4am. I have flown halfway around the world to return home to South Africa. Thanks to bad weather and canceled flights, I somehow miraculously made it home on the same day, only 10 hours after my anticipated arrival time. After 8 hours' worth of snatched, blotchy sleep on the plane, I'm not surprised I could only sleep four about four hours this morning.
Reading in bed, at 5:20 I hear my dad downstairs in the kitchen. He went to bed at the same time as I did, around midnight. I wander downstairs to chat with my dad over his breakfast. At age 58, he is still a practicing psychiatrist. My father is obese - has been for most of my adult life. He carries most of his excess weight in the worst place possible, around his belly. When I was younger, I thought of him as the jolly fat man, like the character out of House of God. Now, I see him as a walking manifestation of a potential heart attack, stroke, god knows what. He has hypertension and constantly suffers from gout, self-medicating with rounds of steroids. This morning he has bags under his eyes; he looks exhausted. The one downside of seeing my parents only once a year on average is that I see how much they age in the interim. My father does not look healthy.
And it's no surprise: since the beginning of the year, for the past three weeks, he has been working like a dog. The new laws in the country haven't made it easier on him: the mandated e-tolls on the highway, which require drivers to pay a fee each time they (very frequently) pass a toll, has resulted in congested back roads early in the morning as drivers try every way possible to thwart the government and avoid the highways. Patients, with fresh money at the start of their medical aid coverage, are taking advantage of a free insurance-paid hospital holiday. In the past three weeks, my father has had between 35 and 50 patients he has had to round on - alone. I jokingly ask him if he rounds with the night nurse or the day nurse. "Both," he chuckles. He's there so early and for such a long time that the nurses switch shifts as he rounds. Around noon, my dad heads to his private practice, where he sees between 10 and 20 patients over four hours. Some patients are scheduled; others just appear and demand to be seen.
My father is over-worked, under-paid, and over-taxed. As I watch him go about his morning routine, I ask him - almost-incredulously - whether he had worked this hard when I was growing up. At this question, he stopped and thought for a second. "Yes, I think so. Things haven't changed much. Patients are as mentally ill now as they were ten years ago."
I balked at this. When I was growing up, I didn't give much thought to how hard my father worked. I knew he worked a lot, and I knew his patients were trying - especially mentally, especially as a psychiatrist. But my father is the one who inspired me to be a doctor. And now I am wondering: what had I been thinking?!
Maybe my father is older and showing his age more as he slows down yet tries to work just as hard. Maybe having gone through my third year of medical school, I can empathize with what my father is doing on a daily basis. The experience is tangible. I realized during my third year of medical school that, for instance, I disliked rounding on patients on a daily basis. And yet somehow, knowing my dad did this every day and how tried and tired it made him did not affect my decision to pursue medicine in the slightest.
So now I am wondering: what makes children of physicians pursue the field of medicine? There're many of us who do so. Is this a case of denial? Do we just see the idealized side of medicine through our idolized physician parent(s)? Or maybe our parents do such a great job hiding the truth from us. It's probably a combination of all of these things.
Even so, medical schools these days almost all require applicants to have done some shadowing experience, where we spend some time with physicians in their clinics. The idea is that we will gain a much better appreciation of whether medicine is 'for us'. Thinking back to my own shadowing experiences, I realize how faulty that logic is. Because we only get snippets: in the OR, I'd get ushered in during the middle of the case to see the 'exciting' part, before being taken away to see the same gloriousness in another case. It wasn't until my third year surgery rotation, where I was required to scrub in from start to finish, that I learnt just how large a part of the surgery was the suturing, the securing, the planning. What I had seen in my shadowing experience did not at all prepare me for the many additional hours' worth of standing, watching. Likewise, when I shadowed a pediatric oncologist, I observed him chat with and examine the few clinic patients he had in the afternoon. What I didn't know until medical school was how this was a tiny, sub-sub-specialized part of medicine. Years of training, rounding on patients, being constantly paged, being at the bottom of the food-chain, spending hours on administrative tasks, were all required to get to this point. Who'd have known?
I do remember the few physicians who explicitly told me not to go into medicine. They were unhappy with their lives, they told me. Worked too hard, paid too little. I ignored them, because I had looked at the physicians I had shadowed and somehow felt that the glamour of medicine would outweigh any dissatisfaction or unhappiness. I look back now, and I think that the doctors who told me not to go into the field were the only honest ones, the brave ones. Because it takes courage to go against the accepted flow of the field - sub specialize, work harder, study more. And in any situation in life, it certainly required fortitude to admit that one is not happy with one's life.
Maybe there is some fault with how we prepare ourselves to decide to go - and ultimately attend - medical school. The truth is, once in medical school, it's very hard to get out of medical school besides graduating as a physician. Perhaps I'm in the minority, and all the shadowing of physicians or the direct observation of one's physician parent(s) is truly sufficient to help one make the decision to become a doctor. Maybe others' experiences were more accurate of what it is to be a doctor. It certainly is possible that I was simply naive and ignorant, and just didn't realize that what I was seeing was missing the superfluous 'fluff' that is part of being a doctor back when I was shadowing. But just maybe, the others go through the rigorous process of medial school, and discover they love being a doctor, all the same. And yet, I know there a small number of compadres, others like me, who thought they really knew, and realize they didn't halfway through. I've spoken with them at length about this. We are the ones who, like the courageous doctors I described above, try gently to tell the wide-eyed premeds we talk to that they should look harder, think more carefully about their choice: it isn't all as it seems.
And we all deal with this in a different way. Some go ahead anyway, perhaps because they are too stubborn to change course (and who can blame them? The years we spent to get to medical school, in medical school. And the money, the debt!), or because they convinced themselves - or truly do - actually love it. Some go into a 'lifestyle' specialty, choosing to stay course but selecting a specialty that would hopefully compensate monetarily the amount they work better than a field such as psychiatry would. Some change course as soon as they get the M.D., going into consulting or just spending their time doing research.
As I lay in my bed with a heavy heart, listening to the birds singing outside my window - a sound that I miss so terribly in New England, a sound that swells my heart with unbelievable happiness - I wonder at the way we all make decisions,the ones that bring us to where we are today. I don't regret my decisions at all. They've made me into the person I am today. I just wish there were an easier way to understand, to see the future, to pass the baton. Because I know that, as many premeds as I may try to discourage from going into medicine, too many will be as stubborn and ignorant as I was.
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