The Illusion of Assessment

I thought I'd be productive with my time tonight and put aside the bullshit I've been feeling. How much have I retained in the last three years? Could it be that I am actually good at medicine without having to study that much? Have a retained the information I've been barraged with by every lecturer who thinks that we only need to know what they have specialised in?

The short answer is no.

Productivity is a constant reminder to me. A reminder that states bluntly that I am so far behind regardless of how much I progress. It seems that the road's end is no where to be seen and that's just how it will remain for the rest of my life as a practising clinician regardless of how much I decide to study.

Thinking about the mathematics of exponential growth, I remind myself that if, theoretically, I stopped all my clinical practice as a student, knuckled down for a year to catch up with the current literature, practices and management protocols, I would easily be behind by several years of research. Several years because the research of the current year had been instilled for the following years and prospective studies and their analysis would take more than a year before it modifies clinical practice.

Dissecting the concept of being behind by that much really didn't help. One of the things I was supposed to complete before I started the surgical rotation was an online assessment, which we call 'required formative'. This means that it is a required assessment, however the results would not be recorded on the system.

So I sat down at my computer and decided to do the 75 question assessment: 70 SBA-MCQs and 5 EMQs on various types of medicine: Cardiology, Respiratory, Rheumatology, Haematology and Laboratory studies. The joy was that I haven't done any of those in the past 10 weeks. My first four weeks were in Geriatrics and the final four in Gastroenterology; neither disciplines were examined and the fact that I'm on the Upper Gastrointestinal Surgery team didn't help either. I remember that some of my friends had their Cardiology, Nephrology, Infectious Disease, Respiratory and Haematology rotations already. They would be so many steps ahead of me already.

It really does drive me absolutely ballistic. I have been examined in the fields that I have not practiced in and the Faculty's response to that would be: "Well you've done in your first two years in lectures. That would have been more than adequate."


So I sat the test and some of the answers were obvious to me and others obviously required so much more knowledge on specific specialties than I would have dreamed to be exposed to in Geriatrics or in Gastroenterology.

At the end of it, I got my result of 53% and wondered, how much more would I have had to study before I even got close to 80%? Then I laughed, remembering that no matter how much I would have studied, it would not have helped anyway since I would have studied Geriatrics or Gastroenterology, rather than any of the specialties they wanted me to study.

No matter how hard I study, no matter how much I bend my back - even if it does mean I snap it - I will never be ahead of it. I will never know enough to help absolutely everyone.

I can never know enough medicine, never enough surgery. There's no such thing as studying enough, no such exam that could objectively test every medical principle.

Tomorrow we start at 0630 and the only thing I can think of is a saying in a movie:

"Just take comfort in knowing you never had a choice."

Somehow we always thought the road would always end since it does spatially

in our vision. But the truth is, parallel lines only ever meet at infinity... somewhere

we, as human beings, can never travel. Just take the road less traveled by, and

hope your decision was worth it. There's no turning back. 

Internal Milieu

I decided to buy a digital recorder today despite the fact that money is not abundant at the moment. Speaking to a few people, I realise that ideas come and go all the time and due to my terrible short term memory, I really do feel the need to record some of the things I'm thinking about. 

This morning, I couldn't wake up on time. My biology intermittently reminds me that all tasks come at a cost and any sleep deprivation I subject myself to must eventually be paid back one way or another. I slept at 2130 last night and felt that I would have enough sleep to wake up for surgical rounds at 0700. That idea went out the window when I finally was able to wake up at 1030, realising that I was very late for absolutely everything. However, I was sure that there was a surgical tutorial at 1100 and I rushed through my morning routine and power walked down to the academic unit only to find out that it started at 1000. It felt like I was still sleeping and I was wondering what I looked like on the outside.

So the only choice I had was to either join the surgical team, which I didn't want to do; or to go home and study. Being at home during the day felt very unusual - I was very picky about where things were and the fact that I had nothing in my fridge except pasta sauce, white bread and some eggs. I knew I really needed to go shopping to get some nutritious food, but then I realised, once again, that money was not abundant.

Studying surgical infections was interesting, but really was just putting a prestige element into common sense. A couple of hours later, the stomach started complaining and I felt like some Subway. There was one down by the train station not too far from where I lived and I headed down for some food. It was so beautiful, hearing absolutely nothing and walking by myself. The occasional bird chirping and car driving past, it felt comfortable not to be constantly interacting (actively at least) with the environment.

I had an appointment at 1530 with the Professor of Surgical Epidemiology regarding some research we plan on doing. After that, I had an appointment with Dr. ML, one of my role models and mentors in medicine. He was my tutor last year in the patient-doctor tutorials, but now he helps me here and there with things I ask. The afternoon certainly looked interesting.

Something else that's interesting is how one's internal milieu can be demonstrated so frankly in their facial expression, posture and gait. I was unaware of what I looked like to the by-passer, however I certainly knew my internal milieu, as one does. That's what we call consciousness.

I realised soon after I arrived at the academic unit that my colleagues were finishing up their tutorial; the one that I didn't attend because I didn't think I'd learn anything. When they saw me, they had a high degree of concern.

"Are you alright?" 
"What happened?"
"Why didn't you show up?"
"Is everything alright?"

They felt like rhetorical questions, like the ones people answer with automatic responses:

"How are you?"
"Good thanks"

It's interesting to see how little people care. My colleagues are only a few years away from being practicing clinicians and they have clinical evidence right in front of them that somebody may be really unwell. I'm not saying that I am unwell, but indeed if I was, they chose to ignore it.

My answer to their questions was universal, as it usually is: "Yes, yes I'm fine. Just tired."

The way I see it is they took a partial history, conducted a very brief physical examination in terms of assessing my appearance and come to the conclusion that something (non-specifically) was wrong. So their investigations and management were merged with the questions they asked above.

When I consistently misinformed them, they had clear evidence of conflicting information - my body language was telling them that I was unwell, and my words were telling them the opposite. So instead of caring enough to pursue what's going on, they walked away.

All those interactions that took place told me one thing: don't go to these people as a patient. They clearly hesitated to extend their hand to a friend or a colleague, let alone a patient. Now let's give them a fair chance: they could've not asked me anything right?

My response to that is this: If the question didn't change the outcome, what difference does it make if you ask it?

"How are you doing?"
"Actually, I'm not doing too well."
"Oh okay. That's not good."


You're damn right it's not good. That simply tells me that one is uncomfortable with responses other than the ones that are automatic. Then the ones that care are disappointed when you give them a programmed response. It's all sarcastic. Social interaction is sarcastic, superficial bullshit.

Yes, I have a lot of things on my mind but the only thing wrong with my today that was different to any other day was my ability to keep it suppressed. I'm sure those of us that care enough to notice the subtle hints (not that they are that subtle) that something is wrong, will pursue it; and when they don't, my heart is broken.

So, why did I buy that digital recorder? Because at least if I listen to my own problems later down the tract when I'm not expressing the same emotional instability as I was when I was dictating it, maybe then I'll come up with a solution to my own problems. Perhaps people may not accuse me of not looking after myself. Of course it's too much to ask friends for some attention, of course it's wrong to expect that people would be there for you when you both know that you're expressing yourself in a way that suggests problems, despite not wanting to express it at all.

If only we cared enough to think.

                 If only we cared enough to listen.

                                  If only we cared enough to act. 

                                                   If only we cared enough to care. 

                                                                    If only... 

Out of my Control

We started Geriatrics in the second week of January. Now I look back at the time I have had in the Hospital, the Geriatric teams had the greatest number of patients and I never heard them complain. The Gastroenterology team had an average of five to ten patients per day and that for them was difficult enough to manage. The Geriatrics team I was assigned had an average of thirty a day and not once did they concern themselves with intensity. It was in this term that I met Irene.

She had been admitted with a urinary tract infection on a background of leukaemia as well as multiple other problems and this was quite a typical story for the patients in Geriatrics. My colleague and I developed quite a meaningful relationship with Irene and aside from visiting her usually with the team in the mornings, we did go out of our way to see her and make sure she was doing alright. After having some surgery for her urological problems, she was doing quite alright and eventually was discharged from the hospital. I didn't get a chance to say goodbye because I had already moved off into Gastroenterology.

Then one day in Gastroenterology, I saw her being wheeled down the corridor in another ward and we recognised each other. We spoke very briefly and I promised I would see her again at the end of the day. After a daunting day in Gastroenterology, I decided to visit her. She was in her own room trying to cut through some apricots in custard because they were cut in halves when I walked in. I helped cut her apricots and she was so very happy about that. We spoke briefly and she told me that she was admitted this time for shortness of breath and chest pain, which was explained by a pulmonary embolism.

I gave her my word that I would visit her regularly. Again, she was discharged before I could say goodbye.

Last week I started my Upper Gastrointestinal Surgery rotation and surgery in its own right is demanding. The registrars, residents and interns were all rushing around making sure things were done and there were so many standards to meet. Luckily, the Department of Surgery thought it might be a good idea to conduct some formal teaching for us medical students. I was on my way to a tutorial and I ran into my colleague, who is on a different surgical team - the colleague that I was paired with in Geriatrics who knew Irene more so than I.

"I thought you should know... Irene's in the resuscitation bay."


Oh no.. What brings her back this time?


"I think the provisional diagnosis is sepsis. Go and check her out soon."


At that point, I must've realised what he was getting at. Alright, I'm heading down now. 


Just then, the surgeon showed up to deliver our tutorial and I had not a chance to leave. We discussed surgery to the thyroid gland and formal dissection of the neck, which in its own right is incredibly complicated. I promised myself that I would go and see her as soon as we were done in the tutorial.

Finally the surgeon said he was finished and my friend wanted my help to find a book in the library. I sorted that out with him and headed straight to Emergency. My colleague was already there with a blank look on his face.

Hey man, which bed number is she in?


Silence. "She's moved on."


It didn't hit me. What? Where? Which ward? - He kept looking at me until it clicked. I realised what he meant - she died. I walked over to her bed and saw the curtains drawn with her family weeping. I saw the distress on her husband's face, who was admitted not more than a few hours before she left us for funny turns at home.

I couldn't believe it. I promised this lady that I would see her again and that I would do the best I can to help her. I found out that she was in hospital and I promised I would make time after the surgical tutorial. Then I failed forever. I could not take back what happened.

So there was a chance, if I skipped the tutorial, that I would have seen her one last time. I could've said goodbye. There could have been closure with the family from my part.

I came back an hour later and asked if I could go in and see her one more time; there she was. Frozen and lifeless with her jaw open. The shell of the spirit still remained behind, reminding us of the person that once was. I expressed my condolences to everyone in the room but I was so afraid to say anything because moments like that, if ruined, would never be forgotten.

Composing myself meant hiding in the dirty utility until the breathing exercises held the tears back. I was in the surgical team - shedding tears during this rotation would be suicide in my eyes. I decided to leave the hospital. After sorting out a few quarrels with the registrar, I left.

I got home and listened to the song I've listened to every day of my life for three years. I had to cry and I did, listening to the song that filled me with guilt, hopelessness and regret. I could've been there one more time.

I'm so sorry. 

24.

How do we become truly selfless?

I think about what commitments we have to people and the exploitations that happen almost everyday. People make decisions on misinformation, disinformation; pretty much anything further from the truth. Doctors are people in society that are respected at a level that is unique. There is no scale I can put it on. I just know there are forces that allow its magnitude. This occurred to me during Geriatrics.

One of the most common problems Geriatricians deal with is Delirium. This is a loss of orientation and attention, commonly occurs in the elderly suggesting an underlying disease. It could be anything from a simple urinary tract infection to a stroke. It is very difficult to explore as patients are confused, have no idea where they are and are at times concerned for their own safety. I wouldn't say I couldn't justify that.

Being part of the Geriatrics team meant plenty of emergency consults, which is not specific to that particular team, but none the less is a significant part of the workload for the senior registrars. A patient had been admitted for delirium and it was up to the Geriatrics team to assess his state and decide whether he required hospital admission. This is a significant decision as it often dictates whether the patient can go home again. It would be so sad having not the slightest idea that you're sick and it may just be the last time you're seeing the front door of your house as the ambulance takes you away.

The registrar introduced himself and asked the patient questions, to which the answers were incoherent, disorganised and nonsensical. The patient obviously was confused and had no idea where he was. His wife and son were there, but he couldn't recognise them in his state. He looked like he was insecure. Not sure whether we were there to hurt him or to help him; so he kept speaking about things that probably made sense to him (so to speak), but meant nothing to us.

The moment of clarity was at the point where the registrar looked at the patient and said "Okay. Stop talking now. I'm going to examine you." The patient just stopped what he was doing and his facial expression changed from confused to collected in a split second. He understood what was happening - Physical examination.

So I ponder the psyche and ask whether there is actually a state of delirium at all... this patient, who was so disoriented in time and location, all of a sudden stopped concerning himself with his value system and completely stuck his neck out (metaphorically speaking) and allowed the registrar to examine his hands, pulse, head, neck, chest and abdomen. How could this be? How did he stop?

Perhaps this was a one-off, I thought... but I was mistaken.

The next day we met a gentlemen in the emergency department brought in from a nursing home who was suddenly aggressive to staff and other tenants. So the provisional diagnosis of delirium was bestowed upon him. He was MRSA positive and so we had to gown up to speak to him. When I arrived, the junior registrar was already in there with the other medical student and were speaking to him. When I finally had my gown and gloves on, the registrar asked me to take a brief history.

Hi sir. My name is ******** and I'm a 3rd year medical student here. How are you?


Go fuck yourself! Is the response I received and I wasn't expecting it because I didn't know his presentation history beforehand. So the others had a good laugh at my reaction, but this patient was clearly aggressive and I soon found out from the registrar that he tried to punch him a few times across the jaw. Luckily my reflexes were faster he said.

What we really needed to do at that point was to give him some sedatives to calm him down. This decision had to be considered very carefully because we must weigh up the use of actually sedating him with the significant effects of sedative medication on a patient we know nothing about. The odds were not in our favour.

But before we could sedate him, someone had to cannulate him.

This man, so aggressive and confonting, saw the needle coming and stopped swearing. We didn't have to hold him down. He complained of pain, but he realised what we were trying to do. Despite his state of aggressiveness and disorientation, he understood the consequences of why we were accessing his veins with a needle.

Perhaps people will respond to me by saying that he didn't know what we were doing. My response would be with a rhetorical question: Why did he change his behaviour just when we were accessing his veins?

The same question holds true for the previous chap.

This number, twenty four, didn't mean much to me before tonight. However, after watching a particular movie, it meant so much to me. It's not my favourite number; it just holds significance to me.

Interestingly, when I was looking for symbolism of the number, I came across many images and pictures, drawings that explained other people's interpretation of it and the value assigned to it.

The variation is very interesting and limitless.

Maybe at some point in your life, you will watch the movie I did, feel the same as I did and wonder God, is that what he was thinking about?


It's unlikely... but as my parents always say:

What if?

Night Shift

It's 2150hrs and I'm looking for parking. In the distance, I see the resident walking towards the entrance. I'm already late. He sees me and realises it's me after working out that I shaved my head. There's a secret room where we have medical handover. Page me and I'll meet you somewhere familiar.

The common room looks abandoned and the couches are cold, proof that nobody has been staying overtime. I put the food in my locker and head back toward a phone. Dr. HC, I'm ready to start...

Good. Meet me outside the intensive care unit. 


The elevators take too long, even at night and the fire-stairs is the path that takes me behind the emergency department. The eerie corridors stubbornly kept illuminated by fluorescent lights freak me out as I hear the echoes of my footsteps; something normally very rare during daylight hours. But night shift is different - we maintain patient's vital signs until the teams arrive in the morning. In other words, we are just mobile labour eliciting a degree of critical judgement to a patient's deteriorating state. We only see people that are acutely unwell on the wards and the emergency department deals with the community's acute care.

-------------------------------------------------------------------------------------------Fast Forward-------------------

It's now 0300hrs and I've had my first break for food. The pager goes off again at 0307 and I'm asked to put a few intravenous cannulas into patients. I head down to the ward and after practicing with needles for about 5 hours, I get the each of them in on the first attempt. Quite the confidence booster.

I'm about to head back to the common room to continue my food break and the nurse stops me. Can you put in another cannula? It's pre-operative. I agree and turn back.

Karen is her name and her veins are absolutely horrid. There is no chance at all I'm going to get this. To an extent, I don't want to ruin my untarnished successes with cannulas. The intern was concerned about this lady's veins and really, I wasn't in any position to start poking until she screamed.

She was uncomfortable, but not because I was looking at her from the end of her bed, holding a kidney dish full of needles for her... she was concerned about death. Something we often forget about in hospital, even as medical professionals.

I've got a problem with my heart and my cardiologist told me I should not have anaesthetic unless I really need it.


She looked upset, stressed and anxious. Not the right mindset in the early hours of the morning before her laparoscopic cholecystectomy. So I decided to sit down and explain the importance of her procedure, the role of the anaesthetic doctors and nursing staff. Ten minutes later she felt better and the physical manifestations of her anxiety had waned. It was very interesting to watch somebody's physiology change after hearing and interpreting a few words; more of comfort than information. I promise I'll visit you tomorrow morning and the first thing I'll say is: "You're still here." We exchanged smiles and I left to go back to the common room.

-----------------------Fast Forward---------------------------------------------------------------------------------------

It's 1900hrs the next day and I'm ready to leave. I've been awake for 36 hours and the break I had was to partially eat some food at 0300. At this point, most of what people are telling me aren't making sense and I'm on autopilot; responding spontaneously but definitely not concerning myself with the consequences of my words to people, especially doctors.

I'm about to leave and so I decide to see Karen. She looks tired from the door and I sneak in until the IV machine starts screaming about an occlusion somewhere in the line. It startles the lights out of Karen and she's awake now. She laughs when she sees me and then squints in pain. You're still here, Karen.


She smiles back and now we're both relieved, despite the pain she's in. I tell her that she's allowed to ask for pain killers. I asked for pain killers at 2pm and I haven't received anything. I remind myself that it's now 1915hrs and this poor lady has been in pain for 5 hours. That's bordering on ridiculousness in my books. When I bring it her nurse's attention, I get told: I'm busy. I promise Karen to annoy the nurse a little more before I leave the ward.

Just when I was heading over the nurse's station, one of the other patients sees me. Doctor, please can you help me? I correct her: Medical student madam. What can I do for you?

Well, I haven't eaten in three days... and they just placed some jelly and custard on my table here and I can't open the lids. 

I almost cried. This poor lady has been without food for three whole days and the person delivering her 'meal' does not recognise that she is incapable of accessing the food. So there it's been several moments, which would feel like a lifetime for a starving person, with the food sitting there on her table. Without exaggeration, it takes me ten minutes to open the bloody lids because they are that difficult! I couldn't blame her for having trouble opening them! She thanks me with a smile and launches into her jelly like she hadn't eaten in months.

I promised I would leave after this last patient I wanted to see. She was under our care during my Geriatrics rotation and I saw her the day before in another ward. Obviously she had been re-admitted for another problem and I promised to visit her later. I went over and she was also eating her dinner.

I sat down and realised that she too was struggling with her food. I really want some fruit and the only fruit they give are these peach slices smothered in custard. But I can't eat them because they're too big to chew and too hard to swallow. So I've just been eating the custard. 


Not sure what anybody else would do, but my first reaction was what I followed. I took her eating utensils and cut the peaches into tiny little pieces that she could swallow and she was so happy she was able to taste fruit again after days in hospital.

People ask me why I stay back. People ask me why I feel the need to stay back. I don't know what they expect the answer to be. Because my question is why are they asking me that question? 


All these patients in the hospital that may be incapable of doing the simplest of things, such as eating, drinking or walking to the bathroom. And I notice a few people that could not access their food, so I help them with it as any person should.

What keeps me awake and concerned is that there is an entire hospital filled with patients who may be being denied the basics of living. Putting a plate of food in front of someone doesn't actually mean they can eat.

Finally I cried at home with my girlfriend when she asked what has been bothering me.

People don't get sick during business hours. People always get sick. And if people are more concerned about their leisure activities, their hobbies and their rest and recreation, who the fuck is going to look after those who are in need outside business hours?

"I want a good lifestyle," is what I keep hearing. I don't know what that means and I don't understand how people are able to live with that; knowing well that there are people at their fingertips waiting for help at arbitrary times of the day and all they can do is brainstorm a good perception of lifestyle.

I don't want a lifestyle. I want to be there for patients when the rest of my colleagues are thinking about their dinner, their television shows and exercise. I always want to be there.

Always.

A Note to a Friend

Some people really change over time and this has been something that has affected me for almost 10 years. It's funny how change can be so scary but the thrill of the risk can make us see past the hesitation and fear. One of my friends and I were very close, to the point where we saw each other every day. The bottom line is that she found herself a boyfriend after breaking up with her former. The gap between her break up and her newly found was filled in by me; her good friend. Now that she has found and selected the person she wants, I have been thrown backstage. Some behaviours I experienced were inappropriate and other times when I needed some emotional support, it was given very poorly due to other concerns, or not at all. Come to think of it, I'd prefer the latter than the humiliation of the former.

Now it seems that every time we speak, I start the conversation, or I make the call. To me, that feels one-sided and incredibly embarrassing that I still care so much about the friendship I held dearly to me last year. Here I am, stuck feeling like an idiot about asking a particular person's attention.

I held in these feelings, occasionally feeding it back, receiving apologies in return.

Finally, I had the nerve of asking the question: Do you think I have high expectations of you?


To which the answer was written:  i don't think you have high expectations of me. I think we're both just really busy and I think I was a bit decompensated this week with everything that happened. I think we should catch up when things calm down for me. I have Community next block and it looks pretty easygoing, so we'll see then. 


I didn't know what to make of this, except to feel humiliated that I brought the question up. I could only think of one thing to say:

I don't recall mentioning that I'm busy. I know my schedule is demanding, but I'm happy to make time for friends. Things were quite different last year. I guess it's been a big adjustment for me. 


The bottom line is that you've got the attention and support you were looking for from the person you wanted it from. And until that happened, you were just happy to make do with me. 


Now, every time I talk to you or make an effort to try, it feels really one-sided because you're busy doing other things, seeing other people and of course, clinical. 


And from my perspective, from the manner of your previous message - it seemed like writing to me or organising time to see me was a chore. 


So in my view, I had the expectations of our friendship in 2010, which is obviously very different from what it is now and I don't think it's due to time constraints. 


To an extent, I do feel that you are uncomfortable talking to me. So don't feel obliged to write back. 

How?

I wake up at seven in the morning and get to the hospital at eight to start morning rounds. Most days I don't get home until five or six in the evening. I'm lucky to get a lunch break.

When I get home, I have to cook dinner, eat and wash up. Sometimes I'm lucky enough to have energy to go to the gym. Then I have the e-mails to read and reply to, which would easily take most medical students an hour to do. After all that it's about nine in the evening and I barely have enough energy to study anything.

Life is full of interruptions and one thing that easily drives me up a wall are the phone calls I get per evening. I speak to my girlfriend a couple of times in the evening and my parents usually once. That's really enough to drive me up the wall... and to throw my phone out the window while screaming the most obnoxious language, even for Penrith.

What I really want to know is how the fuck I'm supposed to get everything done. How do we keep up with the lectures, learning objectives, themes and interactive sessions? How do we prepare long cases and sort out case histories? When do we decide to perform physical examinations, take blood and council patients? At what point do we get feedback from the consultants about our progress in the rotation?

I got home tonight and had some dinner after deciding not to go to the gym after developing some right hip pain and left wrist pain. The right hip pain is probably due to yesterday's gym session and the left wrist is due to my bone disease - a random reminder that I might need to see my orthopaedic surgeon again some time soon.

I feel guilty for feeling like the phone calls are a hindrance. I know my girlfriend and parents care about me, are wanting to know how I am doing. But at the same time, they don't understand how much of an interruption it can be. Like I said, I do feel guilty but there is an overlying feeling of anger.

Tonight, I was going to study the next topic, which was multiple myeloma and well, I got distracted as I always do. I realised that I didn't respond to the online population medicine module and well, I was late in my response. My room mate told me about some bursaries and scholarships available and well, any money would be useful right now as it is difficult to afford living expenses. It's even more difficult to save any money at all. It's impossible to even consider investments, property or mortgage. Those are forbidden words at the moment.

What the fuck?! So when am I supposed to start attaining any form of financial security without begging the cock-teasing institutions for a few thousand dollars to sustain life for a year or so?

Hey students! We've got money but, you don't. So would you like some? Here... fill out thousands of forms and we'll think about whether you're worthy. 


Fucking awesome.

The truth is I'm not sure how long I can maintain this. How long can I work? Can I do a Masters in Philosophy at the same time? What about work? Family and social commitments? When will it be possible to stop thinking about money and the future?

Throughout my entire university life - I have promised my parents that I will do the best I can to look after them when I finally graduate. It feels like I might not even get there. When will I ever be able to have enough money to pay off my HECS debt and other potential landmines for income? How can I ever help my parents?

Will I be able to support a family? Will I be as important to my family members as I will be to my patients?

I look around me and I see people that don't appreciate life. 


So many heedless souls out there, so lost, so adrift... So unappreciative. So undeserving of the precious gift of life that was being denied me. 


And it's all come down to this. Somewhere, somehow... something went wrong. My life wasn't supposed to turn out this way. I was supposed to be someone; I was supposed to make a difference. 


Now, I will... One person at a time.

Kept from Sleep

I lay down on my bed to sleep, thinking it was time for rest. I have been sleeping quite well the past few days, catching up on the luxury of sleep. The comfort of it is so important to me.

Thinking about how old I am and how the age of thirty is just around the corner got me out of bed to write something before convincing myself that I won't be able to sleep.

The light's off in my room and the keyboard is glowing with the screen. I'm almost twenty five and it feels like accomplishment is a word that's so far away.

When will I reach it? Am I experiencing delayed gratification now? They say medical students persist very well because they know that being a doctor is only a few years away. Then interns persist until they are registered doctors and then specialise through the colleges. It seems like a vicious cycle to me.

People have been talking about lifestyle ever since I started this program and I know it's foolish of me to say, but I despise that word in this profession. It feels like people are taking the shortcuts to reach their goals, whatever they may be. Minimising delayed gratification to achieve gratification sooner, better and with a family. But what of the patients?

Acute-care surgeons are almost always on call, especially in this part of town where there is a shortage. What do we do when all the doctors of tomorrow are concerned about their families, their loved ones and their bank accounts? What happens to the patients of the future, when the shortage gets strangled?

I think that surgeons make an enormous sacrifice in doing what they do. Some of them chose surgery because other training programs were more competitive. Others because they short-term spike in income is reassuring for their finances. But some, perhaps the very few, chose it because they believe actions are larger than words.

To care for patients means to start earlier than others, finish later and return whenever you are required to make a difference to someone's life. That is what medicine and surgery is to me. It is the ability to serve those in dire need. It hurts to know so many people are moving away from surgery because of its demands on doctors.

Why am I awake? Because I want to become a surgeon and I want the steps I take in the hospital to make a difference. I want to know that I have made someone feel better, restored function and saved someone's life. I want to make the decision to operate, bearing in mind the best decision is always not to operate. I want to be modest, humble and learn from the arrogance in theatre that this attitude is a dying one.

Serving people does not give special rights to anyone. We have made that decision and if we are angry, frustrated, annoyed or impatient - it is our fault. Nobody forced us to do what we are doing. We need to serve all those arounds us without prejudice. I want to be that person, if I am not already. Polite, calm and respectful, without the notion of arrogance but being knowledgeable enough to make decisions. To have the confidence of the patients and their loved ones.

I'm up and it's almost midnight - what kept me up? The fear of never reaching my goal; the thought that my journey is infinite and that my knowledge is insufficient. My contributions are little and my work insignificant.

So I am awake, wondering what I can do about it.

I can only hope that there are enough surgeons out there to look after the people, but especially in the future.

Save.