Why I left medicine

Rachel Armstrong finds the pressures of being a junior doctor overwhelming

I was chucking my guts up. My fingers down my throat. The pressure inside my head was at boiling point. Outside, the casualty department was in chaos. I was the only doctor on the door. Only a few minutes ago I had been bleeped to clerk in a backlog of desperately sick patients: bleeding bowels, heart attacks, diarrhoea and vomiting, a strangulating hernia, a rupturing abdominal aortic aneurysm. I needed help and strangely found my courage return in the bowl of a NHS toilet.

Having purged myself of all feelings of despair and powerlessness in this battle zone, I calmly returned to casualty with congested membranes, a bloated face, and black lines on my face where my mascara had run. No one seemed to notice. Perhaps everyone else was bulimic too.

Those were black days, trimmed with white corridors and embroidered with the intrusive red light of pagers. On-call weekends were 72 hours; every other week I clocked in over 120 hours; rotations were two or three months each; apprenticeship was years and years; and time was a meaningless concept. There was just an eternity of being on call for the junior doctor to plan the occasional holiday around.

I thought I was okay, really I did. I thought I was just naturally reclusive when I found myself avoiding people, no one in particular just everyone in general. I clung to an artist's pad while I conducted my ward rounds drawing my patients and impressions of the clinical world that I inhabited. I was silent and obsessive in everything I did. I realised I had lost something only when my parents visited me during a weekend when I was on call.

"How are you doing, Rachel?" they asked, offering me a bag of welcome fresh food. They knew I had no time to shop or eat properly. They knew I worked hard, and perhaps they even suspected my eating disorders. They knew never to criticise me. They knew they needed to tell me they were proud of me.

They knew that they could not have been more supportive of my academic success and medical career. Despite the positive input and emotional support I was unable to prevent what followed. I opened my mouth but instead of initiating conversation, I was horrified to hear an unearthly scream escape from my diaphragm and force itself through my throat before I could articulate it into a word. It was deep, painful, and, although I tried to shut it out by forcing my mouth to close in my hands, all three of us could only listen to my body howl.

I had lost my voice.

What had gone wrong? At what point had the first class medical student that could not wait to get into the university laboratory or library every day, who worked weekends, who was passionate about her subject, and who had an unquenchable thirst for knowledge become a blubbering banshee?

The words did not come back.

I wandered around when I was not on duty. Professionally, I did not have to deal with my emotions. I simply switched off. There was nothing really wrong with me. I was just tired, like everyone else. I did not want sympathy. I did not need help.

When I got time off I went looking. I looked in libraries, in parks, in museums, theatres, on the river and one day I roamed into the Barbican Art Gallery.

There it was. Glowing from the centre of a wall mounted light box was a golden brain, cupped in a delicate pair of hands. Its vitality touched me, and, without words, the strength of the image started to heal my wounds. The picture, I found out later was created by Helen Chadwick. A slight, dark eyed, elegant woman with ridged fingernails that betrayed her direct exposure to photographic chemicals.

Meeting Helen changed my life. Over her kitchen table I held her hands and made an incongruous examination of her surface anatomy. While we talked about life, death, and art, I realised that a Pandora's box had been opened.

I started to paint, print, draw, and write poetry. I patrolled the wards with my artist's sketchbook and drew people from a non-medical perspective. With my pen I started to ask questions that did not engage the scientific method. The process of rehumanisation had begun. I realised that everyone who passed through the antiseptic corridors lost their identity and their dignity. This dehumanisation was systematic and institutionalised. It did not just affect patients; it damaged the staff too.

Only the sketchbook saved me. I clung to it as if it was my life. I phoned Helen regularly to exchange ideas, language, projects, and dreams. She guided me through my toilet rimmed twilight zone and watched me leave medicine and start to rediscover the power of communication in the company of artists.

Rachel Armstrong, medical writer, London
Email: scifi@dircon.co.uk


studentBMJ 2000;08:175-216 June ISSN 0966-6494