There are two things you always remember about being in hospital. The times you felt the most afraid and unsure, and the times when someone showed you a kindness.
The patient
As well as keeping Joan’s thank-you card, I also kept Joan.
She travelled with me each day as I moved around the hospital. She accompanied me on ward rounds and we sat together in X-ray meetings. She ate lunch with me each day in the canteen and drove home at night next to me in the silence. She wasn’t alone, either. Others journeyed with me too. The thirty-eight-year-old father with pancreatic cancer. The woman knitting in the corner bed. The dying woman in the side room begging for morphine. The young man in ITU. Children in paediatrics with non-accidental injuries. The terminally ill woman in her twenties, whose identical twin sister visited the ward every day and reminded us all of the devastation of cancer. As each day passed, I collected more and more people, and it was inevitable that the weight of those people would prove too much to bear.
The first thing I noticed was how slow I had become. It felt as though I carried the memory of these people in my legs, because each step took every ounce of energy. Unless it was an emergency, I didn’t rush anywhere, and it took me the longest time to walk from one end of the hospital to the other. A porter told me that each time he passed me in the corridors, I was always staring at the floor and I realised he was right. I had stopped looking up.
My brain became slower too. I doubted myself constantly. Whenever questions were raised on a ward round or in teaching, I couldn’t process what was being asked and I would always be the last to answer. I stared at my jobs list each day, unable to attempt anything on it because the sense of being overwhelmed was so great, so terrifying, it felt like a form of paralysis. If I did manage to complete something, I would return to check again and again and again that I had done it properly, and, if self-doubt is fed and watered by those around you it will soon begin to grow and flourish. On night shifts, whenever I had a few minutes to spare, I would sit in one of the empty offices and take patient notes down from the shelves. At first, it was only the patients belonging to our team, but it soon became any patient. Any department. It didn’t matter, as long as there was a story. I would read through each entry, right back to the referral letter, and ask myself whether I would have spotted something on the X-ray, or had the foresight to order a particular blood test. Did I have the intelligence to prescribe that medication or request a CT scan? Was I smart enough? Was I a good enough doctor? Did I deserve to be there?
I became fixated on the risks of spreading infection, and in between patients I would stand at the sink and scrub until my hands became red raw, but still I wouldn’t stop, and soon my knuckles started to crack and bleed. One of the nurses noticed and gave me a tiny little pot of Sudocrem, and that small act of kindness in a sea of despair moved me so much that I went into the sluice room and I sobbed. I barely ate. I hardly slept. I lost vast amounts of weight. My hair was matted and stuck to my skull. I would crawl into bed each night and lie in the darkness, unpicking the day, and each morning I would crawl out of bed, dress in the clothes closest to my hands, and I would walk back into a life I had begun to think of as the worst possible living hell. The rest of the hospital coped. I watched other doctors march through their work with what seemed like the smallest of efforts. I walked only at the edges, treading carefully, and my goal each morning was to somehow arrive at the end of day without losing my mind.
If you continue to walk at the edges, it doesn’t take long for others to notice. We are very good at spotting when someone isn’t pulling their weight, but less good at asking why that weight is no longer being pulled. We are also very good at confronting people about it, and several times, doctors who were younger and less experienced felt authorised to tell me off for not being somewhere they felt I should be, or not doing something they felt I should have done. Perhaps they were right, but none of them felt the need to question why that might be so.
I had a small library of people I could visit whenever I felt dangerously unable to cope. Different nurses dotted around the hospital who were especially kind. The bereavement officer, who was one of the most compassionate people I had ever met. The sister on Ward 4, who once made my day by telling me I would have been a wonderful nurse. The hospital chaplain, who always stopped to speak to me and who had the wisest eyes of all. The chapel was right next door to the doctors’ mess and I would sit in there sometimes after a difficult shift, even though I had stopped being able to see any evidence of God at all as I walked those corridors. Perhaps it was the comfort of a silence after all the noise, or perhaps it was the chance that somewhere within that silence there lay the possibility that one day I would find Him again.
I had arrived on the wards filled with joy and enthusiasm, and a desire to be the best doctor I could possibly be. The inadequacies of the system, the lack of funding, the absence of people to provide the necessary care, and the misery and the death and the dying had all whittled away at me until there was nothing of that doctor left. She was gone. Sometimes, she felt so far away, I began to wonder if she’d ever existed in the first place. I’d always walked an extra mile, even if I was never the best, but the job had sent me into such a deep well of despair that it took less energy to wear the coat they had now given me: outsider, troublemaker, clock-watcher. It was so very much easier to become that person than it was to swim against the tide.
I had always looked up to the NHS. I had always seen it as a shelter, a constant, somewhere offering protection and safety to those in need, and yet its quiet and petty cruelties took my sense of loyalty and allegiance, and removed it, piece by piece. When my uncle died, I was required to provide a death certificate in order to take three hours off for the funeral. When heavy overnight snowfall prevented me from driving into work, I was forced to wade into the middle of my road, through knee-deep snow, to take a photograph in order to prove that I wasn’t lying; and I quickly found that, despite their name, human resources were not especially resourceful and actually contained very little humanity.
The NHS I loved had turned its back on me. Not only had it allowed me to fall, there were times when it felt as though it had given me a small push in order to get me there.
At the beginning, middle and end of a placement, you are expected to meet with your consultant to discuss your time there. Any issues you may have encountered. Any problems. To review your progress and discuss your learning, and to ensure that your spiritual and emotional well-being remain intact. These meetings are notoriously difficult to arrange, due to both the consultant’s heavy workload and the junior doctor’s endless list of jobs. You are expected to find someone to ‘hold your bleep’ for the duration of these meetings and very often the only thing you can think about for the whole time you are in there, is how much work is mounting up in your absence. Some consultants prioritise these meetings, some do not. Very often, the middle meeting is forgotten and glued to the final one in an attempt to preserve the impression that someone was concerned about you for those four months.
In surgery and medicine, these meetings often felt like a piece of theatre. You sit in front of a consultant, someone you barely know, someone who you’d frantically tried to keep up with on a ward round, someone who clearly coped very well in the job in which you are now struggling to survive, and the consultant you barely know asks you if you are okay. You weigh up your options. You see the cursor hover over a white box, ready to tick. You sit ashen-faced, with red-raw hands, exhausted, gaunt, yesterday’s sleep still sitting in the corners of your eyes, and with a paper-thin voice you tell him that you’re fine, absolutely fine, because ‘fine’ is so much easier than the alternative. Saying anything else would take too much energy, and you know that the small amount of energy that you possess needs to be saved. If you squander it on telling a complete stranger how you really feel, you are worried you might not have enough left in you to make it to the other side of the day.
‘I’m fine,’ you say. ‘I’m absolutely fine.’
But fine is a word that will slide from your throat, and fine is a word that will bury you.
In my placement in general medicine, I sat in front of a respiratory consultant and I was asked this question. He leaned forward as he asked, and for a moment I thought he was going to rescue me. I thought I had finally been noticed. Instead, he listed my inadequacies one by one, carefully dismantling the very last pieces of my self-belief, reducing me to nothing, and he screamed all of this at me with such violence that his spit landed in my face.
After he’d left, a secretary came rushing from an office three doors down, to check that I was okay. She stood in the doorway and looked at me with a curious tilt of the head.
There was more concern in her face than I had seen from anyone in that hospital for the last twelve months.
‘I’m fine,’ I said. ‘I’m absolutely fine.’