50 Shades of Grey's Anatomy

"The dim light of the O.R... Intense silence, apart from the soft beeping of the ECG monitor. Gwen, the hospital CEO's daughter and junior surgeon's love is on the table after a tragic skiing accident on Mount Doom. Enter Dr. McSomething, her first love. As he flawlessly glides across the spotless room toward the operating table, he looks down at the once beautiful Gwen. She is hardly recognisable. He sheds a tear and confidently, without hesitation, and in an assured voice, says 'Scalpel,'..."

Sound familiar? This is how we have been made to believe what medicine is like. It's not. Perhaps a more realistic account would be this...

"The O.R is dimmed for a few seconds as load shedding is initiated, until the generator kicks in. Lights flood the theatre. The monitors beep and ring loudly, with intense noise as the nursing staff, doctors and students struggle to hear one another. Patient number 458952 lies on the table. She was hit by a car while crossing the road. Enter Dr So-and-so. He traverses the treacherous obstacles - the power cable of the wall radio, the diathermy machine, three students, the nursing staff and the overhead lights. He looks down at patient number 458952 - hardly recognisable, because he is tired and this is his fifth operation today. He doesn't shed a tear, only sweat, because the air conditioner has been out of order for the last three months. As he waits for the nurses to find equipment from the adjacent theatre, he says, with a deep sigh, 'Not this again,'..."

I suppose that if this was what was shown on television it would be canned and fewer people would want to become doctors. This post is going to be a difficult one to read, whether you're doing medicine, or contemplating it. I urge you, however, to read it all the way to the end because there is light at the end of the tunnel...

The romance that we are made to believe about medicine doesn't exist. To illustrate this, I will take you through a scenario...

You're a final year medical student. It's Monday, the start of your new rotation: Paediatrics. You wait for someone to orientate you but, alas, the department wasn't expecting you. After a few hours, a senior doctor comes to chat to you. You are told that you will join the various units within the department, which typically consists of a head of unit (the consultant), a registrar and an intern. You are also told that you have to be a part of the unit, fully, as if you were an intern. That means that you are to partake in every activity, every meeting, every clinic, every ward round and all the calls. Oh, and don't forget, if you want to do well in the exams you'll have to read at least four hours a day. Great.

It's been a long morning already and you can't wait to go home and just relax. You can't, sorry. It just so happens that your unit is on call today. You didn't bring food, a change of clothes or a will to be there. None of which is a suitable excuse and you are to stay. (One of the worst feelings for me in medicine is having to walk to the ward as everyone else is leaving and the sun is setting...)

The call starts. The patient files start piling up. The registrar has disappeared because she is writing exams in a few weeks, the intern has gone for lunch (three hours ago) and you and your partner are left in the ward. Alone. On the first day. A mother brings her child, she's angry as she has been waiting for four hours and she shouts at you. Oh, and she doesn't speak any English, only Portuguese, she's from Mozambique. You take a history as best you can and examine the child, who urinates on you. Now you have to take blood from the child, but there are no needles to use. Luckily there are nurses that would love to help you find needles - yes, and no. Sure, there are nurses, and no to everything else. So you leave the patient to search for equipment from other wards and just as you leave, the registrar comes back and finds you M.I.A. Of course...

What happens when you return need not be spelled out. Luckily it's almost 20h00 and that means you can go home, right? Wrong. The intern has come back from "lunch" and wants you to "quickly help out" before you go. This means doing all the bloods, running to the blood bank, putting up some drips and filling out some forms. It's 21h30 now and you're eventually leaving. Getting home is really nice, except that you haven't had anything to eat, you smell of urine and you have to prepare for the tutorial tomorrow.

The next day you're up early, to make sure you don't miss the post intake ward round where you are expected to present the patients that were admitted under your care. You get ridiculed if you don't know much when a consultant asks you questions. "But it's only day two!", sure but you were supposed to read up on the topics already, somehow...

After the round you have to do the follow up bloods, book some X-rays, and go to a tutorial. Eventually you get home and you can take a nap, except you can't because now you have to study, and you probably smell of urine again. This happens every four days, and is not fun. At all. To add insult to injury, you don't get paid a single cent. Instead, you (or your family) are paying thousands per year for you to work. Either that or you have, seemingly, forever signed your life away to the bank or government.

"That means that things get better when internship starts, right?" Unfortunately not. As an intern you get left alone with students, because the registrar is studying. You have to run around wards when all you want to do is have some lunch, but everybody keeps calling you and now the students probably hate you because they think you're slacking off. To add to that, you have to ask the students to help you before they go, as you will be all alone, all night, once they leave.

"Ahh, okay, so when you're a registrar life is easier!" Again, no. You are now responsible for teaching students, helping interns and studying for your very difficult (and very expensive!) exams that are looming.

"Okay, but surely being a consultant is better?" I suppose it could be, I don't really know. Granted, you're 40 and you've missed almost every school play and sports game that your children have been in, because you've been a registrar for so long. You are also responsible for looking after an entire unit and should anything go wrong, you will be to blame. You might also be working in private. Money, yay! That is, of course, if the medical aid is willing to pay or whether you're willing to send debt collectors after your patients when they don't. And no weekends in private, either, I'm afraid. So yeah... "better"...

I promised at the beginning of this post that there would be light at the end of the tunnel, so here it is...

The moment that you realise you want to become a doctor is the point of no return. We all have different reasons why we want to become doctors and some make more sense than others. For example, it was the very first time I smelled the inside of an operating theatre that I knew I wanted to become a doctor. Strange, I know, considering the fact that I really don't like surgery, but every single time I walk past a theatre I am reminded of that exact point in my life.

Your reason might be that your parents are doctors, or that you had a family member who was very ill and you want to help others in that position, or because you're not fond of the title "Mr", "Miss" or "Mrs". Regardless of your reason, that will always be greater than the things I've said above.

Oh, and the above scenario is quite a hectic one, and life after internship could be very different, depending on what you choose to do (general surgery vs. dermatology) and what your priorities are (achieving the highest honours in your field vs. having a family in the countryside). Being a student or an intern is inherently tough, I'm afraid, but not all the time. Some rotations are worse than others.

If I knew what I would be going through at the beginning of my studies... The long hours, not being appreciated, the lack of pay, the workload, the smell of urine... I would still choose to become a doctor, over and over and over again. I know of people who chose to step away from clinical medicine after internship, and that too is okay.

For the most part though, at the risk of sounding terribly cliché, you don't get to choose Medicine, it chooses you. There will come a moment in your career when you will wish that it had just minded its own blooming business and ignored you. A moment where you will wish that Fine Arts, Accounting or the ability to photosynthesise had chosen you, whether you're trying to get into medicine, or studying medicine, or working as an intern. You'll see, it will pass, and in the long run you won't regret pushing on.

Life outside medicine. Wait, what?

As many of you may know, I'm getting married this year (2015). To a final year medical student. Yes, in my final year. Questions like "Where do you find time to organise stuff?!", "Wait, YOU are getting married to that beautiful woman? Does she know?" and "Will there be an open bar?" have arisen quite frequently. Although the latter two are valid questions, let's focus on the first one.

Contrary to popular belief, and to how you're feeling right now, there is a world outside of medicine. It's not just a fairytale written by J.R.R. Tolkien. And realising that is quite important if you're to stay sane, or at least something close. Medicine is an all-consuming lifestyle which won't change until you're a hotshot consultant doing video lectures from your yacht off the coast of your private island. And to think, we choose to do this to ourselves. Thankfully there is a but.

I've come to realise that I don't have much in common with people who don't study medicine. Also, I always get bombarded with questions about lumps and bumps that I really didn't want to hear about from someone I went to school with. Or from my mother. Plus it always gets awkward when I ask someone to pass me that glass lateral to the book. And it isn't just me.

So making friends in Medical School is really important. They will understand your struggles, your tiredness and your jargon and will laugh with you when you joke about polyps. Finding time to spend with these very important people outside of lecture theatres and wards is sometimes difficult, but is a must. Go to the movies, drink wine, go to festivals and have fun. Weekends aren't just for studying, and enjoying life is bound to make it easier to study the next day. Unless you have a hangover, which isn't what I'm getting at here, either.

I've also been asked by prospective students (especially graduates) whether it is possible to have a family and study medicine. The truth is, yeah, absolutely. Look, it won't always be easy and it will take a lot of understanding on the part of your spouse, but it certainly is possible. You also won't become "that strange person living in the room upstairs" to your children. My friend has a family and manages to go away for long weekends without having to stress about the reality that is exams. Granted, it takes a lot of prioritising and working hard the rest of the time, but it's possible and shouldn't be a deterrent.

What if you meet the one in medical school? Should you wait until after your studies or get married as soon as possible? It depends, really. If you have the financial means to get married in your final year (like you're getting married to a chartered accountant, or you've saved up, or that aunt you haven't spoken to in years has left you a pretty penny in her will), sure why not! Claudia (my future wife, for those who don't know) and I are doing a lot by ourselves. The invitations were handmade, the gifts were skillfully (of course) designed, the table decorations crafted, etc. The trick to it all is time management. We spent many nights doing all of these things, but studied really hard to make sure we can afford that time. It was fun and made for a good getaway from the books.

It's definitely worth having a life outside of medicine. The trick is to strike the right balance between fun and work. If you already do these things, or you really don't like people and prefer to spend time with only your books (which I totally get), good for you. Just make sure you do what makes you happy and become a doctor at the end of it all.

P.S To put this into context, I'm typing this a few days before my final year Internal Medicine exam. Let's hope that goes down well.