To explore the influence of becoming a medical student on my identity I painted this self portrait, which I named "Under Oath". In it I depict myself wearing surgical scrubs with words of the Hippocratic Oath, taken from an ancient papyrus, projected onto me. I feel that by becoming a medical student I have not only embarked upon a five year degree but also a lifetime's vocation with other people at its heart. I know that this will be immensely rewarding, but I am also conscious that it will come with challenges as I try to meet the societal expectations of what it will mean to become a doctor. In my painting I tried to demonstrate this using the Hippocratic Oath and scrubs to symbolise the external expectations projected onto me both by society and the professional guild I am joining. Since starting medical school, I have become increasingly aware of how all encompassing the role of a doctor can be. If you don't assume this role adequately you risk behaving unprofessionally or even endangering the very patients you are there to help. Yet, by over-assuming the role of a doctor in society I feel you can lose aspects of your own identity, to the detriment of both you and your patients. In the future I hope to be able to maintain a balance between my own individual sense of self and my identity as a medical student, and hopefully a doctor. In my painting I have tried to convey this through my gaze, holding eye contact with the viewer as an indication of my own individuality.

“Starting line” is an image of myself crossing the finish line of a race and becoming a medical student. In this piece, I attempted to illustrate how my identity has changed since becoming a medical student. The audience in this image represents how I am viewed by my family, friends, and acquaintances as they watch me. I have split the audience in half where the audience on the left are holding up signs in black that represent the different assumptions people had about me prior to becoming a medical student, compared to the audience on the right that are holding signs illustrating what people assume about me now that I am a medical student. This allowed for me to describe how views about me have changed since becoming a medical student. The writing on the track represents various aspects of the experience of being a medical student. Similar to the audience, I decided to split the track in half where the black writing represents what I thought becoming a medical student was like compared to the red writing which highlights my current experience. I have deliberately made the track on the right hand side larger than the writing on the left side to reflect on how there is much more to the experience of being a medical student that you can’t appreciate until you become one. I chose to structure the audience similarly to the track so that the signs in the audience could be compared to the words on the track to highlight how assumptions others have may not be correct or accurate. On the red tape at the finish line, I decided to put the word “start” rather than finish because despite this being an achievement, it is just the beginning of a great journey ahead of me.

My creative piece explores a moment in which I was intensely moved by compassion for a patient and his son, but also desperately in need of compassion and care myself. I was torn between the desire to attentively, gently listen and the impulse to run out and crumple.

As I saw this young man in front of me, it seemed to me that his experiences were mirroring my own. We were in the oncology clinic, and he was there with his father, who was in a wheelchair. I was new to med school and recently bereaved. It was only months earlier that I had held my Mum’s hand for the last time.

I considered the challenges that lay ahead for him. Moments of intense pain came back, smashing into my chest, and winding me. Whilst I so wished to use my energy to show empathy, all I was able to do was adopt a nodding sympathetic posture. My energy was needed to keep myself together.

As I listened to the consultation, I subconsciously hunched forwards and wrapped my arms around my chest, as if to hug myself, reassuring myself it would be ok and yet also ensuring my vulnerability did not escape. I felt guilty as I was unable to be emotionally ‘available’ to the patient.

In the couple of years since then, I have tried to explore what it means to be an authentic, empathetic, and self-compassionate healthcare professional. How do we flourish and not burn-out in an emotionally demanding environment?

I am still seeking depth to these answers from various perspectives, but I find that as a Christian, my relationship with God, and the infinite acceptance, forgiveness and love He gives me, is source of strength I can always come back to.

This painting is entitled ‘The patient examines the doctor’, which is also the title of a chapter in Intoxicated by my illness by Anatole Broyard (1). It is a moving and witty personal exploration of illness and mortality. In that chapter Broyard explores what he looks for in a doctor.

I have depicted the patient auscultating the doctor’s head as a metaphor for the patient wondering ‘what is the doctor thinking?’ ‘Who is this person?’ ‘Does he know what he is looking for?’ ‘if there is something to find, will he find it?’ And, as Broyard crucially adds, “How good is this man?”1

Patients share the intimacy of their body and mind with their doctor, possibly exposing thoughts and details that they wouldn’t even reveal to their own partner. Broyard’s book reminded me how important it is for doctors to make patients feel that they are respectful of the immense trust that is bestowed on them. There is a vulnerability in the basic act of taking your clothes off and letting someone examine you.

The two figures are squeezed into the composition to represent the intimacy of the interaction. I depicted the figures as the same person, to represent the idea that the doctor could easily be the patient, as we are all a patient at some point in our lives. I muted the colours, and faded out the outer part of the painting so that the viewer’s eye is drawn to the two central arms, which are almost entwined. I allowed drip marks towards the bottom, a metaphor for the impermanence of human life, and how our lives unravel in the face of illness. The patient is coming to the doctor because he is ill; once the doctor diagnoses what is wrong this resets the parameters of the patient’s life.

References:

1. Broyard, A. 1992. Intoxicated by my illness. New York: Ballantine Books. (pages 33-58)

Medical student, 2017

Through this work, I would like to show that time is altered forever when a patient is diagnosed with a serious illness. Diagnosis with a chronic or terminal illness disrupts a patient’s life plan and changes how they view time. Chronic illness diagnosis is often associated with uncertainty in terms of prognosis and amount of time left in which a patient can be active. Patients lose control of how they want to spend their time, having to attend appointments at times that are convenient for the doctor and the health system but not for the patient. One example of this is cancer treatment which provides certainty in terms of a timeline, but patients on such a treatment plan must make many sacrifices to attend appointments and treatment. In a system where the patient is supposed to be central to everything we do, a patient’s time is no longer their own.

Patients losing control over their time is particularly true of hospitals. Being a patient in hospital leads to a loss of a sense of time and identity. Patients can no longer choose when to eat and often do not have any control over when they are seen by a consultant. This can also be frustrating for family members who feel left out of the decision-making process. In terms of identity, patients are identified by what is wrong with them rather than how they choose to spend their time or what clothing they wear. There is however another way, the national pyjama paralysis campaign is aiming to reduce the reinforcing effect wearing pyjamas has on feeling unwell (NHS England, 2018). By helping patients to wear their own clothes in hospital they will be able to identify as something other than their disease.

I have represented this patient experience as a mixed media piece made from a broken clock. I have created a piece of art from a broken clock face to symbolise how a patient’s experience of illness is closely entwined with time. This piece also represents how a patient’s life is disrupted when they receive a chronic diagnosis. The hole in the canvas signifies how a serious diagnosis tears a hole in their life plan. This hole also represents a loss of time left, as well as loss of having control over how patients can choose to spend their time. Another interpretation of this fissure is as the rift between a patient and their family, as relationships change due to the burden of illness. The clock face signifies the face of the patient who loses their identity and embodies their illness after diagnosis. The hands of the clock are held together to indicate a doctor’s attempt to reach out to a patient and offer them comfort and closeness. The cogs in the clock which have moved away from the middle, signify the machinery of life, which is no longer central to a patient who is experiencing illness. The numbers represent the hours of a patient’s life, which are no longer the patient’s own and are counting down until their last hour.

medical student, 2018