Friday, 20 January 2012

Epoch

This time three years ago I was sitting in a large lecture theatre with my notes in a perspex folder as I listened. In front of me, nestled in my lap was the beginnings of my belly, that would continue to swell for the next few weeks as the Possum grew. I was no longer a student, and yet sitting there in the lecture theatre, I may as well have been, and life was not so very different to a few weeks earlier when I had been just a student.

My clothes were plain and boring. Partly because maternity wear was mostly plain and boring and partly because I couldn't afford much else. But it was also because part of me didn't care, and the part that did was too vain to accept that I couldn't wear the sorts of clothes I'd like to. I liked that I got a free pass in pregnancy anyway, as I listened to those lectures, surrounded by the excited hubbub of my fellow interns as we prepared to step out into the world for the first time and use that hard won "doctor" in front of our names.

We were naive and excited and optimistic. We had survived medical school and the world was ours for the taking. Bring on the ER scenes of jumping on someone's chest and watching them come back to life while we patted ourselves on our backs for a job well done. The fact that my first arrest that I arrived at was a shambles should have given me a heads up, but that naive idealism pervaded my first few months of medicine. And every time someone called me "doctor" a thrill went through me, as it registered that yes, I was.

I went on maternity leave, came back, and I chronicled the disaster that that was. I didn't come back with my adrenaline fuelled idealism and excited determination to make a difference. I came back desperate and isolated, dreading being at work and dreading being at home. It is no wonder that those first few months were so horrible that I have nearly blocked them from my conscience. But I survived them. Barely. And ended up in Palliative Care.

Palliative Care was to be the hardest and possibly the best rotation I did as an intern. I fought against it, it was the area of medicine I feared most, my personal experience being limited to ideas of giving up and saying goodbye. I learned it was not like that, and that the people who go into this area of medicine are the most dedicated and caring doctors I ever met. There is no money in palliation. Very little respect. So those that are there do it because they truly want to make a difference... and they do.

But by the end of 3 months of dealing with those that were sick and dying and afraid, I was a complete mess. Breaking point on so many fronts, falling apart while being the best doctor I could, leaving behind a family in tatters and so fragile that I felt as if I were made of glass. Transparent and brittle. But there was one saving grace, one tiny spark inside that illuminated through my limbs. I was a better doctor.

For the next 18 months I worked so hard that sometimes I'm not sure I slept. I learned to laugh again. I left home in darkness and often came home in darkness. I learned so much. I learned what it feels like to do chest compressions on someone when rigor has already started to set in. I learned what it's like to push a catheter into an epidural space and the unique joy that is seeing crystalline fluid drip from the end of the needle to show you're in the right spot. I also learned the fear in seeing that fluid flow bright yellow, thick as mustard.

I ordered x-rays, I attended crash calls, I took more blood than flows around my body. I prescribed medications I'd never even heard of, and looked up the formulations on MIMS guiltily, wondering how it is that people have so much faith in doctors. I became so slick with taking blood and putting in cannulas that other doctors would call me to come help. I made people laugh at 2am in the darkness as I punctured their feet and finally found a vein in the circle of light from the lamp so that they would mind less at the tourniquet and stop being so terrified.

I sat in the doctor's lounge and watched the sunrise more times than I can remember. A full lunar eclipse one night. Fireworks another. I fell asleep on the chairs, with my pager clutched in my hand, waking instantly as it vibrated and dashing off to put out more fires. I learned to do so many things that it didn't matter if I was mostly asleep, so long as I could do them effectively and not cause pain or fear.

I experienced death. I learned the smell that heralds multiorgan failure and felt the keening pain of it when it happened to someone I'd come to know. I found that there's comfort in sitting next to a bed in the twilight, when no one even really knows you're there and listening to the breath of someone whose inhalation may be their last. Tinkering with the syringe driver to make sure that everything was perfect. An event coordinator for the last moments on Earth. I learned there are good deaths and there are bad deaths, and tried to explain the difference to the desperate and afraid. I cried sometimes, but not very often. The worst days leaving me empty so that I didn't even know how to feel.

But I experienced life too. I saw patients with head injuries so bad that every morning I'd hold my breath a little, waiting to see if this was the day they'd deteriorate. I saw senseless injuries in people far too young to know what the inside of a hospital looks like and permanent disabilities while families smiled tight smiles and became excited by the opening of eyes. I saw two young people, both barely out of their teens, both have injuries that should have caused death. And they languished on the ward for weeks, barely changing, barely alive. Hearts and lungs that still work as 20 year old hearts and lungs should, but everything else at the mercy of a petulant brain.

And I watched one of those 20 year olds wave to me on the last day. Watched him start to show signs that his brain was waking up, and though he would never again be what he was, that he would be something more than what he had been, when I had washed and debrided the wound on his arm that he could not feel as it laid limply by his side. I saw one of them walk into the ward, a few weeks after she'd been discharged. Not ever again who she was, but smiling and walking alone. A girl who had lain silently in bed for weeks, only one side of her body responding to painful stimuli who had progressed just like the miracle pundits tell us.

But I saw many more who didn't.

I've done psychiatry and seen people trapped in their own minds. I've done pain and seen the same thing; those looking for a magic wand that doesn't exist - a silver bullet that will suddenly make them "normal". Seen some that engaged and accepted, went on and understood how to move past the pain and live the only life they have. Saw plenty more who couldn't. I did general surgery, abdominal surgery, orthopaedic surgery. Stood in theatre in the middle of the night while swooning a little from tiredness as I held a retractor. Gloved up and gowned, felt the sweat roll behind my visor and yawned again behind the mask.

I did months of neurosurgery and fought an inner battle with myself. One version of me somewhere is a surgeon, and operating on brains and spines, giving hope to the Harveys of the world. But as I watched the dedication and the enthusiasm of the registrars and consultants that I admired so much, I knew that I just couldn't. I wanted to so much, but the toll it was taking on the girls and Bingley was too much. I knew if I pursued it that I would lose my family. In short months I also lost nearly ten kilograms, and while I've maintained most of that, and I can't pretend that I don't like it, it played havoc with my health.

And now I find myself here on the very last day of being a resident doctor and I feel overwhelmingly sad. In the last few weeks I've felt relief that it's coming to an end, but the wards and their smell seem welcoming somehow. I know this rabbit warren of a hospital better than most. I know the secret passages and the stairs to everywhere. I've practiced on just about every ward there is in every building. I know the nurses and the fellow doctors. I know the ones who've been here forever and the ones that are only just making a name for themselves. I've made friends who will stick up for me, cover for me and tell me roundly when I'm being a twit. I've found referees that say glowing things that make my neck feel hot and my eyes prickle suspiciously.

And I sit here on my unpaid lunch break, in my tailored sleek dress with the shiny accessories and amazing shoes that I would have only dreamed of three years ago. My pager in front of me, my smart phone on my notes and I wonder at how hard it is to push forward. To accept change.

Part of me wants to just stay here, to keep doing this, at getting better and better at it, to not go down any more tunnels but to sit out here in the warm wind and the light. It has been an amazing three years. A terrible three years. I am so much older that I was three years ago. And if I stay here it's warm and it's comfortable and there's no risk at all.

But deep in my belly where the Gleam resides, there's a warm and flickering fire and that curl of anticipation that a little girl felt as she lay her forehead against the window as she sped to another destination, another new beginning. I don't exactly know where I'm going, I've just bought a ticket for the train and once I'm on it we'll speed away. And sometimes we'll travel through tunnels, and there will be no light anywhere at all. But even in the darkness we'll keep on moving forward, until I'm in the light and wind again.

3 comments:

Penelope said...

Wow you really are amazing. You are very inspiring.

Can't wait to read all about your next chapter! xxx

Mark E. in Oz said...

Thank you Jenn x

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