The Longest Week

Last week felt like the longest week ever.. or maybe one very long day that stretches on and on... it feels like that for me because i didn't sleep for a week. Each day, i get to eat once a day because of the huge workload... there were days that I didn't eat anything at all, yet I barely noticed that I haven't been eating. Oh yeah, I haven't taken a bath for a week already. If i wasn't itching at certain parts I wouldn't mind not taking a bath. I also shelled out for a lot of patients, close to 7000 bucks! Funny how everyone assumes that all services are free in a government hospital--- we end up paying for everything they can't afford, else we suffer the wrath of our seniors... having no money is no excuse for not proceeding to do an operation. I can only imagine how some of my co-residents feel. I know a few of them aren't well off... in fact, they say they chose to work at that hospital because the salary is bigger... yeah right. After spending a fortune for your patients, you'd be lucky to have a few cents left.

Yeesh. No sleep, no food... no bath, no money! there seems to be no incentive to keep on moving along this path that I have chosen. There's no sense of fulfillment.

Change

Funny how a lot of things have changed in just one month.

I first noticed this yesterday, when I was walking around our neighborhood. It seems that i have been transported into another world, in another time. More than two weeks ago, there was a huge storm. I was on duty at the emergency room at that time, so i really didn't witness its intensity, but I knew it caused a lot of damages, based from news reports, and from the number of trauma patients coming in. Most of them seem to have lost their common sense momentarily, thinking it would be safe to go out, even with the strength of the wind blowing outside. I went out for a few seconds before the peak of the storm, and at that time, it was hard enough for me to keep my balance. The electricity was cut off from the hospital for two days, and several areas were flooded with water. Imagine hospital where no x-rays, no laboratory procedures can be done, yet patients kept flooding in. It looked like a disaster area. And when I came home after two days, I was really surprised to see that the ceiling in our house was non existent--- when i looked up, i could see our tin roof. SOme of the furniture were also wet. It must really be one very strong storm because our house became flooded for the first time, and the ceiling in most rooms of our house actually collapsed. For some reason, it's been two weeks and repairs have yet to be started. And when i was walking outside earlier today, it seems like our neighborhood was witness to a war. I never noticed it before because I leave our house before sunrise, and if ever I get to go home, it would be past midnight. A month ago, the whole street was filled with lush greenery. Now it looks so empty. The storm has probably swept the greenery away. A lot of trees have apparently fell down. A lot of houses were in worse states than ours. One significant event can drastically change everything--- just like that.

Even when I was driving yesterday, I felt a bit lost. In a months time, several traffic rules were changed--- and some of those changes really seem stupid. Good thing it was late at night and no cops seemed to be around--- i'd hate to be apprehended again, i'd hate to do all that pleading and begging. It's easy to get used to some changes, but it's hard to get used to changes that doesn't seem to make sense... or changes that were made to something that was better, to something that is of value to you, to something you've been used to, to something very familiar, that it now lies very close to your heart, that it becomes a part of who you are.

Like the changes that are about to happen to me in a few months time. I'll be leaving a part of me behind, I'll be leaving a life behind.

As years pass by, as I grew up, there have been a lot of changes. Before, I can choose to be carefree... these days, that does not seem to be an option, else there would be consequences. Once upon a time I can party all day and all night, now I seem to be slowly getting tired of that lifestyle. I'm growing up. I'm about to finally move completely into my adult phase, leaving my childhood self behind. It's not like I have an option... It's not something I want to do, but something I have to do, so that I won't get left behind. Change is a requirement in this path that I have taken. Before I was a TV addict... I can sit all day just watching TV. I had a lot of favorite shows. These past 2 years, I gave up that luxury, because I did not have time. I hear some friends talking about cool new shows like LOST and PRISON BREAK, shows that I would have loved to watch. Some of my favorite shows like ALIAS have ended, some like 24 are still around, but I have no idea what the storylines are these days. I used to read one novel a month... now I have novels that i bought 2 years ago but I have yet to finish. I can still watch movies occasionally, but that's another luxury that I might have to give up next year. Same with going out with friends, hanging out at bars, drinking the night away,not a care in the world--- at least for one fun-filled night. In the past, there where days when I can just lie down and daydream, days when I can just sit down and write poems and short stories, pick up my pencil, draw some sketches, or paint some portraits. Such simple pleasures have now become luxuries. These days I would rather spend my free time sleeping, a necessity which has also become a luxury. With such simple pleasures that are slowly dissipating, I seem to be moving towards an incredibly mechanical and boring life.

It would be easier if it seems that I'll be leaving something worse for something better, when it would seem that I will be leaving for greener pastures that lie ahead... but with all these doubts and apprehensions, there's a possibility that i'll be exchanging a tumultuous but a good life overall for something that's worse.

Amidst all the confusion and apprehensions, here i go again typing such gibberish.

A Preview

My one month in hell is over. I just finished my pre-residency training, and I got accepted to the 2007 residency training program in surgery--- by default, i guess. There are 15 slots, and only 14 of us were left in the end. I was witnessing natural selection before my very eyes. The rest have already quit early on... sometimes I wonder if what they did was the better option. For one month, I've had a glimpse of the future, and it seems very grim.

I knew it would be really tiring, but I never expected it to be this tiring. And I never expected the schedule to be--- impractical. inefficient. unphysiologic. The schedule was unbelievable, I wonder if it's the same in other government hospitals. First day, we have to report by 4 AM to do our early morning rounds. We have to finish by 630 AM because the first cases for operation are scheduled at that time. 2 hours seem enough, but it's difficult if you have a lot of post-op patients, you have to inspect, clean, and dress all of their wounds. Plus, there's this constant urge to squeeze in a few more minutes of sleep at that time, so you'd want to finish before 6 AM. During work hours, we're either in the operating room, the emergency room, or in the out patient department (clinics), which could finish as late as 8 PM. We do our rounds afterward. Some services finish their team rounds in 3 hours, but for some reason I cannot understand, my team's rounds can last for 7 hours! We usually finish our rounds at 1 AM, so that leaves 3 hours to carry out orders, since we have to start our morning rounds at 4 AM.

Then there's the every 3 days duty schedule, which is apparently only true for interns and clerks. We're practically on duty every single day. Apparently, being on duty is defined as taking all emergency operative cases (like appendectomies) during that day. There are three teams, so three duty days. We just assume different posts everyday. Tehcnically, we can go home on the third day, but since our rounds finish at 1-2 AM, I only go home to eat and take a shower. There's no time to sleep since I have to be back by 4 AM. When I'm in the hospital, I have to squeeze in time to eat in between errands, I can't take a bath so I'm wearing the same clothes for days, I become aware of how much I stink, there are days when I don't even brush my teeth, and for 1 month, I only have a maximum of 2 hours of sleep a day. and that's not straight 2 hours, that accumulative. Every now and then I can sleep for 10-15 minutes at certain times during the day, and when I add those minutes, they amount to at least an hour. In my opinion, I think they should just hire more people instead of dumping such a huge work load on a few people. If I knew my surgeon hasn't been sleeping for weeks, i wouldn't go through my operation. The first year residents look like zombies, dozing off every time they get to stay still. Next year, I'm going to be like them. It gets worse when I'm actually a first year resident. They rarely get to go home. We only got to go home because we were technically not yet employees of the hospital. On paper, first year residents are off on every third day also, but they'd be on call. But with the large amount of work, they're always on call. For one year, there's practically no time to go home. Maybe just to have quick shower--- that's it. It gets easier through the years because the work load is less for seniors, but the fact remains that a senior resident is still always on call. One senior resident who already has his own family told me he hasn't seen his daughter for almost a year. Surgery Residency is a sure fire way to ruin any relationship... which a good thing if you'd want to end relationships. Another drawback for first year residents--- Since they're already employees of the hospital, the senior residents get to treat them shabbily, almost like slaves. I'll also probably run out of money because they use their own money to buy needs for patients. The seniors get mad if an operation cannot push through because of lack of needs. You'd think they'd expect that because most patients have no money at all. They should have a team fund instead of having the first year residents pay for needs. Also, those seniors insist that they are treated to meals every time a first year resident commits even a minor mistake. With all the work load they dump on first year residents, you'd think they'd be more understandable. On the other hand, when the juniors do something good, or perform a procedure successfully, the seniors insist that the poor juniors celebrate by treating their seniors to lunch. WTF?! Either way, you can't win! Sure, the salary is higher than what I would get if I worked in a private hospital, but with all that extra spending, I'd probably get to take more money home if I worked at a private hospital instead. And the work load wouldn't be as tiring.

After a lot of thinking, i guess I can actually live like that. After a month, I got used to not taking a bath, not eating much, and not sleeping at all. I've discovered a person can actually perform his daily functions even without sleep... I don't get sleepy as long as I'm doing something, and they never seem to run out of things for us to do. I just can't tolerate some of the senior residents who were acting like Gods, cursing you and shouting at you even if you're doing nothing wrong. OR they tell you to do things that are impossible to do, then get mad at you. They're obviously using their power to make fun at you. It's even more annoying when you find out they were scum during their first year and the senior residents frequently got mad at them--- they're simply doing to us what was done to them. I can live with expletives, I don't mind if they scold me if I really did something wrong. It's those "power trippers" that really test my patience. I have no problem with authority, as long as those people don't abuse their authority. If ever I'll quit, I'm going to punch those assholes in the face first before I leave the premises.

I've been thinking about which path to take for months. After a month in preresidency, the path seems clearer. Yeah, it's going to be a really bumpy road ahead, but I can take it. I know I can live like that. But questions still cloud my mind.

Is this really how I WANT to spend the next 5 years of my life?

J.D., M.D.

i guess it does have a nice ring to it. :)

after several years in med school, and more than 2 months of burying myself in review books, I've finally made it.

I feel as if I've won the lottery--- and that analogy isn't really far fetched. I was simply guessing for the most part of the exam. and those weren't intelligent guessings at all--- i was guessing without basis for I couldn't eliminate the other choices. Questions were so specific. It wouldn't matter if they asked about common diseases or "must know" topics. Instead, They asked a lot of "out of this world questions"! Like playing the lottery, i just picked a random letter, hoping that I would be lucky enough to be pick the right ones. I guess luck was really on my side on those days. Thank God. :)

In my opinion, I don't think they should make board exams that way. What's the purpose of board exams anyway? Isn't it to determine if we are fit for the profession we choose? how can they determine if we are fit enough when they ask a lot of "out of this world" questions? shoudn't they ask questions about the "must know" topics? those topics that anyone entering a certain profession should know? It's so frustrating when you know you've studied enough, and then you're faced with a lot of esoteric questions. Also, since a lot of people have also been guessing, everyone seemed to be on equal footing, whether they studied or not. hence, many of those who really prepared for the exam, and a number of intelligent people didn't make it. and a lot of those who barely prepared for the exams passed, with plain luck in guessing on their side.

That's why I don't look down on those who didn't pass. I know a lot of them are intelligent. And I know that they would be good doctors. it's just that in the lottery that they call the Physician Licensure Exam, wherein luck is a very big factor, they weren't lucky enough to win. I even feel a bit guilty for being so happy, knowing that some close friends of mine didn't make it. It kinda seems wrong to celebrate.

***

now I have to look at the grueling journey ahead. I haven't really decided on which path I should take. A few more years in residency, plus a few more in fellowship. The actual journey has only begun.

*groan*

in the meantime, i'll drown myself in pure bliss. Just for a few days, then I'll get back to business and plan for the grueling journey ahead.

Butterflies in my Stomach

I haven't felt this way for a very long time. It was the same feeling that I used to feel when I have to perform alone in front of a large audience... to act, to sing, or deliver a speech. Or when I was a contestant in one of those quiz bowls and I felt so conscious because everyone would see me fail miserably... which was often the case because I gave in to pressure. The pressure was too great. Stage fright. I wanted to back out, but I knew that I can't.

I've been aloof and indifferent for the past few months when everyone seems to be panicking already. But just now, I suddenly feel queasy. nauseous. I have butterflies in my stomach. I seem to be on the brink of stress incontinence too. This feeling was all too familiar, though it wasn't since high school when I last felt this way.

After more than two months of studying, I have finished. It seems that I'm not used to studying anymore, since I've been moving at a snail's pace... but I have to study everything again, briskly this time, since i seem to have forgotten a lot of those things that I have studied. This is incredibly frustrating. And to make matters worse, I only have five days--- ONLY 5 DAYS(!!!!) left for review, and I can say that I have never been more unprepared for an exam in my whole life. Those who have taken the exam say that one can never be really prepared for that exam, that you can't really study for it, you won't find the answers in the reviewers, that it all boils down to luck and prayer. They say that for comfort, i guess. but it's making me panic instead of easing my nerves.

The pressure is so great, I don't think I can bear not passing the exam.I hope when I update my blog 2 weeks from now, when the results finally come out, I'll get to post something positive.

Reality Sets in Again

A penny for my thoughts.

I've been having a lot of talks with my peers lately, and I've been having second thoughts about which path I should take in my medical career. I thought I've decided to take up general surgery--- that's a no brainer. After all, that's the only field where I've shown much interest. But many have been saying that such a career is not such a good choice. There are already so many general surgeons in this country, that it seems not worth the amount of time you spend on training (5 years as opposed to 3 years for other residency training programs). After finishing the program, it's hard to earn money because of all the competition. Plus, there are already a lot of established surgeons out there. It's a specialty wherein there's a huge discrepancy between the supply and the demand--- unless one chooses to practice in a far flung province.... but I can't live like that. FOr a short time, maybe, but not my whole life. That's why a lot of surgeons leave the country to search for places where there's a demand for them. They have to earn to live, after all. To add to their woes, some countries prefer those who have undergone residency training in their country. I don't want to spend 5 years of my life in training, then regret it afterwards because i'm not earning enough.

If I choose a field where there's few competition or where there's such a huge demand, I know I'll make money. But I'd be stuck I'm a profession marked by tedium. I don't want to spend my whole life doing something I'm not interested in, no matter how lucrative the profession is.

Maybe I should just take a year off after passing the board exams. I'll have time to clear my head, before I start my journey to the point of no return. And I can do non medical stuff, too. I'll spend the rest of my life being a part of the medical field, having a year off from it may actually do some good. Maybe I can live someplace else for a change, some remote province, so I can think straight. or travel to another country, not one of the usual haunts. Maybe in South America, some place not vandalized by tourism so I can fully immerse myself in another culture. Taking a year off may be my last chance to do the things I've always wanted.

When Reality Sets In

I'm the type of person who prefers to have things planned. I'm not the obsessive compulsive type, I just don't feel comfortable with the uncertainty that comes with spur of the moment ideas. Nor do i feel comfortable with drastic changes.

I already have this rough blueprint of how I'd spend my life in the coming years. When I (hopefully) pass the board exams, I'd apply for residency at a certain local hospital (I have yet to decide which one). Pre-residency usually lasts a month. After that, I'd probably do part time work at a local clinic, or some municipal hospital wherein they pay you on a daily basis. Come January, I'd start the grueling journey of residency, which would last for 5 years. After that, fellowship which would last for another 3 years.

Then a few days ago, my father kept on bugging me to take the USMLE examination so I could take up residency in the USA instead. Whoa. That caught me off guard. For one thing, I'd never expect such a suggestion from him, because he kept on saying that he doesn't want any of his children to go abroad. And if I take the USMLE exams, that would drastically alter my plans for the next 5 years. If he brought that up 5 years ago, I would have wholeheartedly agreed. After all, one of the reasons why I thought going through med school was not such a bad idea was that I could go as far away from home as possible when I graduate. I was a selfish 21 year old back then, and a reluctant would be med student. Funny how 5 years can change a person's perspective.

You could say I'm eating my words right now. I imagined my life would be miserable because I'd be stuck in a profession that I don't really want. But I've learned to like what I'm doing. Even when it gets too hectic at times, to the point beyond saturation, all of those things begin to fade away when you see patients that you take care of actually become well. And nothing beats the joy you'd feel when patients say "thank you", or when they even give you stuff to show their appreciation, even when you know they barely have money to pay for hospital expenses. Nothing can give a person more happiness, than knowing that he has touched the lives of others. Another reason why I'd rather stay in this country is that I would prefer serving my countrymen. I don't think I'll feel content serving foreigners, knowing that a lot of people back home can use my help. Call me idealistic now, but I'd prefer service than monetary benefits.

One minor reason why i'd rather stay in this country is that my family and my close friends are here. I've come to a realization that I would probably feel homesick when I go to a foreign land. And to think I once thought I could live alone, that I don't need anyone. The high probability of discrimination also won't be helping. Who would want to work in a place where they'd treat you as a second class citizen, when you are appreciated back home? Again, I don't see money as a reason. No amount of money can pay for such ill treatment.

Yesterday though, I had a conversation with a friend who has been planning to work in the USA from day 1. I guess it was an eye opener. Sure, he said, I can be idealistic now because I can afford to be. Monetary benefits are only secondary because I can still rely on my parents for that. But what will happen a few years from now, when I have my own family? i guess that's when reality will set in. What's real will overcome the ideal. I used to think all these people who dream of going abroad are only blinded by colonial mentality and the promise of greener pastures. I used to think doctors going abroad were selfish. They'd rather make money than serve their countrymen. I even thought those doctors who study nursing just to be able to go abroad were pathetic. Now, reality sets in. In reality, money is a factor. Indeed, how can you serve others, when you have nothing to eat, no place to live, because you don't have money? One has to take care of one's self before he can take care of others.

Medicine is not a lucrative profession--- at least not initially. Whoever said it was needs to be hit hard in the head to bring him back to his senses. Return of investment takes such a long time. After spending a fortune to get through med school, you'd spent 3-5 years in residency, wherein they pay you such a small salary. The amount you get is definitely not proportional to the work load. In this country, nurses get paid more, even if in some hospitals they mostly just sit around and chat. Residents are one of the most underpaid professionals in the country. It's enough if you live alone, and if you live a very simple life. It's definitely not enough if you're planning to start a family. No wonder those who can afford to go abroad go abroad. After that, you'd spend another 3 or so years to subspecialize during fellowship. You'd need to if you want to be competitive. By the time you finish fellowship, you'd be in your late 30's. That's when the return of investment would come in--- provided you've subspecialized in a field that has a huge demand. It would be hard to have a lot of patients if you're in a very competitive field. And knowing myself, such return of investment won't come quickly--- I won't have the heart to charge excessive fees for my services after all.

So now I'm back to square one. I have no definite plans as of now. I haven't decided which path to take. Maybe I'd take a year off instead, to have some time to think. I guess there's no rush anyway, I have so many years ahead of me.


If only there was a way to combine the ideal with what is real...

No Doctor In the House

I have probably slept for less than an hour, when I woke up to a rude awakening. My dad was banging at the door of my bedroom as if it was the end of the world. Turns out my grandmother was not feeling well. I'm used to this situation, so I didn't feel like it was an emergency. Usually her blood pressure is elevated. Turns out I was right, it was 230/110 mmHg. Honestly, I'm at a loss when this happens. I just ask her to take her prescribed medications for hypertension. At the hospital, such a high blood pressure reading constitutes an emergency (or to be more precise, an urgency since there is no acute end organ damage present). We have to lower the blood pressure gradually. But her doctor who's a cardiologist/ cardiothoracic surgeon says it's normal for her blood pressure to be 170-180 systolic, it doesn't have to be lower than that. He's the consultant, I'm just a lowly... er--- medical bum (what else would you call a person who's finished med school and currently unemployed, just studying for the upcoming physician licensure exam?). Maybe her previous heart operation has something to do with it. I dunno. He's more experienced, and he's the expert, so I took his word for it even if it doesn't really make sense--- you know, it's a bit contradictory to what they've been teaching in med school. I should pay him a visit one of these days to know the rationale of the management. Or maybe I should finally open that highly technical cardiology book that I have that's been gathering dust ever since i bought it. hehe.

Anyway, this time, there's something a bit different, not the usual hypertension induced headache/dizziness. There are clusters of bullae on her upper back, with erythema, accompanied by pain. The whole affected area probably measured 10x10 cm. And there was a 4x3 cm erythematous patch on her right upper quadrant. (Am i getting too technical here?) Apparently, the lesion on her back started 3 days ago, spontaneously, with no predisposing factors, and it looked like the one in her abdomen initially. She self medicated with betamethasone + Gentamycin cream, which allegedly dried up some of the bullae and lessened the pain. Now was that right? A topical steroid for a patient with diabetes mellitus?! I couldn't think straight at such an ungodly hour! And I was confronted with a dermatological problem! Dermatology may seem simple to some people, but it's not. It's one of those subspecialties, wherein a certain common manifestation like bullae or erythema has so many differentials to be considered. And with such symptoms that are not pathognomonic (i.e. pointing to a certain disease), it's harder for someone like me to diagnose. Heck, I don't even have the license to act as a general practitioner yet. At least my head was clear enough to attribute her increased blood pressure to the pain on her back. After a few minutes, it lowered a bit. Gave pain medications too. Told her she doesn't have to be rushed to the hospital wherein only residents and interns would attend to her. It's better to wait for regular clinic hours. As for the skin lesion? officially, my diagnosis as of this time is--- TO BE ANNOUNCED. hehe. i have to scan my dermatology book first.

People in other professions seem to have it easier... I mean, if you're a lawyer, others would approach you if they have problems with the law--- that's not everyone. Same with being a policeman. If you're in the business profession, only people who want to do business with you, or those who seek business advice would approach you. It's different for physicians... virtually every person you'd encounter, even the healthy ones, can approach you for consultation regarding health matters. And most often, those people include your own family.

There's so much pressure when your own family or relatives consult you for their health problems. If I'm dealing with strangers, I can be a bit lax, there's less pressure. I'm not that afraid to make the wrong decisions, I could try again after all (as long as it's not an emergency!) It's also easier with friends, they seem to understand if you don't know the answer. And it seems okay with them if you say you don't know. hehe. But when it comes to family, there's this pressure that I have to perform well, to get it right the first time, even for trivial complaints. I guess they want to get their money's worth, that's why they keep on asking these health related questions. They spent a fortune to get me through med school after all. I'm literally bombarded with health related questions every day. Sure, these questions help. If I don't know the answer, I read up on the topic and therefore I gain more knowledge. I have this cousin who keeps asking me about the treatment for a lot of STDs like crabs, gonorrhea, syphilis (For crying out loud what has he been doing?!), that I seem to be an expert now on the topic. I can tell you the proper treatment at a drop of a hat. hehe. It's just depressing that many times I don't really know the answer. For crying out loud I don't know everything!!! It's impossible to know everything! Sometimes I'm wonder If I really should know these things, that I won't be a good doctor if I don't know the answers to every health related question thrown at me. Maybe I didn't study well enough. Maybe the answers are "must knows" after all, and not as esoteric as I think. For every question unanswered, I can't help but feel so down. And the look on their faces aren't helping. I could almost read their minds, they're thinking that I SHOULD know the answers. I SHOULD. This could be a sign of things to come after all. Maybe I won't be a good physician. In a few years, I could still perform the same way. What a bleak future. What a depressing career.

Geez, I think I'm going to be a lousy doctor.

Little Boy Lost

It's already June and I haven't even finished one subject yet... at this rate I'd be finished with my review of human anatomy on Sunday... that would be Seven days! and I thought I could finish each subject in 3-4 days. Argh. This is getting to be frustrating. The fact that I seem to be encountering some of the terms for the first time disturbs me. How can I forget those terms? Sure, I took up anatomy 5 years ago... but shouldn't I still know it by heart? Or maybe I wasn't a good student at all, with all the cramming I did, that probably resulted to little retention... or maybe I'm just expecting too much from myself... others are probably in the same situation I am in.

Ever got lost somewhere when yo were little? Like in the woods, in the park, or in the mall? I've never been in such a situation... except maybe in my adult life where I can't seem to find a certain place, but being all grown up, i wasn't envelope with fear and hopelessness. My sister got lost in the mall once--- i think she was 3 or 4 years old then. I remember her crying when we found her. I'm in a different situation now, but somehow, I think now I know how she felt back then--- because I seem to feel the same way now. There's this fear of the unknown. Passing the board exams on the first try is a MUST. My peers know that it isn't a gauge of how much you know, or if you're going to be a good doctor in the future. Many intelligent people have failed it, and many of those we consider stupid have miraculously passed it. But there's this public perception, especially with family and relatives who have such high expectations, that if you failed the boards, you're stupid or you didn't study even if you know you've studied hard enough. Others may think that you won't be a good doctor if you failed the board exams once, it's a stigma that you'll carry your whole life.

So passing the boards is a given... but what next? Until now, I still have misgivings if I really want to be a doctor all my life. I guess I have to be one, 9 years of my life would be wasted if I don't become one. besides, i can't think of anything else that I could do. So should I proceed immediately to residency or just "moonlight" (doctors who apply for part time job openings at hospitals or clinics) for awhile? they make more money after all. But on the downside, I'd be left out by my batchmates who'd proceed to residency. Others plan to take the USMLE and take their chances in the United States. I don't really want to go down that path--- first of all, it's so expensive. At my age, I want to give something back to my parents. They've already paid so much for med school, i don't want to "take" more money from them. Also, it is plagued with so much more uncertainties. And I have certain issues--- I don't want to serve a country who doesn't really want me. Funny how many of my peers don't mind if they get assigned to certain remote places in the US, as long as they'll be in the US. Don't they realize that the only reason they get assigned there is that American doctors don't want to work in those places? It's like scrambling for leftovers. It's not about pride, it's more of dignity.

So if I take up residency in this country--- there's a lot of residency programs to choose from. Frankly, I'm only interested in surgery. I find the other programs boring. Internal medicine? zzzz. But there are so many surgeons in the country already, that it has become a very competitive field. After the residency program, there's very little income for new surgeons. Yeah, I know that medicine is a service oriented profession, but let's face it--- you can't serve others properly if you can't put food in your table first. So I have to subspecialize... yet I'm not really interested in the several subspecialties! Plastic surgery? not for me. Urology? it seems boring. Cardiothoracic surgery? ugh. there's trauma, but what kind of patients would I have then? The issue of income comes up again.

Also, should I work in a government hospital where the pay is better but you have so much work you end up looking like zombies, and you have very little free time? Or in a private hospital where there's less work, but you don't learn as much in terms of skills? plus the salary is also very little compared to government hospitals. I guess I can't really blame those who search for greener pastures abroad---- residents in this country are severely underpaid. Nurses earn more, when they have less work, and they only stay for 8 hours a day.

Argh! Just thinking about all these nauseates me!

I've been typing all these gibberish, all these nonsense, when I could have used the time to continue studying instead. hehe. I still have to pass the boards first, i still have time before i think about those other things. Take each step one at a time, that's what they say. Whatever decisions and choices I make, i hope they're the right one--- for my sake, and for others, especially my future patients. I may be a reluctant doctor, but I still want to be a good, if not great one.