Doctors are always in a race against time and the fear of harming a patient never really goes away, says Izzy Lomax-Sawyers.
In the new book Vital Signs, she chronicles her first year as a junior doctor at Auckland's Middlemore Hospital.
Photo: Supplied / Emma Smart
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When you finish medical school it's easy to think you're going to rock up and be saving lives from day one, Izzy tells Kathryn Ryan.
In reality, you're more likely to be wondering how many potassium tablets to prescribe while your phone is ringing and also you need to pee.
"You never know what's going to be on the other end of the phone. Sometimes a patient needs a laxative, sometimes it's because a patient is deteriorating and may be dying.
"You spend a lot of time at work and during that time you're kind of always in a hurry. There are always patients who need things done and some of those patients need things done because they're really sick and you have to quickly tend to their needs so they don't deteriorate further.
"All of the time you're trying to look for that risky thing that no one has quite picked up on that might herald a deterioration that hasn't happened yet."
Every time you experience an emergency as a doctor you get a bit more used to it, Izzy says, but at times it can feel like a huge and scary amount of responsibility.
"For me, I still find I'm really shaken when someone has become really sick and it's been my job to make sure that they get the best care ... the fear of harming someone, I don't think it really goes away."
Many doctors struggle to find a work-life balance, Izzy says, and often the only people who really get this are fellow doctors.
"When you get home from work you're pretty drained and the people that understand that are other doctors.
"Even if we have the best intentions to be balanced humans with a life outside medicine I think we do gravitate towards being friends with each other."
Izzy wasn't always on track to becoming a doctor.
After leaving high school at the end of Year 12, she worked in admin, studied economics and linguistics and worked at Parliament as an executive assistant.
Then Izzy's mother, a lawyer and local politician, stepped in with the suggestion of medical school.
"I think she probably saw how much I love working with people, I like to use my brain … but also applying that to working with people is the most important thing for my well-being.
"I got to the last exam I sat at university and I called her after the exam and said 'Mum, I'm done with study forever'. She said 'that's lovely dear, now think about graduate entry medicine', which of course I did."
It's not just time pressure that prevents doctors from performing the job the way they'd like to, Izzy says.
"You won't necessarily have access to a private room to talk to a patient about bad news you want to deliver and you won't necessarily have the time available to sit down for the amount of time they really deserve to have that conversation.
"At times we end up having to deliver news to people in rooms where other patients are present and leave soon after. It's really hard."
When Izzy did her three-month placement in a psychiatric ward, she was worried she'd meet staff like those she'd seen be cruel to her friend Hermione a decade earlier.
After a suicide attempt, Izzy says Hermione's life was saved by shock treatment and medications administered against her will.
"At times it meant that those of us in her life were interfacing with the mental health system… where some of the staff were burnt out and didnt have the compassion that she needed and we all needed going through this very hard thing."
Many of New Zealand's psych units are "old, dusty musty, buildings", Izzy says, but she was happily surprised to find the Auckland residential unit Tiaho Mai a light-filled and compassionate place.
Holding on to beliefs you have as a junior doctor about how medicine should be practised is surprisingly hard, Izzy has observed.
"You wouldn't think it would be hard to keep on believing that you need to practice medicine with compassion … but holding on to the practice of that day after day with the pressures that you're under is an important role for juniors because one day we'll be the person modelling this behaviour for our juniors and one day we'll be the consultant leading the team that needs to break news to someone.
"I try to hold on to that and every day I get more compassion for those who haven't been able to hold on to it. Because it's really hard doing that when you're always under the immense pressure that you are under in the health system."
For Izzy, the best part of being a doctor on a hospital ward is working with nurses who support and inform doctors in countless ways.
New doctors are taught that one of the most important signs a patient is deteriorating is a worried nurse.
"It's a very foolish junior doctor who ignores that … the nurse is right nine times out of ten."
Junior doctors spend lots of their work hours at a computer, she says, while nurses interact with patients in an "intense, constant way" that's exhausting and really admirable.
"I think they're amazing and we should pay them lots more money."