Different Directions

Ten years ago, along with my fellow medical students, I had been studying hard for the first year clinical exams. One week before the exam things changed dramatically for me, when my wife gave birth to our first child, Amy. Holding her in my arms was marvellous. We were parents! Looking into that little baby’s eyes, I realised life had changed, and I was excited about it. What was ahead of us? What would her personality be like? How would our relationship be in 10, 20, 40 years? Attending to the needs of this new person felt like it would give unending satisfaction. However, there was still an exam to sit. It turns out that looking after a baby is good practice for both night shifts and paediatrics, but apart from that it seems that medicine can be pretty inconsiderate of ‘life’. Parental leave passed quickly. The feelings of wonder gradually got watered down by the practicality of everyday life. Meanwhile, medical training had us moving to different towns, commuting, and all the extra work that is demanded: papers, presentations, audit, courses, studying and exams. At times I wondered: why does life and ophthalmology seem to pull in such different directions? Maybe you have had a similar experience to me, at the end of a cataract case. After peeling the drape off, the patient thanks you, and a fleeting thought comes into my mind: ‘how on earth did I come to be doing eye surgery? What a privilege.’ As ophthalmologists we have dedicated ourselves to the art and science of treating ocular disease. We hold the care of our patients in highest esteem, and have the opportunity to make a dramatic change in their lives. However, our patients go home to their own family at the end of the case. And we go home as well. Family comes in many shapes and sizes, and our responsibilities evolve over the years: parents age, relatives need support, children arrive and grow up, relationships start and end. Our families aren’t clinic lists, and they are likely to be around for a whole lot longer than a two week follow up appointment. Our discipline is demanding, but it is not impossible to be successful both in the home and in the eye clinic. I chose ophthalmology because I didn’t like bottoms or death, but happily, it is also a specialty that can allow for a pretty healthy work-life balance. In those early days with baby Amy, it became clear that studying should not trespass into the weekend. If an exam was on a Monday it felt wrong not to cram the day before, but I discovered quickly that protecting family time was win-win. I wouldn’t feel guilty, I made realistic aims for what I could achieve, and it helped focus my mind to be productive at the right time. Once junior doctor work rotas messed up weekends, it became even more important to protect time off. For me, the best time of the day with kids is in the evening before bed time. It puts my day at work into perspective when we get to sing songs, dance, or read stories about dragons or wizards, and tuck them into bed. Occasionally I do a bit of extra work after that, but usually I’m too worn out. Of course, not every day goes to plan, and often the incessant chores and responsibilities can be overwhelming. Many ophthalmologists would admit to a perfectionist streak (I think the work we do demands it), but being realistic with myself has been just as important. I’m not going to get it right all the time, in fact there are days when it all seems to be falling to pieces, but that doesn’t mean it isn’t worth the effort. I think the greatest barrier to family life in my medical career has not been ophthalmology itself, but the work and employment conditions that many junior ophthalmologists are subject to. Though it varies country to country and from clinic to clinic, I have not come across anywhere that has got it quite right. For example in the UK, in our seven year training programmes we are required to rotate to hospitals that can be hours away from each other, and have little power to control over the location or the terms of our work. Managers seem to perpetually need more from us, for less pay. In addition, ophthalmology and medicine in general, is still far from equal in the opportunities for female colleagues, especially if they choose to have children. For me, discussion with my partner and planning together, has allowed us to ride out the most difficult periods in the training pathway. However, as a profession, we need to be collectively active and vocal in improving the conditions of our work and training. It will lead to a happier workforce and a greater ability to care for our patients. There are some great pay offs for the effort of making time for family life. I really look forward to going on family holiday. It is refreshing to put ophthalmology aside for a couple of weeks and just enjoy doing different things together. The other thing I admit to really enjoying, is when my kids draw me a picture of an eyeball for my birthday. * Dr Gosling is an ophthalmology trainee in Sheffield, UK.

Tags: young ophthalmologists