Dear R,
I remember having such similar thought prior to the end of each rotation, that I can't wait for it to end. The first time, it was to escape from Nambour, Sunshine Coast and all the unpleasant experiences I was made to have. The 2nd time, it was a relief to finally end a consecutive 1.5 years of inpatient term.
Then came CCT rotation. I remember clearly telling you in our first community supervision that the first thing I wanted to learn is to figure out how this whole CCT works. It revealed my complete lack of understanding into a community rotation. I was allowed to learn and grow in my own pace (what a quick learner I always turn out to be). In my first week I asked Grace how Case Review works, Sam the frequency of our reviews, Julie how our team is (she said great), Bryan if he is going anywhere else (he said of course not, he has a mortgage to pay). Very quickly I was flooded with endless script requests and emails. I was thrown off balance by the breath and depth of our responsibility in CCT, which is far beyond a piece of patient list on our hands.
I was initially bored by the patients who seem to be uninteresting and intellectually unstimulating without active symptomology, unlike those we see in the ED and acute wards. You introduced me the concept of recovery, therapeutic alliance and fine-tuning of medications. I started to have to think a lot on my own, often times too much, too obsessively and for far too long. I learned from Sanop who spent time having plan discussion with me at the initial stage. I grasped the gist of it and made use of the trusting nature of Hugh. You are always easy-going. With you, I learned the most from our supervision, your documentation, your observation in MSE, your clinical reasoning, comprehensive plan and the way you lead the MDT.
I was distressed by unhappy depot patients, especially those who screamed at and cried in front of me. I felt stagnated by patients who had difficulty moving forward. I told you about it. You talked to me about ethics, philosophy, clinical guidelines and evidence base. You almost always couldn't stop yourself from talking about psychodynamics. You said it is what makes psychiatry interesting. I can start to agree with you now.
In the last month of my CCT rotation, I was not there. You weren't there either. December, the goodbye hit me harder than I had imagined. I had imagined the goodbye several times in my head. But I had not imagined myself to be crying non-stop on December the 20th, on my way walking to the SHP building, in my office without you dropping by anymore, in the clinic where I would be seeing patients without consulting you any longer, in the toilet where I tried so hard to regulate myself, reapply my makeup but ended up repeating the cycle of motions for over 20 times.
Everything changed but nothing has changed at the same time.
January I did a week of slightly eventful night shifts, had 3-week study break before starting another CCT rotation but this time in Older Persons.
I am more than halfway in this rotation now. 2 more months. I found myself saying I can't wait for it to end again, this time for different and slightly complicated reason. It is nothing in particular, but many things together.
As I will always mention, I am glad to learn the knowledge and skills Old Age specific (and that I get to do Old Age EPAs). With different patient population, I see different focus of clinical presentation and am immersed in the delicacies in medication management. Seeing less number of patients a day, I have more time to think and digest, to include brief formulation under my impression. And I do enjoy how pleasant and lovely our patients are. I like how people can really move on, that they are not stuck with substance use, that they are more interesting than too many DIP I saw in adults, that I am really seeing endogenous depression with psychotic features.
But I am also thinking this is not just what I want to do. I do not want to just see patients with major mood disorder, and they get to move on because the acute episode has subsided not because we have done a lot of other things differently. I do not want to want to do a subspecialty just because the patients are mostly pleasant and not aggressive. I have no deep interest in various types of dementias beyond the basic. Although I have no problem in dealing with such complexity, and I do have interest in the interplay of physical and mental health symptoms.
While I appreciate the quiet time I get to formulate my mood and late-onset psychosis patients, sometimes I miss the excitement in adult CCT.
I also can't do home visit for longer than 6 months.
There are other non-clinical things in this rotation that I dislike. The chaotic organisation, the dismissive attitude and invalidation from V regarding my experience from the very start (why can't ppl just say yes, there are problems and we need to solve them), no one including Lisa willing to make any change beyond verbal fake promises, the chaos, chaos and suffocation from a leadership style that I do not admire.
In every rotation I consciously want to get something from it and sometimes I get something unknowingly.
This time, I guess I have learned, to stay myself in the midst of the chaos. I have learned that working with people, when too closely, can be tiring, and that making small casual conversation to fill in the blank, is indeed a skill, to show that I am nice and easy-going, apart from the fact that I am a good doctor. And I feel more and more, that people need to listen to me. Case managers, medical students, patients and their family. I continue to carry your values and what you have taught me in your absence. I felt my growth again across the few months, in my assessment, plan and formulation.
I am most glad that you shaped me into who I am today.
Everything changed but nothing has changed at the same time. Now when I walked on Level 7 of SHP, when I walked passed people and said hello Marvin, Janine and Hi Bryce, I was reminded of my time in CCT just not long ago. I was reminded that I am a standalone person. Although my memory was heavily tinged with the memory of working with you, I am a standalone person. I worked with you and the other team members. I might be remembered as a kind and friendly registrar. I say hello to them and we warmly or politely catch up and both reminded of the time we worked as a team. that's what's left, after you left. And in each and every day of my training afterwards, I am a person on my own. I am learning to stand on my own ground firmly, in ways influenced by you, and perhaps in my new way. I must not be afraid.
