The pain of being a doctor

My friends know I took up medicine solely because of my dad and I did not look forward to become one when I was a Med student. There were times my professors told me I am exceptionally bright especially when they got to know me in person and wondered why I was passing the years of my study indifferent, unmotivated.  What they did not know about me was I studied previous years syllabus once I passed the exam . For example, in third year, I was studying back second year syllabus. It was weird and odd for a lot of people , but when I studied with the motive of gaining knowledge, I did it better than when I was under pressure of exam.  And I was really motivated to learn on my own rather than listening to lectures.

I fussed continuously when I was about to enter into house man training .Even doing simple injection or putting  a small vasofix inside the vein made me feel nervous.  My nervousness stemmed from the fact that I could have done unavoidable pain especially with repeated procedures due to my lack of skill. My first patient whom I was about to give injection was an 8 year old boy who got a hand fracture after he fell from the tree.  It was in orthopaedic ward and there was a crowd of playful children gathered at one corner and all their injuries were because of their playfulness or accidents during fights. The boy had big brown eyes and he was not afraid at all. The amazing thing was he could feel my nervousness, he looked at me calmly and said “ it’s ok, don’t be afraid to give injection to me. I know you can do it. I am not afraid at all”. I almost wept with joy when my first attempt of injection was successful.  Since then I have done many procedures, sometimes I failed, most of the times, I was successful. I also needed to call for help especially when my attempts to do internal jugular venous catheter were not successful. I used to work in Nephrology and our patients had thickened veins filled with old blood clots , so putting the long catheter inside these veins are extremely difficult. One time, we had to do the procedure for a patient almost two hours even with the aids of ultrasound. The pain of the patient resonated to us and while the patient physically bleeds, we were all feeling extremely sorry for the patient. While I was extremely moved by the courage of my patient, I also realized I might not want to fight as much as they fight for their longevity.

When we worked for the same department for quite some time, we also became attached to the patient inevitably more than we should. At one time, my patient insisted me to go to her house and eat her Mee goreng ( fried noodle ) and I did . It is not only their illness we have to deal with , it is their personality, their background, and how much they look forward to live even their life is full of pain and suffering. One time, haemodialysis unit paged me as one of our young patients collapsed. He was only 24 and had end stage renal failure in his early 20s because of severe hypertension. He was advised not to drink a lot as he did not have any urine output. But he worked in a café .During hot season, it was extremely irresistible not to drink especially you are working and seeing ample of cold juicy drinks. So he thought it would be ok to drink more as he was about to go for dialysis.  As he had excess of fluid,his lungs were full of fluid and his oxygen plummeted. We did CPR, intubation and all sorts of emergency medications to revive him. But it was not successful. The whole dialysis unit wept as if they had lost a family member. On duty staff called out staff at home and all of them rushed to the dialysis unit to say good bye to their friend. I was moved by dedication of my staff but also feel sorry for them . They have witnessed the tragic death of their friend and they had to carry on even with the pain.

At times, we had to juggle four or five severely ill patients alone and the patients are scattered all over hospital. We walked up and down the stairs when we didn’t have enough patience or too urgent to wait for the lift or when it was out of function. My legs were as stiff as longs whenever I came back home after 36 hour disastrous oncall. One time, my friend called me to come and help. He was literally standing between two patients who collapsed at the same time. It was impossible for a person to focus on one patient when he has so many tasks to do. Anyway, we never gave up on any of the patients. We still intubate almost 90 year old lady and kept her in ICU for one month. We did 3 hour CPR for 16 year old patient. We missed our meals, shower time, sleep and we wonder in the ward like zombies with uncombed hair and empty stomach. During our 36 hour oncall, it was a luxury if we can shower or eat three meals properly.

During outbreaks, our duty became doubled as we need to assign extra doctor to take care of outbreak everyday.  We became deprived of sleep and get ill ourselves. There are a lot of things to do apart from taking care of patients such as filling in the forms to inform to public health sector, calling out social welfare, writing case report for head of department and epidemiologist etc. Then if we are not lucky enough, we also need to explain authority who come to hospital and do sudden unnoticed ward round. During outbreak, our leaves can be frozen , that means we have to give up our much needed , long awaited holiday . I remember my colleague and his family had to drive 12 hours back to home as he was called back to medical director to come back.  My 4 days leave to Bali was denied although I had already bought ticket for my holiday as my hospital director thought I should not do such leisure activity while hospital had shortage of doctors.

How about our health? We are also humans made of skin, bones, heart and kidneys as exactly as you. I was contracted with a viral encephalitis, my brain swelled and my body was filled with fluid , most probably due to infection I got out of my patient. I almost died. My friends who worked for emergency departments could not drink enough water or did not even have enough time to pee, ( the advice they frequently give to their patients which they themselves cannot comply ) as they are too busy and impossible to leave critical patients at stake. Most of my  friends have kidney stone, due to holding the bladder for a long time. One time, my close friend had severe pain because of stones blocking his urinary tract and he developed infection in the urine. I had to run and revived him as his blood pressure dropped suddenly. His family was away and when we are sick, we try to look after each other.

We have been abused by family members and patients unfortunately quite often too. One time, I was shouted by a family member as I could not sign the discharge form in time as I was reviving the dying patient. She threatened me that she would report me to newspaper journalist, but she ofcourse could not do such thing. I was also scolded by frustrated family members when we cannot comply with their demands . Most people do not understand we need certain times and tests to confirm the diagnosis and we cannot simply conclude every illness straight away. Even as the head of department for Medical unit, I was still abused by rude people although it was very rare. We have been complained because either we give too many medications or too little medications. We have been complained because we do not smile  and we do not talk sweet. We have been complained because we see the patients either too long or too short. We have been complained because either we do too much or too little. At times, I was complained by family members because I tried to keep the patient for longer stay and the family wanted to bring  the patient back home . After several unsuccessful persuasions, I had to let go as they want to be out of hospital as soon as possible. I was not happy when I saw the same patient coming back in very critical condition. The patient’s look explained everything and I felt like he was telling me “ I should have listened to you”. We don’t have heart to blame the patients because they are the ones who have to deal with consequences of their decision. Yes, they come back at one am, when we need sleep badly, but we still need to wake up and see the patients.

We are also at the stake of physical abuse from patients. One time, my paramedic was hit by a father as he tried to intubate the severely ill baby. My nurse was kicked by a guy as she asked the questionnaire regarding HIV.  But it is not more than the pain of not being able to save the patients. We are also heartbroken when the public to whom we are devoted to are not trusted in our standard of care.

The thing is we don’t have enough support when we are down and depressed. We are too busy even to notice when our colleague has depression as we do not have enough time. I needed to take a break as I was forced by head of department to do so. I lost my patient and I went into severe depression. I was so broken inside that I doubted I would heal again. Many times, I had to get out to balcony to see the sea outside the hospital so that I could breathe and wipe my tears. At times, I was bargaining God to give me shorter life span if He could save my patients. Sometimes, my prayers were answered and sometimes, they were not.

But our lives were not always filled with misery and pain. There are always moments of joys. For example, I was treating a patient with aggressive lymphoma. She was getting lots of complication due to chemo. WE had to refer her to a tertiary centre and after six months, I saw my beautiful young patient , back in clinic, well and wearing a bright smile. I treated a young patient who came with cardiac arrest, septic shock, acute renal failure due to leptospirosis and I had to do CPR, cardioversion, intubation, central venous catheter insertion with the assistance of my juniors . At that time, I was not sure whether I could save him or not. Moreover, our ICU was already full and he could not afford private ICU . So he was monitored in a general unit under suboptimal facility.  I thought he might not make it. After 10 days, I walked towards the same ward and he was not there anymore. My junior told me he not only survived, but also he walked out of hospital well after seven days. That day, the sun looked brighter and I drove back home almost euphoric.

 

I also saved lots of patients who were critically ill, ofcourse with God’s will and guidance. There are lots of counseling about diabetes and my patients have taught me they can do things miraculously even with their illness. I have been hugged, kissed, thanked uncountable times and these moments are as precious as the time, when  I realize how much they became well after proper treatment.

There are times, I am also doubtful about myself when my patients told me I can make them feel better just by touching them. Some claims they feel loved when I touch them and I am compelled to do it so that they can get the placebo effect.  I was also complimented by an old man who was a double amputee that he thought I am the most beautiful girl he has ever seen. I tried to believe him even when I knew he had diabetic retinopathy and was almost blind. Every time, he saw me, he would say “ hey beautiful “ with the sparkling smiles. When one of my patients became too ill because of uraemia, he could not remember most of the things. But when my junior said I was coming, he called out my name and sang the song that I am a very good doctor.  In my patients’ eyes, I am beautiful or too modest, I am fierce or kind, I am annoying or bossy, I am patient or snappy depending on circumstances. But they do know I care about them. I have also sat beside a young dying patient because he was so scared of facing death alone. I held his hands. He died peacefully holding my hands.

This journey taught me a lot of things, my vulnerability, my inability to numb the pain, my heightened emotions as I have so much love about people. I am also broken inside. But I cannot leave because the world needs good doctors. One time, I told my colleague I was quitting Medicine. He said “ Oh, Hnin, you are disfavoring community because you have many experiences which you can apply for the patients” And when my juniors said they became a better person because of me or they took up Medicine because I inspired them, it touched me tremendously because I always see my juniors as better doctors than me. They are more determined, more ambitious and more goal orientated.

At times, one of my junior told me off that I should think about my welfare more than being a good doctor. She said “ I don’t think you want to get rich”. But she is not right. At this age, of course I want to get some money at least so that I can travel.

When someone asked me “ what is my goal?”. I am extremely mad because I feel like I don’t need one. My goal is happiness. I am not interested to get paper  nor recognition. But I want to do what I love . Although I am in denial, I feel that I am already doing what I am passionate about, being a doctor ofcourse.

 

Hninn

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