Pregnant on the wards: Part 2 – the personal.

I write this with a heavy heart.  No dot points, a bit all over the place, but that is how these things go.  If you’ve ever experienced pregnancy or loved one loss, don’t read this.  You don’t need to.  You know it all already and you should live your life and not relive your losses.

A few years ago I became a medical registrar.  In my state, you become a registrar 3 years out of medical school.  In some other states, that third year is a quasi resident-registrar year in which some jobs you’re a reg and in others you’re still doing discharge summaries.  But in my state, you’re sent to a regional or rural site to ‘break you in’.  Three weeks after being a paper-pushing resident, I was the medical registrar for the hospital at night.  All medical admissions had to be seen by me.  All sick patients on the wards, seen by me.  And in a curiosity I think specific to my network, there was no week off after nights.  You would show up to your 8-5 day job, on Monday, work until Thursday, then on Friday, try to sleep during the day, and start nights.  You then did 7 12 hour nights, finish the following Friday, have two days off, then return to your 8-5 day job.  2 days off in 3 weeks, to give you an idea of the workload.

In medicine, as a resident or registrar, you don’t sit.  When the boss rounds, you always offer them the chair when there is a chair (not often).  You don’t have your own desk or phone, there are desks and phones but they’re usually shared between you, the nurses, the physios, the occupational therapists, the pharmacist, the social workers and everyone else who needs it.  Of course it depends on how well funded your hospital is, sometimes the doctors might get a cupboard with a lone computer in it but it’s rare.  You don’t sit, you stand and walk and stand and walk.  Sometimes when you’re tired you perch on the end of the patient’s bed.  As an intern your feet hurt all the time but it goes away eventually.  You see your patients, you come up with a list of things that needs to be done for them (a management plan), always with the goal of getting them home safely.  The list includes tests you need to do to confirm your suspected diagnosis and any new ones that usually come up, other services who need to see the patient who need to be called, and starting/stopping/adjusting medications.  You do this for everyone.  You admit patients, by writing up their history, examination, and a management plan.  Am I procrastinating telling my story enough?

My husband and I had been trying for a baby for the last six months of residency but nothing had happened and we decided to take a break.  I was starting a new job in a new hospital, and besides, it’s not like we’d be living together anyway – he had a job in the city and I had to work a couple of hours drive away, and frequently on weekends.  The new job hit me like a ton of bricks.  At first it was alright, I had a supportive group of consultants, but I was a fish well out of water.  And then, I rotated.  You rotate every 3 months in your early years.  Every 3 months, new job.  New bosses, new juniors, new allied health, new systems, new patients, new fridge to put your lunch in.  It’s exciting and intermittently dizzying.  I rotated into the hardest job I’ve ever had in medicine.  3 months out residency and suddenly I was on-call, every 3 weeks for one week.

On-call in this job meant, that from 8am Wednesday to 8am Wednesday, anyone, from the 4 hospitals in the area, laboratories, GP’s, and sometimes patients, could call me.  They would call me about sick inpatients and sick outpatients and did I want them admitted, they would call me to come in and see people they were worried about, the labs would call me about patients with terrifying lab results who weren’t my patients but were known to our service, resulting in me scrambling to figure out who the hell they were and where I could find them in a very large geographical area.  This was in addition to my day-job, where I had 30 patients, and 20 consults daily, which I usually managed to finish at 8pm on a good day.  The calls would come at dinner time, 2am, 3am, 5am, any time really and at any of those times, I had to go into the hospital if required.  Even if I had been in the hospital for a couple of hours since 2am, I had to be there at 8am, ready to go.  On the Saturday and Sunday, I would round on any patients under the service who were sick, and any consults that were sick, and any new consults.  On the following Wednesday, I would turn off my phone at night with relief.

It’s really boring to complain about how busy your job is, especially in this job.  Everyone has a more hardcore story than you.  Some wear it as a badge of honour ‘if you’re not working your guts out, you’re not working’ sort of mentality.  That’s medicine.  I didn’t write all that to complain about it – that term freaking made me, but I wanted to set the scene.

A couple of weeks into that term, I discovered I was about 5 weeks pregnant.  We’d stopped trying trying but weren’t actively not trying.  And what should have been happy news filled me with terror.  For some reason, the medical workforce had put me on my own in a dodgy flat in a dodgy part of town.  I had no idea how I was going to do this job and be pregnant.  No one I knew had kids.  My family were all interstate.  I’d worked so hard to get a coveted job in this network, and now I was letting them down.  How dare I?  They didn’t have to hire me but they did, when it was so competitive.  Would they think I didn’t take the job seriously?

At the same time, I was being bullied by a more senior colleague.  I can’t go into detail because it ended blowing up to something far greater than myself and I was told by administration I was not allowed to disclose any of it.  To anyone.  Not even my supervisors.  I wouldn’t talk about it here anyway as it’s far too identifying but needless to say, this dragged me down into the deepest of holes, pregnancy aside.  Adding first trimester fatigue, hormonal changes, nausea into that mix, along with the on-call, was a recipe for disaster.  I started withdrawing.  I didn’t see it at the time, but I stopped going online as much, talking to my friends and family as much.  I’d go home and turn on the TV and pretend none of this was happening, alone in that dodgy little apartment.  I swallowed Maxalon, showed up to work, did those hours, put up with the bullying, didn’t go to the bathroom, didn’t drink any water, and pretended everything was completely normal.

Two weeks later, my aunty died.  She was a driving force in my life, a second mother when my own had to work, being a single parent.  Her acerbic brand of humour, rampant feminism, and menthol cigarettes touched my life in more ways than I could ever count.  She was only in her late fifties and the cigarettes had given her lung cancer.  She’d gone into hospital for something unrelated and died suddenly of a cancer complication.  Nothing is ever really sudden in stage 4 cancer, but it wasn’t the slower deterioration I was used to.  I flew interstate to her funeral which was a mistake, as much as I loved her.  I finished my on-call, drove the two hours back to the city, got on a plane, went to the funeral, flew back the next morning and drove the two hours straight to work from the airport.  I was exhausted and it was a stupid thing to do.  She would have been horrified..  And I kept going on at work.  Getting bullied.  Being pregnant and telling no one, sick to my guts, so fatigued I could hardly see, withdrawing from everyone.

And then I started bleeding.

There is nothing in the world like that moment in the early pregnancy assessment clinic, when they send you to the ultrasound and you look up at the screen and see that little, unmoving circle.  I was 11.5 weeks when it happened.  You don’t need to hear the sonographer say ‘no heartbeat’, you can see it.  Everything just stops and zooms right onto that awful, little moment, in that tiny little room.  I stopped.  My mind stopped.  My husband’s head was in his hands.

Afterwards I disappeared into a hole.  I don’t have a lot of words to describe that time.  For the rest of the year I was a zombie.  I stopped talking to everyone, I couldn’t speak, I couldn’t compute.  I’m incredibly lucky I have the most incredible friends in the world who didn’t let me drown.  Even when I didn’t speak, they didn’t let go.  Flowers arrived.  A little gift here, a kind word there.  These were the protective threads that without even knowing, I held onto, that carried me through.  I hard deleted my Facebook account which is surprisingly difficult, (it’s not the same as closing it!), and just turned off the Internet.  I didn’t want the conversations of normal life, of the flow of life, when mine had stopped.  I showed up to work.  I suffered through that fucking term.  It didn’t matter anymore how hard I was working because there was nothing left to lose.  My hair fell out.  My husband and I entered a strange place, that place where you lose your innocence about pregnancy, where you lose the ideal that to be successful you work your guts out.  Something broke in us both.  I can barely remember the rest of that year.  I remember trying to study for the exam but staring at the wall. By the time the written exam had rolled around, the damage was done.  I failed it by 4 points.

I will never know if that miscarriage was due to all of those incredible stressors.  1 in 4 pregnancies end in miscarriage, and someone told me at the time that it’s exceptionally hard when it’s the first pregnancy that is lost.  In hindsight though, knowing what I know now, I would never, ever, have let the job run me down like that, as a pregnant woman.  All of the lessons I wrote about in Part 1 were learned in that black hole of a year and oh, if I had my time again! So if you’re reading this, don’t despair, go back and read Part 1 because it really can be okay if you prioritise yourself and your baby above everything including the job.  It’s a hard change to make, especially in medicine, where you are the last priority, but you just have to do it.  I lost so much that year, and it has taken me years to rebuild.

And so I don’t leave you feeling sad, here is the epilogue to that story.  On the day I found out I had failed the exam, between my tears I also was lucky enough to be telling people I was 12 weeks pregnant, scan confirmed.  And everyone in my network was elated for me (a pleasant surprise!) And although there were more lessons to be learned (like, do not let your employer put you on those shitty set of nights where you get 2 days off in 3 weeks, in the last trimester), it was nothing like the year before.  And when my daughter was finally born, my whole world opened up again and because of what had happened, she was more adored and loved than any baby on this planet and always will be.  I sailed through the written exam on the next go, 25 points clear of the pass mark, and then passed the clinical first-go too (which is a whole other excruciating story).  Because in the end, this too shall pass, and it really really did.

If you’re reading this, and have guessed who I am through this somewhat identifying story, please respect my anonymity.  I write this because I hope I can help others in that hole, who are in a unique situation, but I cannot continue to write without the safety of that anonymity.  Thankyou for reading.

Pregnant on the wards – part 1: the practical.

I hadn’t thought about writing this so thankyou for the suggestion Shedidwhatnext.  First of all, and absolutely first of all, if you’re a pregnant medical registrar, or about-to-be medical registrar, congratulations!!  This is a good thing!  Babies are wonderful!

But that wasn’t your first thought, was it?  In spite of this happy news, your first thought was oh shit.  Oh shit, what have I done?   Now you’re wondering if you’ve thrown a nuclear weapon under your career, you’re wondering if your DPT is going to disown you, if you’re going to be that pregnant medical registrar who everyone whines about slacking off at work ‘just because they’re pregnant’ and mutter about ‘special treatment’.

I repeat, congratulations!  It’s still a good thing in spite of those scary thoughts.

Everything I am going to tell you is with the benefit of hindsight.  Take my advice or don’t take it (because advice is cheap), but know that I learned everything the hard way, and this is what I wish I had of done and known.  Here it is in list form because I struggle to think in any other way these days.

  1.  Being pregnant is a special state of existence.  I’m not being self-entitled, I’m not being earth-mothery, I am being practical.  Pregnancy is a unique, physiological condition that people cannot understand unless they have been there or unless they’ve had loved ones go through it.  The hormonal fluctuations, the fluid shifts are insane.  The fatigue is insane.  The sleep deprivation intense.  The mental fog from all those biochemical changes and the stress you’re under.  And then all sorts of other things can happen that we wont talk about because it may not.  The point is that you DESERVE special treatment because of it.  Those people who mutter words like ‘unfair’ and ‘special treatment’ are ignorant.  They might sound very certain, as ignorant people tend to do, but they’re not.  They’re not in your world so they don’t count.
  2. YOUR pregnancy is unique and there is no such thing as a perfect one.  It. does. not. exist.  So when you develop SPD, or the nausea doesn’t go away, or you get intercostal nerve pain and the muscles rip off your ribs because your kids head is off the chart thanks to Dad’s noggin (not bitter or anything;) ), don’t beat yourself up.  It’s okay, it will be over in a few months.
  3. Tell your DPT.  Especially if the exams are coming up.  Even if it’s before 12 weeks.  I made the mistake of not saying anything.  I was doing relief, I was on nights, I was sneaking Maxalon, I was finishing my round and going to my car and sleeping whenever I could.  I didn’t know you could write a letter to the college and they would give you special dispensation for a seat near the bathroom during the exam.  I wish I had of done this.  I will explain in my next post.  This is a personal decision and I understand if you don’t want to do it, because telling someone means untelling them so I leave it up to you, but I wish I had of.
  4. Join the AMA in your state.  Right now.  Especially if you’re at a hospital with a less-than-supportive medical workforce.  They are amazing.  Most doctors don’t know their rights.  Most are led to believe that speaking up about unfair working conditions will harm their career which is one of the last greatest myths in the job.  It wont hurt your career but it WILL hurt the career of the person trying to pull it off.  There are people in the AMA who have the power to make or break careers, and they’re there to protect your rights.  I have a few very good examples of the AMA stepping in with legal advice and representation and not only ridding the unfair request made on the pregnant/new parent, but actually improving the workplace for the better.  It’s expensive but it’s tax deductible.  I wish I had of.  I wish I hadn’t of worked those 7 nights in a row with 2 days off and then back to the day job at 32 weeks pregnant because the terrible SPD and migraines with vision loss wasn’t worth it.
  5. If you’re struggling, talk to your obstetrician about your work conditions.  They are very helpful and will write you a letter in support.  Mine offered to call my DPT and demand I not work in the conditions I was asked to.  Again, I wish I’d said yes.
  6. You need people on your team.  See points 4 and 5.  The AMA, your obstetrician, your family, and supportive colleagues.  The hospital is FULL of people who have kids who’ve been treated badly and will look out for you.
  7. Prepare to be pleasantly surprised.  Most people don’t think you’re lazy and getting special treatment.  Most people love a pregnant lady and want to help in any way they can.  Let them help.  Shoulders to cry on, cups of tea, interns who will go the extra mile for you, they’re all there.
  8. You don’t get to not drink water all day and not go to the bathroom all day anymore.  Yes we all do it when we’re not pregnant, but the placenta needs blood flow and so does your brain.  Please buy a giant water bottle and drink a lot of water.  Don’t faint at work.  Don’t deprive the placenta.  The placenta needs you.
  9. CALL IN SICK. CALL IN SICK.  CALL IN SICK.  CALL IN SICK.  Do I need to repeat myself?  You WILL thank me.  This job is not worth you or your babies health or life.  If you can’t do it you can’t do it so CALL IN SICK.  You have my permission.  Blame me.  This is what sick leave is FOR.
  10. There will come a point when you DO feel like that lazy registrar.  When you can hardly walk anymore, when you haven’t slept, when your back hurts.  If you need to go on maternity leave early, just go.  Better to leave a good impression than a bad one to people who just don’t bloody get it.  It’s not the end of the world if you don’t cover yourself in glory at work in the final trimester, most people are pretty understanding, and…
  11. When you come back to work for a visit while you’re on mat leave, with a tiny little baby (and make sure that you do), all of those people who made you cups of tea or let you cry on their shoulder, or who did a bit of extra work to give you a break and maybe even grumbled about it, will feel like they had a hand in that babies creation, and that will make them feel good, and suddenly all the mutterings about ‘special treatment’ will be replaced with a little bit of guilt.  The people who didn’t treat you right, who see the new mother with the little, entirely dependent on you human, will also treat the next new mother with a little more grace next time too.  Or a lot more grace if the hospital’s management has hauled them into a meeting after the AMA got involved and made them look like a despot😉

So congratulations again!  And no, your career isn’t over – but don’t make any decisions until the baby is born.  Go on maternity leave, try to have a job to return to, but things may change for you.  I was always going to be that person who got a full time nanny and returned to work full time because career, but once she was born, it was like a new, incandescent universe opened up in my life and tossed out everything I’d ever thought about it.  Colleagues who’ve been super-maternal with plans of part time and/or staying at home, have found themselves putting the kidalid in full time daycare/nanny and returning to work full time, quite happily, for their own sanity.

There is no right answer, there is only the one that works for you and your family.  This is your new mantra, because everyone is going to have an opinion.  Take what works for you and unashamedly ditch the rest.  And congratulations again!

Standing on the other side of the valley.

Time doesn’t behave normally when you’re a doctor early in your career.  Those first few years feel like forever.  At first you feel like it will be cannulas forever, discharge summaries, reasoning with the enraged forever.  Later you feel like it will be night shift forever, 15 hour shifts forever (although I’m pleased to report some states don’t have these!), trying to sort out the worlds problems and always feeling like your boss thinks you’re sub-par forever.  Or like you’re never going to get through those exams kind of forever.

And then in a blink-or-you’ll-miss it kind of a way, forever is over.  Suddenly you’re standing on the other side of the valley, looking at the mountain range you just crossed, dusting yourself off and wondering how you got here.  How those thousands of hours, of paperwork, shit jobs, phone calls where people demean your knowledge, endless flash cards, late nights crying in the storage room while your friend pretends to be a clown to cheer you up (you know who you are),  all ended up being worth it when you were never quite sure they would be.

Suddenly you’re on your ward round with your resident asking them to do something and they’re arguing with you, saying ‘we’ve always done it this way’ and you calmly explain the new evidence for doing it, so they do as you ask (suspiciously) and then your boss comes around, notices, and it’s all praise and ‘excellent work’.  After years and years of not so excellent work.  It’s a strange feeling, experience and knowledge and it’s so easy to get drunk on it.  At the same time, that amazing post-exam knowledge seems to evaporate with every moment.

Four new hospitals this year.  Four new commutes, teams, bosses, systems, all interstate from my training.  I’d be lying if I wasn’t a scrambled egg at the best of times – but at work, all that endless time suffering through all that work pays off into good decision making.

We live in this strange world of ever hastening immediacy.  The 24 hour news cycle, social media, everything delivered to you instantly, except the things you really need.  Confidence, knowledge, these come through mastery.  And mastery comes through endless drudgery, of showing up day after day and getting beaten over and over, but coming back and trying anyway.  I can’t tell you how many times whilst studying for my exam, that everyone in the room knew more than me, or how many times I got the same questions wrong, or had a nap instead of study, fell way behind, and killed myself catching back up again.  All those things, in a world that glosses over those things, are what brings mastery, and ultimately confidence.  When I see a womens magazine article that says things like ‘the sexiest attribute is confidence!’ I shake my head.  Confidence doesn’t come in multiple shades for $39.95 a pop.  And by the time you’ve achieved it, sexiness is low down on your list of priorities.

Was it all worth it?  Yes.  No matter what it is you’re working towards, keep going.  Keep going even when you wake up and aren’t top of things and know you’re going to do a terrible job that day.  Keep going when the encouragement is lukewarm or absent.  Keep going when the curveballs come your way.  Don’t stop.  The view from here is magnificent.

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!