My professors always emphasized on-the-job learning. Questions typically began with “If you were the resident seeing this patient…” I also remember the hard knocks of their pens or tendon tappers or stethoscopes on my knuckles if I stared too blankly at blood test results and ultrasounds, wondering if they could tell that my sudden onset aphasia was just a reflection of the hollow emptiness in my brain. Being a medical student is always about learning. Currently the lowest life form in the hospital at this juncture, the only way up is to learn. Learn till it hurts, and then learn some more.
The best way we learned was when we saw things with our own eyes. Experiences breed a solid memory, like how you will always remember your first drink because of the way it burns and licks your throat and sets the night on fire. Feel it and you won’t forget it. See it and you won’t miss it. Forget the textbooks, the seniors’ notes and the Up To Date articles that we secretly check on our iPhones during clinics when we get asked a question (don’t pretend you never did that). What are words without pictures? What are pictures without touch? Smell melena once and you’ll never forget it. Trace the whorls of a fibroid and it’ll be etched in your mind.
Because we banked so much on learning, we tend to get really excited easily. Ooh have you done the manual evacuation? Have you hard the tricuspid regurgitation in that baby boy over there? We had and still have so many tools for us to learn. Online textbooks, senior-junior mentoring, teaching grand rounds, case write ups, and most importantly and fundamentally, the patients themselves. Learn, learn and learn. Keep learning. Be happy when you see something you don’t normally see. I remember our general surgery rotation had a rare mini dry spell and “he has pancreatic cancer” were the best words I could hear from my consultant for that week regarding a new admission. My mind clicked and raced and I knew the management by heart. ‘SCORE!’, I thought. My clinical group mates and I animatedly discussed management and were excited to do a physical examination on him because his signs and symptoms were just ‘so florid. You would fail if you missed it.’ One by one, we streamed into his room like kids waiting for a ride – prodded his abdomen, took his history, checked for shifting dullness, asked him to turn on his side again and again, took his history again. For all 5 students. All he did was to smile, and shake everyone’s hands when we were done, wishing us all the best for our studies and life. “Same to you!” we chirped, without thinking. We had a good haul today in the candy store of patients, each one leaving the room with a Hershey’s Bar of experience.
People always ask, isn’t being a doctor depressing? Isn’t this a burden? Sick people at every turn, with Death greeting everyone as an old friend just round the corner. Is this, then, the only way to be happy – to see what we want to see in patients? Celebrating cancer, exalting an open fracture. The more blood, the more gore, the better because there would be more things to see. Ask any student what a good emergency medicine shift includes. Chances are it would have someone with a bad RTA, or a really grotesque open fracture. Throw in a cardiac arrest and maybe a death or 2, and most students would be wishing it were their shift instead. I had the stroke of luck to participate and scrub in for a heart transplant – just for a couple of hours so I could feel the consistency of a healthy heart and a diseased one. When the surgery was done and the patient on the table was gifted with a new beating organ, the OT erupted into a mini applause. “Just mending his broken heart” my doctor smiled and joked, flicking his bloodied gloves and gown into the bin. It was only then he turned around and said it square in my face, “but someone somewhere died and gave his heart up.”
Someone died so another stranger could live. Is that supposed to be the beauty of a human organ transplant act? While a family is celebrating with the gift of life, another is mourning for a loss. Whatever my doctor said to me that day, I can never forget. Why do we celebrate cancer? What is behind our high-fives when we percuss a hepatomegaly correctly; or our excitement behind an ongoing CPR? Someone is suffering so another student could learn. Someone is in pain so another student could learn how to reduce a displaced fracture. Someone died despite CPR today in the A&E so that another student could prevent that from happening when the time comes. It’s scary, isn’t it? The idea of sacrifice and how things can come full circle. It’s just that we don’t really see it in front of our faces even when it’s plain black and white.
Something still feels uncomfortable in my gut whenever I recall what that doctor flippantly mentioned after that heart transplant surgery. But the subsequent high-fives we students exchanged, I silently celebrated sacrifice. I thanked patients with as much gratitude as I could show because if not for them, I would not have made it this far. I also wouldn’t have the chance to make it further. Those terminal patients – they probably will never have the chance. Behind their smiles and behind my handshakes and pointless thank-yous, we both know it – they are going to suffer or die or both soon, and I am going to live and be a doctor.
As I walk further away from their beds and closer to the bright future that has been promised to me, it is difficult to remind myself that life isn’t always the way we want it to be. Some people got lucky, and some people didn’t. That is why there are survivors and victims. Black and white. Yin and yang. For every patient I interact with, I want to be accountable to them. To let them know that their 20 minutes with me, a complete stranger, who prodded, poked, percussed, listened, auscultated them without giving anything in return, wouldn’t be wasted on me. This is the only way to keep our head above the circumstances in the hospital and we’ll learn that sometimes we don’t need water to feel like we’re drowning. Even more so in the hospital, it isn’t water – it is quicksand.
Till then, I celebrate the sacrifices made for me by people whom I have barely met and will probably never meet again. Let us high five to that.
Chloe Ting is a medical student and a freelance photographer and writer. She blogs at thelovelyshadows.tumblr.com