The hardest things

Assignments. Midsemester tests. Exams. Assessments. Tutor marks. Not being able to answer questions. Not knowing doses of medications. Not remembering pathophysiology. Not being sure of clinical signs.

A classmate was saying that the thought of the physician training exams terrifies him, because of what he had heard about the low pass rates. I laughed and replied, you can always take it again, and if you fail too many times, maybe you're really better suited to doing something else. I hear of students in science, pharmacy, arts, architecture, engineering, law, each talking about how stressful it is to have weekly assignment, midsemester tests, or exams coming up. Each, including medical students, sighing and not so subtly implying that their course is harder than everyone else's.

I guess I don't completely understand. Not that I don't feel the stress of assessments. But for many years that type of anxiety has not progressed beyond a useful prompt to open my textbooks and get on with work. So with a tad of arrogance, and disdain, I frown in scepticism when people around me rant about how hard everything in university is. I can't help wondering, which part of writing an essay, even if it's several thousand words in length, is difficult when you only have ten contact hours a week? Which part of medical school is difficult, and how much does that first class honours really count, especially when, being old and grey one day, you look back at your life? How are clinicals overwhelming? We keep learning, and have many years ahead to learn. Plus with so many iPhone apps (what a serious disadvantage, not having one yet!) what does it matter if we don't have encyclopaedic knowledge on every topic?

Lately, in my possibly excessive hours of self reflection, I found that the hardest things in university, in medicine, in hospital rotations, have little do with the studies, or even the clinical work itself. Not saying there isn't much to be learnt as a junior doctor. But, being a scribe/secretary/PA/intern for a team during ward rounds, writing scripts, filling in pathology slips, making phone calls - these are not difficult tasks, and hardly deserve the respect bestowed by the "Dr." title.

Rather the hardest things are to wake up to an alarm clock, or worse still, long before the alarm clock sounds. Day after day, after day. It's waiting for trains on a chilly morning, or cold afternoon, and attempting to use the vending machines at the platform to barricade against the wind, only to realise that it's impossible to do so because the wild wind constantly blows where it wills, in multiple directions. It's uncomfortably shifting weight between the collapsing arches of two feet in uncomfortable shoes, and pouncing on opportunities to sit on ledges, lean on benches, kneel on the floor whilst leaning on patient beds to write notes on. It's driving home at night blinking constantly, feeling like there is glue trying to close my eyelids shut. It's being too tired to asleep, or when insomnia lingers. It's when too many early mornings make the days of the week blur into one another, until I score a patient wrong on the mini mental examination, when it was really me who had the days and dates mixed up.

It's being easily upset, fiercely angry, and excessively sad and teary. It's wondering whether it would be better if I live alone forever so that no one else needs to deal with these emotions. It's when the monsters pay frequent visits, when gradually the sorrows of the night spill into the morning, yet there is still the obligation to get ready for the day, be functional, and deal with the grief of others. It's when grief spills into the unconscious world, manifesting in restless dreams with deaths of loved ones, hurtful words, being attacked with a ballpoint pen, lost friendships - waking up with palpitations, elevated heart rate, hearing my own voice cry out, and starting the day with a discomfort that is difficult to describe. It's when, working next year, staying home to sort myself out for non physical illnesses is no longer an acceptable option. It's being physically unwell and feeling guilty for resting at home for a minor illness. It's being disheartened at the room with suitcases, bits of paper, bags, shoes and clothes strewn over the floor. It's at the end of a day, being reluctant to be at home amongst another family's world of hidden but palpable sadness, conflict, uneasiness, which I feel for almost as much as if it were my own. Yet having no real alternative, unless I wish to wander from restaurant to restaurant, bubble tea to bubble tea stores, taking long strolls around the city, or purposely making the train journey home longer, every evening.

In writing I realise, perhaps it's not that I hate medicine, but that I use it as a scapegoat. What is hard is the weariness of functioning reliably, and managing the difficult feelings that come with daily life, both personal and those which arise from clinical encounters. I think that's what my Boggart would be shape shifting into, if there was a physical, tangible, pictorial representation of that fear. I shouldn't scorn at others for what their Boggarts turn into, for them finding their greatest fears, the hardest things, to be other aspects of life.

Day by Day

Day by day, and with each passing moment,
Strength I find to meet my trials here;
Trusting in my Father's wise bestowment,
I've no cause for worry or for fear.
He, whose heart is kind beyond all measure,
Gives unto each day what He deems best,
Lovingly its part of pain and pleasure,
Mingling toil with peace and rest...

God, help me to walk with you through each day, through everything I find difficult. In toil and rest, pain and pleasure, finding strength and purpose in you.