My interns started the term with mixed career aspirations. One wanted to do interventional radiology, the other - 'not sure'. (They may actually be reading this while they're trawling through discharge summaries on the ward. Hi guys!) Now, in their last few weeks of our term, they're thinking about a surgical career. Which I think is great. I've been lucky enough to have had some great advice over the years and I've nutted a few things out myself along the way. All through medical school, I wanted to be a surgeon. I'm pretty sure my fellow students found me obnoxiously set in my ways. Some of my clinical mentors (GPs, surgeons, physicians) would often refer to me as 'the girl who wants to be a surgeon'. I lapped up my surgical terms. It seems I was blessed with small hands with long fingers, a knack for anatomy and the ability to stand up for hours on end. I stayed in theatre whenever I could. I could not be gotten rid of. Even back then, I loved it. I loved doing things with my hands, I loved the ability to make a real tangible difference to people's lives. It was surgery and me; two peas in a pod.
I spent a lot of time trying out every surgical specialty. General surgery, orthopaedics, plastic surgery. I used to want to be a hand surgeon when I was at university which meant doing plastic surgery or orthopaedic surgery. When I was in my second year out of med school, I was trying desperately to get a term in orthopaedics. As a trade off, I got cardiothoracic surgery. To which I was seriously unimpressed. It just did not tickle my fancy at all. But I did it. And I never left.
So what have I learnt along the way?
1. Be enthusiastic but not obnoxious
If you really want to be a surgeon, come to theatre. Follow your registrar when they're on call and see patients in the emergency department. Ask to scrub. Learn to suture, learn to hand tie. But be respectful. This is people's workplace and that is a real patient. Be polite and learn to take no as an answer. Not all the time, persistence matters too. I guess it's a pretty fine balance. I had a medical student once ask me if he could take the vein from the leg for a coronary bypass operation. the answer was of course no, but I had to have a giggle at his guts for asking! By being enthusiastic and keen, you get known by bosses and other people who will then be more likely to support you. Plus you will learn so much! Most importantly, you will learn how surgery and you go together.
2. Surgery is seriously hard work
The days are long, you can go a whole day without eating or going to the bathroom. Emergencies happen in the middle of the night. Your patience will be tested by any number of people or processes. The process of skill acquisition can be hard and frustrating. The stakes are very high. Even if you have a 'gentle' job without inhumane hours and have a great team, it's still pretty hard. I never really appreciated how hard this job could be until I was in the thick of it. Sometimes I have been so tired, I just want to cry. Or quit. I think I could probably get a job as a crew trainer at Maccas. I have no idea where it comes from, but there is something fanning the flames at this point that helps you keep going. Sometimes it's the patients. Sometimes, it's the fact that you know you love the job. Sometimes it's just sheer tenacity. Whatever it is, it sustains you from time to time.
I get through the hard times by trying to maintain some work-life balance. I only do this now because I saw what happens when you let everything get out of balance. Decompensation is not pretty. Even the strongest can fall. Holidays, sleeping in, seeing friends and exercise keep you sane and healthy. Self-care means you are physically and mentally able to give the best to your patients. We don't train for the easy ones, doc.
3. Not wanting to do it is also okay
If you change your mind, it's cool. We work for 30-odd years in our chosen careers. Do you want to be unhappy for 30 years? Probably not. Do something you really want to do and that suits you in all facets. Suits your lifestyle, your skills, your passion.
4. Publish, publish, publish
Surgical training is highly competitive and is becoming more so. More and more medical graduates are coming through and are competing for similar numbers of training spots. You need to stand out. Get great references (see point 1) and great experience. Increasingly though, I'm seeing people publish a lot of material. It can be case reports or full blown research. Ask consultants and registrars you work with if they have anything you can write up and publish.
5. Have a locker and have some stuff in it
My locker contains: lots of funny scrub hats, toothbrush and toothpaste, change of underwear (for long nights), shampoo, mascara, lip balm, make-up remover and emergency food (brown rice and soups). It helps me look like a human rather than the girl from The Ring after pulling an all nighter. I hope it makes me smell a little less like I've been up all night.
6. Get a mentor
I have several mentors. Some have been there at different stages of my career, some have stuck with me. Some aren't even doctors! I'm sure I'll collect a few more along the way. These people have been sounding boards, advocates, advisors, teachers, drinking partners and friends. You don't have to have some awkward conversation like you do when you first start dating someone. (Will you be my boyfriend? Or in this case, my mentor) Most of the time, it's just a natural progression. However, a lot of societies and Colleges now have a mentor matching scheme. You can even chat to someone overseas.
People who aren't your mentors also have things to teach you - what to do, even what not to do. Listen to lots of advice and opinion and formulate your own take based on all of your information.
7. Be yourself
I'm not your usual cardiac surgeon. I read Vogue* and wear high heels. I giggle and I'm pretty cheeky. But I think that probably helped me stand out a little amongst the crowd. And I wasn't about to compromise who I was at heart. But most importantly, don't think because you don't fit a mould - whether it be gender, race, height, choice of extra-curricular reading materials - that you can't do this. Diversity is important. Different people bring different skills sets and interests and create tolerance and understanding in workplaces. (*By Vogue, I mean NW Magazine. Oh the shame!)
8. Learn about management, leadership and teamwork
A big part of being a doctor is to be a leader or part of a team. Not everyone is naturally gifted at this. But being rotten at it can seriously limit your career aspirations. Hospitals and surgery in particular, are basically big teams. We're working towards the same goal in different but cohesive ways. When the team does not work, it's not great for the outcome we're trying to achieve. I would highly recommend reading Harvard Business Review's articles on management and leadership, a book called 'The Charisma Myth' by Olivia Fox-Cabane and the No Asshole Rule by Robert Sutton. Look up to people who manage well and fairly. Learn from them. Trust me, it will set you apart and lead to a great workplace and great outcomes for your patients.
9. The rules of surgery are finite.
I was told these by a paediatric surgeon when I was a medical student. Eat when you can, go home when you can and don't **** with the pancreas. So true. Especially the bit about the pancreas. This advice keeps you alive and upright.
10. Learn mindfulness
This is by no way compulsory but a seriously useful tool. Mindfulness is a form of meditation that does not always involve you sitting down and chanting. Mindfulness is a technique of keeping focus on one thing at a time. Such as watching Keeping up with the Kardashians and not checking Facebook at the same time. I took up mindfulness as a way of managing anxiety and also improving my ability to concentrate on one task at a time. It made me so much more relaxed but has had added benefits in the operating theatre, keeping my focus laser-like. I would suggest reading anything by Jon Kabbat Zinn or using an app on your smartphone such as Buddhify, Headspace or Smiling Mind.
These rules are by no means exhaustive and nor are they compulsory. These are some of the slightly random or seriously helpful things I've picked up during my career. I'm sure if you ask one hundred surgeons for their ten tips, you will get a huge variation in what is actually important. I hope these help you in some way. And just for the record, I never watch Keeping up with the Kardashians. I am moderately addicted to Mad Men though.