A Médecins Sans Frontières career
Dr Nicholas Coatsworth MBBS (Hons) MIntPH FRACP* |

*Former President of MSF Australia, Deputy Director Disaster Preparedness and Response, National Critical Care and Trauma Response Centre, Royal Darwin Hospital, NT, Australia

I had an argument once with a close friend of mine about the semantics of the word ‘career’.  It was an odd discussion, mainly because I looked upon her career with some degree of envy, and as something that I wanted to aspire to, yet she seemed to view medicine very differently.  She had always been impressive, but not in an aloof or detached way.  On the contrary, she was one of the more gregarious people in medical school.  She left us after third year to become President of the University of Western Australia student guild.  The next time I looked she was off in Boston doing a Masters of Public Health at Harvard Medical School.  After a little time ferreting around the surgical subspecialties, including another stint doing Ear, Nose and Throat (ENT) surgery at Harvard, she settled on ophthalmology.  I never really understood why smart people ended up doing ophthalmology.  The eye being a window to the soul, every ophthal registrar will tell you about the first time they diagnosed a systemic disease looking at the retina (sarcoid, vasculitis, TB…), though it never seemed to me to be the right path for clinicians who were good with people, who would have been fantastic physicians given their talent for communication and empathy.  It’s an odd coincidence that three of my closest friends have become ophthalmologists.  And I guess this is where the dispute over the word ‘career’ arose.  You see, my friend argued strongly that career, in relation to medicine, simply meant the direction that your medical life took, a single path in a multitude of scientifically interesting pathways, supplemented by but divorced from the other aspects of your life (in her case, politics, learning how to speak Timorese etc etc).  I was romantically opposed to the view (as distinct from ‘romantically disposed’ to my friend) in that I felt that medicine was a vocation, far more than a job, not necessarily all-consuming but certainly visceral in the devotion to the patient, the pursuit and acquisition of knowledge, the challenge of the uncertain diagnosis, and the life that the ‘career’ as a doctor offers.  For me the word career was too sterile to define all the things that medicine represented.  Career was something that you could change (‘shifting jobs mid career’) if not on a whim then certainly with relative ease, but a vocation implied that you’d found the thing you were good at, and meant to be doing.  As in many semantic arguments, and all arguments had after Race 8 at Flemington Racecourse on Melbourne Cup Day, it became irrelevant.  My friend is a wonderful doctor, a consummate eye-surgeon, and has an extraordinary capacity to take on new opportunities.  I think one day she’ll agree that she has found her vocation.  For the purposes of this short essay, however, I will acquiesce to my friend, and talk about a career and where mine has gone.

I went to medical school at the University of Western Australia.  Everybody in medicine has a latent talent that is eventually snuffed out by the consumptive process of medical education.  Mine was language and debating.  So I was one of those 17 year-old school-leavers who struggled between putting medicine or law as number one.  I watched Rake on ABC last night and I am by no means confident of my decision.  My debating coach, several years later, with some degree of perspicacity would say, ‘it’s good you did medicine Nick, you would have been such an ‘xxxx’ if you’d become a lawyer’.  Nick Coatsworth.  The next Charles Waterstreet, or Cleaver Greene.  One by one the people who couldn’t forswear their other talents dropped out -   the concert pianist in first year, the interior designer in second year.  I watched them and wondered whether they could have married their talents with a medical career, or whether my decision to continue was the right one. 

It would be unusual, I think, to go through medical school without contemplating dropping out at least once a year (the feeling was dulled by euphoria and alcohol at post-exam parties and trips to Margaret River).  For me, the motivation to continue was a desire to work for the organisation Médecins Sans Frontières (MSF).  I thought that this would be the ultimate justification for the missing years of my life that medical training took away (a little dramatic on reflection) and so the first few years of my ‘career’ were largely devoted to making myself a suitable candidate for a mission.  That meant a selection of rural placements, kicking off with a medical and Emergency Department (ED) intern placement at Kalgoorlie hospital (‘doctor, would you like to put some local anaesthetic in the eye before you try and remove that foreign body’), and continuing in the ED at Port Macquarie hospital and Taree.  By pure luck rather than good management I missed the multi-traumas from the Pacific Highway, or the really sick paediatric cases.  I considered thrombolysis to be the limits of my thrill-seeking unlike some of my Kiwi colleagues.  With time through the first post-grad years it became less about MSF and more about which direction I would take amongst the multitude available.  Paediatrics was attractive, and a very good pick up line, but died a quick death when a two year-old’s parents yelled at me for missing a cannula and having to ring the paediatrician.  My surgical consultant offered hope for a cutting career – ‘you seem to be a guy that doesn’t need to go home at 5’ – way off the mark Mr Levitt.  But the deed was done after my second term as a medical intern at Royal Perth Hospital, with Dr Arthur Harris and Dr Steph P’ng as consultant and registrar.  Arthur was a wonderful physician, and a true gentleman, I didn’t see him ever go through a door before someone else, whether that be a medical student, patient or hospital cleaner.  At the age of 65 he beat me 6-0, 6-0 in tennis at the end of term.  After that I had something to look at beyond MSF, and the reason for having done medicine started to become clearer.

There would be no compromise on going away with MSF though.  At the end of my second resident medical officer year I walked into the old MSF office in Glebe to do my interview.  Half way through a Masters of Public Health at University of Sydney (a strategic enrolment to improve my chances in the interview), armed with high school French and a couple of rural terms under my belt I sat for 90 minutes in what was, and still is, fundamentally an assessment of how easy you are to get along with.  Happily they didn’t ask for referees, happily I had not become a lawyer.  A very perfunctory French test meant a first mission in the French Congo, and six tough months closing down a hospital that had stood for a decade in a particularly poor part of a poor country.  Rapidly I changed my view on doing overseas work to ‘make a difference’.  Despite the hundreds of malaria tablets dispensed, the long hours, the fatigue, frustration, and then work with the MSF Board in Australia (with similar emotions), I have never thought that I’ve given as much back to MSF as I have taken away.  There is certainly a philosophy underpinning the organisation that is not quite akin to any other in the humanitarian or medical world and one that continues to generate a certain passion in those lucky enough to work with MSF.

The (not so latent) talent for language, will be troubling the editors, so I will skip over the traumatic but necessary physicians’ examinations, the respiratory and infectious diseases training, and arrive now in Darwin with a young family and a consultant position at Royal Darwin Hospital, which is where I find myself writing.  This journey into medicine was very distant to me 10 years ago as an intern, and had I known how ultimately rewarding it would be I suspect I wouldn’t have believed it anyway.

But reflecting back to my friend and her career - people who seem to do a lot of things in medicine, who win scholarships to Harvard, who learn a language at the same time as their ophthalmology exams, who continue into medical politics or whatever ‘extra-curricular’ activities they manage – I’ve realised that it’s not some sort of super-human effort, or being in the right place at the right time that allows them to accomplish this.  I think partly it reflects the latent talents that people still have in medicine, which I’m certain can be combined with a medical career, and should be used to overcome some of the frustrations of a challenging profession.  The other part is simply taking the opportunities as they arise, putting your hand up when others don’t, and allowing yourself the satisfaction of a vocation whilst maintaining other interests. 

It’s never easy, but it’s very possible.

Good luck!