“A patient’s gratitude is my greatest encouragement,” says Dr. Allan LUI, who completed his internship in June this year. Dr. Anson CHAN, who started her internship in July, nods in agreement: “I try to remember every patient. I usually greet them by name and wish them good morning during my rounds. Seeing their cheerful response is very satisfying.”
As a new houseman, Dr. CHAN is very grateful that she was able to join the coveted surgical division at the outset. “There are a large number of patients to deal with, so I am very busy. Every day, I visit the ward once by myself and then go on rounds with the consultant doctor. After that, I help prescribe medication and according to the consultant doctor’s instructions, arrange for patients to undergo computer diagnostic imaging, X-ray or other tests. Sometimes, I need to draw blood, set up drips and suture small wounds.”
Dr. LUI, who hopes to be an oncologist in the future, jokes: “When I was a houseman, I sometimes felt like a senior clerk because I often had to focus on the computer system to follow up on the consultant doctor’s orders.”
“The working hours are indeed very long, at least 80 to 100 hours a week,” Dr. LUI says. “Our on-call days are especially intense. I’ve worked continuously for more than 36 hours.” Dr. CHAN adds: “Usually every three to five days, we get a ‘call’. For example, we might start work at 7 am on the first day and be called immediately afterwards. On busy days, there is no time to sleep; we might have to work until 7 or 8 pm the next night.”
While they may recount their schedule matter-of-factly, to the average person, it could resemble the training schedule for the Ironman challenge. Both of them, however, emphasise that their passion for what they do overrides the long working hours and onerous duties.
Dr. LUI shares that setting priorities was particularly important during his internship. “Often, there are multiple patients who need to be dealt with simultaneously. The only feasible option is to deal with the seriously ill and life-threatening cases first.”
Dr. CHAN recounted an unforgettable experience. “On one very busy night, as I was looking forward to having a meal because I hadn’t eaten until midnight, a nurse reported that an elderly woman with cognitive impairment had recovered quickly following a sudden slight drop in her blood oxygen level. Despite starving, I decided not to eat but examine the woman first. I then discovered she was having a heart attack. I learnt from the case that even if a patient’s blood oxygen level goes up soon after a drop, the underlying problem might be more serious. Fortunately, I had decided to skip that meal!”
The two fledgling doctors repeatedly stressed the importance of establishing a good relationship with patients.
“Some patients once said that seeing my smile helped them relax,” Dr. LUI recalls: “In response to the COVID-19 pandemic, public hospitals are not allowing patients to have visitors, but sometimes exceptions are made because oncology patients can take a sudden turn for the worse. Therefore, we must be empathic towards the family.”
Dr. CHAN likens herself to a sponge which absorbs information and experience because practicum is completely different from theoretical studies. “Patients come from diverse backgrounds and therefore need to be managed appropriately. We can’t just go by the book when it comes to diagnosis and treatment.”
Dr. LUI wholeheartedly agrees: “By dealing with different diseases directly and interacting with each patient, one can learn more effectively than in the classroom.”
The most important lesson he has learnt is deciding between optimising treatment for cure or for comfort. “I had a patient whose cholangiocarcinoma had spread throughout the body and she was severely jaundiced due to biliary obstruction. She also had intra-abdominal abscesses and was extremely weak. The aggressive treatment option providing her with the highest chance of survival was an invasive procedure. Ultimately, after discussing with the attending doctor, the patient’s family decided they didn’t want to prolong her suffering from a progressive, incurable disease.” Dr. LUI is still moved by how the patient’s son grasped his mother’s hand to comfort her in her final hours. It was a poignant, bittersweet moment for all present that day, he adds.
Asked about where she envisages herself after the internship, Dr. CHAN says, “Before talking about what I gained from the experience, I want to talk about what I can give. I hope to be a competent houseman who follows instructions, works well with everyone and helps reduce the burden of attending doctors.”
Having completed his internship, Dr. LUI is heading to the University of Cambridge for a doctoral degree. He says he plans to return to Hong Kong after his PhD and become a clinician-scientist. “I like connecting with and treating patients, but I also love doing research, so I hope to do both!”
It is clear from their experiences that both Dr. CHAN and Dr. LUI are highly motivated and intend to channel their enthusiasm, care and professionalism into practising medicine at the highest level.