For all the breaking and mending of this profession, it has allowed me to live a life worthwhile. For all the breaking and mending, it has helped me to edge closer to the doctor I wanted to be, the doctor that I still want to become. Because there will always be a need to learn, to improve and to change, very much as I was told on that first day at medical school.
Most important are the words I heard in the past from many people I respected, often on retiring from professional practice, and the same words were very recently echoed by a new friend: let’s remember to check in with colleagues that they are okay – because this is what communities do.
The consultant
Many times during my training I would say to myself, and to anyone who would listen, that I wished I had never done this. I would wish that I had taken a different path, that I’d never seen the postcard in the newsagent’s window and I’d never persuaded a doubtful professor that I would make a good doctor. I would go to great lengths to list all the other jobs I could have done instead. The many careers that would not have left me mentally, physically and financially exhausted.
Now, I look back and I can’t imagine having done anything else. I can’t imagine not meeting the incredible people I have had the privilege to meet, and I am amazed at the fragile decisions I made that allowed our paths to cross, even if it was only for the briefest of times.
One of my deepest concerns about writing this book was that it would deter people from following a career in medicine. If it’s any help to those who might be considering becoming a doctor – I truly wouldn’t change a thing, even the darkest days, even the days that made me question whether my existence as both a doctor and a human being was really worth anything at all. Because of all the days I had, those were the ones that taught me the most.
Mending, like breaking, can happen in the unlikeliest of places.
It can grow from the briefest event and from the shortest encounter. Breaking is accumulative. We collect small episodes of despair and unhappiness, our own Kodak moments, and we carry them with us until their weight becomes too much to bear and we fracture under the burden. Mending is exactly the same. The more often we witness small moments of compassion, the more humanity we see; and the more likely we are to be able to mend ourselves and the quicker we are to heal.
At medical school, we had many lectures devoted to mending: the anatomical, physiological and biochemical methods of healing, of bone and skin and tissue, from infection and fracture and disease. We learned about the complex process of clotting and the coagulation cascade, the direct and indirect wisdom of bones, the acute inflammatory response and the intricate expression of many thousands of genes. The body’s ability to regenerate is remarkable and extraordinary, but it is also intensely fragile and the most important factor ensuring its success is the correct environment. Without the right landscape, none of this can happen. In the wrong surroundings, our body itself becomes a wild card.
When I look at the lives of the people I met in that lecture theatre on the first day of medical school I see many different landscapes. I see surgeons and GPs, anaesthetists and paediatricians. I see those who travelled halfway around the world to follow their career and those who stayed in the hospital where we walked as medical students. I see those who remain working within the NHS and I see those who left and continue to use their skills to help people elsewhere. I agree with many things we were told in that inaugural lecture – it really was the first day of our medical career – but I disagree that there are only two kinds of doctors. I think there are as many doctors as there are people, and as many different landscapes as there are ways of healing.
Psychiatry became my landscape, and within that landscape I learned many things. I learned about the compassion one human being can show to another and I learned about the resilience of the human spirit. I learned that our roles in life are many and valuable and I learned about healing. I learned about the need to look out for each other. I learned about the importance of wild cards.
In a game of cards, the wild card has no suit or colour. It possesses no value. Its currency and worth is determined only by the person who holds it. Wild cards are defined by their landscape and by their keeper, and what is high in value to one player, may be worthless to another. What appears to be a wild card on the surface may, in reality, be anything but.
I am often asked about going to medical school at a later age, about being different, about being a wild card. I always say that the world – and especially medicine – needs more wild cards, but perhaps, if we look more closely, we will discover that we are all different, we are all wild cards. Perhaps each of us is just searching for the right landscape and for our somewhere to belong, searching for the right place to tell our stories, in the hope that someone out there will listen and we will be understood.