Changes

One of the peculiarities of the singaporean healthcare system is the "black tag". Scaling the rungs of the responsibilitity-ladder earns you a nondescript black name badge that looks suspiciously similar to the low-cost primary school "monitor" tags we used to get as kids. People invariably wear them, it's a sort-of status-symbol cum insignia of "rank" - donning the tag confers on the wearer some form of intangible power which most patients and relatives probably don't know - much less care - about, but which identifies you to another doctor as a "senior" doctor.

The irony is that the nametags for junior doctors are actually kind of nice - sure, the hospital logo tends to rub off over time, but it's actually aesthetically quite appealing.

I've been watching one of my colleagues making the switch to his black tag with a little amusement; shortly after passing his surgical exam he - in typical fashion for him - took to wearing his new badge (almost with... wild abandon...) after his previous badge ostensibly "went missing" in his bosses car. Nevermind that he's wearing the trappings without having to don the associated mantle of responsibility of registrarship... the tag makes him happy, and well, we all share his happiness at taking that step towards the rest of his life. We all know how proud he is of, well, himself. :)

I've been slowly suffocating over the past fortnight after abruptly turning into the registrar-in-lieu for my team, our previous registrar having taken the opportunity to scamper for freedom once I swapped into her team. I don't begrudge her her holiday - I've been doing this a mere fortnight and I'm nearly running on empty... I can't begin to imagine how tired she must be after six months on the job... and I knew what I was in for when I decided to commit my life to my subspecialty. Still... the body is tired, the joints actually hurt (gee) and my back is aching... it's all somatisation I know, all in my head. But staying back till eleven in the evening post-call to chop off bits of my patients because there's nobody else who can do it, and because if I wait too long they're going to die... dozing off multiple times on the drive home... it's sobering.

I'm loth to put on my black tag. I'm not "official" yet, I'm still me. And I'm still weak; I want what little time I have left to zone-out before all this becomes all too real (as it is... right now...) and I can't wait for my reg to come back from her holiday... It's exciting to be handed that instrument that till-now only the consultant would wield intra-op and be told to go ahead and throw that stitch, and it's rewarding to see that anastomosis hold-up. It's.... a little frightening to be told to carry-on without senior support in ops which I've only ever watched or been brought-through once or twice before, but never actually flown solo in... and really rewarding to throw that final stitch and know that my patient ought to be just-fine. And it's humbling to be confronted with a retroperitoneal, retrocaecal appendix and be caught in a dilemma -- to play the registrar you're not-quite-yet and open the retroperitoneum -- or to call for senior support because if anything goes wrong you're still technically a junior - and realise that you're really not all that brave after all.

I guess I'm different from The Gentleman. I'll wear my blocky black tag when I have to - when I'm taking my team on the round when maybe, just maybe it makes that much of a difference when I'm doing battle with that nice old irish man's ex-SPG battleaxe of a wife who's inconsiderately called me out of operating theater just so she can try to browbeat me into keeping him in hospital - against medical advice and against his own wishes - because she needs time to formulate a concerted campaign in her quest to lodge a complaint about the ward nurses. But in between, well, I really like my old tag, and I still like cutting out little tiny skin lumps and creating cosmetically pleasing scars in the quiet sanctitude of the day-surgery OT making small talk with my nurses and patients.