*Assoc. Prof., The Australian National University
To tell a story about a medical career is to give it a narrative structure it usually doesn’t have. Most of us make up our careers as we go along. There are exceptions: I knew a student whose obsession with platelets continued undimmed into a life as a haematologist working with clotting disorders. I wasn’t like that. When I graduated, I was impressed enough that someone would give me a job. Even as I began working in Royal Darwin Hospital, I was so ambivalent about being a doctor that I enrolled to do a teaching diploma part-time.
Working as a doctor, it turned out, was different to being a student in the way that walking in the mountains is different to being stuck in a subway. Nobody could have been more astonished than I that I loved it. Darwin – hot, collegiate, untroubled by status – was stuffed with possibility. I still got the teaching diploma, but I also got to fly out to the Tiwi Islands to do paediatric clinics, have my first experience of successful advocacy (we stopped offering a light porn channel to inpatients), and continue some of the research in Alice Springs that I’d begun as a medical student. But it’s a long way from there to Canberra, and getting to what I do now involved going down a lot of byways. But the byways, I now think, were part of the point.
Here are some of the lessons I learned. I don’t offer them up to tell you what to do, but rather to reassure those of you who also end up meandering through the first decade of your career.
Global health can be done in your own part of the globe
The one thing I did want to do as a student was work in other parts of the world. After working in a mission in Zambia during a break between third and fourth year I realised that the contribution I could make clinically was not huge, but that didn’t stop the deep level of enjoyment. In the days before Médecins Sans Frontières (MSF) and the Internet you got to do that sort of work by writing to addresses in the international phone books held at the State Library. I was a diligent writer, and by the time I’d graduated had worked through all the Z countries except Zaire. From Darwin I volunteered to work in a research institute in the Gambia. Later my husband worked in Uganda and I managed three children in one of the most malarious capitals in Africa. I’ve lived or worked in three countries that subsequently went through violent revolution. My worst experience of national despair was travelling through East Timor just after the Indonesians had reopened the border in 1991. We were consigned to stay in the moribund Hotel Flamboyan in Baucau which doubled as the town’s torture centre. The air hummed with the silence of being watched. I think of those places – the arbitrary ledger of who dies and who doesn’t – most days when I work now at Companion House. I rarely travel for work now. But I’m convinced that I have done more useful work as a doctor in Canberra working with refugees than I ever did when working in clinics in Africa.
Children are not the deathknell of your professional identity and career hopes
I acknowledge it can seem that way when you are steeped in the raising of toddlers. Was all that training for nothing? Is your medical practice really going to dwindle into some hobby job like all those angry older doctors warned in medical school? (“Women are never as committed as men”). I lived in Atlanta for a few seasons, and found myself gratuitously informing the other Moms as we waited outside Evansdale Elementary School, “I may not be working now, but really I’m a doctor”. When my three children were little I did less clinical work, and – as with many professional couples – my husband has returned the favour as they have got older, leaving me free to increase clinical hours. I can’t give any advice on work/life balance because by any measure there’s no balance, they just feed into one another. I’m not even sure that work/life balance is ever achievable; humans aren’t spirit levels. Our lives should be enriched by both our personal and work lives. I am a better doctor because of my children, and because of the powerful support of a good partner, especially one who thinks you can do more than you ever thought you could yourself.
Make the most of colleagues given to you by serendipity
Many of the happiest doctors I know ended up in their field of work through luck. I tumbled into general practice because I needed a job while the children were young. I was blessed to be in Canberra, where the training program was run by the inspirational Dr Jenny Thomson, who was supporting GP trainees located in sites as diverse as Kazakhstan, Antarctica or, in my case, the anthropology department of ANU. The general practice she allocated me was one of the quirkiest and most ebullient workplaces I have ever worked in. Fifteen years after starting there it continues to be a joy to work there. The delight of general practice, which grows both from the depth of knowledge and experience with one’s own patients and from the shared nature of the workplace, is very difficult to convey to medical students. In contrast to some of the more technical disciplines, the intellectual work of general practice often involves prudent judgment and synthetic thinking. You learn the hardest skills on the job, and I have drawn heavily on the wisdom of the other IGP doctors, and still do.
Don’t work alone
I don’t work full-time in any of my three jobs. That’s possible partly because I work with networks of colleagues who continue to make work interesting and enjoyable. Part time work almost always extends beyond the hours allotted to it, and if you’re not careful you can be consumed by it. The same goes for working in heavy-duty service areas like refugee health or drug and alcohol medicine. In addition, because the spotlight of others’ admiration can outshine the dim candle of a doctor’s own self-knowledge it is useful to have colleagues who know you, understand the job, and are smarter than you.
Good workplaces celebrate and support their staff: try to find one that does that, and if it doesn’t consider leaving. A few years ago, a gifted colleague, a psychologist, left Companion House to return to Mexico. We had the usual farewell meal, made speeches, played music. Without warning it began to bucket rain – the breaking of a long drought. Wordlessly, the staff of Companion House ran out into the rain at dusk and danced till they were sodden. May all of you find a place to work that gives you such joy.