WHAT SHOULD I EXPECT DURING INTERNSHIP?

“Complete medical school… go on to complete internship, then you shall be on a course to a great path.” Such nice words should stick and like those before us, we get to see the results immediately. Such, was the earnest comprehension of what the medical field offered six years ago. Six years, life was simple. It was a routine like now, only then I did not have to worry about what followed. I just had to read for the exams when the period was ripe. During those innocent years, even what you read was literally that and may be a little bit more. I dreamt of graduation like it was the world to be. No idea that graduation would come and all I would think of is when does all this end. Being a medical student meant your friends called you “musawo” and you swayed your head in that direction with a bit of gait.

It is now almost a year since internship begun and so the end is nay. Even if I have been weathered, battered and drained to an oasis, I am actually not bothered by being told how much weight I have lost (I wonder at how much I actually had). Yet again, I am confused by the dimorphic feelings of this period. May be it was that period when I felt hopeless with a client or that one euphoric time, when by doing something a life was saved. But if you asked me if I would do internship all over again; may be in a different setting I would be maniac to affirm to that. Life is as it is, one stage ends and another begins. Basically, you move one and get going.

There is so such to look back at and in equal measure a lot to forget. The beauty of it, is that this fast paced one year has the good, the bad and the ugly in proportionate quantities depending on whatever your priority is or will be. It is the heart beat of anyone’s medical career or may be not but it serves a lot to lay a foundation on how someone might follow up their career progress. So, do not despair, the love in war stories have such a nice ring to an end; they end.

The good, the bad and ugly of this period is that it is one year; one year of a lot of activity to last you a lifetime. You might see certain conditions once (one example in my case twice- Varicella pneumonia aka chicken pox) in your lifetime and others so frequent dust could not settle on the knowledge.

At the final bend, one asks oneself the same question asked to graduands; “what next?” at almost all corners, rumor mills spin about the latest on the job mart and study opportunities. Whatever your options might, the GPS of your internship could actually be fulcrum to that decision. For those joining, keep your wish lists short and expectations without reservations. For those who are this end with me, the ship is about to set sail.

One mother's love

“Movies always give a certain anticipation to know about the end.” When tension for a follow up act is missing, we usually lose interest in a movie. In about two hours, we assume to have understood and appreciated one’s life’s story. In it, we settle the palpitations with the knowledge that this is after all fiction and the "dead are not dead" but instead suspended from any further set. Oh, how I wish life could actually be.

I decided a long time ago that I could only watch horror movies only if they are the last left for my own obvious reasons (It’s always normal to look forward to a nice ending). As a new career doctor, the reality of death becomes passive. You tend to become supple to the fact that it probably shouldn’t have happened had it just been fiction with a good ending. A good ending, it is almost always evasive when faced with the most challenging of the cases.

I have most recently come close to one such case where I almost brought now the walls of my still and emotionless being in a clinical environment. Compassion, an adjunct to the sick is one I only show whenever am not overwhelmed however passion is usually intrinsic and hard to push back. 
The case is about a female child of 20 years brought into my care with an acute chest syndrome. After a  zillion hospital admissions, this was to be the last time she was in the hospital. She was a patient of sickle cell anemia, 4^th born of a single mother but until recently caused estrangement between her elder siblings and their mother. 
You see, she had growth retardation due to a stroke (bled in her brain) at the age of 10 and since then hospitals had become her other abode. Subsequent unfortunate events meant she would never have a normal life but to be under constant care by her mother. A role only a mother’s love could take on and indeed she made no qualms about it and vowed to do that all her life. In return she forgot to notice how lost time and relationships had moved.

Every morning, I walked past the bed they shared and at all those times this mother held her daughter in an embrace of never to let her go. She fed, bathed and nursed her at each minute of the day. They lived their lives synced. 
I always made it my starting point when beginning my ward rounds, adjusted the treatments accordingly and followed up twice a day. Investigations we had carried out were never comforting, but between the doctors taking care of her we kept this information between ourselves, one last bit was shared with her when almost all hope was evaporating. Soon her situation deteriorated  and she developed acute kidney injury (her kidneys had started failing to excrete the wastes from the body). This we noticed was secondary to sepsis (as per evidence of infection and systemic inflammatory response syndrome). Even at this point we soldiered on.

This “little” girl’s situation became hopeless each passing day two weeks after but witnessing the mother’s love gave me extra motivation to go an extra mile. There was always a sign of despair but with interludes of hope, we believed and prayed for a miracle it was never to be. How shattered, the mother was when the daughter passed on in her sleep on a Sunday morning while they shared their sleep.

Oh, how I wished this was a movie and someone shouted “cut” and then we moved on to the next act. As intern doctors we are faced with many challenges and at times with far reaching consequences than we ever thought of. The love, care and concern of a doctor is at times driven by the changes in environment and previous experiences and nothing will ever prepare for this.

With each imagination one might harbor, you wish someone waves by and off they go home healthier than they came. 

IDENTITY CRISIS

Its approximately three weeks for me to begin my internship as my first posting as a medical officer. I am reeling at this once in a lifetime opportunity and at times stay up the night thinking about it. My thoughts meander into the beauty of practice and the smile of a hopeless patient who then notices he/she still has another shot at life. I guess that is what it would mean to make lives better literally. When dawn reigns after dusk, I struggle to get out of my bed, I then remind myself that it is about time.

With that in mind, I can’t then fathom why my mind conjures at times to cause this restlessness especially during this period. I have had encounters where I need to introduce myself and am just mute for that period as the other person looks at me questioningly. The results have been out for almost two months now for almost everybody is aware that I am a doctor but why then do I stutter.

I have at times been called a medical student which is what I was and at such times my body has been shuddered into overriding cautiousness. Then the times I am referred to as “Doctor Ismael” and it seems more surreal than I have ever imagined or gloated. You could be wondering what then do I need if am not comfortable in my coatings that I have sown myself.

I like to think that I am just confused and as such this shall cease when internship start, a time I will have a different identification to the one I used to put on while at school.

Becoming a doctor is one scenario but to have everyone calling you doctor so and so is yet another case. One becomes a doctor after completing a medical, veterinary degree or a PhD in any of the other courses. Which makes it purely academic in all regards. So becoming a doctor is a recognition of an accomplishment of an academic feat that one should bask in its glory. However to be called a doctor, shows not just a personal recognition but a community recognition of your importance, stature and almost near “immortality”.

With this in mind, I still can’t get myself to getting comfortable yet. This transition period has been most trying in identity crisis. More like when a teenager is confused about being suddenly recognized as an adult. I guess we all (may be the majority) do have a time when identity crisis sets in, I just didn’t expect mine to be this one!

6D10720121312

There are7 days in a week, 168hours, 10140mminutes and so many microseconds. Point is there is so much time in a week but at times it might just feel like a day or even eternity depending on the events that have occurred.

This ending week shall forever be embalmed in my history memory for finally my special guest arrived. She weighed 3.0kg and she made it at exactly1312hrs on 10^th-7-2012 (I won’t even complain for passing on my offer to share my day). An entrance she made, an instant miss congeniality she became but the calmness she reserves leaves you in admiration.

More in admiration is the most amazing person who ensured her safe arrival for all this time. For now am still in a writers’ block due to this event that seems to last forever.

We shall capture up soon for more to come from the mirror story.

JULY 2

It started on Monday `

“To be or not to be..” it must be from Hamlet.

Sometimes I wish my mind would make up sleazing nice stuff like Shakespeare used to. The marveling at me would definitely go up tenfold, a concern that is so trivial at the moment. May be that gift will need a little more honing and finer touch. Of course, that need is usually driven by demand and resources as the usual allies.

Another week and the exhaustion is unimaginable. I thought I was in my holidays which I am. Recently a revelation was made to me that I always have to do a million and one activities and am still ignorant to the actual meaning.

Still working on the autopsy research study and have so far given myself one opportunity to “scrub” in one. Quite a revering experience that one, I should think of a movie scene where I dash out in an unexpected turn of events. You have to imagine that one yourself.

Monday a very unlikely day to celebrate your jubilee but in this case it happened to be me. A gush of pride and jolly old feelings of being born, indeed I was in my happy self, managing to greet every one with a smile, an effort with a few kilo joules this time done without a wince spent. Birthdays, I still wonder why such feelings have to be when you have grown this much. Investigations will begin when this one is steered well clear of. A gratitude to my sisters who made it more special than I imagined a pound I must have earned in that night.

In style the week had begun but the anticipation is still on, this person is asking too much from me. Patience a rare virtue for even a doctor. I however have to exercise my utmost until Monday, a scary feeling by the one supposed to labor. Not sure where my non medical feelings went, but at this time the countdown has begun 4weeks and 4days to the dreaded internship. My future patients be aware, this vacancy will only open then.

Before the week could end I had the fortune of meeting friends I had last seen 3-5years ago. A group destined for greatness you could tell. The beach provided an ideal environment for such a meeting even when I unfortunately couldn’t complete such a wonderful night with these people. Next time it will be bigger and better, coffee we ought to do.

FACT OR FICTION?

When your week begins in an unlikely format, it’s hard to fathom which devil whose path you crossed unknowingly. In my culture the blame would be on the first person you saw on your way from home. Still in primary school, I came across a proverb; “a bad beginning makes a good ending” but no one would admit to fantasying it to come true. It would be akin to a story book character that goes through trials to eventually emerge successful or a hero in what he/she does.

There is some truth to such story book characters despite the wild imaginations usually implored by the authors, most actually do research in these facts. Sometimes it’s such a hard task to discern facts from fictions even in our daily lives. You might at times pause in your actions as something/ person seems beyond your comprehension, at that time you assume it is fiction and it will pass by.

Last week begun as such, a normal initial appointment hadn’t prepared me for a second unplanned meeting that I thought could save me a lot of effort if I had it then. For a moment I thought it was my fiction world and I needed a hero of myself. Trust, maybe I should have taken the mantle of heroism but the imminent memories of characters like those of titanic keeps a cautious side of me alive.

Up to this time I can’t explain why someone, who certainly was a student at one time, could claim he doesn’t speak to students who have research to do. Research he believes should be left to the specialists, the world is indeed coming to naught with such madness lingering on.

That incidence couldn’t freeze time so life had to move on and indeed it was proof that selfish and egoistical people are a minute fraction of the world’s population. With the other part of my study (“Autopsy study…..” as I was being accused of grabbing a pathologist’s role when am a mere student) going on smoothly as I met more nice people and yes I met those I hadn’t seen in years.

Relations I had for long taken a back came to light and by unknown cosmic coincidence of taking paths I wouldn’t have. There is more evidence of the existence of a supernatural being than science might attempt to explain. With a good feeling to culminate a week after a good conversation with a colleague about biostatistics and publications makes me more determined to pursue my dream of clinical research.

At this time, the feeling however elated, albeit a bit from the low set point on Monday, a special guest is yet to arrive. In anticipation, I am and with hope I pray we make a tag team with my special guest and of course the wonderful person making this possible.

MY NEXT FOOTSTEP

I actually can’t put a mental note to the time my holidays started. All the memory drums up is the last days of merry making the semester came with. With the accolade of student of the year award, what more could I ask for from an action packed year five was for me.

Well, the action mainly came from the leadership tasks I assigned myself to or was assigned to accomplish. This combined with the obvious busts of clinical medicine, surgery, pediatrics and obstetrics and gynecology, I could not ask for more.

Now that school is over, the tasks have decreased tremendously. For starters, there are no ward assignments to crumble out of bed for to catch up with. There are no patients to clerk and keep up with but this won’t be long as internship seems to be glaring up sooner than I can imagine.

Finishing school comes with a lot of relief especially if you have been in school for “FIVE” years. One is overwhelmed by excitement and at this time the parties for the usually “dull” medics were on top gear. Dull if you think we are anyway but I differ in that thinking.

When dawn comes after dusk, the question that you have been avoiding lingers back. This time more clear and definite. “What next?”

What next? Well the obvious answer is to rest and rest but that can be prosaic if you have been used to waking up very early, get patients’ blood results, perform a few minor procedures and yet at the same time rush for a 1000hrs appointment with a professor.

So what does someone do after all that, I could read novels till the heavens come down but I could not be still in one place for so long. Lucky for me, I have a research grant to carry out a study that could surely take some of my time but that is certainly not enough for a work junkie like I.

I got whirlwind on a job at some clinic but at this time it was stifling boring and I found myself shuffling my gait in another direction. Next stop is a research project within medical school, just something my mind craved for.

May be now my heart is in the right place and there is surely one way to find out. The mirror will always tell you what happened anyway.