Trainee perspectives, Wellness - individual

The Alternative Path to Fellowship

By Ben Cohen

Ben Cohen headshot
Dr Ben Cohen – Junior Doctor

“I’m finding this very difficult!” I find myself saying in broken Spanish, sitting cross-legged before the Meditation Master.  These are the first words I’ve uttered in days and they ring loudlyin my ears. My friend sits in the row in front of me, also sternly looking at the Master.  We sit on small cushions for hours at a time – eight to nine hours of meditation per day – in deep concentration, practicing new techniques.  We are one hour outside of Buenos Aires, Argentina and I am two months into a year away from medical work.

For the past eight weeks, despite being in Patagonia – one of the most beautiful, mind-calming places in the world – I have found it difficult to be present on my travels.  I burnt out during my intern year and I can’t help but think that, even after 11 months away in South America, the Middle East and a stint in Europe, I will burn out again.  Learning Vipassana meditation was the further calm my mind needed.  Ten days of silence, except for check-ins like this one with the Master, allowed me to focus on myself and the present.

meditation bell
The meditation bell – sounding once at the start and end of each session.

In two languages, often through a translator, I told the Master of my worries.  That I felt I had failed at self-care and developed bad habits.  As an intern, I began questioning my ability to perform my medical role and passion well.  “That was you then”, she responded. “All you can do is focus on something you can change in the moment – on getting the most out of the course.  Everything is transient.”

As health professionals, we are used to hard work.  Our idea of normal hours is often very different to other professions.  We accept working weekends and we accept overtime.  Eventually, without a break, we burn out.  Yet we keep working.  It’s because we don’t know what it’s like to feel burnt out, or we deny our feelings of being so.  It’s because everyone else keeps working, and changing pace is discouraged; it feels like a loss of focus to explore the world outside of medicine.  The focus for many is to attain fellowship status as quickly as possible.  In this field we are creatures of achievement.  There is an expectation to complete medical school, intern year, residency and then progress to fellowship expeditiously.

What’s the point of stories about travel and leisure?  When another junior doctor heard I was taking the year off in 2018, he did the same.  If I can inspire anyone else to view such an action as normal, then this piece has hit the mark.  Based on my own time off, life experiences free of time constraints and free from the lingering chatter of a hospital are invaluable. It is for this reason that I am flattered to be included amongst the other pieces in this fantastic blog, reflecting the academic and professional merits of esteemed colleagues amongst their focus on wellbeing.

Of course, you don’t have to be burnt out to undertake such an adventure.  But I was. After living in six places in five years, moving to Queensland for medical school and then work, I was ready to rest and equalise.  So, stay with me and let’s say it’s normal to take time off.  How do you do it?

Step One – SET A DATE

Set yourself a date to take time off for you.  I was lucky in that I had a non-medical friend to ensure I was committed to this plan.  In late 2016 we promised each other we would take 2018 off work.  Together we made this happen.  There are many reasons to continue working; many people will be surprised and perhaps even judge you for having a hiatus – but it’s okay.

-Stop-

Bring your focus back to yourself – as a person first, with your career in second place.

Our plan was to have no plan.  Fly into Buenos Aires mid-March and see what unfolded.  A couple of days later, after spending the weekend in lively BA, we headed for the airport.  Being allowed to check in with checked baggage 45 minutes before the flight was an omen for lucky travel situations to come.  We made it to El Calafate and northern Patagonia for the end of the trekking season in the south.  Over the next six weeks, we walked.  Immersion in the mountains and valleys of El Chalten and Torres del Paine was one of the most incredible things I’ve ever done.  Days of trekking, carrying our own food, sleeping bags, tents and burners and pushing our bodies was a world away from the daily rigour of the hospital environment.  I found I was beginning to relate to people differently.

ElChalten
Mt Fitzroy, El Chalten with my friend. A lot colder than we look.

The contrast was palpable.  In the hospital there’s such pressure to articulate even the most simple thing as fast as you can.  When trekking, you have a seemingly infinite amount of time to walk, talk to whomever joins you on the trail, or just be silent.  It was a very special and mentally-relaxing part of the trip.  When you are at Fin Del Mundo (English translation: End of the World), the only way to go is up.  So we hitched from Patagonia north towards Bariloche, waiting for potential lifts on the side of the road with hopeful eyes, much like the faces of patients in the ED waiting room.

Step Two – WHAT TO DO

Whatever you want. People will ask you what placement you are doing, or where you expect to gain résumé-citable experience.  It’s okay just to take time off.  Yes, be familiar with AHPRA regulations for Continued Professional Development and plan that into your year.  I was able to do four weeks of placements in fields of interest and make the year work for my career directly.  One in Haifa, Israel in Emergency Medicine and Trauma Surgery at the Rambam Health Care Campus and one in Paediatric Emergency Medicine at Schneider Children’s Medical Centre in Petah Tikvah, Israel. Yet in the larger sense, I gained so much more from the non-medical months of travel.

Reflect on the habits you have engaged in during your year(s) of work.  Time off allowed me to break a coffee habit, and pursue passions of singing and dancing.  Once a new habit is developed, it is easier to maintain back in the demanding schedule of work, rather than starting one afresh in the midst of a frenetic schedule.  Extend yourself.  Learn to build and grill Argentinean asado; dance in the Peruvian Sacred Valley at altitude with minimal oxygen; watch just another rainbow of colours at sunset overlooking the beautiful city of Santiago de Chile.

If you are intent on developing usable skills in a medical situation, become the translator you need in an emergency room by learning a language.  Durante el año pasado, yo aprendí mucho español. (“During this past year, I have learned a lot of Spanish”) Otherwise go to the Feria de Salsa in Cali and learn to move your hips like the Latinos. Trust me, it may take two to (Argentinean) tango, but the Colombians are good enough dancers for even the most uncoordinated gringos to master salsa and bachata.

Colombian transport
Colombian public transport/rice delivery service featuring unexpected but welcome music

Step Three – WHAT CAN YOU EXPECT TO (RE)GAIN

A sense of yourself.  As I’ve noticed, this can become blurred in the hospital environment.  Whether you pursue active self-reflection, or a practice of meditation, some quietness of mind is an excellent punctuation to the noise of a hospital.  We often cannot control the stresses in our life and work, but we can pre-form the way we respond to them.  As an intern, I often found myself in multiple conversations at once, drowning out my own needs.  Be familiar with and care for yourself, so that you may care for others.  Just like the ancient Nabatean people moulded Petra from stone cliffs, we are shaped into junior doctors by our educators and mentors in med school and hospitals.  Listen to yourself and your personal desires, developing them passionately.  Don’t be afraid to put life – yours! – first.

Step Four – HOW TO DO IT

People travel in different ways.  Unplanned, culturally-challenging trips have always been my favourite, but this type of adventure does bring discomfort.  Resilience is vital in the hospital environment, as we often find ourselves working in suboptimal conditions for protracted periods.  I found that mastering the physical demands of multi-day treks, engaging in a 10-day silent meditation retreat and coping with the unforeseen events of travel can give you confidence in your ability to tolerate and deal with strain or the unpredictability of day-to-day work.

Petra Treasury
Petra, Jordan.  One of the most awe-inspiring touristic destinations I’ve ever been to. Ever.

Be aware of application dates for the next year of employment.  Have colleagues and friends who can help you stay connected to life back home – alerting you to important dates and assisting you with applications, too.  When you are travelling, there are amazing things to do every day, and people inviting you out constantly.  Supportive encouragement from people who care about you – colleagues, family, a partner – can ensure you regain focus when needing to write applications and can help you when you return home for interviews.

Step Five – DON’T WAIT

This doubles as the ‘when to do it’.  We are so lucky to be medical professionals.  It is an absolute privilege that makes the hard work so worthwhile throughout our careers.  Yet I challenge you to rethink the pathway to fellowship and spend a little time now exploring whatever the hell you want – you won’t regret it.

About Ben Cohen

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