6am Wednesday morning. Yes, it's another night shift, people! By some freak toss of the dice, I'm doing 2 nights in a row, which is wreaking havoc on my sleep cycle. The upside to all this is: 2 night shifts in 4 days = 22 hours of work, as opposed to 4 days of day shifts = 32 hours of work. But factor in all the extra snoozing to recover and return to a normal human existence, and it works out to be about the same thing. Sigh.

Met another emergency medicine trainee the other night. He's into his 2nd year of traineeship, and taking his Part 1 in a couple of months, but already having second thoughts about continuing in this specialty. Seems a number of my seniors backed out just before their Part 2's, for a variety of reasons. However, the way he puts it, it sounds as if those who left did so mainly because they were disillusioned. Not too sure what they were expecting when they first joined, but they obviously didn't get the fulfillment they were hoping for. Hope they're happy where they are now.

This same trainee asked me a simple question which many others in numerous departments I've rotated through have also thrown at me at some point. Heck, this goes back all the way to the traineeship interview!
"Why do you want to do emergency medicine?"
Other related important questions include: Will you be satisfied with this 10 years down the road, when you're only able to make diagnoses, but are not involved with continuity of care? Do you want to stay in the hospital for the rest of your life, not being able to leave for private practice if you feel like doing so? Do you seriously think you'll still enjoy this when you're a consultant, burning your weekends doing night shifts?

Frankly speaking, I've been hit by the disillusion bug already. This happened about a month ago, when I was all geared up to prepare for the local Part 2 in late September. I'd just joined the A&E department after a way-too-long internal med posting combined with the added stress of SARS, and hadn't had any time to breathe before having to endure the new stress of exam revisions. There came a point where I really contemplated leaving medicine altogether, but I knew that wasn't a viable option considering my circumstances. After much thought, I decided to do the next best thing -- defer my Part 2 till next year, thus buying me some time to recuperate and think clearly, as well as re-evaluate the reasons I loved the ER in the very first place. Luckily, this move has been greatly beneficial, though I still can't find the motivation to study that hard -- blame it on my having 9 months to play with. :)

I've worked with a lot of people these past 3 years, some of whom are so certain what they want to do that they passed their exams in record time and are now full-fledged registrars at my age. Then there are those at the other end of the spectrum, drifting aimlessly from one strange posting to another, not keen on taking exams, perhaps locuming here and there, or even leaving for non-medical careers. At least 2 doctors have joined Singapore Airlines as commercial pilots, something I consider quite a major career switch!

The bottomline, I guess, is that few of us are ever fortunate enough to really know what we want to do with our lives. My choice was made early on when I rotated through the National University Hospital's emergency department, and was inspired by an excellent teacher. But medical school days are often filled with idealism, and I was no different. The real world is always a rude wake-up call, thanks to "the system", which has already alienated many a good doctor, forcing them to leave for private practice or polyclinics.

Ultimately, my first love is still emergency medicine. But like all other disciplines, it'll have its ups and downs, its adrenaline rushes and super-boring/irritating moments. I just try to forget the bad parts and remember the good ones. Heck, that's how I try to live my life in general, after all. :)

I'll leave you with a nice quote from the latest episode of "ER":

Eager medical student: So what's the most interesting case you've ever seen here? Porphyria cutanea tarda?
Dr. Mark Green, aka fatigued ER veteran: Actually, we once had a guy with a live frog stuffed up his ass.

Here's to all the guys with live frogs stuffed up their butts. :D

P.S. Short hello to a reader with the email domain name of mindspring.com. If you see this, could you drop me an email at ojj75@yahoo.com? Would just like to ask you something, out of intense curiosity. Thanks! :)