Dealing with Emotion, by Eileen Poon (M3 2004/2005)

Hi Everyone, I’m Eileen from M3.
My part in this is to share with you some stories and feelings on dealing with death and suffering.

Sounds like a strange topic to share? It shouldn’t, simply because of the profession that we are in.

As medical students now, especially at M1s and M2s, we are usually not in contact with death and suffering everyday. Other than deaths within the family which some of us might have experienced ourselves, death and suffering is really not a daily affair.

So, what kind of sufferings am I talking about exactly?
Just to name a few, we’d most likely come across:
• Death
• Sight of Blood
• Sight and Smell of Puke, Urine & Faeces
• Sight of people in pain – especially the very young/ the very old
• Poor people. Very very poor people
• People who are just basically unable to cope, be it financially, emotionally, mentally or physically

As I’m sure everyone in the clinical years would agree, we seem to have grown up in more ways than we can imagine. There are so many stories and experiences that I’d like to share with you, But, I’m only given 10 minutes. So, I’d tell you about 2 in particular which have struck me really quite deep.

1) I was in the wards one day with my friend. We had initially saw this patient transferred from the ICU. Let’s call him Mr X. Mr X suffers from liver failure whose condition had stabilized. Being enthusiastic students, we had followed the ward rounds (important) and had followed up on the patient’s condition for a few days. Mr X is on DNR.
• We had been involved in a bit of patient care for this patient.
• One morning, Mr X’s condition took a turn for the worse.
• The doctors did what they could, but as he was DNR, there was a maximum.
• So we went about setting plugs hoping to infuse saline into him to raise his dangerously low blood pressure.
• His skin was cool to touch and easy to bleed, difficult to stop.
• Finally his condition stabilized abit.
• Later that afternoon, when we were in the wards checking up on case sheets, this relative of Mr X beckboned to me to go over, saying that the machine that Mr X was on had gone off. I went to have a look, and the air just feels dead.
• Me and my friend scurried off to look for the doctor.
• And together, we went to help ‘ascertain’ Mr X’s death.
• Forms signed and relatives came crowding over. Chanting prayers and all.
• Thereafter, the day just feels weird. Feels wrong.

2) There is this patient. Let’s call him Mr Y!
• He’s a very very young adult. Who got addicted to drugs in his late teens.
• He’s been in and out of rehab, but somehow always not strong enough to combat it.
• So, one day he presented to the clinic. With his remaining bit of his hand gangrenous.
• He had initially had his fingers amputated all the way to PIP joints due to gangrene.
• Rehab guys are give Subitex (methadone)
• There are a number of them, like Y, who pounds the tablets into powder, mix with warm water and inject himself.
• This caused him to have thrombosis.
• He did it again.
• So whilst the surgeons were trying to formulate a management for him, he was warded, he injected himself in the hospital toilet
• Police came, chained him to the bed
• Has a wife, 9 months pregnant.

It is important to realize with the above 2 scenarios, all of us have our own views, our own feelings. Do not judge others on how they react to certain things.

As for your own feelings, especially if you’re very bothered by it, please do not keep it to yourself. Sometimes it is good to talk to someone about it. Someone who understands.

There are a few avenues you can consider:
• Your group mates
• Tutor/ Mentor-in-charge
• Sister/Nursing officer
• MSW
• NUS Counsellor

Ultimately, it is not wrong to feel bad about something, but we have to remember that at the end of the day, we are doctors-to-be, and whilst it is ESSENTIAL to be able to feel with the patients, we have to keep our heads too. This will then allow us to function and work up a plan best for the patient. Because, every patient has his or her own story. Our aim is to help cure the patient, not just physically, but also mentally.

Understand what calms you down, what helps condition your emotions. You might even practice deep breathing.

Everyone’s view of a good doctor differs. Believe in yourself, and your convictions :)