‘THERE IS ALWAYS HOPE’ Tales of a junior doctor in the NHS

Bestselling author Joanna Cannon shares the bittersweet lessons she learned when she became a junior doctor in today’s under-pressure NHS

As a medical student, I was a wild card. I was interviewed for medical school by an elderly professor who was about to retire. The only other time I saw him was on my graduation day. I thanked him for giving me a chance, not thinking for a second that he would remember me. He did. ‘Each year, I would pick an outsider. A high risk. That year, I picked you,’ he said. ‘You were my wild card.’

As wild cards go, I was pretty wild. I left school at 15 with only one O level and very little else. Like many children then and many children now, we were asked to make huge decisions before we even knew who we were. I had no idea what I wanted to do with my life, and so I decided to think about it. I ended up thinking about it for quite a while.

I did lots of other jobs but I never lost the quiet hope at the back of my mind that one day I would return to education. Nor did I let go of my need to learn, and so I would do things to satisfy that need. One August morning in 2003, I happened to look up as I walked through the door of a newsagent’s and saw a first-aid course advertised on a postcard in a window. A small moment tied and knotted to many other small moments, which eventually joined together and led me to being a doctor.

In the coffee break on that course, I told the paramedic who was teaching us how much I loved medicine, but how, in my 30s, I was too old to even consider it. He told me I wasn’t and, in a moment of wild spontaneity, the very next day I enrolled to do three science A levels. Just over a year later, I found myself sitting opposite the about-to-be retired professor in an interview room at a medical school.

Throughout five years of studying, the one thing that kept me going despite the exams, travelling, lack of money and absence of free time was the idea of what kind of doctor I was going to be. You don’t fantasise about prizes or awards and accolades, you imagine the small and the ordinary instead. Having time for patients, being able to explain a treatment to someone in a way they can understand, helping someone’s journey be a little more bearable. It’s only when you arrive on the wards, when you are spat out into an NHS that bends and breaks under the strain of the endless demands placed upon it, that you realise that you will never be able to become the doctor you want to be. The system simply won’t allow it. Instead, as I discovered during my

The NHS is held together by the goodwill of those who work within it

foundation year working in A&E, you will occasionally carry three bleeps because no doctors applied for the jobs next to yours on the rota. Instead, you will trip over your own misery, as you attempt to keep up with everything you are asked to do. You will see patients drift past who are unsure and afraid, but there is no time to do anything about it. Relatives wait for reassurance, but go home empty-handed. Waiting lists are full. Clinics are overcrowded. Everyone pushes and fights and shouts to be heard above the noise of other people’s agony. Rights become privileges. Equality becomes discrimination. Time, money, resources and hope all run dry. The NHS is held together by the goodwill of those who work within it, but even then it will fracture, and you will fall into the gaps those fractures create, and you will disappear.

Against the backdrop of a health service struggling to cope, the emotional impact of becoming a doctor is also something medical school cannot prepare you for. Working in a hospital, you witness people’s lowest, most vulnerable moments, but you move on to the next desperately sad situation before you have had time to process the one you have just left. The child in paediatrics with non-accidental injuries, the 38-year-old father who was given a diagnosis of terminal pancreatic cancer, the young woman dying in a side room on Ward 11, whose identical twin sister visited each day and reminded us all of the devastation of cancer.

I failed to deal with witnessing what I eventually began calling my ‘Kodak moments’, small snippets of other people’s lives that I took home with me at night. I spent precious days off ruminating, wondering if anything could have been done differently. I dragged these ‘Kodak moments’ behind me along hospital corridors all day like a difficult suitcase, and very soon I began to unravel. I became physically and mentally unwell, yet in a profession with care at its epicentre, doctors are notoriously bad at looking after their own needs. In a situation where it’s a challenge to take care of all the patients, there is often very little energy left to repair any damage you might have done to yourself.

It came to a point when I was uncertain if I could find my way from one end of the day to the other, and it was then I knew I had to do something in order to survive. I either had to harden up, which I didn’t want to do, or find a way of processing my experiences, and so I began to write. Because this is what storytelling is: a way of making sense of the world, of seeing things from another perspective. I didn’t write a novel to be published. I didn’t even expect anyone to read it (apart from my mother, who I thought might), but what I didn’t realise was that I was writing myself into a dilemma.

The success of my debut novel, The Trouble With Goats And Sheep, meant that I had to make a decision: did I want to be a doctor or a writer? If I was flying the flag for ‘wild cards’, surely I needed to carry on? Should I give up the thing I had fought so hard to achieve, or should I say no to the opportunity of a lifetime?

Medicine taught me many lessons; lessons that are far more important than anatomy and physiology. I learned that being a wild card is never a bad thing. It taught me that even in the darkest hour there is always hope. It also taught me that life is only ever made up of small moments, and if we can fit kindness into those small moments, then anything is possible.

When I was at my lowest point on the wards, the only way I managed to keep going each day was during the drive home. I would try to remember one thing I had done that might have made a difference to someone. Going back to a patient to explain something because I knew they were unsure, making a cup of tea for a worried relative, combing an elderly patient’s hair before visiting hours because she wanted to look nice for her daughter. Things that took only a fraction of my time, but made the biggest difference; the best ‘Kodak moments’. Strangely, these were the occasions I found the most rewarding, so I made the decision to continue working on the wards, but to do so as a volunteer. It still gave me time with the patients, the thing I loved most, but it also meant I could carry on writing, enabling me to support the mental health charities I believe in and also give a voice to the people who most often go unheard.

 Breaking And Mending (Wellcome Collection) by Joanna Cannon is out now

I made the decision to continue working on the wards, but to do so as a volunteer