Letter 416: Reflections

Working in the psych ward, I've always maintained that if I weren't a doctor, I'd be a scriptwriter earning megabucks in Hollywood. The stories you hear! The characters you meet! The drama in the ward! I could just see myself writing out a film script based on my experiences here over the last 10 weeks :P

I could tell you many a funny encounter, like the eccentrically entertaining Blue Man who, sadly for me, was discharged yesterday, or encounters with characters so delusional that it's sometimes easier for us to play along with them in their own loopy world ("Oh, so you're a hobbit? Really? What do you eat?" *Feigns look of amusement*).

Then there are heartrending stories that end in circumstances you'd never imagine. One such story is a story about a patient whom I've had the pleasure of looking after since the start of my rotation in psychiatry. He's just been discharged today-- 10 days before the end of my rotation. Thus he's been practically under my care since, like, day 1. And truth of the matter is, we never anticipated there would be a day like this for him.

You see, his story is a complicated one. He had actually been in hospital for almost 8 months before he was finally discharged. He had been in 2 different hospitals prior to being transferred to where I was working. When he first came to us, we were quite perplexed by his presentation. Leafing through old notes, gathering collaterals, soughting input from different professors, and discussing the case with my consultant were what kept me occupied for the most part of my rotation, especially during the initial stages of his stay here. Playing sleuth was one thing; solving the mystery, another.

It is an uncontested truth that some things in medicine may remain a mystery forever. Over the last few months as an intern, I have come to grasp this truth more firmly than before. This patient of mine was certainly a diagnostic conundrum, and till now, I can honestly tell you that we never had a conclusive diagnosis for him. Nevertheless, he settled well on his medication regime (which had been modified numerous times ever since he got admitted last year), and responded relatively decently to a few zaps of electricity to the brain. Ooh, the wonders of electroconvulsive therapy!

Over time, he emerged as a pleasant chap whose promising young life was, tragically, complicated by his parents' divorce and his mother's subsequent move to the Pearl of the Orient, as well as the emergence of his mental illness. He was only a year younger than I. Interestingly, he took up Chinese lessons in uni, and, one day, when I gathered he was less muddled by the effects of the ECT, I took the liberty of testing his Chinese, and found out that he could still converse adequately in a smidgen of tainted Mandarin. He even showed me an exercise book filled with Chinese characters he'd learnt. How those rigid strokes reminded me of the way we used to write when we were in primary school! And certainly, the way he behaved sometimes reminded us so much about a primary school kid, if not someone younger. Nonetheless we believed that this was his usual self, and though he may have seemed somewhat immature, he was overall a sweet lad whose ultimate goal is to fly to Hong Kong to look for his mother (can you picture a scene unfolding in Tsim Sha Tsui whereby a young backpacking gwai loh searches his tattered address book for his mother's whereabouts on Nathan Road, and asking the ah paks for directions to her place? Yep. Cinematic.)

In psychiatry, as most patients tend to require longer hospital stay, one tends to grow fond of some patients from a distance-- or rather, fond of the little delights that they bring to the ward unknowingly. Each patient has their unique quirkiness, such as the guy with "caffeineism" who puts EIGHT HEAPED TABLESPOONS of instant coffee and concocts a concentrated elixir of caffeine with minimal amount of water, and who carries his concoction wherever he goes but walks with such exaggerated arm swings that he leaves trails of coffee drops behind him! When he leaves, I suspect we would miss the fun of locating his whereabouts by tracing his coffee trail :>

So it was with this long-term patient of mine that I felt a bit disappointed to see him go too, just like how I was crushed when the Blue Man was discharged (oh he was a classic indeed! And perhaps one day, I shall unfold the Story of the Blue Man-- co-starring Skippy the Kangaroo). Though having said that, I could never have been happier to see him leave. It's a rewarding experience, as a doctor, to see your patients improve, and even though the course of mental illness is difficult to gauge at times (ie never knowing if they've actually been thoroughly "cured"-- hence using the term "improve" in place of "cure"), I firmly believe that if we spent enough time with patients, have a little optimism, and put a little faith in them, they may be on the speedway to recovery. Then again, I'm always a little optimistic when it comes to my patients haha.

Oh and guess what? Before he left the ward, he actually came up to me and shyly asked me out on a date! I was flattered and pleasantly disturbed, to say the least, but of course I said no lah and told him to focus on getting himself better, though his reasoning of "I wanna ask you out because I think you're beautiful on the outside, and also beautiful on the inside" will forever serve as a reminder that being a doctor is an honor, a passion, a calling, and not merely a job.

On a side note, this is why doctors should also treat nurses as human beings and not merely someone to yell at. Thank you Lisa for your homemade galaktoboureko! Dang I still owe you a drink at the pub!

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