Historically speaking, I was not the master of hands on skills. I get bored easily. If I didn't do things well at the beginning, I'd quickly get impatient and abandon the task. I used to learn the piano. I love playing but I rarely play anything to perfection. I can count the number of songs I can play without a mistake with my ten fingers. Even up to exam time, I played the wrong note and stop in the middle of the piece. When I played the school song during the assembly in primary school, I always get something wrong every week, and it only started to become note-accurate on the last few weeks of my primary school life. This was how unreliable I was. I feel sorry for people whom I accompanied in singing competitions and choir because the piano part was always bad (but they always ended up winning somehow, and I get some of the credit!). I can sightread and learn quickly but I never had the urge to practise and perfect it. I blame the teacher that I didn't get on with and the broken piano that I had to practise on until grade 7. My carpentry, soldering and needlework in school were consistently horrible. I just couldn't nail two pieces of wood in the right angle, or solder the electronics right so that all the LEDs would light up.
Having to be able to master hands on skills was one of my worries when I was contemplating on studying medicine. Having seen numerous GP having multiple stabs on me and my family when taking blood before I went into medical school, I had the impression that it was a very difficult thing to do and I didn't think I was ever going do it well. If I have to turn out to become one of these doctors so unskillful that I have to stab my patient multiple times, poke around underneath the skin for several minutes before I could get the blood out, I'd rather not do medicine at all. I had the same thought about the many other skills required of a doctor. I was seriously doubtful of my own ability, unsurprisingly given my history. But, as you all know, I have stuck with medicine in the end, and I knew I just had to put in the effort to learn them well no matter what it would take.
They turn out not to be not as difficult as I imagined. There are steps to follow for every procedures in medicine. For example, in venupuncture (taking blood from a vein), I have to prepare all the equipment, consent, put on the tourniquet, find a vein, clean the skin, warn the patient, stick the needle in, withdraw the plunger, disconnect the bottle, release the tourniquet, withdraw the needle, press on the site and then apply the plaster. I know, too many steps it seems but I have done it do many times that it now feels like a fluid one step action. In an exam, we must demonstrate as if we have done all of these for a hundred times (we call this 'slick'). For nearly every skill the medical student would have to learn, we get a few practice on the dummy first. Dummy resembles very little of the real human, but it allows the novice to get the order of the procedure right. Then when moving on to the real patient, we learn how to shake off our tremor, take time to tap out a juicy vein and dealing with the anxious needle-phobics, in other words steps not included in the textbook but practically essential. In my third year, I would only practise on someone very easy to bleed and gradually I started to do it on more difficult patients. I still miss sometimes (and senior doctors have reassured me that everyone miss at some point), but I am getting there. I don't think I am not as bad as I imagined myself to be.
I have ended medical school rather liking to use my hands. From the very start, because I was really motivated to be good at these skills, I was constantly on the look out for anyone that needs blood taken, cannulated or catheterized, and would leap to the chance to do it. As a result, I am relatively ahead of other people in my year. Compared to the average student, I have done the basic procedures for more times, have tried it on more difficult patients and have moved on to learn more advanced skills. Consequently, I also get a fair amount of positive comments and encouragement from doctors supervising me. All these have made me rethink about learning to use my hands.
Of course, I am writing these because I am seriously thinking about becoming a neurosurgeon. I have never thought about doing surgery before because I didn't realize the skills element to it. I know it's a bit thick of me to say this, but in my third year, when I go into the operating theatre, all I would do is to stand of the corner and watch the operation from afar, occasionally being questioned on my anatomical knowledge. It was boring. In the fourth year, I started playing the retractor but it wasn't the hardest job in the world and certainly didn't require a lot of thinking and learning, so I was bored although it was much better than just watching. Fifth year was quite different. When I was attached to the urology firm, I wasn't expecting many opportunity to scrub up because most of the procedures didn't require an assistant. My consultant and registrar knew I had turned up regularly in theatre and had observed many cystoscopies and circumcision. So on my last week, I was asked to do part of these operations myself. I didn't expect it because we do not normally learn to do operation as undergraduate, usually only the surgical trainees get this sort of operating experience. Eventhough I wouldn't say I have done a good job, I was really thrilled because I was experiencing something new. It was like I have suddenly come to a realization that surgery is just like learning how to take blood. In the end, urology did not appeal to me, but surgery did. On my first day in neurosurgery, the consultant was positioning the patient's head but I wasn't concentrating thinking that I probably wouldn’t need to know this anyway. He said to me 'You have to look carefully Yee Yen, because the next time, you will be doing this'. Yes, such a big difference it made being told that I will actually doing it next time! That was my mistake. It was the equivalent of the difference between hearing and listening. This is the reason why I was bored of theatre before this, because it was just like watching a film, not needing to learn anything out of it, so passive. It was as though I was in theatre just to sniff the air, have a feel of the atmosphere. Since then, I always concentrated when observing an operation as if I will do it next time. I knew I had to assist from time to time, so I observed carefully how to do it well. And every time I did something, even simple things like scrubbing up or suturing, I thought to myself: this time has to be much better than the last time. I could see my skills improving with time, and it was extremely satisfying. As of now, none of my skills are perfect yet and it makes me want to practise them more often so I can be perfect. One day, I was doing quite a lot of procedures, and the anaesthetist said 'you have done many things today, haven't you? Cannulation, catheterization, intubation,' 'removal of meningioma..' the neurosurgeon continued. He was joking of course. I didn't remove a brain tumour that day, but one day perhaps? To put brain surgery side-by-side with skills which I already am doing it seems not too distant a dream to pursue.
Ever since my surgical placements, I have become increasingly frustrated to not be allowed to do things that I knew I can do (either because I have done it before or I have seen it for so many times). The problem with undergraduate medical education is that we don't get enough hands on experience. Occasionally, consultants speak of some ‘back in those days’ stories, about things they did as medical students like administering anaesthetics alone, washing out wounds, having to deliver 20 babies etc. I was meant to sympathize them because it was hard work but instead I am rather envious of their experience. I wouldn’t have minded the hard work at all. These days, we just do not get taught anything other than what are immediately useful for us, and these surgical skills would not be. I was lucky that I had such keen and passionate teachers. Without them, I wouldn’t have realized what being a surgeon is really about.
Back to music, since coming to Manchester and joining the chorus, I saw with my eyes and heard with my ears some of the most talented musicians and the most rhythmic pianist play, how grand a sound an orchestra can make. I feel inspired to be like them. I know how they do it: practise, practise and practise. Anyone can do that. I am now practicing three pieces to accompany my younger sister for her violin exam. (She has also recently been enlightened about the point of practicing, read her thoughts here). I have been practicing everyday for nearly two weeks now and I am not yet bored. I really enjoy practising. I like really concentrating getting a part right, do it again and again and again until it's perfect. Even for scales, when I can do it perfectly in the tempo and ‘legato-ness’ I want, it’s immensely satisfying! But what do playing the piano and neurosurgery have in common? The fine motor skills. When assisting in a spinal surgery once, I was asked to hold a retractor gently under the microscope. I was nervous because my consultant said ‘don’t pull too hard, the ability for the patient to dorsiflex (cork his foot) is in your hand’. I had to concentrate quite hard to do it. There is definitely no room for clumsiness or complacency in neurosurgery. I am still not entirely convinced that I can do it. I need to prove to myself that I am capable of learning to use my hands to operate on delicate structures of the brain and spine. I think it would be harder than venupuncture, but less difficult than playing the piano. So, with regards to skills, I have set myself a challenge. If I can persevere to get a merit in grade 8 piano, I would go ahead to train as a neurosurgeon.
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