A few days ago I spoke with a friend who wants to study medicine. He has a good job that pays more than he would earn as a junior doctor, but what he wants to do is medicine. I’ve always encouraged him because if there’s one thing I’ve always believed is that the only thing that helps you achieve what you want isn’t who you know or how smart, rich, or “lucky” you are, but how badly you want it. Now if my friend is prepared to sacrifice his good salary to go back to being a full-time student for four years and then getting paid less than he is earning now, then I guess he must really want it.
Eventually my friend got accepted into medical school. I say eventually because in the meantime it’s taken him a few attempts at a silly entrance exam, he’s spent money on further study, and his wife has given birth to their first child. It’s taken him some time but now he is actually able to proceed onto the job he really wants – but he hesitates. Why? Why would someone spend so much time and effort striving to achieve this thing that he’s wanted for so long and then hesitate? He told me “once you have a kid, that’s all you can think about”. He told me how he’s also made these other sacrifices in the meantime. He’s changed jobs to accept one where he makes less money than he was before but that allows him to be home more often. His wife has ceased to work to stay home and care for their child. And he is now hesitating on accepting what once seemed like his dream job. But he told me he himself had trouble understanding why he came to do all these things, but all he could think to say was that his child was his life.
I felt such great admiration for him because he had realised that the greatest job he’ll ever do is that of being a parent. That the one job that he is not dispensable or replaceable at is that of being himself: his daughter’s father, his wife’s husband, and his friends’ friend. At the end of the day our jobs pay the bills, and we aim to be satisfied with what we do so it doesn’t hurt us more than we benefit from it. One thing I realised some time ago also is that your job doesn’t keep you warm at night, it doesn’t cry when you’re away from it, and it definitely will never love you back no matter how much you may love it.
Saturday, October 30, 2010
Saturday, October 23, 2010
On the human factor... and the risks of work
As anyone who has ever done a job that involves interacting with another human being will tell you, it's often the human factor that ruins most things. In fact it can ruin it so much you can start to lose your will to live. Let me describe one scenario that is all too familiar for anyone who’s ever worked a junior doctor job in a hospital:
Say the procedure is: patient is 1 year old and has a tumour, patient needs pre-op MRI, patient needs surgery, patient then needs post-op MRI. The actual procedure becomes: need to talk to the patient’s parents about the surgery, risks, etc. You then have to organise the pre-op MRI, which is absolutely necessary for surgical planning – and everyone knows this – but either way someone will have a go at you about because you’re requesting it be done today or tomorrow because the surgery is to be done tomorrow and the boss only told you about it today and the patient did not ask for their tumour to be diagnosed only yesterday. Then you have to discuss the case with the anaesthetist who tells you that you need to put an IV cannula in this child before he gets to theatre, although you tell him that the only accessible vein in this child is in his neck and it took another consultant anaesthetist 2 hours to get a cannula in him last time. Somehow, he tells you, the patient’s poor venous access is your fault and you’re incompetent for not being able to cannulate the child. Eventually the kid gets the surgery (after the 2 hours it took the anaesthetist to find a vein in the child) and you have to talk to the parents again because they're worried something went wrong, they think someone somewhere stuffed up and it's someone's fault, and they get all unpleasant towards you even though you're trying to explain to them that their child is just post-op and they'll improve or that it was a risk you had discussed with them previously, etc. Then you try to organise a post-op MRI and the radiologist decides to pick this occasion to tell you how surgical teams do too many scans, that they don't plan them right, that they order unnecessary investigations, that you personally are a crap clinician, that you don't understand how the MRI machine works, that you are wrong and your patient doesn't need the scan... but they'll do it anyway. So by this stage everything that needs getting done IS getting done BUT all these people have in the meantime made you feel so negative about yourself that you start to wonder if it was all worth it. Like, really, why must it be you that cops the abuse? Your role could easily be filled by someone else who knows how to fill in the forms and talk to people (aka the majority of the tasks the junior doctor job actually involves). So why must it be you? Why? Seriously. Hopefully the kid gets better, and maybe you had something to do with it, but you'll never think of it that way, and the family or the patient will never thank you, so all you remember from the interaction is the abuse everyone laid on you and how small you felt afterwards. Was it worth it? Was removing that child's tumour worth you self-esteem? Was it worth losing your self-worth? Was it worth losing your passion for your job, the big picture? And maybe, just in some, the question becomes ‘was it worth losing your will to live’?
Okay, so maybe the final statement was a bit of an exaggeration but it is not describing a new phenomenon. I always remember that story from ‘House of God’ about the medical intern that suicides and how every year a certain percentage of doctors do. But the phenomenon, of course, isn’t limited to health professionals. Cliff Baxter, one of the executives of Enron Corporation (the U.S. energy company that went bust in 2001), suicided after he was indicted to court for his role in the Enron bankruptcy case. In his suicide letter he wrote, “where there was once great pride, now it’s gone”. As an executive of a corporation like Enron was, Cliff Baxter wasn’t a weak or stupid man, but to me at least, his story warns about the risk of defining yourself by your job. I find it sad to think that having a wife and children, he saw his life as not worth living because he could no longer live with pride for his work. What about living for his wife or his child? What about living because there are other things in life besides work? I can’t help but feel that if you have to rely on your job to make you feel satisfied, to make your life feel like it is worth living, to make you happy, then you’re probably lacking something very important and beautiful in your life.
They say that doctors are especially prone to what is commonly called “burnout”, in general, for the same reasons that they have chosen to become doctors: they are often perfectionists and have a high sense of responsibility. In the workplace these are exactly the things patients and their relatives appreciate and expect. Other co-workers also expect the same thing from them. And what’s more, eventually the doctor comes to expect this of himself. So then he starts going home late to make sure everything is OK (a.k.a. “stable”) before he leaves. He’ll work all the ridiculous shifts and hours he is told to because he’s expected to and no-one before him has been able to change the system so he just has to submit. Of course, with all the time (and let’s not forget effort) dedicated to work and career progression, he spends less and less time with family, socializing, relaxing, and essentially doing all those things that truly enrich human life. It’s then easy to imagine how with work consuming so much of your life, a person could come to define themselves solely by their work. You start to associate success exclusively with occupational achievements and less with the attainment of personal, family, or social goals. Proverbially, you come to ‘live to work’ not ‘work to live’. And once you come to do that, it is not so far-fetched to imagine guys like Cliff Baxter who, having lost his ability to work, come to believe that he has also lost the ability to live.
Say the procedure is: patient is 1 year old and has a tumour, patient needs pre-op MRI, patient needs surgery, patient then needs post-op MRI. The actual procedure becomes: need to talk to the patient’s parents about the surgery, risks, etc. You then have to organise the pre-op MRI, which is absolutely necessary for surgical planning – and everyone knows this – but either way someone will have a go at you about because you’re requesting it be done today or tomorrow because the surgery is to be done tomorrow and the boss only told you about it today and the patient did not ask for their tumour to be diagnosed only yesterday. Then you have to discuss the case with the anaesthetist who tells you that you need to put an IV cannula in this child before he gets to theatre, although you tell him that the only accessible vein in this child is in his neck and it took another consultant anaesthetist 2 hours to get a cannula in him last time. Somehow, he tells you, the patient’s poor venous access is your fault and you’re incompetent for not being able to cannulate the child. Eventually the kid gets the surgery (after the 2 hours it took the anaesthetist to find a vein in the child) and you have to talk to the parents again because they're worried something went wrong, they think someone somewhere stuffed up and it's someone's fault, and they get all unpleasant towards you even though you're trying to explain to them that their child is just post-op and they'll improve or that it was a risk you had discussed with them previously, etc. Then you try to organise a post-op MRI and the radiologist decides to pick this occasion to tell you how surgical teams do too many scans, that they don't plan them right, that they order unnecessary investigations, that you personally are a crap clinician, that you don't understand how the MRI machine works, that you are wrong and your patient doesn't need the scan... but they'll do it anyway. So by this stage everything that needs getting done IS getting done BUT all these people have in the meantime made you feel so negative about yourself that you start to wonder if it was all worth it. Like, really, why must it be you that cops the abuse? Your role could easily be filled by someone else who knows how to fill in the forms and talk to people (aka the majority of the tasks the junior doctor job actually involves). So why must it be you? Why? Seriously. Hopefully the kid gets better, and maybe you had something to do with it, but you'll never think of it that way, and the family or the patient will never thank you, so all you remember from the interaction is the abuse everyone laid on you and how small you felt afterwards. Was it worth it? Was removing that child's tumour worth you self-esteem? Was it worth losing your self-worth? Was it worth losing your passion for your job, the big picture? And maybe, just in some, the question becomes ‘was it worth losing your will to live’?
Okay, so maybe the final statement was a bit of an exaggeration but it is not describing a new phenomenon. I always remember that story from ‘House of God’ about the medical intern that suicides and how every year a certain percentage of doctors do. But the phenomenon, of course, isn’t limited to health professionals. Cliff Baxter, one of the executives of Enron Corporation (the U.S. energy company that went bust in 2001), suicided after he was indicted to court for his role in the Enron bankruptcy case. In his suicide letter he wrote, “where there was once great pride, now it’s gone”. As an executive of a corporation like Enron was, Cliff Baxter wasn’t a weak or stupid man, but to me at least, his story warns about the risk of defining yourself by your job. I find it sad to think that having a wife and children, he saw his life as not worth living because he could no longer live with pride for his work. What about living for his wife or his child? What about living because there are other things in life besides work? I can’t help but feel that if you have to rely on your job to make you feel satisfied, to make your life feel like it is worth living, to make you happy, then you’re probably lacking something very important and beautiful in your life.
They say that doctors are especially prone to what is commonly called “burnout”, in general, for the same reasons that they have chosen to become doctors: they are often perfectionists and have a high sense of responsibility. In the workplace these are exactly the things patients and their relatives appreciate and expect. Other co-workers also expect the same thing from them. And what’s more, eventually the doctor comes to expect this of himself. So then he starts going home late to make sure everything is OK (a.k.a. “stable”) before he leaves. He’ll work all the ridiculous shifts and hours he is told to because he’s expected to and no-one before him has been able to change the system so he just has to submit. Of course, with all the time (and let’s not forget effort) dedicated to work and career progression, he spends less and less time with family, socializing, relaxing, and essentially doing all those things that truly enrich human life. It’s then easy to imagine how with work consuming so much of your life, a person could come to define themselves solely by their work. You start to associate success exclusively with occupational achievements and less with the attainment of personal, family, or social goals. Proverbially, you come to ‘live to work’ not ‘work to live’. And once you come to do that, it is not so far-fetched to imagine guys like Cliff Baxter who, having lost his ability to work, come to believe that he has also lost the ability to live.
Wednesday, October 13, 2010
On priorities
There’s this incident from when I was in medical school that always stuck in my mind. It’s about this patient I saw in a breast screening clinic who wanted to die, and she wanted to die before she even knew that she had breast cancer and could possibly die. It stuck in my mind because it resonated with something I had experienced personally – and something that I am only now beginning to understand.
In the movie (and book) ‘Fight Club’ the main character has terrible insomnia, works a mundane job he doesn’t find motivating but keeps him busy, and leads a fairly lonely life with little friends or satisfaction. To break up his day he starts wishing for something to happen, anything. He wishes his plane would crash, the world would end, anything to end the routine of his unsatisfying life. Of course, he could do something about changing his life (couldn’t we all?), but it’s all so ego-dystonic that many of us would rather wish that things would just change.
Lately I’ve been thinking about this incongruence we have with acknowledging that we are dissatisfied and acting in accordance to enhance our satisfaction. I think one of our main problems is prioritising.
I am someone who is very prone to becoming overwhelmed. As with many people, when I become overwhelmed I often enter this phase of what others might call depression. Sometimes people who find themselves in this state start to wish things would change, for better or for worse but just change. Recently I noticed how I had all these deadlines, things to do, money to pay, people to please, and I started to feel so low. Physiologically there was probably little wrong with me, but I started feeling so down. And so I started to wish again that something would happen. And I wanted something to happen so I wouldn’t have to deal with all these things I had pending. I’d heard Tony Robbins (the motivational speaker) before refer to this persistently low mood as overwhelment rather than depression – and I start to see now how true this may be. But what exactly about wishing for negative outcomes is it that seems so appealing when you’re feeling overwhelmed? I think it has something to do with putting things back in perspective.
Say something bad happens, maybe you’re in a serious car accident or a family member becomes really sick. Suddenly you notice that you can (and should) take the day off work, that that document can be handed in late, that that person won’t hate you forever if you fail to make the party, and that if all these things that were overwhelming you don’t get fulfilled the world won’t end. That’s right, these things aren’t essential! It’s incredibly liberating to realise this. And you realise that all these things have been prioritised incorrectly – or not at all. At the end of the day, the things that keep us alive and satisfied are always the really basic things, things that rarely have deadlines, people who won’t judge you, and things that you probably already have. When life forces us into a place that perhaps physically impedes you from completing the tasks of life that were overwhelming you, only then do we start seeing what our priorities really need to be.
In the movie (and book) ‘Fight Club’ the main character has terrible insomnia, works a mundane job he doesn’t find motivating but keeps him busy, and leads a fairly lonely life with little friends or satisfaction. To break up his day he starts wishing for something to happen, anything. He wishes his plane would crash, the world would end, anything to end the routine of his unsatisfying life. Of course, he could do something about changing his life (couldn’t we all?), but it’s all so ego-dystonic that many of us would rather wish that things would just change.
Lately I’ve been thinking about this incongruence we have with acknowledging that we are dissatisfied and acting in accordance to enhance our satisfaction. I think one of our main problems is prioritising.
I am someone who is very prone to becoming overwhelmed. As with many people, when I become overwhelmed I often enter this phase of what others might call depression. Sometimes people who find themselves in this state start to wish things would change, for better or for worse but just change. Recently I noticed how I had all these deadlines, things to do, money to pay, people to please, and I started to feel so low. Physiologically there was probably little wrong with me, but I started feeling so down. And so I started to wish again that something would happen. And I wanted something to happen so I wouldn’t have to deal with all these things I had pending. I’d heard Tony Robbins (the motivational speaker) before refer to this persistently low mood as overwhelment rather than depression – and I start to see now how true this may be. But what exactly about wishing for negative outcomes is it that seems so appealing when you’re feeling overwhelmed? I think it has something to do with putting things back in perspective.
Say something bad happens, maybe you’re in a serious car accident or a family member becomes really sick. Suddenly you notice that you can (and should) take the day off work, that that document can be handed in late, that that person won’t hate you forever if you fail to make the party, and that if all these things that were overwhelming you don’t get fulfilled the world won’t end. That’s right, these things aren’t essential! It’s incredibly liberating to realise this. And you realise that all these things have been prioritised incorrectly – or not at all. At the end of the day, the things that keep us alive and satisfied are always the really basic things, things that rarely have deadlines, people who won’t judge you, and things that you probably already have. When life forces us into a place that perhaps physically impedes you from completing the tasks of life that were overwhelming you, only then do we start seeing what our priorities really need to be.
The Story About The Breast Clinic
Yesterday I saw a woman at the breast screening clinic who had just been diagnosed with breast cancer. She seemed like the kind of person you’d usually expect to be the one cheering up other people. Yesterday, though, she was just human like the rest of us. The thing that stuck with me most is that she said she was actually happy (even though she was crying profusely) that she was going to die. In her mind she’d already made up her mind that cancer equals death, no other alternative but death. And she was happy that she was going to die because she had wanted to die for some time, before the breast scan had ever been an issue. She wanted to die because her life, she felt, was out of control and she wanted an escape or a change.
Gosh, gosh, gosh. I remember having felt like this before. My life felt remote from what I felt I had been—and I felt powerless, cowardly, and like my life was out of control and without a purpose. And because I wanted to die and at the same time too weak and cowardly to do it, I just wanted something, anything, to happen to me. I fantasized about road accidents, strokes, cancer—anything fatal. At one point I didn’t even mind if it happened to me or to someone else, just something needed to happen to change the direction of my life because I had no direction or purpose to my life. And I felt too weak to bring about change myself. I was so low.
This, I imagine, is how this woman at the breast clinic had been feeling, and how unfortunate that something like this did happen for her. I’m not even sure that it is also what happened to me (or similar) or if it is the opposite.
— 5/05/2007
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