Wednesday, October 28, 2009


After almost eight months, I'm still having a difficulty coping with the stresses and difficulties of fellowship training. The intermittent episodes of unhappiness with my work still happen. At times, I couldn't find the real purpose of my being a physician for the routine work that I have here makes things ordinary and boring. Could it be because I am already at the end of the referral system that all I get to see are cases that pertain only to my subspecialty? Gout here, Lupus there, and a variety of osteoarthritis and rheumatoid arthritis, include the confusing and difficult cases that can't be explained by other subspecialties which they thought can be explained by a Rheumatologist. The mental gymnastics that I am doing everyday at work must be sounding fun and challenging, not. There is something lacking I believe and I'm still in a quest for it.

Despite helping residents in managing their cases or seeing patients at the out-patient department, I still feel inadequate. Despite reaching this far in the hierarchy of the medical profession, I still feel unfulfilled. I miss that feeling as an intern when I get to be called as "doctor" in our medical missions in the far-flung areas of the country and I miss that feeling of "acting" as doctor to those patients I've seen. There's no substitute to the feeling of a young resident who gets to send her patient home, improved and well after pulling his/her other leg out of the grave. Now as a subspecialist, and a certified doctor at that, I wonder why I can no longer feel that fulfillment, that happiness that I used to experience?

Am I on the right track? Did I choose the right subspecialty or the right institution? All the ingredients that are needed for the making of a good physician and a good specialist are found here I guess but there seems to be one lacking ingredient. I love my specialty and this hospital where I am in is a big library of learning. Yet, I'm still trying to figure out this single ingredient that could make the perfect recipe. I'm still trying to discover what could return my enthusiasm back to my chosen field.

I need a dose of adrenaline. I need a breath of fresh air. I need to mingle with a different group of people. Maybe that's what I need. Maybe if I'll be given a chance to get out of the four walls this hospital and be able to see other patients, I might find my purpose again. A break in the routine and ordinary stuffs might just do the trick. What if it doesn't? What if this will never happen?

Tomorrow's another day at the out-patient department. I'll get to see familiar patients some of whom I already know their life's story. A number of them has opened up to me and has poured out concerns that are irrelevant to their disease. Yet I patiently listened to them. I know that I did for I get to remember every detail. Most of them come back feeling better than their previous follow up. Their non-medical-concerns still existent but their medical problems no longer bothering them. They are well so they claimed. Thankful for the medicines that I prescribed, but more thankful for hearing them out.

I think I'm starting to find my purpose again within the walls of my so called prison. If I may not be given the chance to be free for the next 16 months, at least I found my purpose. Subspecialty level isn't just about being good at managing complicated cases I suppose. As a subspecialist, I feel that there's a need for me to probe deeper in my patient's cases, to be connected, to reach out, to be receptive. These patients I'm seeing have been to general practitioners and they were not given the chance to speak their cases because of the voluminous patients waiting for them to finish. As a subspecialist, I could spend a little more time on them. I think this is my purpose. Not just to cure but to listen.

A patient of mine affirmed me this. I know it's not the medicine I've prescribed that made her better for my colleagues will be giving the same medications if she ended up to any one of them. She approached me before I started seeing my assigned patients and requested that I should be the one to see her. She was assigned to a colleague of mine and I took her chart as requested. After our consultation was done, she left teary-eyed,saying,"Salamat po talaga dok sa pakikinig. Sana ikaw lagi ang titingin sa akin. Makita pa lang kita gumagaling na ako." I was speechless. I felt fulfilled…fulfilled as the young intern who acted as a real doctor…fulfilled as the restless resident who just snatched a patient from death.