It is a rite of passage for every Medical Student to think they have every disease they learn about. Med school would not have been Med School if this wasn't the case. When we were learning about myasthenia gravis, we all thought our muscles were tired easily. Exercise intolerance—must be heart failure—headaches—a brain tumour. We could pretty much convince ourselves we had every disease. Sound familiar? But sometimes, as ironic as it seems, when there actually is a problem, we convince ourselves that there isn’t until there is no denying it.
Towards the end of med school, and as the months rolled by in my internship, I started getting symptoms that I was no longer imagining. Worsening mouth ulcers, feeling faint on long ward rounds, pallor, weight loss… of course, they could be explained by long hours, no time to eat, and little sleep. So they were ignored. Writing it down in retrospect, it was so obvious something was wrong, but at the time, I was just trying to be the best intern I could. I just put my head down and continued without complaining. Weeks after the bloody stools started, I finally booked a visit to see my GP. “You know what you have, don’t you?” he said.
I didn’t want to be “that intern” who couldn’t handle the pressure.
I knew I had Inflammatory Bowel Disease. I saw a Gastroenterologist and started medications. The doses were ramped up as my symptoms worsened, yet I still worked myself to the ground. I didn’t want to be “that intern” who couldn’t handle the pressure. The one who let their co-intern bear the brunt of the workload, who didn’t impress the bosses to get a good reference, the one who annoyed the medical workforce just as job applications started. There were just too many repercussions, self-inflicted expectations rather, but it was enough to continue working when I shouldn't have. 2020 me would definitely have grabbed me by the shoulders and told me sternly to look after myself. No job is ever worth your health. But in 2010, I kept pushing on. Until I physically couldn’t anymore and found myself in the emergency department. I was admitted for ten days with severe Pancolitis and was moments away from a stoma. I learned more about being a doctor in those ten days than I did in six years of medical school.
For example, intravenous lines can hurt. I couldn't count how many hundreds I had done, not to mention the thousands of blood tests I had performed as a pathology collector for six years during med school. Every time, I had just done it without appreciating how much it might hurt. But hunting around for a vein with the needle in, blowing a vein, trying to tape awkwardly because we really need to get those meds in, the multiple attempts - it is all surprisingly painful. I was horrified during my admission to realise that it had been such a mindless task for me.
That changed the way I insert IVs forever.
Potassium infusions sting. Everyone knows that. But I didn’t know that it doesn't just sting, it feels like rows of knives dancing their way along your veins. Slowing down the rate and holding ice on my arm was the only way I got through the infusions. The rest of my Intern year I gave Potassium at half the speed.
I had charted Clexane so many times I could do it in my sleep. Not once had I thought about how much it hurt or understood that sheer dread of knowing it was coming. I suddenly had the utmost respect for patients who self-inject daily. That takes courage.
I had an appreciation for why patients wanted to leave the hospital as quickly as possible. The nights are the worst. The loneliness, the beeping, needing to pee with the IV pole attached, needing to show the nurses your bedpan so they could check what your stools look like, listening to the patients either side of you snoring or retching, listening to the code blues called over the PA. It was a lot. I remember overhearing a young doctor, a colleague, tell a patient flippantly they needed an IV and tests as if they were just another task. “Don’t be so dismissive. That’s a big deal to the patient,” I remember thinking. But then I stopped. That was me just a week ago. I was the one who ordered tests, got stuck in IVs left, right, and centre, and charted medications with awful side effects. Shamefully, that was me who called the patient by their disease, "the pneumonia in bed fifteen" or "I think the headache in bed twelve is having a stroke, I better call it.” Not because I was in-compassionate, but because I was literally so busy on a cover shift looking after 50+ sick patients that looking through the patient list to find the name was ten seconds I didn't have in my day. Not because the tests were just another tick box, but because in the grand scheme of things, when we had to put five IVs, order six X-rays, and review three deteriorating patients we just needed to get it done. Suddenly, being on the other side, my whole role as a doctor felt very impersonal.
Nothing teaches you compassion like being on the other side.
I had never been complacent, and I like to think of myself as having been a compassionate doctor even before I had this experience, but nothing teaches you compassion like being on the other side. I have changed so many things that maybe I took for granted, didn't think twice about, or worse, didn't even think about at all. It has made me understand in a way that can't be taught from a textbook. That it’s not “just another IV attempt.” That although it’s an easier vein in the cubital fossa, an IV in the elbow is annoying for the patient and makes it so difficult to do any self-care. That waiting for results is excruciatingly painful. That when a patient doesn't like taking medication, it may not be because they are being difficult but because the medication is difficult and the disease sucks. That it is always worth taking the extra 10 seconds to find out a patient’s name. That time is taken to be patient and kind, even if it means handing over a few extra tasks, is always always time well spent.
I would, of course, rather not have Ulcerative Colitis, but being a patient has definitely made me a better doctor. For that, I am grateful.
The article was originally published in 2020
