losing strategy

"Sell everything you own and follow me." is more or less Jesus' response to a rich man who wants to get into heaven. Resignation (sell everything) is one thing, but it is continual (follow me). Temptation is ever present to re-awaken your desire for whatever was given up. It is an infinite struggle. Also faith itself requires infinite scrutiny, or it becomes a lie.

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And Jesus looking upon him loved him, and said unto him, One thing thou lackest: go, sell whatsoever thou hast, and give to the poor, and thou shalt have treasure in heaven: and come, follow me. But his countenance fell at the saying, and he went away sorrowful: for he was one that had great possessions.

I especially like Mark's account because it mentions that 'Jesus looked at him, and loved him.' That tiny detail makes me read it in a different way.

It's as if Jesus is doing a double take. It's like he's finally found a student who has done the required reading. It's like he's finding fruit in a land full of fake trees. He sees something in the young man - a glimmer of hope, a potential crop. Here's a young punk who turns up every day knocking. The kid has moxie.

So he tells him the truth - but the truth is a father willing to sacrifice his only son, a son sold into slavery, a servant in a foreign land, the head of a prophet on a silver platter and apostles in prison, an angry mob and three men in a furnace, a pair of wrists with holes in them, and Jesus standing in the doorway offering his hand, his eyes gentle and full of mercy, saying, 'leave everything behind and follow me.' Already knowing what the young man's answer will be.

no team in eye

If the foot should say, “Because I am not a hand, I do not belong to the body,” that would not make it any less a part of the body. And if the ear should say, “Because I am not an eye, I do not belong to the body,” that would not make it any less a part of the body. If the whole body were an eye, where would the sense of hearing be? If the whole body were an ear, where would the sense of smell be? 

[...] 

But God has composed the body and has given greater honor to the parts that lacked it, so that there should be no division in the body, but that its members should have mutual concern for one another. If one part suffers, every part suffers with it; if one part is honored, every part rejoices with it.

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people religious about health, religious about cleanliness - what does 'being religious' mean? adhering stringently to a set of actions and traditions - believing that rituals can save you - doing something obsessively in the belief that it isn't futile

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When I was in fourth year of medical school a consultant stopped ward round and asked us, 'who is the most important person in the hospital?' We stared back at him blankly. "Is it Mr Najar? (referring to himself) (I've forgotten the consultant's name but he was almost certainly Indian) Is it the hospital administrator?" He gave us a wide and benign grin. "No, it's this person right here," gesturing to the lady who nobody had noticed before then, rendered inconspicuous by her dark green cleaner's uniform. She looked back at him and gave a bashful smile, unused to the attention. Mr Najar smiled back warmly at her. "How are you today?" "Fine, thank you." He turned back to face us. Our faces were so blank you could draw on them.

"If she isn't here, then the ward will be dirty. If the ward is dirty then patients will get sick. If this person doesn't do her job, then all our work here is meaningless. Do you understand?" Our heads nodded dutifully. "That's why I always say hello, good morning. Isn't it much nicer when people say good morning to each other? Good morning Rita!" A passing secretary beamed at him without breaking her stride. "Good morning Mr. Najar." The cleaner loitered in the background with her hands politely clasped behind her back, unsure if she was obliged to stay for the rest of the sermon.

I had forgotten about Mr Najar until now. I don't remember what happened before or what came after on ward round. It's lost in the sea of trivial mornings and medical school routine. I know now, however, with almost 100% certainty that none of us had understood the point he was trying to make. We just chalked it up to another eccentric consultant's production - the fanfare and palaver that performers feel compelled to deliver for a captive audience (who are themselves rarely desirous of it).

Last Thursday, as the ward round was entering the last bay, a tall, tanned Pakistani gentleman clad in a deep blue jumpsuit paused his mopping and stepped aside deftly, holding the door to allow the group through. Neither the registrar, who led the ward round, nor the consultant, who followed second, nor the core trainee, who hurriedly trailed after them, uttered a word of thanks.

Later that day, a nurse and a doctor were in the doctor's office. He was in the middle of writing up a patient's discharge letter. She was being strangely polite. She was a staff nurse, qualified a year ago, but it was her first time being in charge of the ward. It was subtle, but you could tell she felt slightly out of her depth - that the weight of responsibility had caught her a little off balance. "I'm sorry to keep barging in - you lot must hate it, us pecking at you all the time for this and that."

The doctor scratched his head and looked at his screen. "I don't think it's as bad as when you ask us to do something and we just look blankly back at you like... umm. I don't know how to do that--"

"-- I know and we're like, please don't look at us! We don't know what to do either!" They looked at each other and laughed, a genuine expression of relief, the sound of tension dissipating.

The doctor nodded amicably and returned his attention to the screen but continued, "So if it's something we can help with then... you know, it goes both ways doesn't it? At the end of the day, we're all on the same team."

And as they talked, you could sort of tell that the nurse and the doctor were listening to each other now, the way sometimes a member of the human race listens to another.

time apart

this is water

0. no answer

- so you're saying that good triumphs over evil in the end

- yeah

- not every time, but ultimately, good will prevail

- good guys don't really finish last

- no they don't

- they don't get stepped on and taken advantage of and blamed for things that aren't their fault

- .. no, they do

- so you're saying that this will change

- 

- hello?

1. give and take / imposition / path

no matter what you choose the outcome is the same?


transferring dates into my diary from the rota: four months ago the future's entire course, direction, approach vector, angle of descent lay in my palm. I held all the cards. And now, the pattern of my sleep, my work and my rest will be decided for me for the next four months - and again and again for the next two years - and within the narrow confines of that conveyor belt I will get to make tiny, infinitesimal microscopic decisions that will accumulate and eventually amount to my becoming one or none of the following: a core surgical trainee, a failed poet, a recluse, a house-husband, a homeowner, balding, wealthy, unhappy

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speed of light as a universal constant; you can change the future but you can't change how fast it comes


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your word is a lamp for my feet, a light unto my path
- Psalm 119:105




2. Doctor's mess

Barring patients and medical students, pretty much everyone in the hospital is going through the same thing. Too many demands and not enough resources. The guy in ultrasound I spoke to will get another call within two seconds of putting down the phone, and he will have to deal with another harried request, and decide: 'will this need to be done now or can it wait?' And all of them have to be done now. 9 to 12 hours a day of strangers continuously demanding things of you, each request a unique amalgam composed of bullying and sweetness in infinitely varying proportions, carefully tweaked, calculated degrees of indignation and meekness. The nurses switch up tactics and employ their practiced strategies like an American football coach going through her playbook. You know this because this is what doctors do to nurses, utilizing whatever and whoever in order to do What Needs To Be Done. Here, ruthlessness is an asset and empathy a liability.

Efficient allocation of resources is the key that keeps the hospital running - no matter how run down and poorly equipped and understaffed. In these hospitals, economics is the governing principle, not compassion. If love means self-sacrifice then the best doctors love their patients more than family. So maybe the ideal doctor is the one who prioritises their patients above all else. Willing to walk through fire and burn bridges and be nailed to a cross if it means doing The Right Thing for their patient. I've always wondered why some doctors treat the people they work with like dirt - but the past three days have taught me: it's common sense, isn't it. It turns out that the self is a finite resource. And you get to choose the few you love



3. Mother tongue

Passive aggression as the lingua franca among healthcare professionals

Thou shalt despise the ones who never ask for your help
Thou shalt despise the ones who are always asking for help
Thou shalt despise the ones you need to ask for help
Thou shalt despise the ones who despise us for despising them


When you become a doctor you start classifying people into two categories 1. people who are helping me treat the patient and 2. people who are hindering me from treating the patient

lean mean people-hating machine



4. Muri shinaide

how to take care of others without killing yourself

Playing God - balancing the needs of one patient against another, deciding which requests and desperate pleas are to be granted and which must be denied





5. Conflict of interest / declaration of interdependance

This hostility is fixed into the system, entrenched - because on some level they know that if we manage to do everything we need to do to avoid getting shouted at, it would mean leaving some of the tasks they need to complete to avoid getting shouted at undone

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The registrar has the patient's best interests at heart, at least that's what he tells himself. But maybe he doesn't realise that his best interests, ie having a newly qualified F1 trail him around the whole day means 1. his life is easier in the short term because he can delegate donkey jobs to the F1 and 2. that important jobs don't get done unless the F1 stays back for 5 hours after his shift ends - which results in the F1 being berated the next day because 10 of the 20 urgent bloods ordered yesterday had not been collected. It could be that he doesn't know he's being unfair, or that he knows it's unfair but justifies this by saying, 'that's how it was when I trained! Why should you lot have it better than us?'


But in this hospital, we don't have enough resources for us to go through what you went through without someone getting hurt. Will you deny that as a result of overexertion and a lack of senior support, patients were subject to avoidable harm - despite all your altruism and best efforts and good intentions? And is this really what you want




6. Insult to injury

- am I whining?
- kind of
- Is getting blamed for things that aren't your fault part of the job?
- Unfortunately yes
- you know we're only getting paid 7pounds an hour after tax right
- so stop going in on saturdays




7. Despise thy neighbour

The incurable tendency to focus only on your own suffering
urge to see nurses as the enemy
urge to see all nurses as the same


I have such massive newfound respect for F2s and junior doctors I met as a medical student - who suffered in silence and made small talk and tolerated my attempts to be helpful, and my tacit concealed disapproval, the comfortable distance I've enjoyed atop the pedestal of naivety and self-righteousness.

(The stony demeanour is a precaution against being taken advantage of - because if you say yes to everything, people will keep asking. This explains also the prickliness some of the nurses put on.)

But why does this adulation not filter upstream to registrars and consultants? Because they have it easy (easier) now? (what are you basing this allegation on? where is the proof of this? They are fighting a hard battle you know nothing about.) Even if it were true, why does that erase the merit of suffering? In all likelihood, they have gone through much worse.

I'll tell you why. it's because
1. they do not identify with our pain anymore - either they have forgotten it because the present is so good or chosen to ignore it because the past was so bad
2. They are the surrogate cause of our present suffering. If you wish to go further you could say that patients are the cause of our present suffering. Or you could go even further and blame it on something vast and abstract - you could go into liberal arts mode and say, actually, sickness and disease is the root cause of your shared suffering, patients, consultants and junior doctors alike. But then it is also the reason your job exists. Hospitals don't function without patients, without consultants, without disease, without imperfection, without weakness. If your sole purpose is to eradicate something, then you also owe it your existence. In heaven what do the doctors diagnose?

But the point is that we need each other to survive. No matter how much we disgust each other. But the consequence of this innate revulsion is that we band together with those close to us, and form factions and vilify the ones who aren't like us. They are flawed exactly the same as we are, but we hate the flaws in ourselves, so much that we use the speck of dust in our brother's eye to distract us from the beam in our own. We deny our own hideousness by focusing on the hideousness of others, using arbitrary, superficial differences to try and justify the discrimination.

We have to make the innocent guilty, we need a common enemy, a martyr for us to burn and huddle round for warmth, because there is comfort in being able to multiply joy and divide pain, to share and shoulder each other's burdens. But for there to be an 'us', there must necessarily be a 'them'. And in this kind of environment, we can't get by - we won't survive unless there's an 'us'.


(I've thought this for a while now, but doctors seem to be broken in a way that other professions aren't, which is to say that we are flawed in an oddly homogeneous way. Some well-concealed, insidious and socially acceptable strain of megalomania or white knight syndrome, and you'd think that would allow us to identify deeply with each other, and connect over shared experiences, but maybe its only in the crucible of tribulation that there is enough energy to overcome this mutual repulsion of like charges, and bonds them irreversibly. But as the charge increases, so does its electrostatic force. The larger and more homogeneous the group, the more violent and volatile its pull and push, towards outsiders - towards those who aren't part of the group.)


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How to be kind to a house officer who hates you




8. welcome to the real world / Induction

"you can save this child's life, but only if you cut off this man's hand"

the way the hospital works is the way the world works - so sheltered, have never experienced it firsthand
total shift from being in university to working world - such separated by a rift as vast as the galaxies are from each other - as far apart as the east is from the west
the two realities are incomparable, incompatible
 the unfairness of it all
how to preserve the lessons, values which instilled, kindness, courage, integrity, honesty now do not function, ineffectual impractical - get you killed if applied to your day to day white collar job

having to confront my naivety... do i still value it? envy it in others? is it right to despise it?



9. Hustle


For in this hope we were saved. But hope that is seen is no hope at all. Who hopes for what they already have? But if we hope for what we do not yet have, we wait for it patiently.

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I have no right to say any of this. it's only been 3 days

But do you think it will get better?

I don't know. All I can do is hope, against all odds

Know that the trying of your faith produces endurance

The trying of your faith

The frustration of hope

But hope deferred maketh the heart sick, remember?








10. Muri shinaide pt 2

Hey kid, you don't have to force it you know. Just concentrate on loving the person in front of you. Value them, treat them with respect, whether or not you think they deserve it. Your job is to decide how you treat these people. Whether or not they get it is up to them









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- let's say your mother and father are both drowning, and you only have time to save one of them, who do you save?

- what? my mother I guess

- wrong

- what do you mean 'wrong'?

- the answer is simple: you save the one that's closest to you











11. this too shall pass

Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be restrained; where there is knowledge, it will be dismissed. For we know in part and we prophesy in part, but when the perfect comes, the partial passes away. When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became a man, I set aside childish ways. Now we see but a dim reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known. And now these three remain: faith, hope, and love; but the greatest of these is love.