I vaguely remember instances where I missed work because I was sick. A few hours snatched here and there to see a dentist, get that procedure done and then straight back to my rooms. Even the birth of my daughter seemed like a weekend affair until my boss called me to order. ‘You don’t understand’ I would argue, ‘my patients’ lives depend on me. And don’t forget, I have a whole clan to feed, a paper to write, another procedure to do… there really is no time you see’. And it isn’t just me. So many of us doctors would rather be chained to a hospital bed than miss checking in on our patients. But the sobering fact is, just because this is how we are, doesn’t make it right.
What is the price we pay for this narrative? No more starkly has this been revealed than during the Covid-19 pandemic. We’re losing doctors at an alarming rate and in the process are exposing the multiple challenges we as doctors are all too good at ignoring. Our physical, mental, spiritual and financial wellbeing is as variable and fragile as that of any other professional.
Recently the son of a colleague who passed away from COVID-19 was distraught as he recounted the lack of care his father received as he lay dying. Another friend whose husband had spent his entire career fighting the ills of inequality was heartbroken that the health system her darling husband had worked so hard to create, could not take care of him in his hour of need. It is indeed a tragic and lamentable irony that so often no care is available for our dedicated careers.
And so I ask most sincerely, ‘Doc. How are you?’
‘I am fine, but I have aches and pains all over. In fact, if I’m being honest, I feel exhausted and desperately need to take a break; two weeks to recharge please.’
When I was an intern, I was always on call during holidays and I forgot how to spell the words ‘break’ or ‘holiday’. I even found it repulsive that doctors would take time off and head for the bush, the sea or the mountains. How dare they leave their practice? What about their patients?
That was until someone I respected declined my invitation to speak at a prestigious conference because she would be taking a break. ‘To go and smell the roses’ she said. ‘To recharge. To become myself again.’ This finally forced me to take a step back and think things through clearly and compassionately. Stripped of my preconceived ideas it soon became perfectly obvious that this should be the norm in everyone’s calendar.
And so I now say emphatically: ‘Doc, you are allowed to take a break. And that includes a lunch break.’
I ask again, ‘Doc. How are you?’
‘I am fine, but technically I’m living above my means so actually I’m broke.’ ‘I’m fine, but it is really hard to have a whole clan who depends on me just because I am a doctor.’ ‘I was always taught to punch above my weight you see and doctors simply can’t say that they don’t have money.’
For some being a doctor is a means to an end, for others a calling. For some unlucky ones, it comes with a hefty black tax. For all it attracts lenders who are all too happy to bank on your future income and watch you become entangled in a crippling lifestyle.
I have learnt that practicing medicine is not a way to become super rich – that is not if you practice honest medicine. You will be comfortable before and after retirement, but not necessarily excessively so. We should all know this and live accordingly. Benevolence is after all the direct opposite of being super rich. So let’s instead redefine what success really is, and find true fulfilment in the areas that matter most to us. If this means seeking financial advice from those schooled in plotting the best way to achieve financial freedom, then that is the bravest and most wonderful next step. Be realistic and learn that it is ok to say no to some of your clan’s requests.
‘Doc. How are you?’
‘I’m fine but have too many things on my mind and of late I am barely able to function optimally.’
When I realised that doctors are also human beings, it was a revelation! Ah! They go through grief, divorce, loss, trauma, depression and illness. I now know that many a doctor is walking around with subclinical depression and that the suicide rate amongst doctors is higher than in the general population. When Brené Brown rambles on about vulnerability I think she must at least in part have been speaking of doctors. Many simply crumble in silence. Doc, that fake show of strength need not be your burden to carry. You have seen and supported the vulnerability of others. When is it your time to be vulnerable and embrace the help that can be offered you?
‘I’m fine but my career is not what I wanted it to be. I am not where I want to be.’ I remember my mother asking me why I felt the need to study further after all my years as a student. ‘Surely my long list of degrees and diplomas were enough?’ she would ask. But study further I did, and failure was never an option. As doctors we beat ourselves to death when we don’t meet our own expectations, even though there is nothing further to prove. We earned our stripes years before. So doctor, know this upfront. You have nothing to prove and if you do perchance fail in an endeavour, there is no need to feel defeated. Seek support if you need it, and move forward with your army of cheer leaders as you continue your life’s path. It’s ok to receive mentorship, tutelage, coaching or whatever it takes to pick yourself up and move on.
‘I’m fine but there is this bump on my neck. I’m sure it’s nothing major.’ ‘Sick day? Me? No. Who needs a stinking sick day?’ ‘I can’t be that sick so I’ll just self-medicate.’ That’s until it’s too late. Nobody ever really thinks of a doctor as being susceptible to human frailty but I’m saying it to you now, ‘Doc, you are allowed to seek medical attention when you need it.’ All too often, self-medication is a slippery slope and you need to step aside and seek professional help when you know that you are now the patient.
We seldom stop to reflect that surrounding each and every doctor is a host of people who are in some way knitted to them. They can old, young, rich or poor. Some are grateful for the help given, others are not. But when a doctor falls, he/she never falls alone. Not financially and not practically. We are our own breed, set apart, but never separate.
Many doctors who have died of Covid-19 leave hapless sole practices which can’t be run by anyone else. Others leave a whole clan stranded. This might explain why you can’t be unwell, can’t fail, and can’t be broke. But it also explains why you need to care for yourself before you care for others.
