Reading a friend's bulletin post in Friendster gave me many thoughts. It was indeed a crucial situation during her night 0n-call, having to handle a critically ill patient coming in in the middle of the night and death was just a few steps away. She had managed this patient well.

I started putting myself in her shoes. In 6 months, I'll be graduating if things go well..and I'll be a full-fledged doctor. I am excited about it since I've been waiting a long time for this day to come, but at the same time, the pressure increases because in half a year's time, I'll be given a whole new load of responsibilities. It is a life I'll be responsible for, and I will have to handle the patient before any of my team does. Mistakes should not be tolerated anymore, unlike when you're a student..and no longer can you claim that u're not confident for the fact that u're still a student.

I couldn't help but question myself if that will be me months from now. I have been handling the patients sent in straight from A&E for quite some time now, taking their history, examining them fully and doing all their investigations and making sure that I have a list of possible diagnoses before bleeping the seniors for review, and will be undergoing more training and refinement before graduation, but I am still worried I'll not be able to live up to the title.

What my friends and I have gone through showed how much we have grown through medical school. Those were the days when we still didn't know anything, when we had no idea what question to ask next when the patient said she's got chest pain, when we all go blank when the doctors say "What should you do next if u suspect a case of severe acute asthma", when we see our hands shiver during blood-taking, when we go "the heart beat sounds....erm...abnormal?" and avoiding further questions from Consultants that will kill us in the wards, etc etc. And now, even at final year, you're supposed to be giving a list within seconds for a symptom and rule things out with investigations. We find ourselves still having lots of "I don't know"s, but lesser and lesser as the days go.

My friend was mentioning about this Senior Registrar of her team who was so very firm and calm in her decision even though everyone else from the other teams, nurses, anaesthetists etc were blaming her for managing the patient badly. How can she remain so firm and calm after being told off by more seniors about her bad management? Why was she so dead firm that she's right when there are so many more people, junior and senior, who were against her diagnosis?

I know that one day, I'll be put in such a situation too. Of course, I would be praying for an entire smooth journey up the medical hierachy, but these things are bound to happen.

Is a doctor's calmness and firmness in decisions a sign of overconfidence, or a development through experience?

I feel terribly young at the moment because I cannot see how I'll be that way in the many years to come, yet it is a MUST since there are so many people under your lead and that they have to do your bidding, and you are the person holding the power of determining if this patient lives or dies. I didn't even foresee myself going "CXR, ABG, ECG, bloods done. Awaiting results now. I'll start off by administering blah blah blah..." when I was in first yr or even 3rd year...and now I can't even foresee myself telling juniors to do what I say because I am senior and hence, supposed to be right. Yet, that is how I should be next time.

I have seen all these coming before I entered medical school, but as you sink deeper and deeper into this deep sea, you fear more, you struggle more to live, you feel it more.