In an endless corridor of opportunities, some doors readily open while others need a little push, reflects this newly minted rheumatologist.
Fifteen years ago, I sat at a table across from three people and explained why they should grant me entry into medicine.
This year I began seeing people in my private rooms as a consultant rheumatologist.
If those two versions of the same person could sit next to each other, I wonder how much they would have in common. And what advice would I have for my younger self?
Looking back, I feel as if I have been on the receiving end of a lot of advice.
2006. I was share-housing in Melbourne. My Bachelor of Arts gathered dust somewhere as a heavy sense of duty descended. I could (and should) be doing a lot more with my privilege. Friends supported my shocking fashion choices with the same vigour that they supported my new idea of entering medicine. One step at a time, Max, they advised, you’ll get there one step at a time.
My parents’ advice was more pragmatic. What’s the backup plan?
I was working in a community gym at the time. A client asked about my plans, and I told her. Her partner was a doctor. In front of me she asked him, Is that realistic? Is it possible? He shook his head. I was a little surprised but didn’t make a big deal out of it. He hadn’t seen me on the circus silks the week before. He had no idea what I could do.
I remember being advised to do courses to prepare myself for the GAMSAT. I didn’t have the money for that. Someone gave me an old copy. It seemed straightforward enough. I can’t remember if I got 80% or 80th centile. It didn’t seem enough.
I went back to university for a year to bump up my GPA. I did the maths and figured out I needed to average 85% to average 80%. I was working part time, volunteering a few hours per week and back to living with my parents in WA. My Melbourne friends went largely unreplaced, and their voices faded from my life. Hobbies took a back seat. I started to understand what was required.
I was invited to interview. Be honest, was the advice, be ethical, have a framework for answers.
Other candidates seemed so much more composed. Slick. I felt very working class. Second hand. Like a 1989 Corolla driving into a new Toyota showroom.
I remember being asked by a panellist with tired eyes, “Why do you want to be a doctor?”
“It’s an indoor job with no heavy lifting,” I joked, probably unwisely. But I followed up quickly with the truth, which was something like, “Learning, studying and evolving is a singular joy. Being paid to be a lifelong learner seems like an indulgence, and medicine offers the chance to earn a very good living. It is disingenuous to omit this. Medicine offers flexibility in terms of career choice. City, rural, overseas, education, research.”
I saw medicine as an endless corridor of opportunities. Behind one door, this adventure. Behind another door, that.
“We have to ask everyone,” they said, “would you consider a bonded medical place?”
“I was hoping you would ask me that.” I replied. “That is what I want. I want to be of service where I am needed. If I am bonded, I can’t forget that.”
For me, that day, the first door swung open. Power corrupts, someone told me.
The intervening years between graduation and fellowship have passed in an absolute blur. It’s been a decade of constant transitions. Blink and you miss it.
Seriously. Blink.
You will miss it.
So, what do I remember of that time?
I remember having my first child in PGY2. The poor sausage wasn’t very good at life. A terrible sleeper, prone to gastro, anaphylaxis. He made up for it with round cheeks, big hugs and a killer gummy smile. The kid has more teeth now, they’re actually falling out all over the house, but his smile remains deadly.
I remember when he was six months old having a clear thought, If I can get four hours of sleep, I will be ok to work. It seems crazy to me now, but at the time that was pretty standard for a lot of JMOs. My advice to my younger self now would be, Plan for a year’s maternity leave. They will take you back early if you are ready.
I remember medical admin supporting my return by putting me into a full-time role that was less brutal for a few months. Part-time was not declined but was also not available. I didn’t make waves. I settled into new rotations. Night shift was a breeze now that I had a child. Nurses, orderlies and allied health would ask me how baby was growing. Sometimes they opened up about their own children. I had my little family at home and another in the hospital. The person you walk past at 2am is someone’s someone.
I remember contacting a department I would be working for a few months ahead and asking that the roster take into account my planned wedding dates. The service could not accommodate me. They did end up finding cover. Lucky, as it would have been awkward explaining my wedding Facebook photos if I had “gastro” at the time.
I was four months pregnant with number two at the start of that rotation and going on maternity leave at the end. I was about four weeks away from taking leave and feeling heavily pregnant when the head nurse at that hospital insisted that I attend a visitor behaving erratically. My request for security to manage this visitor was declined. I was not attacked physically, but it felt like a very close call. I felt unsafe returning to work for a few days, so I didn’t. My MDO and the AMA were helpful, though one of the consultants shouted down the phone at me that I was a “silly girl”. I later met with the hospital medical director to debrief. A positive meeting. Cultural change is hard.
I heard a rumour that within six months this hospital was put on notice by the PGMA that their accreditation for training would be revoked. JMOs were reporting bullying. I hadn’t known the PGMA existed. Maybe if I had reported my experiences, the next JMOs wouldn’t have had to report theirs. Know the structures of your organisation.
I also remember doing the maths around that time and realising that my take home pay (minus nanny/daycare/tax/parking/education) was a bit less than I needed to buy food for the family. That was when I decided I would always claim my overtime. If I was going to miss my children’s early years, I would not also be financially crippled by it.
That sparked talk about “efficiency”. Why was I claiming overtime when my peers weren’t? So I became more efficient. And encouraged peers to claim their overtime. Despite my tough talk, I didn’t claim all my overtime. It would have been career suicide. The hours were significant, exams were looming and two children waited for me at home. I honestly do not know how working women everywhere have coped with similar situations on less pay. If it wasn’t for my husband, I would have quit. I was intensely vulnerable to him and to my employers. And I was so lucky to have met such an amazing human being.
I worked full time until I couldn’t. Then I got serious about advocating for part-time and managed to do it for a year. There was one admin staff member who particularly helped that happen. She changed my life. She didn’t hold any doors open for me, but pointed out the ones that would open with a little push. And then, with the help of a few others, I think she nailed them open so that they couldn’t shut for others behind me. I hear that there are now over thirty part-time roles in the same hospital.
Around that time a member of the executive said in my hearing, I hate that doctors with children think they should go home on time. No one else does. And, Rostering around part-timers is just so hard. The personal choice to have children shouldn’t be the employer’s problem. I was a little surprised but didn’t make a big deal out of it. I’d learned not to disagree. Younger me was furious. Older me saw the comments as a sign that workforce changes were unstoppable. Big ships turn slowly.
Peer relationships were interesting. My father once said, The only people who know more than doctors about everything are engineers. He was an engineer of course. I barely had time for my family, so cultivating deeply held peer relationships was difficult. My overall impression of my peers is that they are intelligent, kind, generous humans. And that training places us all under enormous pressure. Some are deeply insecure, others are frighteningly confident. Some subjugate their own needs so frequently that they forget what those needs are. Others have learned their boundaries and hold them strongly. Sadly, when opposites like these are in the same room, understanding does not always seem to be high on the agenda. I wish it were.
Training positions are scarce. I remember one colleague saying to me I am always so interested to hear what you are doing, but also hoping that it is less than I am doing. That kind of friendship is difficult to navigate. But it also reflects a particular sense of humour born from the pressure cooker of navigating endless, infinitely complex and impossible situations day in, day out for a living. What I mean by that is that all resources are finite, while needs are endless. And sometimes the healthiest thing to do in those situations is have a wry smile and get on with the job as best you can.
Navigating supervisors was likewise interesting. We are all perfectionists, all adults. Some supervisors feel inspired by juniors who are filling up rapidly with the latest of evidence-based medicine. They are the best. They have my lifelong respect. Some feel challenged and infantilise the trainee. That can be difficult.
I cannot remember a time when I had fewer than five supervisors at a time – each of whom wanted things done differently. Generally, they agree, but sometimes they do not. Explaining to one supervisor that things were set in motion by a different supervisor, not by me, was an endless grind. And as I became more competent, I started to think more and more independently. That was scary. Get through it would be the advice here. Trust yourself.
It’s hard to pack a decade of struggle and success, friendship, camaraderie and distress into a short piece like this. We all have similar stories. Medicine is full of trauma. Vicarious, violent, insidious trauma. We all feel enormous empathy for our gentle, suffering patients as we watch their lives temporarily fall apart. And we must be careful of those patients with behavioural disinhibition due to disease, drugs and distressing past experiences. At times they cannot help but abuse us. To say otherwise is disingenuous. These episodes are thankfully rare.
I recall the first time I worked an outpatient clinic and started to see patients months after their acute illness had passed. They sometimes brought their children or grandchildren. They were fit. Smiling. Life was good. One bought me some soggy home-made apple crumble. It was revitalising. There was very good reason to hope – even at the bedside of someone in ICU with multi-organ failure. Patients get better. They bake bad apple crumble. Their life is not lived in the four walls of the hospital. What a privilege to use my knowledge and skill to help them navigate their illness.
Boy, covid was something, wasn’t it?
I’ve finished training now. The two children are in primary school, and a few weeks ago I sat down to my do my CPD plan over dinner with a dear colleague. We swapped dreams, goals and funny stories. Every single dream of my younger self has been achieved. Where to from here? Would I tell her to take a different path?
I look back at the younger me and feel as if, should we sit down together today, we would get along famously. She would think I was jaded. A little boring. I would think she was a bit fragile and idealistic. She would ask me why I had gotten so physically unfit. I would not tell her the truth. She already knows that there is no success without sacrifice.
But I would tell her this:
Only those that support or inspire you deserve your ear. For every naysayer there will be someone else ready to support you. Find them. Be cautious but brave.
Secondly,
Though you will fail to do this at times, practice kindness. Always.
And finally,
Keep choosing your own path. Invite those to join you who will make for a richer journey.
Dr Maxine Isbel is a consultant rheumatologist with practices in Perth and Busselton, WA.
