A Decade As A Doctor

Ten years is a long time to get familiar with the bodies and minds of strangers. It’s a decade of fluids, of pus and blood and urine and amniotic liquor and cerebrospinal fluid and vomit and shit and tears. It’s a decade of skin, from the fresh, lochia-covered epidermises of newborns, through the tattooed, scarred hides of hard-living thirty-somethings, to the thin, loose and often bruised skin of the aged. It’s ten years of cavities: ear canals, throats, the organs of excretion and procreation. My hands have been inside more peritoneal cavities than I remember, my gloved fingers have probed pleural spaces and the insides of skulls.

A decade of hospital life is a decade of smells. The musty smell of rifampicin, sickly-sweet gangrene, the better-than-it-tastes smell of hospital food, appendicitis, the recycled oil smell of hospital canteens, the smell of puked-up alcohol, the smell of my own body after a long night of work. It’s a decade of learning to identify the cold, metallic smell of death. A decade of hospital life is a decade of the midnight trudge, from theatre to ICU, from casualties to the CT scanner, under fluorescent tubes that never switch off, up and down hundreds of stairs, along corridors covered in kilometres of linoleum. For six years I did the trudge in a pair of brown Crocs my boyfriend bought me in my fifth year of medical school, until a needle fell from a patient’s arm and went through one of the holes, impaling itself in my foot. It was full of HIV positive blood, but that was neither the first nor the last time I took ARVs as post-exposure prophylaxis. I threw those Crocs away after that.

A decade of hospital life is a decade of calls, of nights without sleep, of Woolworths microwave meals and Coke Zero, of 3am despair, of relief as dawn finally appears through the hospital windows. It’s a decade of sleeping when and where you can, in flea-infested call rooms with broken windows, with your head on your arms at the casualty desk, on theatre couches between cases. Once, a colleague and I found ourselves locked out of the call rooms after a power failure, and slept side by side on a pair of theatre trolleys. It’s a decade of ward rounds, from the all-day kind in the medical wards to the twice-daily whizz-throughs in the surgical wards to the excruciatingly slow academic Grand Rounds. I have left ward rounds to vomit, and once I fainted. It was secondary to a vasovagal response to my patella subluxing, but still, it happened.

I have cried so, so many times. I have cried out of grief for patients and their families, and out of pity for myself. I have cried out of sheer exhaustion. I have sobbed in my boss’s office after seeing an eight year old ripped to shreds by a truck, I have cried in the smoker’s courtyard on Christmas Day, I have wept into my theatre mask whilst doing chest compressions on a patient on-table, I’ve cried at patients’ funerals. After I came back from my first maternity leave I cried so often that it became a departmental joke: we declared Mondays a Free-Cry day and the rest of the week was for Crying By Special Permission only. I have seen so many other people crying. Interns crying on ward rounds after being scolded, medical officers weeping in corners at 3am (the universal Hour of Despair), tough men with tears dripping off the tips of their noses onto their children, women crying as they’re given yet another lot of bad news in a life marked by pain. I’ve seen countless men dronk verdriet, sobbing in trauma units as their bar-fight injuries are tended to, and what feels like thousands of children wailing out of fear and pain.

Ten years of medicine is ten years of successes. There are moments that are instantly satisfying: popping a shoulder back in, pulling a coin from an oesophagus, lifting a new, yowling baby out of its mother’s body. It is ten years of the spine-tingling satisfaction of landing a central line or slam-dunking a tricky diagnosis, and once of seeing percutaneous saturation start rising after I performed an emergency cricothyroidotomy on a man who had been shot through the face. It’s also ten years of slow, hard-won victories. Seeing babies put on to their mother’s breast for the first time after weeks or even months of intravenous feeding, seeing adults who were carried into a ward walk out on their own, after weeks of drips and tests and surgeries. It’s the ability to discover that I can perform with ease an operation I thought I would never master, the satisfaction of doing difficult things through ever-tinier incisions, the pleasure of seeing younger doctors learn and grow. It’s also ten years of failures and loss, of cold, stiff bodies found in beds on morning rounds, of shell-shocked relatives holding plastic bags of possessions, of dejected backs turned on patients who just could not be resuscitated. It’s ten years of the frustration of failing to get a drip up, of wheeling patients back into theatre when I thought I’d done a good job in the first instance. These successes and failures happen almost simultaneously at times: I have high-fived radiologists for reducing an intussusception on the same shift that I have seen one of the surgeons I look up to most in the world sit in a stairwell with his head in his hands, saying ‘It’s just so fucking shit’, over and over again.

Ten years in medicine is ten years of receiving abuse even after saving someone’s life, and ten years of being thanked for the silliest things: dressing a paper cut or cleaning wax out of an ear. It’s ten years of being thanked just for doing my job, and ten years of being thanked even when the result was death.

A decade in medicine is a decade of being carried. I may have carried my tired body on my burning feet, but my spirit was carried by endless seniors and supervisors and colleagues and friends, who saw me at my darkest, most pathetic times, but for some reason chose to continue to believe in me. It’s a decade of being carried by my husband and family, who didn’t know what they were getting themselves into and never chose this life for themselves, but somehow found themselves roped in, and seldom objected.

A decade in medicine is a decade of learning to strike the balance between kindness and toughness. It’s so hard to be kind in a system so brutal. In the beginning I was angry, all the time. With patients for not taking their medication, with relatives for challenging my advice, with nurses for ignoring my orders. I shouted at scrub sisters and interns and porters. I once found myself yelling down the phone at a neurologist at 4am. ‘What is the point of your existence?’ I screamed. When I put the phone down, everyone in the casualty unit was staring at me. I think that very often the person I was most angry with was myself, for choosing a life that seemed so hard and so thankless, and for so frequently failing to do my job with grace. After a few years of shouting, a boss told me that he was going to send me to anger management lessons if I didn’t calm down. I pulled myself together, and considered getting the words ‘Be Kind’ tattooed onto my wrist, as a constant reminder to try to be better. When you are kind to people, they are kind back to you. They thank you instead of shouting at you. They help you instead of blocking you. They forgive your mistakes.

As much as I’ve needed to learn to be kind, I’ve had to learn to know when to draw a line, and when to tell someone (including myself) that something is not ok. Sexism, racism, bullying, unprofessionalism, and laziness are rife in the profession. Empathy for colleagues is essential, as is kindness to myself, but some things shouldn’t be allowed to go unchecked, and discipline is paramount.

After a decade in medicine, in a way, my career has not even started. I’m still not a specialist, and am technically still a junior doctor. In thirty years’ time, as I approach my retirement, I might look back on this post and realise I knew nothing. These ten years past may feel like a heartbeat, nothing more than a deep breath before what was to come. Or maybe I’ll look back on them and think they were they hardest of my life, and feel relief that the eternal doubt, the fear and the worry that are the hallmarks of learning to be a doctor are so far behind me.

A shortened version of this post is up at The Huffington Post SA

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