Tuesday, May 22, 2007

In My Life Today 10

I have spent the last few days in contemplative thought, armed with the clarity provided by a little pill and the stark truth on the ground.

As a compromise agreement facilitated by a magnanimous former boss, I went on an extraordinary 6 month leave from training in a large government hospital. At that time I was in clinical depression. I refused to be subjected to an arbitrary pharmacologic treatment, so I went into therapy, and had significantly improved in the last 2 months of my leave. I thought that was enough to return to the old workplace.

What drew me to the Emergency Room was the chance to make an instant difference in patients that have emergent conditions. Like Surgery before it, a quick decisive move could spell a world of difference to a patient.

And like many government workers, I had to endure problems at every turn. Supplies are non-existent; critical drugs like Diazepam, Epinephrine, Dopamine and Insulin are in short supply. Personnel levels have not increased as population, catchment areas, and cost of private health care have skyrocketed.

But the politics were the most frustrating part of it all.

The crippling infighting and jockeying for position has practically characterized the hiearchial residency training programs for years. It also looks like you have to get used to being treated as competition by the very mentors that taught you.

Of course, 99.9999% of residents are told to grin and bear it; that they will eventually get their place in the pecking order. My sentiments would be seen as a glorified whine of a fool.

So I returned, and I wrongfully expected that the status quo would be lifted. A new boss would be given more leverage to hire more residents with the hospital director's blessing. Supply problems would be eased, and the computers and airconditioning would be fixed.

I must have been wrong to assume that these changes would happen. It was also an error to isolate myself (as required by my therapy) and not find out that these changes were all part of a pipe dream.

Fine, I told myself, I would just have to endure everything like everybody else.

Then I was woken up by crushing substernal pain radiating to my left arm. For some time I thought I was dying. It was different from reflux, a sensation I was all too familiar with.

Fortunately an extensive cardiovascular workup ruled out an organic heart problem.

Unfortunately, the recurrence of the attacks only meant one thing: an anxiety disorder.

Significant advances in psychiatry and pharmacology had lessened the attacks, but at the cost of increased somnolence. And so I was going to determine for myself, in my own time, the specific trigger for the attacks, and hopefully avoid it or live with it.

I was not the only one concerned with the cost of this clarity of mind and judgement. Sadly, I am placed in the unenviable position of having an arbitrarily made time table for deciding whether to stay or to leave the residency training program. Apparently I could potentially be a liability for an area that requires quick thinking and decisiveness. As of today I have 9 days to make that decision.

Personally I think it is unfair to place a deadline. Simply put, I have to choose whether to work under medication or go elsewhere and not be a liability. Any medical student worth his salt would tell you that, unlike antibiotics, you cannot place a deadline for clinical improvement in behavioral scenarios. But that is just an opinion that holds no significance.

As the deadline nears, I feel threatened, rejected, and aimless. The only respite from the cornucopia of emotions I feel while at work is when I share in the camaraderie of the nurses. Their strength is in their teamwork and the seamless transition from being friends to working as colleagues.

I also heard the sublime messages that welcomed me from my extraordinary leave. "Bakit ka pa bumalik?" and "Sana hindi ka na lang bumalik" gives new meaning to the saying "Jokes are half-meant." The lack of applicants from my college to the residency program were another telling sign, inspite of the aggressive marketing and the seemingly endless possibilities of the specialty.

Taking all these into consideration, I am due to make a rushed decision in a few days. In true fashion, my decision would be seen as a calculated risk.

Maybe I'll stay, maybe I won't.
"I have stepped out upon this platform that I may see you and that you may see me, and in the arrangement I have the best of the bargain." - Abraham Lincoln

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