Friday, July 20, 2012

Life In False Colours

My city in the throes of winter
 It is an archetypal winter day in the city. The wind and rain are theatrical, hammering the peninsula so dramatically that it looks as if I'm watching a fake storm, conjured by invisible stage hands in an amateur Gilbert and Sullivan production. I'm sitting in Primi Piatti at Cavendish on my day out of theatre - "Academic Time" is what it is officially called. I'm still reeling from my first few days in my junior consultant rotation in paediatric anaesthesia, and I feel horribly out of my depth. But more so, right now, I feel tragically, self-consciously hipsteresque trying out my new Bluetooth keyboard on Jarvis, my still-shiny iPad. (I have a tendency to name my devices.) Good Lord, I'm even wearing a beanie. But it's six years old and faded. I bought it at the Gap next to Canary Wharf tube station, so hopefully the fact that it came from a big un-cool mutinational corporation will neutralize any hipster pretensions I might have projected.

The Wye Valley at Symond's Yat, Herefordshire
 I've had moments that were even more precious than this. I recall the eight months I spent in Herefordshire as a locum senior house officer in anaesthesia, when I had a tendency to spend my post-call afternoons in the Pizza Express overlooking the great pink crumbly cliffs of Hereford Cathedral, sipping Sangiovese and freewriting in a Moleskine. All particularly affected, it may well sound, but it was my way of mental defragging. Sometimes, I would get into the ancient Audi I had bought for £700 and clunk my way along to Symond's Yat to be inspired. But I would be unable to write anything, so taken was I by the river and the rocks and the forest dissolving sadly into the winter fog. The ale at the riverside inn helped too.

 No Pulitzer or Nobel prizes will ever spring from that notebook; in fact, the most prescient observation I made was copying out the mournful refrain from The Veils' "Talk Down The Girl":

I miss my girl;
I miss my girl

For I was in love but didn't quite know it yet. It would strike me, later, on top of the Empire State Building, suddenly realizing that taking in the giddy sprawl of Manhattan meant nothing to me because I couldn't share it with the one person who was supposed to be by my side. Geographically, it was the furthest I'd ever been away from her, and some silent force was rousing itself from a slumber, conspiring to pull us together as powerfully if we were stars and God had decided to invert Hubble's Law.

Seven years later, we are married, living in a cosy (if cramped) little Edwardian that keeps on swallowing money, with our suburban checklist completed: two cats, dog (stray; rescued, complete with unplanned puppy blues), dog-walker, LED TV, irrigation system. We may well have kids soon, blithely adding to the world's glut of seven billion people. It's too much, and it messes up the prosody of the Katie Melua's "Nine Million Bicycles" when she insist there are only six billion of us. That's one person for approximately every 2 years the Universe has existed. Holy population, Batman!

Some cynics say that medicine only halts nature's process of trying to cut down on the burden of overpopulation, and cite HIV as an example of natural population control. The same people - if they're dyed in the wool right-wingers - balk when I put it to them that homosexuality is also a natural form of population control. If the statistics are to be believed, 10% of the population is either gay or teeters on the brink of it. It's always been my feeling that sexuality has absolutely nothing to do with parental skills, and we may well be shooting ourselves in the evolutionary foot as long as we let hysterical morality stifle what is probably a force for good. I've even heard a few homophobes admit that it is "much better" for willing and able gay couples to adopt children that would otherwise remain homeless and doomed to a life of poverty and disease. Not exactly an exhortation of complete equality, but better than nothing I suppose.

I'm a proud libertarian, with left-wing tendencies. It's jars with my Christian sensibilities sometimes - I don't believe homosexuality is a sin, for example, so this alone makes me a bad Catholic - and I know libertarianism is self-defeating when carried out to its logical extent. However much I believe in freedom I'm forced to defend people's right to their own private beliefs no matter how odious they are - as long as they do not pose a threat to my fellow man. To paraphrase Voltaire, I'll defend your right to believe in what you want passionately, even if I can't stomach it. It becomes murky when approaching ideological brainwashing - but then this is noxious private belief trespassing on the common good.

False Colour Spectrum of Sodium

Like Iris Murdoch, I believe in a common good. I have to, even if it may not exist. It feeds me, and my wife has articulated this beautifully by saying we have to be comfortable in our hypocrisy, else we will crumble when trying to take in all the misery of the world. We really need to see through a glass darkly, the more I think about it. Maybe we can even choose our filters for that glass, then, as long as we know that they are filters, for then we can accept that whatever false colours they project are but a suggestion of what lies out there.

 I don't see myself as superior to the exisentialists who have bravely surrendered their comfortable beliefs to the cold absurdity of being human in a void that probably doesn't care. But neither do I envy them. I just have to be grateful that the thin membrane of my own existence has lasted so long. Still, I can't help feeling it's been strengthened with something, rather like adding glycerine to liquid soap so the bubbles you blow for children last a few seconds longer. I've embraced my suburban blanket, knowing that any guilt it may have engendered doesn't do me any favours - Catholicism has stocked up a lifetime of psychotherapy with that already.

Having processed all that I'm now cold and breathlesss, and my bourgeois blanket seems fluffier than ever. I live in the City of Good Hope, after all. I'll have sweet dreams tonight, that much is certain. Will you?

Tuesday, July 17, 2012

The Virtues of Cynicism / Advice For Young Doctors To Be

Many of my readers have asked me why I don't write more medical stories. Certainly, I seem to get the most comments and feedback when I post the odd vignette from the saltmines. Quantum Surfer was never intended to be a medical blog. I admit there are some personal reasons for this: I mostly shy away from medical postings because it still feels my day job is intruding into my shadow life as an aspiring writer (self-indulgent I know.)

I hated medical school. Don't get me wrong - I'm grateful for having had the opportunity to study the "noble profession" but it was never my passion, until I discovered anaesthesia and felt, for the first time, "at home". I'm also well aware that If I hadn't gone into medicine I wouldn't have met my soulmate either. But I was disillusioned early - my undergraduate years were drenched in a fair amount of humiliation by seniors. (See this postfor more details). All too often clinical teaching was traded in favour of working us to the bone and making us feel as if students were the lowest form of life. I also soon realized how medicine can take over a person's entire life, corroding their boundaries until their existence becomes a tragic exercise in masochism and self-aggrandizement (because nobody ever stopped to give them a kind word or appreciate the hard work they had put in over years and years.)

To be honest, I find most medical blogs trite and self-indulgent (รก la "look! I'm a doctor! See how amazing I am! Especially with my fake navel-gazing philosophy and desperate attempt to show the world that I'm also a cooler-than-thou hipster with a terminal case of FOMO"...) Nee, fok.

Perhaps that's too bitchy. Medicine is a great job, but it's just a job, after all, and that mantra of humility keeps me sane. Patients get up to all kinds of shit, but then so do I. There is no point in assuming complete responsibility for other people's health - we can advise and treat, but only with consent, and it's everybody's right to stop taking their medication and flirt with disease all they want. (Of course, as an anaesthetist, I assume complete control of people's lives at times, but only for discrete periods.)

I've decided being a bit jaded is better than getting drunk on the potential power of being a "healer". Yet, the fascination remains, because doctors deal with the weirdly wonderful machinations of the human body, given almost God-like powers. The public gets intoxicated on the admittedly fantastical expertise of a surgeon's hands that keep death second-guessing itself (oh the nauseating horror of "Grey's Anatomy"...) but, ask yourself, what about the millions of pairs of unsung hands that keep planes in the air, nuclear reactors from meltdown and bridges from collapsing? Or the long-suffering, underpaid souls who educate the next generation, or (at least in some countries) keep the streets safe, or make sure that the medication the doctor has prescribed actually gets given to the patients?

You may think I have a big case of scalpel envy as an anaesthetist, but I love my job, thank you very much. I learnt very early that I was best placed on the other side of the surgical drapes staring at the disco lights of the monitors.

My revelation has been that the "war" between surgeons and anaesthetists seems to have been greatly exaggerated. It exists mostly as a friendly rivalry between us (where I work at least). Maybe I'm just lucky, and if so, I'm grateful. As an undergraduate I was under the impression that most surgeons are narcissist wankers with God-complexes. Then I realised it was just a symptom of the Calvinistic hangover I found myself in while at a particular medical school, plus a good deal of self-loathing on my part. Today I can summon withering comebacks when I feel I'm being patronized by a surgeon who thinks I'm just a technician who'd rather be doing a crossword. Some of my best moments have actually dropped the temperature in the theatre by a few degrees. I hate being patronized as much as the next person. In the cosmic scheme of things, though, I don't mind if the odd surgeon thinks I'm a protocol droid who only wants to do sudoku and cancel all the cases. It's his or her loss if they think I don't care, and so be it if the ego trip gives them enough energy to do the next case flawlessly. I have bigger existential fish to fry.

The anaesthetist is hardly ever remembered, let alone thanked. And sometimes all I need is a thank you. It's not a profession for those who have fragile egos. And I've come to learn that sometimes an offensive puffed-up ego is actually frighteningly delicate, a brittle facade behind which hides a terrible emptiness. Shame.

So here is my rather cynical advice for young doctors to be in ten jaded steps.

(1) There is no shame in deciding you don't want to be a doc. All too often kids who do well at school feel forced to study medicine due to parental and peer pressure. If you really are passionate about something, you will find your niche. But it may be a bumpy ride.

(2) It's perfectly normal to become disillusioned or even depressed. It's a hard, long slog during the best years of your life. So if you work hard, play hard. Passing with 50% and a trip through South-East Asia with friends is far better than getting 90% and a life-long case of regret that you never lived beyond your textbooks. There is no such thing as "MBChB (Wrote Twice)".

(3) Surround yourself with non-medical friends. The variety will keep you sane.

(4) Although you might have to put them on hold, don't let your other interests die. It's a rewarding path of rediscovery when you pick up a pen or paintbrush or electric guitar.

(5) Don't make up your mind too early about where you're going to end up. I hated anaesthesia as an undergraduate - then I specialised in it and loved it.

(6) Don't pay attention to people who say medicine is so hard and gruelling. It takes up a lot of time, and you have to develop firm butt muscles to sit down and soak up all the information, but it's not hard per se. It's just a shitload of facts. You can't get bogged down in detail.

(7)When you graduate you'll realise you're facing a delayed adolescence. Go with it, but with a modicum of common sense. An intern is a teenager with a credit card - I spent my entire first salary in a week and had to live on baked beans and tinned tuna for the rest of the month. You learn quickly. Waking up in your own vomit next to a person you don't know is only funny the first time, and then only to other people.

(8) Nurses can be your best friend or worst enemy. Most work hard and are fountains of advice. A little bit of courtesy and respect equals a smooth time in the wards.

(9) Don't bow to pressure to specialise if you don't want to actually be a consultant. Much better to try a specialty first by taking a medical officer post to see if you like it or not. You can do a postgrad six month diploma in many disciplines (paediatrics, psychiatry, anaesthesia, obstetrics etc.). Travel first. Registrar posts will open up even if you need to wait. Experience counts on a CV.

(10) Ignore sob stories of 36 hour calls with no break for food or water. The work will always be there no matter how fast you graft. What are you supposed to do, pee in your pants and die of dehydration? Keep yourself well fed and watered, and screw the diet when you're on-call. You're doing a patient a disservice if you're about to collapse from hypoglycaemia. You can actually say "I need a moment." I did, frequently, and the world didn't end when I took a five-minute time out.

So there.