We’ve had a lot of media coverage about how hard being a junior doctor is now. It’s barely the tip of the iceberg but it’s given me a lot of pause, and now that I’m part time, working a subacute job in an acute hospital, I actually have more time to listen to what’s happening around me. It’s not pretty. I overhead an intern replying “or, I could put a knife through my heart” when told she needed to do a discharge letter right now because the ambulance was there. No one had warned her. Discharge summaries take a while to write and she was mid-ward round. I saw another guy slamming the desk repeatedly because hospital computer systems. When I went to see a consult I noticed the intern was pale and shaking and when I told her gently that she was doing a good job, she collapsed into tears. Her registrars were being arseholes, because their bosses were being arseholes, and she didn’t play the ‘flirt with your registrar’ game.
And for a while there I felt pretty down. All that media coverage, all that I was witnessing, not to mention my beautifully suppressed own horror stories, and reader, I could write a trilogy and come back for two prequels with all the terrible stories I have, it was so much. The media would love my stories. And they’re never going to get them. The media coverage has given me this strange sense of contagion and in a way, it’s made things worse. This had to happen, it had to blow up, and it was always going to but the more I read the more it brings up for me and I was lucky enough to make it through junior doctor life in spite of my horror stories. I maladaptively coped in my own ways, I stepped back from the glory of the acute limelight in the grey area of a subacute world that isn’t glamorous, that doesn’t aim for cure of anything but focuses on quality of life, sometimes at the expense of length of life. I found the people who think and feel like I do and I joined them. And when I’ve done my training, I’m not interested in a system that eats it’s young. I’ll stay in it to some degree because you always need the peer review of a public hospital, but that once noble cause of contributing to free healthcare for all in a collegiate system of respect (not to mention residents quarters and feeding the staff) is gone, fallen victim to an intensely cynical political environment focused on numbers that can’t be perceived to be giving ‘handouts’. The result is everyone measuring themselves by numbers, how can we reduce the numbers, how can we turn them over, how much can we do in the community that we don’t have to do in hospital (hint: nowhere near as much as you’d think).
However. I did not make it through this far by focusing on all the failings of this system. Your life is very much dictated by the lens through which you view it and you can throw on the green glasses or you can throw on the rose glasses. Choose the green glasses and everything looks sick and rotten. Choose the rose glasses and everything is warm again. The greatest thing that medicine has ever given me is collegiate relationships, of genuinely liking who I work with, and you can see this everywhere. They’re tiny little moments that get drowned by all the traumatic stories, self doubt, horrible days, days where you don’t eat or pee but they’re there. It’s the nurse who hands you a cup of tea and a biscuit, or put in that catheter for you because you’d done a grand total of one but back in Hong Kong they were the catheter nurse but aren’t allowed to do them here because paperwork, it’s the colleague who listened in the corridor to your bad day even though they had so much work to do themselves but don’t mind because they get it.
It’s the consultant who buys you a coffee and takes you to lunch even though you can’t figure out why because you never feel like you’re up to scratch (hint: expectations are lower than you think), it’s the guy down in rostering who sympathetically listens to your rant about the unsafe roster and actually changes it, it’s the person you’ve never met who asks if you’re okay then hides you in an unused office so you can cry it out. There are people who care everywhere. You can’t see them because you’re so afraid, so wound up, so withdrawn and scared that someone might find out how you’re feeling. You feel like you’re alone in this world of overperforming heartless extroverts who loudly tell you that they have no idea what you’re talking about when you complain about how hard things are (hint: that’s their way of hiding it). And yet, here you are back at work, tired beyond belief and unable to remember when you last washed your hair, and there again is the tea and the biscuit, the registrar who buys you a coffee, the nice lady on the switchboard who asks how you’re going. We are all here. We are all here for you. We might not be visible immediately – but that person who stays to listen, who gives you the biscuit, who hides you in the office, those are your people. Get their number, find them again. Find the rotation where you got along with everyone the best and consider that as a career. I was presented with a very clear choice of pursuing a field where I could not be more different in personality to the people I’d be with, vs the one where I loved everyone. I chose the latter and haven’t looked back. Don’t be afraid of finding your people even if the path is different to the one you envisaged for yourself. Our values and ego don’t always line up, but if you can put your values above your ego and live close to them, you will be happy.
I can’t fix the culture. I’m sure as shit not going to tell you to ‘build your resilience’ because that’s bullshit – you are not the problem here. Find your people, get home from work and get on the couch with a block of chocolate and some binge TV. Buy an expensive handbag after your run of nights. Go on holiday to Europe and eat some food, lie on a beach in a tropical place and do nothing. Find the things that make you go “aaahhhhh” with happiness. Learn to shake it all off a little bit because you’re really not the problem, and you’re okay. Learn to laugh at it a little bit. Because slowly but surely it does get better as you gain knowledge and experience and autonomy.
And if suddenly you find that all the things that used to make you go ‘ahhhh’ simply don’t anymore, if you find yourself wondering who you are because you don’t like your favourite food anymore and can’t get excited about going on holiday anywhere, this is what you need to do. You need to buy private health insurance. You need to find a psychologist practice as physically close to you as you can find. You need to ring them up and tell them you need to see someone. You don’t need a GP referral, you can just pay privately if you’re more comfortable with that. When you go to that appointment, all you need to so is sit down in that room, and say “I don’t want to feel like this anymore”. Your psychologist will take it from there and you just need to let it all out. You need to buy your psychologist chocolates at the end of it all because the person you will be when you leave that room will be greater than the one you have ever known. I know you shouldn’t have to, I know none of this is your fault and why should you have to put yourself through this when other people made you feel like this? The answer is, because you don’t want to feel like this anymore.
Find your bright side. It’s in the dark humour, the biscuits, the strangers who listen and the colleagues who care and the psychologists who are visibly horrified by your stories and want to help you feel better, who tell you that you’re fine and the system is royally f***ed. It’s in your family who welcome you home where you’re warm and safe and fed, and the friends who laugh and cry with you. Keep showing up each day and doing what you do. We all appreciate you, we know you’re doing the really high volume stuff. Keep trying to find the bright side, no matter how small, let the cracks of light in. Try to sleep as much as you can. Learn to say “f**k it I’m having lunch” even if the other juniors look at you funny and watch how the sky doesn’t fall and the sun keeps on rising.