Living in an Epidemic

When I was reading about the Ebola outbreak last night, I thought of my time in Taiwan during the SARS epidemic. So I went back to the diaries I kept during this time and found couple of interesting entries. I was there as a Fellow in one of the world famous plastic surgery units during 2003. A Fellow is a young doctor who travels to another hospital unit to train for a specified period as a ‘trainee’ doctor, usually to learn from a specific doctor or a particular procedure/technique.

I have left this entry unedited, as it is a true perspective of an Australian living in Taiwan during the SARS epidemic, both as a doctor and local resident.

25th Aug 2003

It’s been more than two months already since the first wave hit Taipei. I still remember the panic that hit the city during that first week; it was when they closed down Ho-Ping Hospital in central Taipei, with all its patients and staff isolated within the hospital. It was constantly being aired on the news and the hospital exterior was being videoed 24 hours a day, a bit like reality TV. There were scenes of flying badmington cocks over the railings of the balcony, and I remembered the presenter reporting that it was great to see that the occupants of the hospitals keeping up their spirits, and exercising to keep fit. The comments from my male colleagues in the TV room at the time were less than polite. I think something was mentioned about there are better things to do when you are couped up with a whole bunch of young nurses. *eye roll*

Then there were news of individuals who were to be isolated at their own homes because they’ve been in contact with SARS suffers. After which, news of non-compliant isolated individuals venturing out of their homes were reported with the police were called to herd them back home. They have now posted guards around quarantined buildings to stop residents from ‘escaping’. Cases were on the rise, another hospital got shut down, and the mortality is starting adding up.

I have missed my chance to go home. Four weeks ago our department director gathered all the overseas Fellows in his office to let us know that if we wanted to go home and leave the country, he would still be happy to write us a certificate for our fellowship and recommend us for jobs back home. There were 7 of us, two from Harvard in the US, 2 from Italy, 1 from UK and another from Ukraine. The Ukrainian and I stayed. It was really a blessing in disguise, because now, instead of elbowing other Fellows out of the way for an opportunity to do cases, we are both operating more than 12 hours a day. I joked to my concerned parents back home that I spend so much time in the operating theatre with its filtered and uni-direction airflow, I am probably at the lowest risk of getting any respiratory virus. They weren’t amused. Wherease my boyfriend just said that if I got SARS, he wasn’t coming to visit. I’d like to believe that’s anger and frustration talking. I can understand why he’s so pissed at me. I think I would be too if our positions were reversed.

The one thing I have discovered about living in this SARS epidemic is that there seem to be more pregnant women than usual at the moment. One nurse mentioned to me that since we have to take our temperatures every day as required for all hospital staff, she has finally managed to get pregnant during her last cycle as she knew her exact ovulation date. A fellow colleague also mentioned that you can pick the pregnant nurses during this epidemic, as they are usually the ones wearing an N95-grade mask. These are heavy duck-billed masks which have viral filters and are very hot and uncomfortable. Most staff members such as myself (who want to breathe and admittedly am a bit blasé about the whole thing) just wear the regular light ones.

Oh well. You’ve gotta learn to see the bright side of life when living in an Epidemic.

Administration has been harping on about wearing the right masks, but I seriously believe that if I wash my hands (which are raw from scrubbing all day), and keep away from sniffling, slobbering people, I’ll be fine. I have been avoiding public transport as much as possible. I have blistered on my feet because it takes me one hour each way, walking to and from work. After 8pm, I just sleep in one of the spare beds in the Burns Unit. I suppose I am like every other deluded doctor at the moment, we think we are being ‘adequately’ careful and probably invincible.

A thought just occurred to me. If I die in this epidemic, I won’t be able to hear ‘I told you so.’

Well, I guess if I am not back tomorrow, you know I am being ventilated in ICU with SARS.

 

 

‘Doctor’ is my Job. Not who I am.

I hate travelling alone. Somehow or rather, I always end up having a conversation with whoever sits next to me. I don’t mind the conversation, but sooner or later, the ‘oh-so-casually-asked’ question comes up: ‘So, what do you do for a living?’

I always hesitate. I always consider lying about what I do. I just don’t want to say I am a doctor.

It took me a while figure out why. Apart from the fact that once people find out they are talking to a doctor, they lose all interest in talking about anything else. Anything else but every medical condition or surgery they have ever had. Then they move onto each of their family members and friends. In between, they give you their five cents’ worth of why they knew better than the doctor, and how Dr Google was so helpful. By the end of the flight, they would be asking for a free in-flight consultation as to what my opinion was in regards to dear old departed Grandpa’s gouty big toe.

I get that. I really do. I find myself doing the same when I talk to people in certain jobs. When I first met my friend who is an airline pilot, I told him about all my terrible flying experiences. I could literally see his eyes roll to the back of his head as I carried on. But he has no qualms in telling people he is a pilot. In fact, he loves it, because he says it is a great drawcard for chicks.

I don’t think it is a drawcard for me. You could see the interest dimmer in men’s eyes when I tell them I am a doctor, or the body language wthdraws when I mention that I cut people up for a living. Well, not exactly in those words. It is often hard to tell whether it is because they are intimidated or they are just not interested in female doctors. Of course, once they get over that fact – and they haven’t moved onto someone else with a greater one-night-stand potential – I get the low-down about their latest health problems over a beer. No Siree, there’s no flirting for the female doctor at the bar, It’s all serious talk about their latest health problems. When boys fantasize about playing doctors and nurses, I guess they just never really imagined playing the nurse.

People judge people by what they do. Assumptions are made- some are true, but majority of the time, it can be quite far off the mark. These are often based on stereotypes. So, when I tell people I am a surgeon, people usually presume that I am a smart, rich, arrogant, bossy, ball-breaking feminist. Some even assume that I am single. Interestingly, some people talk differently to me once they realised what I do for a living. It is almost insulting when people make comments like ‘You know, you are not like a typical surgeon. You are so normal and down to earth.’  Yep. I eat, drink, wee and poo like any other normal person.

But most of all, I hate telling people that I am doctor, simply because it is not who I am.

I am a surgeon, and yes it consumes my life, but it is still just a job for me. I would still be me if I was a teacher, waitress or cleaner. I would still have the same work ethic, the same standards and the same approach to my work. I don’t identify myself with what I do for a living, but rather, what I do in life.

I think it is a good thing.

It allows me to separate my personal life and work life better. In the time continuum, they do overlap. For instance, when I am out shopping for groceries, I get a phone call from work. But I don’t think of myself as a surgeon doing groceries, I identify myself with everyone else around me doing groceries, the only difference is I am getting a call about work when it’s a Sunday afternoon. When I have issues at work, I don’t bring it home to my personal life.  When I have problems at home, I deal with it like a concerned wife, not like a surgeon.

It is also good for protecting myself. When I get abused by patients, or complaints from colleagues, I find it easier to see it as a criticism of my work, and less an assault of me as a person. They don’t know me, not really, they are just angry at the doctor. This allows me to look at my work more objectively and find out what I may be able to change or improve, rather than get all upset because I feel incompetent, hurt and lose my self-confidence.

My husband likes it. He thinks that I keep the non-doctor part of myself only to those closest to me. He often chuckles when he hears me speaking on the phone to my colleagues at home. ‘You talk like you have balls.’ Not the most eloquent compliment he could bestow on his wife, but he loves the fact that as soon as I put the phone down, I revert back to the quirky chick he married. The one that snuggles up to him on the sofa and lets hm believe that she worships the ground he walks on, whilst taking a piss out of him all at the same time.

Most of all, separating my job and my identity allows me to have a life outside work. I have other interests, many of which are not exactly congruous with what I do for a living. I suppose most people think doctors play golf, sail, travel during their spare time. Me? I enjoy bashing up my Sensei and his gigantic sons during my karate training sessions (free medical care offered if I win).  Other weekends I go to the gun range and work on my not-so-perfect trap-shooting technique, in between cheese tasting with the large Italian community at my local gun club. I seriously think that I would be more comfortable calling myself a mediocre amateur trap shooter (who loves her chilli cheese), than I would a surgeon.

Discovering my identity outside my work gives me the opportunity to find out who I am, and confirms that I am not my work.  It gives me a purpose in life even if someone strips me of  my job and all the associated status it represents. It determines how I do my job.  How many times have I heard of senior colleagues continually postponing their retirement? It is because they are too afraid of retiring – they have nothing besides their work and they are at risk of losing their identity once they stop being a doctor.

I would hate to think my view is a reflection that I am not committed to my work or that I don’t love my work. In fact, I really believe that I make a better surgeon if I am also a regular human being. I hope that people don’t just see me as a ‘doctor’, but rather a kind, thoughtful, considerate, empathetic, intelligent, decisive and trust-worthy person. A person that they feel confident in as their doctor. Because that’s who I strive to be.

Back to the plane.

‘So, what do you do for a living?’

‘Oh,’ I would shrug, ‘not much. I am a lady of leisure.’ I wave my hands around elegantly like a practiced socialite. ‘but I am fairly busy,’ a sweet innocent smile thrown in here, ‘I go to lunches with my girl friends, I love a bit of shopping; I organise charity functions and I always attend my husband’s work-do’s, you know.’

Usually I get an indulgent smile. ‘Well, you lucky girl.’

I would give a very girlish giggle. ‘I know, my husband spoils me.’

The conversation takes a brief break as the air hostess wheels the coffee cart up to us. She bends over to me.

‘Dr Tiffany, can I offer you a coffee?’

Damn. Sprung.

May be there is a doctorate in home-decorating?

Speech to the Wannabes

Good evening. Thank you for giving me the opportunity to speak. I remember sitting in those very seats you are in now, back in the days when I was a medical student like yourselves.

I was asked two weeks ago, by your faculty Dean to give a talk to you all, on why I chose to do Surgery.

I thought very hard about it, maybe too hard. I thought of all the clichés I should throw in, like it’s satisfying, it’s challenging, it’s interesting. But what field in Medicine isn’t? Somedays, I catch myself envying my colleagues in their jobs, and somedays I walk away from a problem, glad I didn’t have to deal with it.  There are days I am appreciated by others for what I do, and there are days when I am belittled and teased about what I can’t comprehend as a surgeon.

So I have decided that, today, I will tell you why I chose not to do anything else.

I don’t think I could ever be a radiologist. I am afraid of the dark. In surgery, I am always working in a well-lit room. In fact, people around me will always move the light so that it is directed at me and my work. The operative lights are powerful, and for someone who loves being the centre of attention, I am constantly in the spot light.

I could never be a pathologist. They deal with dead people, or bits of tissue (which are also dead) removed from the body. I like to work with living people and living tissue. I also like the skills I possess to revive them under certain circumstances. I am sure findng the cause of death or disease is satisfying for the pathologists, but I figured that finding the cause and being able to fix it, is even more gratifying.

I would find it hard to be an anaesthestist, because then I would end up spending the majority of my time with people who are asleep. I already do that when I get home late from work, although occasionally I do get a grunt or two when I tell my husband about my day while he is slumbering. I am not very good at crosswords and sudoku either. I think if I had to sit there, listening to the steady beep, beep, beep for hours, staring at the squiggly lines on the screen, I’d find it hard to stay awake. Worse still, if I was an anaesthetist, I will have to stand there and be a spectator while the really exciting gory stuff is happening on the other side of the drapes. That’s just not me. I’d rather be the loud conquering hero, elbow deep in blood, than the quiet achiever behind the scenes.

I might have be tempted to become an Emergency physician. TV dramas always project them as exciting heroes, with challenges where they can save lives.  But when I did my ED term as an intern, I realised that these dramatic moments come rarely (which I guess is actualy a good thing). I spent plenty of my time in ED admitting little old ladies with pneumonia and falls, stitching up aftermath of drunken brawls, and sedating IV drug users whilst trying not to get spat at. Sometimes I think it’s awesome that the emergency doctors do shifts. That when they leave work, they don’t really carry further clnical responsbilities because they have ‘handed-over’ to the next doctor. I also found it frustrating, because I never found out what really happened to that 40 year-old man who came with babushka dolls in his rectum, as seen on his abodminal x-ray (because he fell on them, so he said). I felt like a traffic director because the responsibility ended when the patient has been referred on to the appropriate speciality for further management. So I never knew what was done to treat them, or if I even got the diagnosis right in the first place.

I don’t have the strength to be an Oncologist. It is probably one of the very few specialties where the doctor deliberately harm the patient with poisons, in the hope that it will treat or hold their cancers at bay. For the few that are saved, many benefit from prolonged lives, which sometimes, are accompanied by suffering. I think if I was an oncologist, I will have to be comfortable with the concept of Death. This would be hard, because in many fields of Medicine, death is viewed as a failure of the doctor’s abilities, even when we know there is nothing that can be done. I like successes, and I take failures too personally. I would not last in Oncology.

I love Paediatrics. It’s the parents I can’t deal with. There were days when I did paediatrics that I was tempted to prescribe sedatives for the parents, and gave my little patients vitamin C pills (also known as placebo for children), just so that the parents felt that I was doing something for their child. Dealing with babies, is like vetenary medicine. If the child doesn’t bark (cry), play, eat or poop, one had to figure out what is wrong with it, sometimes with almost no lead to follow. I am not that smart, I like my patients to tell me what’s wrong and what they want. And I need clues like sledgehammers.

I am a planner – my life is planned down to 15-minute blocks. Obstetrics would wreck havoc with my mental stability. Babies never book an appointment to appear. They come when they are ready, or sometimes, even when they are not ready. They also don’t book the length of their appointments, some want only half an hour and the others take their sweet time in getting to the point. Getting up at 2am to extract inconsiderate babies and performing an emergency caesarean to facilitate their wish to exit via the sun-roof, does not sit well with my planning tendencies. No, obstetrics would definitely antagonise the control freak in me.

I think General Practictioners are important. Family doctors are the crux of all communities and health systems, and they are family to many patients. They deal anything from simple cough and colds to complex medical dilemmas. Their knowledge has to be so broad as to include all possibilities in medicine. They also have to think about their patient’s social situations, and almost take on the role of a social worker. I have neither the acumen for broad general knowledge (I am always the weakest link on quiz nights) or the patience for complex social situations (I have serious foot-in-the-mouth syndrome), so I think I would score an epic fail in family medicine.  I know just about everything in my little specialty corner amongst the big wide world of medicine – so I think I will stick to what I know.

I can deal with a lot of gory things, like chopped off fingers, haemorrhage and fungating tumours, but there are a few things that make me gag. Phlegm and Mucous. I guess that ruled out respiratory medicine for me. Collecting and looking at gooey bubbly mucous in collecting pots brought bile to my throat. Subconsciously, whenever I hear a very fruity cough, I hold my breath to push down my gag reflex. I admire those who deliberately seek out rattling mucous in patient’s lungs with their stethoscopes. Ergh.

Physicians are smart. Like Sheldon in Big Bang Theory. Comprehending complex medical problems, working out multiple drug-interactions and ordering the right tests to solve confusing symptoms seem like second nature to them. They can’t fathom why anyone else haven’t worked it out yet and the looks of incredulous disbelief (or disdain) when a question is asked, is part of their usual demeanor. And yet, for all that incredible intellect, they are pathetic mechanics. They don’t seem to be able to grasp the physical aspects of the human body nor the common sense of surgically removing the cause of a problem.  Don’t ever try to quiz a physician on anatomy. They do know a lung, stomach or the brain when they see one, and they do know the rough whereabouts these organs lie, but they’d be hard pressed to know the origin and route of every blood and nerve supplies. Some even turn pale at the sight of blood, and becomes completely useless when anything remotely looking like a surgical instrument is placed in their hands. My mind is not geared like a physicist or mathematician. I cannot think like a physician. I don’t have the patience to wait and see whether a drug I have prescribed is going to work or not. I would much rather do something active about it. Even then, after surgery, I usually can’t wait for the patients to wake up and let me know if they feel better.

By now, you might think if I wasn’t committed to the world of insane, I would make a good psychiatrist. Wrong. I have lots of time for shrinks. In fact, I have spent a lot of time with mine. I remember thinking, as I went on and on about the stresses of my work and how pathetic I feel, painfully dragging it out into a full hour, why anyone would spend day after day listen to people whine about their problems. In fact, what was even more frustrating, was the fact that there was nothing he could do about my situation. He couldn’t make my bullying colleague stay away from me; he couldn’t tell the crazy patient to stop hassling me; he couldn’t give me two months’ worth of salary so I could take a holiday; nor could he try and change my husband into a domestic goddess. He was a sounding board, someone to make me see a different perspective of my life, and occasionally, fiddle with my medication. He has always told me that I would not get better, or cope with life, until I have decided that I can and  I will. I would find being a shrink so frustrating, because I cannot control how my patient feels, change their situations and be able to actively do something to help. For this one, I think I’d rather stick to my role as a patient.

Please don’t think I am bashing other specialities. In fact, I admire all my colleagues, and at times, I envy them. Because I know I can’t do what they do. But if you want a straight answer to why I chose surgery, here it is.

It is because I love it. I can make a difference in people’s lives, I find what I do exciting, and I know I can do it well.

But this is what every doctor will tell you about their specialty.

Don’t just chose surgery when you grow up, chose something that excites you and something that you are passionate about.

And if that happens to be Surgery. Then you have great taste. Like me.