June 2016

The Medicine

by Karen Hitchcock

The gentlemen’s club

Having a baby and having a medical career

Every hospital has a “residents’ room”. A place only the junior doctors can enter, where posture and politeness are discarded, naps are stolen, bosses are demolished, hook-ups are arranged and black humour reigns. It’s like a pub without alcohol.

I transitioned from trainee to boss in the same hospital. Overnight, I was barred from the residents’ room and granted entry to the “consultants’ room”. I called it the gentlemen’s club. It had chesterfields, old portraits, a cupboard full of (unopened) top-shelf liquor. I’d go there to open my mail. It was mostly deserted – just the odd professor or two sitting at opposite ends – but somehow the toilet seat was always up. And though I’ve never been one to engage in the toilet seat wars – he puts it up, I put it down, seems fair to me – for some reason I started to read this one as a “fuck you”.

Female medical trainees now outnumber male ones. Behind closed doors this is bemoaned as a “feminisation” of the medical workforce. A phenomenon that will lead to decreased productivity due to all that child rearing. To less doctoring per MBBS.

I’ve had countless corridor conversations with female registrars – pre-exam and post, partnered and not – about the best time to have children. They approach me nervously, look around to check no one’s in earshot. When did I do it? How? I fell pregnant with twins in my second year on the wards. I planned to take eight weeks’ maternity leave, and come back as a registrar to start the six years of specialist training. The huge regional hospital I worked in was enormously supportive of me as my belly swelled, slotting me into the less acute units such as geriatric rehabilitation. After the birth they extended my maternity leave, then let me job-share with another kid-wrangling registrar. They saw no problem with me running out to the emergency department’s drop-off zone every four hours to breastfeed in the passenger seat of my partner’s car. This kind of flexibility would only exist in a place battling a workforce shortage. If there’s a line of equally qualified people snaking out the door, who’d negotiate? I know a doctor who received a phone call on the eve of her specialty interview, telling her not to bother because she was pregnant. Outrageous. But imagine you’re hiring a trainee for a 12-month position. The job is arduous. The more work they do, the further into the year they progress, the better they get, and the less you worry about your patients.

There are exceptions, but most heads of departments are men getting on in their years. They are married to women who raised the children and kept the home. This arrangement remains quite common among the younger male hospital specialists, and brings with it a particular kind of ease: last-minute after-hours meetings and early start times – things that put me into hypertensive crises – won’t orphan their children. And yet, at least five times, I’ve heard male doctors joke that their wives won’t let them retire: I’d drive her crazy. I’d get under her feet. I’d leave crumbs on her benchtops.

Periodically, the various specialty colleges form committees to address structural sexism: the lack of flexibility in work hours, the discrimination against the pregnant. The committees peter out or draft idealistic recommendations using words like “urgent” and “imperative”. But it’s all a show. What department would choose complication and distraction over insouciant dedication?

We could change structures in the hospital to make it more family friendly. Have the wards crank up after school drop-off rather than at 8 am. Mandate that a decent proportion of the training positions are part-time. Offer paternity leave. In-house child care. Perhaps then there’d be a few more women running the place.

When I job-shared I had half the week on, half the week off. I never really felt on top of things, or that I knew the patients as well as I might have were I there every day. But no doctor is in the hospital 24/7, and we always work as part of a very large team. Any exchange of information is imperfect. Details will always be forgotten or misunderstood. (Why is that relative angry? Why was the beta-blocker ceased? Has a pulmonary embolism been excluded?) The truth is that no trainee ever feels entirely “on top of things”, so it was invaluable (and comforting) to be able to call my other half.

I tell the anxious registrars who wonder if they can have a family to imagine the kind of life they want. The public hospital can be exciting, raw and rich. So can families. There are areas that comfortably accommodate shiftwork: general practice, emergency medicine, anaesthetics. But I feel sorry for the trainee medical specialists. They’ve chosen a medical career where the most intense period of training perfectly coincides with the time to have children. I veer back and forth between “It’s unfair” and “Toughen up”. They’re far more privileged than the woman working three casual unskilled jobs when her period fails to arrive. Perhaps Western, highly educated, professional women can’t have everything. Perhaps no one can. It seems to me that those bloke-jokes – the-wife-won’t-let-me-retire – belie their own sort of sacrifice.

Count your lucky stars, as my grandmother used to say. The toilet seat might piss me off, but I chose this club, one built over centuries around a gentleman’s schedule. Would I choose it again? I think often of a moment: I’ve just finished the last of my specialist exams after a year of relentless study and work. I’m buckling my three-year-olds into their car seats to take them to the beach. One of my daughters is looking into my eyes with that piercing inquisition young children have not yet learned to suppress. She cocks her head ever so slightly, and there’s neither question nor accusation in her diagnosis: “Mummy. You don’t play.”

Karen Hitchcock

Karen Hitchcock is a doctor and writer. She is the author of a collection of short fiction, Little White Slips, and the Quarterly Essay Dear Life: On Caring for the Elderly.

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