The work of medicine can be grim. Death, pain, madness, addiction, mutilation, indignity are all around you at times. How one copes with it as the objective medical practitioner is hard to define**. I personally feel that the ancient rite of passage of the dissection room in first year had considerable merit in this regard. Its abandonment in most UK medical schools means that current and future generations may be missing out on something other than knowing anatomy. Likewise, the cosseted world of the junior doctors’ contract and hours regulations means that the fruitful maxim, ‘they can always hit you harder’, becomes less true by the year.
Doctors, then, are changing. Their work by and large stays the same in its broad themes. You have to be able to cope with the dark side, which includes a significant attrition rate amongst our own – illness, fatigue, family crises, scandal etc.
Some of our coping mechanism comes from our personality and our background, some is learnt. Some relates to personal beliefs, often religious. Either way, you have to acquire it in order to function. Here is a vignette from Lermontov’s A Hero of Our Time, a mini masterpiece of selfish young man nihilism, written long before trite pale imitations like American Psycho. The hero, Pechorin, is preparing for a duel in the Caucasus mountains, seconded by his worried doctor friend, Werner:
“Why so sad, doctor?” I said to him. “Haven’t you seen people off to the next world a hundred times with the greatest indifference? Imagine that I have a bilious fever, and that I have equal chances of recovering or succumbing. Both outcomes are in the order of things. Try to regard me as a patient stricken with a disease you have not yet diagnosed–that will stimulate your curiosity to the utmost. You may now make some important physiological observations on me . . . Isn’t expectation of death by violence a real illness in itself?”
This thought struck the doctor, and he cheered up.
A true and shrewd observation, which most medics will recognise: the awfulness of illness and death is mostly genuinely fascinating, and can be its own reward, in a strange way.
**As an afterword there is a good quote from Russian/Armenian/American author Vera Nazarian, the parentheses are my own contributions:
“If you are faced with a mountain, you have several options.
You can climb it and cross to the other side (doctors who can do the job, but who get out into management etc ASAP).
You can go around it.
You can dig under it.
You can fly over it.
You can blow it up.
You can ignore it and pretend it’s not there (usually become Public Health ‘experts’ in the UK).
You can turn around and go back the way you came (doctors who don’t cope and drop out of the tough specialties) .
Or you can stay on the mountain and make it your home (the frontline doctors of any challenging specialty who stick it out).”
[I’m still working on career analogies for the middle four *]
*see first comment below