"The worst working days of my life." The ugly side of becoming a surgeon.

I never thought I would say this, but I broke. I give up. I am done. I surrender. I am handing back my dream of becoming a surgeon. I have nothing left to give. I don’t want it anymore. I’ve lost my ambition. I’ve lost my spark.

I started 2018 with optimism and zest. This year would be my year. I would apply for the advanced training program for Plastic and Reconstructive surgery. I’ve done the hard yards, I’m good at what I do, and I have the right intentions… Fast forward to October and I find myself in a hospital bed, barely able to speak or move. If I wasn’t so resilient, maybe I wouldn’t have put up with the abuse for as long as I did. But I did. And all I can do now is focus on what I can do now to get myself back to my former, bouncy self.

The worst working days of my life

February 2018. The start of my term at Hospital X. I had just finished a term where there were three registrars who shared the on call responsibilities equally. Hospital X was staffed by two, so I knew I would be busier… but it wasn’t a 50/50 split. It was 10/4 (me being the person on call 10 days a fortnight).

My two-week cycle looked something like this: I was on call from Monday morning 7:30am until the next Monday 4pm… about 180 continuous hours. This means that at any time during those 180 hours, I could (and did) get called by the hospital. From the first week I was receiving phone calls every night until about midnight, and sometimes even a 3am call here and there. I would then get Monday night off – a momentary relief of one night’s uninterrupted sleep – and then back on call again the next morning until Friday afternoon – another 80 continuous hours of being on call. I got two days off, and then the cycle started again.

My days were long. I kept a log of my hours; I was at the hospital for 120-140 hours a fortnight, and work would follow me home with phone calls whilst trying to park my car in the garage, whilst I took a shower, whilst I was trying to cook dinner, and whilst I was trying to fall asleep. Every fortnight I would only be guaranteed four nights of uninterrupted sleep. The other 10 nights were unpredictable. Maybe I’ll get woken up, maybe I won’t. This mental unrest for 10 days a fortnight was taking a toll on me. I couldn’t go and exercise, I couldn’t plan anything social… I had to be on standby.

Oh, and I was also made to cover some of the on call roster for the Ear, Nose and Throat (ENT) surgery department – a specialty I had no prior experience in. The ENT registrar was not required to reciprocate. I wasn’t treated too kindly by the ENT department, because I wasn’t one of their own. I had admitted a little boy who had a lot of pain after he’d had his tonsils removed and he couldn’t eat. I called the surgeon who did his operation, but before I could finish my sentence, his response was; “He’s not a private patient. I’m not on call,” and hung up. Care factor: zero.

???? S C R U B L I F E ???? This is my every day #ootd ???? Back to fitness & lifestyle soon! I took some videos this week ????????????‍♀️Some are running / yoga specific, but hopefully everyone will find something that’s relevant to their activities ???? Stay tuned . . . #surgeon #doctorlife #thisiswhatasurgeonlookslike #workhardtrainhard #happyweekend #ドクター #仕事 #手術 #病院 #医者

A post shared by  Dr Yumiko Kadota (@mindbodymiko) on May 26, 2017 at 2:17pm PDT

I handed my time sheet to Medical Administration and raised my concerns about how much work I was doing, and how exhausted I felt. The response was, “I have nothing to do with the roster, you have to talk to your own department”. I was worried about how tired my brain was… I need to be fresh to make clinical decisions. I didn’t want to make any mistakes. There was a patient who came back with an infection after surgery. The antibiotics she was supposed to have been charted were not. I wrongly got blamed for that complication.

I was spending more and more time at the hospital. Breakfast was a coffee and banana bread at the hospital cafe. And lunch was an equally unhealthy meal at the cafe. It’s ironic that a hospital cafe can’t provide healthy options. I was eating hot chips every day. I was craving sweet and fatty foods for that quick energy boost to keep me going. I knew I was gaining weight, but I didn’t have a choice. Dinner was often Uber Eats. Some nights I would finish too late to drive home (which was an hour away), so I would find a spare bed on the Recovery Ward. “Recovery”. How ironic. I went to sleep to the beeping of machines, pagers, and the voices of staff working the night shift. It was hardly a space to recover.

After a while, the other doctors began to notice how much time I was spending at the hospital. My locker had spare clothes, socks and toiletries in anticipation for all the nights I would be spending at the hospital. By April I began to feel physically unwell. The combination of stress, dehydration, poor nutrition, and sleep deprivation affected my gut health.

The head of department (HoD) had heard some whisperings about my fatigue and gave me a call that weekend. “We need to look after you. You’re damn good, you’re damn good,” said the voice on the other line with so much conviction that I believed it. “I don’t want you to burnout” … but I already was. For a moment I thought that maybe this roster might change.

Then, I experienced the worst week to date. It started with a 12-hour day on the Monday, as I had a presentation after work that finished at 7:30pm. Tuesday was 20 hours long. I had just finished operating on a little boy who had cut off the tip of his finger, which required re-attaching urgently to save it. It was 10:30pm at the time and I was getting changed to go home when I received another call from the Emergency Department. Since I was still in the hospital I decided I would go and review the patient on my way out.

The man had cut three of his fingers with a kitchen knife after grabbing it and planting it tip-down so that it’d stand up on the chopping board. One of his fingers looked pale so I was concerned about the blood supply to it. I knew I had to take him to the operating theatre that night. I called my boss for help, but he didn’t come. “You’re good at micro, you’ll be fine, see you in the morning,” he said. The patient was a manual labourer and that was his dominant hand – no pressure at all.

I went back up to the operating theatre, changed back into scrubs, and informed the staff there that I had an urgent case to do. I was exhausted but drank some tea to wake myself up. The anaesthetist felt sorry for me and shared a bit of his dinner with me. My eyes were sore as they looked down the microscope to assess the fine structures in this man’s hand. It took four hours to repair all of the tendons, nerves and arteries he’d damaged across the three fingers. Hello Recovery Ward. Let’s sleep here again for a few hours.

“Was I dreaming, or did you call me last night about a case?” asked the surgeon. “I did ring. I finished operating at 3am,” I told him. “You’re a legend,” he said, patting me on the back. I half-smiled. The HoD was also there that day and I asked for permission to take a quick break. The answer was no. “I remember doing those sort of hours when I was at your stage. It’s good for you.”

???? I assisted lovely Dr Sanki in the second stage of a body makeover for a TV show ????. We did a #brachioplasty (removing excess skin from the arms) and #breastlift with implants to transform a patient who has lost an incredible amount of weight! ???? . . #DrAmiraSanki #AMIRAcle #amiradoll #DrYumiko #weightlosssurgery #mummymakeover #niptuck #summerbodiesaremadeinthewinter #WLScommunity #WLSjourney #sydneyplasticsurgery

A post shared by  Dr Yumiko Kadota (@mindbodymiko) on Sep 6, 2016 at 5:34am PDT

Was this supposed to mean that this experience would toughen me up? As a marathon runner, I think I might know a thing or two about pushing my physical limits. Mind over matter. I was made to feel as though I needed more mental tenacity. My tiredness had nothing to do with the illegal and untenable hours I was working. Of course not.

It was Wednesday and that day was 16 hours long, and I did not get that break I desperately wanted. I was so tired that I slept over at the hospital again. Days like these continued well into April. At this stage, I realised that nothing was going to change and my department was benefiting from the fact that I could operate on my own, and they could (literally) leave the unit in my hands.

The days were made unpleasant by all sorts of factors. Being a female never helps, no matter how competent you are. Even after introducing myself as the treating doctor and performing an assessment on a patient, I’d still get asked, “Nurse, when do I get to see the doctor?”

It wasn’t just the patients. An emergency doctor rang me at 3am about an appointment. At 3am? Really? I expressed that it was inappropriate to wake me up at 3am about non-urgent matters. This was hardly an emergency. “Stop being an emotional female,” he said. Oh no he didn’t…. Would he have called my male counterpart “emotional”? I tried to get back to sleep but I couldn’t. How dare he call me emotional!

And yet, when an Emergency Department consultant asked me to run a workshop for their doctors, I agreed. I gave a tutorial on how to assess hand injuries and a practical workshop on how to make a good plaster for broken hands. Even after that experience, my passion for education was still there. Just. I didn’t have time to brush my hair or make a home made meal, but I made time to teach other doctors.

I also had to cope with a high level of violence and aggression at Hospital X. The operating theatres were always inefficient and I would spend almost every day apologising to patients that their surgery was cancelled for the next day and that they would have to come back. I was on the receiving end of a lot of abuse from family members who were angry that their loved one had been fasting all day only to have the surgery cancelled at 10pm. It was so demoralising to apologise for something that was out of my control, but it was all part of my role.

In mid-April, I went to see my family GP about my gut problems. She weighed me, and for the first time in my life my BMI was in the overweight range. I’m supposed to be a runner. How can I be overweight? She’d known me for several years now, and was concerned by how physically and mentally exhausted I appeared. She felt strongly that she needed to write a letter to the hospital, which I gave to my HoD and medical administration.

The letter from my GP made no impact, but I knew I needed to ask for some time off. I also had a sick family member who was about to start chemotherapy, and I felt guilty that I wasn’t there to support my family (especially being the only medical person in the family). My family sent me blood test results and images of scans to keep me in the loop, but it only served to amplify my guilt. The hospital knew of this but I received no sympathy, which you’d normally expect if an employee’s loved one had incurable cancer. It makes me sad that doctors work so hard to look after patients, yet (some) hospitals provide no support to doctors during times of need.

I came back from annual leave with the hope that my working conditions might improve. There were no such improvements; only an extra load imposed on me for taking time off – I didn’t realise that taking annual leave was a punishable offence. I was given an extra weekend to “make up” for it. The only thing that kept me going was a new patient, whom I shall call Mr B. He was a polite and softly spoken gentleman who had developed a nasty finger infection. I was able to treat most of his infection surgically, but he needed further management with intravenous antibiotics and regular dressings.

I wanted the dressings to be done in a particular way, and since my department was not given any nursing support in Outpatients, I would be the one doing it. Mornings suited Mr B and his wife, so I booked him in every morning for 8am and that became my social life and reason for getting up every morning. As well as no nurses, we also didn’t have a hand therapist (despite offering hand surgery), so I was his doctor, nurse, and physiotherapist.

I was interviewed by the @sydneymorningherald about my story ???? It will be in print for this morning’s paper ???? online link is in my bio. I hope that it will increase awareness about the conditions and pressures junior doctors in Australia can be subjected to, and lead to much needed changes in our public health system. . ????: @jamesbrickwood . . . . . . . #juniordoctors #doctors #burnout #mindbodymiko #mindbodysoul #publichealth #doctor #health #wellbeing #mentalhealthawareness #mentalhealthadvocate #mentalhealth #lookafteryourself #lookafteryourbody #healthfirst #selfcare #selflove #metoo #ilooklikeasurgeon #enoughisenough #youareenough #iamenough #putyourselffirst #yogini #sydneyyogateacher #holistichealth #selfpreservation #treatyourselfwell #alicemccallmoments

A post shared by  Dr Yumiko Kadota (@mindbodymiko) on Feb 5, 2019 at 9:42am PST

I saw Mr B and his lovely wife every morning. Before walking into the Outpatients department, I took a deep breath, put on my brightest smile and greeted them “Good Morning”. His blood test results and the appearance of his finger was improving day by day, and I reassured him of that. “You’re my guardian angel,” he said… but actually, he was mine. Without the pleasant daily interaction with Mr B and his wife to look forward to, I’m not sure what else would have motivated me to get up for work every morning.

By this time it was May. I grew more and more weary and disillusioned. I had been trying so hard not to complain because I knew what was at stake. I needed to get onto the advanced training program. It was like I had put my whole life on hold and I was not a valid human until I got accepted onto this program. I needed my bosses to support my application, which meant I would have to keep working tirelessly and produce perfect surgical results.

I couldn’t keep my eyes open, but I could keep my mouth shut. During the day, if I had a spare moment I would go to the registrars’ office, cover my face with my jacket and sleep on a chair. “Who’s that?” I would hear a voice say. “Oh, that’s the Plastics Reg, she’s always here,” would reply another. I stopped caring that I was looked upon with so much pity. I was nothing like the Wonder Woman card my friends had given me. I didn’t even know who or what I was anymore.

Hospital X was a small hospital. The Head of all of the surgical departments had gotten involved by this point. “You can’t make her do all of this on call. The roster must be changed.” Those were his orders, but ultimately it was up to my department. I had already expressed a concern that my ability to care for patients had become compromised because of my extreme exhaustion. It was beyond burnout.

I didn’t want a passive role in this process. I created three possible solutions to ensure a safer and fairer workload, however there was resistance from some of the consultants. Why would they change the roster when it’s so convenient for them? They would take the other registrar over to the private hospital to help with their operations, and leave me at the public hospital to run the unit. They most definitely did not want the ENT registrar to help because that would mean that they’d have to come in for the operations. With me on call, they could stay at home whilst I did the operations.

And so everything stayed more or less the same. The other registrar took a generous two whole shifts off my load, but the revised roster that he distributed showed that I would be working for 19 consecutive days in June, and 21 consecutive days in July. Six senior doctors had raised their concerns with my department, and this was the result. Even my patients started to worry about me. One morning, Mr B asked, “you’ve seen me every day, including weekends… doesn’t this impact your family life?” I smiled and told him, “Yes, but it’s okay. I do it because I love my job”. Both of us knew I was lying.

On the 1st of June I resigned. It wasn’t okay anymore. I was physically alive, but spiritually broken. At lunch time, I begged the HoD if I could go home. The answer, as always, was no. “Just hang in there.” I felt like I had already “hung in there” for three months. The 1st of June was my 24th consecutive day of work, 19 of which were 24-hour on call days. I knew what it would mean to resign – I would be blacklisted and I would never get a job in Plastic Surgery again in Sydney. But I couldn’t keep going. I crashed my car on my way home.

At the news of my resignation, the HoD rang me. “Can’t you just finish your term? It’s only a few more months,” said the voice down the line. “I don’t think I can,” I said. “It’s a shame. You have good hands. You’re good at what you do… but if you can’t handle the hours, maybe this isn’t for you.”

And that was that. The chilling final words from my Head of Department.

This is an edited version of a post that originally appeared on Mind Body Miko, and has been republished with full permission. For more from Miko, you can follow her on Facebook or Instagram.