Nearly Time to Go

A medical student asked me, “Why did you become a doctor?”  I said, “Because I hit writer’s block.”  She laughed.  And a distant cousin: “What attracted you to medicine?  Was it the wish to care for people, or was it the intellectual challenge of the discipline?”

I thought, “Now that’s a good question.  There is the dichotomy.”  It had better be one or the other, or better still, a combination of the two.  If you are attracted by wealth and status, if you are doing it because your “public” (ie private) school think you are just the man for it, forget it and go into the City.

I wasn’t being entirely flippant – actually I wasn’t being flippant at all – when I said I hit writer’s block.  As soon as I was taught to read and write I became a scribbler.  I always wanted to write books.  My mentors were encouraging.

But pause here for a quick parenthesis.  I caught Little Women in the cinema in Kaitaia (of all places) yesterday.  Jo March always wanted to write.  She looks to her friend Herr Bhaer for some candid criticism, but finds his candour very hurtful.  He says of her literary effort, “I do not like it.  I do not think it is good.”  I suppose he might have been a little more tactful.  He didn’t mean that she lacked talent, merely that she had yet to discover her genre.

For myself, I never received criticism so harsh.  (There’s still time.)  As a matter of fact, I was my own worst critic.  I remember a particularly painful exchange with my English teacher in my last year at school.  He handed some work back to me and said, “Every good indeed.  It’s nearly publishable.”

Slain by the morganatic compliment.

And I replied, with the smug hauteur of youth, something along the lines of, “Can’t you tell it’s crap?”

I may have been a pompous prig, but to an extent I was quite right.  You can’t write truthfully of real life unless you have some experience of it.  This is the dilemma for the writer.  You can’t shut yourself up in a garret; you have to live in order to have something to write.  So you must chuck your hat into the ring and enter the fray.  Was it Doris Lessing who said that the dilemma for the writer is not how to write, but how to live?

So I became a medical student and disappeared for forty years.

The trouble the writer encounters when embracing another walk of life is that he will always hold something back.  Yes you can be interested, captivated, enthralled, and even passionate.  The one thing you can’t be is committed.  Ultimately, your mind is elsewhere.  Personally I got lucky.  I was a medical student in the 70s when life in the UK was so miserable – remember the strikes, the 3-day week, the winter of discontent, the power cuts – that I might as well withdraw into a monastic cloister and study.  Then I found I was good at taking histories.  And why shouldn’t I be?  Taking a history is like writing a story.  And the greatest skill a doctor can have is the ability to take a history.

Forty odd years later by the grace of God I got lucky again and published a book.  If I hadn’t been a doctor I would not have been able to write that particular book.  God does indeed move in a mysterious way.

I was musing on the great improbability of the ramshackle shape of my life last week when I re-entered the hallowed portals of the department of emergency medicine of Middlemore Hospital in South Auckland.  Middlemore is the busiest emergency department in Australasia and, to cope with an average of 370 patients a day, it requires adequate staffing, facilities, and human resources.  I have blogged about these before, but make no apology for revisiting the statistics which, for those in touch with the specialty of emergency medicine, speak for themselves.

95 beds with oxygen and suction, 6 resuscitation rooms, 26 full time equivalent emergency medicine consultants, 18 registrars in training, 9 junior doctors, 6 fellows and medical officers of special scale, 120 full time equivalent nursing staff.

When I first came here in 1986, the department’s medical staff comprised 13 junior house officers, supervised by a part-time surgeon and a career “casualty officer”, God bless him.  But by then, the Australasian College for Emergency Medicine was two years old, and spearheaded an enormous drive to create a new specialty.  The forefathers of emergency medicine realised that the traditional way of practising acute hospital medicine, of junior doctors doing their best to keep patients alive until they could be reviewed by a consultant during the morning ward round, was no longer fit for purpose, if indeed it ever had been.  The possibilities for intervention in acute care, and the array of therapeutic options, have meant that expertise must be readily available at the hospital front door.  The development of the specialty of emergency medicine now seems an inevitability.

But of course it wasn’t inevitable at all.  It was a hell of a struggle.  Emergency Medicine had to take on, politically, the combined might of the royal colleges.  The men and women in the front line at this battle were quite extraordinary.

I don’t believe this battle has ever been fought in Great Britain, let alone won.  What is the biggest revolution to have occurred in acute health care delivery in the last forty years?  It is the realisation of the idea that acute hospitals need to be “front-loaded” with expertise.  That (with the exception of a few centres of excellence} this has not occurred in Great Britain, is a tragedy.

I don’t say everything in Middlemore is perfect.  Far from it.  In many ways Middlemore ED is a victim of its own success.  The more you can do, the more will be asked of you.  The environment can be extremely busy, crazily so, and the stresses immense.  Yet, in this my recentest visit, I had the sense of a happy atmosphere, and morale, while challenged, still high.

For myself, looking around this hi-tech department, I can no longer believe that from 1994 to 1997 I was its Clinical Head.  There have been three more Clinical Heads since me.  That all four of us were present during my visit (just as 2 years ago) was for me, extremely poignant.  I am proud to have played a small part in the development of emergency medicine.  Yet I remember one morning in 1999 waking up with the certainty that I’d done my bit.  I’d moved on to Auckland Hospital and the Medical School by then.  I said to my colleague, “Peter, I need to go home.”  He said, “Take all the time you need.”  I said, “No, I need to go for good.”

Over the next twenty years I often wondered about that decision.  Yet, from the perspective of this visit, I’m certain it was right for me.  Inevitably, this time round, things seem a little less substantial to me – or maybe I am the ghost.  At any rate I can recall and indeed re-experience that intense longing to be home.  This very morning I woke up and thought, I need to go home.

After Middlemore I went back up to the far north and revisited Te Paki Stream, Waipapakauri, and Lake Gnatu, once more, imprinting them on my memory.  I have an idea I may not be back for a while.


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