Starting Again

Kerrianne Huynh is an advanced ICU trainee working in Melbourne.

I started at a new hospital this year.

Being new in a workplace is always difficult. Being a new doctor in a new hospital isn’t easy either. You are met with a sensation that you need to prove yourself, or earn your stripes, particularly if you are, like myself, five foot nothing and look like a teenager. It takes time to earn the trust of your peers, your seniors and the nursing staff. If you are anything like me, you occasionally say things out loud that sound rubbish. It did not help that this was on the back of an unsuccessful attempt at the fellowship exam the year before, something that had genuinely rocked my confidence.

The day of orientation was cold. The start was early and my clothes were nice but none of them fit properly. I couldn’t button the front of my coat. This was because I was fat, a remnant of working and studying unhappily for twelve months or more (an old colleague of mine, who I hadn’t seen in ages, had recently mistaken my state of unhealthiness for a state of fecundity). I was seated among strangers, and was struck by the use of the words ‘dignity’, ‘respect’ and ‘anti-bullying’ in the orientation session. They came up often. I was stunned that it was mentioned so many times and suspicious that the words were easier to use than be put into practice.

The amount of cynicism I felt may surprise you. For some people, even hearing these words at an orientation session wouldn’t even bear a mention. The reason for the attention was because I had just left a workplace where these concepts were neither implicitly or explicitly articulated. The irony, of course, is that the workplace that doesn’t communicate these concepts is the workplace that expressly requires them. I have never been in a workplace that was so unhappy and hope never to experience that again.

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I remember my first day as a medical student.

There was a definite thrill in the air. The sense of potential was palpable. There was a real sensation that we had made it and our futures were right ahead of us, bright and shiny and gleaming. The cohort actually clapped after our first lecture – that was how thrilled we were to be there.

One lecture on that first day stood out for me. It was about the high rates of depression, anxiety, suicide and substance abuse in doctors. There was a list describing, in descending order, doctors of which subspecialties were most likely to commit suicide. Yet there were no tools or strategies given to these budding young doctors to deal with this, or even an explanation why we as a profession were suffering.

I would be a doctor for five years before I ever hear the phrase self-care.

As I advanced through training, some of these reasons for suffering became apparent. Medicine is high stakes and high stress. Intensive care is this, times ten thousand. I suffered when I ran my first paediatric arrest. I suffered when I told a mother on New Years’ Eve that her 18 year old daughter was brain dead. I suffered when I couldn’t prevent a young boy dying on his father’s birthday. I have no illusion that my suffering is nothing compared to the patient and their loved ones. Doctors know this and we also know how to compartmentalise our grief. But we also work in an environment where these experiences accumulate and no one teaches you how to deal with them.

Other experiences accumulate as well. I have been screamed at in the workplace. I have been accused of being a liar. I have been bullied. I’ve been ignored – actually ignored – in preference for my tall, white male junior. I listened when a colleague confided in me that she was so stressed about work that she was at risk of self-harm. I worked the night shift a few hours after one of my colleagues committed suicide. Yet no one teaches you how to deal with this. To my knowledge, there is no single medical training college in Australia that provides formal training in self-care or how to deal with work related trauma.

Some hospitals have made attempts at highlighting the importance of self-care but some of these initiatives are ridiculous. If you offer a massage service at work, when do you think an ICU trainee would find time to partake when most days, she doesn’t even have time to eat lunch? The Employment Access Program at my previous workplace was closed on the weekend my colleague committed suicide.

The last few years have shown great interest in the plight of junior doctors and the effect of stress, overwork and the lack of support they experience at work. Cases of bullying, sexual harassment and discrimination have been highlighted. Departments have lost accreditation because of it. The case of Dr Yumiko Kadota is the most recent, but no subspecialty is immune. In 2015, the Royal Australasian College of Surgeons released the results of a trainee survey that showed 49% of trainees had been subjected to bullying, sexual harassment or discrimination. The College of Intensive Care followed swiftly in 2016 with a survey about bullying experienced by intensive care trainees, which showed about a third of trainees had been bullied and the perpetrators were most likely to be their own consultants.

I used to think that my well-being was a personal concern completely divorced from work; that a few extra spa days, exercise sessions and the occasional post-shift drink at the pub would see me right. The idea that somehow more social events outside of work can ameliorate the stress, trauma and dysfunction inside of work is a complete myth. Trainee well-being is a function of workplace environment and the ability of the department and trainee to recognise its deficiency and act on it.

The truth is that cultural change begins at the top and there is great inertia without senior advocacy. I’ve worked in a department where my consultants took perverse pride in how difficult their profession is. That being understaffed and overworked and surviving it all was somehow a badge of honour. Trainees who can’t manage in this environment were told, just like Dr Kadota, that they weren’t tough enough to make the cut and maybe this profession wasn’t for them. But merely surviving isn’t good enough for me and shouldn’t be good enough for my patients. I came to this profession to do the best thing by them, to the best of my ability. However, change cannot happen unless departments realise that the failing is within themselves, rather than the trainees. Tolerating bullying or being bullied is not a mark of moral fibre nor reflects your ability to make the cut. Self-care at work cannot happen if the system is built to prevent it.

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Last year I crammed as many plants as I could into a tiny apartment balcony the size of a prayer rug. The fragrance of lavender and strawberries and plum coloured roses was balm to ruffled feathers and rattled nerves. When the local tawny frogmouths took up residence in this balcony garden my husband and I were gratified and had our breakfasts on the balcony while these native birds napped and preened. It was an escape from the stress of work, and a way that I could literally enjoy the fruits of my labour.

I uprooted myself as well as my garden when I moved interstate but this year, but I was determined to do it differently.

I joined a gym and changed my diet.

I let my husband look after me.

My new garden is sprouting edible nasturtiums, round leaf mint bush and microgreens.

After allowing myself a few months to breathe and seeing a psychologist, I have started studying for the fellowship exam again.

I was very recently able to safely do up the buttons on my favourite coat.

And I’m happy to tell you that after all the hype I heard at orientation, the hospital lived up to its word, demonstrating that fruit grows where there is fertile ground.