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The young boy asked me: “As a doctor and when you go to sleep at night, do you feel a glow of satisfaction after helping people?” Another boy, who was in a perfectly-fitted business suit, asked me: “How much can I expect to earn in the first year?”
It is now 20 years later and I am being invited again to speak with the male students of my old boarding school about their career. It is because of these questions that I am keen to return. What unexpected fun! What an opportunity to hear the aspirations, enthusiasms and worries of 15-to-17-year-olds? Is this where I have come from, 40 years ago?
On my last visit, two doctors were put in a room sitting behind a desk as pupils came in one-by-one to chat with us. I was just starting on my career then and was doing hospital rotations with plenty of on-call. ‘On-call overnight’ was the old metaphor. ‘On-duty’ was the new reality, often for non-emergencies. Litigation fears were the reason for our calls from slumber, often up all night with a full day’s work ahead. A female friend recently said that she was surprised when she discovered the actual reality of on-call. She was changing to another career path within medicine, such as pathology or community medicine, in order to deal with this nasty discovery.
Some of us can deal with a lifetime of sleep deprivation. You would have thought that being a parent might help prepare you. Maybe the wakings of a parent are not the same as the wakings of a doctor.
My own mother, God rest her, used to say: “Sure, didn’t you know that you would be on-call and up all night when you decided to do medicine?” She was saying: “You have picked your bed, now sleep in it.” She seemed to have missed the point! I could see her mind working silently. “What sort of intelligence is this, when future doctors can’t figure out that sleep deprivation is part of the job, like mothers.” So expect no sympathy from parents.
She had a point. As students, we knew that doctors are up at night. But we knew it in theory and not in practice. We knew it in vitro but not in vivo. We knew it in ER but not in St James’s Hospital. I still remember that RTÉ documentary following a ‘junior’ doctor (ie, someone who has slaved away for seven-to-12 years previously) as he did night duty. Those new-fangled locks had been invented and put on all hospital doors for security reasons. A four-number code was needed. Well, this boyo could not remember the code. It was torture for him, and laughter for us, as he put in the wrong code, time after time, aware that the cameras of the Irish nation were looking at him. Knowing that his viewers would never forget, and I haven’t. Of course I can’t remember him specifically, but I remember that he was just like me. I had walked, like a Cranberry Zombie, through the corridors of hospitals, hoping I could write-up paracetamol without fully waking up. I knew if I woke completely that the night was surely gone, but if I stayed almost asleep while walking to the ward and back, there was hope of a restful return to my bed. But still, I had to be as sharp as knives for the full day ahead.
I myself am still wondering what I want to do when I ‘grow up’, because what I am doing keeps changing. General practice is not what it was, in both positive and negative ways. And maybe that is the lesson I want to get through to the students — that the modern workplace is evolving faster than ever before. Maybe the work they will do has not been invented yet. Start somewhere and then follow your dreams as well as your experience along the way. There is no arrival.
To the boy who asked me 20 years ago if I feel a great degree of contentment as I go to sleep at night after a day of helping people, I replied: “What’s this about sleep?” As for contentment; like a parent, we worry at the end of the day about what we missed and how we could have been better doctors or less prone to litigation. We also worry about life-work balance. On occasion, there is room to be satisfied that we are doing something of real value.
To the boy who will ask how much I earn in the first year of medicine, I will say that it is wise to think early about financial reward and even retirement; that a reasonable retirement needs upwards of €2 million in savings. That a ‘poorly’-paid job with set conditions and guaranteed retirement may often be better than a ‘very good’ job with risks attached and no pension. But there might be a price to be paid for this security.
Lastly, I will advise: Can we have the next past-pupil and student meeting with aspiring medical students at 3am? And with aspiring engineers outside in the mud and cold?
Experienced reality is the best teacher. Less vitro and more vivo.