Last week I played squash three times in four days, and when I walked in to work on Monday, I had the shuffle and hunch of a man twice my age. My excess physical exertion had left my calves tight, my shoulder was stiff, and there was the definite suggestion of impending tennis elbow.
One week later, I walked in for a morning ward round with exactly the same demeanour. The only difference was that this time, I had not done anything physical since last Wednesday.
I consider myself to be quite fit; if nothing else, I am fitter than I look, but my physical fatigue took me by surprise.
What then can explain my broken state? Well, that is easy - it was the 39 hours in three days I worked as the Medical SpR, added to by the indignity of losing an hour’s sleep on Saturday night when the clocks went forward. The night registrar was chuffed about this. I wasn’t. I suggested that we split the difference and start the ward round at half past, but ultimately, we agreed that this would be an unnecessary faff.
The role of the Med Reg is a highly pressured one, and one that I know puts many people off being physicians at all. Forget the 30 years you spend as a consultant, it is the 5 that you do as a registrar that persuades many it is not worth the hassle. And sometimes, I can see their point. Today, I am exhausted, and I still have to get through this working week before I can put my feet up and recuperate.
My fatigue does not stem from the fact that I didn’t have any meaningful breaks on Friday or Saturday (I didn’t), but because over the course of the weekend, I played a bit-part in the major life events of a fair number of people. The absorbed stress of working with people who are going through a really bad experience inevitably begins to tell, but too often in medicine, we pretend that it doesn’t have any kind of personal impact. I would like to change this, and to say clearly that sharing space and time with people who are going through the kind of personal traumas that we deal with as physicians is a hard job.
Technical skill and knowledge base are important aspects to being a doctor, but that doesn’t change the fact that there is a real human element to it as well. I am not just a doctor, I am also a young-ish man who has seen lots of people suffer and die. And while there is always something I can do to help the situation, it is really hard not to take some of this home. Some of the events that you help with are moments that patients or their relatives will remember with emotion, sadness and clarity for the rest of their lives, and if that doesn’t affect you, then you have something that I don’t. In many ways, I don’t want it not to affect me. I want my patients’ experiences to be important to me, and that is impossible without empathising them.
I’m now in my fifth year as a medical registrar, and I always assumed that it would get easier as I progressed. To some extent this is true, but I have also observed that the things that I found challenging when I started are the things that I still find challenging now. I am still staggered by the range of responsibility that one person has. From dealing with cardiac arrests, and really sick patients on the ward, the medical registrar also has to deal with admissions through A & E, referrals from other specialties, provide advice to GPs, supervise the more junior members of the team, try to ensure that they have good clinical exposure with enough support, manage the work flow, and make sure that the take is run the way that the consultant likes it to be run. And also deal with the strong emotional experiences that patients, their relatives and other doctors are going through. That is a lot.
So if you see a medical registrar looking flustered, being grumpy, or simply having a tough time, make them a cup of tea, and say something nice to them. Very few people did that for me this weekend, and it would have made a world of difference.