Is it worth the squeeze?

By Dr Michael Conroy - 25th Mar 2022 | 439 views

Everyone experiences pressure in their own way and you need to find out which kind you can tolerate 

As a second year house officer, I had a short stretch in my hospital’s ICU. My college, optimistically, imagined the medical trainees picking up the nonchalance of an intensivist when faced with chaos. I had a creeping admiration for the way they yawned in the face of turmoil and shrugged off despair. But in reality, you can’t be a little bit of an intensivist, in the same way you can’t be a little bit pregnant: It is a binary situation. Nobody wants an almost-right intubation. 

Still, they gave me their best shot, involving me like any other ICU trainee in arterial lines, central lines, and worsening caffeine dependence. It turned out to be one of my favourite rotations. Unfortunately, I had a lifetime of sports coaches and one scared woodwork teacher to testify that ‘hands-on’ was never my strong point. 

I still remember being called to a respiratory arrest one afternoon in the unit. One of my friends, then the senior trainee, had already started the rhythmic ritual of resuscitation with the bag-valve mask over the motionless body. Squeeze, relax. Squeeze, relax. This being as routine as ironing his clothes, he was conversational. A friend of his had recently started in radiology. 

“My worst nightmare. Could you imagine it?” Squeeze, relax. “Your name, sitting at the bottom of that scan report, for the rest of time! What if you missed something?” Squeeze, relax. “I could not deal with that pressure. The stress!” Squeeze, relax. 

Most people would find the idea of performing breaths for someone who cannot breathe to be absurdly stressful, but for my friend it was bland. Similarly, a radiologist who is kept up all night by the possibility that they made a mistake will not remain a radiologist for long. In oncology, I find delivering bad news and dealing with death are the two features most likely to jar that week’s medical student. For most people working in cancer care, however, delivering bad news sensitively is not a drag, but an important part of caring and a skill as structured as inserting a chest drain. And once you recognise dying as an inevitability that you can support people through either well or badly, it loses some of its taboo. 

Unusual strains of every flavour are part of the condition of being a doctor, from GPs to epidemiologists, and it’s hard to escape them entirely. This should not come as a surprise to anyone: We’re different people, it is natural that we vary in what pressures we best tolerate. But why is it important? 

As we (probably) emerge from the miasma of the pandemic and look at our raw new world, we’re all a bit more sceptical about work. One of Covid’s few gifts has been a sense of perspective, and people’s expectations from their jobs are more exacting than before, with fulfilment now the star of the show. Fulfilment can be elusive, though. “Choose a job you love and you’ll never have to work a day in your life” is one of the most readily falsifiable statements you’ll hear all week. Our lives are full of people working in an area they love, but who are utterly exhausted. “Choose a job you love, but keep a reasonable balance” takes you one step closer, but it’s still not quite right. 

I think what my unfazed friend’s experience shows is that we also need to consider which pressures we can best manage. We may all have a vague understanding of what’s demanding and draining, but this actually means something different to everyone. For some of us, giving public health advice for a million people would be unbearably stressful. For me, bringing sharp metal objects near the temporal lobe would be a step too far. 

It can take time and the grind of experience to find out which work builds us up and which wears us down. Sometimes, the dividing lines can be blurred. But if your dream job has pressures that are a lead weight around the waist, then your career won’t stay afloat. 

Maybe, then, we need to bring a little more nuance to advice when speaking to the doctors of the future. Alongside being energised by something they love, they should have some sober thoughts about what stresses they can shoulder and when they’ll unwind. We can all tolerate some squeeze for a while, but then we need to relax. 

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The Medical Independent 8th December 2022

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