Contemplations on medicine and its allure from a student intern

Why did you choose medicine?

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“For the mind does not require filling like a bottle, but rather, like wood, it only requires kindling to create in it an impulse to think independently and an ardent desire for the truth”

― Plutarch

I came across this quote reading Plutarch’s essay “On listening”. Suffice to say, we as 5th year UCT medical students, are on winter vacation granting me the luxury of filling my days with excerpts from all the curiosities I have buried in the recesses of my mind that arose during the arduous semester.

At the risk of sounding trite, we are constantly bombarded with mental stimulation from media, coursework, social obligations and the mechanics of daily living. Running on autopilot, it is easy for our views of the world to simply be digested by these variables leaving us no room to formulate why we actually feel, think and behave the way we do and more importantly if it actually aligns with what we want.

Why are you reading this blog? If you have been directed here from my YouTube channel it is likely because you felt my content and experiences of medical school perhaps aligned with either what you would like in the future or your current experience of being in the medical field. If you fit in to the former category, have you ever paused and pondered about why you actually want to do medicine? I urge you to stop and do so. Is it due to pressures from social construct and status, financial gain, the drive to benefit humanity or the deep curiosity of the human body and the interventions adopted to intervene in human ill- health?

As the writer, I am impartial and unaware and therefore non- judgemental to your answer. It is however interesting to note whether you have the courage to be honest with yourself. One of my favourite youtubers, Ali Abdaal, mentioned in one of his videos that he asked every doctor he came across in medical school training about whether they would still practice full- time medicine if they had won the lottery today. He stated that every single one of them said they would atleast practice part- time with answers including leaving in the middle of an operation. I have yet to conduct this exact social experiment but the most incredible physicians and surgeons I have come across have also suggested financial requirement as an obligation. On the first day of medical school there was an introductory lecture which instructed us to leave immediately if our objectives at all were to make money.

What are my motivations for pursuing a medical career?

In all honesty, I don’t know. I never gave it much thought.

At the age of 16 I did a 2 week career experience rotation at my high school- I spent 9 out of the 10 working days granted by my school shadowing chartered accountants, lawyers and even a neurologist. At this stage I knew I could not pursue a finance degree. Similarly, I did not feel inclined to engage in daily office work. I had always been against the field of medicine. I thought them to be a pompous bunch concerned with social status more than anything due to all the respect my young mind had observed being awarded to the profession. Interestingly enough, the root of the word medicine comes from the latin phrase ‘lex medicus’ meaning statute of physician implying social status historically being attached to the profession.

On the 10th day, as an afterthought, I asked my older brother who was in 4th year medical school at the time if I could go to hospital and attend lecture with him to which he agreed. Arguably, I would say this is the day that determined the fate of my life. The day began when we left home at 7am that morning to get to RK Khans (a district hospital in my hometown) for his internal medicine rotation where we attended on patients in his ‘firm’ before ward rounds. One lady who was critically ill had what I came to learn was jaundice and she died that same morning in front of me.

It was the first time I had witnessed someone dying.

A patient will only be admitted in hospital in a critically ill state at most a handful of times throughout the duration of their life. As doctors we spend almost every single day in that environment. The experiences that we consider a part of mundane life are the most memorable and often tragic days of their life. This was my first experience of the social aspect required in the medical field. I love people. I love talking to people. I love learning from people. I love making people feel happy.

Perhaps from a deep- seated pathological need to be liked arising from an over pronounced genetic trait my ancestors possessed in order to survive by socially conforming through natural selection?

Whatever my motivations were to help this lady, or at least make her feel at ease during her last living moments, I knew I wanted to be there for her. In fact, I knew I wanted to be of ‘help’ to every single person who needed it. My young mind quantified the success of my endeavours to help by how happy they were after I had interacted with them. As a 5th year medical student I have learnt that the success of medical intervention is quite similarly dependent on patient satisfaction as sometimes doing what’s going to restore health to baseline and doing what’s going to make the patient’s quality of life better is not always the same thing.

That day carried on until 11pm with a GIT lecture in between where I happened to know the answer about where the majority of micronutrient vs water absorption occurred in gastro- intestinal tract (I was fortunate to be learning that in Gr11 Biology at the time). I came home utterly knackered but thrilled. I was on my feet the whole day and I met so many interesting diverse people but in my heart I felt happy.

I didn’t think my way into this career I sort of based my decision on feeling.

I knew that I had found a place where I fit in the world. True to form, many years later, long day hospital rotations are still my favourite (although sparse due to the restricted clinical contact hourse during the COVID19 pandemic).

After all of this, I guess I can say I think I’m on the right track? I still have days where I’m not sure. I do not enjoy the egocentric nature of some of the individuals that the field attracts. I especially do not enjoy the notion of doing something for the sake of doing it to boost social recognition i.e. regurgitating content to impress senior clinicians (who don’t care) and jostling colleagues out of opportunities to get clinical experience.

While writing this I received a notification from my university informing me that I will be expected to return in a few days to commence the second semester.

Am I excited to go back and learn about orthopaedics? No, I never particularly liked the typically masculine rotation. Am I going to go back and study it to the best of my ability? Yes so that some day when I have a patient come through with a broken leg when I’m working in the middle of Witsonderwater (South Africanism for the ‘middle of nowhere’) I can help them and hopefully they leave with a smile on their face.

I enjoy learning for the sake of learning when something is particularly interesting to me. I enjoy meeting new people who present as patients and learning about their lives, what’s special to them and their view of the world. I enjoy collaboration with my colleagues in a happy work environment. Finally, I especially enjoy discussing medicine and reaching conclusions independent of textbook resources following the path of logic narrated by the basic sciences. These special opportunities granted in the field of medicine make me feel like a real life Sherlock Holmes experiencing a rush of adrenaline with each ‘clue’ I’ve detected.

If I won the lottery tomorrow would I still practice medicine? Absolutely. I think I have a substantial mountain ahead of me which represents the next 4 years of complying with the arduous training hours in isolated locations all while working in an under-resourced, overburdened system. I suppose the HPCSA qualification as a registered medical practitioner will be the pinnacle of said mountain until the next challenge of specializing. Equipped with self awareness and the implementation of appropriate burnout strategies I hope to maintain my love of medicine and honor the reason I embarked on this journey to begin with.