Doctor, get over thyself

(or, why Meredith Grey and Gregory House are medicine’s worst diplomats)

Salvador Dali, Portrait of Pablo Picasso, 1947.

I remember my first week as a bright-eyed, eager medical student. Okay, not bright-eyed, but instead blotchy, itchy, and generally terrified. I was recovering from chickenpox (let’s just say the bastard affects every. single. mucous. membrane.). I was just shy of eighteen, having recently squirmed out of the relatively progressive blanket of an Anglophone, Anglophile boys’ high school that prided itself in producing “Renaissance Men”. As the summer ended it was clear that I was definitely not in Kansas any more and, worse, had no ruby slippers to wish myself back into a halcyon adolescence. Instead I was forced to adjust to the fragile political climate of a university that had been a bastion of Apartheid privilege, and now found itself waking up to reality with a severe Calvinist hangover (it was 1995, and moderate white South African liberals were still considered communists.)

About 200 of us were put on a bus and driven across town to the medical campus. We were herded into the faculty building (its architectural style best described as ‘That One Time Le Corbusier Took Acid’) and made to sit in a cavernous hall that resembled not so much a lecture room, but the very Lion’s Den from the Book of Daniel. On cue, the Dean of Medicine appeared and informed us in presidential tones that we were the cream of the crop of our generation, winners, the finest, really, the best (evidently Trumpian syntax existed even then).

And so, giddy with expectation, we were bussed back to main campus to begin our studies in the basic sciences: physics, chemistry, calculus, cellular biology, basic botany, some zoology—all very scientific, but rendering us forgotten little planets in the faculty’s solar system. Far away from the event horizon of this thing called Medicine, its gravitational pull was still weak but growing—we hoped—exponentially until it sucked us into the singularity from which we would magically emerge as Doctors. Healers. Miracle Workers. Elites. Possibly even Jedis.

Except, for the next six years, many of us were made to believe we were the opposite of what we’d been told by the Dean: weaklings, losers, ungrateful fledgelings… really, the worst.

Okay, I exaggerate, but this illustrates a major problem I have with how my profession has been taught in the past. While I am happy to report I received an excellent education, I spent many of my undergraduate years plunged into cognitive dissonance. Unfortunately, I was exposed to a catechism that taught that the path to the sacred letters of MBChB was purgatorial, sacrificial, and, at times, an immolation of all things joyful. Our naïvété only served to magnify this echo chamber: the more you suffered, the voices chorused, the nobler you were, and the more you were “purified”. In essence, the sooner you put away childish things like feelings or (gasp!) outside interests, the quicker you approached a hallowed meta-human state where, it was whispered, you could endure 36-hour shifts without food and still find time to author a groundbreaking scientific paper.

Two particularly malignant stereotypes fed on this concept like tumours on an unsuspecting arterial bed. I have named them after two of the most well-known characters in television history, because their personalities are suitably archetypal.

First there was the Meredith Grey, the hand-wringing, complaining, angst-ridden registrar (or sometimes fourth year medical student, newly-exposed to clinical duties) who was constantly telling everyone how hard they worked, how impossibly difficult the exams were, and how so many lives depended on them. This was still bearable, until the moments where they paused dramatically, made sure there was an audience of at least three, and told you how they had just held the hand of a patient disclosing a devastating diagnosis and cried with them (we medics invented virtue signaling years before the term existed). Some wrote bad poetry about it, avoided expensive hair products and trawled the early Internet for discussion forums about the Jungian journey of wounded healers. At least these people had — or seemed to have — feelings, even if they were adept at emotional self-harming.

More terrifying was the inverted trope: the Gregory House. A consummate narcissist, this one was a brilliant clinician possessed of a God-complex that would have made a despotic emperor blush. They were as charming to their patients as they were vicious to their subalterns. Worryingly, their behaviour was copied and passed down the pecking order like a personality virus that fed on drama and theatrics. One consultant insisted that academic ward rounds be staged as a religious procession. He would glide forward in front, his long white coat trailing the floor like the robes of a bishop at Easter Vigil; the registrars walked lugubriously behind, followed by the medical officers, the interns, and finally, the medical students, who spontaneously formed their own mini-hierarchy in the cramped corners of the ward. (One patient, surprised by the mass of medics crowding around her, reached for her lipstick and piped up “Good Lord, it’s the paparazzi! I’m famous!”)

“Visitors” by Robert Pope © The Robert Pope Foundation

It seemed that clinical medicine was governed by two rules: (1) Because I was treated like shit by my superiors, I will treat you like shit; and (2) If you don’t suffer, you won’t be a proper doctor.

My reaction was classical: shock, disbelief, then active denial. There was anger, too, perhaps even bargaining. I didn’t know doctors that behaved like this. They were supposed to be kind, caring, and affable, like our family GP, who was a reincarnation of St Francis. They were supposed to be funny, like the paediatrician who managed to make me laugh at a silly joke when he did a lumbar puncture on my six-year-old self when I had bacterial encephalitis. They were supposed to be imaginative, like the anaesthetist at one of my myriad grommet insertions who told me that I was an astronaut and she was putting on a space mask and I was going to see the stars.

Had these lovely people really walked this professional Via Dolorosa that still lay ahead of me? And how had they somehow escaped unscathed?

I hit an emotional brick wall, rendering the final stage of grief inaccessible: I refused acceptance. I vowed that I would never be a Meredith or a Gregory. Instead, the undercurrent of magical thinking that’s always flowing beneath my consciousness became a survival mechanism. (I thought I was the only one: years would pass before it dawned on me that at least half of my colleagues were doing the same thing.) Maybe it was an epigenetic switch that had been flipped, something I had been primed for, being born in 1977, slap-bang in that unstable cusp between Generation X and Y. And so I raised a quiet middle finger to the hegemony.

I was an average student. I did my work thoughtfully, methodically, but ran away from it whenever possible. I hung out with artists and journalists and historians. I alternated every chapter of a textbook I studied with either a comic book or a grunge mix-tape or a chapter of Camus I really, really couldn’t understand and was only carrying around in order to look cool. I smoked Camel Lights gleefully while studying respiratory physiology. And, for the rest of my undergraduate years, I took advantage of the insomnia that has plagued my life since I was a teen: I continued my literature studies at night, taught English to adult immigrants, and even joined an online werewolf gaming pack on the Undernet (my character, inanely, was named “Balto” and had a predilection for Babybel cheese). I also found work in a pathology laboratory, where the chief technologist and I spent nights listening to Ella Fitzgerald, drinking cheap red wine as dark as the clotted blood in the tubes spinning away in the centrifuges.

It was, at first, an effective strategy. But it was not foolproof. The weight of being a more senior medical student took hold; on-call duties (read: do the shitty work for lazy interns) ate into the demimonde of my nights; examinations made my migraines return. I stopped playing piano. I stopped writing. I stopped swimming. I was angry. I had become the caricature I was avoiding: I was suffering, and somehow enjoying it.

One afternoon I ducked class and drove aimlessly around the city for hours, until I came to rest in front of a 24 hour GP practice in the middle of the student quarter.

I don’t think I actually had a migraine but I walked inside anyway, and told the receptionist with the beehive I wasn’t feeling well. Fifteen minutes later I burst into tears in front of a young GP with Clark Kent glasses and a tweed suit. On his desk were a set of keys to a Porsche. My words must have been a garbled word salad. I asked him what kind of Porsche he had, citing my love for the 911, then told him I hated medicine but I had been named after a doctor in the family and it would be a scandal if I stopped studying. I told him I hated myself and I hated the people who were around me (which was not true: my fellow students were and are lovely people). Finally, it came out: I felt I had slipped through the cracks, that somehow I was a fake, that my name had been mixed up with a worthier candidate’s application form for university when I was still in Matric.

“It gets better, you know,” was all he said at first, chewing on a 4B Staedlter pencil. Why a 4B pencil, I thought through the confusion? Artists use those for drawing… way too soft to make medical notes. Then I saw the framed drawings on the wall: a Siamese cat, a stylised nude couple in an embrace, a distant view of the Sacre Coeur on Montmartre, all with his signature.

“I’ll tell you a secret,” he said when I’d finished babbling. “As much as I love my job, it’s just a job.” He pointed to the wall, then to the car keys, then to a picture of his family. “There are other things. If you let this thing become your life, it will destroy you. So it’s good that you’re sad. It’s good that you’re angry. It means you want balance. I’m not sure I can give that to you, but let’s try.”

I walked out with a prescription for an SSRI and a referral to a counsellor (who, it turned out, was more interested in trying to hypnotise me to elicit false memories of abuse, a strategy that was very en vogue in the late 1990s. The counsellor did, at least, help me vent my spleen as the dam of depleted neurotransmitters slowly replenished themselves and the sunshine reappeared, at which point I told him no thank you, I’m quite sure I wasn’t a soldier in Napoleon’s army in a past life. Later, I found a clinical psychologist who introduced me to the dual wonders of cognitive-based and psychodynamic therapy. Most of my family members agree I’m still mad, only more articulate about it.)

Then a few wonderful things happened. I graduated. I left home. I started internship in another province in a large hospital complex where there were no registrars or professors or academic hierarchies. Instead the shots were called by the nursing staff, who were mildy terrifying, but also excellent teachers. I spent my entire first salary in a week, drove down to the coast for the weekend and dislocated my shoulder in my first and only attempt at surfing. Most importantly, I made friends with several colleagues who were just as frightened and uprooted as I was… and ready to admit (after a few drinks) that six years of med school had nearly eroded their souls. Emboldened, I meditated again on the words of my Porsche-driving, cat-sketching saviour.

Internship turned out to be one of the best years of my life. The workload was egregious at times, often thankless, frequently messy, smelly, sweaty… and yet, in that year, there was an en-masse jettisoning of the idea that we were suffering for some imagined Noble Cause.

I’m not saying that my medical career has been all starshine and puppies and Disney musicals since. My community service year was a small season in hell. But even there I found my niche: I discovered that I was pretty useless at surgery but found solace and fascination on the other side of the drapes, where ventilators puffed and drugs with long names were injected. And so, finally registered as an independent practitioner, I returned to the place I found freedom to learn anaesthesia, the specialty where I had finally found a “home”. One year later, on a late summer morning, I found myself in the hospital canteen because I was peckish after a particularly busy night shift. Without thinking, I asked the tall intern with curly red hair standing next to me in the queue if she would like a honey and Horlicks milkshake. (I have now been married to her for seven years.)

I’m 40 now, and have been doing this doctor thing for seventeen years, five of which have been as an honest-to-goodness specialist. I’ve been happy and unhappy and various grades in between, but I wouldn’t call myself a tortured soul. Specialising certainly wasn’t easy, but it was a conscious choice I made, and I would like to disabuse anyone reading this of the idea that martyrdom has any place in modern medicine.

I can quite confidently say that the greatest professional lesson I learned was not physician, heal thyself, but instead doctor, get over yourself…

“Then [Jesus] said, ‘You will undoubtedly quote me this proverb: ‘Physician, heal yourself’— meaning, ‘Do miracles here in your home town like those you did in Capernaum.” (Luke 4:23)

The idea that becoming a doctor has to be a path of pain and misery is a fiction we need to eradicate urgently. It does both the discipline and the people it serves a great disservice. Are the paths of engineers, lawyers, nurses, or teachers any less important? What of those who have not been afforded the luxury of a tertiary education yet without whom society could not function?

Unfortunately society has fetishized Western medicine into a false god full of promises it cannot keep, which we then abjure and sacrifice when its limits are laid bare. In this dinosaur of a model, we expect doctors to be infallible.

And so politicians would have you believe we are rich fat cats intent on sucking vulnerable patients dry. Charlatans sell understandably disillusioned patients snake oil therapies while demonizing allopathic medicine. Tabloids implicate us as being in perpetual collusion with drug companies holding the health of millions to ransom. At worst, we create a situation where the physician, made to believe she should shoulder responsibilities no-one else would be expected to bear alone, has no space to admit she is human, and fragile, and capable of making mistakes. (Malpractice insurance is soaring to the point that we are heading to a crisis in private obstetric care in my country—with monthly fees that are greater than the perfectly reasonable salary I take home as a specialist anaesthetist.)

I’m not trying to be trivial: mistakes in medicine affect (and sometimes cost) lives. What I’m saying is that placing doctors on a pedestal only to knock them off it is a recipe for disaster, because in doing so, we objectify ordinary human beings with extraordinary responsibilities, denying them the grace to ask for help and comfort—the very things they are supposed to give their patients.

Slowly (and not so slowly), however, things are getting better. At least in my specialty, we’ve abandoned a culture of naming and shaming (something some nanny state health systems would do well to stop perpetuating). Instead, error-reporting is meticulous but anonymous. As such, mistakes and near-misses are discussed in a neutral environment so that everyone can learn. We have embraced social media and the Internet to create a free and internationally accessible culture of education. We ask each other’s advice no matter what our ranking is. Work hours are increasingly regulated, and, as any surgeon will tell you, an anaesthetist who doesn’t get a tea break is a very unpleasant animal indeed.

The evidence for me is plainer, if not easily translated into numbers. If my undergraduate years were an endless performance of Waiting for Godot, my professional years have been more like starring as a supporting cast member in a pleasant dramedy like The O.C. or (bear with me) Glee, filled with likeable characters, engrossing plot arcs, some needless product placements and a great soundtrack. (Music is essential in theatre, and I maintain a key skill of an anaesthetist is to come up with a playlist that accentuates the best aspects of the surgeons’ personalities.)

The two rules are being rewritten: (1) I will treat you like a human being because I’d like you to treat your colleagues and patients as such and (2) The road ahead may be hard sometimes but if you are suffering there is something wrong and you must not be afraid to ask for help. I’ve told students that medicine as practiced in Star Trek — cooperative, gentle, and team-based — is a far better role model than the Cluster B psychodrama present-day medical television dramas keep serving up.

Because where I work, most of us get on with each other, and we get on with the job, and we go home and live the rest of our lives. We are atheist and Muslim and Christian and gay and straight and single and newly-married twice-divorced. We are mothers and fathers and refugees and siblings. We have hypertension and bipolar and high cholesterol and diabetes and give our dogs homoeopathic Rescue Remedy on Guy Fawkes in complete negation of the basic principles of pharmacology. We do Pilates and trail running and salsa and karaoke. We share cat memes and pictures of our children on Facebook. We spazz out over the latest evidence in journal articles and gossip at congresses when we should be listening to the keynote speaker. Some of us never physically touch patients but work fearsome and essential magic behind microscopes and computer screens. Some of us (like me) don’t expect our patients to remember us, but take pleasure that we made part of their journey as comfortable as possible. Some of us have even bravely left the profession entirely because we realised it was making us miserable and found solace in new avenues.

Life remains messy. It’s supposed to be. Yes, sometimes we’re sullen and angry and exhausted and even bitchy, but wherever I look it seems that Gregory House and Meredith Grey are becoming endangered species. Because doctors are learning to get over themselves… and it is only in doing so that we are able to heal, not only our patients, but our very selves, selves that were not born broken or diseased, but merely wounded by unrealistic expectations.

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