Finding the right direction

HEART BEAT: Writing about the health service is like writing about the Middle East. A lot happens, but seldom anything good.

HEART BEAT: Writing about the health service is like writing about the Middle East. A lot happens, but seldom anything good.

The preservation of my sanity precludes the endless cataloguing of failure and incompetence in this most fundamental area and, accordingly, I promise not to refer to it again in this article. Such resolution allows me to return to days gone by and my own little story. I had last written about my days as a medical intern in the Mater and there I shall resume.

As the spring of my intern year turned into summer, our routine professional life, and what passed as our social life, continued as before. We had acquired some confidence, albeit easily bruised, and generally felt we were becoming better doctors, a dangerous place to be indeed.

Everything was no longer a mountain to be climbed and initial fears and even enthusiasms had been dulled by routine, interspersed as it was by occasional drama. We lived in our own little comfort zone and responded with varying alacrity to the rhythms of hospital life.

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In a way it was too comfortable to last and it did not. The lengthening of the days meant the shortening of our intern year and the intrusion of thoughts of the future into our comfortable present. Thinking of our lives and futures had been suspended in our world of life, sickness and death. Now we had to think of what lay ahead.

Such thoughts had come unbidden, like dreams, on many occasions, but now became persistent and for even the most light-hearted of us, serious. "The thoughts of youth are long, long thoughts" (Longfellow) and so they were.

What were we to do with the rest of our professional lives? Were the career paths that we hoped for, feasible? How long would future training take, and were there job opportunities in that particular field?

Should we at this early stage of professional development be looking at the particular or should we seek more experience in the general?

The questions were myriad and, to us, the permutations and combinations of answers were but slowly grasped. Some generalities were obvious. There was broadly a choice between hospital medicine and general practice. In hospital life there were multiple areas: medicine, surgery, obstetrics, pathology, radiology, anaesthetics, etc. Did any of these appeal?

How did you go about taking your first steps in your chosen direction?

Nowadays, once the choice is made, the route to attainment is made clearer and more straightforward. Training schemes exist in nearly all medical disciplines and, in theory at least, once you set foot on your chosen pathway, you should at the end of your journey be fully qualified to take your place as an independent practitioner.

The latter in no way precludes team working in specialist groupings. There is now also better application of training needs to future requirements in the service, although in many disciplines there is still a considerable way to go.

In my days such structured support was simply non-existent, and much individual advice and help had to be sought as to how best achieve the required training. The past and present, however, shared one inescapable fact. It was still up to the individual young doctor to decide what he or she wanted to do.

Such a decision was among the most important of your life. A mixture of motives and vocations came into play here. Can I make money? Will I have to get up at night? Can I have a "normal" social life? My daddy is one already and the door is open. I would like to help people. I find the work fascinating. Will I have to go away for training, or for ever?

Some decided early and pressed on boldly, some required several false starts before they settled, an unfortunate few never settled at all. In theory as Propertius put it in the century before the birth of Christ "let each man pass his days in that wherein his skill is greatest".

Ah, quite so, but we had to find out and acknowledge, sometimes painfully, where our skills and aptitude lay and furthermore was there to be an available arena in which to display them.

There was also the uncomfortable feeling that our own assessment of our aptitudes and capabilities might not be shared by those crucial to our professional development. There was also the problem that the initial fire of certainty and enthusiasm might well be quenched in the cold world of reality. In truth, the future was clear cut for few, and most of us were launching our craft into a sea of uncertainty.

Most of us entertained such thoughts only briefly, and the implications noted and dismissed, on the grounds that the world was our oyster and that it would be all right on the night.

I knew even then what I wanted to do. I wanted to be a cardio-thoracic surgeon. It was a rapidly expanding specialty and I reasoned that it would offer great challenges and opportunities in the not too distant future here in Ireland. That for me, as for most Irish people, was very important. But you must learn to walk before you can run and accordingly, I would first have to train and qualify as a general surgeon and then if the lights were still green, proceed on the specialist road I had chosen.

Years more hospital work, training and exams lay ahead but I looked forward to that, attracted as I was to the surgical, and indeed hospital life. It was imminent and in the meantime I could revert to my boy scout days and refresh my ability to tie knots.

Maurice Neligan is a cardiac surgeon.