October 2021: Women, Mothers and Others as medics

I had my first baby at medical school. I had learnt through my childhood that complaining didn’t do any good and so during the constant nausea of the pregnancy, I carried on.

It was 1982 and even though our medical school had more women than most, being pregnant was not playing by the book. For the most part, it was ignored. As I came up to term, I was on a surgical firm. We were doing a ward round on a female ward and came across an empty child’s cot. The consultant surgeon I was training under, looked straight at me and said “I can see we are prepared for all eventualities.” That was the only acknowledgement of my condition.

I went into labour while assisting in the operating theatre. I bore the contractions silently and timed them on the theatre wall clock. I managed to get to the end of the operating list without letting on and went from there straight to the labour ward.

I had no official time off for the birth of our daughter. My husband was working and we had no family to help. I did have a childminder arranged but I hadn’t expected to be overwhelmed with maternal feelings. I wanted more than anything to be with my baby and by the end of the year and my qualification as a doctor, I knew that I could not leave her for the minimum 80 hour average week of pre-registration house jobs.

Almost 8 years and 4 children later, I started my surgical house job. I knew that I had to do well, extraordinarily well. Two consultants had interviewed me; it was after they told me that I had not got the job, having been out of medicine too long that they asked me what I was going to do – my answer changed their minds and they decided to give me a chance.

I set out to be the best. I put up with the snide remarks and the gendered references – once in theatre, I was left holding a bowl filled with the contents of an obstructed bowel. The consultant surgeon was laughing at me, asking whether this was better than changing nappies.

However at the end of the 6 months I was rewarded – both of the two consultants who interviewed me also paid me the compliment, that I was the best houseman they’d ever had. In retrospect, the consequences weren’t quite as positive as I thought they were at the time.

I had created a situation where I expected perfection from myself at work and also back at home; I tried so hard to be a really good mother to my 4 children and make up for the time when I was away at work. I moved on from house-jobs; the plan was to become a GP, then at least I could be part time.

 On my first day in paediatrics, I was left to resuscitate a neonate without assistance when the consultant mistook the fast bleep as a ‘test’ bleep. As an A&E SHO, the only doctor in the department at a peripheral hospital, I found myself dealing with a 4 year old child in cardiac arrest all on my own – these situations are unthinkable today. There was no debrief, no counselling, I just carried on working; but it hit me hard -perhaps more so, since I had young children.

Despite or maybe because of the way I had handled the paediatric arrest, I was encouraged to pursue A&E as a career and I did really enjoy the speciality -it all seemed to being going well;  flexible training was on the horizon and so it seemed that my working life would improve considerably with a reduction in hours.

I was lucky in that my husband and I had role-swapped when I went to work – it seemed the only choice when I was doing the average 80 hour week, 1 in 4 and he adapted well. He was unusual at that time, which meant that there were few people he could relate to and he was not readily accepted by other ‘stay at home’ women, who were also caring for young children. The attitudes of other men also changed towards him. In social situations, when he told them he was looking after our children – they would turn away disinterested…..

But I felt his rejection – it reflected on me. I was the cause of the trouble. I internalised my feelings. I was also getting tired. Everyone else’s needs came before my own and the stress and vicarious traumas from work, began to take their toll. Then a situation arose in our family that provoked memories of my own traumatic childhood and finally I had an emotional crisis. My repressed emotions came to the surface and once activated, it seemed that that nothing would stop them. There’s a long story in the years that followed the diagnosis of depression……

Eventually I returned to work where I had left off, this time as a flexible SHO in Emergency Medicine. I completed my Membership exams (now titled MRCEM) and was now set to apply for SpR posts. Candidates were expected to visit the A&Es where I would potentially work on the rotation.  One of those visits was particularly memorable. The consultant I met, a man, spelt it out to me. Even though, I was not going to go off and have more babies, I was too old for the job. I would not give back enough years to the NHS, so it was not worth while training me.

I was shocked, but there was more to come. I was told something similar by one of the powerful male consultants in the A&E where I was currently working. He did however, assure me, that if I wanted a permanent staff grade job there, the door was open.

I was infuriated and also determined. Thankfully I did well in the competitive interview and was given a training number on the rotation.

If only fate hadn’t intervened……my children were teenagers now and two required funding for university, my husband was back working. We were dependent on both our incomes and then suddenly, without warning, his company was taken over and he was made redundant. He tried to get another job locally but without success. After much thought, we decided to be positive and move to an area where housing was cheaper and decrease our outgoings. Naturally I was limited to areas where I could get an inter-deanery transfer.

I made enquiries. Initially I was told that ‘economic migration’ was not a good enough reason to move but then my husband found a job. An inter-deanery transfer was agreed for that area.

I flew up to Scotland to visit the new A&E department where I would be working. It turned out that the flexible training dean was also one of the A&E consultants. I sat in his office and discovered the harsh reality of joining this particular deanery, where they had not agreed to the EWTD. (European Working Time Directive which limited average working week to 48 hours.) Even though I remained a flexible trainee, my new part-time hours were to be 39 per week without any increase in my pay. (The full timers worked 65 hours). In addition to this, I was to be expected to do the full 7 night-shifts in a row. I would be required to be resident for 18 months at another hospital over 100 miles away as part of the rotation, never mind the fact that I would be separated from my family. I couldn’t believe what I was hearing – none of it made sense. I knew what I was required to achieve to satisfy the A&E curriculum and it wasn’t necessary for me to go to yet another hospital. I explained why I found working more than 4 nights so difficult since the illness and the fact that I was a flexible trainee to protect my health. But he was insistent-none of this was negotiable. One of the existing SpRs showed me round the department.  He also explained the ‘culture’ of this particular A&E to me – it was supposed to be reassuring to know that this consultant, the flexible training dean, whose office I had just left, would pick on me and make my life miserable until I swore at him in public. The SpR told me not to mind – “it is nothing personal, he does it to every new SpR.”

I decided I couldn’t work under such conditions and resigned my training number. I thought I was fortunate to get another post, working in Psychiatry as a staff grade. There were no anti-social hours at least. But I was a fish out of water and soon realised I had made a terrible mistake.

I went back to the flexible training dean, humiliated, defeated and asked if there was any way I could come back to A&E. I said I was willing to be an SHO again, or a staff grade. He was incredibly rude and he brought up the subject of my mental health and used this against me. His final words were that he would never let me work in A&E either at this hospital or anywhere in the region.

I reported him. He had broken every rule under the sun. I did not know where to turn. Even the BMA were little help. Occupational health were no help either – they told me, I should never have taken the job in psychiatry……….. Once again, my world was crumbling. I didn’t know what to do; the crisis earned me a diagnosis of ‘relapse’ – I thought they must be right. I went off sick.

The Trust (hospital) Medical Director agreed that we should meet – just the 3 of us. It was my word against that of the flexible training dean – he denied everything. I couldn’t help myself and broke down in tears. I knew that I would not get work as a doctor where we lived, I had burnt my bridges.  After the meeting was over the Medical Director validated what I had reported to him – “I believe you” is what he said. But without evidence, there was little anyone could do, so I didn’t work again until we moved back to England.

Yet another gap in my career and this time, it was not my own children I was caring for but a baby grandchild…….but I wanted to go back to work in A&E. There was no such thing as a ‘return to work’ scheme, so I did it myself -I was an ‘observer’ on an unpaid honorary contract but after a day, I became part of the work force, just making sure that I presented every patient to a senior. Thankfully before too long, the department offered  me an ST3- LAS and then I became a ‘trust registrar’.  However the possibility of career progression to Associate Specialist had gone – the 2008 contract put paid to that.

I wanted to return to training. There was a glimmer of hope, when a scheme called DRE-EM arose. On closer scrutiny, it was little different to starting all over again as a CT1 and once again, there would be an impossible commute – this time I would have to work at the base hospital for 18 months, including twilight shifts finishing at 2 am. It seemed like the gods were against me, yet, I couldn’t envisage being stuck at the top of the trust registrar pay grade where I had landed and keep going without any potential for growth.

I was acutely aware that there was little respect for me or my opinion within the medical profession, once my job title was known. I had also witnessed how derogatory others were towards SAS doctors in general. How could I have let myself get to this? I spoke about the possibility of the DRE-EM training to one of the consultants I knew and respected in my department. I was completely shocked by his advice. He told me he thought I was capable and could pass the final exams (FRCEM) but he also told me that I was not the ‘type’ to become a consultant – I was the ‘wrong’ sort of personality. I was not aggressive enough, not loud enough. I was a good follower, but not a leader. He advised me to forget it.

Opportunity arose for us to get a green card and emigrate to the USA. It seemed the answer -I studied and passed USMLE and was given the golden certificate – the ECFMG – the Eligibility Certificate for Foreign Medical Graduates, granting me the right to apply on the computerised matching scheme for residency programmes………..Finally I would be able to complete my training in Emergency Medicine.

 Filling out the on-line applications for ‘the match’ was arduous, requiring considerable detail. It was costly too. There was a fee to pay for each programme you applied to. Finally -press submit – it kept pinging back. I couldn’t understand what the problem was.  

My heart sank when I found the reason…….all residency programmes for every speciality in Colorado, where I now lived, required that your primary medical school qualification had to be within the last 5 years – if this stipulation was not met, your application was automatically rejected. I looked through every document I had been sent, every relevant email, there was nothing about this anywhere. I searched through all the advice sent to International medical graduates……no mention and yet, I could not find a single residency program in the USA for Emergency Medicine to which I could apply. I tried other specialties in Colorado but to no avail. I met with University of Colorado medics. I was given contacts and had meetings with numerous people. It was hopeless. Nobody could help me. My dream had come to an end -I gave up medicine- this time for ever.

Here I was a bona fide resident (green card holder) in the United States and none of my British qualifications including my BSc were recognised – the best I could hope for, was a job which only required  high school graduation. I earned $11 an hour when I worked at a charity for the homeless. It was tough, but I enjoyed it, until I was subject to an unprovoked assault. Once I recovered, I realised that it really was too late in life to start an alternative career and living in the USA without a steady and at least moderate income was not likely to end well. We were living below the federal poverty line, yet, unable to get any state benefits because we were immigrants who had not been in the country for more than 7 years. Time to move on.

It was hard returning to the UK, leaving friends and family behind. But at least I found it relatively easy to slot back into Emergency Medicine, once I overcame the initial anxiety. But I suppose I am a veteran at ‘return to work’ and this time, there was proper support. It felt like riding a bicycle and here I am, this time for life, a SAS doctor back in Emergency Medicine.

I am strong. I am a survivor. I am a woman who has battled against the odds in a world where I was discriminated against firstly because of my gender and then because I had been ill. I have learned that though I have made mistakes in my career, I have also been the first to recognise and rectify them. I should not have been treated the way I was and I hope very much that others do not have to go through similar ordeals. The hierarchy within medicine is breaking down because there are more women within the system, however we must make sure that the fight we have gone through to get to our positions, does not harden our own abilities to be supportive and empathic towards others who come after us.

I am happy to still be working when most of my medical school peers are entering retirement. I can look back at my life and wish it had gone more smoothly and that I had attained my career goal to become a consultant in Emergency Medicine. However, I am where I am and not a lesser person because of it. I have proved that a neat, straight line, career trajectory can be broken, not just once, but a number of times and still lead to a fulfilling life and provide a service to our patients. Those who say otherwise are merely reflecting their own limitations.