For you, Mr A

As I sit in a café in Wellington surrounded by men and women wearing designer suits having “business meetings” over vanilla soy lattes on the company’s dollar, I wonder why any of us choose to go into medicine. I don’t come from a medical family, but I hear stories of doctor parents encouraging their children to pursue anything other than medicine. We could have been astute business minds, articulate politicians, diplomats, or government workers for the Ministry of Education. Close your eyes and picture this: waking up to an alarm at seven thirty, driving into work with the traffic at eight thirty, sitting behind a desk in an eighth floor office with floor to ceiling windows overlooking Oriental Bay, home by five just in time for a pre-dinner run.

Hold up.

Why did I go to med school?

There is no denying that this profession we have chosen is not easy. The experiences I have so far shared are a testament to that. Yet despite knowing that my Doppelganger working at the Institute of International Relations in Boston is less tired and eats healthier and has smaller (or nonexistent) circles under her eyes, there is still nothing else I would rather be doing than what I am doing right now. Despite my bad days I still believe there is no other profession as amazing and fascinating and challenging as the one we have the privilege of being a part of, friends. I am sorry I have been all doom and gloom lately. I admit I have struggled to keep my enthusiasm and optimism these months past, and with that I fear I am becoming someone I do not recognise. So let me take a moment to share with you some of the awesome things about being a House Officer. (Because at the end of the day I can think of at least ten!)

Number 1: The Money

Yes, you start to earn money. You can go on about how for the hours we work your bartender flatmate probably makes more, or if you go to Australia you could make x infinity more, etcetera etcetera, but at the end of the day we make a heck of a lot of money straight out from university. Did you know that only 12% of New Zealand’s population makes over seventy grand a year? After being students for so long it’s a pretty awesome feeling watching your bank account get replenished every second week.

Number 2: The Public

The following is a conversation I had on countless occasions with new acquaintances, store clerks, and baristas:

“So what kind of work do you do?”
“I work at Middlemore.”
“Ohhhh, so you’re a nurse!”
Awkward pause. (Is it because I’m a girl?)
“Umm… no.”
“Ohhhh, so you’re a pharmacist!”
“Umm… no.” (Is it because I’m Asian?)
Further awkward pause.
“So what do you do?”
“…I’m a… doctor.”
“Really?!”

And automatically their perception of you changes. There is an almost reflex respect and trust and… awe that people have once they find out you are a doctor. It takes a bit of getting used to, but it’s pretty damn cool. Plus, banks LOVE you. (Play hard to get, is my advice!)

Number 3: The Ladies

I recently caught up with a friend of mine who was telling me about his “Meet the parents” moment. For you fellas out there, rest assured, you can’t go wrong when the second question the parents ask you is what you do and your reply (with equal parts confidence and humility) is, “I’m a doctor.” [Unfortunately the same does not appear to apply for us ladies. This remains one of two gripes I have against the Universe; that, and the fact we never look as good as the fellas in scrubs.]

Number 4: The Medicine

Early on in my general medical run I admitted a lovely patient who presented with high temperatures. They were otherwise well other apart from a not so remarkable cough so started on antibiotics and discharged. They later represented with ongoing temperatures but this time with a rash. The impression was beta-lactam induced rash so the antibiotic was changed and again they were discharged home. Some time later they were in hospital yet again. Something wasn’t quite right. Subsequent scans showed widespread mediastinal and intraabdominal lymphadenopathy. They ultimately passed away due to a haematological malignancy.

As a house officer you are the foot solider on the front lines and, with that, start to see the medicine coming to life right before your eyes.

You could say I was a skeptical medical student. GI bleeds? Really? Whatevs. Dysphagia is an alarm bell for oesophageal cancer? Really? Whatevs. What’s the big deal with calcium levels anyways? But when you see your patient with a history of reflux represent in ED with a systolic blood pressure of ~70 and heart rate of 120, sweaty and pale; when you admit a patient with a history of dysphagia and dry cough, and a week later discharge them with Oncology follow-up for chemotherapy; when you examine an apparently crazy patient only to find their entire breast is a solid hard mass with a sky high calcium. Everyday you witness medicine come alive. And it’s pretty damn cool.

Number 5: The Free Food

Need I say more?

Number 6: The Need

All throughout medical school you could never fully shake the feeling that you were ‘in the way.’ In the way of busy nurses swarming around the nurses’ station; in the way of busy registrars who had ten patients still to see; in the way of the patient and their family as they watched you practice your examination skills. That all changes once you start work. You have a tangible skill-set on offer; you are the service people have come to receive. You have earned the right to be there, stethoscope around your neck; you have earned the right to do that rectal exam to check for blood or masses; you have earned the right to ask the nurse to weigh the patient before you chart that antibiotic. There are definitely stressors that come with being a service provider, but for the first time ever you start to feel needed.

Number 7: The Confidence

With time and experience you start to notice yourself becoming more confident in your clinical judgement and skills. That wonder you once had as a fourth year medical student watching the house officer get a patient’s consent or take that arterial blood gas oh-so slickly is replaced by — unconscious competence. Clinical acumen develops only with experience; experience is only possible by logging in the hours, by spending all day every day seeing patients. You learn by watching, by doing, by asking, and, most of all, by learning from your mistakes all day every day.

Number 8: The Holidays

Treat yourself. It’s a strange concept, having to ask permission for vacation. But the flip side? Pull out a world map, close your eyes, point, and now open your eyes – what’s stopping you from going there? Nothing. Absolutely nothing.

Number 9: The Future

Maybe this isn’t an upside for some of you because you have no idea what you want to do. But as a house officer ‘the future’ starts to feel very much more real. For most of us we find ourselves on the other side to suddenly realise our house officer years are a metaphorical crossroads. What speciality do I want to commit my life to? Am I ready to commit? What do I need to do to make it happen? Are there other things I want to do before I commit, like travel, volunteer, study, family, kids? The end-game of medical school was graduating. No longer graduands, the world really is our oyster. The question now being, what do we want from the world?

Number 10: The Patients

I first heard of the book, The House of God, back in third year. Renown for its cynicism and sexualisation of internship, I (in my blissful optimism) made an active decision not to read the book. Earlier this year a good friend of mine recommended it to me and lent me his copy. Since then it has been collecting dust on my nightstand. That is, until last Friday; for the past five days I have been devouring every page.

In the midst of the drama, the bullshit, and the jadedness, Samuel Shem captured my heart with one sentence: “He was the first patient whom I’d loved who’d died.”

Five days ago the first patient whom I’d loved died. It is hard to hear that kind of news when you have been so involved with that patient’s care; when you were the first doctor they saw in ED; when you can recall the countless conversations you had with the patient as you put in IV lines, consented them for procedures, and saw them every morning on rounds; when you would walk past their room just to say goodbye on your way home or stop by to have a chinwag with them for no other reason than to have a chinwag. When, on the night before their operation, you call the ward from home to make sure every “t” has been crossed and every “i” has been dotted; when, as they head to Theatre, you realise you are more nervous than they are.

And when you hear they arrested in HDU the only thing you wish is that you could have been there with them.

The timeless magic of our profession, the privilege and the heartfelt honour, is this: we get to journey with our patients. Like the town physician of the 19th century, we have the knowledge to change our patients but, what’s more, our patients have the power to change us. It’s easy to lose sight of this wonderful truth in the context in which we work today, but every once in a while you get a taste of that journey and it is… magic.

To you, Mr A.

I will miss you, now and always. You will always have a piece of my heart.