Joan.

Joan Didion

I can’t quite remember how I came across Joan Didion. I think I saw reference to her packing list from The White Album featured in Vogue, reverently displayed as some kind of gospel of chic, because Joan has always been viewed by the critics as the pinnacle of disaffected-cool fashion.  Here’s part of it:

TO PACK AND WEAR:
2 skirts
2 jerseys or leotards
1 pullover sweater
2 pair shoes
stockings
bra
nightgown, robe, slippers
cigarettes
bourbon

There was something so attractively minimalist, yet at the same time so subversive (the bourbon, later in the list there’s a typewriter), that I couldn’t help but look her up.  And so I read The Year of Magical Thinking, the devastating novel where she processes her husbands death in her strange, descriptive, pragmatic and stepwise style (I can’t bring myself to read Blue Nights), and was fascinated.  Her prose is perfect.  I’d never come across a style so technically perfect as hers.  And yet her constant peppering of high-end brands and name-dropping seemed to grate against something like the loss of her husband.  It irritated me, but I couldn’t stop reading.  It’s this name-dropping that has led her to be labelled a ‘perennial insider’ by critics for years.  Someone who doesn’t understand the masses, the middle classes.  And then I read The White Album just recently, and realised that it’s not that at all.

Joan and I have something in common.  In her work as a journalist, she was privvy to the worst of humanity, the most meaningless of bureaucracy, and the most narcissistic of human taste.  In my work as a doctor, I am privvy to the worst of humanity, the most meaningless of bureaucracy, and the most narcissistic of human taste.  And I understand how, when you intertwine those concepts together, they grate.  Because they are jarringly and nonsensically in opposition with each other, with our values, and our innate humanity.  And now I can’t get enough of her work.

The White Album is a collection of works that she’d previously had published in various magazines like Life and Esquire, and as a collection they are a jarring discourse on America in a transformative time.  Her critics have a lot to say about her, she seems to irritate them and I like to think that she likes that.  I highly recommend The White Album and The Year of Magical Thinking, I’ll probably follow this up with a list of her other books when I’ve read them!

Put your thing down, flip it, and reverse it.

It’s been a long time once again since I’ve blogged, and it’s been longer still since I’ve had the time to really think about what I want to write.  The past five or so years, from day one of internship has been insane.  So many milestones crammed into such a short space of time, peppered with happiness and tragedy.  Now, finally, I’ve come screeching to a near-halt.  A slow drift.

I went part time.  We bought a house.  We moved into the house and now I find myself a regular Bunnings visitor.  I leave work on time because the daycare charges by the minute if I’m not there but more importantly, the guilt kills me.  I suppose that’s what the men at the top mean when they say things like ‘woman can’t focus on their work once they have children’.  What they mean is that ‘women can’t prioritise me 100% anymore”, but I digress.

When you’re used to insane hours, when you’re neck deep in the cult of public hospital medicine, you don’t see it for what it is.  You think there’s something wrong with the people who leave on time.  Something wrong with the people who pick the ‘softer’ specialties.  They don’t have what it takes, they have must have pissed someone off.  The whole idea of crafting your work around your life is nonsensical.  It can’t be done.

In August last year I had a phone call.  The person at the other end of the phone wanted to hire me.  They were interstate, and they wanted to hire me.  My bosses had given glowing references.  My resume was sharp, if noncommittal.  I was reserved on the phone.  I’d been burned by too many heads of departments droning on about competitive it was, how I should ‘throw my hat into the ring’ (a term you hear not infrequently, year after year), how I was competing with the best of the best, and oh my goodness, you want to, job share?!.  Then the usual backtracking over how they support job-sharing but they’ve never done it before and how would it work, how would I make it work, how would I do all the work for them.  I was tired.  I was more tired than I’d been in my life.  I couldn’t blaze any more paths.

The person at the end of the phone sensed my reticence.  They could tell I’d long lost interest in prestige, or dollars, or any of the other pots of gold that the medicine rainbow allegedly offered.  Sensing this, they said magical words I’d never heard uttered in medicine.  Their passion, they told me, was supporting parents with young children through training.  They rattled off a list of things they did and did not want horribly sleep deprived parents doing, and how they had medical workforce on board with this, and that they would arrange my shifts however I wanted.  I was shocked.  I’d never heard of this in medicine before.  Even GP training, that oasis of family-friendliness that calls us all, is suffering from corporate-owned interests impeding on that.  And there it was.  I told the person on the other end of the phone that if they were serious, then I was serious, and I’d be on a plane immediately if they wanted me to be.

Here I am.  Part time, with my roster well controlled and not overloaded.  Surrounded by supportive consultants.  In my own home that I own.  I planted daisies and pelargonium today.  My mother was horrified that I didn’t just get a cutting of the latter, that I’d paid actual money for it, but I pointed out I’d not seen that particular shade of rose-tinted fuchsia in anyones front yard, and that I could grow this one up and take cuttings of it anyway.  The daisies are my toddlers favourite.

The more I tread into that misty territory no one in medicine believes is real, the more I realise that the whole culture of medicine, the whole break-em-down-and-build-em up mentality, the whole, you-must-work-at-150%-all-of-the-time-and-families-have-to-work-around-us schtick, is nothing more than entrenched ideology at it’s finest.  At the same time, I was forged in those fires.  My references, the amazing feedback I’m getting, was built in that culture and I can’t help but respect it.  But at some point, something should give.  6 years out, I get to rest now.  Some people don’t, they push on through that fire, develop skills I could never dream to for so many reasons and they have my admiration.

And as I find my way in this new land, I find myself finally loving my work, my patients, and my colleagues.  As the burnout lifts, I emerge, finally myself in a field where your identity so often evaporates into the thousands of hours spent learning through fire.

In the words of my favourite blogger, we are through the looking glass people.

Kate.

Dr Kate Granger MBE

Dear Kate,

I’ve never met you but my heart is broken.  I was a resident when I first discovered #hellomynameis and I remember reading your story and thinking how amazing you were, how suffering the blow of such a terrible diagnosis and at the same time, using your experience made something positive out of it.  I loved how much you loved medicine.  Your knowledge, the passion you had equally for the science and humanity of it; I remember thinking at the time, will I ever love this job that much?  I was burnt out and overworked by a giant, thousand bed hospital that had gobbled me up and chewed me into millions of tiny pieces.  I loved how you loved life, music, food, how you enjoyed all of it, in spite of it.  I followed you through time, all these years, to today.

When I became a registrar I had no idea what I wanted to do.  I figured a year of it wouldn’t hurt for experience sake and back then, I was so lost and confused by the brutality of the job.  And my first year of registrarship was a further baptism of fire that I wouldn’t wish on anyone.  Multiple personal tragedies, workplace bullying, and discovering what ‘clinical governance’ really means, more being gobbled up by the system, and int that year, being so lost I couldn’t speak anymore.  I kept following you, reading your tweets, feeling the dread that came with each infection, cheering for you when you got home.  Your love of life, of your marriage, your work, helped anchor me, helped me remember what was important in life.

Right at the end of that hard time, I did my first geriatric medicine term and like you, fell in love.  Suddenly I understood it.  It was all the best bits of medicine (for me), wound up messily with the culmination of human experience.  It was medicine, it was families, it was psychology, logistics, pain and suffering, healing, quality over quantity.  And finally, with a new purpose, that horrible year faded into memory, I got my exams and sailed happily into that world where I am now without one single regret.  And throughout that whole, torrid, journey, you were there on your own incandescent, heartbreaking, amazing, world-changing path.

I’m so sorry.  I’m sorry about Christmas.  I’m sorry Chris and God, so sorry about Charlie.  I’m sorry about the baking and the music and the little ones.  I’m so so goddamned sorry that your patients don’t get you as their doctor because you are who they need.  I’m sorry that thousands of people are championing your cause because I damned well know that if the cancer never happened there wouldn’t need to be the cause.  I want to wind back time for you, make the diagnosis never happen because you deserved your family and your career and all the cakes and Pimm’s and other nice, bright things in life. And you took all of that sorrow and turned it into magnificence, the highest form of functioning.

At the beginning of the year at my hospital in Sydney, the nurses had set up a table at the entrance and took photos of us in a picture frame adorned with the words ‘Hello My Name Is’.  We had name badges and wristbands and I wore them until they fell apart.  I’d been introducing myself properly ever since learning of you, not always perfect with it, but so much better than the at-times patriarchal way I’d been trained.  And these days it’s ingrained and it’s perfect because Kate, for you, I’ve practiced and practiced and practiced.  And early on I’ve been that scared resident that couldn’t look their cancer patient in the eye and since you, not any more, and since having my own interns and residents, I’ve trained them too and I know they’ll train all the others.

I love my job now Kate.  I appreciate the little things so much more.  I’ve learned so much from you and Chris, more than just introducing myself properly (and how sad we needed a campaign to teach us this), and forever more, for you, I will introduce myself, I will love my job, I will always try to look on the bright side of life and work with the hand I’ve been dealt.

The last thing I wanted to say, because I’m not sure you ever did, not publicly anyway because you’re a lady, was this.

Dear cancer,

Fuck you.

All of my love,
Another Kate.

Dr Kate Granger MBE and consultant geriatrician, passed away last night at the age of 34 from a rare type of cancer.  She was given less than two years to live at diagnosis, and in the five years that followed, sparked a worldwide campaign to have healthcare workers introduce themselves to patients, and treat them with the respect and kindness that they all deserve.  The #hellomynameis campaign has been adopted by hospitals and health facilities all over the world, and Kate and her wonderful husband Chris have raised over 250,000 pounds for the Yorkshire Cancer centre in Leeds.  Kate wrote two books in this time because she was clearly a spectacular overachiever, you can find them here.  She will be sorely missed by healthcare workers all over the world.

Decision fatigue.

When I was going through training for the exams last year, our director of training gave us a teaching session about decision fatigue.  I’d never heard of it before, but it’s a studied theory that suggests that the more decisions you make in a day, the more the quality of your decisions suffer.  There was a seminal study of high court judges that found if in court all day, with no break, their decisions became harder and more unjust by the end of the day.  If given a lunch break (heaven forbid!) their decisions remained more balanced.

Steve Jobs is the oft-raised example, wearing his signature black skivvy and jeans combination, simply so he would not have to decide what to wear every day.

Women have come to accept the ‘what will I wear today’ battle as if it’s normal.  The more organised of us will pick out an outfit and lay it out, but even that’s a battle of decisions, just at a different time of day.  And some days it’s a complete experiment and by mid-morning you feel uncomfortable and sometimes fat.  Some days you nail it.  Some days you feel like you picked out all your clothes in the dark, from the bottom of your wardrobe and want to hide away from everyone for fear they might notice you’re a massive battler.

In the last couple of months I’ve done an experiment on myself with this, because my life, my job, is so demanding.  On a work day I’m up at 6, trying to get dressed, trying to get my toddler dressed and fed, trying to get her to daycare on time, and then trying to get myself on time.  I cannot have the added luxury of mixing and matching and trying on outfits, but nor do I want to not dress well.  In Juanity Phillip’s A Pressure Cooker Saved My Life, she describes wearing the exact same pants and top combination to work, having gone and bought a variation of colours of the same top, and the same set of black pants.  The book is an interesting insight into the at-times disturbing struggle of a mother trying to work-full time and progress her career while bringing up multiple kids.  It is a vignette (I think) in what an unsupportive workplace looks like – if they’d had any heart at all they would have let her work a bit less because it is such a stressful read full of too many sacrifices, even if at the time it was supposed to be championing ‘having it all’.  (Hot tip:  There is no having it all because no one, not even men, ever did).

As usual, I digress.  I found even the idea of tops and pants too decision fatigue-ing so I bought dresses.  I bought long sleeved dresses that were a bit gathered from the waist down (I hate wearing tight or fitted skirts or dresses and if you have to suddenly do CPR on a patient – not a good look).  So my work uniform is now a dress, tights, and flats, although now that it’s winter, it’s now ankle boots.  I only have dresses that I’m comfortable wearing (translation:  look good wearing) so that I don’t need to try them on in the morning, I pull it out of the cupboard, throw on the tights and shoes, and done.  They’re all different because I need the variation.

Hair and makeup gets done in the exact same style, no experimenting (I can do that on the weekend) but if I’m feeling a bit shabby, big fake diamond earrings tidy it up a bit.

I feel like I’ve Marie Kondo’ed my morning routine and it truly is life changing.  I haven’t compromised my personal style (if anything, it’s a lot more pulled together), and when I get to work, I’m not frazzled.  Starting the day stressed is the worst and I don’t recommend it.

I’m still working on how to do this to the rest of my day, but I feel like the whole “I have no nothing to wear” shitfight is somewhat oppressive and by removing it from our day, it frees us up to focus on other things.  Of course if you have the time, and actually enjoy playing around in your clothes on a daily basis, please disregard, but for those who find it a grind, I hope this was helpful!

Code Blue: Vogue Forum

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In 2004 I was fresh out of my first degree, and had no idea how to function as an adult.  I had to buy a suit to wear to my first professional job, and had no idea about makeup, having schlepped around in jeans and skater-trainers for my entire teenage life and early adulthood.  I showed up to my job in ill-fitting, mix-and-match polyester and felt like the worlds biggest impostor.  A woman there took sympathy on me and introduced me to the Vogue Forum.  My world opened and changed and suddenly I was surrounded by women of all occupations and personalities and passions and it was amazing.  I learned how to buy a suit.  How to wear makeup so I didn’t look like I’d been hit with Homer Simpson’s slap gun.  How to argue for more money, change careers, buy a house.  I.  Loved.  It.  And later when I changed careers, there was more support, and even applause.  There were famous threads, famous users, and it was even in the news a few times.

And then it started to fade.  The post’s grew less.  The forum was redesigned and lost screen real estate.  Some of the most famous threads and users were deleted inexplicably.  We all got busier as our careers progressed.

Later on I had the privilege of being asked to be a moderator which I gladly accepted, but the combination of medical school and subsequent training with my own life stuff in between (and consequent total exit from the Internet for a couple of years), the soul crushing amounts of spam that had to be binned in the background, the time poor moderators, and the unfixeable things like the deleted users and threads and lost screen real estate all conspired against us and now it’s a graveyard.

Except I don’t want it to be a graveyard.  And somewhere in all of that, my moderator privileges remained.  And suddenly now that I’m part-time, I have some time.  Not a whole lot of time, but I have some to write, and interact, and stick up for people and posts from being deleted.  So I’ve decided to out myself as a mod – not one of the earlier ones with the cool and funny jokes, or the later invisible heavy handed ones, one of the newer ones who has so much to give back to the forum.

If anyone reads the forum, please come back.  If anyone reads this blog, give it a go.  I’d really love to pay it forward to the new generation of early 20 somethings who have no idea about the world.  I’ll make sure status-anxiety doesn’t result in the deletion of a $10 a week on food thread or any great arguments in the current affairs section get shut down.  Vive la Vogue!

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Restless for the still.

It is Monday and I am shaking as I walk into the tiny hospital where I’ll be doing my first term as an intern, in a criminally under supervised emergency department (which I’m since happy to report has improved in that regard).  I can barely open the door to the junior doctor’s room I am shaking so much, and I can barely open the locker I paid a $5 deposit for to put my stuff in.  At orientation I was told to bring common sense and two pens so I’ve travelled pretty light.  My clothes feel scratchy and uncomfortable because I had no idea what to wear.  A face appears from behind the lockers, a nice-looking older Asian guy and too enthusiastically I say “Hi! I’m the new intern!”   He smiles at me and says “I can tell”.  I am dying of terror.  My pass falls off on my way to the emergency department.  I drop my pens.  My pass doesn’t work, necessitating a trip to the bored-looking security guys who grab the pass, swipe it in something then give it back to me without a single word.  The first patient I see I spend a long time taking a history and doing an examination and thinking about the issues.  A little too long.  The in-charge doctor rips me a new one for taking too long and tells me to keep it far briefer.  I see a grand total of 3 patients the whole shift because I have no idea what I am doing.  I lose both of my pens during the shift and I’m pretty sure common sense didn’t come with me to work that day.

It is Monday and I am not shaking because it’s six years later.  It’s another new hospital, another job because every 3 months we get a new job.  Often a completely new workplace.  New bosses you don’t know, new colleagues you don’t know, new patients, maybe a locker, maybe not, no idea where you’re going to keep your stuff because doctor’s who aren’t consultants don’t really get offices – they might get a room with computers but it’s shared with nurses, physios, allied health.  You sure as hell don’t get your own phone or computer.  Sometimes you stick your bag under the desk and cross your fingers.  Today I am carrying a semi-expensive handbag and my clothes match, my shoes are shiny.  Again my pass doesn’t work and again I return to security and play on my phone wordlessly while they wordlessly fix it.  My bag is neatly packed with ten pens, a pouch with my neurology tools, a stethoscope, an attractive leather-bound notebook, Mecca’s lip deluscious (AMAZING), my phone, keys, and wallet.  Switchboard has no idea who I am when I pick up my pager, we shrug and joke about workforce, and I go and meet my new set of faces, new bosses, colleagues and patient’s.  I easily get along with everyone, after this long in the game, there’s no point being cold and the sense of relief among us all is palpable.  Oh good, not with assholes this time.  I ask the nurse in charge before I start if there’s anything previous doctors do that piss her off so I can avoid pissing her off, and when the consultant comes for a round, I ask him to tell me how he likes things written and done.  I make mistakes.  I forget to fill in a form.  I get their names mixed up.  It’s the first week, I’m okay with it.

And on it goes.  New job, new people, every 3 months.  For six years.  By the time you’ve gotten to know everyone and your job, by the time you’ve earned their trust, it’s time to move on again.  At first it’s exciting.  Moving around, meeting new people, entraining yourself into a specialties mindset.  But the last 2 years it’s a grind, that perpetually semi-forgetful state bred out of a permanent state of unfamiliarity.  And lately I’ve felt envious of the bosses and senior nurses who know everyone and each other so well because they’ve been there for years.  Years!  Can you imagine in it?  Being in the same job for years?  Not having to move home, to find a new route to work, where to put your lunch?  Not having to reapply for jobs every year?  I almost can’t.  And I’m restless for that permanence.  The argument for this of course is that it broadens your experience and it really does.  It’s a good thing because while it doesn’t make you an expert, it teaches you to ask the right questions.

The good thing about being post-exams is that now at least I’m able to concentrate all those new jobs and workplaces into an area I like instead of all areas.  I’m at 4 different hospitals in vastly different locations this year and I don’t mind so much because they’re all in geriatric medicine but I’m getting tired and very very restless to start standing still.

Why would anyone choose medicine?

It’s been a very long time since I made the decision to switch careers and study medicine.  I still remember the day of that decision so clearly.  It was a sunny Sunday morning in September, the kind with that newly warm air that signals winter is almost over.  That wind that brings excitement and promise and a sense that everything is going to be okay.  I sat up and proclaimed to my future husband that I was going to do medicine.  I can’t remember his response.  I just remember it striking me like a bell.

The lead up to that of course, was all the stuff of life, a job that I hated, a personality that didn’t fit with it, a less-than-straightforward childhood, a friend who suggested medicine.  And at the time I found it so hard to quantify why I wanted to do it.  It was medicine right?  Who wouldn’t want to do it?  Wasn’t it the pinnacle of everything?  That noble field of saving lives that came with the added bonus of sounding impressive to everyone you met.  And sure, I didn’t mind anatomy!

Oh medicine, if I knew then what I knew now.  I’m not going to tell you I was naive and that I hate my job.  I don’t hate my job.  And everyone is naive when they enter anything.  What I will tell you is that medicine took my innocence about people away.  The world I lived in then is so different to the world I live in now and some days I would give anything to go back to that.  Things happen to people that you didn’t know could happen to people.  People do things to people that you didn’t know could be done.  And you see things that you can never un-see, that change you forever.  Those days of innocent hobbies and social lives are gone, replaced with long hours, and soul draining sights and stories.

In time it gets better, your soul gets less drained, the stories are carefully compartmentalised into what is in your control and what is not.  But you get harder.  You become the person who was insensitive toward you once upon a time, and not because you don’t care, but because you’ve simply seen so much horror, that your threshold for what truly hurts is way above everyone elses.

I wanted to help people.  And to some extent I do.  But in hindsight that wasn’t specific enough.  Help people how?  People need so much more from other people than a plaster of paris or a prescription for tablets.  Would I have chosen a path that helped people be healthy and happy if I knew what I know now?  Because a huge proportion of the hospital aren’t there because they want to be healthy and happy.  Which population group do you help?  Those that want to be helped or those that don’t?

If you’re thinking about why you want to do medicine, don’t go and ask doctors why they like their job.  Ask them how medicine has changed them.  See if you want that for you, and if you do, go for it.