Today is my birthday.
I woke up early and lay in bed, relaxed and feeling quite a deep sense of connection — a change from the busy mind I often wake up with.
As I lay in a relaxed morning stupor, I contemplated that I came into existence on this very day 38 years ago — limp, incapable, and dependent but filled with potential. Suddenly I was thrust into a World with a unique human capability of consciously perceiving the environment around me. The thought of the moment I first met my parents is quite remarkable and brings a smile to my face.
I promise I didn’t smoke anything this morning.
After some time contemplating existence and life through a different lens, I jumped out of bed and headed out for a run at 6am.
A cloudless, crisp morning sky. I jog gently, breathing in slowly and deeply the fresh morning air, and as I look up at an expansive sky, the body and mind sharpen. I’m treated to a Capri-Sun styled sunrise with a most drinkable tangy orange, purple and blue-coloured concoction.
I come home and meditate. The silence gives me an idea — instead of fuelling the practice with more sugary treats for my birthday, I’ll buy a round of scratch cards (I’ll fuel a different addiction). During my meditation, I enter a deep sense of peace and calm, and when I stop, I feel a deep gratitude and appreciation for my life.
As with many medics, there’s always a striving for more — not being enough, needing to learn more, do more, be more. A few moments spent recognising how much good in my life has happened purely by grace is both important and powerful.
At least 50 percent — probably more — of the good things in my life have been borne of luck. I didn’t choose my location, parents, my family, my school, my teachers, or any of that. Even friends come into your life by chance, even if you choose to keep them. These are the foundational influences for the development of who I am — someone relatively stable and comfortable, living in a safe environment who gets the privilege of freedom to grow and experience much of life on my terms.
I really have had every chance to allow me to succeed in life. Sometimes, we can over-congratulate ourselves for successes, or be too hard on ourselves for our failures — when so much of it is down to chance or grace.
I enter work and make myself a nice, well-brewed cup of tea.
Three hours later, the appreciation starts to wear off.
A series of chaotic patients, excessive requests, and interruptions from other staff.
My first patient needs their anticoagulation switched, as their clotting profile is too erratic — sometimes the blood is being thinned too much, sometimes too little. It needs quite a thorough assessment using scoring systems. It puts me behind my 15 minutes.
“Hi, there’s a patient who needs their medications for tomorrow as they’re going on holiday, please can you issue them as soon as possible?”
Right now? Yes, of course — I’ll drop everything and make sure you’re sorted to go on holiday.
I do it because they have medications they can’t afford to miss. Probably need to put more barriers up, but really feel like there should be processes in place for it. One of many things needing to be worked on here.
“Hi, psychiatry have rejected your referral as they need more details.”
The patient is suicidal and unable to pick up medications because they’re too anxious to leave the house. What more would you like to know? Their dietary preferences? Their favourite colour?
A task from our remote GP:
“Hi, I can’t download the audiology form, please can someone on the ground print it off and complete it for me?”
Yes, I’ll do your jobs for you. Chuck them my way.
She’s nice and good, but I’m getting pissed.
“Your 11.15am appointment is running 10–15 minutes late just FYI.”
Perfect, I have lots of space built into my day to accommodate this.
Then I receive an email informing me that the study leave I’d been granted in two weeks’ time — which I’ve already paid for and booked flights for — can no longer be granted as there are no other GPs available to cover shifts.
Yesterday, I was also told that I might need to take annual leave to attend a doctor’s appointment that the hospital have arranged (not me)— I can’t quite believe that my annual leave allowance is even being considered.
I’m trying to comprehend the river of peace and gratitude I felt this morning, and its rapid erosion by a sense of frustration and injustice. Confusing.
At lunch, I nip out and walk off the nonsense in the sunshine. Then I get everyone scratch cards and a (small) cake — it’s important to make effort for these seemingly unimportant things. A bit of fun and celebration in life is vital. No time to chat though — I just leave a note for the staff and hand them all a scratch card.
The rest of the day whizzes by:
- Duncan, the 23-year-old with everyone dying around him. His grandfather has had a stroke and is now on a syringe driver with a cocktail of end-of-life medications. Of course. Duncan is obviously struggling but is spending a lot of time reading and meditating more. A supportive chat.
- A diagnosis of perioral dermatitis in a 38-year-old who had been misdiagnosed with eczema. It’s always a rewarding diagnosis because so often perioral dermatitis — a rash around the mouth with inevitable cosmetic concerns — is misdiagnosed and treated with moisturisers or steroid creams, which actually make it worse. Patients are a bit fed up but light up when an alternate diagnosis with a different management plan is made. An antibiotic cream for 8 weeks, avoidance of triggers like makeup or alcohol-containing creams, and she should be fine.
- Marie, a 24-year-old medical student, is overwhelmed by it all. She struggles with the uncertainty of life. We talk about how this comes back to wanting to control things. To control outcomes. An impossible desire. I ask her questions to challenge her framing of uncertainty. Actually, the biggest growth, learning, and adventure come from embracing uncertainty. In medicine, this is such a vital tool for growth as a doctor. It requires egos being shattered at times — because as a medical student, I was embarrassed often. Not knowing what to do or what to say. Awkwardness. Mistakes. A lot of picking yourself up and dusting yourself down. Now I see it as a privilege. As long as you’re adequately supported — which is not always the case.
- A 22-year-old with premature ejaculation, resistant to improvement despite masturbating daily. Understandably, it affects his confidence. He does not have a partner. I refer him for counselling, advise on a start-stop technique (also known as edging) — where one gets to the point of ejaculating and stops — which can help retrain the process. Strengthening the pelvic floor is really helpful too, so I send him Kegel exercises. I also advise him it’s very common and he shouldn’t feel embarrassed. He’s keen for a quicker fix, so I start a tablet for depression that has a side effect of delaying ejaculation.
In the evening, I finish late and head to the pub for a birthday dinner. It’s a joyful affair of good conversations and playful insults — mainly aimed at me, as is often the case when mixed friendship groups come together and have me as a common target. I enjoy it — a form of therapeutic abuse.
So, a full-spectrum birthday — true to life. It certainly could be worse: I could be grappling with grief, sporting a rash around my mouth, struggling to last longer than a minute in the bedroom… and still clinging to the illusion that I can control any of it.
Mindful Medic 