Saturday, February 03, 2001

Kari Ikan Merah

I can't help but feel envy learning that some teenage programmers I know earn a 3-figure salary on a DAILY basis! I'm happy for them (yah right!) but it says a lot about the 'Digital Divide' created by information technology. Youths their age can pick up almost any skill from the deluge of information on the web. Master it, work it better than any crusted middle-aged programmer, and give them a run for their money. Who needs to go to school?

Maybe I should quit medicine and learn PHP!

The scenario for doctors hasn't changed in 50 years. Do you know what it takes for a doctor in civil service to make RM300? Locum. Like touting is for lawyers, moonlighting for pub singers, locum is for doctors. Locum is to stand in at a private clinic when the GP is having a vacation in Tahiti or has reached that age when he decides to spend quality time at home with his family at night. The going rate for locum is about RM30 an hour. Which means if a civil service doctor (who would have to take annual leave) were to locum for 10 hours, he takes home RM300. RM300 worth of seeing scores of ill folk who cough in his face, vomit in his lap, and bleed all over the floor.

RM300 - probably about how much a programmer earns a day, eh? For lounging in an office chair, operating a romping computer with power servers at his disposal, his butt well cooled by a 5hp air-conditioner. Secretaries bring you Mocha, colleagues chia lunch now and then, and a fat paycheck end of the day. Lovely.

LOCUM is the most profitable option a doctor in civil service has. But that's the occasional break. His routine is a lot more grim. To give you an idea, a fresh graduate earns something like RM1700 basic salary. As a house officer his job is to live in the hospital. Home is just where he sleeps. If he's not on call that is. On night calls, he is on his feet all night - sleepless, like the living undead gliding in an out of OR and resuscitating patients in the ER and finally collapsing in a heap for a half hour before he has to get back to work at 7 in the morning. For that (a night call), he earns a whopping RM20.

I remember countless zombie nights like that. No matter how I used to start every night with determination and a courageous spirit, after the 14th admission or so, I would fall apart. Usually it's about 2am when that happens. I would have walked a few miles up and down wards across the vast terrain that is UM. I still have countless injections to dispense, most of them late. My nurse reminds me there are another 4 patients or so waiting to be seen. Stroke. Epilepsy. Renal failure. Maybe a myocardial infarct. The pager hasn't stopped ringing the past 2 hours. I'm in the ward pushing my trolley of syringes wondering when it will all end.

'I can't do this anymorrr,' I tell myself, dragging one foot ahead of the other.

'One more patient and I'm going to collapse!'

I pull out crumpled paper from my pocket and look at the list : Stroke - ward 7S. ABG - bed 24, 7U. Blood CNS - bed 13, 7U. Set CVP - bed 12, 7U.

'Just 5 minutes. 5 minutes, please.'

I sneak into the chart room and pull up a chair. 5 minutes and I'll get back to work. I slink onto the thinned cushion and arch back. The moment my head meets cushion, my entire being is sucked into this blackhole of exhaustion. My body would just flop limply like a lifeless amoeba, fingers grazing the floor, a wave of numbness rapidly engulfing me from fingers and toes, to torso and neck. I'm left with a semi-functioning brain in a dead body. As I plummet deeper into rebound coma, half unconscious, I can feel the angle of my lip droop as one of my facial nerves decide to stop firing.

'It's just a transient ischemic attack. Mild stroke. Probably a bit of carotid insufficiency to the motor cortex,....' I mumble, my lip quivers for a second, and I become a dead log.

I would probably remain that way till I'm discovered rigor-mortised the next morning, except that my good old friend - the pager fixed to my hip - will inevitably ring. 'Beep! Beep! Beep!' The rude blare of the pager shocks me with 1000 volts of anxiety - good enough to yank me from deep REM, facial palsy, brain dead and all,.. to bolt for the phone.

Gasp. Hack. Wheeze.


'Haaa..? Apa you kata? Patient collapse?!! Takda pulse? Takda breathing? Case apa?'

'Alamak.. Ambik resus troli. Pasang cardiac monitor. Sedia adrenaline. Start CPR. Saya datang sekarang!'

Somewhere deep in the endoplasmic reticulum of my gastrocs, some secret calcium reserve pours out onto them actin-myosin bridges. Muscle fibrils miraculously jump into action, cardiac chambers leap to life, previously unfired neurons blaze with renewed energy, all to propel this house officer down the ward aisles to yet another hapless patient.

The next morning - panda-eyed, speech slurred, struggling to keep coffee from drooling out my spastic lip - I'm having breakfast with a couple of other house officers. One guy is euphoric after a weekend of sleep. The other gobbles down his poh-pia, peers into my eyes through the layers of fatigue, disillusionment and despair he sees there. I thought he was going to encourage me..

'You know what? Yesterday I paid my gardener RM30 to clean up the weeds. RM 30!! How much did you make last night, huh, Yap? How much?'

Today, at age 30 I make RM 2000 a month. Let's do a bit of arithmetic here, ok? How much do you think renting a flat in KL costs? Rm700? 800? About there. If I were to work in KL : let's start with RM2000, then minus rent (RM750 say..), minus car payment (RM 500 say..), minus giving to parents (RM300 say..), and tithe (RM200 say..), minus laundry (RM 50 say..), minus utility bills (RM200 say..), minus phone bills (RM 50 say...)

What? Did you say there's nothing left for food?

That's the arithemetic.

Some careers aren't as easy as others. It's a fact. If I were to look at Alvin's paycheck, my skin will produce chlorophyll with envy. If I were to count Ryan's part-time earnings, I'll probably wring his neck in bitter rage till he turns blue in the face. So I don't ask, and I don't look. If I were to measure my financial worth by my net assets - I'm a great big zero. But somehow, somewhere deep in the recesses of my damaged-by-too-many-night-calls brain there's something that tells me it's all worth it. And not because someday I might be a private otolaryngologist making RM20,000 a month.

That's not it. Arithmetic isn't everything. I may never leave the civil service (are you crazy?!!)if I feel called to serve the community in such a way. I would continue to crawl at a RM60-raise-a-year pace. I hope there's enough idealism and faith to be keep me going 10 years from now when the arithmetic still adds up to no money for food. Contentment is a difficult thing to learn. 'The Lord is my shepherd, I shall not want.' - that is a fantastic thing to be able to say, you know. And believe me, most of the time my flesh says, 'I want!! I want!!'. To sit back and watch the world fall over themselves for the latest 29" flat screen, Palm Vx, 2.1 mega pixel digital still, Clark-Hatch membership and say silently to yourself - 'I don't need it. God's given me enough.' That is the start of having plenty.

Lots of incalculable things makes it all worthwhile of course. Like a lady I saw today who was battling diabetes, renal failure, hypertension, gastrointestinal bleed and pneumonia a month ago. I did a tracheotomy for her half wondering if she would even live to benefit from it. Today, I removed the tracheal tube and she took her first gasp through her natural airway again - she made it! There were tears of joy in her eyes. In another case, one man's tracheal tube fell out this morning. His trachea blocked with tumor, a tiny pinhole in his neck was all that was left of the track. With the few short minutes I had I anaesthetized his neck, incised the pinhole and refashioned a track into his trachea. He's gone home with a new tube now - breathing, I hope.

Barely three years out of medical school, and I'm back in school again. Trying to hack it in a Masters' program. I have three months to my first professional exams and I'm looking at this huge syllabus which I've barely begun to cover. A lot of faith is necessary. Hope, the Bible teaches me is not a random stab in the dark. It's trust in a very certain outcome - the outcome that's in the hands of my loving Father in Heaven. A trust that's about surrendering it all to Him when I'm clueless how I could ever succeed. And hey, the Bible also teaches me that God is delighted when we trust Him that way. A little bit short of funds, and facing insurmountable challenges : all that I am, all that I can ever do, I give it up to Him. I know my Father in His ingenuity, will work it all out for good.

And hey.. before any of you start sending me money, let me tell you I have ENOUGH. God's made sure of that. Today I'm going to cook me and Joan some curried Ikan Merah with tomatoes and lady's fingers in my tiny microwave. The CD player and MS10i Pearl speakers I saved to buy as a house officer still packs a punch playing Diana Krall and John Coltrane. My Pentium II 300 Mhz purrs like a kitten running Windows ME, keeps updated, and lets me research bible Hebrew on hope and rest. Sinking into my Sarawakian bamboo rocking chair to catch a read of Nouwen or Scientific American under soft yellow light (from a Bubu lamp I made), hot Ipoh white coffee in hand, beats Starbucks any day.

If there was PHP and SQL back in the 80s, I may not have made it to medical school! But what many young working people have discovered is that work has meaning, and isn't just means of accumulating cash. There's a whole movement among working Christians today to work out how work glorifies God, blesses people, and is meaningful to oneself. At times when I'm pushed to the brink, a tiny voice inside tells me that what I'm doing is my appointed way of worshipping God.. then everything takes on a different light. All the seemingly meaningless things I do day in and day out is worthwhile. And adds up to a service to man and God. Well, I'd go on.. except that my pager just went off! Looks like you guys have been saved by the pager, eh?


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