Losing myself in the process of getting somewhere.

Growing up, I have always placed an immense pressure on myself in achieving good grades. The process was repeated every single time there was an exam- it was as though I had an algorithm to follow:

Exam coming up --> Study --> Sit for exam --> Get results --> Cry about how inadequate I am

And this was repeated. Every. Single. Time.

It didn’t end in primary school. It didn’t end in high school. It certainly didn’t end in the first phase of medical school. And I still go through this same algorithm despite being twenty-three years of age and in my final year of medical school. It’s as though I have this re-entrant arrhythmia in my heart and I either need to ablate this accessory pathway (the path to inexplicable self-bashing) or allow it to continue and eventually let it take complete control over my heart or me for that matter.

A good friend of mine caught me off guard after the exam and the combination of years of pent up frustration and female hormones, which go haywire on a monthly basis unleashed the emotions from my previously tight-lipped self. (No, scratch that. Our hormones were programmed to do just that. So they don’t go haywire. They were made for the purpose of making changes to our body to prepare for fertilization and implantation of a champion swimmer and the trusty egg to the mythical “womb”- the monstrous uterus.) A long rant ensued- the pressure to do well because I feel as though it reflects on how good of a physician I’ll be in caring for patients, the pressure to do well because my parents have sacrificed so much to get me here, the pressure of staying on par with my intelligent colleagues, the pressure of meeting expectations of consultants, colleagues, patients, family and friends and that of my own. In the process of trying to achieve something, and feeling like I always fall short of it, I’m slowly losing sight of why I’m doing it in the first place. I forgot to give thanks to God in good times and in bad. I forgot to stop and reflect on how much I learn on the go, whilst on ward rounds, whilst listening to patients’ histories and coming up with management plans and being a part of the treating team. I may play a small role, examining observation charts, scribbling on progress notes, carrying out venepunctures, cannulations and ABGs but as my friend wisely put it…

“The reason you are here is because you have a role to play. If you are walking in a forest, and you hear the leaves rustle, your presence is important because if you were not there, no one would be hearing the leaves rustle. Similarly, the reason you are doing what you are doing is because you are a piece of the greater puzzle. You might not see the whole puzzle, but as Osho said: "There is no need for any competition/judgement. You are yourself and as you are, you are perfectly good. You just have to accept yourself."

So after examining my thoughts and feelings, I’ve come to this conclusion.

Though the Russian roulette approach to MCQ’s have never been my strongest forte and my nerves seem to get the best of me when doing short cases or long cases with two examiners observing me… it does not and will not define me as a person. Yes, I am flawed. Yes, I have room for improvement. But why do I have to beat myself up about it? I just have to sit down and have a think about firstly, what I’ve done right and what I could have done better so that I can learn from it and apply it for the next exam, next rotation or to put it in the context of an even bigger picture, post medical school. The one feedback I always get from practicing physicians is medical school is good at preparing you for some things and shitty at preparing you for others. There are some things that cannot be learned from memorising bucket loads of information from a textbook. There are some things which can only be acquired with time and experience and when pattern recognition becomes something of a second nature to us.

I’m not saying we don’t have to put in the hard work but if the somewhat artificial nature of the exam doesn’t favour us, we shouldn’t let that discourage us from continuing to love what we do.

I will be reflecting on my progress more frequently from now on.

So for this Medical Specialties rotation…

What have I done right:

·      * Worked hard at interpreting ABGs, ECGs, CXR and spirometry

·      * Did lots of venepuncture, a few ABGs

·      * Practiced short and long cases

·      * Improved in taking a more thorough social, pre-morbid function and current functional status

·     *  Improved in building a better rapport with patients

·      * Practiced ordering investigations, filling out forms

·     *  Practiced looking up drugs and their doses

What could I have done better:

·        *  Synthesising the history and pertinent findings and presenting in a more coherent manner                      Should have reinforced what I’ve read and witnessed by writing on palm cards and reviewing it the next day, then on weekends, then weekly basis.

·         * Could have secured skin better especially in patients with greater skin laxity during venepuncture

·      * Gastrointestinal examination needs to be done quicker.

·      * Interpretation of neurological findings on examination needs to be more structured. Need to improve on clinical reasoning. Need to understand Rule of Four Brainstem.

·    *   Need to work on thinking of firstly rule out what can KILL, then most common causes, followed by the less common causes of the presenting complaint. Elephant in the room!

·      * Need to work on coming up with issues list/ management plan in a more structured manner

I dedicate this to those who feel like they’re swimming against a strong current. Don’t give up. You’ll reap what you sow eventually.