The Beginning Of The Rest Of My Life

(was harder than I thought it would be)

Right after I passed the exam that allowed me to finally call myself a paediatric surgeon, I kept finding myself in conversation about how I felt. Mostly, people told me how I ‘must feel’. ‘You must feel so relieved.’ ‘You must feel so proud.’ ‘You must feel so happy that you don’t have to study anymore.’ ‘You must feel like you suddenly have so much extra time.’ And yes, I did feel all of these things, to an extent. There was, however, a fairly large group of people, most of them people who had lived through a similar exam themselves, who would really ask me how I felt, and then stare at me intently while I tried to formulate an answer. Some of them, while I was bumbling through this mixed up story about how I felt good but also… would interrupt and go, ‘It’s really hard, isn’t it?’ And with these people, I would nod in relief. ‘Yes, it’s really, really hard. I never knew I would feel so bad, and I don’t know why I feel so bad. But I really don’t feel very good at all.’

I’ve complained before about how specialist training in this country is treated as this finite thing that you suspend your life for, thrash through, and then complete. With this mentality comes the idea that the end of this training will be a momentous occasion, that the moment your exam number appears on a ‘List of Successful Candidates’, your life will suddenly change, and only for the better. As a person who runs (albeit slowly), it was hard for me not to imagine this moment the same way I imagine the finish line at the end of a particularly hard race. There will be people cheering and handing out medals, and you’ll get a free Coke and you can eat whatever crap you want for the rest of the day and you don’t have to run for the whole of the following week without feeling a stitch of guilt about it. In the months leading up to the exam I found myself a couple of power songs* which I would listen to as I imagined that final moment, when the examiners would walk over to me and said ‘You passed. Congratulations.’ I thought I would ugly-cry, or scream. I thought I would fist-punch the air as I walked across the graduation stage, and have a photo taken of myself wearing my mortar-board and holding my children. I didn’t do any of these things. I just said thanks, left the room, called my husband and sent a bunch of Whatsapps. I didn’t make it to my graduation ceremony, because I was on call the next day and had to fly back to Cape Town immediately.

I want to say it was a relief to not have to study any more, but that relief was not apparent immediately. It took a long time for that undercurrent of anxiety to go away, that feeling of ‘There’s something I need to be doing’ to disappear. As the reality of not having to constantly study did finally sink in, I became aware of other problems that had been present for a long time, but that I had pushed aside. I seemed to have developed a mild form of PTSD or burnout related to my actual day job: before, I could attribute my constant anxiety to ‘exam stress’ but with that gone, I had to acknowledge that the panic I felt on call days, the anger I felt on ward rounds, the tearfulness I felt before a theatre list, could be attributed only to the way my actual job made me feel. As a result of giving away most of my lists so that I would have more time to study, I had lost touch with serious operating, much in the same way I lost touch while I was on maternity leave. There were a pile of projects that had stalled, that I had almost forgotten about but was obliged to pick up again. On the home front, I had become a clumsy, fumbling parent. I could barely get both kids into the car by myself without losing the plot, I didn’t know how to to play with them. I was so unaccustomed to spending an entire weekend with them that on Sunday nights I found myself more shattered than I thought humanly possible. There were friendships that were peri-mortem, some of which could not be resuscitated. On top of all this, I had gained a significant amount of weight during my exercise-free, Licorice Allsorts binging study confinement, and my cupboard was crammed with jeans that no longer fit.

But mostly, I felt adrift, and like an imposter. I had over a year left on my registrar contract, and the plan was for me to morph into something that was Post-Registrar but Not-Quite-Consultant. I will always be grateful that I had over a year of guaranteed employment post-exams, but for a while I did feel like I was in a kind of a clinical no-man’s-land. I was not needed or expected to do the million essential little tasks that occupy a registrar’s day, but also wasn’t entrusted with the rights and responsibilities of a true consultant. One pathetic afternoon found me weeping in my boss’s office, saying that it felt like there was no place for me at this hospital, which I had come to think of as my second home. I had only a very vague, gap-ridden and uncertain 5-year-plan, for the first time in perhaps my entire life. For doctors who make an early decision to specialise, there may be some uncertainty along the way — what do I actually want to specialise in? Where will I get a reg post? — but mostly, there is always a well-worn path to follow. I suddenly had no more compulsory boxes to tick and although the future was suddenly open, it was also terribly uncertain. I am not surprised that so many young specialists, no sooner than saying they’ll never study for another exam again, fling themselves into a difficult fellowship or sub-specialty, embark on a higher degree, or aggressively start building families. We’re not used to living lives without short-term goals, without a line of beacons ahead by which we can gauge our progress.

And then, that Imposter Syndrome. Man, that’s a tough thing. For me, the feeling it was most similar to was that Not-Quite-New Mother feeling. The baby is out and you are no longer seen as special because you’re pregnant, the gifts and visits and meals have come and gone, and all you have left is this baby you love but that wracks you with doubt. You know how to change its nappy and hold it and feed it, but you worry that at any moment you’ll do something that will break it completely, that you’ll be revealed as a person not fit for parenthood — an imposter — and that everything will be ruined forever. I often still feel like this at work. There’s still this nagging feeling that I just got lucky at the exam, that they just happened to ask me the stuff I knew. I still feel like at any moment I’m going to be exposed as someone who doesn’t actually know the basics, like the dose of amoxicillin or the branches of the coeliac trunk. As I am left to my own devices and trusted with bigger, harder cases, I take complications more personally and doubt myself far more. I didn’t think that months after my exam, after performing several hundred herniotomies, most of them uneventful, that I would suddenly wonder if I was equipped to perform this operation.

I know that I have actually had it relatively easy compared to many. I didn’t have to thrash out into the private sector, and sink my life savings into a new practice, or take on all those big cases without any senior back-up. I didn’t have to uproot my family and move them to another city just so that we could keep eating. I only had to do the exam once, and was fortunate enough to avoid another 6 miserable months in the study centre. Still, this post-exam time has been mentally difficult for me. Definitely not as difficult as registrar time was, but still, not as awesome as everyone told me it should be.

It has now been almost six months, and I am starting to feel better. My Consultoid status allows me to come in a little later in the mornings, and I have easier calls, and I can feel the effect of this on the rest of my life. I can take my kids to school a few times a week, I can actually plan meals instead of raiding the vending machine each day, I have started running again. I’ve read a pile of books and caught up on a lot of TV. I’ve started socialising again. Every week I take on the role as lead surgeon in the bigger operations that scare me, and although I always make sure there’s someone older and wiser to back me up, I’m often surprised by how much I am actually able to do. I’m working on ‘the next step’, the thing I’ll do after this contract comes to an end. I’m finishing up those stalled projects, and starting some new ones.

I remember one Saturday morning, a few months before the exam, I went to Dalebrook with my family. It was a lovely day, and Max and my husband swam in the tidal pool, and Leo fell asleep in my arms. I remember thinking it was the perfect moment, but for some reason all I could feel was a combination of guilt and anxiety. As I sat there I kept thinking ‘I need to leave so that I can study’ but also ‘Why can’t you just enjoy this perfect moment with the people who love and need you? What’s wrong with you? Why are you so selfish?’ Later that day, once I was at the study centre, I felt bad again, thinking about Rowan looking after the children alone, and mentally beating myself up about not making better use of the study time that I had.

I don’t get that feeling anymore — the feeling of always needing to be somewhere else — and that is the best part of being done. I’m not constantly checking my watch in the evenings before the kids go to bed, I’m not filled with guilt every time I open a Long Read that someone has sent me. A midweek dinner invite doesn’t feel like a disaster, a weekend birthday party doesn’t feel like an inconvenience. With the exam and the MMed done, my off-duty time belongs to only my family and me. That’s a really great feeling.

*My favourite power song was ‘The Greatest’ by Sia and now when I listen to it I’m like sure, catchy tune, but really is she even saying anything?