START OF FY 1
START OF FY I
I could hardly believe that my five years in med school were over. Med school didn’t end with applause or closure – we were still in the midst of the COVID-19 pandemic. It felt like a door had closed behind me without asking if I was ready. I stepped forward anyway.
Before starting this new journey, we had two weeks of downtime to recuperate from the gory warzone that was med school. And let me tell you, it was much needed. The hedonist within me was brought back to life as I indulged in long-forgotten activities – smoking, drinking, one-night stands, pigging out – anything and everything I felt like doing. But hey, I deserved it. I had a two-week pass before we started working, and I wasn’t about to waste it.
Once we’d start working, I knew I’d be returning to an all-consuming routine with no room for such luxuries. So I planned on making the most of it. We couldn’t travel because of the whole COVID thing, but that wasn’t gonna stop us from having fun. Every day was chock-full of activity. From boat parties to late nights out, from sunbathing to lobsterhood to drinking ourselves to liver failure, we did it all. We deserved it.
Once those two weeks were up, I was ready for it all. I still remember my first day as if it were yesterday. This bright, fresh-faced kid walking into the same hospital he had been roaming around for years on end. But somehow, it was different. Now, it wasn’t just somewhere I’d go to learn. No. Now it was somewhere I’d go to put all that I had learned into practice. I’d be saving lives.
As horribly hungover and sunburnt as I was, I felt reinvigorated. Of course, that quickly wore off once we started our induction programme. Another two weeks of unending sessions filled with monotonous, endless talks and meetings that were meant to get us up to speed and all riled up for a lifetime of doctoring. They started off by explaining how it all worked. That we’d work six days a week, and that we’d have a thirty-two-hour shift every six days. That we’d spend two years rotating through various medical and surgical specialties – each lasting three months – which would eventually lead to getting our warrants and starting to specialise. All along, I thought I had conquered Mordor and obtained the ring – turns out, I had just gotten to its base.
And then they kept going on and on. My god, it was so boring. Everyone, from senior physicians to junior doctors alike, had something different to say, which all boiled down to just one thing: “Your life is gonna suck for the next two years, and then it will suck way more.” I could understand where they were coming from, but I couldn’t give less of a crap. This was my dream. My goal. The fact that we’d have to work six days a week? The tiring, draining, exhausting thirty-two-hour shifts? The terrifying acute medical conditions you’d have to manage in the middle of the night on your own? The running around the hospital doing menial, uninspiring stuff? I was looking forward to every single damn thing the job had to offer. And so, I brushed off their warnings and dozed through half of the talks and sexted through the rest.
It wasn’t just meetings that made up induction. We had to pay a visit to HR to sign our contracts (essentially waving goodbye to the idea of a forty-hour work week), collect our pagers (old Alcatel phones belonging to a now-obsolete generation), and get sized for our uniforms (at least these scrubs were as comfy as pyjamas). We were also given a map of the hospital – and though we’d been all over during the previous three years, now I’d actually have to know where to go as I’d be expected to go around on my own during on-call shifts. Turns out, our hospital is way bigger than I had imagined.
That’s how my medical career started. That’s it. It was supposed to be me walking into an operating room with Richard Webber giving me his “This is your arena” speech, while I went on to diagnose something no one would ever have seen coming on my very first day, saving the patient’s life and starting my career with a bang. Yes, yes, I know. I’m not Meredith Grey. But come on. Talk about unglamorous starts.
I’d be starting my first rotation in emergency surgery in two weeks, and boy was I excited. I could already see myself scrubbing in and assisting in theatre, trying to gain as much experience as possible, all the while proving to myself just how passionate I am about surgery.
We were also introduced to the firms we’d be working with. In Malta, hospital firms are based on a hierarchy – much like in any other country. At the top sits the consultant, followed by the resident specialist (RS), the higher specialist trainee (HST), the basic specialist trainee (BST), and then, right at the bottom of the hospital food chain, moi – the foundation doctor (FD) or house officer (HO).
During the two weeks of induction, we were made to shadow the firm’s current house officers, who were tasked with the impossible mission of explaining every single detail to us newbies. From the boring, menial tasks to the life-saving ones.
I guess that’s when I realised that when you’re starting out, there’s a steep learning curve that has very little to do with actual medicine and a lot to do with adhering to bureaucracy, pre-set guidelines, and following your seniors’ instructions to the letter. Medical theory is the last thing you need on your first day as a doctor. You quickly realise that you give up most of your textbook knowledge to make space for administrative lore. And so, you buckle up and try to absorb as much as you can, soaking in every little detail.
Tips and tricks that save your ass – like how to balance fifty patient charts on one arm while keeping up the pace during the ward round, as you simultaneously write notes, book investigations, prescribe meds, and answer your pager in a flurry of chaos. Or knowing which computer logs in faster. Or which printer actually works. Or where and who to call (and, more importantly, who not to call) to get things done efficiently. These kinds of things. Junior doctors are mostly glorified clerks who get to poke and prod patients on occasion – that’s it. They’re not the ones making the big decisions. They just do whatever their seniors dictate.
The same can’t quite be said about on-call shifts. At the strike of 2PM, the hospital practically empties and all that’s left is a skeleton staff that’s mostly made up of a bunch of twenty-year-olds trying to hard to keep people from dying. Scary, right?
While there are still seniors on site whom you can contact if the need arises, you’re still mostly on your own – and that’s how you start becoming a doctor. When the rest of your firm isn’t there to make decisions for you. When a patient with chest pain demands your input. It is during these on-call shifts that slowly but surely, you start integrating what you learned during your five years of med school into practice. Those half-assed hypothetical scenarios focusing on a single presenting complaint suddenly stop making sense, because now you’re dealing with an actual human being – not a system with a fault in it. In practice, you’re forced to look at the bigger picture. You have to. And every single decision has consequences and repercussions – even the simplest, most basic management plan.
As the house officers we were shadowing told us, that’s how all doctors started out. Even so, I can’t say I wasn’t the least bit worried. I’d have two weeks to get as good at this as I possibly could…