SYNDROMES: Madalas ARDS, Minsan Impostor (the Halfway There Blog No One Asked For)
An important question I learned to ask habitually to friends, peers, and people in general is
“What makes you Happy?” I always immediately qualify it with,
“It doesn’t have to be a grand thing, it could be a small thing, any recollection of someone, something in recent memory that allows and allowed your Happiness”
Sometimes, the question is not asked in words. For fun, I made a habit of observing people and intuiting the most likely answer.
To my roommate (aka Best Roomie anyone could ever ask for), the answer will be something related to BTS! (Cue preprogrammed meMaryan anecdote: I can almost fluently converse in Army speak because of everything my roommate teaches me! I am genuinely interested in finding out about people’s biases, and there is such a thing as bias-wrecker! And then there’s OT7. HAHA, I always get asked if I am an Army myself, to which I always respond with, “I love what my roomie loves!”
To Sammy (aka the Samwise Gamgee to my Frodo (mostly because she’s really just carrying me through Mount Doom and because literally speaking, she’s a Wise Sam)),the answer would be her rabbit I love calling Francisella Tularensis, or Francis for short. I played devil’s advocate when she was contemplating getting Coco, but after seeing the genuine Happiness in her eyes whenever she would bring up Coco in conversations, I keep praying Science will hack the animal telomere research soon! (Sa future na lang yung Human Life Extension Pack diba HAHA)
To Lai (the real Ate between the two of us), it is her plants! In my short February leave, I had to understand how coconut poles work, what a “propa” is, how a Swiss cheese Monsterra is different from a variegated one (wait, are they different?) And I had to practice self restraint in showering her pots with my leftover morning coffee (“To make sure they all wake up” HAHAHA)
To Megan (my 8-year old clone), it is her cousins! I am still not Favorite Tita, and I rarely get to see her on regular family video calls because she prefers talking with her cousins (hahaha aray).
I find this mental exercise infinitely rewarding if only because it reassures me that people around me have their individual motivations to get up each morning — a reason for being, an Ikigai.
I am in the Middle of this Great Book that talks about that very concept. It also covers discussions on Viktor Frankl and logotherapy (someday I will write a book review/feelings sesh on Man’s Search For Meaning ) and Haruki Murakami. In short, a compendium of many things a Marianne Tiongson gets nerd kilig from (HAHA so bakit po siya doctor ano po)
It also mentions Flow – the transcendental experience of “being completely immersed in what we are doing”. Reading about it made me realize that I encounter this Flow in certain activities I do.
One of which is Writing. When I write, my brain escapes its default hyperdrive mode. The ideas that usually skip from one thought to the next faster than I can process somehow slow down. And when they do, I am allowed a moment to understand them and experience them a second time, now with the benefit of hindsight.
Another is Walking. I always tell people “I need my steps” whenever I would offer to walk with them. When I walk, everything in my body enters a state of relaxation. I don’t have to think hard when walking. And if you find yourself walking with the most beautiful Sunset view in the world, sharing a Silence for Two, you will understand how lucky you are to be existing in this particular moment and in this particular way.
I also experience the magic of flow whenever I have the time to brew my own morning coffee. At home, it means manually grinding coffee beans, and measuring with precision the perfect proportion that will produce an immaculate cup – the right amount of coffee with the right amount of water with just the right temperature. In the advent of espresso machines and ubiquitous coffee shops, manually preparing coffee is time-consuming. But there’s something relaxing about engaging in a process of alchemy with disciplined precision. And the most rewarding part: sharing that cup of coffee whose sweetness, milk content, acidity, and bitterness are customized for the person you are brewing it for.
The many things that make us Happy are protective factors for the rising epidemic of Burnout no one is immune to. So our daily answer to the question of “What makes you Happy?”, big or small, grand or simple, is important.
It is the thing we will hold on to for when we forget.
You see, this Profession is not immune to moral amnesia. We think as Physicians exposed to the greatest of human tragedies,Suffering and Death, we have an unlimited supply of Compassion. In our work, there is no shortage of reminders to Be Kind.
But in our most Human moments, we Forget our Whys. No matter how much we still want to offer ourselves, we realize eventually that we cannot pour from an empty cup. We will learn this the hard way.
In a recent conversation with a friend, she brought up the Doctor’s Version of Caregiver Fatigue. In a moment of honest vulnerability, she asked how to sustain empathy towards patients.
She was scared that she has lost her ability to be patient, and many times, interactions become rushed for the sake of efficiency.
It felt tempting to say that I never got tired of this job or that I was always kind, or that I always had a reserve of Compassion for my patients. But I would be lying if I claimed all of that. Up until this very moment, it remains to be one of my Great Struggles. Araw araw kang ubos, pero kulang ka pa rin.
In internship, the Gap became so wide and palpable I told myself I couldn’t start a 3-year Residency Commitment as someone who is showing signs of Detachment early in practice. It was the tilting point in the Grand Jenga of Plans Post Med School: I had to walk away from the Hospital Life so I can get closer to where my patients are coming from.
It had to be non-negotiable for me: the knee-jerk visceral response upon seeing a patient from Triage should never be annoyance. “Health is a Human Right” should not just be a motherhood statement uttered in convenience.
I knew I had to get out of my Comfort Zone if I were to truly understand what “Home” looks like to patients who went “Home Against Medical Advise”. If I am sending them back to the very same conditions that allowed for their Illness, then I must see for myself what those very conditions look like.
And what I saw when I did exactly that wasn’t pretty.
I realized that the patients who get to our hospitals are the lucky ones – they had the means for transportation unavailable to the least fortunate of them all. The money my patients spent for their fare could have been used for their next meal. This is the image I always conjure in my head – the home visitations to our far flung GIDA barangays in the community. The kilometers of hard-to-pass roads leading to humble abodes. I will be ashamed with my “Bakit ngayon lang to dinala?” because I have the privilege that these people do not have.
And even if I started Residency with a renewed Mission to go where there is greater need, I still encounter the most frustrating Human Moments, the least of them physical exhaustion. The lack of sleep can be remedied with a post-duty hibernation. But what about the lack of motivation to show up the next day? The loss of will to get up this morning? The having to deal with another inevitable patient death? The occasional frustration when we don’t see eye to eye with patients and their watchers? When it is 3 am and they raise their voices at you for policies you had no control over?
It is a constant struggle and an unrelenting striving that only gets worse if you are afflicted with Impostor syndrome. It is the feeling of being a Fraud despite objective evidence proving otherwise.
It essentially asks “What gives me the right to be here?”
It fears the scenario of being found out for who you truly are – incompetent and unworthy of the accolades.
It comes from a place of insecurity and anxiety, cunningly distorting Objectivity to conclude one’s inferiority.
In an old Hospital Playlist-inspired blog of yesteryears, I wrote:
“On our worst days, we wish to free ourselves of this overwhelming Guilt. Doctors do get tired. We also wish we didn’t run out of patience. That we never get tired in every aspect possible – mentally, emotionally, physically, psychologically. But we do. And so we conclude like Ahn Jeong Won did,
“I’m not a doctor, I’m a fraud.”
I can’t count the number of times I asked myself if I deserved to be here at all. My decisions carry a heavy weight that affect actual lives of actual people. My “simple” mistakes result to consequences that others would bear.
On the worst of days, I wish I didn’t have that heavy burden on my shoulders.
At this point, Jeong Won’s brother would ask him to stay for one more year – and another, and another.
I guess this kind of suffering is Universal in this profession. Our Dream comes with the price of constantly seeking that elusive Perfection we were never meant to reach.
Our attempts hurt us because of the guaranteed failure that will haunt us in our most vulnerable moments.
But after everything has been said and done, after tears have been shed and life decisions have been questioned, we find comfort in the fact that we are helping lives breathe easier – in our own ways.
We will not always end up saving everyone’s life. Our mortal body will tire after what feels like an endless CPR inside a speeding ambulance. We will declare our patients’ deaths in a somber voice we have rehearsed to hide the tears about to fall.
And yet, we hold on to the Hope that the things we do will ease others’ suffering. We’ll try again the next day, and the day after that, and the next.
And maybe that’s what we were always meant to do. To try again and again and again, even when it feels impossible to.”
I have come to learn that for Impostor Syndrome, the most potent antidote is a Best Friend’s chastisement free from sugarcoating: the raw and honest Truth. “You are wrong in believing that.”
And when they say it with utmost Confidence and Certainty as they look you straight in the eye in a deserted hallway as you are about to cry, you will wonder if maybe they are right.
So if you are lucky enough to stumble across friends who genuinely believe in you and tell you, “I am proud of you” when you are not so proud of yourself, keep them. And thank them for believing in you when you couldn’t do it for yourself. They will be crucial to your survival throughout Residency.
I am halfway through residency, still looking for the Survival Guide that was never written. If this came with a manual, I would have devoured it already!
As a Virgo, Type A, Enneagram One rolled into one, the past 18 months was a lesson on Unlearning years and years of conditioning to be “Perfect”. What a hard lesson it was, and continues to be!
But I borrow the wisdom of 26-days-into-residency Maryan:
A good friend once told me that Medical Training is also character-building. Samuel who breezed through med school with excellent grades and outstanding academic record could easily conclude that it was about “doing the best or being the best”.
Instead, as a genuinely Humble human being, he reminded me to always anchor Training in the context of Self Growth.
And once I did, every mistake became a learning moment with an end goal of becoming better than who I was yesterday. Each day became an opportunity to practice self-compassion.
5 years ago as a bibbo clerk filled with a “zest for life”, this is where I dreamed I would be in. It is so easy to take things for granted and forget that not so long ago, I prayed to be where I am now.
This previously struggling first year is now less afraid of and a bit more confident in dealing with hyponatremia (HAHA, salamat Renal + Endo + Neuro)
Sure, there are LOTS of CPGs to be read and journals to acquaint myself with. There will be more tests to study for, and oral exams to prepare for.
But if the Universe were to suddenly announce a Pop Quiz with a do-or-die Jeopardy Finals question and it asks,
“What Makes you Happy?”
I hope when I answer
“Is it Life?”
Alex Trebek will beam all they way from Heaven.
xxx
medschool panacea 