" If I evaluate myself in terms of my usefulness,
assess my worth in response to how much others want or don't want me,
I find myself defined by a label,
squeezed into a role.
It requires assertive, lifelong effort
to keep our names in front.
Names not only address what we are,
the irreplaceably human,
they also anticipate what we become."
-Run with the Horses
by Eugene H Peterson.
Of late, my module in Paediatrics has forced me to come face to face with things which I thought I would never have to. Perhaps it explains my broody moodiness over the past 2 weeks.
Medical school. It has not been what I anticipated it to be. A lot of people ask me what it was which triggered the bout of clinical depression in my first 2 years of university- I never have a good answer because a lot of things happened which contributed to it. But looking back, I believe one of the factors was losing my name, sense of identity and placement, in a vast, vast space called medicine.
In the hospitals, no professor calls us by name. You, Medical Student, what is your answer? Hurry up, we don't have all day, you either know it or you don't. We are functional entities, foot soldiers beneath an armour of a white coat and face mask, liabilites to the healthcare administration, dirty words spoken only in hushed tones before patients and nurses. We are Medical Students.
You, Medical Student, come here. Take this blood pressure, set this plug. Make yourself useful.
Those who do know us by name remember only but briefly, if only to do a procedure, before we leave for the next module in a different hospital altogther. What's your name? Wai Jin? Wai Xia? Whatever, call the next patient in.
We keep moving, keep resettling. I miss having that long-lasting teacher-student relationship. I miss being called by my name. We are moving into dangerous ground without knowing it- for our labelling others because of a minor inconvenience is an assailment on our humanity. We call on others for their function, and no longer for their innate worth, their unique qualities. Is that why so many doctors call their patients by their diseases, and bed numbers?
Have you talked to the Multiple Sclerosis yet?
How did we come to this place? We were not like this at the start. I have met few doctors whom have earned my respect and awe, hardly any who know me as a person. The System does not allow for such time. My struggle with Paediatrics made me realise how desperately I need someone to believe in me, made me admit that I learn best with a mentoring style, with someone who cares for me and sees my potential. Because I very often don't.
Medical school is not what I thought it was. In the middle of our Paediatrics posting, we were assigned to prepare for an ethics debate. I cannot describe that sense of bitter surrender and cold disappointment that hit my face, when I saw that few took it very seriously at all. It was seen as an interference to our module. We have our clinical exams in a weeks time, and I understand why studying would take precedence, because I'm trying my best to keep afloat too. But it made me wonder what I had thought the medical curriculum was when I applied for medical school- dynamic, holistic, patient-centred... and how far from reality it really is. Almost 3 quarters of the class was absent when we were given a soft-skills lecture on patient communication. You wouldn't dream of that happening had it been a talk on Endocrine disorders or something more academic. It was a good series of lectures, and I wished all 250 of us had been there.
Neurofibromatosis Type 1. Diabetes Mellitus Type 2. Spinal Muscular Atrophy Type 3. Have you talked to them yet? When did diseases become our patients.
We not only label patients, but ourselves too. We bring destruction to our humanity when we introduce ourselves as Medical Students instead of our names. It is as if that is what owns us, our function.
Good morning, Dr Lee. I am a Year 4 Medical Student-can I join you in your clinic?
You can sit behind me. I'm very busy, no time to teach you. Just watch, you can leave early if you want.
Walking along the corridors of the wards one day, feeling defeated by my inability to present a polished cardiac examination, I suddenly missed having a teacher or mentor to turn to for encouragement and help. I missed having someone who knew me believe in me. I missed being known as who I am- a holistic human being who has likes and dislikes and a whole life outside the hospital, having dreams waiting to be shared with a mentor who can guide and lead me. I missed being in Mr Ho's literature class, where windows in my head would flutter open as winds of inspiration and the wild, wild world of ideas and endless possibilities would fly down the corridors of my head and open doors which I never knew existed, to secret gardens filled with things of awesome wonder. I suddenly missed it, and an old, casual comment about my faring better had I pursued the arts instead of medicine cut me deeply.
It is both my greatest strength and most crippling weakness, to allow words to have such a formidable hold of me. It only takes an unthinking, callous word to haunt me mercilessly, for weeks and months on end, and an affirming one to see me through the most tumultuous of storms. The labels and demands stick, while the affirming words are few and far between.
Medical Student, how long have you been here? Don't you know what causes Scarlet fever? Group A Streptocococcus, remember that. How can you not know this? Geez.
I saw an article in the papers a few days ago on an interview with the Dean of the new Duke NUS Graduate medical school here in Singapore. I stared at that page for a long time, and realised how very much I love medicine. How very much I look forward to going to the hospital every day because there's something new to learn, because there're new patients to talk to. How very much I like it even though the curriculum isn't perfect, even though consultants and nurses often treat us as if we are perpetual hindrances, even though I fumble, even though sometimes I do find it so very hard and trying, even though at times I do feel so very lonely going home near midnight from night duty, even though I do cry sometimes as I wonder if I was made for this, and feel tired and stupid and inadequate and incompetent, most specially in this time doing Paediatrics, which has been the most challenging module I have ever encountered. And it was at that moment, I realised, that as much as I am born an artist, where beautiful prose and paintings are to me what pornography may be to others- a desperately visceral desire, I may have gone to do journalism, or teaching, or social work, or graphics design or advertising... but I would have graduated, and still applied for the Duke-NUS Graduate Medical School anyway.
After I shared a little of what was troubling me, L said to me, "Why do you care what other people say or not say about you or to you? Do they know your thoughts 24/7, how you are like deep down inside, your desires, your hopes and dreams? Who's to tell you you're better off someplace else?"
I was angry with myself. I was angry because of the kind of doctor and person I am becoming- unbecoming. A product of a nameless, faceless curriculum where you are judged on your performance, and known by your name only after decades of trying to prove yourself.
I was angry with myself: The children in the wards are battling against debilitating diseases; some have been the object of abuse; some are at the mercy of a family torn apart and have come to seek shelter because they have no other option; some have been diagnosed with illnesses they will have no idea of comprehending till they reach their adolescence and realise in resentment how far they are from a normal life; some are adults already but still in paediatric wards, living decades of their lives behind a sickening illness, never having talked or swallowed before; some have deformities so bad they are bed-bound, don't even have a proper face and are being taken care of by their elderly parents who are in their sixties already... and here I was struggling with... trying to overcome the next academic hurdle, trying to come to terms with my very material self, trying to overcome my low self-esteem at times, to fight against a system which is tearing me down, to juggle work with church and bible study leading and other commitments and feeling so completely overwhelmed by my inability to cope with this all.
I was angry with finally coming to terms with these ugly truths about my education and what it's doing to me, how I've allowed the System to take away my name and personhood and replaced it instead with what ought to be a name held with pride and honor but has been denigrated into a nuisance- Medical Student.
Medical Student, stand aside, we're busy now. Talk to you later. (Shove.)
A few times when I tried to introduce myself and ask the doctor politely how to address him, I was greeted only with a curt, "You don't need to know." I find it painfully ironic that the only time I remember having my name noted down was when I was seen to be causing trouble in the hospital while trying to make a stand for a patient.
I was also angry with myself for coming so far from the girl I knew years ago, who hardly cared about materialism and was happy with simplicity. I was angry that I was becoming a doctor, someone called to serve the poor, and had contemplated wanting a bike so ridiculously expensive. After that incident, still stung by shame, I have lost interest in cycling this season.
In desperation, I texted Mr. Ho. 5 years on, he still knows me like his friend and student. I just didn't know what to believe in myself anymore. I was afraid of not passing our Paediatrics exam. I didn't know what I was good at. I was afraid of my future, of who I was becoming. And I was exhausted of being a label, tired of being dehumanised in a curriculum which is supposed to teach you humanity.
I remembered how ordinary I was when I first entered college, and how different I had become simply being under Mr. Ho's wing. Like he does for each of his students, he saw potential in me, and developed it. I suddenly came to a humbling realisation that all this while, I have been functioning below my maximal potential because of how I have allowed this System, these terrible voices and labels in my head, and the things people say erode what Mr. Ho had birthed in me many years back in our classroom where he taught us Chaucer and literature, where he saw me not for who I was but who I could be, where he saw me as a person, and not just another student passing through college. I came to point where I had to admit, that for all my independence and self-sufficiency, this road is too hard to journey on without encouragement from someone special to me.
After school, Mr. Ho and I used to sit outside the staff room underneath the umbrella tables talking about my essays. I would write and submit one or two extra every week, and he would go through them painstakingly with me. Then, we would talk about how I was coping. I think he might have been the only one who knew how unhappy I was being vice-president of the students' council. We would talk about history, and literature, and the holocaust and good books and God and life and famous people and forgotten things and me. He always asked. He allowed me to ask. He never made me feel stupid. He would feed me a juicy bite of an answer, and then inspire me to read more, know more, desire more, independently.
In the hospital, most of us are, very often, afraid to ask. We are often told to "go find out for yourself". I remember being told, by more than one doctor in fact, Medical Student, don't ask a question like that. You're not required to know this for your exams. Don't give yourself more trouble than you've got.
What happened to the world being our classroom, what happened to the preciousness of inquisitivity?
I am afraid of who I may become and am haunted that I may not be cut out for this, Mr. Ho. I love going to the hospital every day, I love Paediatrics, but this going is too tough. What is it doing to me?
" Hello my dear Wai Jia. It's funny how things work. I was just thinking of you yesterday and how I can't wait for you to graduate cos you'll make such a wonderful doctor. Take heart: the struggle towards the exams will be hard but you're doing this not for yourself but for the benefit of the future patients including children who will be in your loving care.
Your friend is right in some way because you are a humanist and they don't teach you to be one in medical school because systematically speaking that's not a very efficient model. There is tension always between cool professionalism and emotional investment.
But the amazing thing is that it is these doctors, like you, who feel about dignity and respect for the individual, who give the profession it's beauty and who give us all, your patients, hope.
So you are special because you're artsy, and goodness knows we need more people like you in the profession. So go hit the books for all our sakes and believe in yourself for your won sake and I'll buy you ice-cream after the exams are over if you promise to get in touch then, k?"
I was queuing up for food when I received his text message and the tears just fell uncontrollably.
This is how I know God is watching over me. Why I think teaching is the most inspiring profession of all. Why I must continue to press on on this long, long road even though its scorching and tiring and altogether discouraging at times. Why I will continue to read literature, visit art galleries, paint and pursue writing. Why I must still try my best for my Paediatrics exam next week. Why I must be determined to believe in myself the way Mr. Ho does in me and study well for what God has called me to, even as I press on in this arduous journey called medicine.
And why I will continue to stick to my resolution to always introduce myself by my name to a doctor, nurse, or patient, whether he remembers or listens or not.
Hello, my name is Wai Jia. I'm a Year 4 medical student. Can I speak with you?
"Anything other than our name-
title, job description, role-
is less than a name.
Apart from the name that marks us as uniquely created and personally addressed,
we slide into fantasies and live ineffectiely, irresponsibly.
Or we live by sterotypes in which others cast us
that are out of touch with the
uniqueness in which God has created us,
and so live diminished into boredom,
the brightness leaking away.
Names call us to become who we will be.
Names mean something...
A name recognises I am this person and not another.
The meaning of a name is not in a dictionary,
but in a relationship- with God."
-Run with the Horses
by Eugene H Peterson.
