After rotating through different specialities during the one year of internship, each time entering a new department with its own unique patients and its own way of working you feel like a sponge absorbing everything that is happening around you , dying to squeeze out all this new found experience but wary of what would happen if something went wrong .
The year after internship is the most difficult of all. This is the time you are a full fledged doctor on the ward but know really nothing. Your seniors want to trust you but cant. You are neither responsibility free like in internship nor are you responsible enough to be able to take care of your patient independently.
Its like those awkward adolescent years when you don’t fit in with children and the adults don’t want you around.
But if you can prove that you are trustworthy enough to be left on the floor alone, and your senior does leave you …. You feel like a king. You are in charge of the lives around you. It makes you feel very responsible. I remember being sleepless and extremely careful , rechecking every drug I wrote on my ward round ,reexamining every patient under me so I don’t miss any vital finding.
Also since you are the only doctor the on the floor the patients see most often they get attached to you emotionally as well and you too feel the same about them .
This is the time I remember two patients very clearly . One of them had conceived after a very long time and was carrying twins and was admitted because she had started having preterm contractions . Her babies were only 20 weeks old and it was too early for them to be able to survive if they delivered .
We were on top of it trying to stop her preterm contractions so she would be able to continue her pregnancy till the babies became viable. But despite all we did she aborted the two babies. They came out wailing and feisty, two liitle girls but we all knew that their lungs were too premature to sustain life and we would lose them in a couple of hours. We kept them in the warmer till they would be alive and kept a watch on them. I felt so responsible for that loss that inspite of my duty being over I sat next to the warmer looking at these tiny tiny humans struggling to stay alive.
My senior paediatric resident doctor thought I was probably crazy and he sat in the same room making some kind of a death declaration certificate for them . I was so upset that I fought with him for being so insensitive and didn’t allow him to do that till the babies actually passed on. It was a realization that there are some things that you cannot help however much you try and want to.
The second patient was a young 22 year old girl with Eisenmenghers syndrome .
This is a congenital heart disease in which there are multiple defects in the heart compromising its ability to pump oxygenated blood to the vital organs of the body . If such a patient becomes pregnant her risk of dying in pregnancy is around 60% specially within the first week of childbirth. This young girl had been repeatedly advised not to conceive but her yearning for motherhood was so great that she not only conceived but hid it from her family and the world till she was more than 20 weeks of pregnancy when even a termination of pregnancy was as risky as delivering her baby . She anyway refused a termination and wanted to have this baby to we also decided to go all out to try to save her and give her a baby.
At around 32 weeks she went into preterm labour delivered a tiny little baby girl and within 2 days of that went into heart failure and we could not save her.
I was one of the innumerable doctors in the room when she delivered her child and I cannot forget the look of happiness on her face when she touched her baby for the first and last time.
It was devastating to inform her family when she died . Such a young life lost ! I couldn’t sleep for several days after that.
Those were the days we realized that there was something above us which decided the fate of our patients . Armed with all the knowledge in the world we still couldn’t save everybody.
Knowing this is humbling, and the most important lesson we learn as doctors!
My first 6 month house job posting was in obstetrics and gynaecology and that was the time I fell in love with the subject and decided to pursue it for my post graduation.
My second 6 month posting was in The department of Anaesthesiology. Another branch of medicine which teaches you humility. As you put your patient to sleep you feel their helplessness at putting their lives in your hands . “Their eyes always seem to ask you whether they will wake up again”. And to wake them up becomes your responsibility. Here again I remember a patient on whom we did a ceasarean in emergency at 2.00am in the night…. She came to us with heavy bleeding in the 8th month of pregnancy and to save her and the baby we had to operate. She was given general anaesthesia because she had already lost a lot of blood . Fortunately the surgery went off well but she did not reverse from the anaesthesia for 4 hours. Probably some metabolic disorder that did not allow the quick removal of the drug from her system but I can never forget that night as we sat up beside her doing this and that trying to awaken her. When she finally woke up it was like WE had a new lease on life !!!!
Life is fragile….. very fragile!! No one knows how much time any one of us has in this world . Medicine teaches you to respect life. It brings you so close to death everyday that just being alive seems like a miracle!