An Education

Post call is a strange time. I’m excited about going home to bond with my pillow but I’m just lucid and loopy enough to have philosophical and emotional breakthroughs. “Somewhere between psychotic and iconic”. This is the sequel to Science and Faith.

My emotions are right at the surface after a night of learning by fire and sleep deprivation disarms me and leaves me raw and unfiltered. It’s the best (and most inconvenient) time to write and have car dance parties (see also: post call psychosis jams). It’s strange this meaningful and messy work we do. As I’m sure you’re aware I took a break from the weight of Medicine and it’s sh*tty boyfriend tendencies. It was an education.

Looking away from something you’ve been intently focused on for some time puts things in perspective. I got to see myself outside of the job and professional pursuit that has come to define the bulk of my adult life. Was the rest of me still in there? What are my priorities, goals and dreams and do I need medicine to make any of them valid? The short answer is: I don’t trust anything that hasn’t been questioned. But you came here for the long answer.

I have been inexorably drawn to children my entire life. It’s not just the innocence (which, at time is, is questionable: did you really need to wait until I picked you up to vomit into my bra baby?) it’s the unfiltered humanity. Kids are who we are before we’re taught to be anything other than who we are and are excellent mirrors of what they actually are taught. They scratch their knees, laugh from their bellies and ask deeply moving questions about the nature of the universe and bugs with equal exuberance (and treat your answers with equal nonchalance according to their exact needs at that current moment). They’re also tenacious, designed for love & care and their bodies are often bad liars. My favourite version of me is little badass unselfconscious Ntoetse and that part of me resonates with these little humans spiritually. And though it comes as no surprise to anyone who knows me; despite knowing for some time, I have finally chosen to pursue Paediatrics. As a generalist by nature I’m sad about the doors this shuts. I spent 9 years getting moderately good at the broad scope of adult medicine, able to switch and between and draw upon knowledge from multiple specialties simultaneously and putting all of my clinical skills to good use in the span of a busy evening. I’ve thoroughly enjoyed being a Jack of All Trades Master of None (oftentimes better than master of one). Unfortunately in order to get even better at the literal minutia, I have to put a lot of those tools down.

So I’m back with a newfound resolve. I’ve put a lot of myself on the literal backburner and seriously considered leaving. I tried and failed to change the whole system and tried and failed with equal verve to walk away. So I’m going in less starry eyed but not any less in love. Anyone who gets in the way of my goal is a distraction to be dismissed with relative ease because, say it with me: I didn’t claw my way back to one of the great moves of my life and grapple with the very fabric of my identity to be stopped by some weirdo with a complex or personality disorder. But I’m as naive as I once was. I am aware that as unwillingly choose the path of specialisation, difficult personalities lie in my future. I know that I will repeatedly encounter everything that is wrong our profession and that at my many points my resolve will fail me. I go knowing these things but still I go because now I know why I am here and who I’m in this for.

A quick tutorial for my friends whose medical background is mostly comprised of Grey’s Anatomy and/or Twitter debates. The South African medical degree is a Bachelor in Medicine and Surgery (MBChB) that takes a minimum of 6 years to acquire. It’s a practical qualification built on a solid bedrock of theoretical knowledge reinforced by clinical and bedside teaching. By the time you graduate, your degree has tried valiantly to prepare you for the National health, uhm, system where you will complete 2 years of internship, rotating through the major medical specialties under supervision. We are not the the interns inserting their very first IV cannula on their first day of work. We can do a bit of everything from delivering your uncomplicated babies, stabilising surgical emergencies, treating hypertension & diabetes, and to make a suicide contract, setting your broken bones and even suturing basic wounds. In these two years we are terrified and fearless (See Bara Snapshots 1, 2 & 3). We then spend a year doing community service at the government’s behest, serving under-serviced and thus undesirable communities gaining both clinical and literal independence to pursue the career or specialty of our choosing. There’s no pre-med but that’s a 9 year commitment to being an all-rounder of a doctor before we can plausibly answer the question:”so what are you specialising in?”. Specialisation is a whole entire rigmarole where you’re a full time Masters student with a full time job. The job lasts approximately 5 years where you’re known as a registrar and this comes with wildly high expectations and responsibilities that include but are not limited to teaching.

“Watch one do one teach one”. This is the full extent of medical education that we’re taught. There’s teaching and then there teaching medicine. Similar but distinct skills. You can read books until you’re purple but nothing helps one grasp a clinical concept quite like seeing a physical patient. No amount off googling can equip you with the ability to see someone and know that they’re sick, surmise exactly how sick and fine tune the alarm bell system in your brain that someone is sicker than they look. There is no substitute for clinical experience. This is what ward rounds are, this is why seniority is important in medicine and this is how it can save lives. I’m the guy who’s seen more theoretically knows more (if the my reflect and learn and teach) and this is Dr Google will always play second fiddle. The same profession that holds this truth as central dogma to our very survival, violates it at every turn. Teaching is sacred but few are taught how to teach, groom or mentor.

For as long as I can remember I’ve been inquisitive beyond reason. Somebody told young me there is no such thing as a stupid question and I’ve been running with it since. In every room I’ve been in, in every language that I know, to every teacher I’ve encountered. Raising my hand is so ingrained in me that I do it to this day. It survived university lectures halls and the titters of white boys who yelled their questions on a whim and sniggers in ward rounds where showing respect and letting the adults talk was labelled a “lack of initiative”. Like clockwork it will shoot in the air; this isn’t my first rodeo. I will show you respect as my teacher in that moment and there is no higher form of respect from me than me hoping to acquire knowledge from you. Teachers deserve respect because doing their job well isn’t as easy as they make it look .

While there are those naturally gifted with the art of teaching those who acquire it are no less deserving of our respect. Teaching well is public service. As a lifelong “academic girl” I disliked any subject that required me to regurgitate material without engaging it. Why are children being tested on their memory? Why are bright young minds filled to the brim with hypotheses and possibilities beat into adults that are argue facts as optional and view the critical thinking and vivid imagination that they once displayed as a handicap? Bad teaching has just as many, if not more, far-reaching consequences. I resent authority of any kind that doesn’t hold up to and therefore discourages questioning. “I don’t know”, “I don’t know enough about that to comment” are admissions that required reflection. They’re also invitations to fill a gap. Waaay too many people are being groomed to look and act smart at all costs. All. costs.

My first Come to Jesus moment since returning was when somebody who was both my senior (and thus my teacher) used their perceived status to tried to take this inquisitive spark away from me. She saw my very #onbrand line of questioning as a threat (is there anything less threatening than this girl with her hand in the air?) to her perceived authority and intelligence and wielded both as a weapon against me. I don’t know much but if we kill the dreamers and the eager beavers we’re shooting ourselves in the foot (and will be treated by a generation that was too scared to ask us how to properly manage that exact scenario when I was our time to teach them).

Which begs the question: why is teaching not a skill we’re equipped with alongside CPR and Chemistry? As an intern you teach students and then you literally never stop teaching students at every single level until you retire. You get treated like a community leader because that’s actually who we’re supposed to be. The most senior person runs the department whether they’re equipped to lead or not. A lot of people are crippled by the weight of who and what they’re supposed to be and nobody thought it was a good idea to fill the gaps? Not everyone is a natural born leader or teacher but we naturally recognise both as vital and helpful skills. If you’re going to make a group of people build a complex structure around both, why the hell are we not building them? Medicine has a failed it’s own internal logic. I can help (a tiny bit).

Vulnerability and reflection should be encouraged. I can’t change the way some M&Ms are run as blood baths or comment on the observed benefit they yield beyond fear and blame. I can, when teaching my juniors to do something new, share my former failings when I was once in their to highlight the lesson I’m trying to teach them at the time. A MM&M (mini mortality and morbidity) which by definition is supposed to be us collectively sharing and learning from each others mistakes. A fear of making mistakes doesn’t eliminate that human weakness. It means we’re less likely to learn from them.

Be nice to interns. It’s a thin line and there are word humans who take advantage of kindness but in the whole, in service of their training we are compelled to make them safe and capable members of our fraternity and that includes being strict and critical when necessary served with a health dose of nice. We already know how the alternative goes. And just because you learned through suffering doesn’t mean you need to pay it forward. Just, don’t be a dick. Interns are your junior colleagues. Key word: colleague.

Be pleasant and when else fails be professional. There’s really no substitute for a pleasant work environment, all other variables being equal. My internship brought the power of teamwork and group morale to the forefront in a way others claim is unusual. I was happier doing 9 brutal trauma calls a month because I had my (mostly) reliable team of interns around me. I learn better when I feel safe and whether you’ve drunk the masochist’s Kool-aid or not, so do you.

Teaching and leadership should be actively cultivated and groomed and if neither comes naturally to you, you deserve to be better because the way things are set up, you’re going to be both by design in time; Whether you want to or not. We don’t think about the next generation nearly enough because at every level, the system has designed us to “just try to get through”. This myopic view is holding us back from greatness. We’re already invested in Humans. Invest in humans. They’ll surprise you.

I’d like to take this moment on to specifically and intentionally mention the excellent teachers who’ve literally changed my life. Let’s hear it for the the teachers and leaders who show me how it could be done so well in so many different ways; and the great power that doing these two things well wields over the people you encounter. Whether it was English or Life Sciences, Mentorship, whistling or playing the Piano and even how to Insert a Chest Drain, know that your efforts ignite the childlike spark at the centre of who I am and I can never thank you enough for that.
Little Ntoetse thanks you and there is no higher praise.

I also need to thank the women who carried me through the darkness:

1. My mother who didn’t question me veering off the expected path. She took it in stride, opened her arms, her home and let me recuperate in peace. When the world was spinning she provided a focal point.
2. The fantastic Dr Lerato Khatle of  Young MD, a woman after my own heart who reminded me there is power in your story and lead me back to my mentorship roots. She made me feel less alone when nothing made sense (and the formidable Prof Maswime for connecting us). A misstep could just be a change in song.
3. My grandmother’s prayers. At any given point in time, darkness can never win because you are in my corner.
4. My friends. You didn’t question or judge me. Your careful compassion assuaged my panic. You wrote letters (Thank you Laetitia) and many more of you surprised me by joining me (so many humans had the foresight to take a break and I’m so proud of our generation).
5. Every single human who commented, DM’ed, reached out, shared their stories and joined their pain to mine. We are stronger together. Thank you all so much!

As always, this is a collaborative effort: overhear my thought and share your own. How are where are your respective industries getting things right and where can change come and make a home for itself?

Original post: Science & Faith