Growing up medicine - not everything is peachy

There are moments in medicine where you feel confident and enjoy what you are doing – scrubbing in to the operating theatre, clerking new patients, talking to family members. But sometimes all it takes is just one bad experience to bring it all crashing down. Some of my HOs tell me of patient encounters where they had to deal with difficult family members who were rude, others tell me of the problems they face with their own colleagues. I took it in as advise for my future. Though medicine is indeed a noble profession, it’s nevertheless still a profession in today’s modern society, and as such cannot escape the problems that other jobs face. I am talking specifically about the politics of the work place, and yes, have already seen some play out before me as a second year student!

I was at KK (Kandang Kerbau) Hospital last night with a classmate, doing a night call with Dr. S, one of our Duke lecturers at Children’s Emergency. It was uneventful for the most part; we saw good cases, learnt quite a bit on different approaches and saw some new techniques being performed.

At about 3:00am, a young Indian girl came in for an exacerbation of asthma, and was severe enough to be given magnesium sulfate to reverse her condition. As per KK protocol, she was to be admitted into the High Dependency Unit (HDU). We followed her up to the ward, and were to observe how handovers are done from the CE to the HDU. The handover went smoothly, but as we were exiting the HDU, a doctor came hurriedly towards us, a look of disapproval on her face. She was the registrar in charge, and had a look of someone that had been wronged.

“Did you know that was our last HD bed?” she asked.

“Yes, we were told so by the staff but this girl needs to be monitored overnight due to her use of mag sulf,” replied the medical officer who had come up with us.

The next few exchanges between the two were not very pleasant. The HD registrar had an air of haughtiness, and was not respectful to the MO. Though not blatantly swearing at the MO, expletives were used to express her frustration at why her ward was now fully filled. She even had time to give me a snide remark. At the time, I thought this was a normal reaction – after all, the registrar had just woken up from sleep (you could tell from her crumpled scrubs) and now had more work to do. Doctors are after all human.

Going back down to Children’s Emergency, I did not really think much of the incident. This is not the first time I’ve seen a doctor swearing (I have done it myself, though never in front of my colleagues and patients), nor is this the first time that I have seen friction between departments and wards. It was not till we had to return to the HD at 5:00am (with another new case), that things got a bit more ‘colorful’.

            An infant had come in due to excessive dehydration, and was in a state of metabolic acidosis. He required IV fluids, and was going to be put on a hypotonic fluid regiment (this was an indication that he needed to be warded into HD). Now, knowing that HD was already full, I voiced my concern to Dr. S. He was a senior consultant at KK, and told us to not worry and that HD will figure a way to make room for a child that needed a space.

            I was not part of the administrative process, but the MO who was handling the case reported that he was yelled at and denied a space at HD. We were told to bring the child to ICU instead. The Associate Consultant then made the same call, trying to smooth things over and ask the registrar nicely that we needed a bed. Again, we were met with opposition, and this time it was less courteous than before (I thought this was absurd, considering that he was more ‘senior’ than her). Finally, our infant was allowed to HD, though I am unsure of what strings the Senior Consultant had to pull to get things moving.

            As I was wheeling the patient to the HDU, there was a sense of dread in me. Would the registrar be there waiting, ready to yell at the MO and us for bringing her another patient? No matter, I thought. The patient needed a bed, that was the bottom line. I needed to get over myself.

            When we got there, there was no doctor around to do the handover. Whilst waiting, the MO quietly told us to leave if things got a bit heated between himself and the registrar.  He didn’t want us to get yelled at, nor see such unprofessionalism so early in our careers.

The registrar from before showed up. My MO was reluctant to perform the handover to her (MOs normally handed over the case to another MO, not to a senior doctor). She started asking questions, so my MO replied and described the case to her.

“Are you handing over the case to me?” she asked. There was scorn dripping from her voice, the kind that you watch in movies but rarely see in real life.

The MO remained silent, and said he will wait for the on call MO to come. The registrar continued asking questions, of which he replied her questions again.

“Are you really trying to hand over the case to me?” she asked again. This time, she was sitting crosslegged, ignoring the MO and looking mightily irritated.

The on call MO then showed up, and a handover was done promptly. All the while the handover was being done, the registrar was fiddling with her phone. She at last looked up and asked me if I knew how to calculate free water replacement in a patient. I remained silent – I am aware of the formula used, and we had just gone over it downstairs with our senior consultant. But I was not sure if she was genuinely asking me or just pre-empting a snide remark (as from before). Before I could mount any response my senior consultant walked into the ward.

“Hello boss!” smiled the registrar. “How are things?” she asked in a sweet voice.

“Ah okay, just came up to check on the patient,” replied Dr. S.

“Oh, what is the best way to manage him? Should I check his osmoles in 2 hours?” came her response.

This went on for another 2-3 minutes, and the registrar was up and about walking checking in on the new admission (she was seated for the last 15 mins at the front desk and did not bother to check the new admission before Dr. S showed up). She then told Dr. S how she was teaching us on how to calculate free water correction in an infant, and that we were learning from her. Dr. S just smiled.

            Dr. S then took us to the side, and asked if we had observed anything. His question was vague, more query than demand. I replied that yes, there was a sense of unprofessionalism as well as bad manners that was exhibited. Dr. S smiled again. He asked how she was before he showed up. We described what had happened (specifically how the MO was not treated well). I have strong sense of justice, and felt that our MO was doing his duty as a doctor.

“I knew what was going to happen, that was why I asked both of you to come up here to observe the situation,” Dr. S explained. “I knew she was not going to be happy, and that she would take it out on my MO, but that when I show up that she would do a 180 and change her behaviour.”

“I wanted you to see that,” Dr. S concluded.

We then left the HD, and Dr. S shared with us the importance of being professional, not just to your patients but to your colleagues as well. We talked about respect, and that how people sometimes are bitter at their predicament and take it out on others. This was all not new to me – after all I am nearing 30 years old and have seen my fair share of work ‘drama’.

No, what really got me was this:

“So Dr. S, why did you come up to HD? Normally Cons don’t do that right? You just wanted us to see her reaction change?” I asked.

He looked at me puzzled.

“No,” came his reply. “The MO had told me that she was giving you guys attitude from the last admission. Plus she had yelled at my MO and A/C. There was a high chance she would yell at you guys as well, and I went up there to make sure that did not happen.”

It was my turn to smile.

I mentioned before how there were things in medicine that can make or break your career, willpower or willingness to move forward. Dr. S’s moment of being a ‘mother hen’ is one that I will cherish for a long while. Meeting registrars like the one we encountered will not be a norm, but it will not be an anomaly either. Knowing that there are good doctors out there, like our MO and Dr. S who watch out for those ‘younger’/junior to them is heart-warming. They were a clear representation of doctors who recognize respect goes two ways, and do not hide behind their titles.

            It is hard to describe what I felt at the time, but there was a sense of collegial loyalty between a mentor and his student, between a senior doctor and a trainee, and between an older man and a younger one. I will remember this, and hopefully one day be able to shape and imprint a young doctor to be the best they can be, not in terms of being a clinician, but in being human.



This is a  Public reflection which is publicly available for anyone to read.

Created on 22 October 2017 by Albert Teo