Not only has there been the compulsory Week 1 breakdown, there has been around 6 breakdowns in the past 12 days.
While covering the wards last weekend, I felt completely burnt out. But of course, Monday came along so I kept on going.
That's just what you do.
I started out the year on my 20-week GP rotation, and I loved every minute of it. Moving on to Orthopaedics was tough, but as the trend seems to go, you find that you start to get the hang of things by Week 9, only to switch rotations after Week 10 and end up back where you started - lost in unfamiliar surroundings.
All throughout my internship year thus far, there have been ups and downs, but ultimately I have found that I've been enjoying my training tremendously and even at the worse of times, I love what I do.
General Medicine, however, has been hard. It's a hard unlike anything else I have ever known.
It's the kind of hard that makes you run like your life depended on it, then knocks the wind out of you and then as you crash to the ground, delivers a fatal blow to the back of your skull.
You don't want to get back up, but you do anyway.
What makes you do this?
The fact that you don't have a choice.
It's do or die.
I started my rotation thinking of what a great opportunity this would be to learn and grow in my clinical skills and experience. But now I just feel bruised and battered. I'm just tired.
The real danger is that exhaustion has a tendency of beating the enthusiasm out of you. In the past fortnight I've tried so hard to struggle through the exhaustion and to fight off the apathy. It has not been easy, and it required me to call upon an internal strength that I did not know I had.
Now that I'm finally facing my first day off since starting on Gen Med, I still find my thoughts stuck on the wards. It's a form of psychological trauma.
Have I done all the blood slips for the weekend? Are there investigations that I haven't followed up? Have I missed something important?
That's the problem with hospital medicine. The work never ends and as everyone else has their own work to do, there's no one to cover you if for whatever reason you don't do yours.
And at the end of the day, after being so invested in the treatment and progress of so many patients, it's hard to just shut off when you finally get to leave the wards.
Another problem with hospital medicine is the high turnover rates and the high patient load. As an intern, your days are busy and there are always investigation results to chase up, referrals to be made, tests to order, notes and drug charts to write up, admissions to be done.
The work is constant, and a reliable pen is your best friend. With my 30 - 40 patients a day load in the past fortnight, I have very easily run dry a total of 4 pens.
With the nature of the job being so task-oriented, it's very easy to lose sight of why you're there. It's also easy to lose the empathy - there are just too many pressures on you at any one time, and when you're struggling to catch your own breath, it's very easy to inadvertently look over someone else who is also struggling to breathe.
Rather unfortunately, their lives depend on you. So sink or swim, your patients are your priority.
Rightly or wrongly, medicine involves a lot of self-sacrifice. It involves sacrificing your time, your life, yourself, for someone else, simply by virtue of the role that you choose to take on by being a doctor.
We are told on airplanes that when cabin pressures are low, you first need to put the oxygen mask on yourself before attending to those under your care.
It's an important principle, but unfortunately the medical world has not yet adopted this principle. It is expected that doctors take care of themselves, but the nature of the work and the hours that we work do not logistically allow us to do this.
It is undeniable though that when exposed to a consistent state of low oxygen, the body learns to adapt. We learn to function at a much higher level than most under much less desirable circumstances. We become stronger.
Still, there is a fine line between learning to thrive under extreme circumstances and failing to thrive. Everybody has a limit and often the factors that test those limits are not within our control.
Sometimes it feels like a game of chance. Like Russian-Roulette.
If you're pushed hard enough... Who is going to be the next to have a breakdown?... Who is going to be the next to make a mistake?...
Who is going to be the next one to stop caring?...
Because when the work ceases to be fun... When it starts feeling like a chore and all you do is rush about doing your daily jobs to get them all done before midnight, which is 2 hours past the time you were meant to leave, knowing full well that you have to be back at work at 6am...
When you're pushed so hard that your own reserve tanks of hope, love and joy run empty and you couldn't care less about anyone else's wellbeing...
That's when it ceases to be good medicine.
