Humbled
I.II.IV
HUMBLED
Neurology was shaping up to be the best rotation – for more reasons than one. But above all, I would say that the three months spent in this department helped me reconnect and become more human, as it were.
Here, I got the chance to start taking care of my patients in a more holistic manner as I tried to resensitise myself. For that, this was practically the best environment. Every Monday, all the house officers would meet with the nursing staff, physiotherapists, speech therapists, and occupational therapists to discuss each and every patient under our care – the multidisciplinary approach. Whilst at first this seemed nothing more than a major waste of time, I quickly grew to appreciate it the moment I started taking a more active role in my patients’ care. Suddenly, it wasn’t just about medicine.
As important as it was for me to appreciate the holistic approach, there were far more crucial lessons I had yet to learn – and those I learned the hard way.
You see, as relaxed and chill as it my neuro rotation might sound, it wasn’t all roses and there were busy days. Like when we’d be the admitting firm and I’d have to sort everything out before my working day was over. Or when I’d be on-call and still had to keep up with the following day’s ward work. Or, when we had this especially busy day when Rosa was freaking out given that we had three lumbar punctures (LPs) scheduled on the same day. Sometimes weeks would go by without us doing a single one, and now we had three in one day – crazy.
Having performed a couple myself back in Cambridge, this felt like the perfect opportunity to offload my senior’s workload by butting in. But really and truly, I had one major goal – to become the go-to guy for LPs. I mean, it’s quite a simple procedure, but also time-consuming and a nuisance to most seniors.
The steps are fairly basic. You have the patient lying on their side with their knees to their chest, palpate the spine to find the vertebral level you want (usually L3–4), disinfect the skin, apply local anaesthetic, and insert a long-ass needle until you feel a pop. That pop means you’ve pierced the ligamentum flavum and then the dura to enter the subarachnoid space, where you’ll see beautiful, clear, straw-coloured cerebrospinal fluid (CSF) oozing out. So beautiful. This procedure is done for many reasons, with the two main indications being:
- Diagnostic: To find out what’s wrong with a patient, as in suspected meningitis, where microbes or inflammatory markers may be found in the CSF.
- Therapeutic: Usually when there is abnormal build-up of CSF in the central nervous system that needs relieving.
By the end of my rotation, I had done at least ten of them, with a success rate of around 90%. But boy, it’s that one patient that stuck. She was a first-year medical student who presented with a massive headache and neck stiffness. We suspected viral meningitis (or pre-exam jitters), and an LP would help clarify the diagnosis. Having just done a successful LP on an obese patient, I felt very confident about doing it on a slim girl. And so, all cocky, I spent less than a second trying to find the vertebral space – the most crucial part of the procedure, if you ask me – and went straight in with the needle. My alarm bells went off the moment blood came out. But it’s okay, it happens. Sometimes you nick a vein – retract the needle, and the bleeding stops.
So that’s what I did. I tried again with a second needle, unbothered, knowing the patient would only feel pressure and some discomfort having instilled enough local anaesthetic. Same thing happened. Third time’s the charm, right? Wrong. And then, as is customary after three attempts, Rosa took over. Turns out I was about an inch away from where I should have been and was repeatedly inserting the needle into her paraspinal muscles.
Being the sweetheart that she is, Rosa reassured me that it happens to everyone at some point and that there’d be no residual problems apart from some temporary pain. Thank god for that. Not only had I ruined my perfect streak, but I also felt like a failure and a total idiot.
In hindsight, I’m super glad I failed that LP. You see, when you start the job, you’re met with a very steep learning curve. Some people are like sprinters – fast and furious, accelerating to incredible speeds and finishing effortlessly. Others are like marathon runners – steady, consistent, and paced. And others are… well… let’s just say they’re off to a false start and spend the race trudging along – biting everyone else’s dust.
I, for one, was a sprinter. A cocky, overconfident sprinter. Starting out, I knew I was good. I knew exactly what to do, never leaving my seniors wanting, always one step ahead. I’d go in early and round on my patients before anyone else from my firm showed up, and I knew everything about every single patient. It wasn’t just that I wanted to make a good impression – I was genuinely interested, and I enjoyed it. I was organised and felt like I had everything under control. I rarely missed things, and when I did, I’d realise before it was too late and fix it. I could count my mistakes on one hand, and in a job with endless opportunities for error, none of mine came close to being serious.
I was efficient with administrative tasks and felt I had excellent clinical judgement for someone at my level – always asking for help when I sensed I was out of my depth. I kept cool under pressure, communicated well with colleagues and patients alike, and my bedside manner was top notch. And did I mention my effortless bloodletting and IV cannulation technique? I received excellent feedback from staff and patients, and you can imagine how inflated my ego became.
But that’s good, I told myself. This was my one and only goal in life. I sacrificed everything to get here. I barely had a life outside hospital while my peers seemed to juggle everything effortlessly. The words of Dr Craig Thomas to Cristina Yang echoed in my head:
“Mediocre surgeons will see you and feel themselves wilting in your shadow. Do not shrink to console them. Do not look for friends here – you won’t find them. None of these people have the capacity to understand you. If you’re lucky, one day you’ll train someone just like you. Until then, read a good book. You have greatness in you – don’t disappoint.”
With her as my role model, this was the standard I chased. I even coined my own saying: “Some house officers are born equal, but some house officers are more equal than others.” I’d joke with colleagues of similar calibre. SHOABEB – SHOAMETO for short. Soon enough, I had tiers in my head: excellent, average, mediocre. It was a competition, and it was intoxicating. This was my entire identity, so of course I had to excel.
It felt like healthy competition – until it wasn’t anymore. I was so busy trying to convince myself that I had to be better than everyone else that I lost perspective.
That’s when I realised I was taking pleasure in hearing about my peers’ failures. Like when I’d hear about how someone mismanaged a case (I wouldn’t have done that), struggled with cannulation (fine, I’ll come help), or got yelled at during a consult (wouldn’t happen to me). It turned toxic. It never escalated outwardly – mostly fake-bragging disguised as jokes – but deep down, I knew I meant it. I needed a reality check. And it took one failed LP to knock me off my high horse.
I started reflecting on what I had become. Somewhere along the way, I’d lost sight of what truly mattered: that we were all in the same boat, all struggling to keep afloat. And that’s when I remembered the words of one of my mentors in Cambridge:
“The best doctors are the ones who remain curious and humble throughout their careers.”
Curiosity was never the issue for me. Medicine is a science, and like all sciences, it’s constantly evolving. To stop learning is to give substandard care, to become obsolete, and to drain the joy from the profession. I chose medicine because of the sheer enormity of what there is to know. There’s no way in hell I’d ever stop learning. Humility, though? That was where I was struggling. I’d gone from a self-conscious dork to an overconfident jock in no time, and I knew that had to change.
That one failed LP opened my eyes. It made me realise I wasn’t as infallible as I thought I was. That everyone makes mistakes – including the best doctors. After all, doctors are just human. And the best doctors? They’re not just born – they’re made. Being extraordinary takes time and effort, and it’s about far more than just knowledge.
So I went back to my mentor’s words and let go of the impossibly high standards I’d set for myself and for my colleagues. From then on, my definition of an extraordinary doctor became simple: to be humble and curious.