Doctor in Training

Today I realized that I’ve just finished my 6th month as a junior intern/clinical clerk in medical school. This means I’m already halfway through. So far I’ve already had 2 months of Surgery (where I had my “baptism” into clerkship), 2 months of Internal Medicine, 1 month of Psychiatry, 2 weeks of Ophthalmology and 2 weeks of Otorhinolaryngology (ENT) rotation. I also had a week each of elective at Critical Care Unit and Anesthesiology. As of the moment, I’m on my 2nd week here at Pediatrics.

I don’t know how to begin to describe how I felt about my experiences as a clinical clerk, so let me start by saying that most of my expectations were wrong. The clerkship experience was admittedly different from what I thought it would be, mostly because I only thought of the fun and learning part. I was mostly unprepared of the physical work.

Six months ago, I was dying to finish my final examinations and start internship already. I said I was sick of all the readings and examinations. Now I wish I could have more time to sit and read. Being a clinical clerk opened my eyes to a lot of things about being a doctor, about the realities of working and relationships with people in the workplace, and about myself.

I thought the first 3 years of medical school was hard, but internship is a different kind of challenge. Goodbye to multiple choice problems because this time we get to face real patients with real problems and we are expected to know about their medical history and illness more than what we know about our boyfriends. Of course we don’t have to treat them yet since we aren’t licensed to do that but it always makes me ask myself (and I would often get bouts of anxiety thinking about it) if I am going to be ready for it. Sooner or later, I will have to be doing the job of managing these patients and in a way I will be responsible for their lives.

I have felt, more than ever, that being a doctor is such a high pressure job. When they train us, they don’t want us to be humans. We would have to be superhumans – erratic sleeping times, quick and efficient judgment, empathy, and a vast knowledge bank. Any sign of weakness and you fall prey to the teeth of the lion.

Unquestionably there are so many things you have to know and you can only remember so much. During internship most of your seniors will assume that you already know the answers to most of the questions they throw at you, but more often than not, you don’t or you’re not sure. I don’t know about you but I don’t easily remember everything I read, unless I have associated it with an experience in a patient. I sometimes wish I were more of the ideal student but I’m just an average one with varying interests, especially on things outside of medicine.

You can, if you want, get away with not knowing much (but isn’t that just sad). If you ever get caught in an impromptu oral quiz or rounds and you don’t know what the answer is, it’s best just to say the truth and accept the sermons. If you want, you could let some of the words go in the right ear and let it out through the left ear. A sense of humor also helps lighten up any embarrassing or frustrating situation.

I can’t deny that being a medical student has a lot of COOL factor. You can post a selfie from the operating room and caption it with [INSERT MEDICAL JARGON HERE]. You can also ask your fellow intern to take a picture of you retracting that bloody large intestine. Scrubbed in with a grin! Unfortunately out of all my OR stints during Surgery rotation, I never had any pictures of me scrubbed in. No one else was there who could take a picture, sigh, and I wouldn’t dare ask the anesthesiologist to take a picture of me at 1 in the morning.

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Laparoscopic cholecystectomy. The patient is placed supine on the OR table and the surgeon stands on the left side of the patient.

Here's me in the corner observing the procedure. I'm on anesthesiology elective.

Here’s me in the corner observing the procedure. I’m on anesthesiology elective.

I’ll tell you something. I like watching procedures at the OR but I don’t like what comes after – Q15 monitoring at the recovery room and Q1 back at the room. Plus you have all the “watch out for” instructions that make you feel like your heart is in your throat, especially if they tell you this patient is “toxic”.

I feel like I’m a privileged person for having been able to hold people’s guts (literally), but I admit there were times that I felt like crying. I didn’t cry because I wanted to quit. It was more of a cry of frustration. Being a neophyte, I’m all idealistic and always try to get all the work right but you never will get it right sometimes. It’s even worse when you are the kind of person who is very sensitive to words and you tend to ruminate on things you see or hear.

What happens to me when I get reprimanded for a mistake is that I won’t get it out of my head. I also do self-blaming, which doesn’t help at all and makes me feel more terrible. Up until now, I teach myself to think that anything my seniors tell me out of irritation or anger are not permanent. I just need to learn from them and then let it go (let it go…).

Yes, no matter how ashamed you are because of that mistake you made that you want the earth to open up and swallow you whole, get over it or else you won’t be improving. Like it or not, only a handful of people are given the natural talent to be able to remain calm, quick, and clear-minded in times of emergencies. The rest learned it through constant practice, and as doctors in training, it is one of our ultimate goals. By learning to face our fears and anxieties, and not hiding from them, eventually we can control them.

I’m the only one in my family to enter the medical profession. My sister is teaching at a private school and graduated with a degree of B.E. Education majoring in Special Education. My parents were both college instructors. My grandparents in my father’s side were both teachers and supported my father’s engineering education at University of San Carlos in Cebu. My grandparents in my mother’s side tended to their farms in the province and were able to send my mother to the University of the Philippines Los Banos, and her brother to Silliman University in Dumaguete.

Being the only one who braved the medical field, no one told me how it was to stay awake for 24 hours making sure your unstable patients are closely monitored. No one told me you had to have such a long stretch of patience and learn to be accepting and understanding not only to your patients but also to your co-workers and your seniors. And no one told me there were times you might doubt if this was really what you wanted when you seem to be in the breaking point. But I am here now, by virtue of destiny or desire.

If you are outside looking in, you would think how nice it is to be these doctors. Aren’t they cool and amazing and noble? Inside their real lives, you discover the moments of hardships mixed with the pure joy of service; moments of boredom interspersed with minutes of adrenaline rush; pleasure of achievements after sleepless nights. You also get to experience the dirty realities – that which you don’t want to admit but actually do exist.

Doctors in training work in teams, never as individuals. Inside the halls and the call rooms, you get to know your peers beyond acquaintance level. You’ll know who likes to complain and who loves to get things done silently; who does the “ninja moves” (good at disappearing) and who stays late after work; who likes to count the number of work done and who doesn’t know how to say ‘no’ even when it’s already beyond his/her duty. You’ll also know who you can count on and who you want to avoid.

During internship, it’s not just about how much you know. Your attitude is as important as your knowledge. You can try to keep things smooth between your co-interns but the truth is you never will get along with everyone. You also must learn to swallow your pride and be humble. You can claim that you were treated unjustly by a fellow intern or your senior but I have learned that sometimes complaining a lot gets you nowhere. You can try to speak out and say what you feel, trying your best to sound respectful, but it’s not going to change things in a snap so you must learn to adapt (and probably promise yourself to not treat your clerks the same way when you become the senior). At the moment, try to understand the angry resident or the agitated fellow intern. They might be going through something because most of the time stress turns us into monsters.

Ice cream for a benign last day of IM duty!

Ice cream for a benign last day of IM duty!

Going through all the experiences of internship taught me a lot of things about myself. I thought I knew myself completely but when faced with pressures I realized I had some attitudes to change too. It’s hard to learn to swallow one’s pride and admit mistakes but it’s something that I know will do me good.

Despite all that is tough and tiring in being a doctor in training, it’s a job that can give you much fulfillment. I may have complained about all the exploratory laparotomies that make me leave the OR at 3 in the morning or the hourly monitoring on a full ward where you feel all your leg veins pulsating and painful as you try desperately to keep awake, but seeing them appreciate my services afterwards feels so nice.

I also get free food from patients, which is the best. A box of pastries, a dozen donuts, slices of pizza, a cob of corn, a sachet of powdered milk, and cookies – these are among the PFs (professional fees) that I have received. The trust and respect they also give you make all the work bearable. Sometimes when I see them again when they come back for follow-up and they still remember me, I just feel so touched that it seems as though a hand went through my chest and reached my heart and gave it a warm squeeze.

I just would like to share this experience with an elderly patient who might have been one heck of a guy in his younger years. He would smile and ask the ladies entering his room for a kiss! You can’t help but feel amused by this old man. I have a particular liking with old patients because they remind me of my grandparents. Another elderly patient would talk to me about random things. He had really bad hearing so I would have to repeat myself at least twice and talk while hunched towards his ear. He asked me my full name, and he told me I had a lovely name and that he knew close friends with the same surname as mine. He would then go on talking about his younger times. It was very lovely hearing him tell stories.

So to tell you the truth up to now, I’m still deciphering why I went into medical school. I’ve already made other plans before and I’m interested in a lot of things and absolutely hate studying all the time, yet somehow I’ve already reached this part. Sometimes I tell myself, yeah of course I complain now, but if I ever had another job there will always be other things to complain about. Choosing to be a doctor may have happened to me by destiny or by desire. The reason doesn’t matter as much as what the experiences of being a doctor in training taught me.

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I’m already half way through and after another 6 months, hopefully I officially culminate medical school. I don’t know what will happen after. I quit making detailed plans a few years ago. I’m only certain that I would have to be an official doctor and try to be the best doctor version of me. Also hopefully I learn to accept all challenges with an understanding heart and a strong will. It’s kind of daunting but it’s not impossible. From being doctor in training to becoming a doctor for and of life. I can’t wait!

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