Small Joys of Being a Doctor

Photo by Tima Miroshnichenko from Pexels

The emotions my work stirs are unsettling as they are rewarding. I work in a public hospital. It is a large building that has seen many years. If its walls could talk, it would groan about its weariness.

I first walked into it as a second-year medical student, a year before I started clinical attachments. The hospital is over fifty years old. It was built in colonial times and is aptly named after Queen Elizabeth. It was an impressive structure then. It’s now forced to deal with an unprecedented burden of disease and patients far exceeding its intended capacity. There are many buildings spread around the main hospital building. In the main building, one long, wide corridor branches into smaller corridors that lead to different units. The arrangement of the units is not exactly intuitive. I got lost a few times early in my training. Once I almost missed the 9 pm bus that took medical students from the hospital back to the hostels after an evening on call. I took the wrong turn and found myself in a blind loop between wards. It looked exactly like the turn that led to the exit where the bus would park. I frantically retraced my steps and got to the exit just as the bus was about to leave.

Being taken to the wards a year before clinical training starts was deliberate. It was meant to bring you face to face with what you were training to become. A year before was long enough to have that sink in. My first visit to the wards certainly achieved its intended purpose for it left me stunned. The hospital was a sharp contrast to the medical school. The medical school was modern with plenty of new buildings. The air at the medical school was different. The students that made it to medical school were some of the brightest. Getting a place there was competitive. It was the only medical school in the country. Apart from students like me that had been through ordinary secondary schools, there was a group of students from wealthy families that had been to elite high schools. The medical school also enrolled several foreign students.

The culture I found at the medical school was polished. We started medical training dreamy-eyed and enthusiastic. We wanted to do good and help our ailing population. A lot of the dreams may have been coloured by scenes from medical drama on TV — large, clean hospitals; flawless doctors wearing hospital scrubs and white coats with a stethoscope hanging around the neck.

What met me the day I first walked onto the wards was as far removed from the image portrayed on TV as one could get. I was greeted by weariness and visible poverty. The buildings looked tired. The wards had basic furnishings and equipment. The patients lay in an open ward with several rows of beds separated into three compartments by short walls. The patients looked a lot sicker than anything I had ever seen. It was my first time seeing so many people ravaged by HIV. A senior doctor welcomed a group of six of us onto the wards and showed us around. She was gentle and courteous. She took us to one of the patients’ bedsides. She showed us how to greet the patient respectfully. She also showed how during the greeting, with the patients had clasped with yours, you could already have a feel of the patient’s pulse — clever, I thought. She then asked the patient to open his mouth — his tongue was covered in what looked like a thick layer of white curd. She told us this was oral thrush — a fungal infection that was a hallmark of waning immunity in advanced HIV. I would see plenty of oral thrush in my many years of work long after that visit.

What shocked me more than the state of the hospital and its patients was realizing that this was it. This is what being a doctor in my country looked like. What a contrast with the high life at the medical school. All the students — rich or poor — would have to work with these lowly patients in this humble setting. This was the reality we were training towards.

It’s now many years later after that first visit to the wards. I have walked those corridors thousands of times and spent years treating patients on those humble wards. The emotions the hospital triggers are just as strong. They come in all variety and contrast — frustration perfectly poised with hope, a feeling of helplessness balanced with gratitude for tiny gains. Despair for those that don’t make it out alive and joy for those that looked like they would die but walk out of the hospital unaided.

There is also a certain level of disarray that follows you. It fascinates me as the people seem to co-exist perfectly with it. It’s in our physical surroundings as it is in our thought process. The quick conclusion in the face of such chaos is that the people don’t care or are lazy. After many years, I have learnt there is a method in the madness. You have to humble yourself and learn about the people and their world. Even though I am one of them, I have to learn of them.

Throughout the days, there are distinct but fleeting moments that stand out. It’s these moments that humble me and remind me why I chose this work. These moments are few and far apart but when they come, the emotions they bring are rewarding. They are brief moments, ephemeral at best. Sometimes it’s being melted by the beauty, simplicity and warmth of the people. Other times it’s realizing that the patients we treat have such different lives from ours; that the things we take for granted are precious to them. One such moment has occurred again and again in clinics — realizing that patients put on their best outfits just to come and see me. Their trip for the hospital appointment begins mentally days before the appointment. They worry about what the hospital trip will cost and how long they will wait outside the queues. Most patients dress in their best clothes. “Best” is subjective of course, but I can see that they try their best. Sometimes best is clean and well-pressed clothes. Sometimes it is tattered clothes that reek of smoke from firewood and worn-out shoes. Sometimes it is good grooming. Other times it is a strong body odour and the stench of urine from the patient whose illness has left immobile and incontinent. While I measure my consultation with them in minutes or hours, the hospital visit is an event for the patient. Such moments not only humble me. They remind me that patients are human just as I am.

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African, writer, doctor, speaker. New posts every Monday, Wednesday and Friday

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Tamara Phiri

Tamara Phiri

African, writer, doctor, speaker. New posts every Monday, Wednesday and Friday

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