Pushed into sea

Dear R,

I'm not having a good time. I'm unsure how things will unfold. I'm unsure how I can juggle things well. There are many things I need and want to learn, yet I feel that I'm not learning enough - the speed and the amount of it.

My week 2 in CYMHS became only half a week as I caught a bug again. It is all too much for me, my mind and my body. Too many new faces, new names and their roles. Too many teams, 3 or 4. New places, new directions, new right or left. I do not like the 0.5 + 0.5 split. I do not like to be at different place every day. I do not like feeling as if I'm needed everywhere (at the same time knowing full well I'm so replaceable).

I hope someone can guide me so I can learn well in CYMHS. I hope I can learn a lot of things about eating disorders, not be deterred by them anymore in the future, and see hope too. I hope I can unlock new skills in my assessment. I hope I can deal with family members gracefully and confidently .

I hope this time, it will be another good 6 months, without you, on my own, with my other little angels.

And people, how critical they might be, will slowly learn and see the good in me.

Thank you for giving me faith in myself. 

Sarah, a psychologist who happened to sit besides me in the Eating Disorder office, told me I am only one person, and that I shouldn't expect myself to know all the things already when I have just started. She said it's only 6 months, if I like it great, if I don't then I am not coming back. She is kind. She made things sound easy. I guess these are what you would share with me too. 

I still miss you. But I know, things can't stay the same forever. I can't be stuck in the same scene in the same particular year. I can't replay the story over and over. I need to move on (and I have, and I am.)

First week in CYMHS

Dear R,

Now my consultant K is also a medical director. My supervision was totally forgotten though I took chance to ask one important burning question. My first week was not hectic. I felt exhausted every day. I slept right away after dinner every night. Every day was a different day. I am working across Paeds CL (+ED cover), Eating Disorder across 3 different sites. Finding my way and directions- literally- every day for the past 5 days- was exhausting enough. The next thing is getting to know another working and (human & clinical) management style of another consultant. The next thing is getting to know the new clinical stuff and of course all the other clinician colleagues (and medical paediatric colleagues. The number of new faces and name I encountered this week is none like before). I was glad I shared a moment of small catch up with Eric who told me it felt like first day at school, a much-needed twinship. Overall I felt quite lost this week, I felt like an orphan without a real guide in front of me; at the same time I felt freedom (huge change from the previous micromanagement) which I will treasure once I get familiarity in this field. I remember very clearly I sort of told you I missed inpatient ward when I first started CCT. Now I miss CCT and adult psychiatry. I am afraid that I will forget the 'real psychiatry'. But what is real psychiatry? It is about medications first from my view, then the psychological view. I am unsure if I will like CYMHS. I definitely do not regret Old Age Psychiatry. More in retrospect, I value it greatly. And in retrospect again, I learn something too from the team instability and disorganisation. We learn from negative examples too. 

路过一群人 他们提醒我要继续虚心善良。

Unfiltered rambling。

Leander给我写了很多句道别的温暖的话，她说这些不是场面话，you are a great doctor。我给Farai也写了道别的话，我这次最喜欢的工作大姐姐。上个星期五他们给我们办一场farewell，写卡片，送礼物。昨天V匆匆和我说告别的场面话，我也后来写了告别的场面话。我很满意的是后来我还是赚取了她的信任和好评，学到了该学到的。她说后来的thank you and welcome dinner再见。

昨天我在SHP分别和Kylie和Amritha拥抱。我走去SHP的路上，开车的Bryce经过，摇下车窗和我打招呼。喜欢到处串门口的James今天和我讨了script favour，又坐下来发表一些他的工作政治意见和废话。那个原本的R的 CCT desk（那个他本来就没有什么用的desk），我从原本的抗拒直到必须用那个座位，还很开心有一个安静的空间。我今天又和SHP告别了。我一个人安静地离开SHP。SHP，那个我原本不熟悉的地方，那个有一天的后来，我走去上班的路上突然哭了，又哭着回家的地方。那个后来我发现，原来即使我很敬重的人走了，留下来的还有很多喜爱我和我喜爱的人，原来我曾经给的善良和美好回忆，也会被留着。它们变成了后来的拥抱，他们话语中那个好的版本的我，她们给我的真诚诚实的分享。我感受到了，这是R和我说的reputation，这是我在考题上读到的social power。这是clinicians给我的温暖，这是我留下的善意，当我只需要做我自己（认真工作的我，安静的我，不想假装热情的我。被人看见我的anxiety的我。）

今天我和Older Person Community道别的时候，又在心里和CCT告别了一次。因为SHP在我心里，和CCT连接在一起。CCT对我来说，是R带着我，走进的另一个，更大的psychiatry世界。

这次，我也道别了那种每天的logistic uncertainty，那个没有computer不是clinic的clinic，每天不顺路的home visit，home visit在路上花时间给我带来的疲惫，home visit的cigarette stink and animal fur，那个很多抱怨的office，有点乱七八糟的calender booking，某个incompetent还很多抱怨的case manager，和V一些不必要的plan intervention，她太长的review，她每次都会插嘴我的review然后突然就take over了，她特定的note template和写impression的方式，她给的有时让我很不舒服却不接受反驳的意见。和我其实不是很喜欢等火车和坐火车，不喜欢robina的咖啡。这个一开始的organisational chaos居然就这样持续了一整个rotation。但是恭喜我自己，我survived了。这样的环境和工作方式对我来说是非常不友好的，但是我适应了，还做得很好。我把我的工作做得很好，我学到了我想要学了。

也是因为，这个rotation的workload真的不heavy（只是我一有病人，就会被home visit transport吃时间），我有过很多empty days without patients。这些counterbalance了我某些不愉快（和当我从observation和medication discussion时被V impressed的很多时刻）。我还用了这些时间写了psychological formulation，做learnit modules。就在今天，我读完了一本Nancy McWilliams。

今天也准时收到了pharmacist Ka Man的问候。

我今天和那个总是说我anxious的James说，我现在真的很anxious，关于我下个星期的new rotation。

但是，Dear R,

I think, this time, I will be fine too. I am going to try. I will learn new things again. 

July 26, and a memory anchor

Dear R, 

It has been a year. A year since my first OCA, since my being very upset with a seclusion, since mentally preparing to end my first rotation and move on to the next. I feel like a different person now, though nothing visible has changed on surface.

(Eventually I did not do a 2nd OCA this term, even though I was thinking seriously about it- because of many things- because I have a more important pending WBA, because V has been busy, because she was thinking about another person's iOCA, because I am tired of being micro-evaluated by her, because yeah I need to do another BPSD WBA)

I was not very nervous about starting an inpatient term in GCUH, because although it was my first term in training, it was technically my third inpatient term in a row in my working life. 

I was not very nervous about starting my 2nd term in CCT, because I naively thought nothing could be worse than inpatient work, nothing stressful can happen in the community, my life should be much more relaxed, and comfortingly in truth- you would be there. 

I was only slightly nervous about working in Older Persons community, because I thought it should be very similar to CCT work, because an experienced clinician told me the workload would be piece of cake for me, because the previous registrar told me I would love working with the team. Although I quickly learned that those advice should only have been taken with a pinch of salt, as my real life experience did not reflect the pleasantness of the words, those facts if looked at in isolation, still stand true. If I were to give this rotation a brief comment, it would be 'it was okay'. I do not regret it, but I will not return to work in this team composition; I did enjoy the clinical work (which was a surprise, I thought I'd dislike it), but I do not enjoy it enough for me to imagine if I might like Older Persons one day if I were to do the clinical work with another consultant in a mature team environment. (And V, I must comment on the consultant every time as that is an important element of our rotation- I can't say l learned a lot from her, but I did learn some things from her. And I have learned something specific that only she can give.)

Now I feel daunted. It is the unknown, unfamiliarity and lacking of specific knowledge and skills, the combination of CYMHS plus CL plus eating disorder, an ecosystem of its own plus the lack of even superficial pleasant words from the existing registrar (I do appreciate all sort of honesty even in subtle form). 

1.5 weeks more. I feel unsure, unprepared, wanting to move on (can't wait to leave actually) but feeling unexcited for the new adventure. I hope I can tell you good stories about it next time.