Ishan Jain's Thoughts

Surfing on the Gold Coast felt like a rite of passage. Of course we had to try it.

Luckily, the surf school nearest to us also had the best instructor (in my opinion!). Rohan was the perfect balance of wise, chilled and supportive. He gave us a simple step-by-step guide, and let us have plenty of time practising.

In our first lesson, he held our board to keep it straight, and gave us a push. There was a moment when you suddenly felt like you were flying. You caught the wave. You kept your eyes up and on the beach. You pushed your chest up and somehow got your feet in position. You stand up slowly from a squat and you don’t really know how, but you’ve done it! You’re surfing. The wave then runs out of steam and you fall off. The salty ocean washes over you, you look back. You hear a whistle and a whoop from Rohan. You look up to the sun. You feel a thrill that you wish everyone can feel.

Then, you have to trudge back against the current, fighting for your life just to stay stood up and keep your board with you. After failing to catch some waves, you float back to shore. The end of the lesson marks the end of playtime.

In the second lesson, you try on your own and flip over sideways multiple times. You look at Rohan with a sad childlike look, wondering what went wrong. ‘Don’t really know mate, you did the right things, just happens sometimes.’

There was something about the honesty from this experienced Aussie surf instructor with grey curly hair that stuck with me. For some reason, it motivated me to try and try again. To fail and figure it out. To trudge back over and over. To battle the winds and the ocean. I’d manage to block out everyone else in the lesson.

I like that there was no one else I could let down except myself. I like that there were no standards to meet. I like that there were no expectations. I like that it’s fun. I like that it’s ultimately playing in the water. I like that, so far, I always get brought back to shore.

‘Where are you from?’ has always been a complicated question to answer for me. I’m sure this is true for lots of people. The answer always makes me a bit sad.

I was born in Scotland, but I’m not Scottish. I grew up in Macclesfield, but people say I don’t sound like I’m from there. My parents and grandparents grew up and are firmly from India, but I don’t know enough Hindi to pass for a local. They all end up looking at me slightly confused and with no conclusion. So, I leave feeling the same.

Some TV shows, like Modern Family, show the beauty of growing up and living in the same home for most of your life, with family nearby. This made me think home was about having a stable location. A place to always go back to. A place to call home.

But, having moved multiple times now, my home has also moved. How can that be? So, I started to think home wasn’t about the location. People. Some people are lucky enough to call some people their home. The people that have moved have been my family. But when I live away from my family, I also have a home. Not at first, but with time, it starts to feel like home. An attachment grows that makes me feel emotional each time I move out.

On the last day of moving out of my last home, I sat in each room of the emptied house for a few moments. My mind played a short movie of the memories in each place. Even thinking about that now makes me emotional.

So, what is that makes it home? The people? The location? The streets? The feelings associated. The nostalgia.

After just 3 days in my new place, it’s starting to feel like home. Even though we’ve not decorated or made it particularly ‘homely’.

It’s comfort. It feels safe.

Sometimes, I feel sad that I don’t have a place I can say I’m from. But, increasingly, I feel luckier and luckier that I have even one place I can call home.

I recently came across the concept of ‘Taste’. Having taste, being tasteful, good taste and bad taste. I never thought myself as someone who had much taste. I have always been more functional, efficient and ruthlessly logical. I suppose that was the environment I grew up in.

But as my environment evolves, I’m beginning to think I too am evolving. Into someone who shouldn’t be so functional, so efficient all the time, rushing from place to place. My partner told me I should slow down by about 20%. I agree.

Slowing down has made me notice a lot more. About the world around me, about me. I seem to take more in, be less stressed, my heart rate has fallen. I think more clearly, more deeply. It’s beautiful really. I feel more in touch with myself. I don’t think I’ve ever felt like this before. It’s like I’m getting to know myself for the first time.

I can’t wait to find out more about this person, about what they like and dislike. I can’t wait to form my own opinions, listening to my own brain rather than everyone else’s rambling thoughts. Sometimes you just wanna shut them up and just be.

I started to realise everything in my life so far is a reflection of my taste. And I didn’t like it. I didn’t like my own taste. I wanted it to change. I wanted it to be different. I felt it didn’t reflect me. Who I am, not who I want to be or who I was.

I started to think about people I think of having taste. They know what they like, what they dislike. They have a style. They are selective in what they choose to enter their world. Whether that’s what they put in their mouth or their ears. It’s all intentional. I have never had intention.

I suppose it’s a sense of autonomy. Choice. The more autonomy people have, the more powerful they become. I am in a fortunate position to have autonomy. Not everyone has that. I am very lucky. Autonomy is a gift that I must use wisely.

Gifts are another way of sharing your taste with someone else. They ultimately are trying to draw a common thread between your taste and theirs. The more overlap, the easier the gift giving. The more uncertain the taste, the more difficult it is. Maybe that’s why I’ve usually left unsatisfied with the gifts I’ve received, but quite happy with some of the ones I’ve given. If the taste is clear, it’s an easier experience for everyone.

So, if I can curate my taste over the next phase of my life, I can feel more me. That starts by getting rid of all the things in my life that aren’t to my taste. People, things, clothes, food, books. Being selective about what enters and what gets to stay in my world. Even imagining this makes me feel happy and free.

In my field of work, more and more people seem to be going ‘less than full time’. Nobody ever seems to regret it. So, why am I here working ‘full time’?

When you start to play with the idea of going less than full time with other people, there are both pros and cons discussed.

Some who are full time seem to look down on them, ‘jokingly’ calling them ‘slackers’, perhaps feeling they have to work more than them, but not realising it is an active choice they have made. Some say the money is important to them and their lifestyle. Some have dependents who need this to continue their current lifestyles too. Everyone’s financial situation is unique. Some say the training becomes unbearably long on top of an already long programme. Some say the experience you gain is less as a result. Some say seniors and rota coordinators don’t always support the decision due to staffing difficulties.

But the ones who are less than full time seem to be happy. They are less stressed. They have more time for their loved ones. They have more mental capacity to think. They never look back to full time work.

I think the terminology doesn’t help either. Unconsciously, I feel ‘less than’ if I go ‘less than full time’. I feel like I am 80% of a doctor rather than a ‘full’ doctor if I do 80% of the hours for 80% of the pay. Of course, this isn’t true. It’s a construct that is arbitrarily defined to be ‘full time’ or ‘100%’.

In an ideal world, my hours wouldn’t be so defined by someone else; there isn’t a ‘minimum’ number of hours to put in to pass some boundary somewhere. I understand experience is key, and learning through experience hands-on is irreplaceable. I love being a doctor, I love working and making a difference.

Currently, I don’t feel as though 100% of my time at work is loved, or is valuable to my learning, but a lot of it is. It would ultimately be a compromise for me to go ‘less than full time’, but I think it is a worthy one to make. For the sake of my loved ones, my time, my mental capacity and my value.

I am a junior doctor who selfishly chose to work the strike days. I did this partly to not lose out on my salary on these days, partly to minimise my ‘time out of training’, but mostly to learn. I thought that with so many seniors around, it would be a great opportunity to learn and ask questions in a supported environment. During strikes, I saw more seniors than ever in the hospital. They’re incredibly valuable as teachers, mentors, colleagues, but moreso as people.

I learned this today that experience, both in work professionally, but also in life, personally, is incredibly key. I’ve started to value this more and more in my family too, with my parents and grandparents, and really listen to what they have to say, way more than I did as a teenager.

Today, my consultant told me about this idea of the ‘Banality of Evil’ coined by Hannah Arendt. He told me to remember this the next time a colleague is angry or short with me. I think it can be applied to patients too. Anyone who is part of a system. Which I guess we all are in one way or another.

Essentially, this idea means that the underlying reasons and motivations of ‘evil’, or antagonists in general, are inherently mundane. Boring, simple, uninspiring. The shouting colleague doesn’t want someone else to shout at them, or punish them, for not doing their job. And I guess, to go another layer deeper, they don’t want to be shouted at and feel unvalued, unappreciated, or maybe not get paid as a result of not doing their job. Being shouted at makes us feel unsafe, threatened, unwelcome. The conflict becomes uncomfortable, for both sides really. I am unsure whether a positive release is experienced after shouting or getting angry or annoyed at someone else. I think it’s more of a survival mechanism. Fight or flight.

A couple hours after my consultant told me this idea, I was shouted at by a senior for ‘not doing my job’. I was simply helping someone else, i.e. doing my job, just not for him at that time. He felt overwhelmed by a busy department. By computer tasks he couldn’t perform. By not wanting to do the menial work.

I knew all this. It becomes difficult to remember that his underlying interest was not to antagonise, not to be ‘evil’, but was to not feel overwhelmed, to not feel out of control of the situation, so that nobody shouts at him and he keeps his job and gets paid.

But once I remembered this, I felt calm and under control of the situation. I felt like I understood him, read between the lines, and that if I disengaged, if I didn’t rise to the situation, and fight or flight, then I would be okay. I would survive the situation, while also defusing it.

The system, the NHS, has created this environment where lots who enter wanting to do the right thing and help people become irritable, angry, not their normal self. Lots of people don’t become these types of people too. They control themselves. They think about the bigger picture. They rise above it. These people become some of our role models. I am lucky to be working in a hospital where these people are actually largely the norm. They all tell me it is not like this everywhere. They all tell me to appreciate it while it is here. They all tell me who to look out for, and who to look up to.

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Where I learnt a bit more about this concept:

Hannah Arendt’s lessons for our times: the banality of evil, totalitarianism and statelessness | The British Academy

I liked being surrounded by people who were like-minded and interested in the same thing: making the communities we live in healthier. They were motivating and inspiring, and it was especially useful to see people that even looked like me in senior public health roles in the UK. It is possible!

Some talks really stuck with me, like conversations about communication. We often think of ourselves as medics as good communicators, but this talk pointed out that we aren’t with the public. Not as good as influencers online who grab more attention and shape people’s opinions, arguably more so than politicians and doctors and other professionals. Communication skills with the public vs the individual is a different approach. Framing the issue in a different light was something I hadn’t really considered. We tend to stick to facts and figures, but emotion, stories and memorability is what sticks with people.

The importance of system level change to create the right conditions in which we can be healthy makes so much sense. I would love to be part of this solution one day. Another point highlighted was trying to get our health points across to politicians in a way that grabs their attention too, which likely needs a different approach to the public.

I always used to think I hated politics. I disliked the way in which politics was done rather than politics itself. The excessive wording, the beating around the bush, the delays, the lack of transparency, the seeming lack of trust, the bureaucracy, the impersonal nature of some politicians, the lack of relatability sometimes, the waffle and false promises. I was told that as a doctor, if we want to influence policy to help health, it is difficult to avoid politics completely. Admitting I don’t know much about it is not a weakness. You can never be an expert in anything. I hate the word expert anyway because I feel like you can never know everything, so you’re always a student. What’s the threshold?

Someone else brought up the point of the vocal minority vs the silent majority. The silent majority we tend to think of as reasonable people, as people who are not making a fuss, who just get on with their own lives without trying to impose their views on others. You don’t really want to be the person who is imposing views on anyone. I guess as doctors, you gotta try and present the unbiased facts and call out the issue itself rather than blame any single person or company.

Sometimes, I have patients come to me and tell me things that make me think ‘Why are you here?’.

There are lots of times you hear doctors complaining about patients wasting their time or inappropriate referrals. You rarely hear of the patients that were a good use of their time or were appropriately referred to them. Nowadays, patients come to you with more expectations than previously, according to my seniors. This comes with the unlimited information available to people nowadays, with Dr Google or AI. Sometimes it’s well informed, and sometimes it’s the horror story in the news. I find it increasingly difficult to reassure someone because health anxiety is at, what seems like, an all time high. As is general anxiety about everything I suppose.

And so, when I find constant resistance to what I advise and say as a doctor, I tend to ask ‘So what is really the matter?’. Usually there is something else that’s causing their worries, but sometimes people don’t even realise they have health anxiety and constant worry and stress. The issue comes when what you think they have based off their answers to your history questions and your examination findings doesn’t match what they think they have. And if it’s a name of a fancy diagnosis that fits perfectly, that’s okay. If it’s simply ‘likely stress or lifestyle related’ causes, it becomes more difficult to have people leave satisfied. I think they feel some blame attached to those words, or feel dismissed, even if I’ve done a very thorough history and examination. I often find myself over-ordering investigations, such as blood tests, scans and samples for sputum, urine and stool, to rule things out or to put the patient’s mind at ease. Yes, rare things can happen, and yes, these investigations can be useful, but more often than not, these investigations do not explain the whole patient condition. This nuance can be difficult to portray to a person in just a few minutes.

Medicine and the human condition is unfortunately very multifactorial a lot of the time as it is so complex. We have more answers now than ever before, but we also seemingly have more questions than ever before. I guess that’s the beauty of modern day science, but nobody wants to be considered a science experiment either, and they shouldn’t get treated like that either. The truth is we are discovering more and more medical conditions and diagnoses, and there are more and more medications we can give and investigations we can order and interpret, and more and more specialists we can refer to.

Often, I need to tell myself that I am not a miracle worker, as much as I would love to be one. The most I can do is to try to understand and listen; make someone feel understood and heard. I can try and answer some questions along the way, and provide people with answers as and when I can, but sometimes I have to accept that I don’t know the answer, or I can’t help someone.

It would be interesting to do a mass survey one day to ask people what they want or expect from their doctor…

I have met many patients with self- or officially diagnosed health anxiety. And it got me thinking I, and many others, probably have an element of this too.

Usually, there’s an underlying reason for it. A bad experience with healthcare, an ill family member, a late diagnosis or reading about horror stories online.

All of these things could be extrapolated to many other types of experiences in life. A car accident could make someone (understandably) very anxious about driving, or a nasty comment about your looks can make you very self-conscious.

As Inside Out 2 showed very well, anxiety is a normal human emotion that we experience from time to time. When it starts to impact your everyday life and you feel you can no longer function as you once did, it starts to become a medical disorder and something that likely requires professional help.

My own health anxiety originated from an incidental finding of aortic regurgitation (a leaky heart valve), which can happen to anyone really. It did trigger endless health and wellness research for me which led me to learn a lot of things about health, but also resulted in a lot of anxiety. I started waking up and not listening to how my body was feeling, but what my Whoop Score said. My health tracker became my boss that I was scared to disappoint. And that’s not the way it should be at all. It’s not healthy.

There’s a fine balance with these things, and I find once people have health anxiety, or any medical diagnosis, it becomes the boss of them too. They start blaming everything on it, rather than listening to how they feel, how their body feels, how their mind feels.

It’s taken me a long time to come to terms with my health, my sense of control over it, and controlling my thoughts around it to not let my health or other anxieties be the boss of me. We do have the power to be the boss over them. I like reminding people of that whenever I meet them.

“Independence is true wealth” – Morgan Housel.

I heard this quote today and it spoke to me very clearly.

I have thought many times since starting working how great it would be to simply wake up, not really feel like working, and then simply not go to work. I could sleep some more or spend some time with my partner or outside or doing chores or a million other things. The classic response when someone says this is a scoff and disbelief that it is possible. Yet, lots of people live this way. However, it might be a bit more difficult in our career, when you’re working with patients in particular.

Many doctors nowadays go less than full time. They do 80% of the job for 80% of the salary, and they almost never regret doing so. The money is made up by doing the odd locum shift, and the time is irreplaceable. Sounds great, doesn’t it?

Perhaps with technology and increasing telemedicine, and being involved in research and independent projects, independence is more possible than it once was.

We’ll have to see. But that’s the ultimate goal. Autonomy and control over my time is a new priority I didn’t realise I wanted.

I am lucky to be in a job where I am surrounded by seniors. By people who are in the role I could be working if I followed their career path. They help give you a tangible visualisation of your potential future. Sometimes this is helpful and inspiring, sometimes it is the opposite and makes you question everything. The inspirers seem to be increasingly rare in my day-to-day job. Maybe this is because of the overworked NHS staff, the impossible goals governance teams set them and the ever-changing nature of work resulting in constant adaptations to new pathways and technology. Maybe my threshold for inspirers has increased. Maybe inspirers are simply rare.

Rather than coming across a recent inspiring mentor, I came across an inspiring doctor speaking on a podcast, Dr Guy Leschziner, a neurologist specialising in sleep disorders among other things. The way he spoke about patients and the art of practising medicine made me believe again. It brought out a desire in me to aspire. I want to take such an interest in my patients’ lives and learn from them, sharing my reflections with the world in a non-judgmental manner. This approach was my key takeaway from how Guy spoke – to treat people with kindness, empathy and curiosity. His explanation about the uniqueness of everyone’s experiences coupled with everyone’s unique brain structures and neurone patterns resulting in everyone’s perceptions of the worlds being unique was nothing new per se, but it was refreshing to hear. This is how doctors should be, rather than taking a binary or black-and-white approach to doing ‘the right things’. I often feel like people should be given more credit for living their lives.

I would love to be an inspirer myself one day. I hope I have the remaining energy to do so.