they emphasise the importance of The Big Picture in medical school.
我还记得…
It was difficult to forget seeing a consultant in scrubs, after finishing his last op at 8pm, rushing 4 blocks down to the ward just to explain the nature of a procedure to the daughter of a patient who was due for an ERCP the following day. People don’t get paid extra when they make their way down very much post office hours to speak to families for 5 minutes. People don’t do it for a thank you, for an angpow, for a heartfelt appreciation banner in The Straits Times. People do it because it is the right thing to do, because it is a responsibility in one’s capacity as a professional.
Thus people like these remind us that we are, indeed, important, in our own ways, in our own niche. Yet that realisation of importance must always be entwined with the humility and the recognition that own is indeed blessed, for the ability to serve others is an indication of one’s own good fortune.
