Ng Zhen Ming Jeremy - Excellence in medicine

Submitted 2022-10-28

Emergency medical care can be both daunting and exhilarating. What appears to be instantaneous decision-making sits on the foundation of honed muscle memory and medical evaluation. Irrespective of the hours of practice before your first major emergency, adrenaline always finds a way to penetrate your composure – fingers trembling, heart pounding, as you grasp onto the slither of life in your hands. At this moment, I find myself extracting from the fear and falling back to my instincts, or so-called “acquired instincts.”

The idea of “acquired instinct” relies on continuous training in emergency medicine, albeit requiring lots of practice to develop. Despite being a beach lifeguard and volunteering numerous times in ambulance services, I often feel a sense of imposter syndrome as I stand amidst the chaos of the A&E room as a medical student. How will I ever develop such crisp decision-making like these healthcare providers? My colleagues and I have shared many laughs over the fact that we all feel the same way. Indeed, it took time for me to embrace this reality. However, I found that the fear drove me to develop my confidence in asking questions, which is an essential skill to have. Mnemonics also became my best friend, such as the notable ABCDE. I also found that on top of training scenarios, when my peers and I saw patients being wheeled into A&E, we would bounce ideas off each other for potential management plans. This stimulated us to actively recall our knowledge, making our decision-making for the next patient we see with similar conditions ever so slightly better, slowly developing our “acquired instinct.”

Knowledge is crucial, but more importantly with the ever-evolving nature of medicine with research, technology, and epidemiology, we need to continuously update our knowledge in keeping with current guidelines. Before COVID-19, I was instructed to give 5 rescue breaths. However, during COVID-19, I was instructed not to give any rescue breaths, cover the patient’s mouth with a mask, and immediately proceed to give chest compressions. As COVID-19 restrictions eased, I inquired about whether the procedure was still the same and was informed that HME viral filters were to be used when giving rescue breaths. Being aware and seeking updated knowledge improves patient care and allows us to adjust to improved guidelines, while training ensures that the protection of our patient’s safety and our own becomes instinctual.

Just like how our reaction time slows without enough sleep, our performance in emergency medicine can be impeded by a lack of a good work-life balance. Doing less is not equivalent to negligence; in fact, it was very much the opposite for me. At one point, I was simultaneously working as a lifeguard, volunteering in ambulance services, and studying for medical school. It did not take me long to realize that I was on the path to burnout when my care for a patient was compromised. I had responded to the same spinal injury in the past, yet my instincts did not kick in as my mind was foggy from sleep deprivation. Understandably, there are periods in life when you’re bound to have less time for selfcare. However, it can be as simple as taking 30-minutes to wind down after a tough day. For example, even if I’m exhausted, I make it a habit to do something I enjoy before I sleep as it puts me in a better mental state for the next day. I was also skeptical of meditation but later realized that I have always meditated when feeling overwhelmed – deep, slow breaths while relaxing every muscle in my body. This revitalizes my mind and body to tackle any emergency that arises next.

Our physical wellbeing also helps to cement our ability to respond to diverse emergency cases. In the absence of a LUCAS cardiopulmonary resuscitation device or during a busy day, I have come to appreciate that performing consecutive lifesaving techniques can be extremely taxing. Recently, I have been unable to regularly visit the gym, but I have found that incorporating small workouts throughout the day can help maximize time efficiency. Using the rule of 3, I would spend 3 minutes doing 30 push-ups, 30 crunches, and 30 squats, 3 times a day: before breakfast, during the day, and before I shower during the evening. At first, it was difficult to commit to this routine as it felt unnatural. However, the benefits of this simple workout plan soon made me regret not starting earlier as my sleep, stamina, and alertness improved. Ultimately, having strong mental and physical health translates into a better quality of patient care.

Unfortunately, when working on the precipice of life and death, the scales can swing towards the latter. Yet a degree of preparation can still be established not just for facing different kinds of emergencies, but in coping with loss. Typically, dealing with the repercussions of losing a patient may require a moment alone to self-reflect as the experience is personal. However, I have found that actively seeking for help improves my ability to deal with the emotions linked with adverse events. This could be in the form of therapy, support groups, or even discussing what happened with colleagues who were there. Sometimes, strength comes in knowing you do not have to face things alone. Building a strong foundation for an emotional outlet can go a long way to helping a career in emergency medicine.

Although emergency medicine involves a high-risk environment and has one of the highest percentages of burnout rates in the medical field, every time I step into the buzz of A&E, a wave of calmness envelops my body. Stretchers with patients may be flying by, pagers bleeping, activity all around – this is what keeps me coming back to do extra nightshifts at A&E despite already attending a full day of placements. Consequently, if this is something that interests you in the future, I hope that this essay has given you a glimpse into the mental and physical challenges of working in such a rewarding career.