GP Roy Alexander Briggs Prize

“Buy yourself some flowers” 

I bought myself some flowers last week. I picked them from a flower stall, a bunch of daffodils, their bright yellow heads not quite escaped from the green buds. I carried them home in their elastic band, tucked in the side pocket of my rucksack trying not to crush them with the weight of my laptop and textbooks as I sat on the tube. They felt very fragile in the bustle of the commute. The flowers sit on my desk as I write, in an old kilner jar I bought to make marmalade in but still have not. I bought them to make me happy, no other reason. Two pounds down the drain, or perhaps a small act of self-care.

I had been in the hospital all day, it was my first week at a new placement. Even though I didn’t know what I was doing or where I was going I tried so hard to be confident, assertive and impressive. Who I was trying to impress is not clear, was it my consultant (we hadn’t met them yet), was it the patients (we are all the same to them), was it myself? I had been asked questions I couldn’t answer and when I left I was stressed and I was embarrassed. If I still don’t know the basics, how will I ever learn what I need to know?

The Greek name for the daffodil is narcissus. In Greek mythology Narcissus was a beautiful young boy, who fell in love with his own reflection in a pool of water. So strong was his obsession he was unable to look away, eventually he realised that his love could not be reciprocated. He faded away and in his place he was left as a daffodil. When I got back home I wanted to fixate. I wanted to sit there and obsess about all the things I don’t know, all the things I got wrong and all the things I am bad at. I wanted to wallow in my inability, become paralysed in my learning and just pretend that medicine didn’t exist.

Behaving like this way will not get me anywhere, I will fade away looking at my own reflection like a self-loathing Narcissus. As a medical student it is important that I keep reminding myself of why I am doing this. I want to be a doctor, and this takes years of learning many different skills. You need to work hard to become a doctor and this requires energy and compassion. However, doctors are humans too. We have strengths and we have weaknesses. We have good days and we have bad ones. Being kind to yourself is important, we don’t always get the support we need and burnout is common at all stages of a medical career. To care well for our patients we must first learn to care for ourselves. 

So instead of wallowing, I recognise these weaknesses, I remind myself I am human and medicine is hard, and I carry on. I spend the afternoon drawing my daffodils. I use my iPad as it is new and makes me feel like David Hockney and I enjoy the images I create even if they won’t sell for millions. I love the striking shapes, the bright colours and the ability to animate the process. I chose the colours for their boldness, their happiness, and because they make me think of holidays and summer and childhood colouring books. I don’t want the image to fade away once the flowers have gone. I want to be able to see them from across the room, to represent the calm these flowers brought and the joy I associated with them. The daffodils remind me of my mum who always used to have them in the house. I ring her and talk about my day. I sit down and go over some of the questions I couldn’t answer that morning. The process of drawing was my self-care, allowing myself the time to draw was my self-compassion. 

Daffodils are some of the first flowers to bloom in spring. They emerge from the frosty ground alongside snowdrops and crocuses. They are associated with new life, new beginnings and the end of the hard winter. The next day I left for the hospital again. I had read up on the questions I had not been able to answer the day before. I was relaxed and I sent my mum a picture of the daffodils on a card for her birthday. I knew only a little more medicine than I did the day before but that was okay, I have the rest of my life to learn and I needed that time to draw my daffodils.

As the daffodils sit on my desk I am still enjoying them and I hope my drawing gives you a share of my enjoyment. So, buy yourself those flowers. Don’t see two pounds spent on yourself as money down the drain. Whatever you choose to make your act of self-care, a fancy coffee, or a conversation with friends, make it whilst encouraging self-compassion to become part of your day to day attitude and conversation with yourself.  

 Medical Student, 2021

This piece is a symbol of all the hardships faced by everyone in the medical profession, including even medical students. Different mediums such as a digital tablet, newspaper and yarn were used in this piece as it gave it more of a physical connection and more significance to me. 

The faces represent the ‘mask’ healthcare workers tend to put on, by pretending that nothing fazes them. We often hear that healthcare workers need to pretend that they are not affected by any form of emotion when treating patients, as it could be seen as a sign of unprofessionalism. Unfortunately, sacrificing compassionate care towards patients, as well as compassion to oneself. The strings are connected to the faces, which symbolise the big expectations that are weighed on healthcare workers’ shoulders. People often expect them to never make mistakes, and achieve extraordinary feats. As a result, healthcare workers become too hard on themselves for not being perfect. 

Finally, the hands at the bottom represent the power that we potentially hold. The power to potentially break free from expectations and take control of our own lives. The power to be more gentle with our souls and allow ourselves to flourish, instead of pursuing perfection. The power to be able to grow from a difficult situation instead of simply persevering. Regardless of interpretation, I hope this piece allows others undergoing their own struggles to connect with it and inspire them to be more compassionate in their journey to become a better, happier version of themselves each day. 

Plants need compassion to grow. They need water, they need sun and they need space to be able to thrive. Without these essential components, no one would expect a plant to grow and flourish. Without love and nurture, a plant inevitably fails to grow to its full potential.

So why do we expect this of ourselves?

Personally, I have been very guilty of not showing myself enough compassion. For many years, I have suffered with an anxiety disorder and depression. I did myself a disservice by not seeking help- at the time, I did not think I deserved it. I pushed my body and mind to extremes not only trying to cope with everyday activities but also to hide what I was going through from everyone. I would smile and laugh my way through social activities and then go home exhausted and cry. It was no way to live.

From my experiences, I have learned that compassion is not something that we are born with, nor is it an innate trait. We choose compassion and we choose to act in a way that is compassionate, to others or to ourselves. In my early years as a medical student, I mistakenly thought that showing myself compassion and putting my wellbeing first was selfish. I felt lazy for falling asleep too early when I was tired or unworthy of being a doctor if I did not stay up late enough to work. It is a cycle and attitude that inevitably leads to burnout and there is no doubt in my mind that I made myself sicker, mentally and physically, when I made these unhealthy decisions.

I think plants are a simpler example, compared to a human, of the importance of compassion. In the right conditions, which differs from plant to plant, a sapling can evolve into its healthiest and best form for survival. In my piece, the best form of the sapling is a sunflower. As the first hand waters the sapling, it gives it something that is essential for its survival and it is able to bloom into a beautiful sunflower. I chose this plant because it has become a symbol for people with hidden disabilities and as someone who is a part of that group, it was important to me for it to be represented in my piece.

On the other hand, there are factors, environmental and internal, that act as barriers to showing compassion. In my case, the factors that were harming me were predominantly internal, but it is an ubiquitous experience that internal conflicts are exacerbated by environmental stresses. As medical students, this can be the emotional effect of being with people who are seriously ill and dying or the frantic studying for exams that not only do you need to pass but excel in.

This brings us onto the hand holding the caterpillar. I chose the caterpillar because, from its perspective, the prospect of being able to eat all of the sapling is incredibly positive for it. It will be better off for it and be more likely to develop into a butterfly. As a medic, I have rationalised giving myself less compassion because the patients I see need it more. I have since learned that there is enough compassion to go around, and actually it is far more important to show ourselves compassion because, in the long-term, we would be unable to show other people compassion if we are burnt out.

As an aspiring GP, it is incredibly important to me that I learn how best to show myself compassion. The aspect of GP that excites me most is also the most challenging aspect of this specialty- the possible variety of diagnoses is huge and intimidating. When a patient walks into a particular department in a hospital, it is a given that they have an issue related to that specific specialty and will be seen by specialists. When a patient walks into primary care, there is any number of problems and the GPs job is to narrow it down to discrete diagnoses that can be managed and treated. This can be extremely discouraging as it can take time to diagnose a complicated patient and it can feel like you are not doing a good enough job for that patient. I think an important part of compassion in primary care will be to not expect perfection, which is something I often demand from myself. Sometimes reaching the right conclusion is a lengthy process of trial and error and being sure that you did everything you could at each step in the process should be enough to not feel guilty or inadequate.

So, the question remains, how can we show ourselves compassion? What does it look like? For me, showing myself compassion meant seeking help I deserved and accepting treatments that have changed my life. I have had my eyes opened to a way of being I did not even think was possible for me, and I have energy to dedicate to both patients I meet and, most importantly, myself. At the end of the day, looking after our own wellbeing is the most compassionate thing we can do for ourselves, and by giving ourselves the love and respect we would give to any other human being we can develop and grow into our best selves.

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

Doctors have a choice to make about the extent to which they connect with their patients. They can be open and compassionate and give part of themselves to a patient, or they can choose not to engage with a patient’s story. Broyard describes this dichotomy (Broyard, 1993). On the one hand doctors can be ‘professional’ and ‘scientific’, which he suggests is at the detriment to the doctor-patient relationship. On the other hand, doctors can open themselves up to patients and become part of the patient’s story (Broyard, 1993).

To represent these paths for medical practice, I sculpted two oyster shells, one showing the closed side of the shell and the other showing the open side. The oyster that is open has a pearl inside, representing the rewards that ensue from being open to patients. For the doctor, this is the reward of learning from the patient’s story, and for the patient this is the reward of shared decision making and understanding. The negative effect of being open is the emotion experienced by patient’s that gets loaded onto you as the doctor. This emotion must be managed, which can be exhausting for the doctor. Perhaps this is the price that must be paid for giving away part of oneself.

Oysters also have a hard outer shell, which signifies the resilience needed in medical practice to be able to be supportive to patients. This resilience is needed to face pain and suffering that cannot be healed. Oyster’s shells and pearls are made up from many layers, symbolising the layers of trust in a relationship between a patient and a doctor. These also symbolise the choice of how many layers of engagement to peel away.

medical student, 2017

….This picture illustrates Georgina’s* story. It shows her on one of her various trips to the GP after he’s made a number of referrals and the investigations are all negative. The GP is at a loss. When he gets a nice clear result from a patient its easy; he can file that patient into one of the neat boxes on his shelves. A positive result for strep throat; excellent, that patient can be filed into infectious diseases and be given penicillin. Skip lesions and transmural inflammation found on histology after colonoscopy; a clear-cut case of Crohn’s. That patient can neatly be filed into gastroenterology. Chest pain, a STEMI and a blocked coronary artery; straightforward and treatable. A broken bone; easy.

But Georgina doesn’t fit into any one of these boxes. Defeated she slumps back in her chair and starts to slip through the crack that has opened up on the floor. Tired, unsupported and heavy. The GP, desperate to help puts his hands in the air, also defeated. Racing against the clock he thinks, “Why are so many patients I see like this?…this isn’t what I was taught in medical school.”

The rays of light in the picture edging towards the crack are symbolic of hope. In the past, after extensive fruitless investigation there was little more the doctor felt they could do. After the investigations for Georgina’s abdominal pain ... had come back clear, she had left the doctors office with no particular plan. Although she had been a frequent visitor up until that point she felt too embarrassed to go back. She felt like she wasn’t a ‘real’ patient. She learned to live with the ups and down of the pain.

This picture is made in mosaic style from cut out pieces of magazine, to illustrate that this is a ‘messy’ subject to deal with.

• name and details changed

medical student, 2017