Pteromerhanophobia to Phnom Penh

Something about me: I’m afraid of flying. Really afraid. Nights before a flight I’ll lie in bed made breathless by the certainty of an imminent, terrifying death. Plane crashes are statistically highly unlikely, you say? They happen, I say. Who’d you think is on that plane that vanishes or tumbles out of the sky in the dead of night? It has to be someone – why not any one of us – why not me?

At the same time though, flying fascinates me. Ascending, taking off, watching as your home your country becomes the whole world. Flying changes your perspective on everything. The way back gardens become snow-ridged mountains. The lives and loves and wars played out across hundreds of cultures below as you eat your pseudo middle-eastern sandwich from the Doha section of the airplane meals dept and watch reruns of Friends. It’s another dimension. Marco Polo took 24 years over this journey.

Anyway, there’s a huge world out there; sometimes you have to balance risk of death against the probable gains. And I’m off on medical elective – two months in which we’re let loose to do anything we like (related to medicine), anywhere we like in the world. How on earth do you make a choice like that? I chose a small surgical hospital in Phnom Penh, Cambodia, specialising in cleft lip and palate repairs, burns reconstruction, trauma surgery and cataract surgery. Phnom Penh! It’s almost worth it for the name alone.

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One step back

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If you’re reading this, chances are you came here via a Google search related to ‘medical students’, ‘fainting’, and ‘operating theatre’. Welcome.

So this morning I went to theatre for the first time and saw a laparoscopic appendectomy. I mean I saw ten minutes of one, before backing hurriedly out of a door I really shouldn’t have used and lurching into the corridor. (Yes, I realise this is an embarrassingly low-key surgery to faint in). Did you know it requires two scrub nurses to escort a dazed medical student into a coffee room? This is apparently for health and safety reasons. You’d think they’d have other priorities, such as the girl on the operating table with three holes in her abdomen.

Waking up again is the weirdest part of fainting. I lay there as my brain clicked its way through various possibilities like a surreal fruit machine. Am I in bed dreaming? At a Halloween party, surrounded by revellers dressed up in scrubs? Lying across three chairs in the surgical coffee room, a load of off-duty staff looking at me? I blink and focus. It’s the latter. Oh… crap.

I realise this isn’t an ideal story if you came here looking for reassurance. But don’t panic. I’m here as your somewhat foolhardy guide, proving that it’s not the end of the world and – as the nurse kindly reminded me – it happens to everyone. I got up to go back to theatre, and as I Ieft the room a surgeon walked in… and fainted.

Deep-sea diving for the non swimmer

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About this time last year I was wondering about the way medicine changes you. I’ve spent the whole year fighting the idea. We’ve learned how medical students are actively socialised into the profession (medical schools isolated from the rest of the university, long working hours, separation from other students, specialised jargon that renders us incapable of communicating with normal people etc) and it just backed up my instinct (read: fear) that after a while of studying medicine I would never be quite the same again.

Of course we all change throughout the courses of our lives. Sometimes we can’t see what’s coming at all until a bend in the road reveals an exciting new path taking us somewhere new, never to return. Any profession might do that. But I can’t help feeling that medicine is exceptional. Once we’ve deliberately pierced a person’s skin or put a hand inside their bowels or seen them die, surely that gives a new view on life and humanity that’s difficult to unlearn.

That’s why, every now and then, I feel the need to say STOP! Hang on just a sec… wait there! This’ll all become old pretty soon and unremarkable, but right now I’m in my very first week of clinical medicine and I want to remember it while it’s still strange and new. While the old me is still here. After all, this is apparently the rest of my life.

After a day in the hospital I emerge as if from a long immersion into deep water. That’s how it feels. From within, everything outside is muffled, blurry, forgotten. I’m in some sea so deep and wide I can’t see the bottom. It’s murky and full of things I can’t see properly and don’t quite understand: acronyms and measurements and anatomy and vital signs, all linked by mysterious threads. I’m trying to find my way about through the gloom and I haven’t learned how to use my gills and fins yet. I have no idea how far the unknown goes. Pretty damn far I think.

That really is it right now; a vastness of unknowns. I’ve been pushed in and am only just about swimming. The mysterious threads are a tangled mess. It seems all-enveloping: to grasp it I’ll need to immerse myself completely, let go of the side and dive, and just trust that the oxygen holds. This is nothing like any university that came before. I’m studying with new people in a new place in a totally new way. Rather than learning the biology of the body I’m suddenly dealing with histories and clinical signs and examinations. And meeting patients, imagining they could be my dad or my grandmother but also recognising that perspective that a doctor has to have. The idea that I might untangle things enough to make a diagnosis one day seems absurd.

And all those medic-y things are starting to come true: I’ve already had some very early mornings, been put on the spot by scary consultants and found the short-cut to Costa. I almost can’t believe it’s me but at the same time it’s brilliant and fascinating and it makes me want to learn and be really, really good at it. God knows if I can, but every time something makes sense it’s as if I’ve just dived into blackness and brought up a pearl. I’m so surprised to hear myself say it but if you asked me if I’m happy and inspired, if I really can imagine doing the job, I’d say yes.

PS Needle update:
Hours spent in lectures on venepuncture theory: 2.
Sessions practicing venepuncture on fake arm: 1.
Disgusting videos about chest drains watched: 1.
Actual chest drains seen: 1.
Anecdotes about amputations endured: 1.
Fainting episodes: 0. But the worst is definitely still to come.

Dancing

There’s been a fair bit of fear and self doubt and confusion chasing round my head recently, but sometimes there are moments of clarity too, when I remember something of why I thought becoming a doctor might be a good idea.

Take intimacy. How many professions let you – indeed, force you to – stand with someone at the very front line of life’s battles? Not in any abstract, academic sense but standing right there in the face of pain and tragedy and joy and all the rest. Being there when someone is dying or hurting or getting bad news or becoming a mother or getting annoyed or just plodding on through. Seeing and talking about the most intimate things. Hearing someone’s story.

What a privilege. But after that is it possible, I wonder, to go on with life as normal? After just a couple of days of shadowing doctors on a medical ward I was wondering if I’d be able to ever think of a body as sexy again, take my health for granted, relate to people doing normal, sensible careers.

Of course perhaps doctors learn to switch off as a necessary defence; it may well be impossible to really care about all those patients or think about it too deeply, a bit like it’s impossible to smile at everyone on a crowded London street. Doctors are just normal people after all. I hope I can be good enough not to stop trying to care. 

Tomorrow I become a medical student. I should probably be excited but actually I’m mostly a) cold, b) surrounded by personal junk and very little storage space and c) missing the security of my friends. But I’m interested, I think, in what will happen and how I will feel. This is my last ever night of not being a medic. It is very difficult to unlearn things. So will I ever be the same again?

Change can be scary, but I take comfort from a wise friend who, when told that I was sad to leave my old life because I had been learning to love the present moment, reminded me that the present moment is always where you are. Right here.

And as Alan Watts said, “the only way to make sense out of change is to plunge with it, move with it, and join the dance”.

So we shall see. Here’s to waking up new and dancing.

The events of life

Medical school starts in a month and I’m terrified. Yesterday was my last day at work and now I may never need to work in an office again. All those years of staring glassy eyed at a computer screen wondering what went wrong, why I’m here instead of out in the real world. Wondering if this is just what happens, this is how people get stuck until the end of their working lives; not brave enough to make a change.
 
Does that make me brave? Dear god, I have so many fears.
 
To those who say “but you’re following your dream!”, I say I’ve agonised over career choices for so long now that the question ‘what do you really want?’ has become meaningless. The reality was lost months ago in some bizarre mental labyrinth of questioning and meta-questioning. Is this what I want or just what I think I want? Or what I think I think I want? Or what I ought to want? Or what I will want once I’ve found the exit to the bloody maze and just got on with it? I definitely didn’t agonise this much aged 18 – undergraduate decision making got about as complex as sticking a pin in a map and opening the UCAS book at random. Now I’m worried about everything.
 
I’m worried about where my life will go. I’ve just left a nice, easy job in a lovely organisation in a beautiful town with loads of friends, to spend four years unpaid in an ugly city training in a profession notorious for its lack of work–life balance. I have a home in a town renowned for being full of lovable geeks who are into knitting, riding geriatric bicycles with baskets on the front and making blackberry jam. I just spent the afternoon at a festival in an allotment. An allotment! I love lying in parks while my friends play musical instruments, and dancing in the street at dawn. Will I become subsumed into some frazzled medic mould with no time for anything except regurgitating textbooks, polishing my stethoscope and getting as off my face as possible in an attempt to hide from reality? Not that I have a problem with getting off my face but I’d rather do it whilst dancing crazily in a field to some mad brass ensemble than whilst downing 50p shots in a club.
 
And aren’t there more important things in life? As much as I love studying and want this challenge, I also want to have children and a family. Preferably before I’m 40. And I want to spend time with them. I sat at this festival today watching a mum playing with her family. She probably wasn’t a doctor but her kids were beautiful and happy and loved. They were all out in the sunshine together dancing to music, not in a nursery or on a hospital ward. Why is it that most doctors tell other people not to do it…and why am I incapable of listening?
 
So is it possible to have a balance: be a good medical student, a good doctor and still retain your interests and friends and be happy? All the evidence points to “no, you’ll have no time for anything and even if you do you’ll be too tired, you’ll only talk to other medics because no-one else will understand and you’ll be sucked into a cynical system where you’ll be too exhausted to care about anyone.”
 
But I challenge that, I have to. I need to believe that if I want to have a life I will, however hard it is.
 
I did my first bit of medical school reading today. Here’s the very first line. “Anatomy is the setting (structure) in which the events (functions) of life occur.” Oh brilliant, I want to start an argument already. There is so much more to life than that.