Becoming the Sandman
Last week was our post-LU4* elective, and I was fortunate enough to be included in the Anesthesiology elective. To ensure fairness, our batch had employed a lottery system to determine who goes to which elective, and I was the sixth person picked for the six-person class.
(*LU4: Learning Unit 4. This is the 4th year in the Integrated Liberal Arts in Medicine program of the UP College of Medicine, which is technically the 2nd year of medicine proper. LU1 and LU2 are the pre-med years for the Direct Entrants, myself included.)
Our schedule in Anesth was jam-packed. We’d started our days at 6:30 AM on-the-dot, then we observed procedures and surgeries at the numerous Operating Room complexes of PGH**. After rounds, we held daily small group discussions until lunchtime. The rest of each day was free for us to peruse the lecture materials and prepare for the imminent activities of the next day, and at one point, I realized that I had regained my will to study and be immersed in the language of medicine, which was lost in the haze of my second year of med proper.
(**PGH: Philippine General Hospital. The National University Hospital of the Philippines, it is also an end-referral tertiary hospital.)
LU4 had been a trainwreck. The information we needed to absorb each week was tremendous, and looking back, I can’t fathom how we managed to scrape by every module, every organ system and every disease we studied. It was great to have review lectures about the fundamentals, but this year the subjects also compounded Pharmacology, Pathophysiology, Diagnostics and a host of other elements throughout the diverse specialties we covered. Paradoxically, however, I had more fun in LU4 than in the previous year, probably because at least this year we had more insight as to what medicine actually is; last year was filled with the basic sciences, so the clinical correlates were limited. Definitely, though, my well-being was in the dumpsters this year because of the information overload. Each week felt agonizingly long and monotonous, and at the end of the second semester I was desperately hanging by the threads of my remaining neuron.
I had many realizations by this time, one of which is the idea that motivation is inconsistent, and discipline is not (shoutout to my buddy and ~mentor who’d taught me this). That narrative verbalized what I had been neglecting for far too long in my academic life; I’d always wanted to be the carefree student who can still pass at worst, excel at best, all the while living a lifestyle of socializing and going out, and for a time I maintained such a routine, but it shot me in the foot this year. That I was able to party at the end of a stressful week instead of prepare for the week ahead and prioritize meaningful friendships when “going out”, had become such short-term gratification. And so I’ve swept this life and buried it deep, in favor of a more sustainable, conducive perception of myself and my goals. I started watching productivity videos, which was a surprise, given that I vehemently opposed commercialized conceptions of life and how labor is glorified, but this menial act taught me — is teaching me — how to work on my priorities actively.
I approached the week of my elective anxiously, because I knew that our batch had a get-together the night before (we left at 1:00 AM), and because I also knew that our call-time was 6:30 AM. For some reason, I woke up at 4:30 and still had time to buy cheap bottled coffee from the convenience store downstairs. That had just been the first day, the rest of the week was pretty stable, in my opinion (graciously so).
There wasn’t a specific point in our rotation (until the last day, but I’ll get to that in a bit) that revitalized my love for medicine; it was more of an amalgamation of everything we absorbed as students, including the clinical and life advice we’d received from our consultants.
We sat in during the Wednesday conference in the department. It is during these conferences when the mistakes in management are discussed, and it made us realize that what we learn within the confines of our Zoom lectures cannot possible surmount to what happens in reality. In LU3-LU4, a huge chunk of our training involves learning about patients who eventually get better, whose masses turn out benign and whose fevers aren’t signs of much graver diseases. In that conference, it was the opposite; it was about the case of a patient who rapidly declined post-surgery, and whose derangements were not corrected appropriately. I got reminded about the importance of being scrupulous, of investigating any bizarre finding I encounter, and I think I will never really forget how agitated I was during that conference because of a seemingly minuscule thing regarding the diuretics they chose to give the patient.
From then on, every walk to the hospital became pilgrimage, like I was asking for the grace of the gods of medicine: teach me your ways, make me a good physician, disallow me from making rash decisions, remove incompetence at all costs.
At that point I was enamored by the complexities of healing once again, and I was beginning to consider Anesthesia as a career option because of how it beautifully blends medical, surgical and critical care management. As a self-proclaimed generalist, the idea of getting to do many things in one specialty intrigued me.
Pondering on these musings on our last day, I thought, why not share these feelings to our consultant? And so I did, just as we were about to part ways. They’d seen my posts on Facebook already, anyway, and they probably had an idea about it. I said that I’m considering Anesthesia because of this rotation, and what happened after will be a core memory that I’ll look back on in my medical career.
Our consultant patted me on the shoulder and said, “You’re doing very good”, and I almost felt my knees buckle.
A four-word phrase was able to erase the pain (see what I did there) I encountered during LU4. Remembering this, I think, will always make tears well inside my mind’s eye. The tired nights that refused to let me sleep suddenly became mere dreams just for nostalgia. The breakdowns suddenly became worth it, because someone in this dystopic life path recognizes the efforts I put into reaching the daily objective of breath. Medical school is hard, but a lot of the pressures truly are internalized. Med students often beat ourselves up with the imagery of “you’re not enough”, validated by some exam score, SGD assessment, or in-class admonition.
“You’re not enough and it will cost you your patient,” is what the voice says too frequently.
Don’t get me wrong, I will always strive to be better, to pursue as much medical and clinical knowledge as humanly possible, but I do think that there aren’t much opportunities to be validated externally in medschool. Positive affirmations usually come from our peers, from our support groups, not from the institutions that educate us. And while internal validation is important and necessary for coping, it’s still different to receive validation in terms of my capacity for patient care. It’s not so much as fishing for praise, but more on having that checkpoint that our efforts as students are good, or enough, at the very least. I’m grateful because my institution has mechanisms of giving support to students, from established physicians in different specialties, but the same isn’t true for other schools. I hope to impart that four-word phrase as much as I can, whenever it is due.
In any case, my week in Anesthesia had been great. I found meaning in the act of healing again, met some amazing people, and learned so much about this specialty. Maybe medicine isn’t as bleak as I’d thought just some months ago.
And for anyone who’s in a similar situation, those who feel hopeless, tired and scared about the prospect of being directly involved in a patient’s well-being, know that all of these mean that you care. I can’t stress that enough.
And further,
You’re doing very good.
