Raw Medicine

Why is it that Doctors have it so bad? Right from the day we joined Med School through the days when we graduate and continue into Residency, life is anything but a bed of roses.... the whole world had warned us, I mean those who are in the system already, but then, I wanted to help humanity....

I'm actually completing an old draft that I started writing a few months ago, but left it incomplete. Now that I am in Clinical Medicine, I get to see, how my juniors, colleagues and seniors work hard and are living a life of constant fatigue, on the verge of burnout, most of them. Most of the conversations are about, how bad the last call was, how busy the wards are, how complex and how very ill the patients on the current list are etc. etc. Is this how life is meant to be? I mean as a Doctor? I was given to understand that as a Doctor you will be a blessing to others, and hence you should be in some kind of bliss. But, the reality seemed to be far from it.

I got permission from my team boss for an early day off the other day (for the first time, since I've now mustered enough courage and confidence to ask for such a thing), as my daughter was down with stomach flu, and guess what, since the list was really short I got off right after my rounds, and as I was walking out, the scene outside really gave me an opportunity to see the reality that I always knew existed, but had not really witnessed. I always knew that we Doctors start work really early, but I had not actually seen this in a long time.... When I am almost done with a substantial part of my routine, the rest of the world is only beginning to wake up.... and getting ready for the day! And our work does not seem to end even when the rest of the world is back home watching their fav soaps etc. judging by the bits and pieces of conversations that fall on my ear drums the next day....

The world thinks, the minute they hear I am a Doctor, that I am earning a fortune and living in some condominium, while the reality is as a junior doctor, (a lowly MO) I spend most of my waking hours in the wards and have to plan attend my daughter's pre-school events months in advance and I actually live in a humble apartment close enough for me so that it is easy for me to travel to the hospital and close enough to my daughter's Child Care Centre. 

Calls. The value of sleep, and the value of food. Calls are those very real and tangible hours when you really really contemplate as to whether you did the right thing by choosing Medicine over Information Science/Electronics and Communications/Automobile Engineering or even Law/Pure Sciences, all of which were other options available to me when I was at the cross-roads. Why can't I have a normal job where I can just work 9-5 and sleep like a normal human being and not be worried if anyone is going to die while I am at work. It is the feeling when you are responsible for a particular sector of the hospital and you are just hoping no one's going to desaturate, go hypotensive etc, in short, hoping that no one's going to die while under your care.... That is a terrible feeling even when you're covering a fairly so-called stable sector. You don't want to be initiating ACLS protocols and activating the Air-way Team while you're on call.... All this while you're thirsty, hungry, sleep-deprived sometimes with a distended bladder which has been awaiting an opportunity to be decompressed.

Medicine is not easy. But, someone has to do it. IMHO, the reason why we doctors, have it so bad is, that someone has to do this job else who is going to do it? All of us who chose Medicine when we did, for whatever reason did not know what was in store for us, even though there were a lot of other things that we could have done, and excelled at. Some people would have warned us, but we never cared, we just thought "saving lives" is what we wanted to do. Destiny has it that we have been chosen for this life. All of us know someone who has quit Med School or after graduating quit Clinical Medicine for something easier, lighter, something "normal".  But some of us continue to remain in this field for whatever reasons; we have been chosen for Medicine, and we did not chose Medicine. This is the reason for an indefinite duration of time to come, in spite of whatever might happen to Medicine, as long as Doctors remain responsible for the lives of people, so there will be appreciation, prayers and blessings of the people we care for, and hence respect and gratitude. And that I believe is the strength from where we derive our drive to continue to push forward, and that is the strength that is hidden in the tiny thread that hold us to the system we are all a part of.

An update that is long due

Finally I feel like blogging again since April 2009. Since then, I traveled thousands of kilometers; first in  suburban and remote rural south India and then flew across to another country chasing my dreams. It was a long and challenging war that followed my exit from the so-called Corporate Clinical Medicine into Public Health and finally back to Clinical Medicine. The war is far from being over. 

The decision to transition to Clinical Medicine: 

Public health generally speaking is Medicine "wholesale" and Clinical Medicine is its "retail" counterpart. But often in the practice of Public Health by organizations I came across bosses dealing with mundane statistics and numbers, taking decisions based on assumptions the credibility of which can be questioned many a times; and very generally speaking in my opinion you do not need to be a medically trained person in the first place to analyse incidence and prevalence of illnesses and the social determinants affecting the same, at least you need not necessarily be a Physician to do this. But when a medical doctor with a sound clinical background is "running the show" (which I got to witness during my Rural Stint after med school), things are different, since he has the perspective of a clinician. And to develop this perspective it is necessary to have undergone rigorous training. Hence the need for further training in clinical medicine; or else there is no much difference in the perspective of a Doctor or a Lawyer interested in Public Health. And of course, the joy of dealing with individuals, talking to them, going through the complex process of diagnosing and coming up with a treatment plan is something I could not trade off with Public Health.

Training in Clinical Medicine in the First World Versus the Third World:

I tried as much as I could or probably lesser than what I was capable of to get into a specialty training program in India itself, but as the prevailing circumstances at the time would have it, I had to choose between a high paying job overseas with a possibility of entering specialty training Vs the prospect of spending another year and most of my waking hours poring over books, spending my father's money for not only my expense but also that of my young and growing family..... all of this to get into a training program which will pay me pittance and make me work so hard, that at the end of it I will probably not recognize myself in the mirror. I was stilling willing to face the prospect of taking up a job in India itself while I still try my luck at the Indian exams, but some of my friends convinced me to give the other option a try at the very least. And very soon I was on a flight to Singapore, and before I knew I was already doing ward rounds in Geriatric Medicine with a COW (Computer-on-wheels). It was probably the biggest change that I had ever experienced so far, moving out into another country. Never before had I ordered as many CT and MRI scans like I did, giving Pipericillin/Tazobactam and Carbapenems. This was the first time I am working in a proper tertiary care setup since my internship days. I spent most of my waking hours in the hospital and finally, I applied for the Internal Medicine Residency and was blessed to have been accepted into it. Thank God I did not stay back in India to pursue specialty training or Public Health.

Inspired by the sheer number of online accounts and portals for me to log in and document my improvement during the course of my residency, I decided that I will start blogging again, as a sort of parallel log. So I hope to keep this blog more active until the foreseeable future at least....

Some of God's greatest gifts are his unanswered prayers.