Panacea

But he wanted to justify himself, so he asked Jesus, "And who is my neighbor?" 

---

Yet I hold this against you: You have forsaken the love you had at first.

---


Yesterday I made the other urology FY1 cry. Or rather, I was there when she cried.

We had both finished a mammoth day - neither of us had sat down for a second or had lunch. It was 6.30pm - an hour and a half after work had officially ended and we were in the doctor's office finishing up jobs. For some reason the phlebs hadn't taken any of the post op bloods we'd requested in the morning, which meant during grand round there were a grand round of dirty looks directed our way, with looming registrars telling us, 'these bloods should have been done.' Protesting, 'We ordered them this morning,' and receiving in reply a stern look that said, 'these bloods should have been done.'

By the time grand round had ended it was 3pm. 'Jon - let's go through the list. It doesn't look like there's much to do.' I had a referral that needed to be made by 5pm, because that's when the consultant leaves hospital, two urgent discharge summaries to write so that well patients can go home and we can free up beds, and now urgent bloods that should have been done in the morning. 'There are four patients in EDU to be seen. Let's go down and clerk them and then you can finish up and update the list.'

I knew what this meant. What the reg wants is for me to see patients with him, stay back late and sort out paperwork and add patients to the list so that he can go home at 5pm. Which is fine - I get it - but it wouldn't kill him to see one or two patients on his own.

'Uh, I actually have this urgent referral to do. You know, for Mrs Y.? I can join you in EDU afterwards.'


'You can do that down in EDU, can't you? Just bleep him down in EDU.'

Or I can do it from here, now and join you in EDU afterwards.

'I need one of you to come with me and clerk patients in EDU.'

Why?

Selfish. This has happened before. Don't do it

And if someone takes your cloak, do not withhold your tunic as well.

'Okay, sure.'

Two hours later I'm in the office updating the list and trying to sort out what to do with this referral I missed because I was assisting with a catheter and was told, 'Whoever is bleeping you, just ignore it. You're busy with a patient.'

And whosoever shall compel thee to go a mile, go with him twain.

After we got the catheter in, I washed my hands and scrambled to the nearest telephone.

'Hello dialysis unit.'

'Hi, it's Jon urology FY1, did Dr. X bleep me by any chance?'

'Oh he was here a while ago, but he's gone now.'

Perfect.


By the time I had gotten to the office it was an hour past quitting time and I was in a pretty foul mood.

I texted the other FY1; hey quick q have you ordered bloods over the weekend for ward patients?

Not yet


Which means I'll have to do it.

I quickly checked to see if the urgent bloods had all been done, and some part of me wanted the answer to be no, wanted something concrete to confront her with, and some cruel part of me was perversely glad to find that one of them had indeed been missed.

Normally I wouldn't have mentioned it at all and sorted it out myself. After all, what's a few more minutes when you've already over-stayed two hours. But I reasoned, if I continue to do this, she will a.) not realise that her responsibility includes checking that bloods have been sent off and checking the results and b.) believe that things will continue to magically sort themselves out even if she does forget to order or check blood results.

Plus, it wasn't the first time this had happened. We divide jobs into outliers and ward. I've pretty much been picking up after her every day for the past four days, making sure bloods have been ordered and adding patients that have been missed off the list.

The lock in the door behind me rattled, and she came in looking drained and older by about 10 years.

'Hey, how's it going?'

'Not too bad, do you know if Mr Z had his bloods done?' I asked, already knowing the answer.

'... I asked Zoe (the medical student) to check and she said the nurse was doing them.'

'Because it says on the system, it's been collected but... that was three hours ago.'

'Oh.'

'So it's not been done.'

'I guess not... I asked Zoe though.'

'Yeah but.'

'The rest of them are definitely done though.'

'Yeah but what about Mr Z?'



'I guess he's not getting bloods today then.'

'... So when the reg asks, why haven't bloods been done - what are you going to say?'

'I asked Zoe and she said... the nurse was doing it.'

'So you're going to say "Zoe told me it was being done?"'

She laughs. 'Are you afraid of the reg?'

'No, I'm not - but I just need you to know that... these bloods have to be done. It's not okay to just leave it undone. Do you understand?'

'Alright well I'll do it later then.'

'No - we can handover to surgeon of the week, or ask one of the nurses to do it. That's not the issue, what I'm saying is that Mr Z had an AKI so he needs bloods for today. Do you understand? You can't just leave assuming that that they're done. You have to check... '

Before I knew it there were tears rolling down her cheek. I had not expected this.

I sat there, unsure how to suddenly switch from lecturing to comforting her.

'Hey, what's the matter?' I said at last, trying to sound like a friend.

'It's nothing,' she said, still sobbing furiously.

'... is there... something at home? Something troubling you?'

She shook her head and dabbed at the tears with her wrist.

'... is it the job?'

She gave a small tentative nod.

'It's like... I can't do everything...'

'... As in, we try our best, but people still expect things to be perfect?'

She nods again.

'Yeah, I know... you'd expect them to understand that - there's just two of us... doing a four person job, and it's not like we're sitting around drinking coffee...'

The tears had nearly stopped now, her gasping reduced to a sniffle.

'And I don't know why they still act like it's reasonable to expect us to get everything done. I mean... either they know it's not possible or...'

And then I stopped speaking. Because I realised that I had been doing to her the exact same thing I resented being done to me. Being held accountable without a fair trial - without considering there might be more to the story - something wrong with the system rather than with the individual. She wasn't incompetent. She had sorted out the urgent echo request and another patient's heparin induced thrombocytopenia screen. To have done both by quitting time is no small feat. She simply hadn't gotten round to checking that all the bloods had been done. She was doing her best - and I had somehow convinced myself that her failure to check on Mr Z's blood was due to negligence or some kind of mental laziness.

And I was reminded of something I had already suspected; that cruelty comes from suffering. And that the kind of registrar who abuses their house officer is the kind of registrar who was abused as a house officer - and becomes the kind of house officer who abuses other house officers, and makes nasty private comments about the ward sister's weight and appearance, and gradually loses the ability to understand anybody's suffering beyond his own, and begins to convince himself that any and every minor inconvenience or mishap is part of some grand conspiracy or deliberate, concerted effort to keep him as miserable as he is now.

'Yeah, but I keep making mistakes... keep missing things out.' She says. 'Like yesterday I prescribed blood for that lady - only to find it hadn't been given... and I had to represcribe it, because apparently you can't prescribe 2 units at the same time...' She shook her head. 'I mean... sometimes it's just like... what's the point?'

'Yeah, I know what you mean. Like all that work is for nothing.'

She nods.

'I think maybe you're just tired. It's been a long week and you're only human. Have you been getting enough sleep?'

'I think so.'

'I don't think so - cause you have to wake up early to drive here, and you've been staying pretty late, haven't you?'

'But so has everybody else.'

'... I think what you need is to have a good rest - just spend some time away from work and come back refreshed. I think a lot of it is just stress. And it messes with your sleep too. You know, when you can't get your mind to switch off? I honestly couldn't sleep at all yesterday.'

And then I told her about my delirium dream that consisted of a consultant trying to explain something very basic to me, and me just not understanding at all, and watching as he became more and more frustrated.

And as we talked she managed a laugh, which manifested as a kind of sharp, brittle sound, which I recognised as being the very same one I made just over a month ago and fighting back tears a week later at someone else's house.

---

Above all, love each other deeply, because love covers over a multitude of sins. 

---

Brothers, if someone is caught in a trespass, you who are spiritual should restore him with a spirit of gentleness. But watch yourself, or you also may be tempted. Carry one another’s burdens, and in this way you will fulfill the Law of Christ.

losing strategy

"Sell everything you own and follow me." is more or less Jesus' response to a rich man who wants to get into heaven. Resignation (sell everything) is one thing, but it is continual (follow me). Temptation is ever present to re-awaken your desire for whatever was given up. It is an infinite struggle. Also faith itself requires infinite scrutiny, or it becomes a lie.

---

And Jesus looking upon him loved him, and said unto him, One thing thou lackest: go, sell whatsoever thou hast, and give to the poor, and thou shalt have treasure in heaven: and come, follow me. But his countenance fell at the saying, and he went away sorrowful: for he was one that had great possessions.

I especially like Mark's account because it mentions that 'Jesus looked at him, and loved him.' That tiny detail makes me read it in a different way.

It's as if Jesus is doing a double take. It's like he's finally found a student who has done the required reading. It's like he's finding fruit in a land full of fake trees. He sees something in the young man - a glimmer of hope, a potential crop. Here's a young punk who turns up every day knocking. The kid has moxie.

So he tells him the truth - but the truth is a father willing to sacrifice his only son, a son sold into slavery, a servant in a foreign land, the head of a prophet on a silver platter and apostles in prison, an angry mob and three men in a furnace, a pair of wrists with holes in them, and Jesus standing in the doorway offering his hand, his eyes gentle and full of mercy, saying, 'leave everything behind and follow me.' Already knowing what the young man's answer will be.

no team in eye

If the foot should say, “Because I am not a hand, I do not belong to the body,” that would not make it any less a part of the body. And if the ear should say, “Because I am not an eye, I do not belong to the body,” that would not make it any less a part of the body. If the whole body were an eye, where would the sense of hearing be? If the whole body were an ear, where would the sense of smell be? 

[...] 

But God has composed the body and has given greater honor to the parts that lacked it, so that there should be no division in the body, but that its members should have mutual concern for one another. If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.

---

people religious about health, religious about cleanliness - what does 'being religious' mean? adhering stringently to a set of actions and traditions - believing that rituals can save you - doing something obsessively in the belief that it isn't futile

---

When I was in fourth year of medical school a consultant stopped ward round and asked us, 'who is the most important person in the hospital?' We stared back at him blankly. "Is it Mr Najar? (referring to himself) (I've forgotten the consultant's name but he was almost certainly Indian) Is it the hospital administrator?" He gave us a wide and benign grin. "No, it's this person right here," gesturing to the lady who nobody had noticed before then, rendered inconspicuous by her dark green cleaner's uniform. She looked back at him and gave a bashful smile, unused to the attention. Mr Najar smiled back warmly at her. "How are you today?" "Fine, thank you." He turned back to face us. Our faces were so blank you could draw on them.

"If she isn't here, then the ward will be dirty. If the ward is dirty then patients will get sick. If this person doesn't do her job, then all our work here is meaningless. Do you understand?" Our heads nodded dutifully. "That's why I always say hello, good morning. Isn't it much nicer when people say good morning to each other? Good morning Rita!" A passing secretary beamed at him without breaking her stride. "Good morning Mr. Najar." The cleaner loitered in the background with her hands politely clasped behind her back, unsure if she was obliged to stay for the rest of the sermon.

I had forgotten about Mr Najar until now. I don't remember what happened before or what came after on ward round. It's lost in the sea of trivial mornings and medical school routine. I know now, however, with almost 100% certainty that none of us had understood the point he was trying to make. We just chalked it up to another eccentric consultant's production - the fanfare and palaver that performers feel compelled to deliver for a captive audience (who are themselves rarely desirous of it).

Last Thursday, as the ward round was entering the last bay, a tall, tanned Pakistani gentleman clad in a deep blue jumpsuit paused his mopping and stepped aside deftly, holding the door to allow the group through. Neither the registrar, who led the ward round, nor the consultant, who followed second, nor the core trainee, who hurriedly trailed after them, uttered a word of thanks.

Later that day, a nurse and a doctor were in the doctor's office. He was in the middle of writing up a patient's discharge letter. She was being strangely polite. She was a staff nurse, qualified a year ago, but it was her first time being in charge of the ward. It was subtle, but you could tell she felt slightly out of her depth - that the weight of responsibility had caught her a little off balance. "I'm sorry to keep barging in - you lot must hate it, us pecking at you all the time for this and that."

The doctor scratched his head and looked at his screen. "I don't think it's as bad as when you ask us to do something and we just look blankly back at you like... umm. I don't know how to do that--"

"-- I know and we're like, please don't look at us! We don't know what to do either!" They looked at each other and laughed, a genuine expression of relief, the sound of tension dissipating.

The doctor nodded amicably and returned his attention to the screen but continued, "So if it's something we can help with then... you know, it goes both ways doesn't it? At the end of the day, we're all on the same team."

And as they talked, you could sort of tell that the nurse and the doctor were listening to each other now, the way sometimes a member of the human race listens to another.

time apart

this is water

0. no answer

- so you're saying that good triumphs over evil in the end

- yeah

- not every time, but ultimately, good will prevail

- good guys don't really finish last

- no they don't

- they don't get stepped on and taken advantage of and blamed for things that aren't their fault

- .. no, they do

- so you're saying that this will change

- 

- hello?

1. give and take / imposition / path

no matter what you choose the outcome is the same?


transferring dates into my diary from the rota: four months ago the future's entire course, direction, approach vector, angle of descent lay in my palm. I held all the cards. And now, the pattern of my sleep, my work and my rest will be decided for me for the next four months - and again and again for the next two years - and within the narrow confines of that conveyor belt I will get to make tiny, infinitesimal microscopic decisions that will accumulate and eventually amount to my becoming one or none of the following: a core surgical trainee, a failed poet, a recluse, a house-husband, a homeowner, balding, wealthy, unhappy

---

speed of light as a universal constant; you can change the future but you can't change how fast it comes


---

your word is a lamp for my feet, a light unto my path
- Psalm 119:105




2. Doctor's mess

Barring patients and medical students, pretty much everyone in the hospital is going through the same thing. Too many demands and not enough resources. The guy in ultrasound I spoke to will get another call within two seconds of putting down the phone, and he will have to deal with another harried request, and decide: 'will this need to be done now or can it wait?' And all of them have to be done now. 9 to 12 hours a day of strangers continuously demanding things of you, each request a unique amalgam composed of bullying and sweetness in infinitely varying proportions, carefully tweaked, calculated degrees of indignation and meekness. The nurses switch up tactics and employ their practiced strategies like an American football coach going through her playbook. You know this because this is what doctors do to nurses, utilizing whatever and whoever in order to do What Needs To Be Done. Here, ruthlessness is an asset and empathy a liability.

Efficient allocation of resources is the key that keeps the hospital running - no matter how run down and poorly equipped and understaffed. In these hospitals, economics is the governing principle, not compassion. If love means self-sacrifice then the best doctors love their patients more than family. So maybe the ideal doctor is the one who prioritises their patients above all else. Willing to walk through fire and burn bridges and be nailed to a cross if it means doing The Right Thing for their patient. I've always wondered why some doctors treat the people they work with like dirt - but the past three days have taught me: it's common sense, isn't it. It turns out that the self is a finite resource. And you get to choose the few you love



3. Mother tongue

Passive aggression as the lingua franca among healthcare professionals

Thou shalt despise the ones who never ask for your help
Thou shalt despise the ones who are always asking for help
Thou shalt despise the ones you need to ask for help
Thou shalt despise the ones who despise us for despising them


When you become a doctor you start classifying people into two categories 1. people who are helping me treat the patient and 2. people who are hindering me from treating the patient

lean mean people-hating machine



4. Muri shinaide

how to take care of others without killing yourself

Playing God - balancing the needs of one patient against another, deciding which requests and desperate pleas are to be granted and which must be denied





5. Conflict of interest / declaration of interdependance

This hostility is fixed into the system, entrenched - because on some level they know that if we manage to do everything we need to do to avoid getting shouted at, it would mean leaving some of the tasks they need to complete to avoid getting shouted at undone

---

The registrar has the patient's best interests at heart, at least that's what he tells himself. But maybe he doesn't realise that his best interests, ie having a newly qualified F1 trail him around the whole day means 1. his life is easier in the short term because he can delegate donkey jobs to the F1 and 2. that important jobs don't get done unless the F1 stays back for 5 hours after his shift ends - which results in the F1 being berated the next day because 10 of the 20 urgent bloods ordered yesterday had not been collected. It could be that he doesn't know he's being unfair, or that he knows it's unfair but justifies this by saying, 'that's how it was when I trained! Why should you lot have it better than us?'


But in this hospital, we don't have enough resources for us to go through what you went through without someone getting hurt. Will you deny that as a result of overexertion and a lack of senior support, patients were subject to avoidable harm - despite all your altruism and best efforts and good intentions? And is this really what you want




6. Insult to injury

- am I whining?
- kind of
- Is getting blamed for things that aren't your fault part of the job?
- Unfortunately yes
- you know we're only getting paid 7pounds an hour after tax right
- so stop going in on saturdays




7. Despise thy neighbour

The incurable tendency to focus only on your own suffering
urge to see nurses as the enemy
urge to see all nurses as the same


I have such massive newfound respect for F2s and junior doctors I met as a medical student - who suffered in silence and made small talk and tolerated my attempts to be helpful, and my tacit concealed disapproval, the comfortable distance I've enjoyed atop the pedestal of naivety and self-righteousness.

(The stony demeanour is a precaution against being taken advantage of - because if you say yes to everything, people will keep asking. This explains also the prickliness some of the nurses put on.)

But why does this adulation not filter upstream to registrars and consultants? Because they have it easy (easier) now? (what are you basing this allegation on? where is the proof of this? They are fighting a hard battle you know nothing about.) Even if it were true, why does that erase the merit of suffering? In all likelihood, they have gone through much worse.

I'll tell you why. it's because
1. they do not identify with our pain anymore - either they have forgotten it because the present is so good or chosen to ignore it because the past was so bad
2. They are the surrogate cause of our present suffering. If you wish to go further you could say that patients are the cause of our present suffering. Or you could go even further and blame it on something vast and abstract - you could go into liberal arts mode and say, actually, sickness and disease is the root cause of your shared suffering, patients, consultants and junior doctors alike. But then it is also the reason your job exists. Hospitals don't function without patients, without consultants, without disease, without imperfection, without weakness. If your sole purpose is to eradicate something, then you also owe it your existence. In heaven what do the doctors diagnose?

But the point is that we need each other to survive. No matter how much we disgust each other. But the consequence of this innate revulsion is that we band together with those close to us, and form factions and vilify the ones who aren't like us. They are flawed exactly the same as we are, but we hate the flaws in ourselves, so much that we use the speck of dust in our brother's eye to distract us from the beam in our own. We deny our own hideousness by focusing on the hideousness of others, using arbitrary, superficial differences to try and justify the discrimination.

We have to make the innocent guilty, we need a common enemy, a martyr for us to burn and huddle round for warmth, because there is comfort in being able to multiply joy and divide pain, to share and shoulder each other's burdens. But for there to be an 'us', there must necessarily be a 'them'. And in this kind of environment, we can't get by - we won't survive unless there's an 'us'.


(I've thought this for a while now, but doctors seem to be broken in a way that other professions aren't, which is to say that we are flawed in an oddly homogeneous way. Some well-concealed, insidious and socially acceptable strain of megalomania or white knight syndrome, and you'd think that would allow us to identify deeply with each other, and connect over shared experiences, but maybe its only in the crucible of tribulation that there is enough energy to overcome this mutual repulsion of like charges, and bonds them irreversibly. But as the charge increases, so does its electrostatic force. The larger and more homogeneous the group, the more violent and volatile its pull and push, towards outsiders - towards those who aren't part of the group.)


---


How to be kind to a house officer who hates you




8. welcome to the real world / Induction

"you can save this child's life, but only if you cut off this man's hand"

the way the hospital works is the way the world works - so sheltered, have never experienced it firsthand
total shift from being in university to working world - such separated by a rift as vast as the galaxies are from each other - as far apart as the east is from the west
the two realities are incomparable, incompatible
 the unfairness of it all
how to preserve the lessons, values which instilled, kindness, courage, integrity, honesty now do not function, ineffectual impractical - get you killed if applied to your day to day white collar job

having to confront my naivety... do i still value it? envy it in others? is it right to despise it?



9. Hustle


For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? But if we hope for what we do not yet have, we wait for it patiently.

---



I have no right to say any of this. it's only been 3 days

But do you think it will get better?

I don't know. All I can do is hope, against all odds

Know that the trying of your faith produces endurance

The trying of your faith

The frustration of hope

But hope deferred maketh the heart sick, remember?








10. Muri shinaide pt 2

Hey kid, you don't have to force it you know. Just concentrate on loving the person in front of you. Value them, treat them with respect, whether or not you think they deserve it. Your job is to decide how you treat these people. Whether or not they get it is up to them









---




- let's say your mother and father are both drowning, and you only have time to save one of them, who do you save?

- what? my mother I guess

- wrong

- what do you mean 'wrong'?

- the answer is simple: you save the one that's closest to you











11. this too shall pass

Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be restrained; where there is knowledge, it will be dismissed. For we know in part and we prophesy in part, but when the perfect comes, the partial passes away. When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became a man, I set aside childish ways. Now we see but a dim reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known. And now these three remain: faith, hope, and love; but the greatest of these is love.

washroom sermon

He came to Simon Peter, who asked Him, “Lord, are You going to wash my feet?” Jesus replied, "You do not realize now what I am doing, but later you will understand." 

- John 13:7

---

my mom and I were cleaning the bathroom today. The whole of the bathroom. When we got to the toilets and had to scrub the inside with the brush, I caught myself thinking, 'why don't we get the maid to do this...' 'I'm not even getting paid...' I had no problems scrubbing the sink, wiping the faucets, rinsing the floor, but when it came to the inside of the bowl... surely this sort of thing was not what I was put here on this earth to do. This is not my calling - in fact it's the opposite. This type of thing doesn't suit me at all. Manual labour I can handle, I only ask to be kept far away from sinks, drains, orifices of unsanitary receptacles in general.

After we'd finished, when both my mom and I were thoroughly splattered with flecks of soap and water from the bathroom floor, I started thinking - maybe this is a kind of proof. That the true value of the gift is in what it costs the giver. That you are willing to get yourself dirty in order to make something clean.

vitality at all costs