September 3, 2010
(DOCTOR)
Dean
College of Medicine – West Visayas State University
Thru: (DOCTOR)
Clinical Clerk Coordinator
West Visayas State University Medical Center
Dear Doctor,
I write to apply for a LEAVE OF ABSENCE, to rest, effective today, until December 31, 2010. May I also please ask for your permission to assume hospital duty by January 1, 2011 to make up for the remaining hours that I will not be able to serve during this Leave. Hopefully, I could complete all my requirements and graduate in April to begin PGI on May, 2011.
May I offer two reasons for this application:
1. Despite the many satisfactions and great learning in medical school and hospital training, my physical state of exhaustion is also exacting a toll on my general well-being. The problems of sleep deprivation and stress in 80 or more hours a week in the hospital, with duty-shifts of 24-36 hours, is leading me to a mechanical state and warped lifestyle that is no longer, me. Before it gets to be really problematic, I urgently need to sleep and rest for just a while. I need to gather re-newed energy again which I believe can be obtained from claiming some time and space for a break....to relax in a stress free situation.
“Rest if you must, but don’t you quit.”
(Don’t Quit)
2. It has been an exciting time. Much energy had been spent in learning the science of medicine these past 4 years. Perhaps, amidst “managing” patients and “surviving” hospital training culture, I miss out on “the art of healing” – the comforting or caring dimension of healing...the spiritual dimension of this profession. The focus on sharply defined physiological problems has trained me to control or ignore my natural reactions to commonly encountered scenarious in the ER, OR, Floors, ICU, NICU, etc. resulting to the capacity to remain cool, calm, and detached, no matter how desperate a crisis may be. Now, I experience that some deep part of me feels numbed. If I am to proceed with inner health, I need to return to my natural bearings of recovering my idealism and belief that healing has both physical and spiritual dimensions. I need to recover my original motive for helping the sick. My original vocational inspiration have been neglected, ravaged by the heat of training. I want to rediscover the root of my sacred vocation as a healer. For this, I need time for a Retreat. I would like to discern the spiritual impact of my experiences in medical training. I am sure to find God’s deep affirmation and broadening of my personal and professional life.
“it is not the nature of the task, but its consecration that is the vital thing”
(Martin Buber)
The desire to become a doctor is still definitely very strong. Please know that I gave time and stretched through this fatigue-state for some months, hoping it would just pass as a phase. However, it would not let up. I consulted many people and finally decided, with the support of my parents, to take the four-month leave. I look forward to a rejuvinated and animated come-back-to duty by January and resume my training with all its rigors and stressful conditions.
Thank you for your understanding and kind support.
Sincerely,
Socorro Marie – Eugenie C. Baga
Clinical Clerk
Conferred by:
Cynthia C. Baga Oscar T. Baga
(Mother) (Father)
Noted By:
(DOCTOR)
Office of Student Affairs
College of Medicine - WVSU
Wednesday, November 03, 2010
The Pathophysiology of Compassion Exhaustion and the Duality of Understanding as a Gift and Curse
This is the case of a 25 year old clinical clerk undergoing clinical duty in a public hospital. Through a series of events, she decided to take a leave of absence with the reason of “Compassion Fatigue” 2 months prior to graduation. With no psychiatric cause or management provided for the leave, this move was considered both unorthodox and impractical by the medical community. However, they were given no choice as the clerk was clearly adamant that she needed to go on this leave.
The Complaints I never made
As a clinical clerk, there’s no denying the long working hours and that the lack of sleep is inevitable. We go On Duty from 7:30 am to 5 pm, have a 2 hour break for dinner and showers then come back from 7 pm to 5 am of the following day. Then, again followed by a two-hour break to shower, have breakfast and to prepare for endorsements or whatever things that were left un done for this next day – our From Duty day which goes from 7 am to 5 pm. The following day is our On Call day which again goes from 7:30 am to 5 pm.
However, it is not the long sleepless hours that get to us. It’s the constant nagging and comparison that nurses, residents and doctors tell us that we are blessed to have two-hour breaks in between our 24 -duty hours as opposed to previous years or what they call “their time” that there were no breaks given to clerks. This two hour break is also the source of great animosity when clerks cannot finish their assigned tasks. We often hear: “There’s no excuse for unfinished paperwork because you have two-hour breaks…” or “Good for you, you have two-hour breaks, during our time, we had none and we had to finish everything.”
Whenever I hear these things, I think about two things. First, from what I’ve seen so far from the two batches that I’ve had the pleasure of going on duty with was that the inability to finish paperwork or any other task came from the clerk’s innate capacity for hard work or the lack of it. No matter how long or how short the breaks are, if a clerk procrastinates or is lazy, paperwork and other tasks will still be left undone. This is the reason why some clerks end up with lesser demerits than others, because they are more hard working and have more time management skills compared to others. Moreover, whenever that issue of the two-hour break surfaces, I say to myself “Isn’t it time that the medical practice develop more humane working conditions? Then, why all the fuzz and clamor about wanting to be able to eat and shower?” For a long time, in a public hospital such as ours clerks and interns on duty would only eat for more than 12 hours and could not shower for more than 36 hours. If we belonged to another reality, we could easily file for labor suits, given that clerks and interns are also not compensated. In fact, clerks pay tuition to be trained in the hospital – and with that it is also part of the package of the training that we pay for are the conditions of seeing more patients, learning more, and not being able to eat or shower. Sometimes, because we are too engrossed with being heroes and being life savers that we forget basic human rights.
From the United States, to Europe and the Philippines, I am at awe with the silent war going on between nurses and doctors. I understand that the two professions work hand in hand in saving lives and alleviating dis-ease but why such hostility?
Perhaps because I do my clerkship in a hospital with a long list of traditions and practices that were tested through time, I have to face certain realities that were the product of history. For instance, it is common knowledge that once we enter the halls of our hospital, we become the lowest beings in the planet. We are subject to being shouted at by nurses, aids and janitors. They can do pretty much anything to us like make us monitor, give medication and clean up after our patients if they find themselves too busy combing their hair, talking on the phone or eating. I was even more shocked to know that the reason that why we can be shouted at and scolded publicly for no reason at all is because clerkship is the only time all the other people can do this to us. They say that if we become doctors, the tables will turn and we will be the ones to do those things to all the other people in the hospital. Now, where did this come from? Who started this war? Was it the doctors of old with enormous temper tantrums that led to the wrath of the nurses towards the clerks? Or was it inefficient nurses who warranted scolding from the doctors with enormous temper tantrums that led to the wrath of the nurses towards the clerks? It’s like the chicken and egg riddle, as to which one came first.
Moreover, it is not only the nurses, aids and janitors who seem to have the right to publicly humiliate us. They may have only followed the example of some power tripping residents and consultants.
For example, during bedside rounds, when asked about particular details about our history and physical exam of our patients and if we couldn’t answer, they’d tell us – “Is that all that you know? You reached this level without knowing that?!” In the eyes of our patients, we see apparent distrust toward us such that the next time we examine them and ask them, they become more hesitant and non-compliant because they perceive us as incompetent. As a result, we get scolded again because certain procedures or certain information will require the resident to actually go to the patient and for that particular resident to do it because the patient will no longer allow the clerk to do so.
Another reality about going on duty in a public hospital is the scarcity of resources. For trauma patients, we practice what is known as the Robinhood practice. Basically, it is stealing from the rich to give to the poor. Whenever there are patients who have more medicines, more plasters, more gloves, more resources, whatever is not used, we save them so that if there are emergency patients who have no money to buy these things, we can give them something, actually anything just to get them by. We are also confronted by the reality that despite our best efforts, there are still some patients who think they can come into the hospital and everything is free because they are sick and needy. It’s like when fathers and mothers complain that they have no money to buy medication and they get mad because the hospital cannot provide free medication when they are actually smokers and chronic alcoholics and that if only they had cut down on their vices, they will be able to buy the proper medicines for their children or the proper food and nutrition so that they won’t get sick.
Loneliness
These working conditions were bearable for me as I coursed through the first 6 months of clerkship. I admit it was also hard but because I had someone special to inspire and motivate me, to hold my hand and tell me everything was going to be alright, I pressed on with courage. It was during the preparations for graduation that I felt I was not just about to lose the love of my life, but the batch that I belonged to as well. My original classmates would be graduating while I was to remain for another 6 months. Knowing that a new batch would be joining us – the irregulars gave me much anxiety because first, I didn’t know them, second, I didn’t know how they worked and third, I had lost my dutymates – those people who knew the inner working of my heart, my frustrations and joys.
To make matters worse, the love of my life would be moving unto PGIship thousands of miles away. Only those in long distance relationships could comprehend the stress, the anxiety and the loneliness of such as relationship.
When they all left, I felt alone. It was a loneliness so deep I thought I was going into depression. It was a constant throbbing heartache not to see, hear and touch the one person that brought color and meaning to your life for the past 4 years. It was unbearable not to be able to receive a call or even a text for hours and hours not knowing what was going on with him. I counted three months of sleepless nights, shed tears and lost energy and vigor. I went from being much in love to being much hurt by his absence. It was a terrible shift from being alive to being dead.
Pride and Prejudice
To add insult to injury, the political atmosphere in the hospital didn’t help at all. A select few of the new clerks were making waves in influencing hospital policies that made a lot of people angry. PGIs especially, my former batchmates were beginning a raid of hostility and I soon got bored of going out with them hearing nothing but complaints about the new system and the new clerks. It was a batch thing that grew into so much more fueled by pride and prejudice and I was caught in the middle of it. Clerks were also now responding to some PGIs and the endless backbiting on both sides began. It got to point that I wanted friends that had nothing to do with medicine or the medical practice to avoid the brewing conflict.
The Duality of Understanding as Gift and Curse
With all the things going on, I never really ranted out how I felt about my state. I kept believing that I understood all the circumstances and that there were far better things to care about – up to the extent that I could not care for anything at all anymore.
I remembered saying to myself that all these things and realities that were happening around me were a product or a result of something. I tried to understand where the doctors were coming from when they compared the duty hours. That they belonged to a time and era where everything was much simplier, lesser distractions, fewer patient populations and more time to study and learn and it’s as if we, our generation in our utmost incompetence were the source of the highest anxiety and frustration where actually some of them were simply experiencing the crossroads of a midlife crisis or the bitterness of a questioning life story. I understand how doctors who are so severe grow up to be that way when the only life they ever knew was patients, medications, operations, medical conferences, trips abroad and making money and in the end still ask the questions like; “is this all there is to life?” Surely someone in that state would harbor some form of bitterness.
I also understood where the nurses were coming from. From generation to generation of clerks and doctors who have walked these halls, how many of those showed signs of thanks, gratitude and appreciation to them? Most of them worked there for more than 10 years and still, they are the ones carrying out the work and very little of them get promoted into being chief nurse.
Surely someone in that kind of state could have some form of frustration that is vented out at the object that represents all that frustration – the clerks. I also understand where our residents are coming from. I understood that those who liked to publicly humiliate us, were they themselves victim of a public humiliation or because it was how they were taught and forced to learn, in effect it is the only way they know how to teach as well. The tougher ones have a much deeper insecurity issue that had left their ego scarred that I theorize drove them into dehumanizing other so that they can feel superior even for just a while to compensate. But, that’s just me… I tend to understand and find reasons to sincerely accept that this harsh reality we are in is only the result and that people are also enslaved from where they are coming from and that their unconscious manifestations are the ones that hurt us.
I thought because I had the gift of understanding, the ability to let things go and to simply and sincerely accept people and situations as a result of an “unperfect world” that I already forgave years ago, I would be alright. I thought that understanding was a gift that I had and that because I recognized it, I was the one would adjust.
However, understanding the world and accepting all its imperfections was not only bold, it was also arrogant and impossible and this became my curse. I forgot that I was human too. I forgot that I also felt hurt whenever I was publicly criticized. I forgot that I too had needs like sleep and food. When I was bagging a premature infant who eventually succumb, I thought to myself that I had lost sleep, but this father had lost a son! – How understanding of me, how compassionate to understand the plight of the father! How arrogant of me to think such! I had become full of myself into thinking everything was alright!
From I Understand to I don’t Care
It was like a dark overwhelming power had seized me. I swung from a deep sense of compassion and understanding to a deep sense of not caring anymore because I eventually grew tired of caring. It is the classic STAR WARS metaphor for turning into the dark side. It is when I believed so much that I was cut out for this line of work that I began to lose myself in it, in its perks and the power that came along with it. I lost myself into thinking I could care so much for others and that I could neglect myself. Who am I to think such? I am no saint. I also lost myself into the daily grind of the work that I do – because I was “doctor”, this was a noble profession and I could get away with other stuff because of the reverence the MD suffix in the name could bring. It became a career instead of a vocation, a source of pride instead of a source of humility. I felt indestructible and that’s when I grew tired the most!
My growing apathy was hitting my hard in all directions. I lost the fervor of faith, in going to mass and seeking spiritual advice. It was taking a toll in my relationship with my boyfriend, sometimes making me lazy to text or call or nourishing the relationship which needed a lot because of the distance. I was distancing myself from true friends and engaging in drinking binges and other unhealthy activities. These coping mechanisms were a desperate attempt to recover what was true and good that was lost in the chilliness of indifference. I desired the fire and the passion to once again feel, but my medical work and training has had me using my head for so long I forgot how to feel.
Chronological Story of Reasons for waking up
In the morning of September 1, 2010 I woke up remembered the different reasons why I would get up in the morning to go for duty through the different months. At first in November up to February, I woke up for my patients, to do their daily progress checks, dress their wounds and check for bleeding, check for a fetal heartbeat. By March and April, I was waking up because my boyfriend was inspiring me, with all the things he had accomplish, finishing clerkship and getting his MD at last. By June and July I would wake up because I had too, so that I would have less demerits and absences to cover once I started to pay for them as graduation grew nearer. By August, I was waking up because I could learn something new, a new disease, I new method for examining, a new “aha” moment – moments that didn’t come, moments that flew by, moments I took for granted.
And, so as I decided on whether I would get up on that faithful day of September, I asked myself; “I wonder when will be the time that I could wake up and go for myself?” Not for others, not for grades or demerits, not for frustrated learning experiences but for the shear joy and deep desire to do what I love, a love that had been forgotten.
It’s Actually Compassion Exhaustion
That morning I went back to sleep in my bed because I could not find the reason to get out of bed I was looking for. After two hours, I opened my eyes and decided to inquire about my leave of absence, the requirements and the process and this was the first time I felt alive again in a long time. I guess that day I got out of bed for myself afterall – the reason: Compassion fatigue. No! Compassion Exhaustion!
The Complaints I never made
As a clinical clerk, there’s no denying the long working hours and that the lack of sleep is inevitable. We go On Duty from 7:30 am to 5 pm, have a 2 hour break for dinner and showers then come back from 7 pm to 5 am of the following day. Then, again followed by a two-hour break to shower, have breakfast and to prepare for endorsements or whatever things that were left un done for this next day – our From Duty day which goes from 7 am to 5 pm. The following day is our On Call day which again goes from 7:30 am to 5 pm.
However, it is not the long sleepless hours that get to us. It’s the constant nagging and comparison that nurses, residents and doctors tell us that we are blessed to have two-hour breaks in between our 24 -duty hours as opposed to previous years or what they call “their time” that there were no breaks given to clerks. This two hour break is also the source of great animosity when clerks cannot finish their assigned tasks. We often hear: “There’s no excuse for unfinished paperwork because you have two-hour breaks…” or “Good for you, you have two-hour breaks, during our time, we had none and we had to finish everything.”
Whenever I hear these things, I think about two things. First, from what I’ve seen so far from the two batches that I’ve had the pleasure of going on duty with was that the inability to finish paperwork or any other task came from the clerk’s innate capacity for hard work or the lack of it. No matter how long or how short the breaks are, if a clerk procrastinates or is lazy, paperwork and other tasks will still be left undone. This is the reason why some clerks end up with lesser demerits than others, because they are more hard working and have more time management skills compared to others. Moreover, whenever that issue of the two-hour break surfaces, I say to myself “Isn’t it time that the medical practice develop more humane working conditions? Then, why all the fuzz and clamor about wanting to be able to eat and shower?” For a long time, in a public hospital such as ours clerks and interns on duty would only eat for more than 12 hours and could not shower for more than 36 hours. If we belonged to another reality, we could easily file for labor suits, given that clerks and interns are also not compensated. In fact, clerks pay tuition to be trained in the hospital – and with that it is also part of the package of the training that we pay for are the conditions of seeing more patients, learning more, and not being able to eat or shower. Sometimes, because we are too engrossed with being heroes and being life savers that we forget basic human rights.
From the United States, to Europe and the Philippines, I am at awe with the silent war going on between nurses and doctors. I understand that the two professions work hand in hand in saving lives and alleviating dis-ease but why such hostility?
Perhaps because I do my clerkship in a hospital with a long list of traditions and practices that were tested through time, I have to face certain realities that were the product of history. For instance, it is common knowledge that once we enter the halls of our hospital, we become the lowest beings in the planet. We are subject to being shouted at by nurses, aids and janitors. They can do pretty much anything to us like make us monitor, give medication and clean up after our patients if they find themselves too busy combing their hair, talking on the phone or eating. I was even more shocked to know that the reason that why we can be shouted at and scolded publicly for no reason at all is because clerkship is the only time all the other people can do this to us. They say that if we become doctors, the tables will turn and we will be the ones to do those things to all the other people in the hospital. Now, where did this come from? Who started this war? Was it the doctors of old with enormous temper tantrums that led to the wrath of the nurses towards the clerks? Or was it inefficient nurses who warranted scolding from the doctors with enormous temper tantrums that led to the wrath of the nurses towards the clerks? It’s like the chicken and egg riddle, as to which one came first.
Moreover, it is not only the nurses, aids and janitors who seem to have the right to publicly humiliate us. They may have only followed the example of some power tripping residents and consultants.
For example, during bedside rounds, when asked about particular details about our history and physical exam of our patients and if we couldn’t answer, they’d tell us – “Is that all that you know? You reached this level without knowing that?!” In the eyes of our patients, we see apparent distrust toward us such that the next time we examine them and ask them, they become more hesitant and non-compliant because they perceive us as incompetent. As a result, we get scolded again because certain procedures or certain information will require the resident to actually go to the patient and for that particular resident to do it because the patient will no longer allow the clerk to do so.
Another reality about going on duty in a public hospital is the scarcity of resources. For trauma patients, we practice what is known as the Robinhood practice. Basically, it is stealing from the rich to give to the poor. Whenever there are patients who have more medicines, more plasters, more gloves, more resources, whatever is not used, we save them so that if there are emergency patients who have no money to buy these things, we can give them something, actually anything just to get them by. We are also confronted by the reality that despite our best efforts, there are still some patients who think they can come into the hospital and everything is free because they are sick and needy. It’s like when fathers and mothers complain that they have no money to buy medication and they get mad because the hospital cannot provide free medication when they are actually smokers and chronic alcoholics and that if only they had cut down on their vices, they will be able to buy the proper medicines for their children or the proper food and nutrition so that they won’t get sick.
Loneliness
These working conditions were bearable for me as I coursed through the first 6 months of clerkship. I admit it was also hard but because I had someone special to inspire and motivate me, to hold my hand and tell me everything was going to be alright, I pressed on with courage. It was during the preparations for graduation that I felt I was not just about to lose the love of my life, but the batch that I belonged to as well. My original classmates would be graduating while I was to remain for another 6 months. Knowing that a new batch would be joining us – the irregulars gave me much anxiety because first, I didn’t know them, second, I didn’t know how they worked and third, I had lost my dutymates – those people who knew the inner working of my heart, my frustrations and joys.
To make matters worse, the love of my life would be moving unto PGIship thousands of miles away. Only those in long distance relationships could comprehend the stress, the anxiety and the loneliness of such as relationship.
When they all left, I felt alone. It was a loneliness so deep I thought I was going into depression. It was a constant throbbing heartache not to see, hear and touch the one person that brought color and meaning to your life for the past 4 years. It was unbearable not to be able to receive a call or even a text for hours and hours not knowing what was going on with him. I counted three months of sleepless nights, shed tears and lost energy and vigor. I went from being much in love to being much hurt by his absence. It was a terrible shift from being alive to being dead.
Pride and Prejudice
To add insult to injury, the political atmosphere in the hospital didn’t help at all. A select few of the new clerks were making waves in influencing hospital policies that made a lot of people angry. PGIs especially, my former batchmates were beginning a raid of hostility and I soon got bored of going out with them hearing nothing but complaints about the new system and the new clerks. It was a batch thing that grew into so much more fueled by pride and prejudice and I was caught in the middle of it. Clerks were also now responding to some PGIs and the endless backbiting on both sides began. It got to point that I wanted friends that had nothing to do with medicine or the medical practice to avoid the brewing conflict.
The Duality of Understanding as Gift and Curse
With all the things going on, I never really ranted out how I felt about my state. I kept believing that I understood all the circumstances and that there were far better things to care about – up to the extent that I could not care for anything at all anymore.
I remembered saying to myself that all these things and realities that were happening around me were a product or a result of something. I tried to understand where the doctors were coming from when they compared the duty hours. That they belonged to a time and era where everything was much simplier, lesser distractions, fewer patient populations and more time to study and learn and it’s as if we, our generation in our utmost incompetence were the source of the highest anxiety and frustration where actually some of them were simply experiencing the crossroads of a midlife crisis or the bitterness of a questioning life story. I understand how doctors who are so severe grow up to be that way when the only life they ever knew was patients, medications, operations, medical conferences, trips abroad and making money and in the end still ask the questions like; “is this all there is to life?” Surely someone in that state would harbor some form of bitterness.
I also understood where the nurses were coming from. From generation to generation of clerks and doctors who have walked these halls, how many of those showed signs of thanks, gratitude and appreciation to them? Most of them worked there for more than 10 years and still, they are the ones carrying out the work and very little of them get promoted into being chief nurse.
Surely someone in that kind of state could have some form of frustration that is vented out at the object that represents all that frustration – the clerks. I also understand where our residents are coming from. I understood that those who liked to publicly humiliate us, were they themselves victim of a public humiliation or because it was how they were taught and forced to learn, in effect it is the only way they know how to teach as well. The tougher ones have a much deeper insecurity issue that had left their ego scarred that I theorize drove them into dehumanizing other so that they can feel superior even for just a while to compensate. But, that’s just me… I tend to understand and find reasons to sincerely accept that this harsh reality we are in is only the result and that people are also enslaved from where they are coming from and that their unconscious manifestations are the ones that hurt us.
I thought because I had the gift of understanding, the ability to let things go and to simply and sincerely accept people and situations as a result of an “unperfect world” that I already forgave years ago, I would be alright. I thought that understanding was a gift that I had and that because I recognized it, I was the one would adjust.
However, understanding the world and accepting all its imperfections was not only bold, it was also arrogant and impossible and this became my curse. I forgot that I was human too. I forgot that I also felt hurt whenever I was publicly criticized. I forgot that I too had needs like sleep and food. When I was bagging a premature infant who eventually succumb, I thought to myself that I had lost sleep, but this father had lost a son! – How understanding of me, how compassionate to understand the plight of the father! How arrogant of me to think such! I had become full of myself into thinking everything was alright!
From I Understand to I don’t Care
It was like a dark overwhelming power had seized me. I swung from a deep sense of compassion and understanding to a deep sense of not caring anymore because I eventually grew tired of caring. It is the classic STAR WARS metaphor for turning into the dark side. It is when I believed so much that I was cut out for this line of work that I began to lose myself in it, in its perks and the power that came along with it. I lost myself into thinking I could care so much for others and that I could neglect myself. Who am I to think such? I am no saint. I also lost myself into the daily grind of the work that I do – because I was “doctor”, this was a noble profession and I could get away with other stuff because of the reverence the MD suffix in the name could bring. It became a career instead of a vocation, a source of pride instead of a source of humility. I felt indestructible and that’s when I grew tired the most!
My growing apathy was hitting my hard in all directions. I lost the fervor of faith, in going to mass and seeking spiritual advice. It was taking a toll in my relationship with my boyfriend, sometimes making me lazy to text or call or nourishing the relationship which needed a lot because of the distance. I was distancing myself from true friends and engaging in drinking binges and other unhealthy activities. These coping mechanisms were a desperate attempt to recover what was true and good that was lost in the chilliness of indifference. I desired the fire and the passion to once again feel, but my medical work and training has had me using my head for so long I forgot how to feel.
Chronological Story of Reasons for waking up
In the morning of September 1, 2010 I woke up remembered the different reasons why I would get up in the morning to go for duty through the different months. At first in November up to February, I woke up for my patients, to do their daily progress checks, dress their wounds and check for bleeding, check for a fetal heartbeat. By March and April, I was waking up because my boyfriend was inspiring me, with all the things he had accomplish, finishing clerkship and getting his MD at last. By June and July I would wake up because I had too, so that I would have less demerits and absences to cover once I started to pay for them as graduation grew nearer. By August, I was waking up because I could learn something new, a new disease, I new method for examining, a new “aha” moment – moments that didn’t come, moments that flew by, moments I took for granted.
And, so as I decided on whether I would get up on that faithful day of September, I asked myself; “I wonder when will be the time that I could wake up and go for myself?” Not for others, not for grades or demerits, not for frustrated learning experiences but for the shear joy and deep desire to do what I love, a love that had been forgotten.
It’s Actually Compassion Exhaustion
That morning I went back to sleep in my bed because I could not find the reason to get out of bed I was looking for. After two hours, I opened my eyes and decided to inquire about my leave of absence, the requirements and the process and this was the first time I felt alive again in a long time. I guess that day I got out of bed for myself afterall – the reason: Compassion fatigue. No! Compassion Exhaustion!
Wednesday, May 26, 2010
Missing you
There was a time in my life when I was sitting in a bench in the administration building of my university. Back then I was feeling like a little toddler lost in the supermarket watching the people buzzing around and no familiar face was there for comfort. I thought that having been uprooted from my comfort zone was a crossroad I would never cross once I've mastered that. Perhaps I have not mastered being uprooted or maybe there is just no mastery to it because we get uprooted so many times in a lifetime.
It has been years since I felt this way. First year medical school confronted me with the same adjustment anxiety that left me tormented for months. Finally now after three years, when I thought I have found my niche, my place, my people and my passion, I again feel that same feeling of being awkward, being uprooted and having that same sense of unfamiliarity where no familiar face is available for comfort.
As far is career is concerned, most people in the medical profession call this stage COMPASSION FATIGUE. Working 24-32 or even 36 hour shifts for the past 7 months is no joke. Aside from the lack of sleep, academic demands and the daily grind of dealing with the toxicity of life and death situations, there are more occasions of slavery and power struggle. Nurses order us around. The facilities of fuming hot consultation clinics and dripping conference rooms house our day to day activities. Benches and counters are converted into study tables and nap areas but it may also be quite impossible to get some naps if you get calls of patients pulling out their IVs and catheters in the wee hours of the morning for you to put them back in so they can have their medications.
These are just some examples and there are a lot more of powertrip and heartwarming and heartbreaking stories to tell but the bottom line of all these is that it's really really really tiring. These days I go to the hospital for the attendance so I don't have to pay the exponential demerits that goes with absences. I only find myself making sure a patient doesn't die on me and sometimes they just do. It's frustrating looking myself at the mirror and feeling mediocre about the way I conduct myself in this noble profession but efforts at improvement are as parched as this wretched drought. I know exactly what I am supposed to do but I don't find strength nor enthusiasm to start doing them today. I end up procrastinating.
As for my social life, there's the occasional going out with friends. I try my best but when I get home I feel more tired than ever. I thought going out would give me a break from the routine I'm stuck in but I end up finding more excuses to crawl into my hole as soon as I'm done socializing.
Maybe, all these boils down to losing the presence of someone very dear to me. I am usually not one of those persons who wraps around my life on a particular individual but after three years of being together it just happen. Unaware our lives were intertwined and now that we are in a long distance relationship, I feel so lost.
I used be positive at our system of education, though imperfect, he is that blessing that draws me to the hospital everyday and starts my day with such freshness and energy. And, when confronted with tiring tasks and frustrations, he was there, with his shoulder and his hugs to make me feel alright. Now I can only get that from his texts ..."Mwah.."
I kept my circle of friends but he was the one I opened up everything for the past three years. Now, this separation anxiety is so severe I can't even talk to people or at least really express what I truly feel - sad and lost.
And yet, despite this misery I am thankful for the bit and pieces of texts that take a few seconds of our busy day just to connect and the few minutes of calls just to make me know he's still around, even miles away.
I have been uprooted once again from my comfort zone that is him. I feel once again like that toddler lost in the supermarket unable to walk confidently and find my way around. I wish my heart would expand like a big balloon to engulf and include those around me and that I would find in them that small part of inspiration that he monopolized for so long. But until then, I remain in this little hole... missing you.
Friday, April 23, 2010
Pearls...
Today is the graduation of Batch 2010 in Medical School - Batch Mumbaki - Cheers!
I could not help but feel gratitude and happiness for my classmates who have finally completed 4 years of medical school, including the dreaded Clinical Clerkship year. Much has happen to us, we grew up as well as learned (I hope...) and many deep experiences and friendships and love lives have been forged in the process. For someone like me, who sat on the sidelines and watched my batchmates (???) graduate, I couldn't help but also feel ambivalent about not being able to fully celebrate this moment with them. Some of these people, this may well be the last day I see them as we have no other way to go but go about our own separate lives. The past three years, I have been looking for the good reasons why I am in this place; hoping what I long for - answers - would be like pearls, oyster tears signifying something good born from something sad. Although I can never deny graces, today I feel more alone. Watching the significant people whom I have had the privilege of being friends with move into another dimension in life is like feeling a deep sense of separation anxiety.
Moreover, I am also counting the days until I am separated from the love of my life - who will be undergoing his Post graduate internship in Davao City. I would like to think that of all people in the world, we two can handle the distance. Both our parents have succeeded in that department through the years and make good role models. But, it is also certain that changes are inevitable - for our sake I hope change for our good. Distance can be both a challenge conquered resulting in a deeper commitment but it can also be detrimental to our relationship. It was good of him to leave me with me knowing of what he really feels - (After he stepped off from the stage, I noticed, he was looking for me - for me moments like these are reserved for the significant people in ones life; parents, family and those who really contributed to his success in finishing medschool, for me to be included in "his family" must be indicative of his truest feelings and intentions). It is an honor to be loved by someone, especially one whom I love as well. Hopefully, despite the challenges, we can always hang on to this foundation.
I could not help but feel gratitude and happiness for my classmates who have finally completed 4 years of medical school, including the dreaded Clinical Clerkship year. Much has happen to us, we grew up as well as learned (I hope...) and many deep experiences and friendships and love lives have been forged in the process. For someone like me, who sat on the sidelines and watched my batchmates (???) graduate, I couldn't help but also feel ambivalent about not being able to fully celebrate this moment with them. Some of these people, this may well be the last day I see them as we have no other way to go but go about our own separate lives. The past three years, I have been looking for the good reasons why I am in this place; hoping what I long for - answers - would be like pearls, oyster tears signifying something good born from something sad. Although I can never deny graces, today I feel more alone. Watching the significant people whom I have had the privilege of being friends with move into another dimension in life is like feeling a deep sense of separation anxiety.
Moreover, I am also counting the days until I am separated from the love of my life - who will be undergoing his Post graduate internship in Davao City. I would like to think that of all people in the world, we two can handle the distance. Both our parents have succeeded in that department through the years and make good role models. But, it is also certain that changes are inevitable - for our sake I hope change for our good. Distance can be both a challenge conquered resulting in a deeper commitment but it can also be detrimental to our relationship. It was good of him to leave me with me knowing of what he really feels - (After he stepped off from the stage, I noticed, he was looking for me - for me moments like these are reserved for the significant people in ones life; parents, family and those who really contributed to his success in finishing medschool, for me to be included in "his family" must be indicative of his truest feelings and intentions). It is an honor to be loved by someone, especially one whom I love as well. Hopefully, despite the challenges, we can always hang on to this foundation.
Friday, April 02, 2010
Sometime in a cave...
I was surfing the internet getting updates from friends, today is Good Friday and for the first time in years I had abstained from watching tv. Tapping and clicking away in the internet, I stumbled upon the inspiring homily of gratitude and tribute of Fr. Danny Huang to Fr. Joe Galdon. And, as I read through the black and white lines, I remembered what I missed most during this past few months. In his homily, Fr. Danny claimed that Fr. Galdon taught him how to read, write and teach - in aspects that "deepened and honed not only his mind but his humanity".
It's quite ironic that in a profession such as mine that deals with human body, I miss the feeling of being deepened up to the core of humanity. No one in my world talks or even thinks about humanity - we're to busy being doctors (or at least we think we are.)
Sometimes in a cave - like the one I'm feeling I'm in now, you find yourself in the abyss, in the silence, in the nothingness. Perhaps, to agree with the general theme of the season - death is necessary to feel alive once again. I needed this moment, this cave, this "stuckness" to feel alive again.
Tuesday, March 30, 2010
Reminder...
When I wake up each morning, it automatically comes to me to get ready to go to the hospital. When I get there, it becomes a blaze of patients, papers, classmates, nurses, staff and hospital concerns. When everything is in 911 mode it's very easy to take for granted periods of thanksgiving and some time to honor little and huge sacrifices.
This season, I am reminded that He has offered the ultimate sacrifice - His life that we may have hope and a reason to really live. Salamat sa reminder (of His sacrifice) from the skinny trisikad driver peddling his way to make a living, to the patient who succumbed to a hemorrhage caused by a blunt trauma to an internal organ, to the nurse who made kamusta first before demanding work to be carried out, to the batchmate who shared a laugh or two despite many paperworks, to the resident who listened even if he was tired from duty, to my boyfriend who shared a good meal despite the inconvenience of time and budget and to a good friend who made an inspiring and apt video for this particular season.
Little sacrifices are more than just reminders - they are snippets of hope.
Wednesday, March 24, 2010
Hypothermic
As the graduation day of my batchmates come nearer and nearer, the countdown calendar in the bulletin board decreases in number of days, so does the graduation fever increases in heat and intensity... and I'm experiencing hypothermia...
Preparations are being made for new paths and new opportunities and I can't help but wonder how alone I will feel once they've all moved on to another level in our training. I will surely miss this batch but I also find crumbs of hope and things to rejoice for.
Some thoughts though...
In a famous surgical resident's story about how a mouse was transformed by a magician to a cat, then to a dog, and then to a tiger (animals higher in the food chain) and still the mouse still had a mentality or rather a mental capacity of a mouse, I couldn't help but wonder as to how much I have gained so far after 4 mos in Clinical Clerkship. This period of saying goodbye at the same time enables me to revisit the things I need to do and accomplish before I too can say goodbye.
Another thought to ponder by; "The grass is always greener in the other side..."
It seems that when it comes to relationships, the latest trend going on around me is that people are looking for something or someone to fill the lack or the void of an absence. It's nice to see the other perspective but I feel I like my grass the way it is now. In the words of a wise classmate; "May mga bagay na masarap kasi bawal." Even if most people say long distance relationships don't work, I still put my bet on us that it will.
Finally, this season of lent, the season for repentance and forgiveness in its ultimate form - I'd like to think of all the times I have practice neglect for the patient because they're too toxic and I've already been exhausted. And, also of all the times, I have to forgive people and situations that cause inconvenience and added stress. May these memories be stepping stones for the purification of my desire to become a doctor, (a doctor with compassion..)
Preparations are being made for new paths and new opportunities and I can't help but wonder how alone I will feel once they've all moved on to another level in our training. I will surely miss this batch but I also find crumbs of hope and things to rejoice for.
Some thoughts though...
In a famous surgical resident's story about how a mouse was transformed by a magician to a cat, then to a dog, and then to a tiger (animals higher in the food chain) and still the mouse still had a mentality or rather a mental capacity of a mouse, I couldn't help but wonder as to how much I have gained so far after 4 mos in Clinical Clerkship. This period of saying goodbye at the same time enables me to revisit the things I need to do and accomplish before I too can say goodbye.
Another thought to ponder by; "The grass is always greener in the other side..."
It seems that when it comes to relationships, the latest trend going on around me is that people are looking for something or someone to fill the lack or the void of an absence. It's nice to see the other perspective but I feel I like my grass the way it is now. In the words of a wise classmate; "May mga bagay na masarap kasi bawal." Even if most people say long distance relationships don't work, I still put my bet on us that it will.
Finally, this season of lent, the season for repentance and forgiveness in its ultimate form - I'd like to think of all the times I have practice neglect for the patient because they're too toxic and I've already been exhausted. And, also of all the times, I have to forgive people and situations that cause inconvenience and added stress. May these memories be stepping stones for the purification of my desire to become a doctor, (a doctor with compassion..)
Friday, March 12, 2010
Time to Think
Today after months of heavy working conditions, I finally have time to think. Sitting here in my room, tapping and yapping away in my new keyboards gives me a feeling of ease I have not felt in quite a long time. There is soooooo much going on in my daily activities that I no longer know where to start cleaning up the chaos. So much in fact that exhaustion will merely push me to stop. As if there was nothing more to say or think about and further postpone this cathartic relief.
Last night, I learned that the greatest thing I fear in a long distance relationship is myself. It has been decided that my boyfriend of four years will be doing his post-graduate internship in his home-city miles away (Davao City). And, for months I have been fuzzing about how male doctors get into trouble with the usual flirting with hospital staff and other medical professionals. There seems to be an unwritten law that says; "What ever happens in the hospital, stays in the hospital." Thus, the fear of not being able to know what happens in the hospital in Davao. This was further aggravated when a good friend of ours broke up with his girlfriend of seven years because he fell for another friend of ours during their tour of duties as clinical clerks. The events unfolding were like a prime time pinoy teleserye which was much anticipated and talked about.
In this complicated situation, I was wondering the whole time; "What if he falls for someone in his tour of duty in Davao." My personal stand is that I cannot really blame him because I will be miles away and there will really be times that I will not be there for him in the stressors and hazards of this line of work. But, in all this I was hoping and praying that nothing of this sort happens eventually.
It was only two days ago that I was the one who had my back on the wall. Some residents and classmates of mine had a drinking session after duty and I did not inform my boyfriend about the event. That night I didn't inform him because I already knew what he would react to - that these male resident/s could not be trusted because of their reputation with our other female classmates. I knew it was harmless if i went, but he may see it differently. So i went anyway but didn't tell him about it. The following day, I felt somethings not right about his reactions, I was suspecting that he was suspecting so i decided to come clean and tell him about the "tambay session" the night before. My delay in information dissemination did not suit well with him but he told me to no longer fuzz about it because it was in the past. Thus, ending the issue.
I only bring it to light as I remember the events now because I will need to handle these things properly with him. I dont want to hurt him or disappoint him when I go out with this types of people but at the same time I simply cannot keep on turnign down every invitation of this sort because when you come to think about it, there's nothing really behind some friends sharing conversations over some bottles of alcohol and having a little fun after a hard days work...
Next week will be the feast of St. Joseph - Husband of Mary and Patron of all husband, fathers and maybe boyfirends. He was an ideal man who was just and caring and secure and loving. I have always prayed to him for guidance and strength, and true enough even if i had my share of relationship mishaps, I never done anything or made a decision that I regretted. It is in these times, that I remember him more because I will be entering uncharted waters - nothing secure or permanent especially in something as complicated as a relationship (lalu na long distance)... I know for now that our individual choices shape the direction of our lives but I will also leave something a bit to FAITH and to DESTINY. Maybe only a handfull believe in this two things these days, sometime I too am tempted not to believe anymore. But what if these two have some stake at my life too, that FAITH and DESTINY also have a place in what I am going through... then maybe some power in this universe will actually give this something to help it work out well in the end.
Last night, I learned that the greatest thing I fear in a long distance relationship is myself. It has been decided that my boyfriend of four years will be doing his post-graduate internship in his home-city miles away (Davao City). And, for months I have been fuzzing about how male doctors get into trouble with the usual flirting with hospital staff and other medical professionals. There seems to be an unwritten law that says; "What ever happens in the hospital, stays in the hospital." Thus, the fear of not being able to know what happens in the hospital in Davao. This was further aggravated when a good friend of ours broke up with his girlfriend of seven years because he fell for another friend of ours during their tour of duties as clinical clerks. The events unfolding were like a prime time pinoy teleserye which was much anticipated and talked about.
In this complicated situation, I was wondering the whole time; "What if he falls for someone in his tour of duty in Davao." My personal stand is that I cannot really blame him because I will be miles away and there will really be times that I will not be there for him in the stressors and hazards of this line of work. But, in all this I was hoping and praying that nothing of this sort happens eventually.
It was only two days ago that I was the one who had my back on the wall. Some residents and classmates of mine had a drinking session after duty and I did not inform my boyfriend about the event. That night I didn't inform him because I already knew what he would react to - that these male resident/s could not be trusted because of their reputation with our other female classmates. I knew it was harmless if i went, but he may see it differently. So i went anyway but didn't tell him about it. The following day, I felt somethings not right about his reactions, I was suspecting that he was suspecting so i decided to come clean and tell him about the "tambay session" the night before. My delay in information dissemination did not suit well with him but he told me to no longer fuzz about it because it was in the past. Thus, ending the issue.
I only bring it to light as I remember the events now because I will need to handle these things properly with him. I dont want to hurt him or disappoint him when I go out with this types of people but at the same time I simply cannot keep on turnign down every invitation of this sort because when you come to think about it, there's nothing really behind some friends sharing conversations over some bottles of alcohol and having a little fun after a hard days work...
Next week will be the feast of St. Joseph - Husband of Mary and Patron of all husband, fathers and maybe boyfirends. He was an ideal man who was just and caring and secure and loving. I have always prayed to him for guidance and strength, and true enough even if i had my share of relationship mishaps, I never done anything or made a decision that I regretted. It is in these times, that I remember him more because I will be entering uncharted waters - nothing secure or permanent especially in something as complicated as a relationship (lalu na long distance)... I know for now that our individual choices shape the direction of our lives but I will also leave something a bit to FAITH and to DESTINY. Maybe only a handfull believe in this two things these days, sometime I too am tempted not to believe anymore. But what if these two have some stake at my life too, that FAITH and DESTINY also have a place in what I am going through... then maybe some power in this universe will actually give this something to help it work out well in the end.
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