THE BLOG

What I Learned Over A Decade As A Public Sector Doctor

The practice of medicine is progress and success balanced with failure and loss.

25/11/2016 05:59 SAST | Updated 25/11/2016 12:21 SAST
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A decade as a doctor is ten years of the midnight trudge, from theatre to ICU, from casualties to the CT scanner.

A decade of hospital life is a decade of smells; the musty smell of rifampicin, sickly-sweet gangrene, appendicitis, or puked-up alcohol. It's the better-than-it-tastes smell of hospital food, the recycled oil smell of hospital canteens and the smell of my own body after a long night of work. It's learning to identify the cold, metallic smell of death.

It's ten years of the midnight trudge, from theatre to ICU, from casualties to the CT scanner, under fluorescent tubes that never switch off, up and down thousands of stairs, along corridors covered in kilometres of linoleum.

For six years I did the trudge in a pair of brown Crocs my boyfriend bought me in medical school, until a needle fell from a patient's arm, through one of the holes, and impaled itself in my foot. It was full of HIV positive blood, but that was neither the first nor the last time I took ARVs as post-exposure prophylaxis. I threw those Crocs away after that.

A decade of hospital life is a decade of nights without sleep, of microwave meals and Coke Zero, of 3am despair, of relief as dawn finally appears through the hospital windows.

It's a decade of sleeping when and where you can, in flea-infested call rooms with broken windows, with your head on your arms at the casualty desk, on hospital couches or theatre trolleys.

It's a decade of ward rounds, from the lightning fast to the eye-wateringly slow.

I have cried so, so many times. I have cried out of grief for patients and their families, and out of sheer exhaustion and pity for myself. I've sobbed in my boss's office after seeing an eight-year-old ripped to shreds by a truck and wept into my theatre mask while doing on-table chest compressions. I've cried at patients' funerals.

I have seen so many other people crying. Scolded interns sniffing on ward rounds, medical officers weeping in corners at 3am. Tough men with tears dripping off the tips of their noses onto their children, or howling as their bar-brawl injuries are tended to. Women crying as they're given yet another lot of bad news in a life marked by loss, what feels like thousands of children wailing in fear and pain.

Some moments are instantly satisfying: popping a shoulder back in, pulling a coin from an oesophagus, lifting a new, yowling baby out of its mother's body.

Ten years of medicine is ten years of successes. Some moments are instantly satisfying: popping a shoulder back in, pulling a coin from an oesophagus, lifting a new, yowling baby out of its mother's body. It is ten years of the spine-tingling satisfaction of landing a central line or slam-dunking a tricky diagnosis, and once of seeing percutaneous saturation start rising after I performed an emergency cricothyroidotomy on a man who had been shot through the face.

It's also ten years of slow, hard-won victories. Seeing babies put onto their mothers' breast for the first time after weeks of intravenous feeding, seeing adults who were carried into a ward walk out on their own. It's discovering that I can perform with ease an operation I thought I would never master, and the pleasure of seeing other, younger doctors learn and grow.

It's also a decade of failures and loss, of cold, stiff bodies found in beds on morning rounds, of shell-shocked relatives holding plastic bags of possessions, of dejected backs turned on patients who just could not be resuscitated.

Ten years in medicine is ten years of receiving abuse even after saving someone's life, and ten years of being thanked for the silliest things: dressing a paper cut or cleaning wax out of an ear. It's ten years of being thanked just for doing my job, and ten years of being thanked even when the result was death.

I carried my tired body on my burning feet, but my spirit was carried by endless seniors, supervisors, colleagues and friends, who saw me at my darkest, most pathetic times, and continued to believe in me.

A decade in medicine is a decade of being carried. I carried my tired body on my burning feet, but my spirit was carried by endless seniors, supervisors, colleagues and friends, who saw me at my darkest, most pathetic times, and continued to believe in me. It's a decade of being carried by my husband and family, who never chose this life for themselves, but seldom objected.

It's a decade of learning to strike the balance between kindness and toughness. It's so hard to be kind in a system so brutal. In the beginning, I was angry, all the time, with patients for not taking their medication, with relatives for challenging my advice, with nurses for ignoring my orders. I shouted at scrub sisters and interns and porters. I once found myself yelling down the phone at a neurologist at 4am. 'What is the point of your existence?' I screamed. When I put the phone down, everyone in the casualty unit was staring at me.

Maybe the person I was most angry with was myself, for choosing a life that seemed so hard and so thankless, and for so frequently failing to do my job with grace. One day, a few years ago, a boss called me in and said I needed to calm down. I pulled myself together, and considered getting the words 'Be kind' tattooed onto my wrist, as a constant reminder to try to be better. When you're kind to people, they're kind to you. They thank you instead of shouting at you, they help you instead of blocking you. They forgive your mistakes.

I've also had to learn to know when to draw a line, when to tell someone (including myself) that something is not okay. Sexism, racism, bullying, unprofessionalism, and laziness are rife in the profession. Empathy for colleagues is essential, as is kindness to myself, but some things shouldn't be allowed to go unchecked, and discipline is paramount.

After a decade in medicine, my career has barely started. I'm still not a specialist and am technically still a junior doctor. Maybe in thirty years' time, as I approach my retirement, I'll look back and feel relief that the eternal doubt, the fear and the worry that are the hallmarks of learning to be a doctor, are so far behind me.

We're interested in more stories from the public medical sector. Please tell us about your experiences.