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Chicken Soup for the (Med 5) Soul - from your fastidious ward
teacher
給第五年醫科學生的‘心靈雞湯’
Author:
A Professor
Affiliation: The Chinese University of Hong Kong
(The sentiment expressed in this article is strictly personal and does not represent the
views and opinions of the Establishment).
If you think this article is just another ‘been there, done that’ patronizing statement on
how you should run your life, or ‘ABC guide’ of how to pass your exam, or
‘Dummie’s guide for climbing the medical hierarchy’ then you are wrong - my
innocent one. This is not a piece that you would find in the index pages of Harrison’s
or discussed in those marathon afternoon lectures and tutorials. The only
circumstances you might hear the content of this article discussed are probably as
quiet whispers at the dormitories or long sighs down those lonely hospital corridors.
(OK…..right……I can recognize these clueless eyes behind your surgical masks right
now…No idea of what I am talking about?) Correct, you should have no idea. Not yet
anyway. I am talking about the adrenalin surge of your first cardiac arrest when you
were the only doctor around, your first confrontation with the screaming family of
that patient who had just decided to die unexpectedly during your shift, your first
struggle with that tingling feeling down the spine when you realized you had nearly
committed a serious mistake, your first taste of patient’s leftover food items in the
ward kitchen during a busy nightshift when hunger overwhelmed you, your first
dissociative fugue 1 after waking up in the morning post-call and finding yourself
unable to recognize your own face in the mirror, the humiliation of being told by
someone you would never make it to specialist training because you just didn’t ‘fit’
his expectations (i.e. to be more like him), the exhilaration of tubing an arrested
patient’s throat or delivering someone’s first child unassisted for the first time, the
profound amazement of seeing your leukemia patient who was so ill that he nearly got
‘switched off’ at ICU some years ago, greeting your ten years later with a bear hug in
a restaurant, together with his wife and five kids, and then finding yourself mumbling
quietly to yourself: ‘Everything I have gone through in medicine has been perhaps
worthwhile after all……..’
The human mind has the incredible capacity to repress those unpleasant aspects of
life-altering experiences like childbirth and medical training in order to coax the body
into doing the same thing again. That is why our species is so successful, and why
people can still graduate from medicine and stay as doctors. Next year, most of you
will match headstrong (or headfirst) into the frontline of that battlefield called
‘internship’. This battle is about facing one of our worst fears - confronting and
overcoming your vulnerabilities and insecurities. The intern year is likely the fastest
year of ‘growing up’ that a young mind has to ever go through. The responsibilities
that come with the honor of being addressed as ‘Doctor’ must never be
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underestimated. Nothing will fully prepare you for the emotional roller-coaster ride
that entails. Hopefully, this article might just help that a little bit….
So what pearls of wisdom this fastidious ward teacher has to offer to her dear Med 5s?
Since I find most medical students respond to power-points slides or point forms more
readily than prose and essays, I shall summarize some food for thought for you in
point form – the 10 ‘Chicken Soup’ insights from your ‘New Age’ 2 teacher.
Point 1: Know thy limitations. That is, know what you can do and what you can’t do.
This involves a balancing act of maintaining your self-confidence while restraining
any tendencies towards becoming an arrogant ‘know-all’ (or the proverbial
‘smart-ass’). Humility does one a lot of good, as some religious books would tell you.
Recognize when you need help, acknowledge that someone always knows better, and
most importantly, ask for help when you need it. It is not a shame or embarrassment to
ask for help. A good doctor never stops asking and learning because as you grow older
you will learn the truth in that ‘cliché’ - ‘the more you learn, the less you will realize
you knew’.
Point 2: Be honest with thyself and be honest with others. Do not make up things
or information that you don’t know or are not sure of (e.g. bed 10’s bilirubin level
from the other day) because you fear that others will find out how little you know.
Lying will undermine your credibility as a doctor in people’s minds in the long run.
Point 3: Learn from thy mistakes. This is a hard one, and I sometimes think only a
saint can do this right. Face up to your failures, have the courage of admitting it to
yourself and hopefully to others. Don’t brush them aside. It is only by doing this
would you learn and find resolution, and move on. Remember, one does not define a
hero by how high he climbs, but how quickly he picks himself up after he has fallen.
Point 4: If thou want to be treated with respect, thou have to earn it. Work hard,
and others will work hard for you. Treat your patients/ nurses/ peers/ consultants/
examiners (PS: not in any particular order) nicely, and they will treat you well. There
is no free lunch, and there is no short cut.
Point 5: Avoid losing thyself in The System. It is very easy to become
depersonalized in the chaotic hospital environment because of the stressful
atmosphere and stereotyped roles each of us has to play. Very often the demanding
patient fails to see that tired, discouraged young person behind the surgical mask, and
conversely, the impersonal doctor fails to see that once-a-beautiful-young
mother-now-turned-bald-and-bloated ‘case of lymphoma day 10 post stem-transplant’.
Try putting yourself into someone’s shoes* (note*: a figure of speech for
C-O-M-P-A-S-S-I-O-N, just in case) for a minute, then your anger/ prejudice/
frustration/ disgust…..etc will dissipate.
Point 6: Thou shall learn to handle stress in thy own way. One of the ways when I
get too overwhelmed with the stress of a situation is to stand back, take a deep breath
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and then tell myself, ‘yes, I am having a really bad day right now. But one day I am
going to look back and tell myself that, gee, that was a really bad day, but I got over it
just like any other regular bad days in my life.’ The fact is you should not bottle up
stress because it will wear you out in the long run. You need to wash it away like a
bad odour as soon as it happens to you. Go and debrief with your friends/ peers/
parents/ pets/ indoor plants/ taxi-driver/ the cashier girl at Café De Coral about just
how bad your day has been. For those who are more reserved, go and smash that ball
instead, turn that loudspeaker up or jog that extra 10 kilometers also helps. It does not
matter how to combat stress, remember, just don’t sit there and sulk and ruminate and
let stress metastasizes within you like a cancer.
Point 7: Develop a sense of humor. Black humor helps a lot, especially if you are an
oncologist. You will find that most oncologists are infected with a light-hearted sense
of sarcastic humor. It is perfectly healthy to laugh at yourself too every now and then
because it is a really good way to beat stress. It is through this black humor that most
oncologists, I think, can handle the worst spectrum of pain and suffering that
humanity has to offer on a daily basis. The other way, of course, is to believe that God
and all His entourage exists (i.e. guardian angels, cherubims, archangels, the sugar
tooth fairy….etc), but that’s another can of worms altogether and I would like to keep
religion (and politics, too) out of this article.
Point 8: The futility of constant worrying. There is no point worrying about things
that have not yet happened and things that are well in the past. Constant worrying will
only wear you out and turn you into a sleepless zombie, and the worst thing is,
worrying stops you from focusing on the Present. It’s true that you can prepare
yourself better by anticipating the future, but there is no prize in mulling over what
you cannot control (e.g. worried about how you could have done better in that exam,
about being able to get the Nobel Prize…..etc). The following paragraph is a parable
and targets those who like hiking. You can skip to Point 9 if you have no idea what
hiking is (or if you cannot stand the sentimentalist tone). Life is like a long mountain
hike, and the peak always seems impenetrable from a distance. However, the closer
you get to it the more likely you are going to find a little pass or a sidetrack that will
lead you to the top. There are many roads to the top, too, some are straight and easy,
but some are tortuous and dangerous. Many a times you will find yourself at a
cross-road, wondering which path to take. What you’ve got to do is to take the path
which you think is the most appropriate at the time, then you steadily move forward
one step at a time. Do not blame yourself or others if you get lost or get stuck because
no one can foresee the future. You just have to pick yourself up and move on to a
different path or turn back. For me, doing medicine has been the best hike (and still is)
in my life because it has enriched my life and my perspectives on the world around
me. Like many people, I had little idea of what I wanted to become at the beginning. I
started off following somebody else’s road and then slowly made my own track as I
went along. Sometimes I turned back too, feeling defeated, but only to realize later on
that because I had decided to turn back, I could find newer opportunities hiding in the
corner, waiting for me.
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Point 9: Reward thyself after a long day, because thou deserve it. Look after
yourself. If you think you are physically / emotionally not 100%, go and get help. It’s
the bare minimum you can do for yourself. Why study medicine to help others when
you could hardly help yourself in the first place?
Point 10: Make short-term goals that thou can reach, and most of all, have hope.
Always have the Big Picture in your mind – i.e. why do you put yourself through
medical school in the first place and what do you want out of it. Don’t burn yourself
out too soon. You are only in your twenties and you have a lot more life to catch up.
Statistically you’ve got at least 50-60 more years to fix things that didn’t turn out right
for you in the past. Have hope. If you want to know what hope is, come and visit us at
ward 4E or 4F and talk to any of our cancer patients. Some of our patients will go
through Hell just to extend that extra few months of life to see his/her child’s
graduation or wedding. I remember distinctly this patient whom I met in Toronto, who
had metastatic lung cancer and had since passed on. She enjoyed a 8-month remission
after chemotherapy and used that time traveling around the world with her husband.
On the front cover of her grey hospital records you would find this colorful Polaroid
photo of the couple standing triumphantly on top of the Great Pyramid of Giza. I
asked her how the photo got placed there and so she replied, ‘I made the doctors put it
there, just to remind them not to give up hope on patients like me’. Learning to
become a doctor is still a noble tradition regardless of what the cynics say. Don’t
forget to ‘take time to pause and smell the roses’, as the saying goes. Try to find
beauty in everything, even in the most ordinary things. Next time when you are about
to walk (or storm) out of the Prince of Wales Hospital’s front entrance at 5.30pm, lift
you head up to and look at those hills surrounding the hospital. If you ignore the
telegraph poles and the polluted mist, those rolling hills are in fact, poignantly
beautiful.
References
1
Wikipedia on-line reference: In psychology, a fugue state (aka psychogenic fugue or
dissociative fugue) is a state of mind where a person experiences a dissociative break
in identity and attempts to run away from some perceived threat, usually something
abstract such as the person's identity. A fugue state is often triggered by stress. The
condition often follows interpersonal events in which a person is exposed to rage,
threats to their self-esteem and challenges to habitual patterns of impulse control.
2
Wikipedia on-line reference: New Age describes a broad movement of late twentieth
century and contemporary Western culture characterized by an individual eclectic
approach to spiritual exploration.