Last June, 33-year-old Dr Muhammad Haikel Lim was on his Postgraduate Year 1 (PGY1) rotation with the Department of General Medicine at Sengkang General Hospital. It was his first posting as a House Officer (HO). Still new to the hospital and its routines, Lim was rushing to the wards via a side entrance one day when he crossed paths with a woman carrying a shopping bag on her way to the taxi stand outside the hospital’s emergency department (ED). Mere steps away from Lim, she suddenly collapsed.

It took the young clinician a good few seconds before the gravity of the situation sank in—that he was the only person there at that moment with the knowledge to make a difference. Muscle memory from all the clinical scenarios that had been drilled into him during medical school kicked in. Even as he assessed the patient, Lim called for help.

He quickly determined that the woman was experiencing a seizure and followed his training, making sure that she did not hurt herself. Time stretched, dragging seconds into minutes until the ED porters and nurses came over to assist.

Starting work during a pandemic made the jump from being a medical student to a HO daunting for some. Currently on her rotation in Internal Medicine at Sengkang General Hospital, Dr Allena Bhavya Kanti, aged 27, said, “Starting work in the middle of COVID-19 made me more anxious. There were additional protocols and guidelines to remember, a lot of dos and don’ts to follow.”

Dr Kwan Yu Heng, aged 32, shared her sentiments. Even though Kwan was familiar with working in the healthcare sector as he had been serving part-time in various capacities across the National Healthcare Group and the Ministry of Health before embarking on his studies at Duke-NUS, the pandemic brought many changes with it.

“There are many new rules; for example, having to wear an N95 mask inside Singapore General Hospital’s ED. The hospitals were zoned into hot and cold areas (COVID-19 and non-COVID-19 areas) with safety advice clearly demarcated,” said Kwan, who is currently on rotation with Orthopaedic Surgery at SGH.

Dr Kwan Yu Heng (left) marks his rotation at Changi General Hospital with a friend // Credit: Kwan Yu Heng

But with guidance and support from his colleagues, Kwan felt assured that the safety of staff, patients and visitors had been placed topmost. He added, “I felt that there was lots of guidance and sharing at the start as we are new and in the middle of the pandemic. The seniors on the ground were exceptionally watchful of our safety. I felt safe.”

Another unique challenge these doctors faced was keeping on top of the frequently changing safety protocols and guidelines that affect their day-to-day work was constantly being refreshed.

Dr June Yu Zijun (left) and a colleague during a short break on their shift // Credit: June Yu Zijie

“The need to adapt and keep learning in the face of so much information, on top of regular HO work, was challenging,” said 30-year-old Dr June Yu Zijun from her posting to the Department of General Surgery at SGH. Before her journey at Duke-NUS, Yu had earned her undergraduate degree from the University of Cambridge.

An additional unexpected mental burden that hung over them while they adapted to the changing requirements—and one that was borne out by the events of recent weeks—was aptly described by Lim.  “Whenever a patient on the ward tested positive for COVID-19, the care team’s anxiety was palpable,” said the National University of Singapore Master of Psychological Science and Biostatistics and now Duke-NUS MD graduate.

“I guess there was some sense of responsibility, that this is what we were trained for—to help our colleagues on the frontline; but there was always this background level of fear—did I come into contact with someone who was COVID-19 positive? Am I asymptomatic? Am I in danger of passing it to my children? To my pregnant wife?” added Lim.

In the face of these challenges, the four graduates unanimously agreed that their patients were their strongest motivator. Yu said, “There were times when our actions would directly affect another person’s quality of life and survival. It was tough at times, but knowing that making the right choice—and sometimes, the more difficult one—and acting on that, overcoming the odds, could really make a difference to the patients is very fulfilling and motivating.”

For Kwan, learning from his patients and seniors, being stronger and calmer in the face of emergencies and seeing his patients going home to get better were the most rewarding.

Like many in the healthcare field, these young clinicians are so focused on caring of their patients that they sometimes neglect their own mental wellbeing. Now, with some experience under their belt, they all agreed that it was important to reach out to others when needed to take better care of themselves.

“It’s going to be a tough transition,” said Yu. “There will be times when we might even think of giving up after we have had a particularly bad day. [But] remember to have faith in yourself. You have the resilience to overcome these difficulties. We did get through medical school and the tough times then!”