Don’t think you are, know you are

in CME/Training by

I love the outdoors ever since I was a kid. In fact, I spent most of my childhood summers in the highlands driving water buffaloes and riding horses uphill with my cousins! So when a friend invited me to climb Mt. Apo one day, I answered with a resounding “Yes!”. Never mind that it was 20 years since I last set foot on a dirt path. Forget it that I’m terribly out of shape for the summer’s race-to-peak craze. The temptation to beat the trekking odds is there. And the chance to be on top, no matter how amateurish and hard it will be, is downright exciting. I’m not the kind of guy who shun opportunities. “Count me in! When are we climbing?

It was visibly elated to know that despite the hundreds of others worthy of such “luck” I have been accepted to a residency program of my choice. Knowing you’re not “brainy and in shape”than most of the applicants, you’d jump at the slightest hint of acceptance. Coming from a well respected center, this is not the type of opportunity you think about twice. Indeed I jumped at the opportunity, not knowing where to put my ass around so many icons and pillars in the world of orthopedics. I am putting forth my best show- “to belong”. I immersed myself in the “cloak of invincibility” and forgot what’s coming…

“Mind over matter” is no gainer.
I have to prepare for the climb of course, even if I got so little time to do so. The stubborn and stupid in me believed I can shape up for this climb in two weeks. “Two weeks is better than no preparation at all” I said. I have climbed hills in the past, but not mountains. “I guess thats enough?!”.

I tried to amass orthopedic tidbits so that in endorsements I can answer and in pre-ops, I have something to blurt out to show everyone I know something. This “critical mass” is all, but voluminous widget- a disorganized heap of ideas that I rarely knew worked in reality or in patients. Often, I never understood the wisdom and experience of my more senior residents and consultants no matter how much I read. Some of these “experiences” I think, were never even supported by an RCT! So the egoistic me thought I’m ready to wield a scalpel just because I’ve read Netter two days ago.

“I know Kung Fu!”- Neo, The Matrix
In a short time, I read so many things about trekking and mountaineering, more than improving my fitness and stamina. “I knew mountaineering!” The brain can accommodate such information explosion , but not our body-physical fitness and stamina especially. Physical fitness and stamina can only be achieved through disciplined training. Two weeks of training (as I learned later), didn’t even raise my heart beat. In this kind of treks, if you don’t have discipline, no time is ever enough preparing.

Bingo! I started cutting skins and pounding bones, to my salivating happiness. At long last, my dream of healing people while cutting them, became a reality. Ironic as it is, but thats the way I think the art and science of orthopedics is learned. I am a surgeon now-or at least thats what I’d like myself to believe. “I cut, ergo I heal”

“Come on! Stop trying to hit me and hit me”- Morpheus, The Matrix
So the apprentice in me, eager to prove he can conquer a peak despite the obvious half hearted preparation, went on with the the climb. Barely a hundred meters from the jump off site, we went into every sort of obstacles. I was carrying a back pack heavier than what my body can endure. I packed in so many useless stuff without really asking the more experienced climbers. It is such an agony to hike with a heavy pack full of useless gadgets and clothes. I was darn too tired dragging my ass through the trails and obstacles. Which made me drink my water supply fast and inched in thirst before the next water refilling stop. Obviously, my fitness and conditioning was well below minimal for this trek. It was a cycle of recurring mistakes and lessons after all. Even if I read all about it and I knew it even, theres no substitute for experience in the wilds. And the worlds of the older and more experienced climbers rang with so much wisdom.Looking back, I left it to luck for us to survive.

Then the morbid realization came after I encountered my first ever mortality.Fifty six year old female, with perfectly controlled DM, a cardio clearance, post hip replacement, found dead in her ward bed, from a silent MI, the night before the patient is to be discharged. The patient gave me a token gift- a handsome polo and a tie the day before and a tight, cheerful hug. “Salamat doktor sa pagopera mo sa akin!“What went wrong? What the heck did I miss? I read and studied books and journals for this case! And this was not even an eventful procedure! At two AM, I was devastated mulling over the reasons for such unexpected demise. Then a consultant told me, he had a similar case before and he noticed that such age group is prone to “silent’ death post op. I gnash in agony.

“Don’t think you are…Know you are!”
After luckily surviving the inordinate trek and making it to the top of the Philippine’s highest peak, it is then that I realized how lucky I am to survive a journey with all my ego and stupidity at the forefront rather than wits and fitness. There is more to lessons learned on your way up, than the vast emptiness of the so called “peak”. So what now? Here I am standing on the tallest place in my land. I could barely see a thing because of the fog. There’s not much place to go around the peak. It will be crowded soon because all other climber will have to stand on this peak too. And this peak would just be another jump of point to some other peaks. There so many other peaks to conquer, treks to make and obstacles to hurdle. “I’m afraid of heights”. This sudden realization, of the fear being alone in the heights rather than falling itself, sent a chilling message to my heart. I have to go down.

Surviving residency is not just”luck” for residents. It is a given. The moment you entered the training halls of “cutting and pounding”, you have to “learn the craft” and make it to the top- which is your practice. Surviving the training is one thing, learning from mistakes during this training, is another. It is such a folly to dream of “the peak” without having to take a hard look at where you’ve been, and on whose shoulder your standing. The vast empty place you call “top” is nothing without “the craft” learned on your way up. It is here where you realize so many stupid things you did on your way up. You see butt holes in your ego, anecdotes in your reasons and immaturity at best, to your personality. More importantly, it is here at top, that you realize wisdom of “bone cutters from ages” who told you something about it, but did not so learned in haze.

So I’m taking the “jump”!
My learning has just started. Somehow I felt, it was just a beginning of a climb, to another mountain perhaps. It will be a another long arduous journey. Surely I’d be more careful now, with the lesson learned and wisdom of I gained from ages. I will need this wisdom on my way down. And on my next climb, my journey here would be nothing if have not learned something…

Looking back, I am yet into another journey-my professional practice. The realization of the wisdom of my mentors before, stuck into the ages of my wits. I am also an educator right now. That though perhaps, like the resident in me before, its very hard to see the wisdom of experience from seniors and educators and then fit them into what I read , into what I do. Surely, the experience is there for some reason. And in our journey to better serve our patients and community,we’re only half prepared if we don’t learn from those mistakes.

So, to everest?

Dr. Remo-tito Aguilar co-founded #HealthXPh. A board certified orthopedic surgeon, he is Chief of Clinics at General Santos Medical Center and Medical Specialist II Orthopedics at the Southern Philippines Medical Center in Davao City. Dr. Aguilar is a healthcare social media evangelist and writes his medical musings at The Cast & Curious (www.remomd.com).