"By leaving your comfort zone behind and taking a leap of faith into something new, you find out who you are truly capable of becoming." – Anonymous
I have always considered myself as somewhat of a risk-taker and overcomer, not shying away from the challenges life threw at me and savouring the feeling of accomplishment after completing a hard task. But leaving safe, comfortable Singapore for a Health Manpower Development Plan (HMDP) in Columbia University Medical Centre amid a global pandemic was hands down one of the biggest and toughest decisions in my life.
Getting through the uncertainty
The decision was fraught with obstacles from the very start. I spent 2019 flying back and forth between Singapore and the US within the space of three months to take the United States Medical Licensing Examinations and interview, and thankfully secured a fellowship set to start in July 2020. The first quarter of 2020 was spent buried under paperwork for visa and administrative matters for the fellowship, but the thrill of starting something new made even the most mundane tasks bearable. Then, all my plans started to fall apart as news of COVID-19 started to break out. Amid the COVID-19 wave that swept the US in 2020, the Ministry of Health (MOH) postponed my fellowship until further notice, while at the same time recalling those who were already abroad on their HMDP back to Singapore.
The uncertainty hanging over my fellowship plans only grew in the ensuing months. The fellowship was postponed again when January 2021 came. With New York chasing me for a target start date (as there were other candidates on the waiting list eyeing my spot) while still unsure of whether I could go in 2021, I decided to inform them to secure my place for July 2021 after discussing with my department head, and proceeded with my paperwork while praying for the best. There was no news up till one month before the intended start date of the fellowship, when MOH finally gave me the green light. My departure in June was unfortunately an untimely one as Singapore's COVID-19 cases started to pick up in May – I felt apologetic leaving my colleagues who were managing a heavier workload. Due to tighter safe-distancing measures during that period, I was not able to bid a proper farewell to my colleagues and bosses over a nice meal together.
A new environment
I arrived in New York just when the city was starting to recover from the initial wave of the pandemic. Measures remained tight – to gain entrance to the hospital, one had to go through swab tests, show proof of vaccination and undergo mask-fitting sessions.
The aftermath of the pandemic hit closer to home as the catheterisation (cath) lab was short staffed due to the deaths of several nurses from COVID-19. Almost one out of five colleagues I spoke with had previous COVID-19 infections and many had lost their loved ones to it.
Hearing the accounts of the cath lab staff being posted out of their comfort zones to run COVID-19 wards, and the fear and insecurity of being in wards out of their areas of expertise reminded me of how grateful I should have been for the better situation in Singapore. Back home, we were split into "hot" and "cold" teams while rotating through the National Centre for Infectious Diseases and it was very organised and under strong leadership, despite the fluid COVID-19 situation.
Being in a different country with a new hospital system and cath lab, as well as different equipment and ways of doing things, was a huge challenge to me personally. I immediately lost confidence, even in the very basic steps which I used to be able to do in the blink of an eye. I had to work my way up again from the bottom, adjusting to new equipment and systems, and learning new ways of doing things from my mentors. I now understand the importance of doing an HMDP – not only do I learn the knowledge and skills in my field, but it is also a really humbling experience which brings out the survival skills I never thought I had, and it broadens my perspective in seeing things – at the hospital level, and in procedural and even cultural aspects.
Work life is also more eventful in New York. As COVID-19 vaccine mandates kicked in, quite a large number of staff who chose not to get vaccinated (on non-medical grounds) were forced to quit. Leading up to the retrenchments, they were holding protests daily during lunch time outside the hospital building. Even up till now, we are short staffed and still in the midst of hiring new staff who are undergoing training in their new job.
HMDP takeaways
A change in scenery has indeed been refreshing – catching Broadway musicals, taking short domestic trips to other states like Washington and Florida, and checking out New York's food scene have been great experiences after being grounded in Singapore throughout the pandemic. On the other hand, living in upper Manhattan (nearby Harlem) comes with its risks – the crime rate has risen during the pandemic and notifications of crimes or shooting cases in the neighbourhood are not rare. The hospital has a night escort service for staff which I've utilised frequently despite living a stone's throw away from the hospital.
Now that I'm at my halfway mark of the HDMP, I have settled in more comfortably and am starting to enjoy working with my new colleagues. I feel a great sense of privilege to learn from my supervisors, Dr Jeffrey Moses and Dr Ajay Kirtane – both leaders in their field – and work with them on complex cases as a team. Besides just focusing on procedural skills, learning their thought processes and reasoning is also proving to be very valuable for me. In the short span of six months so far, it has been a fruitful experience: I have participated in recruiting patients for trials that are potentially practice-changing in the interventional cardiology field, and in a live case in a major conference; wrote an editorial in a renowned journal; and was interviewed live during a discussion of a complex case.
As an advanced fellow, I was also given a supervisory role, scrubbing in together and guiding the junior fellows. This was not what I had expected to take on, but I realised that learning to be a good tutor is as equally important as honing my own skills. I observed that the teaching system in the US is systematic with more hand-holding, as compared to the Asian style of learning via apprenticeship. I hope to bring back to Singapore some of the good teaching practices I have learnt in the US to benefit the next generation of doctors.
Was the HDMP worth it, you ask? Although it was not all what I expected it to be, leaving my comfort zone and placing myself in a whole new environment has made me realise what I can be capable of. I find myself growing as a cardiologist, but also as a person open to new perspectives and cultures, and I am certain this is an experience I would truly value in years to come.