Oh, the places you’ll go!

I was looking through the archives of this blog (now added to the sidebar) and had to shake myself – wait, I’ve been a doctor for 7 years?  I’m PGY….7?!  When did that happen?  I feel like internship was yesterday, I feel like I was scurrying around the bowels of the hospital, the weight of responsibility for every patient ever weighing on me, and the anxiety that I had normalised crushing me like a vice.  Struggling to find something to write about, I had a look through some old posts and realised that I had so much free time before I had a child!  I thought back then I had no time…but goodness, knowing what I do now, I felt downright jealous of myself.  All those posts with food experiments, sewing, coherent musings on life.  Of course, my daughter is the absolute light of my life and I wouldn’t trade any of that for her, but how strange time as a concept is.  We never think we have time.  We have one child, no time, and then people go on and have 2, 3, 4 and laugh at their earlier selves.

Anyway, PGY7?! (Post-grad year 7 for the uninitiated).  On Facebook today I saw some colleagues had got through their surgical fellowship exams and I felt so proud.  It is such a long, long, long road.  From that first year of not knowing what the hell is going on and feeling stupid 120% of the time, to that year of overconfidence of residency, then back to feeling stupid 200% of the time, of being that person in the room where everyone is nodding at the lecturer and you’re pretty sure you’re the only one who doesn’t understand, to those effing exams, and then onto advanced training…and all of your own life in between and that’s not even close to putting it into words.

7 years ago I wrote a post about choosing life over prestige.  About your head is filled with noble ideas of curing cancer, and doing highly ranked research, of doing the super duper prestige specialty.  I mused if intelligent and smart people also did the less prestigious ones (they very much do).  And I said I felt like physicians were the guardians of humanity.  Virchow once said that “physicians are the attorneys for the poor” and in my 7 years I have learned often that he was right.  It’s not until you do physician training that you realise the power of advocacy, of advocating for your patient – and their family.  I can’t tell you how many consults I’ve had where someone’s discharge has been delayed because of ‘unreasonable family’.  But usually they’re people who, in terrible circumstances are afraid and not at all understanding of the behemoth they’ve been forced to engage with.  I’ve written countless medical reports in support of my patients to help them escape terrible situations, I’ve kept them in hospital for this.  And I’ve argued with so many teams about not sending people home, teams who are getting crazy pressure about ‘beds’ and ‘lengths of stay’ (the amount of time a person spends in hospital – the hospital only gets money for a certain amount of days and past that it’s out of their budget), where I’ve had to pull the card that reminds the other person on the other end of the phone that my focus is on what’s best for our patient.  The managerial overreach seems to get worse every day, and every day I daydream about how well we could do with endless money.

When I was more junior I used to think that the ‘serious’ medicine was in the knowledge.  In the research, in the molecules, in the jargon.  Maybe it is, I’m not sure.  For me the medicine now lies how to improve lives.  Not just treat diseases.  Anyone can memorise and spit out a treatment protocol.  It sounds really impressive when you do.  But learning how to step back and say, hang on, what’s going on here?  What’s happening in this persons life that is contributing to this?  This is the part of my job that I love.  It took me a while (and some horrendous exams) to stop reducing people to a list of jobs, to a list that I constantly wanted to shorten and start listening, and working out a way forward without having to spit out treatment plans.  Those plans are important of course, but with every human you encounter, there is a bigger picture.  At some point I had to relearn compassion.  Pain is real, even if someone else’s pain annoys you.  The elderly are part of who we are, they deserve all of our respect, all people do.  Compassion for stressed out and anxious families needs to be endless, we need not be combative.  And compassion, not empathy is ultimately what gets you through.

PGY7.  Not even including medical school.  Years and years of facts and physiology, of problem solving. And for junior me, and junior you – yes it’s worth it.  I never knew the power of this job until I got (for me) what it is really about.  It’s sticking up for your patients, it’s wanting better for them and their lives, it’s asking them and yourself how you can achieve it.  It’s demonstrating patience, compassion and endless validation and reassurance.  Your knowledge keeps up on it’s own after a while.  But the other stuff is an endless and wonderful practice.