“an intimate friend and a hated enemy have always been
indispensable to my emotional life...not infrequently…friend and enemy have
coincided in the same person”
Sigmund Freud
The first time I rotated in the unit as a registrar, I had
been a doctor for almost six years and working in paediatrics for just about
three. Despite this, it was unlike any kind of medicine I had ever been exposed
to.
It was intense and pedantic. It was pathology on steroids - literally
and figuratively. At it’s best it was every kind of complication straight out
of a text book and at it’s worst it was vaguely referenced on Google. There were medications I had never heard of, procedures I
had never seen and
equipment that looked science-fictional.
equipment that looked science-fictional.
It felt that if you touched something you
would break it (including the kids) and if you said something it would be
ridiculously stupid and probably invoke the famous sigh of deepest
disappointment from the boss.
It was the worst kind of feeling a doctor can feel, overwhelmed and out of control and not surprisingly I hated it.
I’m not convinced all that much was different the second
time around, except maybe that I am regrettably a little bit older,
theoretically a little bit wiser, and unfortunately a tad bit tougher.
It’s still crazy busy.
On a good day it is well controlled chaos and on a bad day,
concentrated visual mayhem. Eight hour work days are still just a human
resources guideline and afternoon handover rounds routinely stretch into early
evening.
There is always light, always noise, always movement.
Empty beds are filled again quickly, families hover on the
edges, shuffling in and out. You can get through a day and night without ever
really stopping. Eating while writing notes and hydrating with coffee and
energy drinks.
The kids are still the sickest of the sick.
Replaced by some strange robotic version of themselves –
faces hidden by CPAP masks or ET-tube strapping, fed with tubes and drips and
flattened with sedation so that their cries are replaced with the beeping of
monitors.
They come, sometimes failed by the systems that should see
them fed properly, immunized properly or managed earlier properly. Sometimes
they come for no clear reason at all. Well fed, well cared for, overwhelmingly
loved – struck down randomly by a particularly devastating infection, or a car, or a bullet, or a fire.
The stories are still raw.
On one of my recent calls I took over a beautiful baby girl
who’s body was shutting down in the face of overwhelming sepsis. After a long
night of struggling, all of the tricks had been tried without success and in the
early hours of the morning she started to slip away. I explained to her tired
parents that there was nothing left to do and watched her sweet dad stand next
to her bed, take her little hand and say firm and loud… “You can go now my
baby. You can go.”
I know exactly what you’re thinking. How could you like
this? Could you ever even love it?
So why was my heart heavy all of the last week at the thought of walking
out on the last day?
Could it be some strange version of Stockholm syndrome?
You see; I love the mayhem less than the controlled chaos, but it does
keep me on my toes.
I love the chatter, the team work, the friendships that form
on ward rounds and coffee breaks, and in the inappropriate laughter that follows a
serious situation – a misunderstood form of debriefing.
I love the babies. I love how they are resilient despite
what they’re up against. I love taking them off ventilators and finding their
faces. I love watching them peel away their sickness and sedation to show you a
smiling little person underneath.
I love how much it teaches me… not only about physiology and
pharmacology, but about myself and what my strengths are as much as exposing my
flaws; how it pushes me to be better at being a paediatrican and a person.
Lastly, I love that it’s raw – because I think it means that despite being
more mature, less naïve and thicker-skinned, there is still plenty of heart
left.
