Learning outcomes

4 weeks into the second semester of Year 4, I’m getting more sleep and study time than ever. I started the semester with two very chilled rotations, which gave me a lot of insight regarding what studying medicine and being a doctor really means, at least to me, and I’ve never been so sure about my choice of career.

Medicine is paradoxical, contradicting and altogether confusing. We are trained to analyse a person’s features, posture, behaviour, and be able to have several ideas, diagnosis and plans in mind within 5 minutes, basically giving someone a label after 5 minutes of shaking their hands and getting their names right. Also, we are taught again and again, to never judge too quickly, to always pry into their lives and stories, that anything and everything under the sun is possible. We are always drilled on the ‘classical presentations and features’, and yet, they always ask us ‘What else?’.

These few weeks have exposed me to a huge variety of people, and it made me love humanity, and made me realise how much one can develop themselves just by being around people.

For the past 3 weeks I was writing up on a psychiatric case, which gave me a huge opportunity to read up and understand what psychiatry really is, even before my psych rotation at the end of the year. People call them ‘crazy’. Yes, they are not normal. Yes, some of them have a tendency to become aggressive, and might impose harm on you if you’re within reach. Yes, they are humans too. They didn’t choose to be mentally ill, to be locked up in a guarded ward, and they certainly didn’t choose to receive those judging gazes just because their hair was messy or they talked funny.

I like how they treat psych like any other department here. Although there’s still a lot more that can be done, the awareness is far greater than what I’ve seen back home, where having a mental illness meant that you are too weak to cope with what everyone else goes through too, or that you’re attention-seeking or just plain crazy. Meanwhile, people spend hundreds and hours just to see a freaking gastroenterologist after 2 bouts of diarrhoea because ‘GP’s are useless’. Talk about crazy.

Psych isn’t meant to be shunt at that small isolated building behind a tertiary hospital. Psych should be IN the main building, with clinics as frequent as Rheumatology clinics. Psych should be on signboards, with it’s own hotline and emergency contact, because it is as serious as hypertension, and these people need as much help as the diabetics, if not more. Mental health deserves more attention and awareness than it has, because it is not that they don’t care about their own well-being. It’s because they don’t know, don’t realise, or have too little information on what to do and where to seek help.

Multiple times I’ve heard drug addicts and alcoholics being called ‘parasites’, and all kinds of nastier things. To be honest, I used to think that they didn’t deserve this amount of help and care, as compared to people with medical issues, because while some people get sick for no reason, they actually brought those diseases and psychiatric problems on themselves by drinking and taking drugs. Not until my previous registrar said something that changed my mindset. He told me that these people need whatever amount of help they can get, because they didn’t know better, they didn’t choose to be sick either, and they really are sick. I know that we tend to deem drug or alcohol induced problems, psychiatric or medical, as illegitimate, because they’re not ‘organic’ problems, and also using drugs is a crime in most places, making these people more criminals than patients.

My registrar made me realise that as a doctor, illegal or not, right or wrong, it’s not for ours to judge and act. As doctors, we treat. There’s no such thing as a legit sickness. If you can’t go to work, can’t eat or sleep or poop like you used to, if you have trouble feeling joy and pleasure in what used to make you happy, you’re sick. If they’re sick, we treat. They have the law and the society to punish and judge them, and our job is to make sure that at least someone is taking care of their health, both physically and mentally, because everyone deserves to be healthy.

People generally don’t become dependent on substances for no reason, that’s the benefit of doubt I’ve been practicing. It will be great if we could find out the reasons and fix them, but generally, behavioural problems are caused by trauma that have been going on for an extremely long time. Not everyone is as privileged as us, to have a mother who cares enough to whack that cigarette off our hands, or worry when we’re acting a little differently. Not everyone is fortunate enough to even grow up with shelter, food, and support. You have no idea the amount of trauma, harassment, loss and neglect a person had to go through to drive them into having a personality that people call ‘crazy’.

The past week in oncology made me feel all kinds of things. I’ve seen people who are so sick that eating half a teaspoon of baked beans was a struggle, people who are almost at the entrance of death and know it, people who were just told that they have an incurable disease and was thrown a million facts and information and asked to make choices they never thought they’d have to make, people who are told that their treatment have been working and that they’ll soon be cancer-free, people who have been cancer-free for awhile but paranoid of every tiny ache and glitch, people who had recently become cancer-free but are still haunted by the amount of pain and suffering they went through, people who see their loved ones becoming paler and more frail everyday, people who are so motivated that they know twice as much about cancer than I do…

I’ve gained a great amount of respect for oncologist and palliative care physicians and staff. I’ve seen kind people, but their kindness amazes me everyday. It’s definitely not easy, dealing with hundreds of patients with terminal illnesses, and family members who have different views and demands, but they’re always so keen to listen, to help, and even arrange even more help. I’ve been very happy with patient care here, but oncology is a whole new level.

And this is how I realised I can never be a surgeon lol.



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