There are many reasons people decide to go to medical school, but if you ask someone on their first day, why they are there, they will tell you it’s because they want to make a difference. They will tell you it’s because they want to do something valuable – something important. They will tell you it’s because they want to save lives.
Saving lives is a big crowd puller when it comes to med school entry, and I can truly understand it. On my last placement before finals, I found myself in A&E, the not-quite-a-doctor, trying desperately to avoid getting in anyone’s way. On one of my shifts, a woman was brought in by ambulance. A woman who was in her forties and usually in good health. A woman whose presenting complaint was a racing pulse and a feeling that something terrible was going to happen – a sense of impending doom. The general opinion was that she was having an anxiety attack (or rather, ‘just’ having an anxiety attack, because society still likes to put ‘just’ in front of anything to do with mental health), and she sat in a cubicle in the assessment unit and waited for a series of routine tests.
Ten minutes later, she went into cardiac arrest.
She slid, very gently, from the chair, on to the floor, and her heart stopped beating. If you ever wondered about the definition of teamwork, you will find it on a crash call. It’s a sharp, blinding algorithm of efficiency. A crash call has its own tribe, its own trolley, its own rules, and as a medical student, I was told I should stay and watch. In the very next cubicle to where the woman had slid to the floor, there just happened to be a consultant cardiologist seeing another patient, and he appeared from behind a curtain, and he took over.
And the cardiologist brought the woman back to life.
In a fusion of machinery and drugs and experience, her heart began beating again. The cardiologist managed to pull her away from wherever she had gone and brought her back into the world. She was resurrected. It was fast and clean. It was uncomplicated. The woman even tried to stand up (no, really). It was the first crash call I’d seen, and I was mesmerised. I thought all crash calls would be like that (they are not). The woman was taken to somewhere more appropriate than a cubicle in an assessment unit and the floor was cleared of debris. The cardiologist turned to his audience and said ‘she was right about the impending doom, wasn’t she?’ and he disappeared again behind the curtain – where I heard him apologise to his patient for leaving so abruptly. The department carried on.
I did not, however, carry on. I was transfixed. I wanted to ask the cardiologist how it felt – how it felt to return a life to someone. How it felt to do a job where you could, at any moment, become a hero. How it felt to argue with God. But I didn’t. I didn’t ask him any of those things, because I had learned very quickly that in medicine and surgery unless you enjoy being looked at in a very curious way, you do not ask people how something feels. Instead, my gaze followed him around A&E for the rest of the afternoon, and whenever I spotted him, I thought ‘there is the man who saved a woman’s life. There is the cardiologist. There is a hero.’
On the first day of medical school, if you ask someone what their chosen speciality would be, cardiology is always very popular. ‘It’s the prestige,’ people will tell you because in medicine, there is a certain hierarchy of body parts, which I have never quite understood. When it comes to kudos, hearts trump brains, brains trump bones, bones trump skin. Kidneys would, of course, trump everything, but they’re far too clever to involve themselves in such shenanigans. All I’d ever wanted to do was psychiatry (it was the whole reason I went to medical school in the first place) although I glanced in with awe at some of the other rotations I passed through – the grace and compassion of palliative medicine, the utter joy of care of the elderly. But at the end of a very long road, I knew psychiatry was waiting for me, and knowing that was sometimes the only thing that kept me going. As I travelled that road, though, I would sometimes remember the cardiologist and I would feel a whispering of regret that I would never know how it felt to kneel on the floor of A&E and to save someone’s life.
But when I finally reached the end of my journey, and I walked into psychiatry for the first time, so many of things I’d learned about in medical school suddenly became clear. I realised that in psychiatry, all of the other rotations I’d experienced suddenly made so much sense. All the clinics and the surgeries. All the ward rounds and x-ray meetings and the hundreds of miles I’d walked along hospital corridors. Because in psychiatry, I now had the privilege to work with patients who were at their most vulnerable, patients who were in their greatest need of compassion. In psychiatry, I had reached the very bones of what it means to be human, and every other rotation felt like a prologue.
When I walked into psychiatry for the first time, I realised that if you ever wondered about the definition of teamwork, you will find it on a mental health ward. The doctors, the nurses. The OTs and the HCAs and the ward managers. The CPNs, the pharmacists, the volunteers. An entire population of people whose purpose in life is to give a patient back their self-belief, to rescue a life worth living. So many times on those wards, I saw small moments of compassion – so fleeting, so transient, they could easily have gone unnoticed. If I told them here, they would seem insignificant and they would be lessened, but to watch them across a ward or a dayroom took my very breath away. Because it taught me the kindness one human being can show to another, to a stranger. And this kindness is nothing to do with wearing a uniform or a stethoscope. It’s to do with being human.
When I walked into psychiatry for the first time, I learned something vital. Perhaps the most vital thing you can ever learn as a junior doctor. I learned that saving a life often has nothing to do with a scalpel or a defibrillator. I learned that lives are not just saved on the floor of A&E or in a theatre. Lives are also saved in quiet corners of a ward. In a conversation in a garden. On a sofa in a TV room, when everyone else has left. Lives can be saved by spotting something lying hidden in a history. Lives can be saved by building up so much trust with a patient, they will still take a medication even if they don’t believe they need it. Lives can be saved by listening to someone who has spent their whole life never being heard.
I learned that returning a life to someone very often has nothing to do with restoring a heartbeat.
I learned that psychiatry is filled with heroes. Heroes who return to their car each evening, and who drive home in the darkness and the silence, perhaps never realising they saved a life that day. Lesser known heroes. Quieter heroes. Although perhaps the quieter heroes are the greatest heroes of all.
On my first day of medical school, if you had asked me why I was there, I would have told you it’s because I wanted to make a difference. I would have told you it’s because I wanted to do something valuable – something important. I would have told you it’s because I wanted to save lives.
Which is exactly why I chose psychiatry.
Joanna Cannon is a psychiatrist and a writer. She lives in Derbyshire and has a successful blog.