Internship Diary (Part 1: The Very First Day)

The very first shift as "doctor", on her own

A clinic with just three beds for "emergency" cases. A working EKG is a blessing. Ketorolac is a friend. A mortar and pestle sitting in a room, sending me back to 1800s to the day when I was a witch.

A lady in her 60's came with the complaint of being unable to urinate, distended abdomen, severe abdominal pain, patient could not walk for a week. Oh God what should I do?? Called my supervisor, SBAR (situation, background, assessment, recommendation) was nowhere inside my head, panicking (lol). Maybe the patient had ?stroke. Was told to put a catheter. Omg how come I not know. Trying to put a catheter on, finding the urethra was like finding my will to live (somewhere, but somehow seems inexistent). Catheter was put, patient felt better, sent her home only to almost have a heart attack the moment I realised that the patient could have a spinal cord injury - should be referred for a further work up. 

Embarassing. Disappointment. I'd let the government take 1000 social credits (if possible) from me. Mind you, I did a fair share of studying spinal cord pathologies as a neurosurgery elective student. God really tells me to humble down.

New three patients came, panicking, crying, screaming (the patients, not me - though i was so close to joining them). Motorcycle accident involving adolescents, three kids on a motorcycle, driver kid was wounded (you'd meet like at least 10 motorcycle accidents in a week if you live in Lombok). Lacerations -  I love skin suturing but something about the lidocaine is completely sus - sorry kid.* 

First shift I already had to pull out my debate skill from junior high, this time to use it to tell patients to bring their kid with suspicion of fracture to be sent to the hospital. They refused, not sure what they'll do. High chance it's shaman - my school prepared me for this but I didn't have time to do the textbook checklists and decided to just jump to refusal consent and let them home.

Fly high, little angel

A lady called us to come outside saying it's an emergency. Ran to the lobby with a bed, saw a pickup car with more than 5 people in the back, the driver pulled out a kid, unconscious and he put it on the bed. Blood was slowly flowing from the ear and the nose. Kid was as pale as a ghost. No pulse, no breathing - should start CPR. I hinted on a colleague to activate the code blue, everybody else was hesitating.** Pupils were no longer responding. Pronounced the time of death. Cleaned him and did an exam to find out that his hard palate (roof of mouth) is broken to pieces. Very very high suspicion to what we called 'basal skull fracture' - where the floor of your brain broke and everything else that should be contained within it got all messed up. With the facilities available, the lengthy process of referral, it is to no surprise that he did not make it.

Tried to ask the crowd, calmly, what happened. One lady said they found him on the side of the road, then the nurse asked in the local language, they changed the story again saying that the saw the kid was being hit by a car that they don't know - somehow the story changed again that he got hit because he was running around on the road.

None of them was the mother. The mother came not too long after, crying on the floor. I don't know if I will ever be able to answer this but... how do you tell a mother that her baby will not wake up from their last sleep? and that this was not a bad dream? She handed me the family card and it's just her and the kid, it's just two of them together, i don't know for how long.

The next day I got the news that the kid already went out of the road, but the driver was a first-timer in driving. Rest in peace little angel.

*Also wanted to disclose something about sterility but let's not (at least for this time)

**Many places still consider CPR to be "taboo" meaning that if you do it without consent, Indonesians still find it that the CPR might be the cause of the death and they'd sue you, for trying to save them, just because how uneducated we can be, even the roots (so yes, you could still get in trouble even when it's obvious you're doing your job just because the people demanded to the authorities and the authorities aren't very much educated people themselves.

Being a doctor, so far

24 May 2025

I've been thinking to myself, that maybe, I'll quit working as a doctor. Maybe not soon but I can feel that it'll happen at some point in my life, but maybe not - so who knows.

Has it ever been a 'true calling?'. Not really, I will be honest with you though medicine has always been interesting. It's a very complex science about humans' bodies and everything surrounding it. In its truest sense, medicine is not as complicated - you eat well, socialise well, get enough rest and accept the fact that we cannot deny ageing and everything will be fine. But that is not the case for most of us - the environment we live in has been intoxicated with pollutants, we've grown to be lazy as a result of the advancement of technology that equips a body of machinery with wheels sending us anywhere we wanna go,  and our genetic somehow betrays ourselves by gaslighting our cells into thinking something's wrong when there isn't. 

Most of them, unfortunately, are the consequences of our own actions or at least, collective actions of our previous ancestors.

I have always loved reading complex cases since I were young, my birthday gift when I turned 16 was an album of complex surgeries, I collected books and familiarised myself with a complex concept of addiction since my adolescence. The concept of apoptosis intrigued me in high school and my favourite book to read at home when I was 5 years old was "Dokter di rumah Anda - in English: Doctor in your house" which is basically a book that contains algorithm that tells you what to do for every symptoms you might develop. 

People would say that I'd be talented as a doctor - even the doctor i visited when I was like 6 or 7 said that I might want to be a surgeon because of how calm I was when I had to get my small tumour excised from my palm. I've always loved donning sterile gloves and be part of paramedics training in my teenage years (the fact that I'd done it three times, in three different languages should convince you enough about that). But the older I get the more I question whether being a doctor is really all about saving people and solve complex cases with everything facilitated and is everything as simple as it's always been described?

My mum dreamt of me being a doctor more than anyone else. I did not want it because I knew it'd be hard and my proclivity towards maths, especially calculus and algebra made me inclined to the more technical subject such as architecture, engineering, or a designer or some sort of.

I admit though that, indeed, there was a part of me that was very much interested in medicine. But it wasn't the 'healing' or 'helping people' that made me interested - it wasn't the money either, I've been aware from my teenage years about how doctors (especially the GPs in Indonesia) don't make as much as people think they make. It was the science, especially in the area of molecular oncology or basically finding drugs for cancer. I finally bent to the wish of my mother and worked my way to get into a medical school in my final year of high school. I somehow, to many disbeliefs, got into the 'ivy league' of Indonesia med school.

I enjoyed studying and working but the older I get, I keep losing balance to life and became less and less happy with everything. I got sick physically and mentally but I kept going anyway because I had to finish what I started. 

I graduated not too long ago, scored at the top 10 percentile. I did what I could to make my parents proud. Then comes internship, chose to be away from my family and wanted to explore the country a bit more. I spent most times working anyway.

I was ready with most things when I started out but turns out I feel like I wasn't even close to being ready.

I hate myself more doing this job more than I hate myself as anything else. I do care about my patients as the people they are and not because I am a doctor. 

I honestly don't care about people's lives being miserable from their poor decisions, I don't care about anyone getting offended, I don't care about the health department being not happy with me sending 'easy' patients for further workups. I just don't care about a lot of things outside the science of medicine itself and what I should do as per textbook doctor.

And no, I am honestly not a fan of poking needles and put them on two different antidiabetic drugs and two different antihypertensives on elderly because to be fair, when they seem fairly healthy, what i find matter would be how they're comfortable and they should spend more time with their grandchildren than waiting on corridors. I am not a fan of prescribing cough medicine on children either because most of them are self-limiting anyway. 

I know these attitudes would cost me a lot and I can already feel slight sentiments from people who are not used to it. How can I convince people who are used to give 2-3 drug injections to people with mild symptoms that the patients, though their discomfort, don't need it?

And no, I am not in this for the money but I am not in it either if I have to work voluntarily especially knowing that there is hardly any war and that the directives of national insurances can have 300 million rupiah per month for themselves. I refuse to work with everything so limited, barely sterile field, when the government can afford a fluffy chair for them to sit. 

I also refuse to humble myself to their rule because who likes a patient being terminal? If I can send a suspected tumour patient for a biopsy, even with being sure that it's 90% gonna be benign, why should I not send them? Because the national insurance decide that after the biopsy that it won't be covered once known it is benign? That's a stupid reason especially knowing that the national insurance have 8 billions of profit per year and they're still asking hospitals to return their money with the accusations of "fraud". 

I am not by any means, a supporter of fraud, but if I have to send my diarrhoea patient back home because apparently they're not diarrhoea enough (at least 10 bowel movements in a day) and their fever has not reached 40C, just for them to come back again on their motorcycle probably on the verge of dying later, I'd rather do the fraud and let them be in a safe space of a hospital. 

At this point, I feel like the national insurance directives should also take oath to not harm patients and that they should be held accountable for every patient that dies because of their stupid rules.