“Tom Wolfe was right. You can’t go home again because home has ceased to exist except in the mothballs of memory.” (John Steinbeck, Travels With Charley)
Once you leave something, can you ever truly come back? Yes, you can physically return but even if things are the same as when you left, you will surely find yourself altered by your leaving, your being away and the often difficult path of coming back.
I know from the experiences of friends that after long periods of sick leave, maternity leave and other career breaks, that it can be hard getting back on the medical horse.
I didn’t work a lot last year, and the financial repercussions of my lighter work load eventually caught up with me and my family. This prompted me to look for a way to catch up. And so I came to sign up for two weeks of locum work up north. 9-6, five days a week, plus a busy Saturday morning clinic on one of the weekends.
As well as the financial motivation, I was also getting sick of being out of the game, and worried that the longer I stayed away, the more likely I would lost all my confidence and would never be able to go back. This was, in some ways, a test.
I chose a locum in the same town in which my mother (also a GP) works, so if I got stuck I could ring and say ‘where should I send this patient?’ or ‘does this plan sound reasonable to you?’
Happily my good friends would also be holidaying near there, my parents live there of course, and other supportive friends had said to ring them if I needed to at any time. My own family would be far away- but there was Facetime.
The anticipation of the long hours and stress, along with feeling uncertain of whether I still had the requisite knowledge and skills had me wondering if I was making a huge mistake. I imagined all sorts of situations where I would be helpless. The ‘drug seeking patient’ was one scenario I doubted my ability to manage in a way that would leave me and the patient not too shaken by the encounter.
I asked colleagues how they would prepare themselves for returning to work after being stranded on a deserted island or similar, for the better part of a year. Their tips included sitting in with a colleague for a session, which I did. I asked a colleague whose work embodies the kind of practice I aspire to myself if I could observe her, and this proved very valuable.
Watching and listening as she saw her patients reminded me that this was all still familiar. I would not be at a complete loss. As an esteemed GP e-friend said this part of me would always be there; it could not be forgotten. This part, the doctor part of me, will always know how to develop rapport, engage with a patient, hear them (truly hear them) and respond. To prioritise clinical issues. To weigh up risks, and set out a plan.
Any small factoids of clinical knowledge that are forgotten or simply hidden from the conscious mind can be looked up, re-learned.
Another friend of mine, handily also a psychiatry registrar, gave me some mantras to recite to myself as I navigated my way through the nervousness on the first days of work. One of these I think we could all benefit from:
Feelings are not facts.
You may feel out of your depth and as though you aren’t coping, but just because you feel this, doesn’t mean it’s real. Look at what is real. See, you just saw three patients. You’ve finished your notes, you’re walking to the waiting room to call another. You smile at the nurse in passing. Look at you. You’re coping and you’re getting things done, despite the way you feel. As the hours and days pass, the feeling lessens, because it is no longer relevant. It is a false clue, pointing to a false reality.
Because you can come home. It’s different and you are different, but it’s still home and you’re still you. And you’re not alone.
When the time came, I did just fine.