From rags to riches

Today's entry has been brewing in Jerome's mind for a long time. Months, in fact. It wasn't put down into words because the issue touches a tender spot and he finds difficulty discussing it in prose without getting too emotional. Yet he thinks the issue is an important one to share, so he sat down one fine day and started typing away... Word by word, phrase by phrase.

I saw the tissue seller lady some days back, waiting for a bus. You'll probably know her as the lady who sings a fanciful tune to the words "one dollar, one dollar, tissue one dollar." She was dressed in a dull shade of green, carrying a nondescript, brown cotton bag. People in the queue who recognised her smiled, and she reciprocated courteously. Yet, you could see in her eyes that she was tired. She looked like she has just finished work.

This was on a Sunday morning, at 0020hrs.

Soon after a young chap dressed spiffily in a black jacket, carrying a Louis Vuitton bag, sauntered along, talking into his Prada LG phone.

The social divide.

You see the same thing in front of Paragon everyday: old folks playing tunes with their harmonicas, asking for a small token of appreciation while sitting in front of an elegantly decorated display window with words that read "Salvatore Ferragamo" across the top. And shoppers obviously satisfied with their latest acquisitions meanders around the perfomers, clad in Gucci and smelling of Chanel.

Jerome is not against branded goods. Heck, he carries an expensive, GPRS-enabled HP Ipaq and is secretly wishing to get Raoul shirts for his birthday. He is just lamenting on the social divide that seems to plague developed countries across the world.

He is fully aware, and decidedly reassured, that the government has never overlooked the low-income group when it comes to unpopular policies that make us dig deeper into our pockets. He is especially approving of programs that upgrade their work skills and enable them to secure better jobs and be self-sufficient, although he is uncertain if these efforts have enough reach to the poorly educated who cannot read and recognise the existence of these programs. And it is through the witnessing of these stark social divides that Jerome reminds himself how fortunate he is and to give back to society. Yet, everyday, he falls into meaningless and frivolous gripings of slow traffic, crowded trains, and busy work schedules, when there are people around him who work in menial, low-paying jobs until 12mn everyday while he takes 8-hour shifts seeing patients in an air-conditioned room.

Jerome takes his hat off to these individuals, and may this entry be a constant reminder of how we all can make their days brighter by helping within our limits, even if it's just a simple smile.

Turning on the heat

We call clearing the patient queue "fighting the fire", and the department would have had burned down many times over if this metaphor is taken literally. Yet fireman Jerome gets a thrill each time he is on duty. In the process, Jerome gets his hair singed, his legs scalded, and his face scorched. His trusty weapon of firefighting has taken most of the beating, after being dropped many times over, and run over by a trolley once. Yet, he gets to fulfil his yearn for instant gratification each time his patients improve right before his eyes. He is an impatient man, so he cannot be bothered to wait and see if iv rocephine for 3/7 works for your pneumonia. He wants to shock you so you wake up from VF, and tube you so your sats improve, pronto.

This is why Jerome is not deciding on internal medicine for his BST, though he has been told he is "medically inclined". He's not fantastic with his hands either, which jitter a bit each time he does his T&S. So, surgery is kind of out too. This leaves him with nothing much actually.

Not too long ago Jerome received career counselling from a senior, who stated point blank that he is "not politically savvy enough" for a surgeon, and "not patient enough" to do ward rounds every day for the rest of his life. She also reckons that Jerome will be "bored with anaesthesia," what with their meticulous, obssesive-compulsive behaviour, and minimal patient contact.

Jerome is grateful for these candid remarks. He now thinks he should probably try out a career in firefighting.

The comeback kid

Jerome returns to the blogosphere after a year-long hiatus, due in part to his need to practice writing in full sentences instead of cryptic phrases like "heart S1S2" and "LoSoKo".

The past year has been eventful, as anyone who's trudged through housemanship will probably say. Memories of handling a patient list of 40 alone or feeble attempts to battle ptosis after a tumultous night call bring a curiously stimulating chill down the spine, because, despite all its aborrhence, we have all made it through and eliminated the "P" before our MCR numbers.

And we make further progress. Friends around have taken their exams and gotten their traineeships, all ready to embark on the next phase of their careers. Yet, jerome continues to dawdle around, agonisingly uncertain of what his next move should be.

Jerome doesn't hate his job, but the truth is, it wasn't as exciting as he imagined it to be. Medicine can be a rather mundane thing because it seems to him like some sort of a "pattern recognition" activity where you fit history and physical examination to a list of differentials, then investigate to confirm it. This gets pretty boring after a while, as he believes the polyclinic doctor seeing the 16th URTI patient of the day will probably confirm.

There are definitely interesting cases around, especially in his present department (A&E) where you can see firsthand a VT returning to a perfusing rhythm after defib, amongst other things. Perhaps this is the only place where it is possible to reduce a shoulder dislocation, T&S a finger laceration, I&D a buttock abscess, intubate a collapsed patient, convert an SVT, and wrestle a delirious drunkard, all within the span of 8 hours. This explains why Jerome’s spirits have been lifted since he came to the department.

However, Jerome’s going back to army soon. Whilst it's going to be a much welcomed break from clinical work, it will be prudent to start planning for the future so that the 2 years in green uniform will not be wasted.

Unfortunately, attempts at planning for the years ahead have been painfully unproductive, because Jerome suffers a relapse of his self-pity in M1 when he struggled to rationalise his choice of medicine over “the other thing”. It is interesting to note that he has just received a feedback form where the last question asks "If given a choice, will you choose medicine again?" and his eyes wanders and looks forlornly at the box marked "unsure". Jerome had no answer to that question. And he never had for the past 6 years whilst in the medical fraternity.

So, Jerome remains undecided of his next step. Maybe his friends can offer some advice. In the meantime, Jerome continues with his job and valiantly endeavours to whack the self-pity out of his psyche.