Dear Me,
Hello! I am you – writing from the future. This time machine I invented lets me send a letter back one year, so please enjoy this note from yourself. If I recall, this time last year I was worrying a lot about surviving housemanship and adapting to the unfamiliar physical and emotional demands of being a junior doctor.
Well, since I know you have a habit of peeking at the last pages of books, let me do you a favour and spoil the ending: you survive. Unfortunately, not without some battle scars (trial by fire, as they say). They have taught me valuable lessons about my relationship with work, and I hope to share them with you.
Calls are always better with friends
You might not think medicine is a particularly lonely place to be – always surrounded by patients, whether you like it or not. But at night, do not be surprised to be the only junior on the floor.
You will be tempted to hole up in a room and focus on your duties by yourself. But it is dangerous to always go alone. When you get used to self-isolating in the hospital, you become less likely to ask for help, even when you are out of your depth. That puts patients at risk, not to mention the toll social isolation takes on your mental health.
Actively seeking out others on call, sharing supper or even just spending a few idle hours in the medical officer room together is enough to fill a difficult call with joy. Even if you do not know anyone on call, every call is a chance to make a new friend. This does not go just for doctors either; you will find that some of the best comfort and jokes come from nurses and pharmacists!
Also, do not skip post-call breakfasts; the sunrise is always better witnessed in the company of those who survived the night with you.
There is a difference between resting and recharging
As a doctor, rest does not come easy. Between the early mornings, late nights, calls and floats, the physical fatigue can be overwhelming; many people post-call will sleep until the next day. You will be tempted to protect your rest to an extreme degree: staying in bed past noon, choosing not to meet friends after work, all for the sake of getting an early night.
At some point you will realise that more rest will not help you feel less tired.
You need to do things that recharge the mind – things that lift the weight off your shoulders. It does not matter what it is, and it does not always have to be the same activity. It only has to ease the tension and inspire you to keep going.
You may point out that someone who is too tired will not be able to do the things that recharge them and will therefore continue to accumulate fatigue. But in truth, when you find something that breathes life back into your work, you will find the strength to do it even when running on no sleep post-call. Find what recharges you, and the rest will follow.
Have great expectations, but greater self-compassion
At the start, you will get frustrated with yourself for your incompetence. You cannot present patients on rounds as nicely as others, you can only handle half as many patients, and you take twice the time needed to clerk admissions. But worst of all, you will beat yourself up for not knowing how to bear the responsibility of being a doctor. Other people seem to know how to make the right decisions and what to say in difficult situations. Medical school can teach you how to hold difficult conversations, but you have to learn for yourself the words that actually bring comfort to patients – especially in situations where you might be the only one available.
There will be a day, before rounds, when you palpate the abdomen of a boy due for discharge. You will recognise the rigidity and rebound tenderness in the right iliac fossa, the tachycardia, and widened pulse pressures heralding the systemic inflammatory response. You will escalate a case of perforated appendicitis with impending shock, but because manpower is tight, you will be the only one available to stabilise the boy and prepare him for the appendectomy. It will take two tries to get his laboratory results; you will forget to order antibiotics, fumble through the surgery referral, and finally come to speak to the boy. You will not know what to say, but you will see the shock in his eyes and his body shivering with fear. You will find a blanket for him, tell him that he will be okay and send him off to the OT.
The boy will write to you when he is well and thank you for your reassurance. That letter will remind you that competency is built in the midst of failures. You just need to keep giving it your best effort.
There is much more I want to tell you, but this time machine has a word limit, so I will let you learn the rest as you go. Do not worry – you will be fine.
With love,
You
