Ishan Jain's Thoughts

Getting closer to knowing myself, day by day.

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  • Health and ‘Wellness’

    I am, like many others, concerned for my health. I want to optimise it, to have it perfect so that I have ‘nothing to worry about’ and am ‘healthy’ and live injury- and disease-free. Wouldn’t that be great?

    I have consumed a lot of health and ‘wellness’ (which is just health) content over the last couple years. I had a scare where during a teaching session at med school, the teacher caught something on my heart scan – an ultrasound showing aortic regurgitation – a leaky heart valve. Which for those who don’t know, isn’t something too major to worry about, especially if it’s asymptomatic, i.e. not really affecting my life. But, at the time, as a final year medical student, I suddenly felt like I had been given this ‘bad luck card’ by life and a life-shortening sentence. Now, there are many many worse medical conditions and things one can be told, and I knew this rationally, but there is this vulnerable feeling as a patient that all logic and rationality goes out the window briefly and you think ‘Is this it?’, ‘Am I going to die?’.

    As someone who has always been a bit scared of death and its unknown, this question did go through my mind. My friends and my cardiologist reassured me. Dr Google reassured me too. But, it did spark my first real interest in taking ownership of my own health. I’d never considered myself unhealthy until this moment. And even then, I didn’t label myself like that.

    I started to trawl through the minefield that is health and ‘wellness’ content online to try and take control, and work out what I could do to help my own heart. I was told a month before running the Stockholm Marathon not to do it by my cardiologist. I naturally had the question ‘wait, so how much exercise is good for my heart?’. I’d always thought marathon runners were the epitome of health, but this information was now telling me otherwise.

    Since then, I have read infinite articles, read many books and listened to countless podcasts about health. I have a natural interest in it as a doctor too, but this was mostly stuff you don’t really get told at medical school. You get told to eat healthy, to sleep, to ‘look after yourself’ and to ‘not be stressed’. But, what does that actually mean? I then learnt of this whole new world where many people, some doctors, some health professionals, some not-so health professionals were sharing and preaching about what to do for health. Some things sounded mad, some things were viral, some things were incredibly popular and some things weren’t. Everyone seemed to be an expert. And I felt like I knew nothing after 6 years of med school.

    Two years on, I know feel like I’ve reached the stage of full circle in my reading. I’ve sorted through a lot of information, I’ve picked up some bits, I’ve developed my bullshit filter, I’ve used some first principles from my own education and I’ve come to some conclusions. But it is an ever-developing space with some really exciting research about microbiomes, epigenetics and DNA-editing.

    From all my reading, and constant bombardment from Instagram and social medias of ’99 habits you need to know right now to live longer’ which get me, I ended up:

    • Buying:
      • 2-year Whoop subscription
      • 1-year ZOE subscription
      • Lingo monitor for 2 weeks
      • Lumie Bodyclock 100
      • Scalp and body scrubber
      • Several sleep masks
      • Ear plugs
      • Mouth tape
      • Several books
    • Downloading the apps:
      • Don’t Die
      • NBack
      • Medito
    • Listening to lots of:
      • The Diary of a CEO
    • Subscribing and unsubscribing to several email newsletters:
      • ZOE
      • Dr Karan Raja
      • Blueprint
      • British Society of Lifestyle Medicine
      • Wim Hof
      • Dr Mindy Pelz
      • The Doctor’s Kitchen
    • Following:
      • Way too many health influencers on Instagram

    It’s been an expensive and tiring journey. Both for me and those around me.

    I’ve learned a lot, that’s for sure. There is a lot that we can do to take care of ourselves and look after our health. A lot more than I realised. But also a lot of it is common sense and is basic. Yet, many make many thousands and millions selling courses, products and a lifestyle that is maybe ever-so-slightly more healthier than a free one.

    The main summary I’ve taken away from all this is:

    • Sleep, exercise, eat and drink well
    • Brush and floss
    • Go outside
    • Keep yourself and your spaces clean
    • Don’t take things too seriously
    • Don’t live the same day again
    • Try things, learn things, make things
    • Be kind to others
    • Be kind to yourself
    • Be yourself wholeheartedly

  • Working on GP is draining

    I really enjoyed the start of my GP rotation, but now at only 2 months in, I feel drained. The end of each day drains me more and more. This wasn’t what I expected, as I was going into this rotation thinking it could be a potential career. But now, I’m not thinking that. I have a newfound respect for GPs and how they deal with the constancy of their clinics and days. There is endless admin, follow-ups, typing, letters, referrals, organising tests, meeting patient expectations and quick diagnostics. I don’t see anywhere near as many patients as an F2 that actual GPs do, and I still feel like this.

    But, there must be something else. Not working Fridays, weekends and nights must be better, surely? Coming into this, I thought that working on my own seemed great, no one telling me what to do, learning constantly, having my own independence, but I guess I was wrong. Each patient is unique, and I do like speaking to people, generally. Some parts are repetitive, I don’t love typing so much and working at a screen all day isn’t ideal.

    I think it’s the feeling of progressing towards something that’s missing. Each person, each patient, each case just has so much delay to finding out the answer. In reality, people are so much more complex than a clinical vignette. They have so much going on sometimes that it’s overwhelming. Or they don’t have much going on at all, and it’s not intellectually stimulating. I have yet to find that sweet spot of challenge and curiosity at my skill level in GP to find it enjoyable. If things I advise and do help, you never hear from them again. If things I advise don’t help, I will be sure to be the first one to hear about it. The way this is just is not satisfying. I understand that is the system.

    But, it would be nice to be able to hear that things you said and did actually helped. It would be nice to get more positive reinforcement. Them never coming back doesn’t feel like enough. I want to track their lives in a way. I am so interested in finding out what is happening behind the scenes, outside the appointment.

    Maybe there is a way to do this in the future. Maybe I just need to audit my own work to find out, call each and every patient I’ve met so far on GP and see how they’re getting on. That would be nice. I do remember most of them.

    I think another thing that’s missing from GP is the camaraderie. Everyone has a million things to do, so always seems in a rush. I have met lovely people and it is nice chatting through patients with supervisors that care. I didn’t expect to miss that. You start and end the day on your own. A small handover at the end of the day would be nice. Some clinical and some not so clinical chat. I’m grateful to at least have this when I go home.

    I guess another aspect of GP is that it is pure service provision and ‘customer satisfaction’. I haven’t met GPs here that have other projects going on, research or wider goals. Maybe they do and I just don’t know it. But, I’m almost too drained after each session to even socialise with them and learn these things.

    We’ll get there. Wherever there is. We’ll find a way to forge a meaningful path in this thankless career, one way or another.

  • My dad had surgery today

    My dad had a cataract surgery in one of his eyes today. It’s a short, routine procedure that’s under local anaesthetic so what’s the worry, right? The main fear of surgeries is never waking up again from general anaesthetic. Yet, there was palpable anxiety from all of us in the family, me included. What if things went wrong?

    Experiencing the other side as a ‘patient’s relative’ was humbling and maybe also exactly what I expected too. For a procedure taking about 30 minutes in total, from start to finish, we were there for 6 hours. Yes, it was free and yes, it was complication-free (so far, touch wood) for which I am grateful. But, there wasn’t much kindness towards us today. From being greeted at reception coldly to not being allowed to go in to see him afterwards ‘because it’s too busy’, it felt like we’d turned up on the wrong day to the wrong place. The hospital was one of the nicest NHS hospitals I’ve ever seen – no complaints about the decor or cleanliness, but kindness and warmth from people were lacking today in our experience.

    It made me really think all the times I’ve spoken to patients and their relatives as a doctor, and I feel I do try to be kind and empathetic, but I know there’s not always time for it. I’ve never denied a relative a chance to visit, even if it’s ‘too busy’ or the ‘wrong time’, and I will continue to do this, even if it goes ‘against policy’. It isn’t the right thing to do. It isn’t the best thing for the patient.

    Another point of reflection was about vision. Eyes. Sight. My dad came out wearing an eye patch and tape over his eye, like a battle wound was covered up. Luckily we were there to drive him home, read the medication instructions and give these. It did make me feel for those who didn’t have family or friends to do this for those out of surgery. Without vision, the world is very difficult and very different. Do we look after our eyes? I don’t. Not as much as I know I could. Using screens all day long to work and not to work while not using the 20-20-20 rule is probably killing my eyes slowly. I do try to eat a healthy diet and I don’t smoke, so that’s something at least. And I don’t itch my eyes as much as I used to – they do look less red than before. I’m getting better at contact lens hygiene too, and wearing those less and less too. I’m prioritising my sleep a bit more too. So hopefully that’ll help. I should go out in the sun more though, apparently a bit of that helps too.

    My experience of the world would be so subdued without my vision. I want to be more grateful for what I see. For seeing. I remember the first time I tried on contact lenses, and I could see completely clearly, I cried. I was 12 years old. The optician’s room was just so beautiful. The colours were so vivid. The world looked so rich and full of life. I still occasionally feel like this when I put my contacts on. I feel free. I’m seeing the world in HD. 4k even. Most of the time now I’m just furiously wiping my glasses lenses with my t shirt I’ve worn all day and wondering why they’re not clean.

    Being an eye surgeon and gifting people their sight must be magical. Must be impossible to train as one because who wants someone who isn’t an experienced expert operating on their eye? That’s one specialty I have a lot of respect for. But it’s not for me. Too many micro movements.

  • Separating work from home

    Growing up, I always saw my dad working late hours into the evenings and weekends. I see this even now. Sometimes, it frustrates my mum. Sometimes, she understands. It’s always from a kind place – as she just wants him to be present, both with her and us. Sometimes she expects me and my brother to be working just as much. But, I’ve always believed that I don’t want to be like that. I have wanted to be present for my family from a young age. I have wanted to be prioritising them over work. I have wanted to separate work from home, so that I’m never frustrated at my family and always present. I know now that these things are harder than they sound, but I can at least try, right?

    I’ve seen this with my own limited experience while working. The commute doesn’t always decompress me as much as I hoped it would by the time I get home. And sometimes, I need another few minutes to just deflate and exhale all the day’s frustrations and hard feelings. I have found just having these few minutes of peace to myself really helps. Writing, talking it out, breathing or even just closing my eyes for a few minutes for a much needed but unintentional nap in my parking garage, really does help. Just one of these things ensures that I enter the house with a fresh headspace, ready to take on whatever is happening at home; ready to be present for my family and friends. I visibly notice the difference when I don’t do this. It’s a lifesaver. I’d rather come home a few minutes later than come home in a bad mood.

  • Overwhelm & Indecision

    Lately, I’ve been filling my free time with endless thoughts. Overthinking about each and every branch of my future career and life path, and the various hurdles needed to surpass to get there. Wherever ‘there’ is. It’s tiring, overwhelming and ultimately I’m not sure I’m closer to making a ‘decision’, but perhaps closer to a ‘direction’.

    I’m in an incredibly lucky position, something I need to remind myself of more often, because I have unlimited choice. I have freedom and the foundation to be pretty much whatever I want to be. I’ll likely end up happy in most of those paths, because I’ve learned to be happy in myself rather than what happens to me on the outside. Which almost makes things harder – there’s no single ‘right’ choice.

    My barber likens this phenomenon to an all-you-can-eat buffet. In the previous generation, the number of cuisines and dishes on the table were limited. It was easier to compare individual choices and choose one. As time has gone on, the number of cuisines and dishes on the table has exponentially risen. They’ve become more accessible with globalisation. What compounds this choice anxiety is that we can now more easily experience what would have happened if we’d chosen the other cuisine, or the other dish. We can compare with others at the press of a fingertip through the internet, learning about people at earlier or later life stages, choosing the same or different cuisines or dishes. Seeing all these other choices play out and work out well gives us the impression we may have made the wrong choices; reminding us we could have chosen a better dish. The truth is that all cuisines have incredible dishes, and everyone has different tastes, preferences and dietary requirements. Learning to enjoy what’s on the plate in front of you takes practice, and might be easier if you don’t focus on all the other choices you could have made.

    The internet has given me a wealth of information to consume when I try to find out what career paths I can take as a doctor. I got tired after reading article after article. But I did learn some things which I will try to take with me as I make my own path. Being a doctor is a role that has lots of moving parts; lots of factors to consider. Lives are so complex. We are learning evermore information about the human body. It is very difficult to keep up with all of the latest advances and projects people are leading to improve healthcare. Everyone wants a better healthcare system, a better NHS, and some people are doing really good work to try and contribute to that. It’s inspiring, but also daunting, because it seems like everything you can think of has been done already.

    I came across a unique approach to guiding career choices – to go from the inside-out, i.e. to start with me and who I am, rather than try and pick a random path and follow it blindly.

    • I have always believed in kindness
    • I have always believed I am incredibly lucky and fortunate to be who I am
    • I have always dreamed of being part a happy and loving family
    • I love learning about new things
    • I love novelty and trying new things
    • I feel most comfortable when I am being wholly myself, in a forgiving environment that embraces curiosity

    When I write this list, it brings me peace in making big decisions. It helps remind me that lots of paths will meet this criteria. It also helps remind me when to leave and look for a path that gives me the above. So, whatever path I do end up falling upon, I will do my very best to continue matching myself to what I am doing.

  • Why is it so hard to know what I want?

    I am struggling to answer the question ‘What do I want?’

    My mind jumps to a million different answers, all at once, and then I feel overwhelmed and shut down, and end up doing none of those things. Or I end up doing the thing I didn’t really want to do.

    I am writing because I struggle to articulate. When I say things aloud, the words that come out don’t always resonate with what I actually felt or actually wanted to say.

    I have read too many pieces of advice on this topic, listened to too many podcasts and not actually thought for myself for a while. There is a lot of noise around me, a lot of people who seemingly have it all figured and a lot of people who don’t. None of it is getting me anywhere.

    So, let’s try and simplify things and break it down.

    There are some things I know I want. There are some things I know I don’t want.

    • I want a family. Yes, everyone does. But I have always, from a young age, wanted a happy living environment and to be the parent to my child that I maybe wanted growing up.
    • I want freedom. To be unrestricted. To do what I want. Doesn’t everyone?
    • A real life Disney movie. Pure, happy, kind, nice, happy ending

    I also want:

    • To not work night shifts.
    • To look after my health because I don’t want to ever be an inpatient in a hospital.
    • I want to be able to think in a calm environment.
    • I don’t like chaos. I don’t like being on the conveyor belt to see patient after patient. It’s draining.
    • I want to make a real difference

    What has frustrated me about my first 1.5yrs as a doctor:

    • There is endless admin. It’s medicolegal, defensive work ingrained into us. Seniors will tell us how much it’s changed over the last 10-20 years, in front of their eyes. It’s repetitive, it’s draining.
    • The underlying problems don’t really get dealt with. They get pushed around. More bureaucracy. Not enough answers for patients. Not enough solutions. Come to see your GP, get referred here for blood tests or scans, and there to be seen by this doctor, at some point in the next few weeks to months. There is a lot of waiting and uncertainty for patients.
    • Staff are tired. They’re overworked, stressed, busy. They’ve had enough. They’re burnt out. It’s sad to see. I can see this for myself too.
    • There are constant conveyor belts everywhere. It feels like working in a factory, not a GP practice or a hospital. There is constant turnover of staff and patients. We are very replaceable as doctors. I don’t think we realise this.
    • I can’t seem to help patients as much as I’d like to. I’d love to have the time to sit with them to go through all of their issues, to educate, to help them feel empowered about their health. At the same time, I feel tired of preaching, of saying the same things over and over again. It feels like a hamster wheel.

    Another thing I know is that whatever this is right now is not what I want to keep doing. Something needs to change. Something doesn’t align at the moment.

    I can’t wait for that moment much longer.

  • ‘Meetings are not work’

    Coming to the end of my psychiatry block, I have had a realisation about meetings. There were just too many of them. I sat through mindless meetings where time felt like it had completely stopped and I was stuck. Morning meetings on paper took half an hour, but in reality felt like my entire soul had been sucked out at times, and I was being punished.

    Sitting through meeting after meeting makes you realise that they are simply not work. They are a substitute for work. They don’t really help move anything forward. They can be summarised in an email. They are usually thoughts people have already had before the meeting. None of them have been revolutionary. They may change the odd thing here and there. Some of these changes aren’t really pushing the needle though.

    Meetings are tiring, they require a different type of social energy that takes some time to recharge afterwards. I could work on something I care about, something I’m using my mind for, for hours sometimes without a break. I couldn’t sit through a meeting, even on a topic I cared about, for longer than half an hour. I wonder why that is.

    Actions ultimately speak louder and more profoundly than words. Words actually are mostly filler. Mostly mind dumping. Mostly unnecessary. It’s interesting that people find the need to share their every thought at work as if it is what they’re there to do. That’s what writers do.

    One of my seniors told me they did a job in Denmark where meetings were very few and far between. Work was actually done. Progress was actually made. Things got done. People were doing things they wanted to do. People felt motivated. People weren’t drained. The environment was different.

    Ideas do need to be bounced off people sometimes. This can be done outside a formal meeting. Creativity isn’t plan-able. Meetings certainly aren’t most people’s creative spaces. Idle thought and flow states aren’t reached when they are interrupted by meetings upon meetings.

    Here’s a call to just do the work. Stop calling meetings. Talk to people individually. Actually connect and listen to them that way.

  • My busiest day yet

    Today was my busiest day yet. I’m the only doctor covering three separate sites while on call for psych. All 20 minute drives from each other. It’s been manageable so far. But today was tough. I’m coming home at nearly midnight writing this having left home at 8am.

    I counted the number of calls I got and it was 48. I don’t know what I was hoping to gain by counting them. A massive range of tasks. Objectively a really interesting day. I met so many people, staff and patients, I lost track. I didn’t really eat or drink between 9am and 9pm. At times, it felt like chaos. But at the same time it was controlled. I was a motor. I just kept going. I was steady.

    My tracker showed just 10 minutes of stress all day. I remember I had an on call shift once showing nearly 6 hours of high stress. I think this was because I was the only doctor on site. I wasn’t really influenced by others as much. I had time while travelling in between sites to calm down, listen to music or my podcast and just chill. I had time to think. I had time without people telling me what to do. I was managing my workload. And I liked it. I enjoyed it. I was almost in a flow like state in the afternoon. I only really felt the tiredness later once it got dark.

    With this many bleeps, you unfortunately can’t do every one. Not without compromising patient care. The way I work prioritises quality of care over speed. And I will try to keep that up throughout my career despite all the external pressures to do more and to go faster than is comfortable. I have gotten more used to handing things over and switching off after work about the day, but it is difficult. As my supervisor told me, it’s a balance between trying not to be a perfectionist but still showing plenty of care and effort with each patient. I think I’m slightly towards the perfectionist side at the moment. But I’ll get there.

    The issue with this is that it’s a team sport. If you look hard enough you’ll find some holes, some mistakes from others, some things done by others that aren’t quite the way you’d do them. Sometimes you don’t even have to look that hard. And it’s about picking which ones you wanna deal with, and which ones can do without. Even if you start going through your own work, you’ll find plenty of holes and things you might change. I find it hard to accept that’s that and am always looking for the next gap or the next miss. I love finding those imperfections, but I don’t know when to stop sometimes.

    I think the key with the busy days is to try and reflect on them. Same with other less busy days too. I’ve found it makes me a better doctor. Some people today appreciated my work. Some people were lovely and very grateful. And that’s always nice. Some people swore at me. Some people distracted me. Some people got annoyed at me. Some people felt ignored. I can’t please everyone unfortunately. I’m trying to engineer my brain to remember the good bits. And think about what I could have done about the less good bits. And if I’d have done nothing different next time, then that’s that.

  • It’s tough for carers

    Having worked with lots of families now who’ve been through a lot emotionally with health issues, I’ve seen what feels like the full range of families. I’ve seen distant families who never visit and don’t pick up the phone, and those who are there every second of every day. Some hit you harder than others. Today, someone I’d gotten to know over the last couple days really got to me.

    An older man, the husband to his wife with dementia. She’d only had it diagnosed a few months ago, but has been suffering for years. Family suffering all the more. Especially this man, who knew his wife for 30+ years, had many incredible memories together, and now she sometimes forgets who he is. He told us she talks about her husband in front of him, with the same name, and same memories, but he isn’t even acknowledged. Even though he’s sat right next to her. It’d be upsetting to hear for anyone with a heart and tears. Someone in his generation, of his kind, wouldn’t normally ask for help, wouldn’t normally admit he was struggling. And our team were apparently the first to properly listen. He’s met countless doctors yet we were the first. It’s shocking really.

    It’s so powerful to listen. We can offer help, signpost him to all the services in the area, his GP, medications, charities, all these unlimited things online. Yet, the most important thing he actually needed was someone to listen. To hear him. To empathise. It’s free to listen. It’s hard, but it doesn’t even take that long. It’s easy. Yet, why was it that we were the first in a few months to hear him?

    The environment maybe helped – we’d talked to him alone, away from his family. No more having to put up a brave face. The crutch for the rest of the family. The lone wolf.

    It felt admirable to see him cry. It felt like a privilege to be the one to look him in his teary eyes afterwards, heartily shake his hand and tell him that we’d sort it out. We’d look after his stresses. He left the room with visible weights off his shoulders. The relief was palpable. My feeling was that he’d cry once more after he’s left the room too, maybe at home, but this time, tears of relief. And after that, things would start becoming slightly more okay.

    The situation is a tough one. Dementia is incurable. It’s progressive. It’s a loss of their mind. A loss of who they once were. And medications can only do so much to attempt to bring that person back. It might make them calmer, but does it make them more themselves? That’s what these families really want, is someone who’s familiar to them, someone who remembers them too for who they were. As I read in Oliver Sack’s ‘A man who mistook his wife for a hat’, “Who are we without memories?”

    I feel incredibly lucky to be in this position to help these people. I wish we could do more. I wish there was a magic pill, a way to just click and make it all go away. But unfortunately there isn’t.

    It reminded me how lucky I am to not have a family member with dementia. To be able to look after my health. I hope so anyway. Nobody chooses to have dementia. But hopefully I can do as much as I can to prevent it in myself and my family.

  • Doctor, do you believe her?

    I was doing psychiatry nights and it’s my job to work out why new patients have come to the hospital and find out more about them. So, there was this one person who took some time to talk to as they had a complicated story.

    Their story was interesting and I wanted to do things properly rather than subject them to prejudices and biases from reading their notes. When some people have certain diagnoses or labels on their notes, I have seen many people be treated differently because of these. Biases can work both negatively and positively, they can result in people being given more or less time and attention. Seeing both makes you really think that biases are so common. Even the most simplest ones, and the ones you’d think no longer exist.

    In this situation, my patient was a woman. And after leaving the room, the healthcare assistant who was with me asked ‘Do you believe her?’. It wasn’t the first time I’d heard that phrase. It wasn’t the first time I’d been asked this. But, this time it really hit me. This person has just spilled her life story to me after I carefully built rapport and trust, and it was an extremely vulnerable time for them. I understood that some details were inconsistent but I do believe that the assumption should be to believe people’s stories. Innocent until proven guilty. Truth until proven lie.

    It made me feel sad for people like her. It made me feel sad that some of these people are subject to these biases, especially in mental health, where these healthcare assistants and mental health staff have worked for many years, and likely dealt with some genuine and some not so genuine people. Their trust seems to have been eroded by their experiences. And their faith in humanity seems to have dropped – even in telling the truth; their truth. Everyone’s truth is slightly different, everyone’s version of the truth is unique. And just because we don’t agree with their truth should not mean that we don’t believe their truth. Or at least give them a chance.

    I think what made me sad was that the bias was such an outdated one, yet seemingly such a common one. Women not being believed is a huge issue, not just in mental health, but in society. This issue seems to be still present today. I just think it’s incredible with all the advancements we’ve apparently made in society, that such an outdated prejudice of not believing a woman came up.

    I guess you just have to keep trying to stick to what you know is right, and try not to be too influenced by the people around you and the prejudices, the biases. We all do have some element of unconscious bias, and being aware of them and trying not to act on them, keeping things equal and fair is important.