Malta – Week 3: The Tipping Point
MALTA
Week 3: The Tipping Point
June 7 to 13, 2023
PART I
By my third week here in Malta, it felt like I had already settled into my new routine. As I tried to juggle my work as a doctor and a divemaster and everything else in between, I found myself with barely any free time.
With so many things on my plate, the best way I could think of to keep track of all my commitments and goals was to make an Excel sheet. This, it turns out, was a success. Somehow, I was making everything work. I’d work on most days, keep up with my reading and writing, and made time for everything else – biking, catching up with friends, going on dates, and even chilling. Like that, I managed to do everything I had planned. It worked.
But, as I quickly figured out, a new routine is a routine nonetheless. The charm of being a divemaster soon faded as the sheer amount of work involved overshadowed the little diving time I got to enjoy, with most of my time there spent assisting on courses or working at the dive shop. Working in the hospital lived up to my expectations, easing me back into medicine as I did consults and reviews, although it wasn’t quite as fulfilling as I thought it’d be considering I’d spend much of my time doing medicals.
Redundant Stamping
With all their ups and downs, I was already used to both jobs – and that’s when it all hit me. I was once again stuck in a rut. I think it all boiled down to one thing. For months on end, I had been as free and untethered as I had never been before. Now, once again, I was shackled and bound by everything I had come to renounce – commitments, bureaucracy, schedules. The feeling of liberty I’d feel when running straight out into the sea or when trekking alone up a mountain – gone, vanished.
I wondered… Would I be able to ever feel that sort of freedom here in Malta? Would I be able to feel as alive as I did whilst travelling here? The way I saw it, I had only two things tethering me here – my love for medicine and my lack of money. The rest, I could easily do without. But, with that being my reality, I had to face the facts and try to make the most of this one. I did my best trying to incorporate all that I had learnt throughout the past year into my everyday life, but that too didn’t seem like it’d be enough.
I mean yeah, sure, I didn’t do everything I’d set out to do – like hiking (too hot) or water sports (too expensive) or music (too little time), and I wanted to pace myself, having a history of taking too much on my plate and overwhelming myself so much that I end up bailing on everything. But I wasn’t overwhelmed, despite my schedule being chock-full. I wasn’t overwhelmed. I was just… bored and feeling stuck. It took me just two weeks to get to that place. The idea of starting my specialisation and going back to the same lifestyle I had before my trip seemed all too possible now. I had implemented changes in my life but these too quickly became the new norm. And normal just doesn’t cut it for me. So what the hell is the solution? How the hell could I be free in my everyday life?
It was during this time that I went on my first solo bike ride out on the open road. Riding on my bike with the wind in my face as I’d gather speed down a steep slope, I found myself feeling that same freedom I used to experience when I’d be alone on a beach running straight out into the sea or when climbing a mountain on my own. Somehow, against all odds, I had found a way to feel that same freedom all the way here. Not to mention, it felt like I was somewhat rediscovering my country. Of course, I’d be doing short circuits around my hometown at first, but right from that very first ride, I could tell this was gonna be yet another passion!
To add to the list, I also started doing some yoga. Whilst my room didn’t exactly have the same backdrop as the one at Eagle’s Nest in Lake Atitlán, I could just picture it when I’d close my eyes and start doing those crazy body contortions. The first time I gave it a go, I remember lying flat on my back during Shavasana when all of a sudden I felt this sudden surge of emotions. I started bawling my eyes out – an equal mix of post-exercise feel-good factor and this rush of nostalgia as I looked back on my first time doing such poses. How very Eat, Pray, Love of me, huh?
Perhaps this was the solution. Maybe, just maybe, it’s these things that make life worth living when stuck on a tiny island. Doing new things, breaking boundaries, pushing yourself to the limits.
PART II
The Accident and Emergency Tipping Point
Adding on to my newfound existential crisis was another one that had been building up over the past year. I had one thing pending with regards to my career progression – the emergency medicine job interview.
For months on end I had been struggling with the choice between surgery and emergency medicine. The first hoop I had to jump through was my surgery job interview – now it was time for the second one. I walked into the AE department all suited up expecting the unexpectable. Once again, I found myself completely at ease, in the presence of two other jittery doctors on the verge of a complete nervous breakdown. Even more reassuring than the fact that practically everyone gets accepted for this training position given the astounding lack of staff, was the fact that my ex-colleagues seemed over the moon as they saw me walking in. I was greeted by seniors and peers alike as I had triumphantly returned after a year away, ready to join their leagues (or not).
Still undecided on which specialty to choose, this might have just been the tipping point. The surgical department is known to be quite the toxic one, with the stereotypical arrogant and jackass surgeons thinking they’re at the top of the hospital’s food chain, their egos taking the best of them on many an occasion. Here at AE, it seemed like everyone was working hard to keep a sinking ship afloat – the sheer workload and intense conditions building this sort of camaraderie between everyone.
The Long-Awaited Interview
This time round, I was the first candidate to be called in, the interviewers being my ex-bosses. With a gleaming smile on their faces they welcomed me to the room and offered me a seat. We went over my resume and then proceeded to discuss a case, which, I think, went well.
Then I was asked a couple of stupid questions about teamwork (again) by a guy from HR, and then the usual question – “Why emergency?”. Well, I’m not one to beat around the bush. Had they asked me that same question a year previously, I would’ve had to lie through my teeth and tell them it had always been my first choice whilst making up some random inspirational crap for them to accept me and just like that, I’d have a back-up just in case I wouldn’t get into the surgical programme.
Now? Now I had to tell them that after having worked in that department, I not only felt right at home, but came to love the actual work – the variety of cases and the fast-paced approach complementing my persona. I didn’t mention the fact I’d want to specialise in expedition medicine further on – for them, that would’ve meant they’d spend years training someone who’d just up and leave after all that would be over. With the head of department telling me he’d be looking forward to having me on the team, it felt like I had been practically offered the job right on the spot.
Of course, that still kinda meant nothing. First of all, that wasn’t a guarantee. Second, I was still unsure about my choice. But, worst of all, after this interview, I was as uncertain as ever with regards to my future prospects. God knows how many times I had listed both specialties’ pros and cons over the previous year, but somehow, it felt like I had made little progress and achieved nothing when it came to making this decision.
Ideals, Egos, and the Gut Feeling
I brought it up to my closest friends, asking for their advice. It was mostly the same things I had been ruminating on, though some of their perspectives were quite elucidating. Some were shocked at me suddenly changing my mind, having always been so resolute in my pursuit of becoming a surgeon.
I for one didn’t want to let this affect my decision. I owed myself the opportunity to change my mind if I wanted to. Hell, not doing so would mean refuting a year’s worth of growth and self-discovery. Some cautioned me that if I were to reject the surgical position, I’d be closing that door once and for all, given that it was my first choice and that by choosing the second I’d practically be spitting in their face. Of course, I could always reapply there and hope for the best or take my chances elsewhere if I did do that. Some thought I was having what most would call a quarter-life crisis – with the wanderlust and sense of exploration and adrenaline still clouding my mind. I’d probably find it hard to go back to any kind of work after a year off, they intimated. Well, working was the only thing keeping me sane ever since I had arrived back home.
All this did nothing but screw with my head even more. There was, however, one perspective that differed from the rest. If I were to be accepted for both job positions, I’d probably know which one I’d want to accept right away. With that moment being months away, I’d still have some time to mull it over. That said, I had been acting on my gut feelings for the better part of my life, and, on most occasions, they haven’t let me down. And my gut feeling at that moment was pushing me to one side – emergency medicine.
Emergency Medicine VS Surgery: One Last Showdown
Right there and then, I could kinda picture what the rest of my life would look like. I’d start my training at the AE department. I’d probably be a bit overwhelmed at the beginning – having to get used to the system all over whilst taking up more responsibilities than ever before.
- Choosing emergency medicine: I’d miss the OR and probably have some FOMO as my surgeon friends would discuss their intricate operations over drinks, but hey, I’d have my own cool stories to tell. Over the years, not only would I make a family out of the colleagues I already get on with so well, but I’d also start excelling at this new job, working hard to focus on my real goal – that of expedition medicine. It’d be a few years of tough work, but after that, I’d get to practice medicine wherever I’d want – be it on a mission with MSF, on a cruise ship to Antarctica, in a dive shop in the Caribbean, or in a remote community in the Amazon. The world would literally be at my feet.
Perhaps a bit too idealistic, maybe a bit far-fetched – that said, up until a few years ago I was sitting here writing the same thing about becoming a doctor or leaving on a solo trip around the world and look where I am now. On occasion, I’d look back and wonder whether I would’ve even had what it takes to become a surgeon – especially when I’d wheel a patient out of AE into a different ward where definitive management would be taken care of by specialists, or when I’d be too overwhelmed by all the travelling and moving around. Add onto that the impact it would have on my mental health and it wouldn’t be all roses either.
- Choosing surgery: Then there was also the life I’d be leaving behind. Were I to become a surgeon, I’d start off on the same path; overworked and overburdened, only more so given the longer hours. I’d belong to the hospital, with seventy-hour weeks being the new norm – goodbye freedom and goodbye putting myself first. Of course, that wouldn’t matter, because the little time I’d spend in the OR would make up for it, not to mention that I’d be working towards achieving a lifelong goal. Plus, there are some surgeons who seem to make it work and have it all.
After many, many years of hard work, I’d become a neurosurgeon (being equally idealistic about my potential). I’d probably be making heaps of money and work in a state-of-the-art, high-end hospital whilst practicing the very same thing I’m most passionate about. But would I be happy? Would I be happy confined in a hospital when there’s so much to see and do out there in the open world? Being a neurosurgeon wouldn’t open as many doors as emergency medicine would, with my niche being limited when it comes to practicing in remote areas. Would I be happy with travelling every once in a while, in short bursts rather than for longer periods of time?
I don’t know whether these lives I’d envisioned for myself were biased given that the former is by far more compatible with the lifestyle I had led over the previous year. All I can say is, I had changed. My old ‘happiness is for the mediocre’ mantra was now obsolete. I’d experienced happiness and now I wanted more of it. Before, I used to think that anyone can be happy, but only a few people can strive for excellence. It was all about that for the better part of my life. Happiness was not something I quite valued.
But now? Now it suddenly mattered. And the best part is, happiness and excellence don’t have to be mutually exclusive. I don’t envision myself as becoming this sloppy expedition medic who just does it to earn a living and travel all around. I wanna do it for the very same reasons I aspired to become a doctor – to learn more about medicine, to connect with people, to make a difference. On the other hand, as a surgeon I think I’d have to give up one for the other. I don’t think I can be happy giving up that part of me which makes me feel alive.
So I guess I had made up my mind after all. That said, I was still full of doubts. I expected to feel this weight lifting off my chest the minute I’d decide, like it usually does when I decide to follow my gut. But this time round, it didn’t. I knew what I stood to lose and it wouldn’t come without a price. I’d just have to go along with it and give it some time to sink in.
PART III
Stabilising the Downward Spiral
The rest of the week was quite weird. Mostly cause by the end of it, I was kinda okay with my routine and kinda okay with the fact that my future still looked cloudy at best.
I think part of what made me want out so bad was all the stress that had been accumulating without my knowing. And, little by little, things started to fall into place as I realised I was headed on another downward spiral. My game plan for the week:
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First off, I had a candid conversation with Maria about my job as a divemaster. I told her I was spreading myself too thin and that I wasn’t getting enough dive time – the very reason I had signed up for this. I agreed to work there once a week, thus staying within the system and ensuring I’d get to dive at least once a week.
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Then I was given different duties at the hospital – mainly going around different long-term care facilities to review patients and do ward rounds. This made me feel like I was a doctor once again, reminding me of the job I used to excel at. Having actual patients under my care gave me this sense of fulfilment unlike any other I had felt in ages.
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Also, I had no idea how much of a toll Momma Bear’s cancer scare had taken on me. Ever since she had received the first batch of results, she had done her best to rush the remaining investigations, which, thankfully, all seemed to point towards her having a benign tumour. Of course, she’d still have to go through surgery – with her fertility still in question – but at least she seemed to be out of the woods.
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Finally, I made sure to secure some time for myself. I’d have more free time to do whatever the hell I’d want – be it reading or writing, doing yoga, biking, hiking, going on cultural visits, and even taking up new hobbies if I wanted to.
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By the end, I felt reinvigorated – excited to be making the best use of my time. I was still unconvinced with regards to my career prospects, sure, but at least everything else seemed to be going well. I’d have a few weeks or months to think about that.