A fork in the road - part 1

Much of this year has been coloured by conversations about broken things. That distal radius fracture. The neck of femur fracture. That tibial plateau fracture. Okay, I’ll stop listing components of my day job now. But the conversations about broken things have not been limited to bony anatomy. I’ve thought a lot about training pathways in medicine this past year and listened and learned from many of the people around me. The funny thing that happens when you shut up and listen for long enough is that you actually hear the in between of what people are really trying to tell you – the disquiet that doesn’t sit quite right about the way certain things are in surgical training or the sheer tiredness that coats the aftermath of being oncall. Yet, we all somehow live through this.

When a patient comes into hospital with a fracture, we question why this has occurred – the mechanism. We then give ourselves a big pat on the back because we’ve done the good doctoring thing and understood the patient’s story. We feel all warm and fuzzy inside and then spend a great deal of time figuring out when to break out the power tools that the powers that be somehow agreed to bestow upon a bunch of children with medical degrees. We buy into the conceit of cure. I think that part of the lure of surgical training is the promise that you can learn the skills, the tricks and tools of the trade, to fix something. To fix some broken thing that would have otherwise remained broken had you not intervened.

The question I’ve been asked a lot this year is “do you really want to do this?” When conceptualising a medical career, I think ‘want’ comes into it – but only in so far that it nudges towards the general direction and shapes the outline of things to come. Now this is where we come into the great act-of-faith stuff that you may not have even realised existed, had it not nudged you down that particular fork in the road. Maybe the leap is liking the idea of something enough that we invest enough of ourselves into figuring out if this thing, is actually the thing we want. Funnily enough, it takes time to become good at something. It takes time and a load of effort to become competent at something. So ‘want’ may drive initial motivation but I believe there are other things that sustain you when on a particular pathway.

The anticipation of an end goal (not necessarily the fulfilment of it) is what gets us to initially take action. Unfortunately, the anticipation of an experience can often feel better than the actual attainment of it. Plus, the end goal post moves all the time. This is why I think the whole concept of ‘I will be happy when I achieve x/y/z’ belongs in the same loony bin as trying to put Ikea furniture together with power tools.

Having lived amongst the surgeons this year, it almost rests as a particular type of identity. What most people don’t truly recognise is the special type of loneliness that comes from both the aspiration to this life and actually living out this type of life. The arduous ‘hustle’ is glorified but no-one really pays that much heed to the story of the young dad who missed out his daughter growing up and is now somehow now in primary school. Or the young registrar in her 30s who desperately wants a family but has spent too many late nights holding vigil at a hospital that considers her only yet another cog in the systemic wheelhouse. But it’s not even these big picture stories that fill up the whole canvas. The canvas is made up of the bits and pieces that can slowly wear away at even the most hardened veneer. It’s the late night phone calls that might only happen once or twice, or that might happen every hour on the hour. It’s the quiet in your car on yet another drive back to work in the dead of night. And then the showing up to work the next morning like we’re inhuman against sleep deprivation. It’s the entirely unreasonable expectations and standards we hold ourselves to.

So perhaps the dream looks a little different than you initially thought. So why do this and what makes it all worth it?

Part 2 coming....