Time, Place, Person

*Wai Jia has just finished her one-month internship in the department of Internal Medicine and will begin her Geriatrics posting next week.

“Auntie! What time is it? Where are you? Who am I?”

She was shaking. Her eyes were droopy. Her head was tossed to one side sleepily, as her chest heaved up and down heavily. One look and you knew something was not right.

During my one-month internship at our local geriatric hospital, where I was tasked to function as a junior doctor under supervision, I saw many elderly patients being warded for the same condition. They would come in drowsy, trembling, mumbling to themselves, spouting gibberish or even flailing about violently, at all times of the day. Once, during my 36-hour sleepless night shift, I was tasked to catheterise a male elderly patient at 2 in the morning. This involves the dreadful task (no doubt more dreadful for the patient) of putting a tube with the diameter of a chopstick through a man’s private parts to drain one of any urine which might be retained in his bladder, which could be the cause of infection, a common cause of delirium.

“Uncle, where are you?”

Gibberish was his reply.

Not all patients with delirium present as obviously, though. One little old lady whom I took care of came in looking nothing more but sleepy. It was only on further investigation that she was diagnosed with delirium. Asking a routine set of questions helps to clinch the diagnosis.

By asking 3 questions, “Auntie, what time is it? Is it morning or night?”, “Auntie, where are you now?” and “Who am I?”, one gets an idea of how oriented the patient is to Time, Place and Person. It is part of the Abbreviated Mental Test.

Delirium has a fluctuating course. Patients get better, then worse unexpectedly. Mdm T’s daughter confided in me one day, “I’m very worried. My mother has never behaved like this before. She’s been asking me why the patient sleeping opposite her doesn’t have a roof over her bed! I thought she was getting better, now she’s gotten worse!”

I could understand. Just a day ago when I asked Mdm T the 3 questions, she answered that she wasn’t sure if it was night or day, that she was in prison, insisted that she had to take a walk to a particular place called St. Michael’s so she could have some ‘good food’, and said she didn’t know who I was, even though I’d been seeing her day after day.

Bizarre, no doubt. Patients in a state of delirium become disoriented to Time, Place and Person.

Not oriented to TPP, is what doctors would write in a patient’s case notes. Delirium refers to a clouding of consciousness.

My one-month internship ended yesterday. With the responsibilities of a junior doctor under close supervision and having 36-hour shifts to slog through (a feat of stamina through the night, no doubt- it means working and seeing patients from 650am till 2pm the next day non-stop), I finally had a foretaste of what working as a doctor in the department of Internal Medicine is like. Working life is different, tougher. And unless one stays strong to one’s goals and faith, one easily becomes disoriented.

It made me wonder if I too needed a reminder to be oriented to Time, Place and Person.

36-hour shifts (also known as calls) 6 times a month can really throw one into a circadian flux- am I ready for working life? I was only scheduled for 3 calls this time. I have never lost my temper with a patient, and could never understand when I heard stories about patients and doctors getting into arguements. But I learnt, that at 5am in the morning, sleep-deprived and hungry and overworked, one can lose one’s cool easily in the face of an over-demanding, whining patient. I know I nearly did. Overwork can cause a clouding of consciousness too, I thought wryly.

Time.

I asked myself, did I know what time it was? It made me see the importance of orienting oneself to Time, even though my body clock had been thrown out of whack, because it would help me understand that at 5am in the morning, working non-stop since 6.50am the previous day, I needed God’s grace to be extra patient, extra kind even though I was tired, cold and hungry and didn’t need someone to complain about my blood-taking skills.

It reminded me, that in the face of overwork, we each need to realise our limitations and remind ourselves that at unearthly hours, we may not be the same person. This awareness can help us be more aware of our emotions and reactions to situations.

Place.

Did I know where I was? Do I know where I am? I learnt, that it is easy to complain about one’s job. God, how can they make us work 36-hour shifts? God, how come there’re so many sick patients, why are some of them so ungrateful, why am I so grumpy? Why am I so lousy at some procedures? Am I in the right profession? I realised, my complaining spirit came from forgetting where I am- on earth, on “the side of heaven which isn’t perfect”, as what Prof S had told me. Once I remembered where I was, in a place between perfection and loss, redemption and fall, then I came to see and appreciate God coming through for me as I journey from one world to the next.

Do you know where you are? Or do you, like me, complain in a way as if this world were meant to be perfect? We aren’t there yet. Heaven is still a while away.

Person.

Have you ever doubted your abilities? Trust me, on a 36-hour call when you’re asked to draw blood from a patient whose skin is coarse and wrinkly and whose veins are dry and collapsed from every angle and you can’t get that precious vial of ruby gold, all those years of studying and intellectual amassing just make you feel like a fool for not being able to do the most basic job a junior doctor is expected to do. At 3am in the morning, when the phone keeps ringing and nurses keep calling regarding another breathless patient, I can only imagine the overwhelming sense of helplessness and stress one feels. I suppose, it comes from forgetting the person one is and the Person God is.

It helps to be reminded, that I am but a little person, a child still learning, still growing, and in times of desperation and utter frustration, the Person of God is bigger than me, and He, not I, is in control. God is also personal, and is with me even as I fumble and try my very best. Remembering this, often brings me the much needed calmness I need to steady my hands and the strength to tell myself that no matter what time it is, and where I am on this imperfect plane of existence, the Person of God will consistently bring us through our hurdles, struggles and challenges, through and beyond the 36-hour call.

It is 3am in the morning. I am on earth, in a transit from fall to redemption, sin to perfection. I am little but God is big and with me.

And all at once, I find that when I’m oriented to Time, Place and Person, my consciousness is no longer clouded, and I can work joyfully and peacefully again, with clarity of mind, at 5am in the morning.

“Uncle, I have to take blood from you. It’ll just be like a big ant bite, okay?”