#fkugm

Pada reseptormu akan tanda kebesaran-Nya.

Khawatirlah, jika ilmu (terutama kedokteran) ini tidak membuatmu semakin tunduk dan jeli dalam bertingkah.

Melihat cairan khusus agar tekanan bola mata tidak berubah saja,

Harusnya membuatmu semakin bergetar akan syukur nikmat mata dari-Nya.

Melihat tulang patah harus dibor dan pasang besi-besi penyangga.

Atau bahkan, memberi nafas imitasi setiap 5-6 detik sekali sesuai kebutuhannya.

Bukankah seharusnya pulang bukan hanya bawa lelah?

Melainkan kelembutan hati karena ayat-Nya, dan luapan rindu menghamba

Mentaubati dosa, mensyukuri karunia.

It is 12 noon. I have arrived home from my Radiology final already. But more than the Radiology final, today is a significant date: it is officially my last day in clerkship (koas). It’s finally done.

Let’s quickly capture my emotions while they’re fresh:

There are a few aspects to this. One is that my personal journey in clerkships has come to an end. And second is the disbanding of my “koas group”, the group of people I’ve (in various combinations of sub-groups) spent the last two years with. Let’s talk about the latter first to get it out of the way. I suspect I don’t have much to say on the matter. (Oh no, I rhymed “matter” with “latter” and now this probably sounds like a ballad). Anyways, my group. They are a mix but not exactly a very good mix. That is to say, they have diverse personalities but probably not as diverse as one would hope for. There are the quiet people, the loud mouths, the hard workers, the stragglers, and let’s not forget, the assholes. But it’s not fair to categorize people like that. I think those are just the common positions that people assume - sort of like a self-configuring flock of migratory geese - when put into such groups. As for my own experience: I went into this group knowing full well that I will have to tolerate them and they will have to tolerate me for a full two years. That meant that I had to keep a lot of my opinions to myself, try to mitigate conflict, and take everything they say with a fistful of salt. I (correctly) assumed that a lot of conflict in groups like these stems from one person feeling that another isn’t pulling their fair weight. Although, due to language barriers, having a busy life, and different culture, I did often slip and mess stuff up sometimes (usually bureaucracy/paperwork, which Indonesians love to be enslaved by so much). But other than that, I always tried to be generous about my time and energy in night-shifts and taking on responsibility for portions of work. I never complained to them that I did an hour more or that the topic assigned to me is too hard compared to the others. This was a good decision. Feelings of jealousy and anger are much more taxing than doing an extra night shift or taking a harder subject to make a PowerPoint on. Not constantly comparing my plight to others put me generally at ease throughout these two years. I cannot say the same about some of my groupmates. Right off the bat in my first department (Neurology) two years ago, I saw the seeds of discord already being sown. There were tears and public venting, and many chose to appease whoever was in front of them rather than be diplomatic and nip issues in the bud. I remember feeling that several of these groupmates were immature and irresponsible with their backbiting, self-serving, passive-aggressive ways. My feelings have not changed. I will give you a fresh example. So, since koas is ending, we’ve been burdened with lots of paperwork that we individually have to do. So I’ve been delayed with one of these documents, and I have been making slow but steady progress on it. Not doing it won’t harm anybody but me. Anyways, one of my groupmates obnoxiously asked me if I had done it yet. Shocked that she’d show concern for me, not a millisecond passed that the reality sunk in: she just wants to feel superior and slap me with a chastigation. I replied that I’m dealing with it as we speak. “Make sure you finish it or else you won’t be allowed to do UKMPPD” (the Indonesian medical competency exam) she said. I acknowledged. Then, out of the blue, a couple of hours later, she typed out the exact same question into my group’s Line group and tagged me by name. A decent human being would private message another when the conversation is between just two people. Publicly posting it in a group is looking for an audience. And of course, the question was not intended for me as she had already asked me verbally just a couple hours before! She just wanted to make me look bad to the group. And sadly, 99% Indonesians can’t see through things like that. Of course, I could’ve returned the fire and publicly demanded an explanation of why she’s trying to belittle me in front of the groupmates asking me the same question she already got the answer to just earlier. Instead, I chose to let her inflate her ego (again) at my expense. I’ve lost count. “Whatever. All this will be over soon and none of this will matter,” I thought. Besides, Indonesians generally have no problem with slander but are terrified of conflict, so engaging her would’ve drawn the typical, “hey hey hey, calm down, she’s right” sort of crap anyways. I want to end this part on a good note with a clear disclaimer though: several of my groupmates have been great and I felt lucky to have them on many occasions, specially when I was exposed to stories of other groups from my friends. There were many times I said, “I owe you one” to them. And there were a few times that they too overlooked my flaws. Will I stay in touch with these groupmates? I doubt it. Our lives will diverge and I never really gelled with them on a social/personal level beyond the perfunctory. It isn’t over yet though. I still have to traverse through the rocky path to UKMPPD with them (i.e. take evening preparatory classes with them). So I’ll be seeing them for the next couple months and then again for graduation (if we all graduate together). Actually, I just remembered: three of my initial groupmates changed some grades (after receiving lower marks) and got in major trouble back in our first department. They were reprimanded stiffly and kicked out for a semester. So, they’ve been absorbed into other groups since they’ve been back, due to scheduling issues I’m guessing. Anyways, I won’t be seeing them very much anyways since they’ll finish next year.

Okay, now I’m free to tell you how I personally feel about finishing clerkships. Before me is a vast, dark abyss. On the other side of this chasm is a glowing residency in the US beckoning me. I have to take a few steps back, run as hard as I can, and then leap. But time is running out. The longer I wait, the wider this chasm gets. It feels out of reach but I know that it isn’t impossible yet. As Jim Carrey’s character said in Dumb & Dumber, “So you're telling me there's a chance, “ when faced with near-impossible odds. That’s basically all I’ve got. I have no choice but to take the leap. If I fail, I will think of a plan-B. But for now, there is no plan-B. There never has been. I selected UGM from a list (WHO FAIMER) of recognized universities for working as a doctor in the USA. My plan since day-1 has been to get my MD from UGM and then write the USMLE to get into a US residency program. That’s the beast cracking its knuckles to beat me to a pulp after all this. So, one of my main emotions right now is: unrelenting fear. “How will I do it?”, “What if I fail?”, “Will anybody help me?”, “What if it’s too hard?”, “When should I have started this?”, “Is it too late already?”, “What else do I need and how will I get it all?”, and other thoughts are bothering me constantly.

The other emotion I’m feeling is relief. I’m done this 7-year journey of med-school and it’s a good feeling. I’ve achieved something in my life. I haven’t exactly summitted yet, but it’s still something. No more koas departments! No more night shift. No more refkas, tutorial, minicx, and exams! (I know you’re saying, “wait for residency!”)

On the flip side, I’m also sad. I enjoyed the clinical rotations a lot more than the theory years at campus. I love doing stuff with my hands, talking to people, and seeing quick results of my work. The pride you feel after looking at the fine suturing job you did on a mangled foot, or repairing an episiotomy to make it like new (well, not exactly like new), cannot be compared to anything you do in your theory years. Sure you study hard for a pre-test and then get a 10/10. Great. Does that make anyone smile internally until it spills out onto their faces? I doubt it. Everybody cheats on those pre-tests anyways, walking in with the questions and answers memorized. Yeah, I never chased a high GPA and I never took pride in having to do that sort of crap myself in order to survive med-school here. But I can tell you that I felt awesome delivering babies, assisting surgeries, pretending to be a real doctor in the ER, winning hard-earned trust in the OR, and following up on my patients. And I am definitely going to miss that. I hope I can get into a residency soon and revive all these happy feelings somewhere else.

I’m feeling stupid. I should’ve studied harder. (Oh look, the same retroactive advice I give myself at the end of every academic year since grade 2!) I should have though! I got distracted by various things including my personal life issues, business demands, relationship issues, social life, being lazy/tired, and the whole system of inefficiency developed by UGM to keep students busy slapping stamps, filling forms, and Whatsapping teaching doctors. Had all these things been better managed, I’m sure I’d have the energy and time to actually enrich myself with books or at least videos on the stuff I was seeing at the hospital. Sadly, I rarely ever laid my finger on any book in the last two years and I was using Google more than anything to get that last minute answer to pressing knowledge gaps. My mind still goes blank when I glance at an ECG (ugh, I should know this by now!) and I don’t have even half the drugs memorized as I’m probably expected to by now.

And on the flip-side, I’m also feeling smart and confident. I delivered babies all by myself, damn it! Without supervision! I sutured up patients in the ER. Also without supervision. I did rounds with confidence in Internet Medicine. My white coats aren’t so white any more. I’m experienced now. I’ve seen it all and done it all. I’ve been there, and also been there and there too, and I know exactly how this and this feels. I’ve been in clerkship long enough (two years) to start saying, “during my time” when referring to things while giving advice to my juniors.

What other emotions am I feeling? Tired due to insomnia. Yes, I had coffee last night. An Americano from Ethikopia next door. It tasted better as I drank it. Not because of getting desensitized to the bitter flavor but due to the sugar at the bottom of the cup. Anyways, I will try to take an hour nap to recuperate some strength. And then I have to go for evening lessons at PADI (no, not the diving thing) for UKMPPD prep.

It’s hot and I can feel various folds on my body are already damp. The time is 1:51 PM and the appointment with the Radiological Oncology Consultant was about an hour and a half ago. The koas student sitting next to me is resting his elbow on the armrest of the wooden bench, his neck tucked in, his eyes shut, and he’s occasionally taking deep breaths and nodding, hanging somewhere between sleeping and dozing. We are waiting in the dusty, eerie Radiotherapy and Nuclear Medicine building, next to the Forensics building. This is where we’re supposed to meet our teacher to continue our discussion with her.

The last time we met her, a couple of days ago, it was on the 6th floor of the ICC (International Cancer Center) building at the back of the hospital. I wondered then why they put such a flashy-looking building near the rear of the hospital where it would be obscured from view. Maybe that’s the only place in the congested RSUP Dr Sardjito complex with some empty space left? I scuttled from umbrage to umbrage, shielding my face from the blistering sun with my book, while stealing looks at the dozens and dozens of people hanging around the entrance and lobby of the building. As I got close enough to the building and started to see the faces of the patients, I entertained a thought that perhaps, like the lepers in Ben-Hur, the cancer patients were banished here to keep them away from the “healthy” society. The patients there didn’t appear angry or sad. They generously smiled at each other, perhaps more so than is usual in Yogyakarta, because they knew full-well why they were all there, and perhaps because they felt they weren’t alone suffering such a fate. Perhaps they’re looking for reciprocation of a reassuring smile? Unlike other departments where patients animatedly discuss their diseases, I felt that here, patients were too busy with their internal monologues, practicing what to say to the doctor, as they patiently waited. Or perhaps, they were too weak to talk? No, like many “cancer patients”, they looked healthy and free from any complaints. The greatest pain they were experiencing is probably the anxiety about the malignant tumor growing within their bodies.

“There’s so many!”, I thought, as the realization about countless number of people there hit me. Many came with their spouses or accompanied by a child (well, not children, but mostly older teenagers or people who would have 50+ year old parents). Some patients sat alone. I felt a bit of sadness when I saw the solitary patients, as loneliness always strikes a delicate chord with me. These are people undergoing a terrible disease which will probably kill them very soon, and they’re left alone to face the doctor (well, “face the news”, would be more accurate) alone. I had stood behind the doctor and watched her go through patient after patient, spending about five minutes per patient. One 50-something-year-old patient had masses growing within her chest. She had already gotten a mastectomy and that that’d be that, but the cancer came back. The doctor was candid, but remained unsmiling, explaining only the most necessary to the patients in bite-sized packets of patient education. One of the younger patients was concerned about his dry mouth. She started replying while still writing in the medical record, “it’s a side-effect of the chemotherapy”. She ended with her fingertips clasped and pointing towards the patient in a posture of power. The patient looked reassured but a part of him was still unconvinced or perhaps he simply didn’t understand. Either way, the doctor couldn’t have made it easier to digest. He threw a quick gaze at his partner and then slumped in his seat, allowing the doctor to finish scribbling and motion him to leave. My mind drifted as I stared out of the floor-to-ceiling glass of the doctor’s office and towards the buildings of UGM and beyond. “Life is delicate,” I thought. Our time here is limited. We will all surely die. The only question is “when” and never “if”. Every human who has ever lived has died. I felt my throat being tight and dry from the anxiety of thinking about mortality. Then, I remembered a quote which went something like, “I don’t feel sad that I wasn’t able to experience the billions of years before my birth, so why should I feel sad about missing out on the billions of years after my death?” In fact, as humans, we can’t be physically everywhere, so in fact we only experience a very narrow segment of events happening right now. Then there’s our fickle memory that forgets past events. Not being present is no different than not being alive, for all those people and objects we can’t interact with. So, we’re just dust, waiting for the next wind to blow us away, leaving little to no trace. We’re so insignificant, no more than a biological beaker of chemicals, active for the duration of the reaction and then, a slow decay without any fanfare. But, somehow, this beaker is able to look up at the stars, wonder, and fathom its own existence. Sobering!

Ok, let’s enter the time-machine, and go back to the present: it is now 2:09 PM, still hot, and the guy next to me... well, his head is still bobbing on Plutonian seas. Coming up here (I’m on the second story), I was told that one of the patients wanting to register for radiotherapy was given a date in December. It is currently June! There are clearly a lot of things we can improve today rather than chanting the age-old mantra of “cure cancer! cure cancer! find a cure!” 

Radiology, so far, has been just a bunch of BIKOs. These are basically lectures in a small classroom. Sometimes we break into smaller groups, get some homework, and do some discussions, but these tend to be very one-directional, not much unlike the BIKOs. So, that just means, all we do are BIKOs. Radiology isn’t heavy, so there’s free time here and there, and the residents seem to be quite relaxed (and not the stressed-out, pressure-cooker-dwelling residents of Internal Medicine, looking for a punching-bag in the shape of a koas student -- maybe I exaggerate, but sometimes it felt that way, okay :-D ). When I get a chance, I think I’ll go sit at one of the terminals (computers) and just browse dozens of radiographs: X-rays, CT scans, USGs, etc. I believe, as part of the scheduled activities of the Radiology department, I will get a chance to actually go see the scans happening at some point. Otherwise, I’m happy to just try and interpret the radiographs. In my heart, I know that within a few years, all this interpretation will be done by artificial intelligence (computers) and we won’t need Radiology specialists. But still, it’s fun to see this part of medicine. It makes more sense too as I’ve gone through all the other departments and am familiar with a lot of the diseases. (Did I mention Radiology is my last department? No? Ok, I’m mentioning it now then!)

Since it is my last department, as you can imagine, it’s quite emotional for me to reach this point. I’m not talking about sappy, crying sort of emotions. What I mean is that I’m finally stepping back and looking at the whole picture. 7 years I have been here! 7 years! That’s around 1/4 of my entire life. And it’s the most recent 1/4 too, so it is more significant. Was it worth it? It’s too early to answer that question. One thing’s for sure though, it has been a huge sacrifice of more than just money and time.

Before I entered the Anesthesiology department, I didn’t know anything about it. I mean, I had the preconceptions that everybody else usually has: anesthesiologists give sleeping gas to patients undergoing surgery and then themselves sleep during the surgeries. I had heard throughout my life that they’re the laziest doctors who get paid a lot to do the least amount of work.

Okay, that’s not actually true of course. Well, they do sometimes fall sleep during surgeries :-D but it’s rare and it depends on the type of surgery. I will explain...

Let’s define anesthesiology first. I will try to use the fewest words: anesthesiology is the branch of medicine that deals with keeping a patient alive in critical situations. What is “critical situations”? It’s when if there is no intervention by a doctor, the patient has a high chance of dying. Surgery and being under general anesthesia are critical situations. General anesthesia is the act of putting a patient in a very deep sleep where if it is too deep, it can be permanent (the patient dies). So, when general anesthesia is given during surgeries, anesthesiologists are always present. They make sure the patient gets enough of the right sort of anesthetic meds (I’m over-simplifying here to keep it simple) to not feel any pain but also not die.  But wait - let’s not stray too far here. I told you about the definition of anesthesiology, right? Well, as you would’ve noted, it’s a pretty broad definition. I mean, “critical situations” can be anything, like a broken leg in the ER or a patient taking his last breaths in the ICU. Well guess what, anesthesiologists work in the ER and the ICU also. In some places, these doctors are sometimes called “intensivists” because they work in “intensive care” units (ICUs) or “EMs” (emergency medicine) specialists. But in Indonesia and many other countries where they don’t have intensivists and EMs, the work of keeping patients alive in critical situations is done by anesthesiologists.

So, what exactly do anesthesiologists do? Until now I keep saying, “keep patients alive” but I’ll try to be more specific (for the unimaginative among us). They’re always watching the monitor for the patient’s vital signs: blood pressure, oximeter reading, heart-rate, breathing, and ECG -- usually in that order. They’re also constantly making sure the fluids are balanced and there is no danger of shock or acidosis/alkalosis. As you can imagine, this requires a good anesthesiologist to have sound understanding of the cardio-vasculo-respiratory system along with the kidneys and GIT. 

Maybe many people don’t realize it but the anesthesiologist is one of the doctors who visits them the night before their surgery. We call this visit the “pre-op”. During the pre-op, we ask a lot of questions that then help us decide what sort of anesthesia the patient should be given and how risky the surgery is. We come up with an “ASA score” based on the result of the pre-op and the lab results (which we have to pore over during the pre-op). If it’s “ASA 1″, it means it’s a low risk surgery and if it’s a higher ASA such as ASA 3, then we may have to consider postponing the surgery if it isn’t absolutely necessary. During the pre-op we find out history of operations, past and current illnesses, and even things like false teeth. Why are false teeth important to know about? Find out in the next paragraph...

One very important thing that anesthesiologists do that I forgot to specifically mention is: airway management. During coma (e.g. coma induced by general anesthesia), the patients may not be able to breathe themselves (properly). So, we have to make sure that we use an airway device such as an endotracheal tube (ET) and a ventilator to help the patient breathe. During the pre-op, we need to find out which is the safest and best airway device to use during the operation. We do this by assessing the Mallampati score - which is basically to see how small their throat is - among other things. Mallampati 1 means you can see their uvula and a pretty poor Mallampati of 4 means that you can’t see any part of their throat from inside their mouth. We measure the opening of their mouth and the distance from their jaw to their neck and then from that point on the neck to their adam’s apple. The scale we use to measure isn’t centimeters or inches. Instead, we use the patient’s fingers. It’s easy and fast. So, if you haven’t figured out why we ask about false teeth by now, let me explain: when we’re inserting an airway device in the patient’s mouth, there’s a (high) chance that we’ll be accidentally hitting the teeth with it - and there’s a risk the tooth may come off and fall into the throat. There are other reasons also: if a patient has no teeth, then their mouth would be smaller and thus, more difficult to insert airway devices in their mouth.

The anesthesiologist’s job (in the operating room) starts with the pre-op (in the ward) the night before, as I’ve described. Then, the next morning, the anesthesiologist is the first one in the operating room. Wait. Instead of talking about “the anesthesiologist” in the third person, I’ll just talk in first person as if I’m in the anesthesiologist. Okay, so, the next morning, I am the first person in the room (and no longer speaking in the third person -- Sorry). I check the patient manifest (as I like to call it). I see the age and the weight of the patient next to their name and type of surgery. I check my notebook and I’ve already done all the calculations (with the help of the Anesthesiologist Android app) for the medications and fluids for this patient. Great. I smile alone in the bright operating room as I notice that those meds are stocked on the little anesthesiology cart parked near the head of the operating table. All of them are in glass ampule bottles. Careful not to cut my finger, I remember to turn the dot printed on the ampule towards myself, place my forefinger on the opposite side, grasp the top of the ampule with my thumb, hold firmly, and break the ampule’s neck over my forefinger while simultaneously applying an upward force using my thumb. I hear a “pop”. I pause. No blood. (the pain always comes later, so I check for blood first). Okay, no blood. No awkwardly broken glass. My latex gloves aren’t ruptured either. Awesome! I then expertly turn the ampule upside down, insert a needled syringe in with the other hand, and pull the liquid drug into my syringe faster than you can say “anesthesia”. I do this 4 to 8 times, loading syringes like ammunition in guns before a battle. Then, I check the equipment required for the airway. If it’s supposed to be ET intubation for example, I get the correctly sized laryngoscope and blade (making sure to check them), throw my stethoscope over my neck, grab a couple of ET tubes, connect the suction tube, find an OPA/MAYO, a stylet (pfft... nobody uses those anyways), and check the oxygen. While I’m thinking, “what else, what else... what did I forget?” the doors open and the patient is brought in. There’s an awkward transferring of the patient from their guerney to the operating table. I grab the bottle of infusion fluid (usually ringer lactate) and hang it. I make sure the patient’s arms are out sideways and bound, sort of like Jesus on the cross. Either there’s a 3-way stop-cock or just a bulging ball thingy on the IV cannula. With the 3-way stop cock, I have to screw off the needle off the syringe, screw the syringe on the stop-cock, turn the stop-cock to open it, and then push the drug into the patient. It’s easier with the bulging ball thingy: I just stab it with the needle of the syringe and push the drug. Then unstab and I’m done. Drugs are pushed into the patient before the patient even realizes that anything is happening. The patient is usually very quiet and looking scared - sometimes even praying. The operating room staff often talk to each other, pretending the patient is an object or isn’t even there. It’s weird but that’s just the operating room culture here. The patient might feel everybody is really relaxed and waiting for something. And they’d be right. They’re all waiting for the anesthesiologist to give the go-ahead. And the anesthesiologist looks like he’s waiting too. His eyes dart from the monitor to the clock, and then to his notebook, and then to the patient’s face and then quickly towards the anesthesiologist’s cart - remembering suddenly: “Omg, I forgot the syringe used to inflate the cuff on the ET!”   Eventually the drugs do their magic and the patient seems to fall asleep. If there was a moment when the 80s action music would be queued, it would be now. The anesthesiologist’s heart-rate goes up, pupils dilate. 

All eyes in the room are now clearly fixed on the anesthesiologist, except the patient’s of course - they’re closed. Very gently but quickly, I graze the patient’s eyelashes. The patient doesn’t flinch. This is it. I perform the triple maneuver - with just enough strength not to look strained (or break the patient’s neck) - and then, using the mask connected to the oxygen, I oxygenate the patient, preparing them for what I’m about to do to them. 

The surgeons stand there, fingers criss-crossed in front of them, waiting for the anesthesiologist’s next move. It’s the most interesting part and nobody in the room wants to miss it. Time ticks and tocks. The anesthesiologist knows what he’s doing. The lungs have something called the FRC (functional residual capacity). This is like extra space that we can saturate with oxygen, like an auxiliary tank of fuel, so we can get up to 5 minutes to insert tubes without the need to give the patient any air. So, despite the oximeter showing 100% oxygen saturation, I keep holding the patient’s jaw with my middle, ring, and pinky finger with the mask affixed on the face with my first finger and thumb. My other hand squeezes the rubber bag to manually deliver breaths to the patient. The squeezes look random, but they aren’t. One eye is on the patient and his rising-falling chest, and the other bounces like a ping-pong ball between the monitor and the clock. This is probably how famous figure-skaters feel: they know the world is watching but they have to focus so hard not to mess up that they can’t even spare a moment’s gaze or thought on their audience. Another milestone hits. Without taking a single step away from above the patient’s head, I pull the oxygen mask off. A mental countdown clock starts as the oxygen in the FRC starts diffusing into the lungs. With hands as stable as a horse, I snap the laryngoscope together, yank the patient’s head back, shove the metal blade in their throat, bend over forwards and down slightly, and with the other hand, insert the ET tube into the correct hole (the breathing hole, not the swallowing one). A stethoscope is then used by an assistant on the lungs and the stomach. It is like a referee being given a chance to decide something very critical. He nods and gives a thumbs-up. I sigh with relief and continue bagging while using tape to stabilize the tube which is now going from the ventilator to the patient’s lungs (almost). The tension in the room eases. More drugs are pushed into the patient. The surgeons are given the okay and they begin their butchering and gossiping.

The anesthesiologist may look relaxed during the surgery but he’s constantly listening to the monitor: “beep... beep... beep... beep...” and the second there’s a “boop” instead of a “beep”, the anesthesiologist whips his head to look at the monitor so fast, you can almost hear the swoosh and crack of a bullwhip. And yes, the beeps from the monitor actually mean something. The frequency of the beeps is the heart-rate (everybody knows that) and more importantly, the pitch is the oxygen saturation. Every five minutes, the anesthesiologist has to update everything including vitals and medications onto a chart. There’s a load of paperwork involved, so it isn’t unusual for there to be a desk provided for the anesthesiologist’s use in the operating room. At the end, the patient is brought back out of their induced coma, the airway device removed in a responsible manner, and the patient prepared for transfer to the recovery room. I accompany the patient until the recovery room and make sure he’s stable and (sort of) awake. Now I can walk back to the operating room and do it all over again for the next patient.

At the end of the day, when I’m exhausted, I remember I have “jaga malam” (night shift). Luckily, before that, I have time to shower and eat. Oh wait, no I don’t. I have to do pre-op. After the pre-op, I rush to the ICU; a sad reminder that anesthesiologists are also intensivists here.