The Doctor Will See You Now

'Impossible is just a big word thrown around by small men who find it easier to live in the world they’ve been given than to explore the power they have to change it. Impossible is not a fact. It’s an opinion. Impossible is not a declaration.'  Mohammad Ali

I had no cash reserves when I started as a doctor. I used my credit card to buy some business clothes and shoes, and spent that Saturday and Sunday feverishly preparing to start work on Monday. My mind was so prepared to be unemployed that the idea of starting work took a bit of getting used to.

I was due in the hospital early on Monday. I woke up at the usual ungodly hour to get ready. This day, I wasn’t catching a tram as a student, but as a doctor.

I arrived at the hospital for orientation. It was scary. Starting work as a doctor is scary for anyone; the idea of having someone’s life in your hands, even under strict supervision as a baby doctor, is nothing to be sneezed at. Doing that with quadriplegia just amplifies the nerves.

The media came to cover my first day. They asked me how I felt. ‘Excited, but terrified!’ was my answer. Some of the journalists had taken the whole journey with me, so we were all happy to see that day come to fruition.

We spent two weeks in orientation, which covered things like prescribing, referrals, ward rounds and other basic topics that the medical intern should be able to do. There were also the tick-box exercises mandated by human resources. Some of these were pointless online activities, often to mitigate a risk that has appeared on a bureaucrat’s radar at some point. No one learned anything, but the organisation can say that their staff was trained in whatever topic it was – usually at a significant cost.

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Many mandated training modules for healthcare staff often come from a reaction to something. Often, there is nothing meaningful to gain from it apart from the organisation being able to discharge their responsibility.

I also had to complete training that other doctors didn’t need to do. I sat in a room for the better part of a day learning about occupational violence and its management. The hospital thought that I was at higher risk of experiencing violence.

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Another key question for me was which medical specialties to do. That involved a conversation with a doctor who looked after the interns.

He was a good man, but an occasionally intimidating one. It wasn’t unusual to see him storming around the hospital yelling profanities about subpar management by other doctors. Still, he had a heart of gold. We set up a meeting. He said to me, ‘We need to do this year in a way that is not tokenistic, not too easy, and has credibility.’ There are some specialties well known for having less than vigorous workloads. I was not to spend too much time in those specialties. We decided on psychiatry; obstetrics and gynaecology; vascular surgery; general medicine; and extended time in emergency medicine. Vascular surgery in particular was known to be a spirited specialty. But I was going to be starting in psychiatry. Just as in student life, it had a better pace for me to get used to being a doctor. In contrast to being a student, though, I had actual responsibility now.

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Everything is a big step in early intern life – even prescribing paracetamol. What if I cause liver failure? What if the patient has a reaction? When I had days off, I was terrified that I would come back to find that some monumental error had killed someone.

This is not far-fetched. Remember the grumpy doctor? In a moment of vulnerability, he once told us about losing a young patient to a pulmonary embolism. This is a blood clot that gets lodged in the lungs. It can be fatal. Ever since he lost the patient, that doctor has been extra vigilant about pulmonary emboli. Medicine does that. When we make an error, we swing far the other way to being overcautious, sometimes to the point of detriment. My colleagues have experienced the sudden loss of paediatric patients, adult patients, and even people they have known personally. The marks left by these losses are deep. Imagine carrying the death of someone with you.

As an intern, you learn more about the medical hierarchy. The medical student is more insulated because they have little responsibility. The intern is responsible for things, and they answer to those above them. Those above aren’t always forgiving. Ryan Holiday said in his book Ego is the Enemy that, ‘It is a timeless fact of life that the up-and- coming must endure the abuses of the entrenched.’ In medicine, the entrenched wield power not just by virtue of seniority, but by the influence they have on a junior’s career. They can make or break it.

There are also power differentials between specialties. Radiology, for example, is at the end of the line. Everyone needs something from them, but radiologists rarely need anything from anyone else. Therefore, requests to radiologists can be met by snappy rebukes. Emergency medicine refers patients to every specialty. Other specialties, apart from general practice, rarely refer to emergency medicine. This creates a power imbalance that sometimes results in difficult conversations. The way people behave in situations of perceived power differentials sometimes shows the dark side of the human nature.

Hospitals are therefore a unique social microcosm. In a 1963 article called ‘The Social Structure of a General Hospital’, Robert Wilson says, ‘Because its work goes on around the clock and its life-sustaining goals demand a maximum of self-sufficiency, the hospital constitutes an internally diverse society within a society.’