Translator: Beatriz dos Santos Morimoto
Reviewer: Denise RQ I'll never forget that Saturday night. I was working at a Community Health Center in the sprawling Cape Town township
of Khayelitsha. I was on call and, typically
for a Saturday night, it was hectic. I worked with another doctor, and together we saw dozens of patients
through the course of the night. Most of them were drunk
and injured in some way. Most of these injuries
weren't very serious. There were stabbings, beatings, some superficial gun shot wounds. All that these patients required
after we'd assess them was pain relief, and dressings,
or stitches to their wounds. Admittedly, there were some serious cases. We'd be alerted to them by the sound of a stretcher being wheeled
at high speed down the corridor, and my colleague and I would drop
whatever we were doing to attend to them. Once we'd stabilize them,
we'd then refer them on to secondary and tertiary level hospitals
for further management. We couldn't save a few of these cases. One of the patients
that we did manage to stabilize was a man in his early thirties. He was brought in at around three in the morning
with a stab wound to his back. The knife had penetrated quite deeply into the fleshing muscle
just below his right shoulder blade and he bled profusely. Our priority on first seeing him was to stop the bleeding
and to rehydrate him. It was particularly important
to rehydrate him because he was extremely drunk, so chances [were] he was already
dehydrated before his injury. After we'd stabilized him,
I prepared his referral notes and I made arrangements for an ambulance to take him to a secondary level hospital, where he would need to be seen
by the surgeons there to repair his wound. I saw other patients
after that particular patient, and by morning
I was getting ready to go home. That's when I heard him
in the room next to mine. He was shouting at one
of the nurses and swearing at her. "I have been left here to die,"
he kept shouting, and he didn't seem to believer her when she told him
that he'd already been attended to. So I went to intervene. I tried to talk some sense into him. I even showed him where I'd made
my notes in his folder. But he was having none of it,
he continued to shout and swear, so I walked away to finish off
my handover notes. I'd forgotten all about that patient when I left the hospital
later that morning. My mind was on getting home, taking a shower,
and going straight to bed. But just as I was driving out
of the hospital gates, I saw him again. He was standing across the road,
trying to wave down a taxi. He wasn't wearing a top, and the dressing that we'd applied
to his wound was soaked with blood. He'd clearly just stormed out
of the hospital in a huff. My initial instinct was to go to him because he really needed
to be in hospital. But I didn't do that. Instead, I sat in my car
and watched from a distance. I watched as taxi after taxi
passed without stopping, and each time he would shout after it
and wave his arms frantically. Eventually, a taxi did stop. He got in and it drove off. That's when I engaged my gears
and resumed my journey home. I remember that scene
like it was yesterday, though the reality is it happened
more than ten years ago. But it stands out so vividly in my mind because it represented a moment of clarity after months of confusion and indecision. I knew in that moment that it was time to quit medicine. That's right, I quit. I left clinical medicine and I shut
the door firmly behind me. Now, with that kind of start,
you'd be forgiven for thinking this talk is all about death, disease,
and the dysfunction in our health system. And while those elements are part
of my talk today, there is more. Because this is really a talk about what becomes available
when we have the courage to let go. It wasn't easy walking away
from my profession. I felt shame and guilt
for having walked away. I wondered
whether I'd been foolish and naive. How could I have spent so long studying and then chosen to leave it all behind? Was it all wasted? I no longer trusted my ability
to make important decisions, and I tried to run from it all by working in fields
completely unrelated to medicine. But I couldn't hide. The questions kept coming. People wanted to know why I left. And the voice in my own head
was getting louder. So, towards the end of 2012,
I went looking for answers. I did a "postmortem" on the premature death
of my medical career, and I packaged it in the form
of a memoir by the same name. The most obvious place to start
this inquiry was with my own story. I was born in the Johannesburg
township of Soweto, not far from here. I was the younger of two children. My upbringing was fairly typical
for a black person growing up in the townships
during the 1970s and 80s. This was a very dark time
in the history of our country - the dying days of Apartheid - and that particular monster
wasn't going down without a fight, [and] as I'm sure many
of you will remember, there were riots and boycotts, police spraying tear gas, people being shot and imprisoned. And while all of this was going on
in my external environment, there was turmoil
in my internal world too. My father was an alcoholic, and life at home was often very tense. It felt as if we were always teetering
on the verge of collapse. My world nearly did collapse, when my brother died
when I was 14 years old. So, by right,
life shouldn't have worked out for me. But it did. I love to learn and most of all,
I love to read. In the middle of my father's rants, I would bury my head in books. And I learnt
that more was possible for me, beyond the sniveling confines
of my home environment. So I set my sights on the biggest dream
I could dare to dream: to be a doctor. And I worked very hard
to realize that dream. It was a very proud moment for me when I graduated
from University of Cape Town in 1999. But that's where the fairy tale ends. "Hellish" is probably the best word
to describe my experiences during the time that I worked
as a doctor in public hospitals. I worked long hours,
in poorly-resourced healthcare facilities, looking after very sick patients. This was a time of AIDS denial
in this country, so patients were dying in their numbers. It got to a point - There was a time when I started to wonder whether the HIV was some sinister virus that was being targeted at my patients. Everywhere I looked, it seemed as if patients
were either infected or dying from complications
related to the disease. It got to the point
where I just didn't want to know anymore. And it wasn't just that I was
constantly giving my patients bad news; but it was also that, then,
I couldn't do anything about it. I was effectively dumping
a devastating diagnosis on them, and then leaving them to deal with it with whatever supportive measures
they had at their disposal. In addition to HIV and other diseases, we were also dealing with war zone
type of violence in our communities. I don't want to tell you the gory details of the gruesome ways in which people caused each other harm. It causes one to question
the kind of society we live in, and how little regard there is
for the value of human life. So that morning in Khayelitsha, as I sat in my car watching that injured man
get into a taxi and drive away, it'd all come to a head. I was disillusioned. I thought
that my world-class medical training would equip me to deal
with the daily challenges I faced. I was traumatized by the horrors
I'd seen in the emergency rooms, and I felt impotent to make any real impact
in the lives of my patients. It all came together
as I watched that man go, and the resounding question
in my heart in that moment was: "Who had I become
that I could watch a patient who clearly needed medical attention, get into a taxi and drive away?" The truth is, I had become
someone I didn't recognize. And certainly, someone
I did not want to be. So I left. And what followed
was a process of soul searching that lasted close to a decade. At first, this soul searching
was characterized by doubt and self-recrimination; later on, there was more meaningful introspection
and reflection. And ultimately, I arrived at an acceptance of myself and the life changing decision
I had made. While interrogating
my journey through medicine, I also spoke to other doctors
who had chosen to walk away. Their stories were harrowing. Stories of junior doctors
working very long hours, taking on too much responsibility, with very little supervision
from more experienced doctors. There were stories
of shortages of medication, equipment, supplies,
and of course, personnel. Some doctors cracked under the pressure. Like Nina, a talented young doctor who suffered a breakdown
during her first year as an intern, and Wanda, who told me how she felt she was playing God with people's lives. Another doctor, Ludoe, spoke about what he termed
the "health disservice" in the system. Others simply became disillusioned when they realized
that there was a mismatch between what they were taught and what they could practically do
on the ground. There was a common thread
which ran through all of these stories, one of trauma, overwhelm, and burnout. I was very fortunate that I was able
to write about these experiences. It was a cathartic process for me, and it allowed me to bring closure to a very challenging chapter of my life. And thankfully, it's also given rise to a long overdue conversation
in the medical fraternity about what's not working in the profession
and in the health system as a whole. It's as if my story
has broken open a wound that's been festering for years,
but wasn't been attended to, because no one wanted to admit
that it was there in the first place. So, at last, we're talking
about what it's really like, and I believe
that we've taken a critical step towards healing healthcare
and those who work in it. But while it's all worked out well now, for a long time, I gave myself
a very rough time about leaving. After all, so many of us were brought up on the notion of perseverance
and hanging in there at all costs. No pain, no gain. We've internalized this story to the extent that we won't allow
ourselves to let go, Even when holding on is sucking
every ounce of vitality out of us. And the critical voice
doesn't only come from within. I've heard people say to me:
"How dare you?" "How dare you walk away from something
that so many would give anything for?" "What right do you have to try
to make another life for yourself?" What right do I have? The right to wholeness and fulfillment to follow my journey wherever it may lead, to stumble, and fall,
and pick myself up and start again. The right to well-being. It's a right we all have as human beings. I would even go as far as to say
that it's our responsibility, particularly in the health sector, where the well-being
of others is in our hands. That's what becomes available
when we choose to stop suffering, yet, so many remain stuck. There's fear of change, of criticism,
of letting others down. What they fail to appreciate is
that there is a big difference between letting go of what no longer works and giving up
because we just couldn't be bothered. It takes courage
to really look at your life and to see when things aren't working,
to acknowledge it; to see when you're actually doing
more harm than good. It's a powerful act to put your hand up
and say, "I'm struggling!" And when that struggle starts
to impact your well-being, and the well-being of those you love, and potentially, the well-being
of those you serve, then it really is time to make
some tough decisions. Believe me when I say this, it's not easy, when you realize that some dreams
must be allowed to die. But, out of letting go
something else becomes available. When I chose to walk away
from the medical profession, I gave myself a second chance, a chance to thrive instead of suffering, to find and do work that I love, and to contribute to make
a difference in my own way. There is so much going on in our world
right now that demands our attention. I believe that we must
take up to that challenge with passion and commitment, and that means that we must be willing
to let go of what no longer serves us, and what ultimately, prevents us
from truly serving others. The world needs us at our best. Thank you. (Applause)
