4th week

23 Feb Monday

I did not expect the relationships I had with the (female) case managers would be so profoundly genuine. I dropped by the CCT office sometimes as I have twice weekly clinic at SHP. They were happy to see me (so was I). Kylie hugged me. They told me everything that has been happening. People and the oxytocin, is something I did not expect. 

Though things and place change, when people are different. That includes the inpatient wards. 

26 Feb Thursday

I had bad week Tuesday onwards. It was because of the uncertainty, the changes and my accumulating unfinished notes. 

I have no clever reflection to make this week. 

I just found that those stress and anxiety couldn't be controlled if the acute issues are real. They weighed me down. They creeped into my house and my bedroom. When I could not breathe, I almost wanted to take a sick leave again, then I reminded myself the importance of my own reputation (as an honest and responsible person who only takes real sick leave) and the annoyance and inconvenience I will cause to the other people. Sometimes things are worse in my head. 

I can't believe it is the 4th week already. I still find myself struggling (practically, not clinically). Because ironically enough, despite my hardest effort to find a new routine amongst the chaos, things just keep changing. There is a political battle going on. It made me feel disgusted. Is every place the same?

I need my RDO. Tomorrow is my first RDO of this term. 

2
Having coffee at Sens Fusion whenever I am at SHP becomes a comfort point. 

2 nights

Dear R, 

I imagine you would ask, how's your nights. 

I did two nights the last weekend. My first night was a bit crazy, my 2nd night was good (no referral from ED!). 

There was an overnight seclusion, which was ongoing until my 2nd morning. I had to do a Reduction and Elimination Plan midnight (which reminded me of the few times I had to do R&E plan in my inpatient time; and the time you showed me the way to track down the previous R&E plan patiently).

My last two stretches of twilight/nights were a sort of escape from CCT for me- they turned out to be insanely hectic and I still have the lingering dread. Escape. As an unhealthy avoidance, I am now thinking about escape again from Older Persons (this time for an entirely different reason), but my previous on-call experience made me think twice. On reflection, now that I have stepped out of the CCT role, I do treasure my time in CCT. I have such realisation when I was doing the on-call shifts. The accumulation of clinical experience, the different exposure and different learning, made me a better and more competent doctor. And now Older Persons too. I need to keep reminding myself the reason I chose it in the first place. 

In my nights, I found myself feeling more independent and confident. I remember you said it all takes time and practice, when I once raised a similar question in our supervision. I also remember me telling you that confidence needs to come from within myself. I am starting to feel it now. After you left, this is what I have to be, in front of the other consultants. There is no more wings that I can hide under, no more gentle understanding. I need to stand up for myself, voice my opinions, show them my capability. 

And to be a leader, is what you were trying to teach me. To be a good leader, is what I had been learning from you. Thank you for showing me your gentle but powerful leadership. I often felt that emerging skill in myself, particularly when I was doing night time seclusion reviews, where a group of security guards and nurses were waiting for my instructions.

My knowledge and clinical instinct- I often need time to think alone, and decide on the plans. I always am proud of myself when I successfully requested for medical admission, after my psychiatry review. To do that, I have to take a bit of medical history myself, look at the bloods workup, and list down the medical issues so that ED and medical team can take it seriously. 

My post-night Sunday was not bad. I woke up at lunchtime to have lunch and do grocery shopping with D. I came home and slept again.

And no, I don't quite look forward to my next night shifts.    

2
I really do miss you，当我经过我们曾经一起走过的病房走廊，经过那台你说see you by the piano的那台钢琴，经过我们第一次supervision的会议室，经过那个走廊转角，右边是我曾经坐过6个月和你随意出入的inpatient office。

当我看见日出的阳光照入PICU，我看见我们每天早上一起巡房的身影，看见你，看见我，看见我们乖乖的intern。我恍惚了几秒。物是人非，说的就是这样的感受。But life moves on，你说。你说给自己听，也说给我听。

Fantasy

Dear R, 

I am unsure how to describe my week now. 

I was not real busy, but I was busy spending time travelling across sites/carrying a mobile clinic with me/modifying my documentation including the sequence of my MSE and how lengthy my impression should be into my new consultant V's preferred style. 

That might be the hardest part for me, having to duplicate her way, having to discard my way which also means sacrificing a bit of my usual efficiency. 

I cried at work on Tuesday secretly (which was found out by a cleaner who offered me genuine kindness). I have been naive and protected for enough years. This is a complicated world and there are some situations that I need to learn to read, something under the power imbalance that I need to put up with. 

Our team leader repeatedly reassured me that I will enjoy this rotation and we have a good team. I believe I will enjoy this rotation, if I can gain something every day with breathing space and resumed sense of control.

Having a good team is something I always feel grateful for, as this is completely luck dependent. Working in CCT last year has shown me I can work nicely and happily with two teams of case managers and the happiness is genuine. And I can work with people, work in a team, and be a mini leader. 

It has become more apparent my sensory and emotional sensitivity is something I have no control over. When I feel upset, I feel upset, and it follows me home even after I tell my mind to stop. What is true for most people might not be true for me. For eg, I don't foresee myself falling in love with doing home visit 'because it is fun going out'. The physical exhaustion impacts me more (although yes the experience is good, and doing home visits for elderly frail patients feels meaningful).  I need to find my peace and joy at work, and they are gonna be in different way from last year.

Some good feeling I had this week, or positive update from my entry last week is that I had chance to get my quiet lunch back at my usual coffee spot in SHP :) I didn't realise it will become a precious spot for me when I was working in CCT. I also walked past my secret lunch spot in the hospital on Monday and thought of my busy yet happy inpatient time with you. 

It has all become memory which I stored away in a sweet spot. I am walking on a new journey. I might grow into a different person. I might not be naive anymore. I can't be abrupt and overtly emotional anymore. I need to learn to read the hidden rules of the world. Is this part of growing up, to becoming a consultant or a leader? Just like how you have patiently explained to me the reasons I need to learn to be firm and assertive, that is to not feel eaten up and miserable. I have felt that, and I guess, that might be what you have gone through in the past. 

Might be time to shed the fantasy. 

Another first week

Dear R,

I was thinking a bit too much. No one now will ask me how I am doing every week or how I find my first week or how I am liking Older Persons.

Things, people and how the place operates are different. They are all too different that I have been completely exhausted by the end of each day every day for 5 days, even though the maximum number of patients I saw in a day was two.  

I have turned PGY5 this year. This will be my third year of regging. I'm dragging more experience with me, I no longer feel the imposter syndrome, but this could be the most exhausting first week for me in the past few years.

I feel more at ease around (albeit new) people. I have more than basic skills for my job. This hospital and the training system is not new to me now. I have done inpatient and CCT. You have told me I am good. I have good time management.

It is always the little adjustments and change. You told me it is always good and better to be honest. I did and it worked I guess. People are understanding, like you said. My anxiety about change and new everything, my need for a sense of control, and quiet.

No one will teach me how to find my ways now.

After you left, I realised I'm a different person in front of anyone else. I now remember that I need to be confident and I have good reason to be. I remembered your encouraging nod when you were waiting for me to answer questions, when I was in a different physical space, sitting in front of another consultant.

My first week was chaotic, that was not just my perception.

I am trying to establish my new routine and structure amidst the uncontrollable home visit environment, my lack of VPN access, the travel, the time and energy that go with it, the many morning meetings, the travel and carrying mobile clinic with me and the inexistent quiet spot.

I need to get back my quiet lunch break (although connecting with people and sharing our feelings and thoughts with each other are good sometimes). I need to think and type my notes in a quiet spot. I need to go home on time, every day.

I wonder if I really miss CCT or just the sense of familiarity, and safety with your presence (as I also remember feeling out of place during my first month in CCT). I did really miss the clear cut clinic time and then Case Review next, the predictable days. 

You are right that Older Persons is less clinically hectic, and is quite similar to CCT.

My mailbox stops flooding. No more scripts jobs that can get too much. No more 5 MHRT reports to be edited in a day. Case managers don't need to run after me almost all the time for random jobs or to solve sudden clinical concerns (in retrospect I see that I have managed it all so well in CCT).

I have new things to learn. New EPAs. New patient population. New set of clinical picture to be set into my pattern recognition. 

New boss to adjust to. New style. Learning to work with different consultants is a kind of learning too.

I want to learn more, as always, as you know.

I hope I can find my new pace soon. I learn much better in a state of peace.

 

Thank you for reminding me that I need to work with different consultants. I have been too comfortable working with you.

谢谢你 完好平安地 把我送入stage 2.

这条路 可能不容易 可能会让我愈感压力

但是 我会好好地一步步往前走

谢谢你给过我温柔和保护 它们变成了我的底气

I will be fine.

2

And well, as I was reading back what I have written, I realised I still miss you. 

I still miss you. You said it is tough. You are always right. But this is so much tougher than I thought. 

I know, life moves on. 

The next stop.

Dear R,

Tomorrow will be my first day of Stage 2 training.

I can no longer introduce myself as a Stage 1 trainee and people will no longer give me the forgiveness they give to fresh junior registrars. If my new consultant were to ask me, what do I want to learn in this new rotation or in stage 2, I might be honest and say I always don't know what I have to learn, in the depth of unknown and uncertainties. I remember when I first started as a PHO 2 years ago, I said I want to learn to be a good registrar (and I quickly did, in that particular unkind environment, although no one except the nurses and the MHA delegate gave me the recognition). Last year when I started my first year reg job, I said I want to focus on meeting the training requirements (and I think I did more than enough somehow and I learned more than I expected especially from you) and I want to study more for my knowledge. 

I am unsure exactly how much I need to be better this year, to be a good Stage 2 registrar. I still have a lot of worries if not more. I haven't read Stahl. I want to read Gabbard and the other similar books that you have recommended. Do I need to look more like a confident person who can lead the team? Do I need to now worry about my psychotherapy case because good registrars appear to all have started doing it in their year 2 (but I don't feel ready yet)? Can I leave my scholarly project to the end, while I will be having two iOCAs at the end too? But first, I want and need to (and must?) pass my upcoming MCQ exam. And I will be worried about my MEQ exam next. 

And also, quite importantly, I need to have good work-life boundary (not just 'balance' as my good time management always allow it to happen) this year.

Talk to you soon. 

(Sorry, you have to be my ongoing imaginary person to write to for now, while I am transitioning to the new phase. I hope you will never find this out.）

(Oh ya, I forgot to let you know that, yes, I had a good break. And even on re-re-re-reflection, I am still very happy that I had a very good year last year. So thank you again.)

（2月了，生日快乐呀。）

原本这3个星期的假期让我很guilty。
原本想回马。原本以为我会觉得很无聊。原本以为我会想出门shopping。

但是这3个礼拜就这样每天感觉很occupied地过去了。
每天在家，每天都occupied。
舍不得假期的结束。

3个星期的静止。

我的脑袋，终于安静下来了3个礼拜。当我感受这份平静的时候，才知道，原来平时工作时我的restless mind，是我没正视的stress and anxiety。开车去上班的时候，走路去tram station的时候，脑袋总有声音。在工作的hyperalertness，精神的紧绷，常常都boundary维持不好地带回家。

1月初，我做了一个星期的night shift。原来不管做了多少次，afterhours shifts就是会让人压力and overstimulated。这种感觉，是无法被习惯的。

然后我又和R正式道别了。他给我非常温柔和完整的再见。

下一站，我又会勇敢一点。

2
3-week mind and body break。原来我这么需要，这种哪里都没去，静止一切的假期。

3
下一站，下一站。在熟悉的地方，没有熟悉的人。

我又要勇敢一点。

4
时间一多一点，就会ramble得比较多。这几篇的内容都挺repetitive。最近有人翻起我很旧的文，让我又想起过去。这就是文字记录的坏处吧，会记得的太多了。但是人要往前走，那些回忆和情绪的负担，留给文字吧。

谢谢文字，一路陪伴，陪我度过小时后很多不开心。现在陪我度过adulting和长大后的焦虑。