Date/Time: 10 February 2009, 0200 hrs.
Location: A forsaken patch of dirt, Pulau Tekong
Person: Tan Chin Yee, 19 years old
I had a rifle in one hand, and an entrenching toola in the other. Both were chafed and bleeding from digging trenches. I had not eaten for five days and not slept in two. My helmet and sweat-drenched uniform robbed me of any modicum of comfort brought by the cool night breeze. I sat at the corner of the half-dug trench and inspected the remaining work to be done, feeling hopeless. I started crying. My buddy Kevin crawled over from his trench, carrying a bottle full of water. He passed it to me, along with half a biscuit. "Eh, give some face and don't die on me please. Just do what we did in training, dig one part at a time, finish strong, book out and eat McDonald's. Before you know it, ORDb lo".
Indeed, I have "ORD-ed" more than a decade ago, but I often think back to this memory. While I was in that trench, nothing mattered aside from getting sleep and a warm meal. Little did I know that one and a half decades later, I would be drinking beer on my balcony, reminiscing about this experience while writing this article on starting housemanship. But what does my experience serving National Service (NS) have anything to do with starting housemanship?
Together with the hundreds of junior doctors who enter the "trenches" each year, I anticipated being drained, misunderstood, hopeless and on the brink of giving up. How then does one prepare for what is to come?
Trust in the training
While preparing for my Doctor of Medicine final examinations, an enduring mantra was to "trust in the training". Even though at times it was hard to see how being able to distinguish between a mid-diastolic and early diastolic murmur would help me become a better doctor in an era when two-dimensional echocardiograms have become de rigueur, I noted that certain "reflexes" kicked in while completing my Student Internship Programme (SIP) postings. It is challenging to succinctly describe "toxic-looking" to a newly minted medical student, but over the years of clinical training, I have gained the ability to mount a sympathetic response commensurate to the patient's severity of illness. I know by instinct to watch the patient's potassium and creatinine levels when starting him/her on angiotensin-converting enzyme inhibitors, even though I can no longer remember where the juxtaglomerular apparatus is (nor how to spell it). Similarly, I hoped that going into housemanship, I could rely on my training (both in medical school and continued learning) to carry the day.
Trench buddies
It is hard to downplay the importance of having good comrades while in the trench. Just as how Kevin crawled over with half a biscuit in my most dire time of need, I hoped for this spirit to continue in housemanship. Indeed, my friend Dr Tang Haoming and I had a taste of it during our general surgery SIP posting. Together with newly minted house officers (HOs) Drs Joycelyn Soo Mun Peng and Tan Shyn Yi, we struggled with the endless admissions and sick inpatients, all while trying to learn how best to use the electronic medical record system. We witnessed firsthand how HOs from other surgical teams came to our aid like how Gandalf showed up with the Rohirrim at the battle of Helm's Deep in The Lord of the Rings. As though by magic, orders were placed, notes were written and patients were discharged – we had just discovered the beauty of "ghosting changes". Eventually, the day ended, with all of us exhausted but not beaten. We thanked our mysterious benefactors and hit the sack. Ultimately, we hoped to do the same for others when Haoming and I began our time as HOs.
One thing at a time, aim to finish strong
Ultimately, the HO year, just like my time in NS, is a finite period. Even though my 19-year-old self saw NS as a never-ending torrent of push-ups, rifle cleaning and digging, that period somehow ended sooner than I expected and turned out to be more enjoyable than I thought it would be. I simply needed to, as Kevin said, keep digging, one part at a time. As someone who occasionally runs, I often mentally break the 5 km run into chunks of 100 metres. I then delude my brain into thinking I am running only 100 metres, and repeat the process 50 times. Analogously, I have seen during my SIP experience how efficient HOs – like Drs Tan Shyn Yi and Joycelyn Soo – list and prioritise things for the day, get into the zone and bang out tasks, one at a time. The days whizzed by quickly because we were in "flow state", and before we even knew it, a month had passed. Similarly, what is the HO year but just three chunks of four one-month intervals?
Taken together, I know instinctively and from experience that the training we received is adequate, the challenges are not insurmountable, the suffering is temporary, and the lessons learnt and friendships made will last a lifetime. I hope only to have the presence of mind to know these whenever I am in the trenches. I am sure that in no time, I will be drinking beer on a balcony in 2040, pontificating with old fellow HOs about how 2024 was all a great, formative experience, and that the new Generation Alpha HOs have no idea what it was like in the "wild 2020s" with no ChatGPT-generated issue lists and Boston Dynamics blood culture-taking robots.
Afterword
I initially penned this article just before I had started my HO year, and as I revisit it now about ten months into housemanship, I am thankful for all the "trench buddies" I have had during my national service as a HO. The time has, as expected, blazed by, and now I am dealing with the trepidation of being a newly minted medical officer. I look forward to welcoming you all incoming HOs into the trenches with me.
Notes
- A digging tool used in the military. Its handle was as rough as sandpaper; good for grip, bad for epidermis.
- Operationally Ready Date. This marks the completion of full-time NS training.