Things change. People change. Or maybe they don't...?
I was beginning to feel like if this is all that there is, if this is truly who I am and how I am going to be spending the rest of my life, I don't really want any part of it. That's not to say I was/am suicidal my any stretch of the imagination, don't worry, I'm far to melodramatic and squeamish for that. And I love life far too much. Or at least the little that I remember of life, for it was starting to seem like a long, long, long time since I had lived it.
I'm not sure when it happened, the precise, defining moment where I was suddenly filled with clarity and said "No more. I simply cannot do this anymore." But it did.
I was in Montreal on holiday, ostensibly to recover and recuperate from my deadly draining job, only I got so terribly sick during the first few hours I was home that I spent the rest of my "vacation" lying on my back with a 104 degree fever and a combination of bird flu/ebola.
It was at some point during my lucid moments battling SARS that I realized that as sure as I was not standing there, this job would kill me. Maybe not today, maybe not tomorrow, but someday. I would wake up with cancer, MS, major depression, single, alone, bitter, miserable and desperately regretful of the choices I made. Or chose not to make.
You see, medicine is a funny, funny thing; it's a bit of a cult, mixed with the army, mixed with a prisoner-of-war camp, and it's very hard to get out of. The realization I had when my feverish haze cleared was not that I needed to quit my fellowship: it was that I needed to quit medicine altogether.
When my sister and I were young, people
often asked: “What do you want to be when you grow up?” My sister answered with
unabashed confidence: “A ballet dancer. And an ape.” She was three at the time
and has since gone on to become a solo performer and writer, teaching drama and
creating unusual one-woman shows that often require her to play multiple roles,
including animals. So she wasn’t too far off.
I hesitated, then responded “A surgeon.
Maybe in the war.” M*A*S*H* was my favourite television show at the time and I
suppose I secretly wanted to be like Hawkeye Pierce; in the thick of trouble,
saving lives, all the while being glib and charming and although not always
liked by everyone, definitely loved by all. I believe I have always wanted to be a
doctor, or at least envisioned myself becoming one from a very early age. This
was without rhyme or reason as there are no doctors in my family and I had
virtually no information on which to base this decision. It was more of a gut
feeling, a “calling,”just something you “know.”
After following a long, circuitous route to medicine with many near-misses, detours in operaland and maybe-I-don't-really-want-this-after-all-ville, I made it.
Third-year heralded the start of our
two-year clinical clerkship. We were no longer classroom bound, but bona fide
doctors-in-training, complete with lab coat, stethoscope and the dreaded pager.
Unlike many of my classmates, I entered clerkship without a clue of what I was
going to do. My specialty picks had fluctuated from Family, to Obstetrics, to
Psychiatry, to Pathology, and I was no closer to choosing. In clerkship, I learned there
are three types of people:
1) The Hard-Core Gunners: these people know that they want to do Plastics or Cardiac Surgery (and most often it is surgery) from Day One. They do all their electives in this, they live, eat, sleep, and breathe this. And they often go on to do this.
2) The Generalists: these folks either want to do Family medicine, or they just love every rotation so much that they think maybe this could be right for them. And probably it could. They are malleable and flexible and easily content to practice any kind of medicine.
3) The Black Clouds: these people are in the minority. They realize they dislike every rotation for one reason or another. They either don’t like patients (and choose anaesthesia, radiology or pathology) or they don’t like medicine (and choose psychiatry or to drop out, which never happens). I was one of these people.
Only I didn’t want to admit it. How could I
like nothing? This was medicine? This was my dream! I just wasn’t looking hard
enough. The one thing I hadn’t tried was Neurology. I loved a lot of the
aspects of psychiatry (only too many borderlines, too many social disasters,
and too many people who didn’t want my help) and I loved things about Internal
Medicine (only too many GOMERS (see House of God), too many sick, sick patients,
and too many social problems), so Neurology seemed to be a perfect fit. And in
some ways it was. I did a one-month elective at McGill and saw fascinating
cases of the brain gone wrong: there was the temporal lobe epilepsy patient
with complex auditory and visual hallucinations of mustard sandwiches and the
dissection of a dog; there was the woman with Alzheimer’s and encephalitis who
thought she was at a winter carnival, there were stroke patients who no longer
recognized their left arm as their own. I had read Oliver Sacks and the
material was pretty riveting.
I spent two excruciating years training in Edmonton before
requesting a transfer to McGill. I blamed my unhappiness on the city, the
perpetual darkness, the -70 weather, the lack of eligible men (I did manage to date an
oil rig worker and an ophthalmologist!), the distance from my family and friends
most of all. The work was the stuff of nightmares, just like the movies:
endless nights of call, being up all night trying to save dying patients when
you are fresh out of medical school, post-traumatic stress disorder every time
you hear an elevator, microwave or a truck backing up, thinking your pager is
going off. I didn’t really like the neurology either, but I thought that would
come. I would get more experience, feel more comfortable. And in fact the first few
years of residency are just so horrifyingly awful and lacking in sleep that you
don’t really question whether or not you are satisfied with your career: you
question whether it is Saturday or Tuesday. You question whether you are alive
or dead.
In residency I
realized several things: I did not like seeing patients, or at least more than
very few per day or week, and I did not like most aspects of neurology. If I
never had to see another stroke patient or patient with a peripheral nerve
problem, it would be too soon. I was, however, interested in epilepsy. It was a fascinating field, I had a superb mentor, and there were loads of research opportunities.
Fellowship seemed like the logical next step: I could secure a position at an academic center, do predominantly research, teach, and see patients a few times a week. It was just what people did. More school. More studying. More endless work for no pay. Who wouldn't jump at the chance? (Sane people, people who have not been brainwashed by decades of torture is who!).
Unfortunately, fellowship did not prove to be what I had envisioned, my ticket to academic liberty and enlightenment, a chance to recuperate from years of sleepless nights and drudgery.
The work was endless, the hours unforgiving,
numerous reports needed to be written each week in a very stringent, completely
uncreative style that all must be vetted by an attending physician. In fact, I
could not make any clinical decision without consulting an attending physician,
something I have not really done since earlier in my residency. I was used to
being independent, autonomous, and confident in my clinical judgement. Very rarely
are my decisions questioned or changed it is merely the fact of running every
detail by a senior physician that adds to the hours and frustration of the day.
The nursing staff was for the most part highly incompetent, doubling your
workload as each order needed to be repeated and rechecked. There were no
residents or medical students responsible for epilepsy patients, making me a
nurse, med student and resident all rolled into one. I did everything from the
history taking, physical examination, note writing, typing of orders, literally
every detail of the patient’s admission, along with the hundreds of hours of
EEG each day. And it never seemed to end. And it was highly monotonous. Then there were the weeks and weeks of call, plagued by insignificant complaints by patients and nurses at all hours of the night. Rarely was I ever called about anything important. And the insurance issues. I felt like I was becoming a social worker or moonlighting as an MBA in healthcare administration. And for what?
In November I decided to take two weeks’
holiday. I had been planning on going to
That was when it really hit me: I have to quit this job and I have to do it fast. I am becoming an insane person, someone I don’t recognize, someone so fragile, so high-strung, so strung out that the slightest noise sends me jumping out of my chair, that the mere hint of a tough situation sends me running the other way, because short of lying on a deserted beach with an unlimited supply of maragaritas, there is not much else I can handle.
I recently came across this quote by Dr. G
Hirsch in reference to the hypothetical breach of the psychological contract
that occurs when physicians realize that medicine is not what they had signed
on for:
“ I
agree to sign away approximately a decade of my life for my medical training
with the guarantee that I will ultimately receive professional autonomy,
respect, status, financial and job security, meaningful and intellectually
challenging work, and career gratification”
As terrifyingly dizzying as all this is,
for the first time in as long as I can remember I feel as though I am doing the
right thing, that I may have a chance at finding out who I truly am and what
makes me happy, and that at 35 it may also not be too late to find a meaningful
relationship and marriage and children – all things I have wanted desperately
but which have always eluded me. I can’t help seeing the parallel between my
personal and professional lives: for years and years I have wilfully suffered,
giving everything I have, receiving nothing in return, and accepting sheer
torture at face value, never finding true happiness in any arena. Medicine does
that to you; it conditions you to strive for delayed gratification, no pain no
gain, it may seem miserable now, but this is all leading towards something
great someday…That day never seems to arrive.
The one thing that has kept me steadfast on
my course is this Turkish proverb that I heard so many years ago:
“No
matter how far you have gone down the wrong road…turn back.”
So, now I am ready to turn back, or at
least to stop going down this wrong road, only I’m not sure where the right one
is; without a map or compass, it seems nearly impossible, only I know the map
is an internal one, and the road is one that I already know but just haven’t
been able to see, blinded all these years by neon signs leading me in the wrong
direction.
Three cheers for the "Black Clouds!" Here's to undoing the last dozen years of accepting delayed gratification. Life happens now.
PS The sun is shining and the fruit trees are blooming here, maybe the road leads to San Francisco...?
Posted by: Hannah | March 22, 2007 at 19:42