This essay was written in 2010 while I was an intern doctor in Tribhuvan University Teaching Hospital, Nepal and was published in the annual book of the interns at that time (MBBS, 26th Batch). I read it again a week ago, and chuckled at what I had written back then. The core theme of this essay still rings true, though. I debated whether I should edit or rewrite it, but decided to leave it as it was (including several grammatically unsound sentences) for two reasons. One, you will see that I didn’t use to write well. You can read this essay and the essays I write these days and compare. This will tell you that writing is a skill which can be improved with work. The important thing is to keep writing. Two, this essay shows what an intern doctor at that time from 2010 working in TUTH, Kathmandu felt like. If I edited it now, it would be contaminated with my present day feelings. So, here you go- my experiences from 2010 working as an intern doctor in the wards and emergency room of one of the biggest hospitals in Nepal.

I am now an intern doctor in Tribhuvan University Teaching Hospital. I don’t know how it goes with other institutes but over here being an intern is not a joy. You long for the day when you can have those two beautiful letters before your name, call yourself an intern, and start working in the hospital. The craving for it is more intensified especially while you are enduring the 6 month long final exams. But when you finally achieve that, you realize that being a medical student was far easier. Intern is really a difficult stage to be in. Neither the hospital nor the college feels that you belong to either of them. And you are expected to perform both as a consultant at certain times and just as a helper (attendant) at some other times. So, frustration begins and that clearly shows in our dealings with patients as well.

But believe me it’s a privilege to be an intern if you can make proper use of it and look at the brighter side of things. You are the one who is going to be most in touch with the patient. You are the one drawing their blood, giving them forms, admitting them, discharging them, doing their dressings, catheterizing them, tapping their pleural/ascitic/cerebrospinal fluids, explaining their queries, and so on. Even though you are the most junior member of the team, you become the most important one and the one directly attached to the patient. Because we share more time with the patients, we are the front liners in answering their queries and solving their problems. So it isn’t unusual that some patients remember your name as their treating doctor instead of the consultants’.

That is why the way we deal with them, we talk to them, becomes of utmost importance. I am using a cliché here that even the talk and touch of a doctor heals 50% of patient’s problems and like most of the clichés this also has some truth to it. It is sad that we haven’t been taught a word about the thing which we have to do most of our professional lives, i.e. the way of talking to or touching the patients, dealing with them, patiently responding to their queries. It is very sorry to see some of the interns talking to patients in rude manner, ignoring their questions, telling lies, not accepting their own mistakes, and blaming them on patients or their relatives instead, and treating them as things instead of people. This problem is seen with each hierarchy of doctors, not only interns. Even some of the faculty members’ behavior towards patients has been far from exemplary so it is no wonder that we have been learning the wrong way of doing the right things. It is also one of the reasons why patient and patient party are respecting doctors less these days and always approaching the medical fraternity with hostility when anything wrong happens.

Internship is a delightful period of learning and experiencing. This is the ideal time to decide which career you fit in best and to decide which subject you want to specialize in, because it is the time you are allowed to have glimpses of the pros and cons of most medical specialties. However, even more important aspect of internship is that you get close to patients like you never had been during medical education. You are, if serious and interested and responsible, in charge of the patients of your unit. You know why they arrived to the hospital, how they were diagnosed with that particular disease, what treatment they have been getting, and what have been the consequences of those treatments. But the significant part is that you also get to know all other aspects of their lives, if you have a good eye and ear. How did he get the disease, how is he coping with it, what are his relatives’ feelings about this, what did he use to do, what regrets he has, what are the things he wants to do before dying, what is his learning of life, etc. Of course, these are more relevant in context of terminally ill or chronic diseases like cancer but learning these non-medical aspects from patients is always fascinating. Today I want to share a few things my patients have kindly taught me during my internship till date.

LIFE IS BEAUTIFUL, ENJOY EVERY MOMENT

Life is the most precious thing we could ever have. We never appreciate the true worth of all dear things to us, until there is a risk of losing it. We, while healthy, never appreciate the importance of having a sound body and mind. Only when there is a threat to life, we start to realize its value. Frankly, how often do we feel rich and satisfied about just being alive or being healthy? I realized how important it is to be healthy when I accidently pricked my finger while suturing a laceration of a patient who was at a high risk for HIV/Hepatitis B or C. I remember how restless I was until I got the reports of his serology which fortunately was negative. Every day we live is luck. Life is so uncertain and that’s its beauty. That’s why life is so precious. Every day so many people are dying but we are still here- alive, healthy. So, don’t kill your time complaining about things! Be happy that you are alive and healthy. That’s the greatest thing that could be bestowed upon us by the Almighty. As an intern doctor of TUTH, I was fortunate to get acquainted with varieties of patients and diseases. It was heart breaking to see young people dying of mere UGI bleed, people having lung cancer at only 25 years of age and losing their lives. You really never know when you are signing off from the world. You never know when you will be sick. So live your life to the fullest. Enjoy every moment of it. You never get the chance to live that moment again; and suddenly you realize that you missed an important part of life. Do all those things that your heart is asking for. Never wait for the appropriate moment. It will never arrive. You need to squeeze it out. Live such that if you are suddenly in hospital today and the doc says that you are going to die in the next 6 months, you have no regrets.

• THINGS ARE NOT IMPORTANT BUT PEOPLE ARE

How many of us give importance to things around us? My clothes, my  house, my degree, my money, my grades, my phone, my laptop ! We must have had fights, emotional upheavals, or even broken some good relationships for issues related to these items. But those are just things! Like all things, they are there only to make our life happier and more comfortable, not to take away our happiness. They are just things! They are replaceable. More important are people, your near and dear ones! They are irreplaceable. They are your treasure. Value them, keep them in high regards, because one day you or the other is going to depart and then you will have only regrets. Don’t give importance to things. Give importance to people.

•  THE SPIRIT, THE WILL TO FIGHT

Some patients are such an inspiration. When on one hand, I see young people who are frustrated and losing hopes and committing suicide, on the other hand, we recently had a 76 year old patient of hepatocellular carcinoma who was very confident that he would survive despite the doctors team telling him otherwise. He underwent hepatic resection with bypass surgery, and developed unfortunately post operative surgical site infection as well as hospital acquired pneumonia. He asked us what were the things he could do to improve his chances of survival. We said his survival depended on nutrition, dressing, antibiotics, and chest physiotherapy. I had never seen any patient of any age whatsoever, who was so determined at being fit. He was constantly doing the chest physio with that blowing device that is common in TUTH wards. Many of you will notice that many patients for unknown reason just hate that device but this old man was blowing it all the time. And when I was by his bedside to do the dressing, he asked me to wash hands before I touched him (not that I wouldn’t have washed my hands before the dressing, but the fact that this request came from patient was a surprise) and to dress his wound perfectly. On his own insistence, I did his dressing even three times a day sometimes. And the happy part of the story is that he was miraculously discharged, contrary to our consultants’ initial opinions. I hope he continues to live healthy.

•  COMPASSION

I am talking about an important virtue of a medical professional that has been slowly disappearing (or maybe it never existed in first place), apparently because it has never been included during devising (??revising) our MBBS curriculum. Compassion, it is called, the trait kindly bestowed upon we humans alone by the nature, the trait which makes we human beings HUMAN in truest sense, the trait that differentiates us from other species, the trait which is the foundation of society and human civilizations. And in no other field will this virtue be more important than in the field of healing, the field where human sufferings are to be taken care of. Ironically, this seems to be the profession where this has been lacking most.

Compassion is a great virtue. And the sad thing is you can’t teach it. But you can practice it to the extent that it comes naturally. I have realized it personally that as an intern you CAN bring changes to people’s lives if you have COMPASSION ingrained in your character. You can bring a smile to their lips. There are many terminally ill patients in the wards who have been ignored. As much as their disease is killing them, our turning a deaf ear to their concerns or lack of gentleness in speech and touch also must have contributed to their poor quality of life. By changing our attitude towards patients, we can indeed change the attitude of patients towards us. People in our part still feel as if it is a great opportunity to talk to their treating doctors. If a doctor comes to their bedside, talks to them with compassion, and doesn’t show that s/he is superior to them but makes them realize that s/he is listening to them and feeling their pain, that’s it- that doctor will always be remembered. You don’t need to memorize Harrison’s for that. Just do this, and your patients will not forget you. They will come searching for you. As much as people are quick in deriding us for our mistakes, they are also always indebted to our kindness. Just speaking politely, empathetically, and professionally will make you renowned and you don’t need any fellowship training for that. Just have a positive attitude. Try to understand patients’ problems. It’s not always easy. It’s not easy to smile to “kichkiche” patients or patients who seem to show to you that they know about their disease more than you do, who seem to show that they don’t want to be treated by a “fuchcche doctor” or “just an intern” but even then, try dealing those arrogant patients with a smile and use soothing words than harsh ones by putting yourself in their shoes. Try to imagine how afraid and anxious they are and see the situation from their perspectives. Then you will realize that their over-concerns or panic or hostility are not as utterly unjustified as it first seemed to be.

Being friendly with patients is not always possible. But being friendly with patients is not always necessary as well. Just don’t be harsh. Don’t propose yourself as superior to them. It is not essential to make them friends. But be professional. When you are friendlier than required, there is a risk of them demeaning you or asking unnecessary troubles of you. Don’t be their friends, be their doctor, but be a compassionate, gentle, listening, faithful and helpful doctor. Talk to them. Explain the situation to them in as easy to understand language as possible. Remember our consultants are not always the ideal ones and we shouldn’t copy from them. Never copy the way they deal with patients because they are consultants, but if you come across a consultant who really does it well, then try to learn from them. Try to be better than your consultants. It’s not enough to be good when you have the ability to be better.

• NO SUBSTITUTE FOR KNOWLEDGE! EITHER KNOW IT YOURSELF OR ASK.

In the field of medicine there is no substitute for accurate knowledge. You are not allowed to make mistakes. Any patient coming to a health facility deserves the best treatment that current medical knowledge and research has to offer. The patient shouldn’t be deferred from the best possible treatment just because you didn’t know it. It is inexcusable. As an intern, being a novice in the field of treatment, we are bound to make many errors. It could take a heavy toll on our emotions if we are unable to manage them well. Learning and not harming the patient in the process is a heavy balancing act. Of course, as interns we are not expected to know everything. But playing with a patient’s life or experimenting with them is a crime. If you don’t know something, ask. Don’t hesitate to ask. Nobody knows everything from birth. Don’t try anything on your own which you don’t know. Ask. There is no shame in asking. But it is shameful to make mistakes and make patients suffer from that. Take help from seniors or colleagues. Never let your ego precede patient’s benefit. Thinking about one’s ego at so early an age is detrimental to success. You should always be ready to learn irrespective of age. Ask seniors, colleagues, study, go to library, search the net, but just don’t bluff. In medicine, as Prof. Vaidya says, you are either pregnant or not pregnant, you can not be slightly pregnant. If you know it, do. If you don’t know, learn. But never guess! Innocent people shouldn’t suffer because of your guesses! Accepting you don’t know is the first step to learning. But pretending that you know, when in fact you don’t, is a fatal mistake to which we all are prone. Avoid this if you want to succeed. Patients will be more grateful if you make efforts to find the best possible treatment for them rather than trying random investigations or treatments on your own, hurting them and making them suffer unnecessarily. Always try to imagine what if you or your relatives were the patient? This also means if you want to save your ego/prestige in the long run then you need to work hard, and study and practice as much as you can. There is no substitute for hard work and accurate knowledge. Medicine is probably the only such an amazing discipline where you can literally put into practice what you studied everyday. Therefore, studying and learning in medicine is a privilege, not a burden!

• MAINTAIN YOUR DIGNITY

We have so many things in life besides patient care. We have to organize every aspect of our lives. Many a time we hear the phrase among doctors that “Oh we are just humans!!”. But we are not ordinary humans. We are considered to be in the uppermost echelons of our society. Many are looking to us for inspiration. They are watching us and our conduct. We are taken as examples. Small mistakes we do or any irresponsible behavior we exhibit will make news and patients and patients’ party harbour bad impressions of not only us but entire medical fraternity. Therefore, it is incumbent upon us to perform in a respected manner to maintain the dignity of not only ourselves but all the medical professionals!