Speaking to a prospective medical student the other day, I found myself coming full circle.
I was him once upon a time, speaking to four men in their forties and politely assimilating their thoughts about medicine having a low ceiling, their gripes about the poor pay and long hours, and thinking privately to myself that I was different from them, that my zeal would never burn out.
Well here I am now, the man in his thirties telling some starry-eyed kid what it feels like to look at my peers with their five-figure salaries and five day work weeks, never having to go on call and think... hmm.
Perhaps one of the most sincere things I said to him that I hope he really, really heard and didn't just brush off is this:
You need a reason to get into this at all - and it has to be Personal. Helping the world isn't personal, it's an excuse. It's a line to feed to entrance committees - and it just isn't enough. All the feel good fuzzy wuzzy stuff wears off after a while - for everyone, great and small. It's just inevitable, because optimism can only take you so far.
If you were inspired because of the zeal you saw in an old man's eyes while he was seeing patients, because of the transferrence of hope you saw from him to his patient... it's not enough. Because that old man is special - the zeal burning in his eyes is special - it comes from some deep-rooted conviction - some might say insanity - that is intensely personal.
You can't be him - because he is unique. You have to be you. You need a Reason.
Of course being intensely passionate about helping people might be your reason - maybe that alone is enough, for you. Maybe you'll prove different to all the rest of us -- (unspoken - maybe your flavour of crazy is crazier than ours...) -- but chances are it isn't.
I told him my own reasons - once upon a lifetime ago, I watched my grandmother die in pain, slowly succumbing to liver cancer; and I watched as my father palliated her day in, day out for six arduous months. I watched him make the long trek (well, long by local standards) across the island; I watched as the lay members of the rest of the family failed to understand, and accused him of poisoning her. I watched him titrate the morphine to keep her at first lucid but pain free, then gradually less lucid, but pain-free. I watched the pain and sadness in his eyes and realized - this takes courage, and this is special. To make a difference.
To cure someone, to heal - that's one thing, and that's ok. But to be there when they are in need, even if there's nothing more we can do but titrate a daily morphine dose - that takes something extra.
I didn't want to be my father - I can't be. He's tougher than I am. And unique. But I wanted to try to perhaps be a pale shadow.
When I was in medical school I watched a great man, a GP attend his patients on his daily rounds in his village. The day ended with home visits - not house calls, just home visits. He was geriatric and tended to fall asleep easily. A lot of driving (is he awake, is he awake?!?!) and a lot of cups of tea (ok he's definitely not awake). He brought me to some Tory meetings (god knows why) as a prominent village politician which was... unsettling, but he also brought me to a funeral for one of his patients, a teenaged boy suffering from clinical depression who stopped taking his medication and threw himself in front of a train. He had his head bowed, as if in prayer, but once in a long while a tell-tale tear fell.
Time has passed, and I've changed now - as I told the wannabe - we all change. It's inevitable.
I can't be these people, I'm not strong enough. To tread the thin grey line, and perhaps step over the barrier that divides intimacy from professionalism - perhaps these are just terms the weaker of us coin to preserve our sanity, or to stay within bounds of the law, shrug - I can't do that. My comfort zone is firmly on the safe side of the line.
I save legs now. Nice and impersonal, and I enjoy it. Everything fits - I like the operating, I like the interventions, and I like the woundcare. Sometimes in clinic I connect with the patients who want to be friendly, often-times I don't, and it's just you, left leg, and I. I'm still making a difference, in my own way. And I still have that personal reason, that makes me think on those dark days when I'm 36 hours out from my bed, and falling asleep doing an appendicectomy because my junior colleague doesn't know how to - and wondering about people who never have to experience this ridiculuos hardship, at what, two bucks an hour... well, it makes me think - don't think about it. Don't even wonder why the government underpays us. Just don't think, because well, I have a reason.
Medicine is an insanity. I told him as much.
But the single most important thing I told him was that he had to speak to many, many people - people who had reasons, and people who didn't. People who were staying, and people who were leaving - then decide where his own personality lay. I told him to aim for fifty people, because it was important to know, before he dove in and potentially made a mistake.
I told him it's not prestigious. No, it's not - because the lay public assumes everybody else is glorifying doctors, and they want to be cool and different so they bash them. That's how you get morons writing into the strait's times berating people for writing about good doctors, and saying "the point of this thread is to bash doctors, we don't want to hear about your good doctor, doctors are supposed to be good by default". And it doesn't pay well unless you go private. People will bitch about twenty thousand dollar salaries - but these are end of life salaries in sixty something year olds past retirement age. Nobody bitches about pilot pay (well except pilots) or laywers' pays. How much does a CEO make? How much does a politician make?
Do they ever have to do calls - and are they expected to keep functioning well past the sensible limit of endurance? There are studies that show that its just not possible to remain functional after sleep deprivation - yet we're expected to do it. Without commensurate reward.
And it doesn't require you to be very smart. It's just following guidelines, and being competent. It requires you to be good at following instructions.
It doesn't save that many lives - the true geniuses like the head engineer of Cook who designs new stents - he saves many more lives than we do. And he's a lot smarter than most of us.
I also told him - as a poly student trying to make the jump into med school - it's an uphill struggle for you. Your peers will venerate you, and those with political agendas will proclaim you their poster boy - it gets trying after a while being a "hero" and a pawn. And the JC students who make up the bulk of your contemporaries, well many of them will secretly belittle you. They will keep trying to judge you poor. Acceptance may be difficult to achieve. There will be all this... extra unpleasantness for you to wade through, which only a certain... insanity will help tide you through -- you need a reason.
And without that reason, well - what's the point? Why put yourself through so very much, only to realize one day when you've changed, when you're older - that what your peers are doing does look attractive enough to you that you want to make the jump and start over. That what they do is challenging for someone of your calibre, or earns the rewards you know you deserve.
And as we spoke, understanding dawned in his eyes, I think, and he thanked me for telling him to get a wholistic view before he dove into the unknown.