Ah Chou is dreaming again: Christ in Gethsemane, pleading with His Father to let the chalice of suffering pass from him, even as his Passion awaits. The Son of God: in agony, sweating drops of blood, trembling under the weight of the world. An angel lifts the chalice of suffering to Christ’s quivering lips -
And Ah Chou awakes, cold sweat soaking through his pajamas.
He checks the time on his phone. 5am: he’s already late for work.
Ah Chou is a junior doctor who only started work a month ago. In his country, junior doctors are called “housemen”, presumably because they spend more time at the hospital than they do at their own homes. “You’ll never see the sun — you go to work before sunrise and you finish work after sunset,” warned a senior doctor once. He was right.
Ah Chou takes a fleeting shower, gets dressed, and speeds to the hospital. He has to finish “reviewing” his patients before his seniors arrive; his seniors would expect a full and complete report of the patients’ overnight progress, and every missing detail would elicit certain fury.
“Reviewing” a patient meant asking a patient some pertinent questions — “Did you sleep alright? Any pain? How are your bowel movements?” But most of what constitutes a patient review is monotonous, pointless work, such as making a summary of the patient’s entire time in the hospital, as well as copying down the patient’s drug history from the patient’s drug chart. Pointless because all you need to do is to flip a few pages back to see the patient’s past medical history and consult his drug chart for his medication history. This ritual is a mere formality to mark his junior status. But what else is he if not a junior doctor — barely useful, stupid, and forgetful, and so the obsolete tradition continues.
It is 5.30am. His seniors will arrive around 6.30am, so he has an hour to review eight patients. He does his work as quickly as he can, sweating as he tries his best to commit minor details to memory in case he is interrogated by his seniors (once again, a pointless exercise, since almost every patient detail you could ask for is in the open case files).
6.30am. His assigned senior doctor arrives; senior in the sense that she is two years further along the medical career pathway than he is. But you wouldn’t guess it by their interactions: she walks in like Hippocrates reincarnate; every junior doctor squeaks, “Good morning, Doctor” and then recedes from her path. Ah Chou can see that she is in her usual temperament today: malicious.
Ah Chou stands at a corner when she begins reviewing the patients herself; senior doctors barely trust the patient reviews of junior doctors, so they write their own.
“What is the patient’s latest potassium levels?”
Ah Chou isn’t entirely sure, but he must give an answer, and quickly. “3.5, Doctor.”
The senior doctor scowls with displeasure. From the patient’s case notes, she reads the correct figure: “It’s 4.0.”
She bangs a hand on the table, startling the patients. Ah Chou braces himself for what he knows is to come.
“You lot of housemen are really useless. You come in earlier than I do, but spend all this time doing nothing. It is better if you are not around and I just do the work all by myself.”
Ah Chou nods reverently and apologizes. It is the only acceptable response.
The senior doctor raises her voice. “Go back to medical school and learn why potassium levels are important. 3.5 and 4.0 are not the same thing. Just get out, you’re really useless.”
Ah Chou freezes for a moment. If he leaves the room, he would be derelict in his duty; if he stays, he would probably have to endure a few more rounds of shouting. Damned if you do, damned if you don’t.
Ah Chou decides to stay, but does his best to make himself as inconspicuous as the bedside curtains. He is sweating again, and he feels a sense of panic rippling through his chest. Useless. Go back to medical school. He has heard those words countless times; every junior doctor in his country has.
Eventually the big bosses, aka the medical specialists, arrive to do their ward rounds. Specialists only address senior doctors during their rounds; the juniors might as well be ghosts. He remembers a joke he once heard: a junior doctor is but a glorified clerk with a “Dr.” in front of his or her name. Junior doctors are often locked out of the “meat” of actual medicine — reading X-rays, discussing possible diagnoses, bedside teachings, and the finetuning of patient treatment. Why? Well, junior doctors are junior, slow, and stupid, isn’t it obvious?
To understand the poisonous dynamics of medical hierarchy in Ah Chou’s country, you need to understand one key thing: there is something worse than the death of a patient, and that is being blamed for said death. Doctors and nurses — everyone is playing a game to do the bare minimum to avoid blame for a mistake. Nurses are focused on one thing and one thing only: documenting what they have done for their patients, and if anything happens, inform the doctors and document that too. Nurses are above spending too much of their time suctioning the excess saliva off a patient or sponging down a patient’s fever — that’s the responsibility of the patient’s family. And so each patient has at least a family member that sleeps by their side, either on a plastic chair or on a makeshift cardboard bed. Visiting hours are 24/7.
Once you understand this core principle of medicine — the avoidance of personal blame at all costs — you begin to see why doctors are so vicious to each other. Medicine in Ah Chou’s country is dystopia realized; doctors snitching on each other, gossiping about each other, shoving responsibilities to pliable colleagues and then making a quick escape once their shift ends.
After Ah Chou has completed his morning tasks, he and his other junior doctor colleagues sit down for lunch at the pantry. As usual, the chatter is about “malignant” senior doctors (all senior doctors are quickly appraised by their juniors to be either “benign”or “malignant”).
This time, the topic is about a wicked senior doctor in another department that is known for her vicious tantrums.
“Did you know, Ah Chou, that once this senior berated a junior so badly that he had to take psychiatric leave for a week?”
“Yes, Ah Chou, and this senior doctor would literally press her pen into your flesh while yelling about how incompetent you are.”
Ah Chou barely nods; he is used to these stories; he has been a victim of such behavior himself. Verbal abuse is the native tongue of medicine in his country. Physical abuse happens sometimes; sexual abuse rarely.
Ah Chou is fatigued; he had been working 16-hour shifts for the last three days, and 16 hours commonly stretch to at least 18 hours with the heavy workload (and no extra pay). The conversation recedes in his mind while he drinks some orange juice from a plastic cup. In a brief moment of delirium, the plastic cup before him transforms into Christ’s chalice. Ah Chou is back at Gethsemane again.
Why are his dreams increasingly eroding into his daily life? Ah Chou is a devout Catholic, going to mass at a nearby cathedral as often as he can (which is to say, at most twice a week). He begins to sweat again, and his heart races. What is this dream trying to tell him? What does this chalice represent?
In the afternoon, he has an appointment with the resident psychiatrist. To attend his appointment, he has to excuse himself, which is always a humiliating experience, since mental illness is considered a Gen Z weakness. But all his seniors already know that he is suffering from depression and anxiety; seniors gossip too. All he needs to say is, “I have an appointment, Doctor” in a deferential tone and he is quickly shooed away. There is only one type of appointment that junior doctors are allowed to keep during working hours, so they do not need to ask.
The psychiatrist is a kind man who has seen too many junior doctors walk through his doors. He knows the system is rotten to its core: little Napoleons commanding the wards, soul-shattering working hours (36 hours in some cases), and everyone, even the seemingly well-adjusted, walking a fine line between feigned cheerfulness and deep depression.
“How have you been, Dr Chou?” asks the psychiatrist in an empathetic tone.
Ah Chou’s mind is blank. He thinks of nothing, he feels nothing; yet he often feels on the verge of tears. Christ’s chalice of suffering suddenly pops into mind.
“I’m — the same, I guess.”
The psychiatrist asks a few more questions and he gets a few more nonchalant answers.
The psychiatrist lowers his voice for the next question. “And… Dr Chou, have you had thoughts of ending your life?”
Ah Chou almost snickers at the question; sometimes he feels that his life has already ended and that he is in purgatory paying for his sin of choosing medicine as a career.
“Well — the same.”
The psychiatrist nods knowingly.
A drug prescription and Ah Chou is back to work. Immediately upon returning, he sees a group of doctors huddling over a patient’s bed.
A senior doctor glares at him. “Hurry — help do the CPR.”
Apparently, the patient has become unresponsive. CPR is hard work; you have to press into the patient’s chest with the strength of your arms, right up to your shoulders. It is not uncommon for patients’ ribs to break, but better a few broken ribs than certain death.
Because CPR is laborious work, the junior doctors take turns. The junior doctors are never invited into the management of the unconscious patient beyond administering CPR; the seniors talk among themselves about this drug and that drug at this dose and that dose, but never include the juniors in their discussions. Junior doctors are a pair of arms, that’s all.
When it is Ah Chou’s turn to perform CPR, he kneels by the patient and starts pumping. Ah Chou looks at the patient’s face: not a healthy color. As Ah Chou gets into the rhythm of CPR, his mind wanders, and again the chalice manifests itself before him. How does it feel, he wonders, to be a patient receiving CPR? If life creeps back in, is the feeling euphoria, or horror?
Eventually the senior doctors tell them to stop: the patient can’t be saved and he is declared dead. His family members are allowed to come in. Curtains drawn, sounds of sobbing can be heard.
Sobbing, yelling, the cartoon voice that junior doctors use when speaking to their superiors, the eternal beeping of the monitor machines, and the loud beating of his own fragile heart: these are the sounds of the hospital from the perspective of Ah Chou.
It is 10pm. Ah Chou still has some discharge summaries to write, this time by hand because the computers are not working, which often happens. He also has some work left to him by one of his more brazen colleagues. The colleague in question did not officially hand over any tasks to Ah Chou; he just left them undone, which meant someone needs to clean up his mess, or else the whole group of junior doctors will be called in for a dressing down and be told to write an apology letter for being incompetent, careless, and stupid.
The final task of the day: Ah Chou prepares the blood bottles for the night shift junior doctors so that they can draw blood from relevant patients overnight and send the samples to the lab before tomorrow’s morning rounds begin. When he finally drives home, he is almost sedated with fatigue. He nearly fell asleep at the wheel and was lucky to break his car just in time before hitting another vehicle. Car accidents: another common feature in the life of a junior doctor.
Ah Chou showers, takes his depression pills, and climbs into his bed. Suddenly, his chest tightens and his breathing quickens. Another panic attack? Ah Chou grabs for more pills and swallows them. He cannot afford a panic attack at midnight — he needs to sleep while he can, and the countdown to the next working day has already begun.
In bed, Ah Chou dreams again. This time, he himself is in Gethsemane, and the angel is holding the chalice of suffering to his lips.
“Drink.”
Ah Chou looks at the angel, so radiant, so loving, so tender. An angel of light. He wants to obey; he wants to do God’s will.
But what does this chalice mean for him? Is it a cup of suffering that leads to death the next day, like Christ’s, or is it one that demands him to endure, endure, and endure?
Ah Chou weeps.
The angel touches his face, and clarity fills his mind. He knows what the chalice represents, and he knows what he must do.
Trembling, he grasps the chalice with both hands, and pours the bitter liquid down his throat.
