Pursuing a career in healthcare is a huge privilege. For a subject that comes so close to the surface of humanity, there is far more to be learned from lived experience as opposed to the textbooks.
On the medical course you will find a variety of patients; some who will tell you about how well behaved their dog is, and some will look you in the eye and say 'no' to any past medical history whilst being on a bible of medications. Yet amongst all the dialogue there will be priceless encounters that will resonate with you for a long time.
As I arrive at my final year of medical school, I gather and reflect on some valuable lessons I will treasure for life - despite being a mere twenty-two years of age.
Lesson #1 : Life isn't meant to be easy.
As someone who has an immediate family member with a chronic illness, I already had some understanding of the impact of poor health before entering medical school. My previous ‘normal’ became something so different.
It meant living with uncertainty. Heightened levels of responsibility. The heavy weight to hold in one's head. I would find myself in this repetitive habit of thinking, 'why is my life so difficult?', and it was only when I started to see patients (thanks to Norwich Medical School’s early patient contact) that my attitude changed.
I've now probably seen a few hundred patients so far, and each person came in with their own unique problem(s); heart, lungs, bowels, nerves... all with their implications on that person's life. Someone had to prick their finger around three times a day - every single day - just to check their blood sugar is in control. Another person needed dialysis four times a week just to cleanse their body from waste and toxins, whilst likely to feel very awful in between those sessions. I try to imagine how life-changing it would be to have any of these conditions. I can’t remember the last time I had to think about how my pancreas or kidneys were doing, and I’m very grateful.
From these encounters, I recognised that I didn’t have the same problems as these patients, but I did realise what we all had in common. Whilst the word 'cancer' would ring in my head most of the time, it may be 'asthma', 'Crohn's', or 'psoriasis' for someone else. This reminded me of a quote I read somewhere, probably on Twitter, that illustrates this point:
"For you is your mountain, for them is theirs"
We consider our problems relative to what we have lived through. People can only assess how bad something is relative to their lived experiences, which forms their paradigm - the lens through which they view the world.
Speaking to patients every week at a general practice and hospital helped me to reshape my way of thinking. Rather than constantly seeing myself as a victim, I saw it as a worldly issue that everyone is facing, each morphed in their own particular way.
Which brings me onto the next point...
Lesson #2 : You can't change reality, so change what you can control.
I suppose this is a principle adopted in medical practice too. Some conditions are incurable, but it wouldn’t make sense to sit and do nothing about it. So we try to manage the symptoms so that patients can at least live more comfortably. A concept that we can transfer to our everyday lives.
I saw a patient with a colostomy during my gastroenterology rotation, who came in to talk to us (medical students) about her experience of living with a stoma bag - and it was one of the most positive interactions I've ever encountered.
For background - a stoma is formed after a surgical operation to remove a section of the patient’s intestines due to its disease (e.g. cancer or inflammatory bowel disease). Because the intestine is now shorter and can’t make it all the way down, a small opening is created on the surface of the patient's abdomen, which connects the remaining healthy intestine to the outside world and releases waste into a bag attached to the skin.
Understandably, there surrounds a huge stigma to having a stoma. From the daily routine and its upkeep, to body confidence and intimacy… It is surely a difficult change to accomodate, but this patient’s mindset threw me by surprise.
Having this stoma brought her more than it took away. It was an end to unbearable and excruciating pain, and she could finally go anywhere without having to quest for the nearest bathroom. She befriended her stoma - quite literally - who she named “Mike". There, she radiated this great sense of empowerment, despite knowing how differently she lived to even the closest people around her. She created her own normality.
I went on to see this mindset in many more patients - they didn't dwell; they accepted. They accepted that, at some point in life, we would all suffer in some way or another, and that's the way life goes. That’s not to say we shouldn’t experience sadness or anger - we are humans after all (a friendly reminder of the Kubler-Ross ‘Stages of Grief’ model) - but it would be ineffective and damaging for us to harbour these feelings for too long. The sooner we can accept, the sooner we can focus on the next best thing, and the better version of ourselves we can become. I learned that, if we came to a halt every time a bad event occurred or a negative thought entered our minds, we would never be able to breathe peacefully again.
Lesson #3 : You have the capability to do anything.
Imposter syndrome was no stranger to me in my high school days. I doubted everything and anything I laid my foot on. And by far, my biggest doubt was if I was ever good enough to get accepted into a UK medical school.
The interesting part was, I found people around me to be surprised to hear this. What they saw was the surface, the tip of the iceberg; they saw the cumulative successes and wins, without the paralysing self-doubts along the way. It made me realise that people had these grand expectations of me whilst I was causing my own damage. To put it short, I burned a lot of nerve endings (an Arabic proverb), sheerly from all the thoughts in my head. Luckily, medical school came at just the right time...
We see so many ‘overachievers’ in this competitive field, often hearing our peers admiring, sometimes envying these overachievers as if they possess this unfair, supernatural advantage:
As conflicting as it sounds, I thought of how unnecessarily complicated these overachievers were made out to be, as though they were some sort of special breed of humans. “How hard could it be?” says the person who would deliriously revise the periodic table in her sleep. On a serious note, I realised that it was one thing to be a nervous wreck, and another thing to not want something bad enough. Both are possible reasons as to why we might not fully reach our potential, and I knew very well that my issue was the former one.
Recognising my limiting factor, I pushed myself to take risks at medical school. Saying 'yes' more, seeking opportunities and taking authority was the best change I made. Fast forward to my fourth year, I made valuable networks with some big names in medicine, organised a national conference, plus picked up many valuable skills along the way, such as leadership, public speaking and above all, confidence. People start telling you things you never thought you'd hear. So, after a few yeses, some dedicated evenings and a handful of courage, was that all it took?
It made me realise no one is superior to another. We're all simply human beings, each gifted with a brain embedded in our skulls and blood pumping through, free to choose what we invest our time in. And guess what? Turns out medical school isn’t just for the elite. Adam Kay mentions this famously exaggerated expectation in his fantastic book, ‘This is Going to Hurt’, that some of us “don’t want to think of medicine as a subject that anyone on the planet can learn, a career choice that their mouth-breathing cousin could have made".
As Steve Jobs once said,
“Everything around you that you call life was made up by people that were no smarter than you. And you can change it, you can influence it… Once you learn that, you'll never be the same again.”
Lesson #4 : Don't believe everything you hear.
We've all heard something like this - "Neurology is SO hard, I heard x, y, z came up in the exam and it was literally never mentioned in the lectures. I think I failed". Naturally we would all freak out just thinking of such a nightmare - it surely sounds like a recipe for failure. And, well, yes, it sometimes happens. But hearing this can really blow things out of proportion and make you feel far more anxious than you need to.
Back in the early days of medical school, these phrases were pretty much the meat of our conversations. Our fears were attached to this anonymous quote that we would all naively believe, creating this deep-seated hate for a syllabus that wants nothing but to catch us out. Of course, with time you start to realise that these just serve to be easy conversation starters to help young medics mingle. Please don't fall for them.
It’s likely that this is the experience of just one person in a very particular scenario. In reality, it may have only been two marks in an OSCE station. People like to make stories to entertain, gain reactions, spread gossip, and unfortunately it can cost us our mental health. When it comes to preparing for an exam, or anything for that matter, just realise one thing - we can't control the mishaps of the future, but we do have control over the now (refer to lesson #2). So put in all of what you’ve got, and let fate take over the rest.
Lesson #5 : You have nothing to lose.
Life is finite. Obvious, but when you're on a course that teaches you the principles of (a) prolonging life and (b) improving quality of life, it's easy to forget that we still will have to leave this world at some point. Yes, even us superhero medics.
So with this limited time in mind, it changes the dynamic. Suddenly, a lot of the things we're attached to, or hold onto with great importance, melt away into nothing. The deadlines, the quarrels, the heartbreaks, and famously, the fear of failing. A fond saying amongst the London folk which I learned during my time at university goes, “it’s not that deep”, which equates to “it’s not a big deal”. And rightly so, for I can only think of a few things that are really that deep. (I also happened to learn a whole dictionary of London vocabulary at medical school, but that’s for another day).
I've seen a whole range of people at university, and I recurrently see the type who are reluctant to put themselves forward, fearing vital losses in the bank of “street credibility”. The presumption that our audience is just waiting to seize the moment we stutter over our words, fail or make the wrong decisions is exactly what we need to overcome in the first place.
Fortunately, a human's first priority is their own survival, almost parallel to our fellow animal population (that’s not to say that we don’t have the ability to be loving, caring and selfless individuals too, but hopefully you’ve realised that this is a slightly different context). If you were to get a question wrong in the lecture, you replied ‘To All’ on that university email, or you just happen to entirely humiliate yourself somehow - it’s very much likely that no one actually cares. People are far too consumed with their own chaotic thoughts, plans and problems to ruminate about such things. Chances are, it’s only you that’s thinking about it the week after.
So in that case, why do we hold back? Instead, why don’t we live to do what is best for us, freeing ourselves from the restricting thoughts of what the reaction around us may be. Because even so, the weight of being potentially embarrassed for five minutes is trivial compared to what could be possibly achieved if we just went for it - whether that might be from having the courage to publicly speak, to embarking the journey to pursuing your dream career.
I leave you with this quote:
"Remembering that I'll be dead soon is the most important tool I've ever encountered to help me make the big choices in life. Because almost everything - all external expectations, all pride, all fear of embarrassment or failure - these things just fall away in the face of death, leaving only what is truly important. Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart." -Steve Jobs
These lessons are by no means exhaustive (nor mutually exclusive) and I am sure everyone will have taken away something beautifully unique from their time encountered with patients and classmates. Medical school is truly what you make of it, and whilst people constantly tell you how long of a journey that this five or six-year degree is, I do subtly wish it would last just a little bit longer.