How Do You Do What You Do?

One of my school friends had a baby last year and just bought a house, one of my friends just got a pilot licence and is travelling the world, a random couple on the internet is renovating an age-old castle (I learnt that the temperature can only be raised by 1°C every week whilst restoring a castle to protect the woodwork.) I met a truck driver who was telling me that the best part of his job was the view of the stars in the night.

It reminds me of the words of Bianca Sparacino, "It is quite simple. When it comes to anything in life– relationships, friendships, the work you do, the art you make— when it comes to anything, if it does not create an avalanche within your chest, if it does not move you and inspire you, if it does not come from the deepest part of who you are, it is not for you. It is not for you."

As I'm nearing the end of my medical school journey, one would think I am used to all the little nuances that distinguish this study from the rest. But alas, I am not.

Since the beginning, we have been having communication skills classes. This is where each of us in a group has to go up in front of the class and have a conversation with a set objective, with a 'simulated patient'.

The simulated patient is an actor hired by the medical school who takes their job very, very seriously. No, genuinely. Some of them are truly deserving of an Oscar for their performance.

After the "consultation", the tutor and the group go through what you did well, and what you could have done better and we discuss strategies. This method is effective and essential.

It isn't very different from the training simulation scene from Pixar's 'Monsters Inc'. Click here to watch the scene.

Last week, I knew I had to have a conversation with the simulated patient about the inevitability of her death and the prospect of palliative care. I was dreading this. I'd rather do a sexual health consultation in front of everyone (which I did in my third year).

When the class started, one of my friends volunteered to deliver the news. The simulated patient (who was a child), and the simulated father of the patient held hands as she asked, "Am I going to die? Are you going to let me die?"

I couldn't take my eyes off what was happening, and I felt heavy. My friend handled the conversation as well as he could. He said, "We are not giving up on you, we are going to make you as comfortable as we can."

Then came my turn.

The simulated patient asked me to talk to her simulated father and prepare him for her death. I sat with him as he cried.

I told myself- This isn't real.

"I'm afraid I have bad news. She's nearing the end of her life." I said, trying to distance myself as much as I can.

This isn't real.

He cried and asked, "How long does she have?"

"She is in her last days. I'm sorry." I croaked. I truly was sorry that I couldn't do much but say I was sorry.

This isn't real.

I answered more of his questions about death and what to do when that day comes– one step at a time.

I don't really know what happened after I finished the consultation. But I remember it felt like I was in a trance. I blocked everyone out until it was just me and the man in front of me.

I kept repeating to myself that it wasn't real when I replayed the scenario in my head before I went to bed.

But it was very real. It was a version of reality that is happening every minute right now, and it is a version of reality that I have signed up to face in the future, and it is a version of reality that everyone will experience whether they have signed up for it or not.

I am not sure if there is anyone who is completely unfazed by these scenarios in medical school.

In my first year, I had a recurring dream of washing blood off my hands like Lady Macbeth. "Out damned spot!" The blood would just reappear on my hands, and I'd wake up in a panic.

This isn't real. I'd tell myself.

But eventually, I calmed down once I realised that it was my blood in my dream. And it was okay because even though it was scary, I was learning to control the bleeding.

I once cried to my family friend saying, "Everything upsets me. I can't handle anyone's death. I don't think this is the profession for me."

She said, "I think you are perfect for the profession because you understand the value of life."

I thought it was poetic to learn to heal with a bleeding heart. But I didn't realise until later that it might even be a requirement.

Every time I've felt overwhelmed, the book by Charles Mackesy, titled 'The Boy, The Mole, The Fox and The Horse' comes to mind.

"I can't see a way through," said the boy.

"Can you see your next step?"

"Yes."

"Just take that," said the horse.

I got here one step at a time and I was very sure of every step that I took. How do I do what I do? I do it with all of my bleeding heart. Dealing with difficult situations has become easier, and I've become better as well. But for better or for worse, in sickness and in health, till death does us part, this is the career for me. It is a privilege to say that it is my calling to live a life of service.

Disclaimer: None of the details in the above story belong to anyone I know. The names (and other details, including simulation details) have been meticulously changed to protect confidentiality.