Is there a doctor on board? Before I became a medical student it was these words I imagined would one day summon me to perform some heroic life-saving act. I thought it would be me who would dash to the front of a plane, and undertake a daring procedure, never before tried outside the confines of a hospital, which would pull some poor soul back from the brink. Afterwards of course, I would modestly return to my seat, slightly embarrassed by the tsunami of admiration flowing my way from all those who had witnessed my gallantry.
It was not quite this scene that greeted me when I did actually hear those words for the first time, nor was my reaction particularly heroic. On a packed commuter train this November, I stood, headphones in my ears squashed up against my fellow travellers, totally oblivious to my surroundings, when a ripple went through the carriage. Even with my music on and my line of sight obscured by suited shoulders, I could see that something was happening. As the crowd pushed back to make room, I looked down the carriage to see a man visibly shaking and sweating, looking, as even the most medical among us would say ‘a bit off’. It was then that those words I had once longed to hear were uttered ‘is there a doctor on board?’
It is at this point I should say that I am not a doctor and will not be for some years. I am however, a medical student and as such have a certain level of knowledge, if not experience, which may have been useful. Yet it is hard to explain to people what a medical student really knows. From the day I applied to medical school my family have asked me to diagnose them, to give them advice and information, as though merely deciding to pursue medicine arms me with some expertise. Really, at this stage I know very little and can do even less. But explaining this to people is often fruitless and so I field the questions as best I can and always end by saying ‘but you should go to your doctor’. The process of studying medicine is as much one of learning information and skills as it is one of learning how to handle responsibility. And it is this responsibility that really represents the challenge of medicine. One hears always about how hard medicine is and I agree it is hard, but not for the reasons people think. Anyone can learn information by rote and anyone can learn to take bloods, order tests and tie sutures. But not anyone is able to take responsibility for people’s lives, and I am still learning whether I am one of those who can.
However, personal responsibility only goes so far when one is ensconced within a system as complex and layered as the NHS. Yes, people must take ownership of their decisions regarding patient care, but much like the workers on a Fordian production line, each person has a fairly narrow set of roles. But outside the hospital, away from the systems built to protect both patient and doctor, you are alone, a rather uncomfortable place to be.
So when I did hear the call I had once dreamt of, I did not run, or even walk, to put myself forward. Instead I shrunk into my coat and pretended not to notice what was happening. I was even wearing my hospital issued scrubs and felt as though everyone in the carriage was suddenly armed with X-ray vision and could see my scrubs through my coat, I felt as if they knew. I could still see the man and could see he was still conscious and a few minutes later heard the conductor arrive and summon an ambulance to meet the train at the next station. All appeared to end well, yet the incident has prayed on my mind ever since.
Examining my decision since that day I have rationalised a few things; the man was conscious and seeing as CPR is the only skill I could legitimately be expected to perform as a medical student I could not really have helped him. I have also relied on the age-old sense of a diffusion of responsibility. There were so many others there to help, it did not have to be ME. And lastly I have asked others what they would do. It seems most of my contemporaries at medical school would have hesitated to step forward. Some have even been in similar situations and have not acted. Unexpectedly, even senior doctors have said they dread the call to help people once outside the walls of a hospital. Of course, those I spoke to said, they would help if it was strictly necessary, but that didn’t mean they welcomed the opportunity arising. And on closer inspection it is easy to see why, acting on ones own means shouldering all responsibility for the outcome, good or bad. What if you are the doctor on the plane and are called to help, yet in your holiday mode you have knocked back a couple of complimentary G&T’s? Can you really help in good conscience? It is for this very reason that many doctors don’t travel under the ‘Dr’ title, but prefer the anonymity of ‘Mr’ or ‘Miss’.
Really, what all of this raises for me is the question of whether one can truly disentangle one’s professional identity and one’s personal one. Is a doctor a doctor all the time? And if they are am I willing to take on that responsibility?