Part 1: Why do people choose to end their lives?

It's my (one day of the week) off. Let me tell you about the day I had yesterday, expectation vs reality style.

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Expectation

I sleep in, wake up, order in some breakfast and coffee, do my dishes, take my trash out, put away my laundry... You know, essential tidying of the space I live in in hopes that the organization, calm, and clarity manifests in my inner mental state, an otherwise chaotic cesspool of clutter. Then, I study the topic 'Acute Coronary Syndrome' as best I can, ask my colleague if any of their patients are sufferers of it, and of course there are. There always are.

I wear a tight black t-shirt, and wrap the white and blue print circle skirt around my waist. An outfit to signify "It's my day off, I am not working, so don't you dare ask me to do anything."

I go to the hospital, meet my patient, tell them I want to ask them questions about their heart attack, and that I am going to have my final assessment today. They agree, we have a nice long chat, I take notes, and feel warm and fuzzy inside from our interaction, thinking, "Hey, maybe I could actually do this doctor thing after all." Then, I meet my mentor, present my case, answer their many questions, and pass with flying colours.

Okay, honestly, not even in my fantastical expectations did I expect to "pass with flying colours". I anticipated a struggle, given the nature of my mentor, notorious for their ten thousand questions and temperament. But I did expect to pass, having chosen a simple case any respectable house officer ought to know how to handle, and having reason to believe that my hour long chat with the patient led me to a satisfactory point to be assessed. They would stamp the last empty page of my logbook, then I would fill out my leave forms, and submit the bundle to the physician in charge of house officers, meeting the submission deadline of two weeks prior to our End of Posting (EOP).

I go home, pack my stuff, weather tolerable traffic on my drive into the city while listening to Glorious by Macklemore, meet my partner, we crack open our beers, and drink to celebrate that with just one more week of work, and another of a much needed vacation, I would be officially one thirds through the madness that is Housemanship.

If only life were so kind...

Reality

Do you know what had happened instead? Up until the point I met my mentor, everything went according to plan. But then they asked me to take a complete history from the patient, and examine them. For context, when I attempted to have my assessment with them yesterday, I ended up choosing a very advanced case that wasn't suitable for house officers. They gave me a second chance, and asked me to choose a simple case, make some notes, and we could do the assessment the next day. "On my day off?!" I thought, but screw it, I wanted to get this over and done with. They also told me it did not matter if the patient was already discharged, as long as we could have a discussion about the topic, diagnosis, management etc.

I acted in accordance. The patient was a genuine treasure, answering the questions I had asked earlier all over again, just like rehearsals. The experience was bizarre. If you have a clinical examination, you're not meant to have had a go at it before hand, because it's ingenuine. The idea is to assess how I go from meeting to treating the patient, and you shouldn't be able to fake that encounter. After the charade ended, we proceeded to the on-call room, and they asked question after question, testing my knowledge. It was a question about typical chest pain, for crying out loud, but their antagonistic tone was starting to throw me off. "Don't switch back and forth between English and Malay, just stick to one language. Be  professional," they retorted when I quoted the words my patient used to describe their symptoms. "Weird," I thought to myself. I didn't realise I was here to have my language skills assessed, and whatever language we both understood that effectively communicated my point should have been sufficient. But hey, whatever, I'm at their mercy now right? I chose English.

They pressed on on what clues the patient gave away that suggested that their diagnosis was an unstable angina. I tripped, and fumbled, but eventually got to what they wanted to hear. "Unstable angina is when blah blah pain occurs, which this patient clearly describes themselves as having experienced". Risk factors? Got it, I started rattling on their risk factors, until they cut me short. "I didn't hear you ask the patient any questions about their comorbid diseases, where they follow up, or their compliance to medication," to which I responded, "Oh, that's because I spoke to the patient for a good while earlier, and I must have missed some questions the second time around." I was nonchalant, but not flippant. This was not what I was under the impression was going to happen today.

"Okay, in that case, you can just fill out your own logbook since you've done everything before. I can't assess you." Then they got up, and left the room.

Before the door closed on itself, I could feel my face heat up like a deep fryer, and my eyes welling up with tears of frustrations I barely have the words to describe. I sat there for what felt like a long time, before someone entered the room, and I awkwardly left. Suffice it to say, I had a breakdown in the middle of the hospital hallway. I sat on one of those benches outside the wards that you'd usually find anxious families on, buried my face in my hands, and felt the weight of every negative thought I had come bearing down on me. My breath quickened and deepened, and I just wanted to run as far and fast as I could away from this life.

In that moment, I thought about the house officer from Penang General Hospital that jumped to their death from their apartment building just three weeks into Housemanship, and wondered if this was why they did it. Did someone discount all their efforts, and in a nutshell tell them that they're not even worth being assessed? Did they lose hope in everything that they were working towards? Did they just want to give it all up, and turn their back on life once and for all?

In that moment, I didn't know what I was going to do.

[To be continued]