Masochist or martyr?

The only difference between a suicide and a martyrdom really is the amount of press coverage.
Chuck Palahniuk, Survivor

Do you ever play the game where you decide which decade you’d rather have lived? Does the fashion of the 60s or music of the 80s draw you back? Maybe you wish you’d lived during the advances of the Industrial Revolution or the exploration of the Renaissance? In the end, the current decade always wins for me – as a women, there’s so much more freedom and opportunity, and I’ve got used to the technology and lifestyle choices available now.

Except for one thing. I wish with all my heart that I wasn’t working during the collapse of the NHS. I wish that I could work in a time where I could just be a doctor, rather than a politician or activist or economist. Because that’s all I am; I am just a doctor. And yet I am in the process of preparing for the next set of junior doctor strikes; persuading colleagues of the benefits, creating action plans with senior management, organising pickets and being a spokesperson for the strikers. A full walkout from 8am to 5 pm on 5 consecutive days. Fuck…

Full disclosure – I voted to accept the contract. It’s not perfect but I trusted the BMA when they told us that it was the best that they could negotiate. It is a significant compromise but I had made my peace with that. I also voted against further strike action when asked in a questionnaire. I felt that strike action can only be escalated so far before the balance of unacceptable risk and irritation swings the wrong way. And I was tired. I was so tired of fighting that I just wanted it to be over. I wanted to believe that this was the solution and that it could be made to work.

But I was in the minority – the contract was rejected and strike plans approved. Although some of those who voted ‘no’ did so out of misplaced idealism and an unwillingness to compromise, most did so because they could more clearly see the risks and felt that a satisfactory compromise had not yet been reached. This Guardian article from May is the best description I could find of the state of play after the last negotiations but it misses the crucial points that forced many of my colleagues to vote ‘no.’

And in many ways they were right to do so – the sexism and gender pay discrepancies remain unchallenged. Providing those that return to work with mentors to get their practice back up to speed ignores the financial cost of taking time off. Returning mothers haven’t forgotten how to be doctors and working part time doesn’t stop their professional development, but it will cost them through delays in their pay progression and in additional, anti-social child care. And the fights over weekend pay don’t question who these doctors are that will be working these extra weekends. Morale is so low that no one wants to be a doctor any more – recruitment is down and there are dangerous gaps in all rotas already. It’s not an appealing job and none of the current measures make it any more attractive. I just don’t know how current staffing levels can be stretched across seven days, and it seems that I’m not the only one…

I can’t help but feel that this is the crux of the problem – no one wants to be a doctor any more. The profession is fucked, with dissatisfaction and rot seeping into every single corner. It’s toxic, it’s sinking, it’s failing.

Depressingly, my bosses’ answer is simply to leave the country. To give up on the NHS and go somewhere where we’re appreciated. And doctors are leaving in droves to work in Australia or New Zealand or America or the Middle East or anywhere else to be paid more for doing less and generally having a much better quality of life. 

‘Why would you stay?’ asks one consultant who has been headhunted to Virginia with an offer of double his salary plus a new house, ‘Unless you’re some kind of masochist!’

His choice of wording made me smile as it’s not the first time I’ve been asked if I were a masochist by a colleague because I love the parts of medicine that put most people off – I love being on-call! Being the med reg on-call is beyond hectic and I am harassed for the entire time. My bleep never stops, I shoulder the burden of the majority of the sickest patients in the hospital, as well as being the last port of call for pretty much everything else, but it’s awesome! I love finding the order in the chaos, I love maintaining this control and actually making a noticeable difference to my patients’ care. And occasionally I get to show off how smart I am when I can see the answers lost in the mess of symptoms, signs and investigations and that’s pretty fab too. It feels like real medicine and it’s definitely worth the drama!

So am I a masochist?

Sexually, it’s an easier answer. Although I’ve never properly played with pain to be certain, the thought of it doesn’t really appeal to me. Yes, an occasional spank is awesome but I find BDSM in erotica hot simply because of the descriptions of pleasure in these acts. I am turned on by their lust and their arousal, not by the pain itself.

But professionally? That’s harder to determine. Do I enjoy my work because it’s hard and because it’s emotionally painful, or do I enjoy it despite that? And what does that say about me?

In a way, the second option is even more depressing. As I’ve hinted in the title of this blog, the extreme alternative to this professional masochism is martyrdom. I willingly go in every day to perform a job that is breaking me, emotionally, financially and professionally. I am compromising myself and the care that I can offer my patients because there’s nothing I can do about it. I can bitch and sigh and complain, but I still trudge on. Dangerous staff shortages ensure that I am asked to work right to the limit of safe hours because there’s no other way and I am constantly tired. High patient expectations mean that I have to apologise all the time for deficiencies beyond my control, hoping for understanding when clinics are delayed or when A+E waits extend beyond the fabled four hours but soaking up the anger when they don’t understand because there’s nowhere else for it to go. I don’t mind that I’m not paid anywhere near as much as friends in the private sector; I don’t mind that there are no perks and I pay through the nose for compulsory exams, professional subscriptions, car parking, lunch… I accept each and every blow that is rained down upon me because that’s how it has to be.

Except that I don’t accept it. I am not a martyr, I am not powerless, and I actually don’t enjoy working in these conditions. Something has to change but I cannot fight this alone. We have to stick together, we have to show a united front because this is just the beginning. The NHS is failing but giving up will only make it fail faster. After the junior doctor contract issue is settled, the consultants are next and then the other allied health professionals after that. There is no back up plan; no one has yet suggested an alternative healthcare system that offers the same equality of access to health services so, even though it breaks my heart and tests my philosophical and political reserves, I will be on that picket in two weeks and I will continue to be vocal and active in my support for the strikes.

It’s difficult though. It is testing me. I don’t know for certain what’s right any more. I’m not a politician and I’m not an economist. I have to trust what I am told and I have to carry on reading everything and anything that I can to make sure that I’m basing my opinions on fact rather than spin. And I have to stand with my colleagues, even if I do not always agree with them. As a profession, we have to speak with one voice and that voice wants to strike again. As a profession, we have decided that the controlled compromise, which is a deliberately chosen word as I still believe that there is no patient risk in this strike action, is preferable to the long-term danger of the new contract.

And I have chosen to be a masochist rather than a martyr. We’re all that’s left now anyway; everyone with any sense has gone already. I hope that you can all understand and will continue to support the junior doctors because, believe me, I know how hard that is. But I’ve decided that if I’m going to be beaten, humiliated and fucked, it’ll be with my consent and under circumstances that I can control. The NHS is lucky to have me and I’m not done fighting for it yet…

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