悲伤的第三者

不喜欢当那个默默承受和累积悲伤故事的人。在psychiatry ward里每一场病的始源都是哀伤的故事，medical ward是老年人到人生尾端苟延残喘的无奈。原来Paed ward给我带来的震撼更大，都是无法选择的基因和命运。Ambiguous genitalia, anal atresia, uncontrolled T1DM，它们的含义不仅仅是课本上的clinical features investigations management，而是活生生的人，背负着疾病，比我们想象中更坚强地往前走。那个12岁印度女孩，对谁都很friendly，愿意分享，令人打从心里喜欢她的女孩，原来双亲在车祸去世，和哥哥寄住在阿姨家。她和凯说，why are u sad, I am not sad. DKA男孩，很小的时候妈妈乳癌去世，现在有了继母，和同父异母的兄弟姐妹。那个8岁男孩，chromosome 45 X0, 46XY， 动了几次手术，身体里还有待解决的子宫。我们几个学生，以他的private organ作为我们大开眼界的specimen，脸上写满不愿却没开口拒绝。我听凯说的，17岁没有vagina的女孩，仰赖药物注射suppress menstruation，还和一个没有sphincter control的artificial anus活了17年，现在面对hysterectomy和机会渺茫的vaginoplasty的重大抉择。那些我害怕的事情，不偏不倚发生在他们身上。不同程度的恐惧与不安，寂寞和疑惑。这些幼小身躯，幼小而坚强的灵魂，让我想哭。原来我真的很幸运了，并且幸福。我在乎的人健全快乐，这么简单，原来就是最大的福气。

2
下午会有Thalassemia病人输血。今天看见一个小哥哥，照顾妹妹，年龄大约9岁和3岁。小哥哥好成熟，很认真地照顾妹妹，闪烁发自内心的爱。妹妹走到哪里，追到哪里。直到一个moment让人心疼的，就是他开始被输血，行动不方便，妹妹却溜到病房里，他起身，试图拖着输血管走动。Dr J也注意到，于是叫我们把妹妹抱回来。

都是爱，让人心疼。

=)

不时会想起我们还没正式在一起的那些时候，你会定时抽时间教我anatomy，真的教得仔细。虽然对不起都忘光了。和帮我回答maple lab practical问题。不小心轮到我到外present的时候，我都紧张兮兮地找你。因为只有你知道我一无所知的弱点。感动不是一时，而是长久的。所以我也会尽能力范围帮你做你不擅长的东西。CC听到我帮你做这些的时候觉得我很好，其实你更好，在我无助崩溃的时候牢而有力地把我拉起来。记得dr s去年问我男友给予support的问题。我说你会帮我解决课业上的难题。dr s问，那么实际上他帮过吗。我根本不需要犹豫就可以给予肯定的答案。提醒我这些的都是今晚凉凉的风，让我想起从前我们在foyer熬夜念书。有一个半夜突然下了毛毛细雨，你坚持替我批上你厚厚的外套。第一次被男生批外套，还有你的味道。

Sparkle in the dust

Last year was my worst year so far, in terms of mental state. I was depressed most of the time. I was not interested in anything at all, not interested in any clinical presentation or rare diagnosis that will make my peers jump in excitement although not literally. I dreaded going to hospital, walking under the sun, climbing up the smelly staircase to my ward, being part of the crowded and forever busy ward. I didn’t remember learning anything actively. Anything retained in my brain from Year 3, was there by means of natural osmosis, not by my hard work. I had mind block halfway clerking patients. I had to force a smile while thinking back the last question I asked my patients, and the next. My mind was a chaos. I felt like escaping every stressful bedside. Negative emotions accumulated inside me, I let them out by crumpling the medical notes I was holding. Squeezed them until I felt the hardness of each angle of the crumpled paper. I still attended most of the classes, even though without the ability to concentrate.

In my room, when I cried I can’t stop. I cried until my eyes were swollen and my double eyelids were gone as a result. I cried I had to breathe through my mouth.

Then there was this patient I randomly clerked. His AML was not officially diagnosed yet when I met him. He was still well, he still can talk when I first clerked him. Then his condition deteriorated and could not speak in full sentences anymore. The second time he was admitted, he had an arm abscess at IV branula site, an infection as a result of chemotherapy. He was the only patient I remembered clearly from last year. He was nice and was willing to talk to me even when he was very ill. I remembered it was a hot afternoon. I went to medical ward to check up on him. My every movement felt reluctant and heavy. When I was in the hospital lift, I put my hands in my lab coat and looked at the floor. I pressed the lift open for another person to enter, didn’t look up nor reply anything when he said thank you. I felt like a non-human, walking in an alien environment that doesn’t belong to me. That was until I saw the patient in the ward. He was lying on the bed, worse than how he was the day before. I smiled to him. Just like that, he made me smile from the bottom of my heart, when I didn’t even want to make eye contact with anyone. It was like a sparkle in the dust, a sprouting flower in the desert, a tiny drop of rain in drought.  

But I was not sure how he was coping with chemotherapy, or more blatantly, if he is still alive now. He was 78 last year.

----

“As medical students, we are confronted by death, suffering, and the work entailed in patient care. While being simultaneously shielded from the real brunt of responsibility, though we could spot its specter.”

“ All at once, it dawned on her and she began to cry: wherever this ‘Practice EKG’ had came from, the patient had not survived. The squiggly lines on that page were more than just lines; they were ventricular fibrillation deteriorating into asystole, and they could bring you to tears.”

The first urinary catheterization I witnessed in my life, was performed on a patient who is now dead. He died in the afternoon, in the crowded stuffy medical ward with regular beeping from ECG machine. He has died before I cared to look at his face properly, to know his name. I eagerly observed the procedure, performed by a houseman assisted by another houseman, without knowing the patient's story. And he died.

Being surrounded by life and death, having to witness all kind of difficult lives, I have learned to blind my emotions. Until I forgot, an ECG of asystole doesn't just mean asystole. It means someone has died. We are learning through people who are dying, or who have died.