WHAT MADE YOU WANT TO BE A DOCTOR ?

Last week, I was covered in blood.

The tubing connecting my patient to the life support machine spontaneously ruptured and
blood was hemorrhaging everywhere. While we were quickly repairing the defect, my hands
were deep inside my patient's open chest to massage the heart to keep the circulation going.
I still get the shakes from that moment. Unlike the television shows, there was no euphoria
or 'high fives' after resolving the crisis. No part of me thinks this was a life saved. It was a
death luckily averted and we all knew it.

A month ago,
I came home after taking overnight call in the hospital. I hadn't seen my 2 year old son in 48
hours. He had learned three new words and desperately wanted to play. I was so tired and
desperately wanted to sleep. I forgot to hug my wife. I chose to play with my son, but I was a
zombie. It wasn't a quality moment and I think he knew it.

A year ago,
a physician from a community emergency room called me asking to transfer a patient to my
ICU. It was a teenager recipient of a heart transplant a few months ago and I knew
immediately that the donor heart was being rejected by the immune system. The ER
physician did all the wrong things and only contributed to destabilizing the patient. The
patient was unlucky to have presented to an ER physician who was self-admittedly
unfamiliar with pediatrics. I was so angry and frustrated...not at the doctor individually, but
at our medical system that is still so vulnerable to medical errors and misdiagnosis. The
patient ultimately died and like the hundreds of thousand patients before him slipped
through the torn safety net of our healthcare system.

Five years ago,

I was signing the discharge paperwork of a 1 year old after being hospitalized for 8 months
following cardiac surgery. This patient suffered numerous complications related to his
complex heart defect, including a massive stroke. After months of rehabilitation, he was now
ready to go home, albeit with a fragile heart. As I was saying goodbye, I remember looking at
his single mother and seeing fear in her eyes. Her son demanded special care and would
unquestionably dominate her already stretched life. "I'm scared of my son. What if he tries
to die again?" I tried to reassure her but couldn't find the words to soften the reality of the
situation. "We are always here for you" and she half-smiled at that notion. When she was
gone, the staff celebrated the success, but I couldn't shake the feeling we were single
dimensional in our care. I couldn't feel balance or satisfaction. I called her a week later but
got her voicemail. I left a message. I told myself to call again a week later. In the midst of
the busy surgical schedule, I forgot to call her.

10 years ago,
I entered the field of cardiology. Every child with heart disease were suddenly my patients
and I was suddenly an expert. A good friend of mine called me for consultation about a
newborn baby with a murmur. I told him "dude, we were in the same class just a week ago,
and you are calling me for advice?" I listened carefully at the murmur and thought it
sounded benign. But to be sure, since I was early in my training I obtained an
echocardiogram. I could not have been more wrong. The results showed a massive defect
and the baby required surgery. My colleague congratulated me for the great pick up. I
remember re-reading my note that clearly states "this murmur is likely benign in nature and
no follow-up is warranted by our service". I remember asking myself when does luck
become less of a factor in medicine?

As an adolescent,
I had romantic notions on the life of a physician. The self-fulfillment and gratification that
comes with being a healer appealed to me in an instinctual way. I thought that the
profession was filled with glory, prestige and honor.

The motivating factors to enter medicine are now different than the motivating factors
sustaining me in medicine. The farther I advance in my profession, the more I realize the
following: to think of myself as an individual is a fallacy. I've come to appreciate the 'we'
behind healthcare delivery, including the family that resumes care beyond the
hospitalization. I've come to appreciate that the only way to be better is not necessarily to
perform better as individuals but to shed light on those dark blind spots within the system
where our patients quietly fall through the cracks.

Years from where I started, there's less prestige and even less glory. But there's more honor
than I could've imagined.

Yesterday,
I was discharging one of my favorite patient from the ICU. Her post operative course was
difficult and challenging, but this 8 year old girl was bouncing to get home and with a wide
smile on her face she declared 'I hope I never see you again!' to which I wholeheartedly
whispered 'so do I.' Her mother thanked me for the care we provided. I used to hate it
when I am thanked because it's awkward to say "you're welcome" or "no problem." But
now, I know exactly what to say.

It's our privilege.

I applied for medschool because I thought I would enjoy being a doctor. I liked what I knew
about science, and I liked the way people trusted you to keep their secrets, or help them
when they couldn't help themselves. I wanted to serve my community with all my skills. I
liked volunteering, I liked it when the patients were well enough to go home because of
something the doctors did.
Those were all childish and probably naive reasons to have done medicine. Everyone would
probably have cycled through at least a few of those.

But these probably wouldn't have been enough to keep me going through my long and
arduous training. And believe me, when you're here, things keep on coming to test your
resolve.

I started medschool anyway, and for the longest time there wasn't an epiphany or a startling
realisation.

Then one night I was walking home after a late shift at hospital in the middle of my third
year. Nothing spectacular had happened during the shift, we had just gone round helping to
put cannulas into people, wrote up some medications, reassured an old lady in the cancer
ward, and done some basic paperwork. But there I was, the cold january night, walking up
the road to my house, when it hit me.

I was going to have thousands of days and nights more of this humdrum. Writing up
medication. Putting cannulas in (or failing). Walking around the hospital looking for things
or people.

And I was still excited about it.

I knew for sure that this was what I wanted to do when I realised that even the dullest days
wouldn't make me love it any less. Everything was as it should be. I was where I belonged.
I've never looked back since, although we've had some pretty horrendous exams, and some
pretty ghastly days since then. I found the great reason, the one that could power me
through.

I think my main message is that it's probably not true that everyone who does medicine was
always certain that they were going to do it. It's all right to come to that realisation later
than your peers. It's all right to have an out of world reason, or a reason that only you can
understand. And sometimes it is the weirdest thing that makes you hang on despite
everything. :)

Hope this was useful!

Science courses were always my favorite. I was interested in people, and what makes them
the way they are, so it seemed right. I always enjoyed school, and didn't mind being there for
a long time, and I wanted a job that felt important and meaningful. Internship year was
brutal, but fun in a boot-camp sort of way. Each subsequent year of training got easier.

Interestingly, I have mostly retired, quite early, from medicine. I did not do a fellowship
after internal medicine training, rather having two children. Therefore, I am by default a
primary care or urgent illness doc. This is a hard life. Seeing large numbers of sick patients
in rapid sequence, we are expected to treat all of their many many medical problems using
the best current practices, answer all their questions, remember to schedule all their routine
screening tests, find some way to motivate them to eat right and exercise, and score high on
our patient satisfaction scores. In 15 minutes. And science has less to do with it than I would
have imagined.

I actually discouraged my son from going to medical school. He did go, however, and is a
very smart doc. He is doing specialty and sub specialty training, however, and so I think his
life will be a bit more pleasant. I have found that what I really enjoy is teaching. Best of luck
to you.

I was five years old. Yep, you read that right. I knew I wanted to go into medicine before I
even stopped wetting the bed.

The reasons why I wanted to do it weren't so apparent back then -- it was more of whenever
I was around doctors, I felt empowered, confident, fearless, and felt like there was no one
else but them in the world. It was like a love story, an infatuation with the profession --
childish love at first sight.

To give context, I was quite sick as a kid, always out and about in clinics and hospitals.
Procedures like countless injections, IV drips, three stitches above my eye without
anesthesia habituated me into the world of medicine. I was sort of traumatized by
physicians, but I also saw them as incredible people who had the power to ameliorate the
awful concept of human suffering. I wanted to be in that position where every day of my life
would be dedicated to making another human being smile.

So from then on, I became a huge science nerd since I obviously couldn't practice medicine
as a kid. Reading a college level microbiology text as a fifth grader was my "gateway drug"
into medicine.

As I grew up and matured and although the individual reasons for wanting to enter
medicine became more apparent to me, there was still something in the back of my head I
couldn't explain. It's like getting married. I've flirted with medicine. I've had my one-night-
stand. And I've started dating. But there's that point where you knowyou have
found the love of your life that you'll go to the edge of the universe for. And the reason for
that is...

It wasn't one singular reason but an amalgamation of every reason. It was very important
for me to have realized that. Medicine was the only profession that allows me to
simultaneously help people while pushing my mental limits. It tests the limits of human
compassion, memory, physical stamina, and resilience. And it was a nod back to the exact
feelings I had as that five year old kid -- empowerment, confidence, and fearlessness.

Saat ini saya bisa dikatakan baru seumur jagung menekuni profesi sebagai dokter. Profesi yang paling
diimpikan oleh kebanyakan anak (sepertinya). Termasuk saya ketika dua puluh tahun yang lalu. Sosok
seorang dokter sangat familiar dipikiran saya. Ayah saya berperan besar sebagai teladan bagi saya untuk
menjalani profesi ini. Cinta pada pandangan pertama terjadi ketika saya mengintip dibalik tirai yang
berhubungan langsung dengan ruangan praktik ayah saya. Saat itu saya masih usia 5 tahun. Saya
penasaraan mendengar suara teriakan dan memberontak, tampak Ayah dengan sigap dibantu oleh
seorang pria yang merupakan keluarga wanita tersebut, darah berceceran di lantai, wanita tersebut
dibaringkan dan ayah memberikan suntikan pada bokong kanan wanita tersebut, lalu wanita tersebut
tenang. Ayah pun menyiapkan semua set bedah minor untuk mengobati luka wanita tersebut secara
mandiri. Tampak darah mengalir di pelipis wanita tersebut. Tugas ayah sudah selesai, wanita tadi masih
tampak lemas. Ternyata dari keterangan keluarga, wanita tersebut memiliki gangguan jiwa, mengamuk
dijalan dan ditimpuki dengan batu oleh anak-anak gang yang usil. Saya masih menyimak kejadian
tersebut dibalik tirai. Ayah saya masuk ke dalam ruangan tempat saya mengintip untuk mengambil obat-
obatan yang akan dikonsumsi wanita tersebut.

"Pa..papa gak takut sama wanita tadi ? Badannya besar terus habis kumat" kata saya

"Yaa..kalau sudah jadi dokter gak bisa pilih-pilih pasien, harus siap nolong orang, biar orang jadi sehat "
jawab Ayah.

Itulah cinta pada pandangan pertama terjadi oleh seorang gadis usia 5 tahun saat melihat Ayahnya siap
tanpa gentar menghadapi pasiennya. Untuk menjadi dokter, ayah saya menekankan agar mampu
bersikap disiplin dengan waktu, pantang menyerah mempelajari setiap hal, apalagi ilmu kedokteran
merupakan ilmu yang tidak hanya memerlukan mental yang kuat, namun juga pengalaman dan seni
serta hati yang ikhlas.

Saya sangat menyukai ilmu alam, menyaksikan perubahan biologis semua hal yang ada disekitar saya,
hal tersebut sangat menarik, nyata dan menyegarkan. Akhirnya saya memutuskan untuk melanjutkan
sekolah saya di kedokteran hingga saat ini berperan menjadi dokter. Saya menikmati cara mereka
menyampaikan beragam keluhan mereka dan mempercayai saya untuk memberikan solusinya. Hal yang
sangat menyenangkan ketika bertemu kembali dengan pasien saya diluar tempat kerja saya dengan
kondisi yang sehat.

Saat saya bekerja sebagai dokter internsip di daerah Kalbar, dikarenakan tim kami sangat sedikit,
konsekuensinya jadwal jaga kami menjadi lebih padat. Ketika itu hari Senin, saya bertugas pagi di poli
umum, hari itu pasien kontrol di Poli begitu ramai, hal ini karena dokter spesialis Penyakit Dalam sedang
cuti sehingga pasien kontrol beliau ditangani di Poli Umum. Jam kerja selesai pukul dua siang. Bagi saya
pulang bekerja lebih baik digunakan untuk waktu tidur siang agar pas jaga malam nanti stamina saya
masih penuh. Pukul delapan malam saya mulai jaga di IGD. Entah kenapa malam itu cukup banyak
pasien dengan kondisi berat, ada pasien kecelakaan dua orang dengan cedera kepala berat, pasien
keracunan akibat percobaan bunuh diri dan pasien syok. Penanganan untuk pasien tersebut tidak bisa
hanya lima menit saja. Perlu monitor ketat, informed concent keluarga pasien dan prosedur tindakan
lainnya. Tim jaga kami beranggota total lima orang. Jam sudah menunjukkan pukul 1 pagi. Saya
mendapatkan konsul dari perawat di ruangan bahwa ada pasien gawat. Otomatis saya harus segera
mengecek kondisi pasien. Pasien tersebut dalam keadaan apnea dan rekam jantung menunjukkan PEA,
saya pun segera melakukan resusitasi ditolong perawat. Secara fisik di pukul tersebut sesungguhnya
saya lelah. Sementara saya pun mendapat telfon dari IGD bahwa ada pasien yang juga perlu ditangani.
Pasien diruangan berakhir plus artinya meninggal. Saya pun harus menyampaikan berita kematian yang
menjadi duka bagi keluarga yang menemani pasien tersebut. Saya tidak bisa berlama-lama larut dalam
suasana kesedihan mereka karena masih ada pasien anak yang perlu penanganan di IGD. Pasien anak
untungnya dalam kondisi stabil, saya pun melakukan pemeriksaan lanjutan, anak tersebut mengalami
demam karena infeksi virus dengue namun belum dalam tahap demam berdarah sehingga masih bisa
dilakukan rawat jalan. Saat itu pukul lima pagi, azan subuh pun sudah berkumandang sejak satu jam
yang lalu, saya pun solat subuh setelahnya istirahat sejenak di kamar dokter merebahkan badan.
Bagaimana pun tubuh saya sejatinya masih bisa bergerak namun pikiran saya harus diistirahatkan
sejenak. Baru sekitar sepuluh menit istirahat selepas solat, datang tiga orang pasien kecelakaan lalu
lintas, satu tampak tidak sadar, dan dua lainnya tampak luka terbuka yang besar. Selanjutnya saya
segera melakukan penanganan gawat darurat hingga pasien stabil.

Hal ini menjadi sangat penting untuk saya sadari bahwa dokter merupakan profesi yang hanya
mengizinkan saya untuk secara simultan menolong orang ketika berada pada keterbatasan untuk
berpikir. Menjadi tolak ukur diri terhadap perasaan, memori, stamina fisik, dan pertahanan diri. And it
was a nod back to the exact feelings I had as that five year old kid -- empowerment, confidence, and
fearlessness

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081585923204

Anak bukanlah manusia dewasa yang bertubuh kecil. Dalam proses tumbuh dan kembangnya,
mereka akan melihat, memperhatikan, hingga meniru lingkungan sekitarnya, dalam hal ini orang dewasa
akan menjadi teladannya. Hingga masanya mereka tidak sabar untuk segera menjadi orang dewasa.
Mereka ingin segera merasakan kesuksesan dan bebas mengembangkan dirinya. Namun dari semua hal
tersebut, ada nilai yang sangat diperlukan oleh seorang anak sebagai pondasi hingga menjadi dewasa
yang sukses, yaitu penanaman nilai sopan santun.
 Dengan nilai sopan santun, otomatis anak-anak akan mengerti bagaimana cara bersikap dengan
bijak, hangat, dan bermoral. Dalam hal ini cara berkomunikasi dengan anak untuk menanamkan nilai ini
sangat perlu diperhatikan dengan cermat oleh orang tua. Dengan latar belakang profesi saya, saya akan
melakukan kegiatan kelas interaktif dan memfasilitasi orang tua berserta anaknya, adapun hal-hal yang
diangkat seperti peran orang tua untuk 6 tahun pertama tumbuh dan kembang anak yang nantinya
akan dibentuk komunitas "sayang anak" bagi para orang tua disana dan mengadakan kegiatan dokter
kecil yang memiliki pribadi percaya diri, bertanggung jawab, dan sopan santun.