The Space Between

“The seeker embarks on a journey to find what he wants and discovers, along the way, what he needs.” 

― Wally Lamb, The Hour I First Believed

I learnt a lot of things while I was a paediatric registrar. I learnt how to interpret paediatric ECG’s (mostly). How to ask the right questions about a headache to know if it warrants a CT scan. I eventually figured out the physiology of left-to-right shunts and diabetic ketoacidosis. I experienced first hand how you don’t mess around with Staph septicaemia or a neonate with persistent pulmonary hypertension. I learnt how to pace myself on 30-hour shifts, to avoid the ward during visiting hours and that drips are never done quickly just before lunch.

Fortunately, registrar time isn’t forever, and so for the last 9 months I have been floating between unemployment and temporary locums. Tomorrow I start a 2-year fellowship in Paediatric ICU.

This is as a reflection on what I learned (without being taught) in the space between.  

Firstly, I rediscovered quiet.

Quiet hours at home with my books and my thoughts.

Quiet days of being the only doctor in a practice, getting through the patients in my own time, making my own decisions.

Quiet adventures on the road between Bethlehem and Qwa-qwa, taking the long way home through Golden Gate and stopping to get coffee in Clarens.

Ghostly quiet 3am drives on empty roads to an emergency caesarean section.

Quiet, un-dramatic, low-maintenance friendships, that were strong and solid foundations when I leapt into uncertainty.

Secondly, I experienced working in extremes.

I went back to doing things that I haven’t done since medical school. Weighing and measuring, checking temperatures, giving immunisations and vitamin A drops. I went to plenty of elective caesars with APGARS of 10 and 11. I saw a lot of rashes and runny-noses, coughs and colic.

The simplicity of a well baby check is surprisingly refreshing. Ticking the boxes of growth and development and having a chance to chat to a parent about how parenting is going. It’s not something I really did in my training. Being part of the process that makes a sick child well is an intensely rewarding aspect of my job. I realised however, in these moments, the sparkle (maybe tears of relief) that comes with telling a tired mom that she’s doing a great job, is equally rewarding.

In other moments, I morphed into the Paediatric Consultant. Instead of writing the prescription and doing the bloods I now checked them. Instead of making the phone call to ask for advice I know dispensed it. I had to learn how to step out of the ‘hands-on’ role – a comfort zone where you have almost complete control – and let the system function. This was possibly my biggest learning curve and a skill that definitely did not come naturally.  As paediatricians especially, we rely heavily on what our own eyes see and hands feel when we walk into a room with a sick patient. There are subtleties in the way a baby is breathing that you unfortunately only learn through experience, which can either reassure you or warn you about an imminent respiratory arrest. The hardest part about being responsible for children you are called about is distinguishing between a junior who has made the right assessment and is in control and one who has completely missed the septic shock and needs gentle but firm redirecting. 

In the space between these two roles I have realised that there is still so much to learn. I didn’t finish registrar time thinking that I knew everything, but I had a sense that I had summited a mountain. Now that I have caught my breath and rested from that intense pace with which you work and learn at in your junior doctor years – I can appreciate that I am only at the start of this expedition. There will always be new concepts to grasp academically. There are lessons to be learnt in building relationships with not just the children but also their parents. There are lessons in knowing what you, your facility and your staff are capable of doing. There are lessons in digging deeper to fight another day but also in accepting defeat graciously. There are lessons to be learned in training the juniors that work for you – building them up without breaking them, yet fostering resilient spirits that can be advocates for themselves as well as their patients.

And then there is the constant challenge to learn how to not be consumed in all of this learning.

To sustain and nurture relationships outside of work.

To have skills that are not all about vascular access and intubations.

To have time in the fresh air.

To stay hopeful.

To be at once, both the master and the apprentice.