G.S.

They are revered in public, but sometimes jokingly reviled behind the closed doors of medicine. They have a cocky air about them, only because an extra, maybe even seemingly unecessary dose of confidence is necessary for the very thing they were born to do. They can be rough, brash, and demanding, because of what systems, people and the world-at-large demand of them.

General Surgeons. They’re one of a kind.

So I’ve been in denial. Until lately, I didn’t realise how much I enjoy Surgery, far more than any other internal medical specialty. Because of its crazy lifestyle (think 630am to 7pm working hours and 36-hour calls once or twice a week), its seemingly bad reputation and the persuasion of others for me to try something a little more “female-friendly”, I had sought my solace elsewhere, exploring Obstetrics, Ophthalmology, Orthopedics and other surgical specialties offering friendlier working hours.

Then came SIP. It’s the Surgery Internship Programme, where they work you, as they say, “like a dog” to prepare you for the gruelling life of a house officer/junior doctor right after graduation.

It was then that I found out, that after rotating through all the different specialties, my heart beats in a different way in General Surgery.

I guess sometimes, you only realise how much you love something when you see how much you are willing to give up for its sake. It can be quite scary, especially if you have been in denial for a long time.

Before entering medicine, I never knew surgeons worked 7 days a week. I never knew of such things called Calls, which are 30-over-hour marathon workshifts where one works from 6 or 7am in the morning till 2pm the next day, with hardly a wink of rest in between. It involves continually seeing new patients being admitted, interviewing them, examining them, speaking to family, ordering lab tests, taking blood, preparing them for operations and if you’re senior enough, actually doing the operation itself. I never knew they were bad-tempered not so much because they’re unreasonable but because anybody sleeping those number of hours would be a little cranky too. I never knew surgeons had to operate through the night, that sometimes, they don’t sleep for more than 30 or 40 over hours.

Last night was one such night. It was Saturday. We started work at 6am. Today is Sunday, we ended work around 2pm. On call, my team and I went without any sleep between the 2 days. There were not one, not two but three open laparotomies through the night. A laparotomy is an operation where the tummy is barbarically opened up and one’s guts are all dug out to explore and repair the abnormalities.

Someone had suffered multiple stab wounds from assault. The knife pierced his liver, his lung and his diaphragm. The operation was brutal. The scar was a huge crucifix emblazoned across his chest and abdomen. The main surgeon, together with my seniors, deftly and swiftly rummaged through the mass of injured organs to stop the vicious bleeding. When the operation was over, I caught a glimpse of the patient’s face. It was bruised, haggard. He looked thirty or forty.

Outside, a wailing family of almost twenty members burst into hysteria when my senior broke the news to them that even after a heroic rescue effort by the team, the patient collapsed just minutes after the harrowing surgery. The patient didn’t make it. He was only 19.

More surgeries through the night kept the surgical team awake. My senior, Dr. N, did not have dinner perhaps till 3am in the morning. Dr. D and Dr. U slept for 20 minutes during the night. They are very senior already, they could have gone into private practice. Still they choose to slog it out because of their passions, because of their desire to train better and because of a fiery desire to pursue excellence in a field they could call their own. They laugh and joke and talk in the operating theatre not because they take their work lightly, but because the tension is so high that they have no choice but to do so.

At 5.30am in the morning, as I held a surgical retractor for the surgical wound of a patient who had to have her almost-burst appendix removed, and I realised that I had slept only for 20 minutes since 6am the previous day and had been running around seeing patients with my seniors, running in and out of operating theatre with them, and that I was dead tired but happy, happier than when I had far easier hours and yet the days seemed like eternity in other specialties, that I realised that it’s really, really true when they say your passion can and will take you further than you ever thought possible. People always ask how we manage to stay awake in those hours of the night- it is God’s grace and something I believe called Conviction and Passion.

Passion is what keeps you up at 4am in the morning when every fibre of your body is screaming for rest. It is what keeps your legs running to the next patient because you know it is an impending emergency. It is what keeps you asking your seniors questions without fear of ridicule. Passion, is what makes you want to excel, and do the littlest thing well. A consuming love for God, then, can enable one to desire to pusue excellence not only in work, but in relationships and life too.

“Last’s night call was normal, Wai Jia. Welcome to GS (General Surgery),” said my senior doctor.

I asked the surgeons what made them give up so much of their lives, their evenings with their wives, their weekends with their kids, their energy, and all they said was, there was nothing else they would rather do. General surgery saves lives. It is direct. It requires teamwork. It is exciting. It is bloody, gory and in-your-face. But it is also tiring, does not pay as well as other more comfortable, more glamorous subspecialties, and it is downright demanding. There’re a lot of jokes made about surgeons in the medical fraternity, even more about female ones. We jokingly say they’re narrow-minded, that all they think about is cutting people up. We joke that it is a field predominantly owned by testosterone-filled males who’re stuck-up, impatient and grumpy. The female surgeons must be odd, single or childless, or all the above.

I suppose, there is a grain of truth in each of the statements. With such working hours, one feels chronically tired and yet pumped up, all the time. When I saw my seniors doctors seeing patients on a Sunday morning after an entire night of non-stop surgical emergencies in the operating theatre, and took in that this was what they did on a normal basis, I began to respect them in a different way altogether. Say what you want, but this, is a superhuman job. Imagine going in and out of surgery in the middle of the night dealing with wailing families when the last wink you had was more than a day ago, and the last meal you had was more than ten hours ago.

What can you do? It’s life and death for someone else.

My question for myself is, is the sacrifice worth it? If I were male and single all my life, my answer would most definitely be a resounding yes. But life poses its realities.

Is it wrong to want to settle down and have a normal life where I still have time to cook and paint and serve at church? Yet, isn’t it also wrong to settle for a job I don’t enjoy simply because of the better hours? I’ll be upfront- I don’t enjoy Family Medicine (aka GP work) or anything without an element of surgery. Yet, is the sacrifice to pursue this passion worth it? 7 days a week. Patients fall ill on Sundays too.

Right now… I’ve not met anyone to sweep me off my feet, and if that doesn’t happen, do I then pursue surgery? But why should I even need to wait? But if I don’t, would I then regret it? Ten years down the road, all alone while my friends have all married, with eyebags and a sleep deficit so huge it would take a hundred years to rouse me from slumber, would I look back and hate myself for my guts. Or would I look back in anguish and regret my sacrificial decision after marrying someone who turned out to be a scum of a man. I hate scums.

A senior told me this week, that for a woman to be a surgeon and to have a family life, a very unique set of circumstances must befall her. I suppose, very few men would tolerate that sort of lifestyle, fewer would tolerate a spouse with a higher salary, possibly a higher status. It is not impossible. But how, without her family and spouse feeling neglected, I do not know.

I don’t know what it is about me that enjoys challenge so much, and I don’t mean it in a good way. To quote my folks, “Why do you have to choose such difficult options? Why surgery, not family medicine? Why triathlon, not just simple running? Why liking to travel to developing countries to visit the poor, not just community service here?”

I don’t know. It must be the adrenaline that my mini-me craves for.

God, what would you have me to do? Give me wisdom and give me strength.

And I know it’s crazy for me to say this- that I’m really glad that I didn’t apply for any specialty or residency programme this year because I suspected this would happen. I suspected that somewhere down the line, in the most unexpected of places, at 5am in the morning when I’m sleep deprived and hungry and dehydrated and shivering in the operating theatre holding a retractor for a surgeon, I would discover what made my heart leap, what gave me grit and what gave me enough stout to say I liked something enough to miss a comfortable life because fulfillment is an elusive word which has no reason.

I’m still not sure what kind of doctor I will be. I’m not even sure what kind of woman I will be. I’m not sure if I will still enjoy surgery after feeling chronically tired and grumpy from long working hours and a lack of sleep. But I know one thing for sure-

-that for now, I really like General Surgery. And that scares and excites me, still.

Vocation is the place where your deep gladness meets the world’s deep need.

– Frederick Buechner