M5: Legends and legacies.

“Got cases?”

“Cases galore. 65/12. 45/18. 31/02.”

“Good ones?”

“Just the first 2. Last one is… okay.”

So it was true. Even though each of us swore against it, it was true. Once upon a time when we first entered medicine, each of us swore within our hearts that nothing short of death would come between us and loving our patients like our very own loved ones. We’d call them by first name. We’d know their occupations, where they lived, what they liked to do in their free time. A sinister legend had it that as we progressed into our higher years of study, things would change. Patients would become “cases” and diseases and bed numbers. So have you seen the LUNG CANCER at 4513? We swore it would never happen to us.

As the final exams draw nearer and every minute of the day becomes precious, I see with my own eyes how the legend may be… true.

“Is 45/13 a good case?”

“Yar. Must see. Damn good lor.”

Who cares about his name. The location is more important. Numbers tell me his location, his name does not. 45 tells me it is say, a respiratory ward, giving me an indication of his illness. A Mr. Mah, however, does not.

“Uncle, how are you today? My name is so-and-so. Thank you for letting me examine you.”

The over-rehearsed twang to the introduction gives its politeness away. After all, a proper introduction is 1 mark out of 15 in the final examination.

“So, Mr. Mah, what is your occupation?” A friendly tone scores points.

“WA, LET ME TELL YOU AH. I HAVE WORKED SO MANY JOBS! TOO MANY TO COUNT. LET ME TELL YOU….! IN MY YOUTH AH, I WAS SMOKING, AND I WAS LAZY… SO I….”

Panic ensues. Perspiration, like blood, drips onto the ground. The clock is ticking. 14 minutes left to interview the entire complicated medical history of this gentleman. To be honest, the occupation doesn’t really matter most times. It is the presenting complaint. Fever or no fever, chills and rigors? Nausea? Vomitting? Bloody or non-bloody? Any neck stiffness? Photophobia? Rash? Diarrhea? Pain? Where? How? When did it start?

13 minutes left.

“WAH, I TELL YOU AH. I WAITED SOOOO LONG AT THE POLYCLINIC. THE BUS-STOP IS SOOO FAR FROM MY HOUSE. I TOOK 15 MINUTES TO WALK THERE, THEN WHEN THE BUS CAME, I SAW THE NUMBER WRONGLY! IT WAS SUPPOSED TO BE 95, BUT I TOOK 92… IT STARTED RAINING LIKE ANYTHING YOU KNOW. WA, I SHOULD HAVE CALLED AMBULANCE, BUT SO EXPENSIVE…!”

12 minutes, and one’s heart turns stone cold.

A train runs through one’s head: (Look Uncle, I’ve studied 5 years in medical school to graduate. I have 15 minutes to find out what’s wrong with you, 2 minutes to make an educated guess, and 8 minutes to be grilled and barbecued by an examiner who looks like he could pulverise me if he wanted to. I really don’t care what bus you took. )

“So, what color was your vomit? “

“EY, I TELLING YOU MY STORY! CAN YOU LISTEN TO ME?”

“I’m sorry Uncle. It’s just that, I have a time limit. Can you help me please? Do you have diabetes?” One hangs onto this questions like a baby onto its mother’s breast.

“DIABETES? YA HAVE!”

And one’s mind starts running like lightning.

10 minutes 55 seconds seconds left. Meanwhile, one’s mind scrambles for a diagnosis while one tries to appear calm. Is it gastritis? Is it oesophageal varices? Secondary to alcoholism? How about bronchiectasis?

Thirty questions to ask about diabetes before time runs out. When did you have diabetes? How did you find out? Do you go for follow-up? What medications do you take? Do you have eye, kidney or foot problems? Heart surgery? Previous stroke? Laser done? What? Did you say you were admitted before? Why? You can’t remember? No Uncle, not Anlene. IN-SU-LIN! Do you take INSULIN?

4 minutes. Do you live in a flat with a lift-landing? Do you need financial assistance? Do you smoke? Take alcohol? Tried to quit? See a doctor regularly? (Uncle, please answer me crisply. My future depends on you. Don’t tell me it was raining and that you forgot an umbrella. Help me, please. I beg you. )

“YOU ALL AH, ALL THE SAME. WHY ALWAYS ASKING ME THESE SAME FEW QUESTIONS!”

Therein lies the dilemma.

I always knew this tension existed. Except that at no moment did it hit me more acutely than when I had a foul taste of my own medicine last week.

The night before the results for the award were announced, two reporters called me up for phone interviews. So when did you do Kitesong? Why? What inspired you? Oh, you had what? How come? Really? Tell me more. Huh, why not? You mean you what? Okay, yea sure.”

“So yea, that’s why I…”

” Uh-huh. Oh, sorry to interrupt you mid-way. Okaythanksbye!”

The phone hangs up abruptly. Excuse me?

It reminded me of past interviews that I had had- bad ones. Somehow, something of the dysrhythmic uh-huhs and over-zealous thankyou and hang-ups after a very intense conversation with scripted questions and little natural responses left slightly rancid tastes in my mouth. For the bad interviews, I had felt used, if only just a little. I felt wrung dry. As if all my experiences had been reduced to an assignment. In those instances, I could hear, from the noises over the phone, that my words were sifted- what was newsworthy and what wasn’t?

Suddenly, it hit me- did my patients feel the same way about me too? Did I make them feel like just another case, another write-up or research project?

I’m sure not all of them did. Some are most happy to furnish us with information, knowing it would benefit the next generation of doctors. In the same way, I oblige to interviews with the hope that my message may spur others on. And I know that many, if not most reporters do have good intentions. Yet, these grander purposes make no excuse for our bad bedside manners and lack of human touch.

Did you feel tired, after hoardes of us had asked you, over and over, what do you have? Did you feel just a tinge of being used? Did you? Did you ever?

I’m sorry. I understand how you feel. You are not an assignment, you are not our case write-up. You are not Ward 65, bed 12. You have a name, a family, a community. You have a hobby, a life outside this illness. This illness is not your name. You are God’s child. You are everything we knew you to be, before we were assigned 15 minutes to interact with you to pass our exams. You are and continue to be our greatest teachers.

Till today, my most fruitful and memorable experiences laden with the most learning value have been those meaningful interactions with patients I still keep in touch with today.

But it is not that we are heartless. The medical curriculum is extremely rigorous, and to look into the whirlpool in the eyes of every patient to try to see the glimmer of fear and anxiety and grief of their cancers, chemotherapy, degenerative diseases and incurable illnesses can be too much to bear. Keeping a distance, even with clinical jargon and fancy terms, helps us in some way, to maintain our sanity. Picking up scientific clues and piecing medical jigsaws together is stimulating and carries us through to the next day.

We see patient after patient after patient. 75/13. 65/09. 96/12. What? 76/03 doesn’t want to be examined anymore? Oh man. It was a supposed to be a good case.

Has our very endeavour to become noble doctors driven us further from our ideals?

Last week, as I left hospital, the father of a paediatric patient told me, “Before my daughter had this condition, I always thought doctors were normal people. But you are not. You are extra-ordinary. You are special people.”

I wonder if he knew about the 36-hour no-sleep calls we had to do 6 times a month. I wonder if he knew that we work more than 80 hours a week, and get paid less than $10 an hour for running around handling emergencies on overnight no-sleep calls. As he said this, his nose soured as he looked away at his cherubic daughter with curly hair lying on the cot with Pooh bear next to her.

” You have to be. It is people like you who let people like me sleep better at night.”

At this point, tears poured out from the edges of his eyes, as his fingers lingered across his little girl’s cheek. She had a hole in a heart and a transposition of the major arteries.

“Thank you sir. I just want you know, it is the courage of parents like yourself which keep me going, too.”

My finals are coming. Every moment has become precious. But there is no other occupation I would rather be in, nothing else that would satisfy this hunger in me that can only be called a calling. Today, I want to make the decision, to do my best to call and remember all my patients by name, and remember them as human beings, as God’s precious children and not numbers or diseases or by their scars.

Sinister legends can stay that way- sinister. But I want to remember all my inspiring professors who choose to tarry by their patients’ bedsides to chat a little, who choose the more courageous path by looking at those whirlpools in the eye. They are inspiring, and legendary, in their own rights. 15 minutes or not, one must try to be a decent interviewer, and not a crazy information-sucking machine designed to churn out diagnoses and treatment plans.

After all, legends are exactly what they are, and are as true as we make them to be.

“Thank you Mr. Mah. It was great talking to you. I hope you recover soon so you can get back to looking after your grand-daughter and walking her to school again every day like you used to.”

Let’s write our own legacies.