Battlefields.

The past two weeks have been overwhelming, to say the least. What with having worked 80 hours each week, having completed two 30-hour shifts running around seeing patients through the night since being awake at 530am in the morning, and being barraged with a variety of different scenarios, unfortunate events and a battery of emotions, it’s been quite a roller-coaster.

It’s only when life and death present themselves so real and closely to one, does one realize the significance of being a physician. Doctor- the title comes at a price.

Every day, one is faced with challenges and abrasians to one’s values, ethics and sense of courage. There are many ways of doctoring, many ways of cutting corners or going the extra mile, and I am learning, it takes more than a will of steel or some high-horse morality to keep one going day after day after day. In the face of exhaustion, pressure from time and the expectations of one’s bosses, as well potentially unreasonable demands from a small group of patients, one realizes that nothing short of divine strength and faith can see one through till the next day, and the next 30-hour shift.

I was post-call yesterday (which means I just ended my 30-hour shift from Friday 530am till about noontime on Saturday, with hardly any sleep in between) and will be on-call again on Tuesday.

In a highly stressful job as this, with emotions and tragedy and joy and drama all rolled into a day’s work, one can find oneself caught in a whirlwind of emotions. I remember I cried that day. That early morning at 2am after receiving the news, I shut myself in the toilet and just cried. After all, we are human too.

It all happened so fast-too many things, in too little time.

I had learnt, that shortly after his discharge, the blood pressure of a patient whom I had grown quite fond of had crashed. That means he was this close to dying. I don’t know how exactly how or why it happened and don’t know the details thereafter, but knowing that, and remembering how his wife had placed her trust in me, and how his daughter had held my hands to thank me for looking after her dad, and how he, one day, finally softening from his fiery temperament, came to ask me why I even bothered talking to him and making him feel like a human being when he was so hostile to everyone… made it difficult for me to imagine how their family was coping now. They were reassured that he would do well after discharge, but his blood pressure crashed suddenly, and I do not know how he is doing now.

That same day, I got news that someone who had played a big part in my growing years and who had been a pillar of wisdom to me in my younger days had jumped off the top storey of his home. Parkinson’s disease, a debilitating and humiliating neurological disorder that only worsens with time in spite of medication had left him feeling too much of a burden to his family.

That same night, I was on call. I wondered how I would get through the night with so much weighing on my heart and mind.

A little old lady was complaining of chest discomfort. Beaten by all the drama that had happened that day and the days before, and also recovering from an extremely difficult confrontation by hostile relatives of a patient a few days previously, I asked God for strength and help. What was I to do? Ask the patient for symptoms of chest pain and breathlessness. Do an electrocardiogram to look for ischemic changes. Check her cardiac enzymes.

“Doctor, thank you so so much,” came the anxious daughter’s reply.

The phrase, “Hello, I am Dr. Tan. How can I help you?” has become a question I ask with fear and trembling. Trepidation often follows.

Check her cardiac enzymes– that meant having to take blood for the patient, something I still wish I were more proficient at. Oh God, help me. She was tiny, frail and shrivelled, how was I to draw these urgent set of bloods from her? But out came the steady stream of crimson relief which I sent off immediately.

Hours later, her cardiac enzymes returned- and the numbers were in the thousands, compared to a measly 32 in the previous blood result. Her undescribable chest discomfort had turned out to be a heart attack after all. Drowsy (both her and I but in different ways), two nurses and I wheeled her to the Intensive Care Unit.

We are so close to life and death, and that scares and inspires awe in me every day.

It scares me because I know I could potentially kill or save somebody. And it inspires awe in me because I realize that every day, I am standing in the gap for somebody, and I have the ability to make a difference. I could help somebody with my knowledge and care, or kill somebody with my ignorance or tardiness.

And yes, though the tears can come, at the end of it all, one must face the world of illness, tragedy and drama with fortitude and courage. And in the face of tremendous pressure, one must maintain composure and remember, to love always.

“You don’t have to spend so much time talking to patients’ family you know,” said someone to me, “Act busy. Whenever they talk to you, look at your watch and never spend more than 5 minutes explaining. There’re so many patients you need to look after, you can’t be spending time communicating all day.”

It brought to my mind my time in Africa, where the missionary doctor would spend quality time with each patient so every patient who walked through the doors of his clinic would feel loved and cherished. He never wanted any of them to feel neglected. It reminded me, that truly, God has so much patience with us and enjoys spending time with us, communing and connecting with us. And that is why we must remember love, love, love when dealing with the loved ones of our patients- even if they are unreasonably demanding, or hostile or overly anxious. God does not look at His watch when we ask for His attention. In the same way, we must try our best to spend time with our patients and their families, too.

A lot of miscommunication which begs a lot of explaining later on can then be spared.

Yet, even such a simple thing like this can be a tall, tall order when one has been working and running around from one hospital tower to the next, up and down flights of stairs for the entire day and still has the entire night till the next morning to function as a loving, compassionate and competent doctor.

Every day is a challenge, a returning to the battlefield to fight.

So today was my first rest day in two weeks, and already I feel like I’ve been stretched from end to end. Public holidays and weekends hold no meaning for us. This month, I’ve been scheduled for calls and work for every single public holiday and nearly every single weekend.

But I look at where God is, remember what He has called me to, and remind myself, that it’s a new day tomorrow. Today, I am tired. But tomorrow is a new day, with my next 30-hour call only a day after.

By myself, I know all I would want to do is huddle up in a corner to cry. But with God, His courage and His faith, every day becomes an opportunity to love and care for the sick, to trust in Him for giving us strength and vigor for the days ahead, and to do our best for every patient we meet.

I can’t do this alone, God.

I need You in the battlefield with me.

“It is God who arms me with strength
and keeps my way secure.
He makes my feet like the feet of a deer;
he causes me to stand on the heights.
He trains my hands for battle;
my arms can bend a bow of bronze.
You make your saving help my shield,
and your right hand sustains me;
your help has made me great.
You provide a broad path for my feet,
so that my ankles do not give way.”
-Psalm 18:32-36