076: Big fish or big pond?

I watched a couple of videos explaining the difference between being a big fish in a little pond and being a little fish in a big pond. And I thought I would attempt to deconstruct my thoughts on the matter via writing about it. This is what I came up with.

1. Ponds are relative. 

At high school, I thought that that was a big pond. There were around 50 of us in the year; most extremely talented, driven and academically successful. One can sort of predict this cause to gain entry, you have to fill in an application, take an entrance exam and participate in a 3 night evaluation camp. Competition was fierce for a 12 year old, but I didn't know any better. Upon taking the first test in Form 1, I was ranked at number 35 in the year. Problem was, I never was a double digit for anything. So one might guess that I was under enthused. So I pulled up my bootstraps, put my head down and worked; resulting in finishing top three every year after. So as fishes go, I thought of myself as one of the bigger ones in this small-ish big pond. Academically at least. I was never great at sports and my social skills lacked big time; so academic excellence was so ingrained into my identity. This subsequently carried on to college.

But then university happened. Medical school happened.

My pond got a lot vaster, the water was choppy and fishes were huge left, right and centre. I met award-winning researchers and student leaders from elite British boarding schools; all extremely bright thinkers. Now, drowning against the current feels like a norm and one's instinct is to keep up because one feels so behind. Like kayaking against a strong current or more literally in my case, against rowers from Oxford and Cambridge. At this point, one's instinct is solely to survive. Everyday, I felt minuscule, inadequate and not smart. Quite gradually, I lost a large chunk of my identity. My ego was severely battered and bruised, not by anyone else, but through my own doing - as a result of constantly comparing myself to my peers. After many months of intermittent thoughts of "what am I doing here?", I acted. I coped with it like before; by pulling up my bootstraps, putting my head down and worked. But as circumstances (ie. the pond) have changed, now, my aims were quite different. Which brings me to my second point.

2. Bigger ponds come with lower expectations of oneself.

At this point, the days of chasing glory are over. Now its just about not getting left behind. Praying that you are at least not in the bottom 10% with every page revised. Greatness is no longer a goal, I just wanted to be good enough. However, what I learnt through this process is quite enlightening. Fear, and in this case, fear of failing, is one good motivator. One might not aim for glory, but that doesn't mean that the fear of fire does not lead one to the sun. Practically speaking, I didn't aim for anything except passing, but with the grace of God, I somehow (and surprisingly so) picked up a few academic prizes along the way. Every time that email with results come, I am sure that an administrator have messed them up. Because looking around, I always feel inadequate to deserve any such praise. But I guess inadequacy goes both ways. Unless you are a crowned genius, if you're in a big pond, chances are you will feel inadequate most of the time.

Inadequacy becomes one's new norm. One's new identity.

3. Big ponds are worth it.

I think the bottom line is: big ponds give you hope. If you can look at this situation positively that is, cause big ponds can be the source of hopelessness too. But to me, big ponds are a great blessing. Because here, I am surrounded by awe inspiring people. Here, noble prize winners are lecturers, award-winning professors are tutors and history-making clinicians are mentors. Just the mere proximity to them transmit flickers of hope that I could possibly be them one day. I could literally, follow in their footsteps in hospital and observe how they work. I could have conversations with them about the future of medicine or science's next frontier. This not only happens in the scientific world as London in itself is a hub where prominent religious scholars congregate to spread knowledge. I can just stand still and take it all in my osmosis, and I would feel like I am progressing.

In a nutshell: yes, big ponds will shatter one's ego. After a month, it will be as abstract as a modern art painting. But in return it gives glimmers of hope. Hope that one day, you could be a bigger fish than when you came. Cause really what is the point of being a big fish in a small pond if that is the limit of what you will become? Big ponds keep you on your feet, make you progress, make you better. And that push really, makes it all worth it.




________________

Sidenote:

Done with ponds? Try the ocean next.
(credit this ocean idea to husband, Akmal Khadir)

075: Death's door

*Details have been altered to preserve patient confidentiality

Arms are throbbing and sweat trickling down my back. On my way back home, it was raining. Everyone is in a hurry to get back home, its rush hour after all. Each of them preoccupied with their own lives, giving me enough space to reflect.

Walking in the rain without an umbrella, I thought: I did my first actual CPR today. On an actual patient. Whose heart stopped. A heart that couldn't be restarted. 

It was a mere twenty minutes between the nurses calling the doctor worrying that her fingers and toes were blue; cold as ice, and when the paramedics closed her eyes shut; preserving her dignity in the light of death. "God bless you," he said as he gently pulled her upper eyelids down. I was there helping the doctor upon the first call. I failed to insert a cannula. But I did help write the patient's details on the blood sample bottles. Between the chaos of oxygen masks and sliding her on a paramedic bed, wheeling her towards the ambulance, her pulse was lost.

I was given the task to call for help. When I got back, chest compressions commenced. Hard, fast, brutal. Shock pads were on her chest. After two minutes, just like clockwork, her heart's rhythm was assessed.

Asystole; a term to describe the absence of any rhythm in the heart. The closest one could get to flatlining. Basically, her heart stopped beating. This tall, muscular paramedic started to fatigue. I mean, he was a big man. He did CPR with one hand at times. I volunteered to take over. Up till now, the only practice I had was on dummies so I don't really know what possessed me to step forward. Arms throbbing, sweat trickling down my back. I managed 2 minutes before my muscles burnt out and my brain gave up. The big paramedic took over again. 

After 8 minutes, the doctor came to us and called it. "After discussing with the medical team, she has signed a DNAR, is everyone ok to stop?" Nods all around. It was a silent agreement to let her pass with any last shreds of peace. Everyone stepped back and she was wheeled back to her bed to be cleaned for the last time.

The doctors thanked us for helping. "Are you sure you're ok?" they asked. We nodded then headed home.

I don't know how I feel. The best way to describe it is numbness. Like an out of body experience. But reeling in my mind like a broken record player is the patient's last words. Loud and clear, I hear her shouting her two final wishes: "let me die" and "please help me."

074: The joys of medicine

"Save one person, is akin to saving the whole of humanity." (Quran, 5:32)


I am now in my fifth year of medical school - the penultimate year. Just shy of 1 and a half years till graduation. This year has proven to be a large upgrade from last. Fourth year was spent acclimatising oneself to clinical work, getting lost in the endless corridors of hospitals and fidgeting with blood results and stethoscopes. Each touch on a patient was greeted with utter caution and anxiety.

But after a year of practising, each of us grew in confidence. We now know what the consultant is talking about when she says, "Send an MCS, I think she has a UTI. Have you done an AMTS? She might need a TWOC." Yeah, medicine is filled with strange acronyms that can only be truly learnt after repeated exposures to them. 3 weeks in, and I have taken blood unsupervised, examined a patient with Ramsay Hunt syndrome and wrote in patient's notes during morning ward rounds. Basically, I feel more useful. Although I still feel like a nuisance from time to time, taking up coveted floor space in already crowded wards.

However, day by day, I am reminded of what a true privilege it is to be a doctor. For one, you are able to help people in their times of need. In times of pain, loss and loneliness, you are there to go through them with your patients and hopefully provide them with some relief. Most times just being a listening ear is enough for them to unburden their distress.

Secondly, patients trust you with their deepest darkest secrets. Even as only a medical student, I have heard countless beautiful and heartbreaking stories - all ranging from "My late husband knocked up my sister" to "I lost my son two years ago, he overdosed on heroin." Everyday I collect strands of people's lives; diverse and colourful. I have to pinch myself to think that this is my future job!

Lastly, you make a difference everyday. In the wards, no doctor leaves on time. They willingly stay 3 hours or more after the end of their shifts, motivated by the fact that their work is important. If the work stops, people might die. It truly epitomises the happiness of pursuit. The work drives you, it fills you with warmth and satisfaction. It lights you up inside. Although the work is indeed hard and demanding, seeing your patients being wheeled out of hospital better than when they came in, makes it all the more worthwhile.

So I hope that if my future self reads this, I am reminded that to work as a doctor is a true privilege. And if done with the right intentions, will be a source of light, love and happiness for many years to come, inshaAllah.