As the world declares open season on China, be sure not to wrongly point the arrow on the Chinese PEOPLE.

There is a distinction. The state is the not people. In the midst of our growing frustrations and anger at the current state of affairs, this distinction can be easily blurred. We have to be careful where to point our fingers, if fingers are to be pointed.

As the world continues to rage war on the new virus, which, along the way, has gathered many unfortunate but often politically-driven and misguided names such as the “Chinese Virus” or the “CCP Virus”, resentment is growing in many parts of the world, including in my own backyard. Many such resentment, sadly, is increasingly placed against the Chinese people in general and, for lack of an obvious distinction, ALL Asians.

Unhappy times breeds anger and resentment. I get that.

People need to vent. They need an outlet. That I am aware.

But we all know that is not an excuse. Luckily, the majority of the good people in our country gets that. I know that for a fact, having lived here for the majority of my life and thoroughly enjoyed how multicultural, for the most part, this city and this country has been.

I am not here to talk about racism. That is the easy tag line towards any optically-racially-related incidents in our society. But tagging such a general and politically-correct label on the topic, and  touting the simple and diplomatic remark of how “racism will not be tolerated in our society”, although noble and needed reminded of, solves little.

I am here to talk about misplaced anger. And how that blurs the lines between poor judgement and racism, and how, if allowed to propagate, can tear our society apart in such a way that a simple political statement of “stopping racism” cannot repair.

For hate and anger, once brewed, only continue to grow on the inside. And even if suppressed, often become a nidus of infection, much like an indolent virus, waiting for the opportunity to resurface and boil over.

And for that, I am getting increasingly concerned about the potentially unintended consequences as politicians, especially in America, upon stabilizing their internal affairs, begin broadcasting their anger towards China, the nation. All the while, many of their avid listeners, keenly holding on to their every word, might widely interpret their messages simply, as anger towards Chinese, the people.

Sadly, for in America, while still in the midst of a raging infectious disease war, is also in the escalating stages of a raging political war. At the helm, a politically-insensitive president who is prepared to do and say whatever he needs to be re-elected. And one of his current playing cards, perhaps as part of his potentially winning hand, is to direct the suffering of the American people towards an easily identifiable target: China. He is a master of the political arena, and of the vulnerable American people’s emotions. I suspect that he is all too ready to turn his people’s despair into an emotional rally cry towards a potentially triumphant campaign. 

But sadly, it would appear, that even his opponent, Mr. Biden, whom I would have normally expected a more diplomatic approach, have equally identified this to be the correct angle to wage his political battle. For he, too, has clearly expressed his desire to unleash his diplomatic fury at the Chinese government.

So, deserving or not, in the next few months, we will be hearing a lot of strongly worded rhetorics against the Chinese nation. From both sides, among many other smaller voices.

To be clear, I, too, am angry at how this whole thing unfolded. As a front line health worker, I am perhaps at the most deserving spot of being angry at this outbreak. I also want accountability. I also want transparency.

But in the midst of all these rhetorics, I am afraid it will be the Chinese people who will suffer most.

For again, while there is a clear distinction, I am afraid that the general public will simply not be able to differentiate when we are raging a war on a government, and not instead against the people.

Very easily, therefore, if we are not careful, those very people, would become the mislabeled image of the enemy.

We can not allow that to happen.

We have to be smart in reading the messages carefully. We have to be smart in not letting their rhetorics drive our emotions. The speakers may not all be polished and crafted. Us, the listeners, will have to be held to a higher standard.

We have to remember what our values are, in our society, and of the people who helped built this society.

We have to control the outlet of our sadness, our suffering, and our anger.

Indeed, we all hate the virus. We hate the situation we are in.

But none of us, ever, should hate the people who this virus is here to infect, no matter where such infection happened.

The Covid Years. A glimmer of hope.

No, it’s not been years.

That’s a gross exaggeration. Although I’m sure to most, it may have felt like so.

It’s been approximately 2 months since our local province had declared a State of Emergency over the COVID affairs, mirroring what’s been going on in much of our “top of mind” developed worlds, give or take a few weeks.

Here, Spring is looming. April was one of the driest, sunniest months on record. We were blessed with such fortunate timing amidst our social distancing orders. With the sun comes hope. With flowers come happiness. Green leafs bring a sense of calmness. Dry pavements brings an invitation to get out and play.

Us humans have a short memory. Both a blessing and a curse. I find even myself, who stay glued to the television set for daily news of the world pandemic, slowly losing sight of the nasty images of overwhelmed hospitals and mass mortalities during some of the “televised” peaks in our worlds. My mind gradually shifted to a level of normalcy. My attention towards the new focus of reopening, of reintegration, of our society and livelihoods.

“I worry that people are going to forget about the risks…”, said my mom.

“Let them forget a little.”, I said. For the time being. Let them have some emotional relieve. Daily stern reminders to be vigilant will mean diluting the key message when we need them to listen again.

And we will need them to listen again real soon. The second wave will come. It’s just biology. Nothing has drastically changed in our fight against the virus. It is still here. It is still circulating. We are still susceptible. Many will still get sick and die.

But perhaps, something HAS changed. It isn’t all the same, is it?

In warp speed, more impressive than I have ever witnessed in medicine, is our increasing knowledge-base of the virus and its complications.

In fact, that is where I’ve heard the term “Covid Years”. In our current battle against COVID, enhanced by an unprecedented scale of international collaboration and experience-sharing via easily accessible social medial channels, one week feels like a year of progress.

The shear volume of data, of observations, of thoughts and novel ideas, have been staggering to date. Overwhelming to be sure. For many of us clinicians, passively surfing through volumes of online updates, podcasts, video conferences, have unfortunately became a favourite pastime in our non-clinical hours. Some might even call it an obsession, or addiction. For we have no sports; what else do we have to distract ourselves with other than, well, more COVID news.

But in my mind, that will became our main salvation going forward.

The light at the end of this dark tunnel isn’t going to be a proven vaccine, or a widespread availability of a successful therapeutic. Not yet. Those would take too long, and if they do come this year, would be prone to such a high degree of “bad science” that I’m not even sure if I should support that notion.

The ongoing angle to fight this battle, to gain and keep an upper hand, will come down to knowledge and preparation.

And our numbers are reflecting that success.

Locally, despite somewhat persistent case numbers, admissions rates and ICU numbers are declining.

Are we humans becoming less vulnerable to the virus? No. We are simply adapting as a population to know how to fight it better.

Perhaps one of the earliest “lessons” in this pandemic, stemming from observations in Wuhan and Italy and early New York, was a call to “intubate early” for severe cases. They crash quickly, we were told.

Suddenly, many COVID patients around the world ended up on ventilators. Just like that, hospital capacities grind to a halt. Death rates rose for those who needed but lacked an ICU bed.

On top of that, widespread worries about aerosolizing the virus into open space forced many clinicians to avoid previously useful “bridging or temporizing” methods, such as high flow oxygen, or BIPAP or CPAP, that has been invaluable in the past for other respiratory struggles. As such, even many “non-COVID” patients who might have benefited from these therapies were denied such interventions, perhaps leading to progression of their non-COVID illnesses. This might be hard to prove, but logically plausible.

But within weeks, the medical field has turned the corner. Progressive observations from NY and other hot spots described a changing of attitudes, that perhaps such “early intubations” were not, in fact, protective, or possibly even detrimental. A new observation, of many “happy hypoxic” patients, dumbfounded clinicians, as they stared at patients with numbers that should not normally be compatible with life but instead lying prone “happily” tapping on their iPhones.

Suddenly, we aren’t rushing to jam tubes down all these people’s throats “to keep them alive” anymore. From a hospital resource point of view, this would have profound positive influences.

Meanwhile, week by week, we are discovering new and unsettling complications of this virus, from unexpected thrombotic events to neurological complications to, for heaven’s sake, serious atypical inflammatory conditions in kids. These unexpected events are truly what makes this virus awful to deal with, in my opinion.

But week by week, we are pulling together as a human race to discover new insights in how to detect and counteract these complications.

As for our collective livelihood, our economy, and our social needs, our path towards reopening and reintegration will not yet be solved by a viable vaccine, but instead be guided by our improving knowledge on the determinants of prevention, identification, and separation of this virus from our society.

There, too, it will be knowledge and preparation that will enable us to get as close to, although no yet to the same level, to our previous normal.  

In popular social media circle, a lot of fuss has been made about the virus “mutating” or “evolving”.

But nobody is talking about the “evolution” of the human race. We, as a whole, integrated by modern technology which allows our collective wisdom to be shared and utilized instantly, has an edge to fight this thing. (Indeed, cloud computing and networking companies aren’t just helping us stay afloat in the stock market, they are also allowing us to keep winning in this fight).

For throughout the summer and come next fall, we are going to need all of this knowledge and preparation to keep fighting.

And for that, together with the sunshine and booming flowers, I am starting to develop a small hint of optimism, that we might just be able to pull it off, vaccine or not.

Where is the light?

As days of social distancing grows and the astonishingly abnormal patterns of our lives started to become the “new normal”, my sense of hopelessness and depression about the distance future continues to blossom.

It is no question that my mind, despite the battle we are facing and continue to brace for ahead of us, has been more bogged down by our lack of endgame, universally across our planet. I have eluted to this fact numerous times before.

Last night, in a rare “social” encounter with friends on Google’s video chat platform to celebrate a friend’s birthday (poor girl had to eat her cake by herself in front of the camera), my friends asked me whether I truly believe this would stretch into the summer.

Why the hell would it not? Do you see a breakthrough coming before then. I don’t.

The fact of the matter is, all these extensive efforts in city-wide shut down and social distancing (a necessary evil, despite the profound affect on our economy and way of lives), is purely to buy us some time. Effectively, it stretches the trajectory of the disease in the population down a line, in an effort to keep our current needs at bay. A necessary evil, but nothing to celebrate on.

Ultimately, until there is a breakthrough, nothing will have changed. Having globally infiltrated every country on the planet, there is zero chance of us getting as lucky as we did in SARS, when the disease just vanished, before any of us arrived at a long term solution.

We cannot count on such luck. Even if it goes on a hiatus during the summer, this will be back, next fall, again and again. Like the flu. But deadlier.

Of the three paths to victory: diagnostics, vaccination, and therapeutics; I see the latter two obviously too long to wait on, as there is little chance of them becoming of widespread use within a year (without us being recklessly in doing so). Diagnostic holds the most promise to reality in our current year, but even then, I have yet to see something promising on the horizon. What we need, is something as cheap and simple, and as sensitive and timely, as a test like a home pregnancy test. But it cannot be antibody based, because the we still miss the window period of the infection. There lies the technical challenge. Currently, the most sensitive tests requires PCR machines to amply the RNA of the virus, dependent on a good acquisition of the sample (a step that is prone to failure, thereby drastically limiting the sensitivity of such test, a measure of utmost importance in a screening assay). To me, that is the closest thing I can think of in order to drastically gain an upper hand on this battle. Something that is cheap and foolproof enough that can be used in all parts of the globe, including the slumps of India, and the favelas of Brazil.

Short of such a breakthrough, all we can do is social distance, and continue to erode our lives.

Realistically, I gave our society one to two months maximum, before message fatigue kicks in, and people, despite their good conscience, starts breaking the rules even if they remain in place. Policies makers know this too, I believe, and will strategically loosen their measures, only to allow some slack so they can tighten them again in the next cycle.

So summer we should be looking at a relaxation of the measures, if only by necessity, for our salvation, and to allow the economy a needed dose of relieve.

Come next fall, I told my friends, I don’t see us being a very different position globally. The virus will likely still be with us. We will likely still be afraid. And measures will likely still have to take place.

But likely, we will know much more about this virus, and how to track it, and how to handle the infected. That would allow us to implement less stringent policies, and use better diagnostic tests and tracking measures, to maintain a tighter but much more accepted way of life as we enter into next flu season. Hospital capacities will have evolved, based on the vast adjustments and improvements we are currently doing, and together with our increased understanding of management and therapeutics, would be in a much better position to handle a surge.

As for myself as a health care provide, that is where the light stops burning. We will still be on the front line. We will still be at high risk of exposure. We will still need a massive load of PPE to do our daily clinical duties. And unless we all acquire immunity through our work, assuming that such immunity is effective and lasting, we will still be afraid to see our families.

For the masses, it is likely that life will be “a little more” normal after the next few months, with an asterix. For the rest of us, we will continue to run this marathon.

Until a breakthrough is found.

Fearful brainstorming.

There’s been a lot of gratitude lately towards us front line health workers.

I don’t quite feel like we deserve it.

Not yet, anyway.

With all the social distancing measures and the mass panic over the coronavirus, people have now became scared silly to even get near the ER. In a way, it goes to show how many “unnecessary ER visits” there were in the past. But some of us do fear that people aren’t coming when they should come, and when they do, they may be gravely ill. It’s all a fine balance. But for the time being, we will take the “calm before the storm”.

And since none of us are used to any sort of calm at work, it feels, somewhat, undeserved.

Especially when you see footages of the hardest hit places, and what our colleagues go through there.

But then I realize, maybe we do deserve some of this gratitude. For being here, for standing guard, for treating those who come, and for risking ourselves at the front line of this long battle.

Just yesterday, I realized that one of my most believed teacher at my old teaching hospital ER, fell ill from the COVID virus. Thankfully, it seems he should do okay. But the news almost brought tears to my eyes. In fact, I think it did a little.

Much of our struggle at the current stage is mental. I’m sure it’s on all my colleagues minds when they come to work, and when they go home to their family (those who don’t have the option of staying away for months, as I am doing). We know we are high risk in contracting it. We know not all “healthy young people” would do well routinely. I myself have mild asthma, so I do have some worries. We do the best we can, donning personal protection equipment. But every time you put on the equipment, it is a reminder of the risk that you are taking. And for that, yes perhaps the gratitude is deserved.

We are also frantically using this time to plan ahead. We have the benefit of seeing what other places go through when a surge hits. We have, fortunately, appeared to have acted in time to allow ourselves to try to prevent that same surge, while at the same time plan meticulously for it.

My department is smaller compared to some of the others in the city, meaning that we have less resources, and less physical space, to handle a surge of respiratory patients. We also have less staffing, should any number of us take a hit and have to be off work for weeks, to be able to absorb such blow. That bit really worries me.

And that is one of the biggest challenge of this outbreak, as I explain to my friends. Hospitals and ERs are not built for this. We have limited space, and limited staff, on good days. We cluster patients routinely, and we do not have the physical infrastructure to allow proper “social distancing” of our patients when they all come at the same time. My department has one negative pressure room. Upstairs, our ICU has 8 beds. They are always full.

There is also lots of planning from the personle side. We know this is essentially an ICU disease. So that means, the ER docs, the ICU docs, and all the nurses, have to have a game plan to all work seamlessly together. We’ve also spent a lot of time working out the kinks in our team-oriented attack, involving as well our anesthesiologists, as they are the usual del facto airway experts. When you bring a lot of bright people together, all capable of doing things their own way, you need to make a lot of rules so that we are all, when the chaos hits, doing things the SAME way.

So that’s what the last couple of weeks has been like. All of us, brainstorming and discussing and planning, on how we can literally transform our department on the spot to account for these expected needs. My best friend in the department, another Dr. T, has been taking this task to heart, and spent weeks mulling over options and physical space limitations and led the charge on this endeavour. I offered my usual critical eye and the occasional idea. Piece by piece, we are transforming our ED, for something that hopefully we would never need the full extend of.

Lots of anticipation. Lots of planning. Lots of fear. Lots of hoping.

And in all likelihood, this will be the new normal, for months to come, if we are lucky.

If not, for years.

For as stated in my last post, I am not aware that we have arrived at any endgame yet.

And so, the stalling tactics continues.

What is our Endgame?

What is our endgame?

I feel like we are not fighting in the right area. Or at least not talking too much about it, in addition to everything else.

It’s been over a week since the world’s sports stage has shut down. It was a turning point for global sentiment, in my opinion. Until then, the world sees this as “other people’s problem”. I was shocked to see thousands of fans still filling packed stadiums to cheer loudly for their favourite pastime. Don’t get me wrong. I NEED sports. Background hockey games is the only thing that fills the air in my empty condo when I’m home. The void created by the lack of sports is eerie. But it was a wake up call. And hopefully it came in time, although I’m sure already a little late.

Worldwide, everything is being shut down. The earth, at least in the parts that dominates our headspace, is closed. This is perhaps the single biggest event most of us will ever see in our lifetime. I sincerely hope it is. Social distancing is the number catch phase on planet earth. Flatten the curve closely second. But all this is to buy us time. Time for what? What is our endgame?

We know we cannot fight this by social distance. And I do not believe as a globe we have the stamina to social distance for 1-2 years, which is probably the least amount of time required for a widespread vaccine to be rolled out even if a successful candidate were to be identified TODAY. Same for therapeutic treatment. We cannot wait for those, it would take too long.

I think the real fight needs to be in diagnostics and isolation. Currently, suspected cases have to be swabbed by a provider, and the swabs takes anywhere to hours (in other parts of the world) to up to 7 days here in Canada in the past week. Plus there’s a high risk of false negative. Furthermore, lack of supplies and inability to keep up with the pace of testing is forcing us to shut down widespread screening programs, thus essentially shoving our heads in the sand and making all of us fly blind for the next few weeks as we head into the heat of the battle.

As vaccines and therapies are likely months and years away, our only chance to end this might be to efficiently identify those transmitting disease, treat them while isolating effectively, then let the virus starve off, globally. Everything hinges on effective, cheap, rapid turn-around, and hopefully point of care testing.

I don’t feel that there’s enough international discussion and collaboration on this front. I started the discussion in our Canada physician facebook’s COVID19 focused group, and seems we are reliant on scattered companies and individuals around the world to make this happen. We need to bring them together (conceptually, online of course) to create something that can change the way we fight this battle.

The beginning.

It looked like a war zone.

That was my first impression, when I walked in for my night shift. Not so much patients, they seem the expected amount for the night. But the setup. Make-shift dividers turning hallways into “spaced out assessment areas” as our ER’s best effort to keep anyone with respiratory symptoms separate from each other. The so-called “social distancing” phenomenon. It’s a compromise, of course. Physically our department only has one negative pressure room, and another so called “decontamination” room which I’m not sure what criteria qualified for the title. It’s likely still early in the Pandemic in our city. Globally sports leagues just cancelled their seasons. Sending a final wake up blow to the causal observers who up until that point had view this as a “China virus”, or just something from afar, or something that’s purely associated with travel. It is not. It is here. Likely circulating undetected for weeks to months. I welcome the shock wave to bring some senses to all people and all levels of government. I’ve seen efforts being stepped up to prepare. Too late, in my opinion, and not enough. Widespread recommendations that sounds nice on paper but likely written by people who has no clue how feasible it would be to carry out, especially at smaller sites like ours. So, the call was to attempt to isolate anyone who presents with respiratory symptoms. Impossible. So this military looking department is what we came up with at the very moment until the next, better idea.

These are stressful times indeed. I haven’t seen my parents in weeks, and actually didn’t even meet my brother who flew in to pick up his two daughters who had stayed in town longer due to the school closures in Hong Kong. I debated a lot over that decision. To my 4 year old niece, and to some extend my 9 year old one, this would seem harsh and suggest disinterest on my part to be with them. It is not. But being at the high risk position that I am, as front line medical staff, and with the elusive but highly contagious nature of this thing, I couldn’t risk it. I fear I am looking at many more weeks to possibly months of staying away from my parents in person. Thank goodness for FaceTime.

People are stressed at work too, as you can imagine. Which is ironic, because stress decreases our immune system, making us all more susceptible to fall ill. And that is what I am most fearful of. The incapacity of our health care system, and in particularly, our doctor group, with withstand anyone missing any work for any duration of time.

I’ve personally be recovered from a cold, which I’m quite over by now, but some persistent sinusitis symptoms and slight stirring of my post viral asthma kept me self-conscious with an occasional cough. I don’t believe I’ve been exposed yet to any positive Covid 19 patient, but of course one can never be sure. I’ve swabbed many, and fortunately all so far came back negative and most were consistent with the flu. I’ve always kept a mask on and almost never touches a patient without a pair of gloves. But what troubled me, and it’s something that’s plagued me for some time now in this profession, is the inability to “call in sick”.

My friends would ask, shockingly, “you can’t call in sick??”

My reply, usually, unimpressed, was that “well who’s going to replace me?”

Few other profession has this concept, I find. Most people have sick days, or even if they don’t, they lose earnings, but they just don’t show up. In the era of heightened awareness of communicable diseases, that is commendable. It should be encouraged. It should be the norm.

But doctors, particular smaller groups like those of us in our ER department, has never had the luxury of that. To miss a shift, we have to find our replacement. That you cannot obviously just find ANY replacement, because only those within your group are qualified to work on behalf of you. So, you only chance is to draw from your existing pool of colleagues, most are already overworked, stressed, or just unable to help because of their own scheduling obligations. It is a very unsettling feel. Knowing that no one is ever really there to save you. For such an intensely demanding job, when really you should always be top of your game, this is extremely ironic. If you need to miss a shift, you post it on your group’s schedule calendar, and hope that someone can do it. Very often, if given enough time, that does happen, thanks to my beautiful colleagues. But most of us who fall ill need to cancel in the last minute. And that, unfortunately, does not happen.

At the time of writing, I’ve just came off a night shift and is due for another one tonight, and I’ve posted these two shifts in hope that someone would relieve me so I can continue to nurse my asthmatic cough in peace. I don’t expect myself to be relieved.

I hope this virus change that culture. We have to have a new systems. For far too long, doctors come out of this difficult and harsh medical school journey and feel an obligation to be “toughened” enough to motor through most adversities. The very notion that “doctors get sick too” has actually gotten some interesting following on social media as if this is someone a foreign concept. But as we preach for the masses to no longer try to “be a hero and work through your sickness”, we should create ways to adhere to such similar advice. It is not yet possible, due to the way the employment structure is set up. But if there is anything this viral outbreak has taught us, is that there are lots of ways we are going to have to change in how we live. We have been too relaxed for too long. We should have seen this coming, and we did not prepare adequately for it.

The Healing of an Emergency Doctor

(I had written this post actually a long time ago, when my emotions were still raw, and far from having came through on the other end. I've always wanted to post this, however, as a reminder to myself, and to others in similar position, of the mental struggle and recovery we go through sometimes with what we do. This has been well over a year now, and I have been working diligently on my regular shift routine. But still not a day goes by that this does not weight on my mind, if anything, simply as a gentle reminder of how expectedly sometimes things could go. It has changed me, no doubt. How could anyone not. I'd like to think for the better, but that would be suggesting that I wasn't at my best before. I think, the better perspective, is that we always grow, we always learn, and we always keep trying. That is what we do.) 




I cried for 3 days straight. By the third day, my tears have started to dry up. But it was still hard to get out of bed in the morning.

All I could do was sit and stare. Sometimes with my head down on my elbow at the table. Sometimes my head buried into a pillow. Thankfully, I had sports highlights or hockey games playing the background. I couldn’t bring myself to care. But it was a good diversion to the vast emptiness that surrounded my home, so full of quiet sadness.

I lost a patient. It was highly unexpected which makes it even more traumatic to hear. The scary thing is that even upon reviewing, I don’t think I would have done anything particularly differently. All of the colleagues who reviewed the case with me reassured me that they would have managed everything the same way. But that doesn’t make it any less painful of a reality to deal with. And when you dissect everything down, there are always areas where a slight tweak in thinking might have altered my plans. But in the bigger picture, it was unclear if any adjustments would have made a difference in the terrible outcome.

I started by sharing with a few close friends who had asked. One offered me a shoulder to cry on, and I let it all go over her poor sweater. I found the best consolation via emailing back and forth my small team of colleagues, all of whom I felt comfortable sharing with and some of whom have so much more life experiences than I have and offered me their kind perspectives. Those emails got me through the first several days.

Two colleagues also helped me pick up two of my upcoming shifts. Crucial, as I was in no shape to work in this mess. This gave me about a week to get myself together before I have to perform at my best again.

By day 3, I shared the news with my family. I wanted them to know my sadness, and why I plan to not do much celebrating this Christmas. They offered their unconditional love and support, as always. They understand the risks that I take each day in my job and that these things could happen.

I also called a work-place counsellor, someone who offers counselling and crisis management for physicians. She was compassionate, understanding, but I found lack the true clinical real life experience to offer me much comfort beyond some generic grieving approaches and advices. But it was still good to talk things over.

By day 4, I was able to be a little more productive with my mind, and I started to use it a little more by studying and reviewing some latest updates in my field. There is a lot of web-based continued medical learning these days, something called FOAM, or Free Open Access Med-ucation. It was perhaps the most productive way to get my mind off the sadness, and served the dual purpose of also trying to better myself as a physician. In fact, learning something new got me a little more eager to work again. To apply those new knowledge into use. To make use of my training again for some good.

I also hit the gym. My mind and body was still sluggish as hell, but I knew it would be good to get my blood flowing. I still didn’t care much for my own health, to be honest. I still feel like I deserve to sink in this sadness, as I’m sure the family is doing, even if it means, irrationally, as an attempt to share a little bit of their pain to help lighten the load.

In the depth of sadness, there were many slow, passive, circulating thoughts. Most of them were to do with how the family can ever cope with this, and how something like this tears so many people apart. The sadness is all encompassing. Overwhelming. Suffocating. But I embraced it. I felt like it’s part of the process. One cannot start to recover if he hasn’t hit the rock bottom of his emotional turmoil.

I thought about quitting, although it’s not really a realistic option for I’m scheduled all the way into June and I have obligations to keep. But can I really keep doing this job. Can I ever stand to face such a tragic outcome again. People in our line of work face such drastic consequences every day. Most of us are numbed by it. Most of up wake up each day and go to bed each night without ever thinking about it. We go to work. Do our best to put in a good job. And usually go home feeling that we’ve done right. But it’s when something like this hits us, then it really sinks in the unreasonable pressure that we actually face each day. That sometimes when we thought we did our best, something terrible like this could still happen.

My brother pointed out, correctly, that most things we see isn’t black and white. There are always so many factors, so many considerations, that go into our decision making and made us commit to one path or another in our clinical approaches. Critical analysis happen in a dynamic ever-changing fashion in a fast paced uncontrolled environment and often all we can do is make our most sound judgement in the presence of all the available information that we are possessing at the time.

But that does not matter. We are the gate keepers. Between good outcome, and terrible ones.

By the fifth day, drips of normal human emotions starts to passively creep back into my head. Desires, hopes, even the occasional brief smile when I see a funny commercial on TV. Like faint flickers of a tiny candle light, my mind quickly smothers it. Go away, as if to say. I’m not ready to welcome you back. I’m still feeling sad.

On the 6th day, with 2 days to go before I have to work again (I gave myself a week to recover from this), I started to force myself to live somewhat of a normal routine. I hit the gym again, did a bit more self study, and even tried a little bit of Christmas shopping and then had dinner with a friend. If I were to perform at my best again, which is what every shift requires, I needed to gradually pull myself back together.

On day 7, with one more day before going back to work, I told myself, it’s time to put this away in my mind. No it’s not the same as forgetting about it. There are lessons to be learned. But I can’t be wearing this on my conscience and still expect myself to perform admirably.

I have to be able to face the consequences of whatever happens as long as I try my best. I have to be okay with the risk of another bad outcome, even though I dearly hope nothing like this ever happens again. A close friend and a colleague reminded me, that as much as we like to play the role of the determinant in our patient’s outcome, very often all we can be is the best possible facilitator. There are things beyond our control. We do our best with what we can control, and try to learn to let go of the rest.

One of the more productive thing was returning to work (I couldn’t have done it any earlier, but a week was about the right time to get myself back into functional mode). Going in, and just simply focusing on the medicine, doing what I’ve always done, applying my same reasoning and decision making that I trust, helped filtered away some lingering doubts and uncertainty. Seeing new faces, and just focusing on solving their problems, helped refocused my attention onto others and not what’s been going on. There are still moments of vulnerability, but with each shift the patterns become more regular, and my trade-mark quick shuffle started to pick up its pace again as my mind warp back into turbo mode, releasing the surge of serotonin that not only lifts my productivity, but my mood.