Mr. Primary Physician, on Work

On work, translated…

Becoming medical doctors is a hard and long road to take, after graduating from the medical schools, we’d still needed anywhere from three to six years’ worth of resident training then, we might become, the primary physicians. And still, the Chief Resident, is the process that every single doctor, from youth to maturity, needs to pass through, before becoming a primary, to be trained in the executive functions, as well as getting to know how the hospital systems worked too.

During our time interning, we’d all called the Chief Resident “Master CR”. After the few years of trials in the hospital systems, each CR all had their specialized skills, and learned everything about their specific areas of expertise. They may be very well-rounded in all aspects, or hardworking, uncomplaining, handled everything that goes on, big and small, in the hospital systems.

from the papers here…

A few years later, I’d gone into the psychiatric department, and became a primary physician too, and, I’d gotten a brand new look at what being a primary is all about.

The Executive Functions, the Paper Works, are Endless

First, the executive functions are very cumbersome. Take for instance, the teaching of seminars, setting up the auditorium, chauffeuring the lecturers, the coffees, the teas……we’d needed everything covered. And, every day, we’re bombarded with endless post-it notes, and I’d wished I could have three sets of arms, three heads, so I can, satisfy everybody’s needs.

And, although the executive functions are dealing with “people”, but, there are rarely any moments in a hospital when everything goes according to the plans, and, there would be, constant issues happening 24/7. How to get everybody satisfied in communicating with everybody else, that, is the primary physicians’ workload.

“Mr. Primary, the acute ward’s newest patient, after assessments will need to get transferred into the ICU!”, my younger classmate called to tell me.

The Chief Resident of this hospital, is responsible for making the beds available to those patients who are desperately in need of them, but, there would always be not enough beds and too many patients who needed a bed, and, with the population of the patients growing by the minute, situations surfaced, I’d had to work hard, to “make room”. I’d gotten up, to check to see if the beds are available yet, I saw the workers in the ICU still very busied, and they’re to hand over to the nightshifts, I’d struggled a bit, dialed back.

“Hey, there are still two on the waiting list for the beds in the ICU here, can you transfer tomorrow?”, I’d said, considering how busy today has been, entering and exiting will cause a lot of troubles, and would put a ton of pressures on the doctors of the ICU, as well as the doctors on duty, so I’d made this call.

But, after I hung up the phones, Dr. Y called.

“Primary, what’s the problem with the bed transfers with you? How come our patients couldn’t get transferred right now?”

“Dr. Y, because there are, already two people waiting on the list for the beds in the ICU already……”, I’d answered in a fearful manner, I’d felt like I was, lying.

“As a primary, how can you only care about the conditions in other units! Where, are your principles?”

Dr. Y who’d looked after the residents especially, all of a sudden, sounded, too strict, but, it’d reminded me of the flaws I’d had, in deciding—no matter what, the assessment of the medical conditions should come first. I’d reexamined the problems, thought for a while, and, because of the needs, I’d transferred the patient into the ICU that very day.

The primary physicians held onto the principles, and had to “make room for outsiders too”; when the other hospitals wanted to transfer someone over, because they’d not have the machines, the equipment, the primary physicians needed to be the first line of defense, and decide whether or not to take in the patient.

One day, the surgical department from a nearby hospital called, “Primary, we have an eighty-year-old woman who is having her bipolar disorder relapse right now, and wanted to transfer to your hospital.”

Eighty years of age, that’s not the classic age of onset for bipolar, I’d felt that red flag on the inside. After hearing, I’d learned that this elderly woman was hit by a car as she’d gone out alone, and, in the E.R., she was conscious, showed no signs of hematoma, she was sent to the surgical ward to stay for a few days for observations, and a few days later, she’d started screaming in the middle of the night, and was diagnosed with bipolar, but the effects of the meds are limited.

“Did you get her blood, to eliminate delirium (an acute, sudden-onset set of symptoms that would cause confusion, hallucinations, and language troubles)? Did you do another CT on her brains again?”, I’d quickly asked.

Although the hospital put out the fact that they did treat her in the psych ward, and asked us to take her in immediately, but, this quick deterioration, plus a history of external injuries, I’m thinking, that “it’s not that simple”, I’d asked the other hospital to do a complete diagnosis, then, call back.

The very next day, came the even more shocking news, “We’re not transferring her anymore. She had subdural hematoma, she’s now, waiting to get surgery.”

I’d clicked open up the images, a problem that shaped like the new moon appeared, it was, supposedly, the bleeding from the head external injuries—that bipolar wasn’t the diagnosis at all, because the hematoma, causing the delirium, that, was what’s real. And, if this patient kept on getting treated as bipolar, then, it would only cure the physical symptoms, and, don’t know how long it will be, after she’d stepped on the landmines, will the truth come back out again.

I’d let out a sigh of relief, glad, that I was able to, keep my cool in communication, and stood my grounds. This time, before the bloodied tears overflowed, I’d learned my lessons already.

Working as a primary, is like entering into the workforce all over again, learning to communicate, to adjust and adapt, to set up one’s own value systems and principles too. The teachings, the challenges, of our instructors, had helped, shaped us, and slowly, made us, into the figures of authority in our own views back when we were novices.

What is meant by “Sir”, is not just about the seniority in age, but the ability to bravely take the responsibilities, and handle each and every challenge with bravery, with maturity, with confidence too. And, becoming a primary, it’s not only what is gained from the specific trainings of the specific branch, but also, a lesson in life too.

And so, this, is a system where you’re supposed to work your ways up, at the beginning, you were inexperienced, so, you may work as a physician’s assistant, and, after you’d learned enough, then, you’d gotten, bumped up to working as a resident, and, you’d encountered even more specific cases that you’d not handled from before, which will make you mature, and, you’d climbed those steps one by one, to get to where you currently are, and, everything you’d learned from before, is still being used even as you’d gotten that bigger, shinier title.