I can still remember that red, rectangular, Hello Kitty-themed, toy chest mom and dad got me when I was young. I think it was suppose to be a toy first aid kit, with a pink stethoscope, a green scalpel, a pair of scissors and forceps, a roll of tape and it’s holder, a few empty ‘medicine bottles’ and two small round containers (for creams maybe? or specimens?). I cannot recall when I was given that chest, or when it disappeared together with the rest of my toy collections, but I remember playing with it, and acting like I was one of those medical officers working in the ambulance, rushing to places where medical attention was needed. I remember how I broke the scissors and had someone tie the fulcrum together so it could still move. I remember placing the stethoscope around my neck like how doctors do it in the hospitals.
Growing up with both my parents working in the healthcare system, I was exposed to medicine at a very young age. I’ve seen the very limited ‘pros’ medicine has to offer (job satisfaction, a cool title in front of your name, having people assume that you’re really smart and capable), and the long list of ‘cons’ (short holidays, long erratic hours, waking up at 3am to answer a call and rushing to the hospital within 5 minutes of the call, scratching your head all day all night, solving a thousand problems everyday with none of it being really yours…). Despite all these, in 2014, I chose to enter med school.
And then in 2016, I chose to continue my degree in the university that has one of the highest failure rates among those that were on the list. A school that needs its students to be functioning at intern-level before they even graduate.
I started my clinical years with a breast-endocrine surgical rotation, and the first two weeks were chaotic. I was somehow expected to know how surgeons work, to be able to scrub in and assist in surgeries, to suture mastectomy wounds, and also have an idea on all kinds of neo-adjuvant/surgical/adjuvant therapy for cancers, or how they know if lymph nodes are involved, and what structures to look out for when they’re removing a thyroid gland. Just when I was getting the hand of it, I was rotated to an upper gastrointestinal surgical team. And suddenly, things became snappier, people were more inpatient, and patients were a lot more sicker.
General surgery made me understand why people (physicians and interns) roll their eyes when they say ‘surgeons’, though I admire them for the passion they have in surgery, being able to perform lap-chole and Sentinel node biopsies >10 times a week. It taught me how to present a case in 30 seconds. And now I know the significance of ‘how’s your bowels/urination’ or ‘are you passing any wind at all’ or ‘hows your appetite’ when we take histories. I now understand why ‘past surgical history’ is important, and also the power of compression stockings and Clexane. I also found out that anesthetists are actually quite cool and they don’t just sit there all day playing with their phones, and that you can actually get a sore arm for 2 days after doing bag-and-mask for half an hour just because the patient has a loose tooth and they don’t want to knock it off during intubation (maybe that’s why the doc was so keen to let me do it without prior training).
After those 9 long weeks, I realised that I will probably never become a surgeon.
I think I have learnt more about medicine in the past 4 weeks than those 2.5 years I spent back home. From learning how to place multiple problems together and weighing risks and benefits to finally being able to (vaguely) interpret test results and scans and relate them to clinical findings. From being able to differentiate different uses of antiplatelets vs anticoagulants to understanding ‘it’s not fluid restriction, it’s salt’ in oedematous patients. From differentiating different kinds of dementia to finally seeing some sense in neuroanatomy.
My dad always tells me that ‘medicine is an art’, and I sort of see where he’s coming from now. Fluid/salt titration, fluid challenges, to thrombolise or not, empirical or broad-spectrum, warfarin or NOAC’s… These are all things with no hard and fast rule to follow, and you just have to… learn…, preferably without killing anybody or causing any morbidity.
I am amazed with how much we have all changed. I used to dread going for classes in pre-clinical, and clinical skills session were just daunting, but we’ve now become these group of nerds who envy people in other hospitals for have one tute more than we do, and be super braggy when we have a consultant or tutor who’s a damn good teacher. We talk about cases (without revealing names… ahem… confidentiality) as if they were as interesting as ‘so-and-so is seeing who’, and acting like I’ve seen Zac Efron when it’s just a patient with subcutaneous emphysema.
Despite all the note-writing and lungs-drawing during ward rounds, and all the mini mental state examinations I do on a daily basis, I am the most productive I’ve been for a very very long while.