(Some thoughts on choosing medicine as a career by first-year medical students in a creative writing module, TCD 2014)

Screen Shot 2014-02-18 at 12.39.35Heart diseases cause 22.18 % of death in Malaysia which is nearly 1 out of 4 deaths that you can encounter in a typical hospital in Malaysia. The age adjusted death rate is 138.75 out of 100,000 populations, which is 2.5 times higher than the death causes by all types of cancer combined making it the number 1 killer in Malaysia. This frightening statistic is one of the reasons why I want to become a doctor or more specifically, a cardiologist. With the increasing fatality rate due to this disease every single year, I would like to add up the workforce of fighting this disease in my own country and if possible, the world. Local statistics show that heart disease risk factors, such as obesity, hypertension, diabetes and high cholesterol levels are on the rise. This arising risk factors is closely related to our lifestyle. About 75% of Malaysians never exercise at all but consume more food than the daily energy expenditure. Most of it are unhealthy junk foods. This is the second reason why I chose medicine as my career path. A doctor should not only be a person who sits 9 hours on the chair in a typical week days diagnosing and prescribing medicine to the patient. A good doctor gives advice to the patients and tries as best as possible to lead them towards healthy lifestyle as I believe prevention is better than cure. These are some of the objectives of a doctor which I am clear of.

Pretty cliche and plastic right? If I was given this kind of text, I would honestly just go through it as fast as I can because I can guess where it was going from the first sentence. I’m sorry to make you read one of the paragraphs in my copy-pasted-facts filled personal statement. Even I myself don’t clearly know what does age adjusted death rate really means or….what am I really doing in medical school. The only thing I remember for sure is how everything started three years ago. After passing the high school examination with a pretty good result, my family talked me into doing medicine when I was about to send an application for a local aviation company scholarship. I had reasoned with them about my choice but my parents are quite conservative (I don’t know if this is the right word). All they see about the most promising life I can live is that when I can head into the career path of an unremarkably average successful people. That is what I can simplify about their thoughts. At that point, I started to realise all these years I go to school because I am supposed to, not because I want to learn something. I don’t know if I’m lucky or unlucky to end up in a medical school.

I can’t help but always imagine the frightening future of me sitting on a desk in an typical government hospital like a zombie, 40 hours a week for a few hours of productive work just to pay taxes, support a family and get the largest mortgage that I qualify for and spend 30 years paying for it, when I know that I was close to pursue my dream. Don’t get me wrong. I honestly respect the medical profession as an honourable career. It is just me who can’t really accept how static the life of a doctor, working in the hospital.

Looking at the bright side, medical school is not that bad after all except for the fact that I only have to continuously study hard and accept the ethical principles that I usually don’t see eye to eye with to pass the exam. The stupidest thing I’ve tried so far is styling my hair in a way that makes me think that I look intellectual and wearing spectacles to make me look like I study hard. Doctors are not doctor for their appearance, but because they have interest in it.

The only reason I know that led me into this career is my need of satisfying my parents. I guess I don’t need to find so many reasons to do something that I have thousands of reasons to dislike when a meaningful one is enough. But I always pray that along this path, I will eventually find something that makes ME love doing medicine. Or if not, you’ll probably see me at a flying school in the future, leaving my medical degree certificate hanging on the wall for my parents.

PS: This is not an essay to express how much I blame my parents for making me choosing this course but rather to show how much I love them. They are not what you’d probably think of right now.            Conservative is the best euphemism that I could think of for ‘narrow mindedness’ which I save for myself in case if I am wrong about medical career which I hope that I really am.

~

Screen Shot 2014-02-15 at 01.07.44A med student and a Jamaican toucan shared the same dorm room. As you can imagine they approached life rather differently.

The toucan would frolic about the room washing, cleaning, cooking obscene amounts of ‘bacon’ all the while the student would hunch over a pile of books in the dim-lit corner, delving deep into another hours worth of meaningless minutiae. His stoic profile was his simple broadcast to his roommate “DO NOT DISTURB”.

As the toucan slapped on another batch of bacon he leant back on his bean bag as he blurted,

“Ey mon, I’d be a far betta docta than you man. I could get to de ospitale ten time quicka den you. We’re racing to Tallaght Ospitale tomorra”

And so it was that they would race. The student never wasted time talking to people while he studied, only when it was absolutely necessary. The student’s lack of protest was essentially meant it was on. That’s why the bird always spoke in definite sentences.

It was just then that the student considered his worth. He knew the toucan didn’t know the first thing about the talocalcaneonavicular joint, but when it came down to emergency logistics, do or die, get from A to B to save another human being, Timmy the Toucan would probably win.

“What am I doing with my life?” he began to think…

Why medicine? All I do is sit in this corner, never help Tim around the room. In a lot of ways, I’m useless. “Street Smarts” are lost on me, I don’t know the first thing about cooking and I don’t have a job. Is it really worth leveraging 5 years of uselessness with what would be (hopefully) a future of usefulness?

All my friends slowly drifting away.. The suspicious looks as I tell them I’m in at 9 for the 99th time. My xbox skills are clearly fading. Amidst this odd cacophony of doubt and worry, the student conks out.

The race was scheduled for 8 AM, before lectures of course, from the door of the BMSI to the door of Tallaght Hospital.

The two roommates arrived to the start-line together. The toucan looking slick as ever, shades, flatpeak, toothpick, the works. Beneath all the style however, he was unsettled. The entire trip to Trinity the bird wondered why the med had such an air of nonchalance about him…

“3…2…1… GO!!” squawked the toucan out of nowhere. The student smirked at how frivolous the toucan’s trickery would be. For just then the lad strapped into his newly-made jetpack, as one does! His proficiency with machinery allowed him to fashion his new invention from cups of coffee, coke cans, bungee cord and old anatomy texts. He rocketed into the air with such power, such force. He zipped past the toucan. ‘I’m not useless…’

It was just then. Right as he scanned over Dublin city that his mind bundled back to his anatomy lecture. Right then that he raised his head up from his A4 pad with scribbled toucans and jetpacks. For it was right then that he realized that this ludicrous daydream was oddly symbolic of his reasoning behind choosing medicine.

As an avid lover of machinery it may make more sense for this student to study engineering or other. For what are we modern-day humans without our precious tools? We are a stubborn race, we always attempt to better our lives. Out of our own sense of self-worth (or hatred of toucans) we enhance our output as an individual with machinery. This student, however, is enamoured by the concept of enhancing human’s output by enhancing their body and mind directly. For one day he considered the workings of a pacemaker and how intrinsically brilliant it is, despite being simple in concept. He thought of how the practical use of a car pales in comparison to that of an artificial limb, he thought of how the human body is in and of itself the most ethereal and visceral machine ever known. To understand even a portion of it is almost mystical, especially that squishy stuff at the top. This is his slightly bizarre reasoning behind choosing medicine.

This is not to say the cloud of doubt does not cast its shadow on him from time to time. But every time, the same thought shines through. The thought that maybe, just maybe, he could give one, just one person their very own jetpack of the body or mind.

And so his attention set on Dr. Mahony’s lecture. For he must plant his feet back onto this arduous path toward a medical degree, peppered with bioengineering knowledge to try make that jetpack…

~

People continually ask me why I want to be a doctor? Why I chose a career path laden with long working hours, a poor work – life balance and one which often comes with little gratitude for the work you do. They ask me this question looking for one simple, straight forward answer.

The Truth is I don’t have one.

My earliest impression of the medical profession came when I was admitted to hospital suffering with acute appendicitis. Rushed to hospital in the middle of the night, writhing in pain and delirious with a fever I was terrified and wished with every fiber of my being to be anywhere but there, the support, care and attention I got at the time has remained with me and made the memory a little less alarming. I was mesmerised by what they knew about me simply by testing my blood or asking a few simple questions, the ability at which they eased suffering sparked an immediate and long lasting desire within me to be a physician.

I love working with people.  They annoy me sometimes and let me down, but I truly believe that people are good.  As a doctor you can walk into a room and within 5 minutes of meeting someone be intimately involved in the most personal and vulnerable parts of their life.  That is amazing and a privilege that most people never experience.

Often people assume it’s for the money or the status or the ability to play god. however the real reason is  I am in medicine because I love learning, I love problem solving and I love people.  When you find something you truly love, then money becomes less of a concern. So why medicine?  Because I would never be happy doing anything else.

~

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My conviction to study medicine has gradually grown from a feeling, a thought as tiny as a seed, a seed that originally settled in my soul, having been blown there from the observations I made watching my dad. He is a GP.

At the age of 18, when filling out the inevitably CAO form I had experienced death in my life, too much death for someone my age. The most significant was the sudden loss of my uncle in a traffic accident in 2010. While this incident altered me in ways I can’t even begin to explain, it also fully opened my eyes to the importance of the medical profession. I believe medicine and doctoring are veritable mélanges of the different experiences and emotions of the human condition.

Looking back on that time in my life, it is clear to me that it watered and nurtured that tiny seedling and is now a constant reminder of the good I can do. I believe that seeing someone youl ove hurting and yet being strong enough to hold your nerve and show support truly shows inner strength and compassion towards those who are ill.

~

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[A fragment of life] Picture the scene. Sixty very liberal, very intoxicated youths in a Spanish villa, by an Irish harbour.

Questionable dance-pop and the questionable sing-along pulsing through the walls.

A smell of sticky beer, vodka and vomit in the kitchen.

A taste of sticky beer, vodka and vomit in everybody’s throat.

Outside, a youth is sprawled across a deckchair on the verandah. He’s covered in Jägermeister, dried blood, more beer – and of course vomit – and this particular youth is unconscious.

His pockets are empty: his wallet forgotten in a random bedroom he had napped in earlier. His phone is in pieces in the next room, having been danced into dust by a casually curious girl, but that’s another story.

For now, what’s important is the youth himself. Young, relatively innocent in his alcoholic sleep with Spike Island and Haulbowline and Passage West in the distance and the scent of fresh seaweed in the air.

The boy was less interesting that the setting. He wasn’t particularly distinguishable in this raving mess at all, but the narrator must introduce themselves at some point, no?

~

Screen Shot 2014-02-13 at 19.07.54The question ‘Why Medicine’ has always been a question that lingers around me. It is something that people ask me often and at times I end up asking myself.

I grew up seeing my grandfather suffer terribly with Parkinson’s Disease. As he grew older his condition worsened and eventually inspired me to become a doctor to try to help others that have his condition.

Well, to be completely honest, that was my stock answer to the question of ‘Why Medicine’. It came in very handy during interviews or when people asked. I would briefly tell them about my grandfather and that would be that.

As much as the story is true, though, and as it does explain to others why I chose medicine, when I put the question to myself in private, I just answer that I just always wanted to. True, it is a little vague, but it’s the truth. I never imagined myself doing anything else for a living besides being a physician. I have heard doctors personally lamenting their busy lives and crazy hours, but that has never deterred me. Right now, I know what I signed up for.

Even though it might not satisfy the interviewers, I am happy with the answer I give myself. Anyhow, soon people won’t ask me the question and it will only be myself I have to answer. I plan to have no regrets about it.

~

The sun hit the water and exploded into a million shades of blue. The ocean was flat so I felt safe to roll over flat on my back to avoid its dazzling reflection and just let the water rock the surfboard back and fourth while looking into the brightening sky of the morning. There are few certainties in life, sure death is always one and taxes another, unfortunately, but there are always things you never think about, day will always follow night and occasionally even the ocean will take a break and cease its endless assault against the defenseless coast. However, in an embarrassing twist of fate an old friend was just visiting me in San Diego for the first time in a few years. She always loved to surf but didn’t get to do much of it anymore, and in anticipation of her arrival I had been boosting about the fantastic rollers we had been having for the previous weeks running up to her arrival and now that she was actually here it was, naturally, dead calm. She paddled over alongside me with a smirk on her face that conveyed both the frustration of the situation mixed with the delight for rediscovering a long lost passion. We had not only been high school students together but also undergrad and later PhD students at UCSD, we both studied biochemistry and both ended up in the same research lab. In fact she was the first friend I made upon moving to San Diego when I was 14. She later dropped out of graduate school, transferred to Harvard law school and became a senior lawyer for a major environmental organization. At some point while scanning the horizon for the next potential stir of water the conversation turned to why she left graduate school. To my utter astonishment she said it was because it made her feel ‘stupid’. After a couple of years of feeling stupid everyday it was time to move on and do something else. I had always considered her one of the brightest people I knew and her subsequent career supported this view. At that point the gentle push and pull of the ocean seemed to give way and become more bumpy and disturbed, the sign of a renewed assault, and even though the sun disappeared behind the marine layer again I kept thinking about her comment all that day and for some time the next too.

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Her comment disturbed me for many reasons that I had never connected on a single line of thought before. What bothered me most was difficult to explain, science had by then made me feel ‘stupid’ also but I had either gotten used to it or had become too comfortable in the routine and security of daily life to give much thought to it or my previous childhood dreams of becoming a doctor. Either way I had been intrinsically unhappy for some time with my own career and the lack of direction and interaction with people on a daily basis that it entailed. But the metaphor ‘stupid’ that she had used implied a whole lot more than just this. For most people who study science we do it because we are good at it. In high school and college science means taking courses and doing well in those courses means getting the right answers on tests. If you know those answers you do well and fell smart. However research was completely different in that you needed to frame the correct question that would lead to a significant discovery, design and interpret experiments so that the conclusions are absolutely convincing, foresee any difficulties or problems and either solve those issues or look for ways around them and finally you only realize that you asked the right question in the first place when you get the right answer. In this context the scope of things I didn’t know wasn’t just vast it was for all purposes infinite and at that point all the dots connected and I saw the full picture. This realization hit like a wave in that I didn’t want to live such an uncertain life with no eventual practicality, end goal or purpose to it, just wondering around in a scientific desert till I either found water or died.

So then why medicine, simple, I’m a geek who loves science and loves a challenge. I also enjoy working with and understanding people more than lab rats. Another certainty in life is disease and illness and I’ve always had a genuine interest in health and the causes of ill health. Medicine simply offers the opportunity of a life that integrates all these interests, not just some of them, into a more holistic career. I still feel stupid though – it’s just in a more literal context now.

~

I was 4 and I was living in Italy. My dad had gotten a job over there and so, my mum, my older sister and I moved over there with him. We lived in an apartment in a humble but impressive town in the north, just outside Turin. We have a blissful life over there. The weather was perfect- It actually snowed in the winter and was hot and sunny in the summer-something we were not used to in Ireland. My dad’s office was no more than two minutes away from the apartment, which itself was about 5 minutes from the town that had scenic parks, divine pizzerias and heavenly bakeries.

One day, I think it was in January, we were eating lunch as a family in our apartment, as we did most days. My sister and I were finished school for the day- school ended at lunch time for our classes because we were both so young. As happened every other day, my dad went back to work after we ate and the three of us stayed in the apartment and played games, or whatever it is a mother does with her 4 and 6 year old daughters, in a foreign country and being 7 months pregnant.

My dad had only been back at work for about an hour when he received an anxious call from my mum. She told him that we all felt nauseous, dizzy and had bad headaches. She mentioned how my sister and I had fallen asleep on the couch, and how she would probably do the same now. My dad had eaten with us and he felt perfectly normal ,so food poisoning was ruled out straight away. Immediately he sensed something was very wrong, and he was right.

Within a couple of minuted after my dad arriving home, the ambulance had arrived and we were being carted off to the local hospital. The paramedics told us that they thought we had carbon monoxide poisoning. Carbon. Monoxide. Poisoning. I was four, so I was completely oblivious to what that was, but the look on my dad’s face told me it was bad. Really bad. I had never seen anybody look like he did before then, nor have I seen that expression since. Now, almost 15 years later I know what that look was for- he was facing the real possibility of losing his whole family.

We reached the hospital and already I had started feeling much better. Just getting out of that apartment and being given oxygen had quickly alleviated some of the symptoms. Unfortunately, my sister and I were in a different ward to my mum, and my sister did not take that well at all. She was hysterical. Me, on the other had, I was intrigued. It was my first real experience of being in a hospital. Obviously the situation wasn’t ideal, but I found myself living it up. I just remember being fascinated by everything; all the equipment, the doctors, the nurses, the oxygen masks, the IVs and the injections. I was four. I should have been afraid, but i wasn’t. I think it was then that it happened. I didn’t realise it at the time but now I know, that was where my dream and desire to study medicine came from. Thankfully we all made a full recovery, my my younger sister was born perfectly healthy two months later. I’m sure that if that outcome had been different I would not be studying medicine today. The skilfulness, the expertise and the kindness of all the doctors and nurses was inspirational! How could I want to do anything other than medicine?

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~

After trying to lift her car several times, to no avail, Sarah had become accustomed to the idea that in order to become a superhero, she would need to earn her superpowers, the way Luke Skywalker had, rather than be born with them, like Clark Kent. Nothing would prevent her from becoming the thing she had dreamed of since she was a little girl. She had convinced herself it was a question of will and concentration, and would sit in her room for hours with her eyes closed, mentally preparing herself to the idea of flying. She knew that when she was ready, wings would grow out from her back. It would be difficult to get used to their weight, and to the tugging below her shoulders every time she unfurled them, but she would manage. Until then, though, she would resign herself to her imagination. She drew out designs for her superhero costume, and dreamed of flying from New Delhi to Atlanta in 4 minutes flat. She could see herself saving lives, and flying away as quickly as she had swooped in.

Screen Shot 2014-02-13 at 19.20.36One day, while visiting her aunt and new-born cousin in the hospital, she went to buy herself a pack of candy while the adults cooed over the baby. She was standing in the corner of the elevator, munching on her m&m’s (focusing on the initial crack of the colored layer, then the sweet, melting chocolate, until finally the crunch of the peanut) when a woman in blue scrubs and a white coat walked in. Sarah stared at the back of her poney tail and admired the way every strand of hair was neatly tucked away, the way the white coat fell stiffly down without a crinkle or a fold. When the elevator doors opened and the doctor walked out swiftly, she didn’t hesitate to follow her.

A few steps out and she already felt like Alice in Wonderland, looking for the white bunny that had lead her here and instead finding a whirlwind of characters she never knew existed. There was the rush and buzzing, people flying from one side of the hospital to the other in a cool, collected panic, their ebb and flow resembling the careful mechanics of a clock. The doctors swooped in and out of patients’ rooms, rescuing the ones they could. She could imagine the surgeon, in the midst of a complicated surgery, calmly turning his face to the right, eyes still riveted on the bloody gap his fingers were in, and the nurse wiping away the sweat that was slowly sliding down his forehead. No shaking hands or rapid breathing, nothing to accompany the difficult task he was performing. Everyone just seemed to know where they were going and what they were doing. “This is as close as it gets,” she thought.

~

The uncertainty, the trepidation, the apprehension, the feeling of sickness in the pit of your stomach, it’s the first day. People tell you “it will be grand”“everything will be okay”, “going to college will be the best experience of your life”“you’ll meet so many interesting people”, “you’ll make so many new friends” and “your mind will be opened up to so many new ideas”, but they fail to prepare you for the anxiety and dread of the first day. Age or past experiences do little to alleviate the feelings of uneasiness or uncertainty. You are overwhelmed by fear, your thoughts are plagued by questions like “will I make friends”, “who will I talk to”, “how difficult will the course be” or more importantly “will I be able for it”.

A famous poet once said that “no man is an island”; he obviously was not referring to the first day of college. For in first few hours, we are all islands, isolated by fear, surrounded by a sea of uncertainty and despair. We go through the motions, conversing for the sake of conversing, hesitant to show our true selves or true feelings, our vulnerabilities are exposed, while all the time, the haunting questions resonate in the back of our minds.

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However, as the hours pass and the tides of uncertainty begins to recede, causeways based upon budding friendships begin to develop and the students are no longer islands, but they become continents, united by this shared experience. However, these events do not transpire without losses, there are inevitably causalities along the way, like islands eroded by the waves of anxiety and fear, lost to the sea of doubt forever. One wonders if preventive measures were implemented, could some of these losses have been avoided.

As the days and weeks elapse and calmness ensues, the friendships that were forged on the first day become stronger and new ones develop and the feelings of fear, uncertainty and insecurity experienced on the first days become an all too distant memory.

~

New world

The world is like a new place to be.

He has gone so far, he can’t believe;

So far, he thought he would never be;

So far, his old self could never foresee,

To a place so far from misery:

The world, they call Medicine Overseas.

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The first time he touched down in Dublin, he couldn’t believe his eyes, yet everything was too vivid to be a dream. He had never been to any other country in his life, so it made him feel like the world was new.

And, on top of this, to be studying medicine after 12 years of school! This also felt like a new world to him. Every morning he woke up and still couldn’t believe he was in this new world.

His dream to study medicine overseas was finally real.

But why? Why he would actually want to study medicine? What makes him willing to sacrifice his life for this stuff? For money? There are lots of other less complicated jobs that would offer tons more money than medicine. For pride? No. For publicity? Nope.

The only reason that feels true to him is just to be a champion like his father. Seeing his father being so helpful to his community while he was growing up, has left him wanting nothing more than to follow in his footsteps. Throughout his childhood, he witnessed many heroic moments at his father’s clinic: people always seeking him out for help, looking to him for advice, thanking him. His father was just too good not to be a role model. That’s why he doesn’t care if it takes so much sacrifice, his whole life even, and why he doesn’t care about the voices of criticism about his chosen path. As long as he can be a champion for the people, just like his father.

And now, here he is, in a new world of medicine and Dublin, taking his first step on that path. Realising he has only just started the journey, and there is more then a thousand steps ahead to take, he doesn’t care: the most important thing is knowing that he is on his way in this new world.

~

Melisma_

One of the more pessimistic medical blogs that I read while trying to decide whether or not to stay in medicine defined it well – this course is Nerd Everest.  In my experience, the most rewarding things to study are usually the ones that seem to actively repel any attempts to understand them.  For a long time I hated learning piano, until one day it mysteriously clicked.  Studying physics for the Leaving Cert was the same – at some point the thing just stops kicking you in the brain, and decides that you’ve earned a shot at real comprehension.  Both required discovering a new way of thinking about the material, and I don’t think medicine is going to be any different.  Some day, what seems like a melisma of clumsily co-opted graeco-roman, just a whole shanty town of syllables, may turn into something intrinsically meaningful and intuitive (I hope).

I can’t say I’m not disappointed at the lack of anything to just sit around and ponder, because that’s how I imagined college to be since I was old enough to imagine it.  A possible exception is ethics, though instead of meandering philosophical chats, it’s a case of playing at being lawyers for a few hours, since one traditionally prestigious career wasn’t enough.

Medicine gets stuck in my head to a much greater extent than any other subject I’ve ever studied, in a sometimes literally visceral way.  When I was on my way home at the weekend the moon was shining over the Suir as brightly as I’ve ever seen, and the first thing I thought about was how the texture of the river’s surface looked remarkably similar to that of the mystery hernia discovered at my anatomy table earlier in the week.

This year I live in the city, at the back of an old Georgian house with a view of a community centre from my bedroom window.  While I’m glad that I don’t get tormented by traffic noise, there are drawbacks.  This past week there have been exams going on in the centre, which have been giving me the fantods.  It’s an environment that’s getting more and familiar, comfortable even, and I’m not sure how I feel about that.  So what if the only thing I’m good at anymore is taking exams (and even then, it’s hit and miss)?

~