being a doctor

i haven't written much about what it's like to be a doctor. in fact, i don't think i have written anything about being a doctor since i became one!

well. it just struck me. i have been a doctor for nine months now. i think i need to mention, before anything else, that i felt more like a doctor when i was a final-year medical student doing rural medicine in zambia, than i ever have since i started working last november.

sure, i am filled with a warm satisfaction at times - yes, i am doctor dhamidhu eratne. yes, i am a highly educated and highly trained professional. yes, it has taken a lot of work, effort, sacrifice, determination, and a ninety-thousand dollar student loan to get to where i am right now. it's not an egotistical, god-complex pride, it's more a wholesome acknowledgement.

for the most part, i have thoroughly enjoyed being a doctor. it sure as heck beats sitting in lectures all day and cramming for exams. i have no regrets. even though at times one can feel like nothing more than a glorified clerk - working in a big tertiary centre such as auckland hospital - there is nothing else i would rather be doing.

what is interesting, and what i have come to realise more and more - is what it is in particular that i like so much about this job. it is not, in fact, faxing forms, having to endure the beaurocracy and limitations of a heirarchical organisation. it is not having to witness the unconsciousness and mindlessness of the egos that this profession breeds. it is not the minutae, the esoteric diagnoses, the high-powered investigations, scans and blood tests, the salivary antibodies and late potential ecgs and brain natriuretic peptides or hour long academic debates about the percent values of certain physiological tests that really inspires me.

in fact most of the above actually causes me to become quite uninspired, frustrated even, before i am confronted by what really inspires me, and i am then reminded of the essence of what it is all about.

i say interesting, because for a lot of people - the minutae, the high-powered, fancy end of the spectrum is what really tickles their fancy. and that's not a bad thing. but it seems to me sometimes, that we are losing perspective. we strive more and more and spend more and more for such little gain. what really excites me is the simple, down-to-earth "real", clinical, medicine that makes real differences to significant numbers of people. à la zambia.

and i say interesting, because i realised the other day that the best parts of my day, the times when i feel most satisfied about what i am doing - is when it is just me and the patient, the person. just listening. just being there. just being able to take the time out of a busy day full of to-dos and boxes to tick, and to just go into a patient's room, close the door behind me, sit next to them in a chair, and talk and listen. for me, the pneumonias, the heart attacks, the exacerbations of copd, the cellulititides, the bowel obstructions - they all become so boring! no matter how many times they tell you that 'no two pneumonias are the same' - it simply just isn't so. what is fascinating - is the people. their stories. their families. their fears. their hopes. their histories. their war stories. their grandchild's artwork, that splashes the colours of a childhood utopia on generic walls.

there are so many moments of inspiration and movement that i can talk about. two particular ones stand out.

mrs. b was recently admitted to hospital and diagnosed with lung cancer. she went home and was commenced on chemotherapy. there was hope of months, if not years. she started writing a book about her experiences while in hospital. our running joke was that i was definitely going to be included in the book, but the way i was portrayed would depend largely on how good i was at putting lines in her, performing arterial blood gases on her, or inserting chest drains etc. luckily things went well for her and myself in that i passed all these tests with flying colours, and so my glorious image in her book was secured.

two weeks later she came back. fluid had accumulated in the lining of her left lung causing her lung to collapse, making her breathing terribly difficult. the cancer was winning. months and years, suddenly became weeks...

i heard she was back, and went to visit her. the brief ten minutes with her moved me tremendously. she had come to a level of understanding, of acceptance, and of harmony with the reality of her situation that amazed me. her peace and strength blew away the stream of tears within me that i had created for her, and i could only feel in awe, inspired, and moved - by someone facing the inevitability of the loss of the physical, -with the strength and power of timeless presence.

i urged her to keep writing her book. i could only imagine the inspiration it could give so many people, even if only one percent of what i felt could be conveyed by her written words. she told me i was still in the book. i was the Great Listener. i couldn't help but shed a tear as i left, not a sad tear, not an insecure tear, but a universal tear of sorts - knowing that i would never see her again - but that her memory would stay within me, and that hopefully one day i may see her book in a bookstore somewhere.

the other moment happened just last night. it was a busy night. so many calls. some of them ridiculous, some of them tedious, most of them frustrating. presence was hard to come by. i found some presence when i found a moment to lie on a couch, concentrating on my breathing as a welcome snooze embraced me. then the pager rang. patient. hospital number x. needs arterial blood gas done. now. ward 72. room 12c. so i shook off the flakes of slumber and lumbered over. i was a picture of automaticity. beep. in to procedure room. kidney dish. alcohol swabs. one. two. abg syringe. one. two. needle. one. two. gauze. one pack. tape. walk. room 12. bed c. hello my name is dhamma i'm the doctor on tonight sorry to disturb you i have just come to do an artery blood test we need to do the test to see how the bipap has affected the levels of oxygen and carbon dioxide in your blood which arm is better ok the left it's a bit uncomfortable but this will only take a minute.

"will you hold my hand while you do it?"

and i was snapped back into presence.

whereas before it was all about me and what i had to do and my to-do list and what i needed for the abg and this artery on some body that needed to be bled in order to tick off one more box before this bloody night could finally end - it hit me that here was this elderly lady, a wife, a mother, a grandmother, a respected pillar in her circle of society - who now had been converted (mostly by us), to a generic, numbered, hospital-gowned collection of organs and vessels and bones. a stranger just bustled in to her room at 4am with a yellow kidney dish full of needles and told her that she needed a test because he said so. she was a person. and she was afraid.

i stopped. i smiled. i turned off automaticity. i need both my hands to do this but i'll get your nurse to come and hold your hand, ok? i reassured her and properly explained what i was going to do. she cried. and then smiled and thanked me. thanked me for what? being human? i set my equipment up. i inserted the needle. she twinged. i saw the automatic frustration that flew in - if you move it makes it harder for me - i let if pass through me. she squeezed her fist and i could see she was squeezing the nurse's hand even tighter. while i waited for the blood to slowly pulsate up to the desired mark, i breathed.

and then the funniest thing happened. the alarm that i had set on my phone earlier started to go off. a nice tune played. i couldn't reach into my pocket and turn it off, so it kept going, getting louder and louder. i couldn't help but laugh. the nurse laugh. mrs. m the human being lauged while the needle lay in her artery, slowly collecting blood into its stomach of a syringe. nice song, nice song, she said.

and then it was done. i turned off the alarm. i stroked her hand. i said goodbye.

and then i went on to the other to-dos.

a simple encounter.

yes, but the difference is -

i now try not to forget to hold people's hands.