Final year.

***Warning:  this post contains confronting themes including domestic violence, traumatic death, and bullying.  Details have been altered to protect the patients***

On Monday I start my final year of training.  It’s surreal that I’ve been writing this blog since my final year of medical school, albeit increasingly less frequent over the years as other commitments have taken over and I’ve often lost my words.  Something happens to you towards the end.  This rising tide of anger at all that you’ve been through, something inside you just wants to quit right before the end, burn it all to the ground.  You say things like “back when I was an intern”, even though when you were an intern you hated that.  And you tell stories about your internship and beyond that seemed perfectly normal to you, but through the lens of the post-bullying, post-metoo world, were actually really traumatic.  And then you realise just how very much you have supressed over the years, when you start telling your resident about a rotation and suddenly the things you had forgotten roar into your consciousness.  And you realise you barely processed them at the time.

To the lady broken and bruised all over from years of domestic violence, finally ready to leave, you are a hero.  I’m glad he went to jail and I hope he’s still there and that you’re okay.  To the guy in his forties who died of tumour lysis syndrome in front of me while calling for his mother, I’ve never forgotten you.  To the lady who died with her lungs filled up with cannonball mets, who had a small child, I’ve never forgotten you.  That nice lady with fevers who had a lung filled with MRSA that was picked up a day too late, I can’t think about you without tears, even though it was 8 years ago.  To all those kids with ‘adult’ cystic fibrosis, I wonder if you’re still alive, if you were responsive to ivacaftor and friends when it came in long after I’d moved on, I wonder if your lives are better now, if you’re still alive now.  To the guy who nearly bled to death in front of me, when I’d been made to work 24 hours straight as a second term intern, I hope they fixed it.  To the young guy crying in pain from liver mets, when I was too junior to understand that you would die that day, I hope you weren’t in pain when you finally went, and to this day I feel the sting of realisation that you were going to die that day, so young  To the beautiful husband of the lady that died suddenly, who we couldn’t contact because you were too poor to have a phone, I have never forgotten the heartbreaking grace you displayed when you arrived that day.  To my darling indigenous uraemic renal patient who I know must no longer be with us, you made me love medicine.  To the young man whose life was destroyed by tuberculosis, no one ever quite believes me when I tell people your story.  To the racist aggressive guy who abused the nurses, I have never regretted telling you I would chuck you out if you tried that again.

To the man who died because the system broke down, I can hardly think of you without suffocating.  You deserved more time on this earth.  To the little boy who became the first and only child I had to break bad news to, whose mother who had turned her life around and was dying before you, I hope I didn’t fuck it up, I had no training and I did my best.  I hope you’re okay and surrounded by love.  To the lady with the massive saddle PE who got me at my most junior running the arrest, I’m glad you lived.  To the lady with pneumonia that wasn’t pneumonia who wound up on ECMO, I prayed silently during every single ward round when we saw you.  I saw the religious icon in your room and I prayed to it.  I still don’t know who it was.  To the man crying in the emergency department as he died of a heart attack, I’m sorry I didn’t fight harder to get you the midazolam faster.  To the ED Registrar who heard me questioning your ability to read an ECG after a horrible arrest, I’m really really sorry.  I was out of line and I’m mortified at my own behaviour until this day.  I was traumatised by what I saw that night and I didn’t realise it – I hope you’re ok.  

To my renal patients, each and every damn one of you, I will never, ever, forget you or your faces.  And you June, I will never forget you, telling me to just be as I am, no matter what.  That you could be so giving, so kind, even though you must have known.  And to C, I looked after you for three months and because the night doctor forgot to tick a box, had to pull you out of the fridge in the morgue to certify you and I’m so sorry.  Neither of us ever wanted that.

To all the consultants who have berated me, locked me in dark rooms, threatened me, bullied me to ‘make me better’ – I hope one day you get the help you need and realise what decades upon decades of built up and pent up vicarious trauma has done to you.  I am not better because of you, I am better in spite of you and I will never, ever, be you.  To every single workforce administrator who bullied us via the rosters, who threatened our jobs, who weren’t there when we needed you – your time is up.  To the new age ones who listen and roster appropriately, thankyou.

I could do this all night, I have so many more memories of it all.  I’m currently at the loveliest department, on the loveliest campus in the world.  And yet I walk around it, constantly on edge, waiting for the other shoe to drop, waiting for someone to find some fault, for a horrible horrible arrest to happen.  And it doesn’t.  But every day, echoes of those experience follow me around, burn me out a little, even though the real burnout is long gone.  Every time the supervisor report comes around, little memories spring up, the dark room, fear the responses out of proportion to my performance spring up and I wonder how badly I’m going to do.  And every time I do really well, and every time I don’t see what they see.  I still see that intern, failing cannulas, being berated at the weekly meeting in front of an entire department for not using the right ICD10 codes, standing helpless in front of patients dying from diseases that are long past the window for cure, if there ever was a window at all.

And as I walk into this final year, slowly I start to realise why most consultants aren’t full time anymore.  I start to realise just exactly why there is no shame in walking away from this, of going to the community where you have the most opportunity to make a difference.  To prevent these situations, to have those crucial discussions that protects our patients dignity and quality of life.  I don’t ever want to completely leave, but it’s been a long long road and reliving all of that, by working in all of that for decades is something I’ve realised I don’t really want.  I do want to heal from all of that, and for that reason this year is all about that, of letting it go, of doing the rest of my life on my terms, whatever that looks like.