Travel

After scraping through my Psychiatry exams, I was able to take a breath of fresh air. My muscles were finally able to relax and I could slouch in a lazy sort of way. Third year is now behind me and I can focus on the challenges of 2012... But not before heading out of the country for my elective term.

I'm not sure how electives work in other medical schools. Our elective rotation is at the beginning of final year. I chose to organise my own like most other colleagues and decided to go to the hospital my parents met, where I was born.

Istanbul has been quite an experience so far. Traveling is certainly different and seeing another country's people (even if I'm one of them) is always an eye-opener. The culture is so different, so vivid.

The history is vast, stretching from early Christianity through multiple Empires and resting in the hands of the Turks. Walking down the cobblestone streets and hearing the sounds of the Imam calling the people to pray is just something else. There is a sense of affection in the atmosphere, where you can approach anybody with any question and they will greet you with a sense of respect I barely experience back at home.

Witnessing courtesy upon public transport was magic. Watching the young make room for the elderly, offering them a seat or a hand was amazing. One lady entered the bus via the backdoor with a large suitcase because it was very crowded. She struggled to get her bus ticket out of her purse and then I saw the people pass her ticket from one to another up to the bus driver and back. Such a commonplace occurrence here, unheard of back in Sydney.

Aside from sight-seeing, I've been able to concentrate on absolutely nothing. Just looking around, breathing in the cold air of the Northern Hemisphere, taking in the scent of the soil and occasionally tuning into some conversation.

People start asking what it is you want to specialise in once they realise you're in the final stages of a medical program and I've said "general surgery" so many times that I'm not sure if it's really what I want to do or what I just keep telling people what I want to do. I didn't get as much out of my surgical rotation as I'd wanted and I'm taking advantage of the elective term to be sure general surgery is the way to go.

I speak to colleagues about their career choices and some of them are so certain in their decisions that it baffles me; I'm not sure if I should be happy or feel sorry for them. I've already seen some colleagues crumble at the very hint of second-guessing their career choice and it saddens me to see these potentially amazing doctors devote to a certain field so blindly. The irony is in the simple fact that it's not their fault.

Somewhere under here is a medical student
experiencing role confusion.

We've all experienced some degree of role confusion in a hospital. A patient or their relatives might've mistaken us for a doctor, for example. Some of us have also felt the pressure of role confusion, when a nurse might've asked us to write up a medication in a patient's chart knowing the doctors were long gone. We eventually become part of a team and commonly the work is so intense, our role as an observer is violently crushed beneath the boulders of responsibility. Naturally, we believe that we have a reasonably good idea of what a team's specialty is about given our participation and our career choice may largely be determined by the level of responsibility given. Also, not mentioning how nice a team was and how that influences a person's decision in career would be criminal.

I find myself in this state of relaxation and it has allowed me to feel my insight into the field of surgery and how limited it may be. As a medical student, it's easy for me to criticise the work of other doctors and healthcare professionals without feeling the pressures of time, a pager and several registrars on my back and the handful of consultants on theirs. Once I think of all this in a non-stressed state, the accumulation of doubt about my career choice doesn't take long.

So the question that many non-medical friends ask remains: Why Surgery? And maybe I should take a shot at answering it:

For starters, it allows me to offer very intimate care. In my mind, accessing the workings of the body with the understanding of anatomy is as close as you can get to any patient. I believe obtaining consent from someone about dissecting their tissue planes is not only professional and ethically crucial, but also an important part of the healing process. Patients often present to surgeons when all other medical efforts have failed, meaning that in most circumstances surgeons offer hope and care in time of greatest need. I want to offer such help to people.

Within me there is anger toward the next generation of doctors. People are enthralled in hobbies, television shows and many other things that hibernate the active mind. An alarming proportion of these have university degrees and professional responsibility that require more than a person's ordinary attention. Hospital administrators and the justice system have put in place laws which literally strip doctors of their licenses due to misconduct, unprofessional behaviour and negligence. No no, the fact they exist doesn't disgust me... the fact they're necessary does. It's obvious these 'practices' have become so common the entire cohort must be forced to recognise them. The essence of all this? The moral code that once would've stopped medical practitioners has now eroded into the sandstone of standards. Therefore, society's examples of morality now lay hesitant not because it's wrong, but because they can be prosecuted.

Also, what is this bullshit about working hours? When one loses a credit card, there's a 24-hour phone line to call so your limit doesn't get maxed out in 5 minutes. When shit hits the fan because the plumbing's blocked, there's a 24-hour plumbing service so you don't have to take a week of annual leave cleaning shit off your business shirts. If you're hungry after a late night, McDonald's is open 24 hours a day, seven days a week. So what? Doctors are only available 9am to 5pm Monday to Friday? Why? Because after all the education, training and research, there are more important things deserving attention like Bondi beach, Gucci and Mercedes Benz? Get serious.

Patients need our help and if we are to be their go-to general practitioners or specialists one day, we must make ourselves available to them when they need us, not when there's a spot in our dairies. Doctors are public servants. Yes yes, our children, spouses, parents, siblings are important too; but we took on a moral oath when we decided to pursue this... or did we?

As a surgeon, one must be available at all hours of the day for long periods of time because they are required in dire need. You can't tell a patient with a knife through his/her abdomen that they'll have to wait until you finish your 18 holes. Same goes for patients dying of cancer. Yes, it can take weeks for a tumour to kill someone, and that may justify taking your time... but if you were living with something growing inside trying to kill you, every minute of that experience would be horrifying. Other specialties are more forgiving and it's the main reason people abandon their surgical aspirations. Of course, one must be realistic - there are waiting lists and patients must be prioritised, tragically sometimes according to their socioeconomic status.

But someone has to do all this. I want to be one of those people. I want to offer people care when they need it, not when I feel like it. And yes, I want to be taken seriously and not appear too stupid in front of my colleagues and patients... hence, being a Physician is out (because I don't think I'm smart enough). Psychiatry is emotionally taxing and whoever thinks it's an easy specialty seriously needs revision; perhaps even ECT.

Here I am, eager to be useful, trying to help and I'm optimistic about this elective term in general surgery. Our Dean of Medicine once told us about some research done on medical students suggesting the elective term as being the most career-changing rotation in our clinical years. It has gravity. There are reasons why I want to do surgery, but also reasons why it may not be such a good idea. I must continue to think it through carefully. Slowly but surely.