Apple Humble and Custard

I have been thinking about where I am in the training pathway. In terms of seniority, I’m at the bottom of the pyramid. These thoughts may well linger until I’m a consultant, which is at least a decade away and it seems soooo far. I knew this well before applying to medical schools, but at that time I was more concerned with getting one of my ancient bunion feet through their well guarded, reinforced doors.

Being mature medical students, we may have achieved other things in life but in the eyes of the healthcare system we are still simply medical students. Previous accomplishments on our CVs might have granted a small sense of pride and demonstrated ability but might now be irrelevant. Regardless of whether we were once CEOs, engineering post-doctorate geniuses, professional sportspeople or stay at home mums/dads, it almost doesn’t matter and as mature medical students we have to swallow the same helpings of humble pie as our younger classmates. I suppose I could say force fed as there’s not much that can be done about the situation – it’s just how it is. Many skills, particularly interpersonal, management and organisational skills are definitely transferrable but knowing the inlet angles for turbine blades of a specific jet engine probably is not.

Being older often helps with patients, but not always with staff. When meeting any new staff there is always a familiar eye dart” from face down to name badge – searching for the words that denote one’s grade and thereafter how to behave towards the badge-wearer. Everyone does it and at all grades, due simply to the hierarchical structure.

Different members of hospital staff have widely differing opinions about medical students. We may be seen as being: useful, helpful, eager or sometimes useless, lazy, hindrances. Last week, a consultant said to me: “Hey you medical student, I’m too busy, go with Dr Smith”. In her eyes I was nameless even though she’d just done the eye dart thing and my name didn’t matter because I was “only” a medical student. Another time I was dismissed with a: “Shoo-shoo medical student, I need to use that computer” They need to remember that not so long ago, they were also “Hey you, shoo-shoo medical students.” I have no issues with those younger than me telling me what to do and don’t need or deserve special treatment, but good manners are fundamental and rudeness is unnecessary.

In military terms I’m an ageing cadet in basic training, no tours of duty under my belt, no medals. I’m still hoping just to make it to the passing out parade with proud family watching. Already in my 4th year of training but not yet even a private. I’m in the meat grinder again, somewhere near the beginning, being obediently churned through but this time hopefully emerging as well trained mincemeat (mutton dressed as lamb?) ready for action in the NHS.

Frozen meat grinder GW 300 – Seydelmann. Source. CC BY-SA 3.0

Sometimes I think about my previous job, a job that had little wrong with it, paid the bills and allowed me to live a decent comfortable life. A perfectly good and even enviable job. When I gave it up, I told myself “There may will come a time in the future when you’ll miss this job, the job in which you worked hard to reach a senior position, the job which surrounded you with great people and which you may regret giving up.” I told myself that, I did. But I also told myself I’ll regret it even more if I don’t try – so I thought “f*%k it” and hit “Send”

So, in truth I do miss being in a position of seniority that roughly correlates with my age, my ex-colleagues, the relative flexibility of my previous career (oh the flexibility!) and having a salary!

But (and a very big butt): aside from the odd crass ignoramus, I love what I am doing. Everyday I’m seeing and learning fascinating things that few others can or will ever see. The new born whose first breath I witnessed, the young man who walked right out of hospital but who only a few days earlier was unconscious and critically ill, the lady who can see clearly again, the caretaker who walks pain free after his hip replacement. It’s not always a happy ending but just to meet these people and catch a glimpse into their lives is a huge privilege. Also being taught by those rare breeds of doctors and consultants who know exactly how to teach and genuinely care whether medical students are learning or not.

So my medical student colleagues old and young; persevere with cultivating that thick lichenified skin, we are bottom of the pile – munching humble pie, but on top of the world and there are infinite helpings of great custard.

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Post-Mortem

By the time we had arrived at the mortuary the intestines and other glistening organs were already in a large metal bowl, quivering everytime another part was thrown in. Not long ago they were living, functioning and keeping someone alive but were now a fatty wobbly jelly .

It was not the ideal first post-mortem for students to see. This particular person hadn’t been seen for a while before being found. The smell was not how I imagined, I can only describe it as almost “foody” and it’s ingrained in my memory. The table was stainless steel, shaped into a shallow basin with a sink and plug hole at one end and our distance to it was a compromise between being close enough to see and far back enough for the smell to be bearable.

Post-mortems are usually performed when the cause of death is unclear so the pathologist’s task is to find out what happened regardless of whether the person passed away yesterday or a few weeks ago. The pathologist analyses the body and organs and the cause can then be written on the death certificate.

Mortuary technicians seem to do most of the preparation, organ removal, ‘closing up’ and cleaning and although they aren’t doctors, they are incredibly skilled in human anatomy. As our technician continued to cut or rip flesh and organs from their rightful places – with noises akin to horror movie material, I found it difficult to balance their actions against the respect that they obviously had for the bodies.

It reminded me of when a friend once said: “Thank goodness for people like you who study to become doctors.”  I replied that he could easily have gone down the same route as me but his reply was: “I’m talking about the horrible things you have to see.”

I really don’t mind the ‘seeing’ and after dissection classes nor do I mind the idea of being around dead bodies but perhaps pathology is not for me.  I’m sure there could be days where I’d enjoy aspects of pathology particularly the investigative parts and be inspired by a career in pathology but today wasn’t one of them.