It's 6.50am but it is bustling with activity. Everyone is purposeful, no one is idling. I forget, the hospital never sleeps. Machines are beeping, people are breathing, hearts are beating, phones are ringing. There is never a quiet moment.
It is 6.50am. There's no buildup, the day starts full-swing.
A stack of files, thick with patients' case notes, each laden with medical, surgical, social and pscyhological histories awaits me.
"Wai Jia, I want you to take charge of these 6 patients," my senior consultant says. She is wearing a long skirt with a collared shirt. She has rosy cheeks and her baby face is framed by streaks of aged, white hair.
The sky outside is pitch black. It is still predawn. Fans are whirring and teasing the hair of patients, wet with perspiration, sleeping in the ward. Some are awake and have not slept for the whole night because of pain. I am examining the patients on my own, charting their progress, and writing their management plan down.
"Good morning Macik ('aunty' in malay), apa kabar?" How are you?
I am suddenly aware that I am doing what a doctor is doing.
Internship. It is a big leap from being a final year medical student to a house officer. This one-month internship at the General Medicine department was put in place to help us learn on-the-job skills to ease us into working life.
It is 6.55am. I have 6 patients to review before the more senior doctors arrive.
Mdm H is dangerously ill. She is wizened and frail and put on several drips and antibiotics. When her skin is pinched to be examined for dehydration, it is like rubber and stretches to the sky. Every day, I review her blood pressure and temperature because she is unstable. She is groaning behind the oxygen mask, and responds with a moan when I call her name in malay. Every morning I begin my 6.50am-day by checking her diapers and doing a per rectal examination (which involves sticking one's index finger into the anal canal) to check for blood. She has black stools- is she losing blood because of a bleeding gut causing her critical condition? We monitor her closely every day.
Mdm Y has metastatic adenocarcinoma. This means she has cancer spread all over her body. On the first day, I say I need to examine her but she is very hostile. "Tua yi seng kua! Lu buey hiao!" (The big doctor will come, you don't know nothing, I don't need small doctors!)
I am shocked but I realise she is in a bad mood for good reason. She has been vomitting all day, for days. Her stomach is so distended and tense, and it reminds of Questin Blake's drawing of James in James and the Giant Peach written by Roald Dahl. After draining as much as 3 litres of bloody fluid from her, she feels better and she smiles at me.
The other beds have shorter staying patients. Mdm S has a heart condition and asthma- my malay comes in handy because she knows no english. Ms M has dengue fever and I need to tell the family that they need to be screened for dengue- it is a disease notifiable to the Ministry of Health.
Just when I'm about done with examining and speaking with all the patients, asking how their night went, the house officer and medical officer come and I've to present everything that I've found so they can check through my work. Finally, the senior consultant Arrives and I present everything all over. It is a multi-level system, with multiple checks, so mistakes are elicited and corrected. There were a few mistakes I made. "It's okay," they say. They understand, they've been where I am before, "just keep learning."
By this time, it is almost noon. We whisk ourselves to another room, and I am to present a powerpoint presentation on hyponatremia (low sodium conditions) to all the doctors in the ward for our learning purposes. It is 1pm, but we have not yet taken blood from our patients. I rush off,
and panic because I have 3 patients to draw blood from, 2 of which have tiny, tortuous veins. I miss the first time, and cringe. Remember those times you heard people complaining about being poked in the hospital? I have now become one of those inexperienced people trying to gain experience. And I cringe because I am trying my best. Finally, I focus, with perspiration dripping down my forehead, and glorious crimson blood flows through the tube. I have never been happier. My first victory of the day. I heave a sigh of relief. Lunch hour has passed, another new patient is admitted and I attend to her with my senior. My gastric pain comes with a bang.
It is 3pm. I've to review all my 6 patients a second time before the day ends so that I can report any emergencies and my patients' progress to my seniors. I rush down to grab lunch, and buy lunch for my seniors because they have not eaten either. Breakfast more than 9 hours ago.
Monday, Tuesday, Wednesday, Thursday... Friday. Every day, day in and day out, I learnt that this is what the doctors do. Once a week or so, they have a 36-hour shift (call) to do, which means working through the night since 6am till 2pm the following day. My first call starts next Wednesday.
I am exhausted. But smile because the patients are so sad, and only light up at another's smile. Many of them simply stare into space. Dr. E once told us, "Always smile, no matter what, because a smile halves your patients' pain."
He is always smiling.
I am busy checking somebody's blood pressure again because I don't want to make a mistake. I am engrossed.
"Doc. Doc."
I ignore the voice, then I realise there's no other staff in the room but me. Is she calling me?
For the first time, I realise someone is calling me Doctor. And it is not, unlike previous times, because the patient is mistaken or confused or has dementia. She is calling me doc because I have been reviewing her, charting her progress, examining her and ensuring all her tests are done for the week. She beams at me, "Doc, when can I get discharged?"
"Mdm Tg, I think tomorrow will be the day. I'm sorry one of your tests got delayed yesterday because of a communication breakdown. We're very sorry." I use my grown-up voice to speak.
She smiles, "It's okay. Thank you so much for taking care of me."
I give myself a slap on the wrist. I shoud've checked the notes again yesterday. And I learnt, that we are human, we fall short, and we owe it to our patients to extend grace to us for our feet of clay and our daily failings. Every day, we make mistakes. Every day, we just have to learn from them and move on.
"Doktorrr," an Indian nurse smiles at me before I leave. It is 6.05pm. "Going home?"
I laugh, "Yes, er.... I hope so. We've been here since 6.50am!"
"Why you choose this job ah? So stressful, you know."
And I know it is a genuine question because a nurse like her, unlike the public, knows we don't get paid "much" for the number of hours we work in public hospitals. Someone once joked that for the pay per hour worked, junior doctors are paid almost the same as a cashier at Mac Donalds. They are not far from the truth, but I remember, that we are not in it for the money. Enough means enough. I am on internship so I am not paid but certainly, I now understand what public service means. Only dedication makes one stay.
Mdm Tg has been discharged. As I go about my daily duties to see other patients, I know she has been watching me. Watching me fumble, watching me report to my seniors, watching me arrive before she awakens and leave only after her dinner. Before she leaves, she turns back just to smile at me and thanks me personally for seeing her every day. She knows I am the most junior 'doctor' there.
I am really about to leave but remember I need to interview Mr. T to learn about his chronic kidney condition, and examine Mr. S with a lung tumour so huge that it is causing a huge pear-sized lump to protrude from his left breast. Mr. T had his first session of dialysis and is now very concerned about his kidneys. Mr. S just got told 2 days ago that his lump which causes his constant breathlessness is... terminal. Their beds are next to each other. Both of them are sullen.
"You know, I'm the youngest in the family, the only one who doesn't smoke or drink. And I've got lung cancer." Hai shi zhong, he says in Hokkien, still got hit.
I approach them. I smile, or try to. Their dinners arrive and I try to sound chirpy.
"Mr. S ah, wah, your dinner looks so good! Char Kuay Teow (fried noodles)! You even have wolfberry soup!"
"Haha, you like? Come, I'll share half with you. Jit lang jit pua (each person, one share)' he says in Hokkien. He laughs through his oxygen prongs in his nostrils.
Mr. T is next to us and he says in mock jealousy, "Hey, how come you have soup?"
I look over and realise he has a special diabetic diet and so has rice and fish instead. "Haha, don't compare!" I say, "haha both are nice!"
Mr. S with the lung tumor who just lamented about his fate now starts to laugh and joke, "Come come, we'll share. Jit lang jit pua."
He says the Hokkien phrase in a sing-song way. Jit lang jit pua, it means one share per person. I realise he's trying to be funny because he's quoting it from a famous Hokkien song.
We all laugh. It is past 6pm. My tummy is now quiet and no longer painful. My body, however, is more tired than it ever was from training daily. I now knock out and sleep till the next day shortly after I reach home and have dinner.
The indian nurse is still awaiting my answer, "Why ah, doktorr. Why you choose dis job, can you tell me?"
"I don't know, " I say. I think about the dehydrated, constipated and sleep-deprived state that my colleagues and I are in and say, "I guess, I just like it, I don't know why. It's very tiring but it's also fulfilling."
I wave at my patients, telling them I'm about to leave, and they all smile. Even though they are still grappling with news of their cancer or life-changing diagnosis.
"Thank you doctor."
And then I realise, it's worth it. All that work done just to hear a depressed patient laugh and make jokes and thank you genuinely because of an extra effort made.
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