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.


Troy said...

As always an absolute delight and relevant way beyond the medical paradigm :)

Adalbert Ernst said...

Thank you!

Dr Guinevere said...

Excellent post and very relevant advice! If I could reiterate anything I'd say that one should do what you love, or try at least to love what you do. Medicine is too tough to follow through with if you are in it for any other reason than satisfying your own passion. Your parents won't be with you at 3 in the morning when you're still awake and feel like you're the only person in the world to be at work, and you will never be paid enough to justify not being tucked up in bed at 3 am. Love what you do and you will enrich your own life as well as that of others. It'll never be pleasant to be up at 3 am though.

Adalbert Ernst said...

Dr Guinevere... sorry I only reacted to your comment now (like nearly 2 years after.) Thank you! I love your blog and follow it keenly. I like your comment that you should do it just to satisfy your own passion, since then practicality flies out of the window. I also think too many people get disillusioned that their day job is NOT their passion... it doesn't have to be... just do it well. :)