Let me look back over the last forty years I spent in the medical profession and present an overview of what most of us would encounter in our journey as medical professionals. Most doctors would have had to change jobs and locations of service during the course of their career. This also adds to the broadening of life experiences. A medical student recently asked me if I was tired of working for forty years! That made me ponder on what inspires and sustains a doctor to be on this self-giving journey for many years of service! Let me reflect on the five seasons of a doctor’s professional life.
1. The Learning years
2. The Formative years
3. The Engaging years
4. The Consolidating years
5. The Retiring years
1. The Learning Years
Most of us spend up to fifteen years to complete our formal medical training from the time we begin our undergraduate studies. Many doctors aspire to specialise in some branch of medicine, surgery or paediatrics for which they need to compete for a post-graduate seat through the entrance tests. Life after graduation is therefore a season of waiting, preparing and competing for various examinations during the periods of undergraduate, post- graduate and post-doctoral studies. It is a season of adapting and responding to changes.
Many leave home and have to adjust to a new language and culture alongside a hectic schedule of study. During this time many new relationships are made and also important decision of marriage. Thus the learning years are demanding, with both fulfilling and stressful experiences.
During my conversations with both medical students and doctors, I found that most of them use this time to advance their knowledge, skills and clinical acumen and pursue one or more research interests. For many undergraduate students, it is only during the clinical years of training the learning of basic science makes sense and fits into the whole picture of learning medicine.
For me, it was a challenge to find a balance between extra curricular activities and learning demands. I did enjoy taking part in sports, being part of the core groups that formed the local Evangelical Union and later the Evangelical Medical Fellowship of India, the Medico-Friend Circle, etc. Each of these took a good deal of time A well meaning professor called me aside and advised me to restrict my extra curricular activities to the week- end and devote the week to study. I took that advice seriously because it came from someone who showed considerable interest in my professional development. I began spending even more time during the weekdays in the wards and library which freed the week-ends for other activities.
During the season of training, it is essential to give primacy to learning, because we are under obligation to be good stewards of the opportunities given to us. I feel that any neglect or lack of attention to learning during the training years would reduce the prospects of becoming a competent doctor.
We are under pressure to compete, as training opportunities are often less than the demand. For one postgraduate seat, there might have been 200 competitors during my time. There are several criteria to be fulfilled to pass an examination. Fortunately there are enough job opportunities!
During the postgraduate and postdoctoral study time, most of us encounter difficulties due to the indifferent or hostile attitudes of those who oversee us. This morning, a professor was talking to me about the intense difficulties her daughter is having to get her dissertation for her postgraduate course approved by her guide because of which she is not able to appear for the forthcoming examination! The explanation by the guide on enquiry was, ‘It is good to face some difficulties to prepare for life’. This is an unreasonable outlook by any standards. To inflict this form of suffering is most unfortunate. Some who have faced such incidents carry the hurt and anger built up during their training years into their work, so that even after many years they communicate bitterness and resentment in their relationships with their students.
It is desirable that students gain a sense of direction in the learning years. Even students who have been forced into studying medicine against their wish because of parental pressure, can be enabled to come to terms with the situation and find meaning in learning.
The words of Amy Carmichael of Dohnavur, ‘In acceptance lies peace’ were often quoted by Dr.Frank Garlick, while counselling students to trust God even in the most trying circumstances. Every student can be helped to turn a disadvantage into an opportunity and move on with openness to all the vistas that lie ahead if this hurdle is crossed.
It is likely that some of us get jolts through failures in examination or not getting seats for post-graduate training. Such instances are not roadblocks or a cause for retreat, rather they are occasions to revise our direction and pursue our purpose sensibly and wisely. I have had set backs in the earlier period of my learning years and looking back I know that those very experiences brought lessons of significance and became formative in my life. These interruptions in the course of our formal learning are pauses given to us to reflect and renew our perspectives. I am moved by the record of the learning years of Jesus. We are told that ‘Jesus kept increasing in wisdom and stature and in favour with God and man.’ (Luke 2:52). Even at the age of twelve years, He had the scholarship and competence to engage in serious discourse with the religious leaders assembled in the temple. Yet, when His mother came searching for Him and desired Him to return home with them, He willingly went with them. This, in fact, highlights the affective domain of learning, where Jesus subjected Himself to the discipline laid on Him. He listened to those, under whose care he was growing up.
The focus of the modern educational technology is on the learner, the learning process and the student-teacher relationship. Each of these dimensions has a bearing on the outcome of learning. When the learning experience is integrated and holistic, there will be sound content added to the domains of knowledge, skill and attitude.
2. The Formative Years
Psychologists say that the second and third decades of life are the formative years - a season, when we come to terms with ourselves and formulate an inner frame of reference for personal conduct and public life. The eminent psychologist, Howard Gardener, who introduced the theory of Multiple Intelligences three decades ago, elaborated these cognitive dimensions. These dimensions include inter-personal, intra-personal, musical (rhythmic), verbal (linguistic), visual (spatial), logical (mathematical), physical movement (kinaesthetic) and later, emotional intelligence was also added to these.
We are being formed through the inner and outer experiences that we face. The learning from multiple interactions converge to form the core of our character. The unfolding of the multiple intelligences determine how we behave. In the study of medicine, we are also influenced by the code of ethics, good practices, altruism and the call of service. For those, who have a personal allegiance to Jesus of Nazareth, there is a profound inner dimension to life and work as we listen prayerfully and discern what the Lord would have us do. The practice of regular Bible study and meditation on the mind and character of God revealed in the person of Jesus will guide us. The healing stories of Jesus recorded in the gospel of Mark are a starting point to enter into the healing mission of the Jesus of Nazareth.
Jesus approached those who were sick with concern and compassion. He went beyond their physical ailment and initiated them into a journey for change. He instructed, corrected, encouraged, affirmed and explained. Most of those who had an encounter experience with Jesus were led to a transformation. I find there are several learning lessons in the healing stories for our personal growth, if we meditate on them habitually. The profound and mystical truths often require frequent reading and reflection for assimilation. The healing stories help us to see those who come seeking medical help as those who seek for reality in life and not merely patients. The doctor can become a path-finder for them. This helps us to look beyond the salary we earn, the comforts we need, the positions we hold, etc. and be moved by the higher calling like St. Paul who, ‘... became all things to all people, that I may by all means save some’. (1 Corin 9:22).
The different versions of the code of ethics in medical practice have been influenced by the Sermon on the Mount in some way or other. The two chapters of the gospel of St. Matthew (Matthew 5 & 6) outline a value system for personal and collective conduct. It is a charter for godly living among people of all traditions and practices. I have found it useful to have a weekly reading of the Sermon to allow the leavening process to operate within my soul. It is necessary to return to this message when we are faced with various challenges in our lives and carry the message upon our hearts for it to be internalised. That is how we can arrive at our personalised commentary of the Sermon on the Mount, which is a summary of all that Jesus taught.
The parables of Jesus are another rich resource for personal formation. They portray heavenly truths with the help of simple earthly stories.
We live in a post-modern society, where the culture of self-indulgence, personal prosperity, acquisitiveness, instant gratification, and the pursuit of success drive people to live disconnected and imbalanced lives. We too get unconsciously drawn into this way of thinking and living. It is not that we do not trust God enough, but we rationalise the call to, ‘seek the kingdom of God and His righteousness’ and interpret it contextually losing the eternal perspective. The parables were spoken by Jesus to reveal the mysteries of God in an understandable language to those whose minds and hearts are open to God’s ways of living. The parables challenge us to live differently without giving in to the pressure to conform.
William Barclay and Dr.Martin Lloyd Jones are two New Testament expositors of the Sermon of the Mount, the healing stories and the parables of Jesus, whom I frequently refer to. These scholars captured the essence of the teachings of Jesus and wrote classics of a unique nature. There are equally moving reflections by Dr. John Stott and others. However, when I asked a group of health professionals, whether they had come across these and a few other authors, not many had heard about them. In fact, on asking abut their reading habits, not even 25% present in the meeting confirmed a habitual pattern of reading books for personal nurture. In the age of the visual media, we watch various programmes of entertainment, sports, politics, etc. and are likely to be influenced by the commonly portrayed declining standards of ethics, personal morality and value system. It is for this reason, that even greater attention needs to be given to formative education so that our vision remains clear and the light glows bright. Jesus spoke of our light turning to dark-ness when he said, ‘If therefore the light that is in you is darkness, how great is the darkness!” Matthew 6:23.
The declining habit of reading the Bible is equally disturbing to me. In another meeting of a few hundred people, I asked about the habit of reading the Scripture apart from during the time of family prayer or personal devotion. Only a handful said they had the practice of reading the Bible for instruction, personal formation and spiritual education. Scripture reading (lectio divina) is an essential nurturing resource for the ‘mind of Christ’ to be formed in us. (1 Corin2:16).
For our formative development, it is good to cultivate the habit of being in touch with mentors, or spiritual directors to help in interpreting the turns and turmoil of life. It is a good practice to set apart about two hours a week, half a day once a month and one day in three months for personal retreat. A retreat leader can be an immense resource in making these times restful, reflective and renewing. This formative practice will become a resource for us to live integrated lives with a sense of wholeness which will protect us from crisis and burn out, which is common in the lives of professionals.
3. Engaging years
Most professionals spend about thirty five years or more in actual clinical practice after the training years, usually beginning around the age of thirty years or so. During this time we are required to hold together our professional responsibilities, spirituality and vocation, family life, involvement in the lives of our own children, church and social life.
I have been in touch with a family who has been struggling about whether to continue working overseas or return to India. Both husband and wife are happy at work and the educational opportunities available for their children. The wife has a strong desire to return, but her husband is less inclined. As they engage in this process of discernment, I realize that they are experiencing the stress of decision-making. They do not feel confident to share their inner story with others for fear of being exposed.
We all face similar situations in our personal life, professional work and family life. I have had opportunities to be involved with expatriate families who come to live in India from Australia, Europe and Canada on a missionary vocation. Most of them are in the third decade of their lives with young children when they come to India. One challenge they all face is the initiation and adaption to a new culture, language and social life. Some adapt well and choose to live in India for longer periods and some others return after just one term of service. Those who adapted well usually had well meaning friends who ‘pastored’ them and provided the support during troubled times to pursue their vision.
One doctor, who returned after two years of service in a mission hospital, changed her earlier decision to work in a mission hospital because she felt lonely, misunderstood and used at work. When we hear such stories, we are reminded of the risks we face on account of the job which unsettle us and even cause us to lose our perspective in life. The challenges, disappointments, or trauma on account of situations at work, home, church, neighbourhood, etc. may take a heavy toll on us. Jesus alluded to this when He said, ‘These things I have spoken to you, in me, you may have peace; In the world, you have tribulation. But take courage, I have overcome the world.’ (John.16.33).
Jesus lived fully and freely enabled by the resources He found in God, His Father. He was not preoccupied with the need to defend Himself when there was slander, malicious propaganda and accusation against Him. Peter gives us an insight when he says Jesus, ‘... committed no sin, nor was any deceit found in His mouth, and while being reviled, He did not revile in return; while suffering, He uttered no threats, but kept entrusting Himself to Him who judges righteously’ (I Pet2:22-23).
The way of ‘abundant life’ that Jesus advocated is the inner wellness that comes from walking with Him, even when we face difficult circumstances. The prophet Micah calls us to ‘... live justly. To love mercy and to walk humbly with your God’ (Micah 3:6). Even those who are keen to attack us would find nothing to talk about us if we live lives centred in God.
A professor of Surgery, who did not consent to pass a candidate who performed poorly in a postgraduate examination, was not appointed again as an examiner for a decade. He endured this personal humiliation well because, he believed in his higher calling to entrust his circumstances to the God of his life. During this period of waiting he was able to innovate some new surgical procedures, for which he got considerable acclaim. He did not stay too long ‘looking at the closed door’ that Helen Keller spoke of from her life experience of living with deafness and blindness, but turned the waiting period into an opportunity to move on in his calling.
We need an outlook to life which is God-centric and not directed solely towards prosperity or success. This to me is the greatest of all challenges. In the highly competitive environment we live in, most decisions are taken under the influence of receiving and giving favours and not based on merit, so that it is likely that we may feel excluded or side-lined at times.
This is a reality that many will face, which is not a judgement of our ability or skill but a portrayal of the setting in which we live. I have come across many lamenting their loss and losing the joy of living and serving. Such people need support and protection, lest they lose the mission to live godly lives. It is an opportunity to hold on to our faith, as Daniel did by refusing to respond to the enticement of the king Nebuchadnezzar but he ‘..made up his mind that he would not defile himself with the king’s choice food or with the wine.’ (Daniel 1.8).
Our calling in the places of our work, congregations of worship, social settings, home, etc. is to actualise what Jesus admonished His followers, ‘Let your light shine before men in such a way, that they may see your good works and glorify your Father who is in heaven’(Mat 5.16).
It is now two weeks since my mother’s home call. She moved on after a brief illness. In one of the recent conversations with her, she said, ‘I have had a good life’. It was comforting to hear her say that though I was surprised as she had many trying times in her life. She held a full time job as a teacher and managed the home and a farm with minimal farm hands to help. Since her retirement and my father’s demise, she continued to run the affairs of the home and property single handedly. She chose to face life with composure and welcome her situation wholeheartedly, with the result that she became an efficient, hospitable and entrepreneurial person. She chose to overcome her circumstance and found the grace to adapt to the situation with courage and fortitude.
We are called to be fully present in whatsoever situation we are placed. This enables us to welcome even hostile events and wait and see how God can surprise us with His abounding grace in due season. In a culture of instant gratification, we need to advocate the hope and mystery of waiting for God’s time.
4. The Consolidating Years
Five years before I retired from Christian Medical College, Anna and I went on a month long retreat at the invitation of a couple we knew us for several years. One of the exercises we had to do during the retreat was to make a plan to close any particular phase in our lives. I was aware that I would have to face the challenges of retirement and so I chose to prepare for that transition. That exercise opened my eyes to several important things I needed to do so that the work that I was engaged in would continue without any interruption. This prayerful preparation helped me to look at many details I was not aware of till then.
The last five years at work before retirement became a significant period of finding and training good leaders and enabling them to oversee the departmental affairs. I was enabled to start new facilities and training programmes that would sustain the quality of work and empower colleagues by enhancing their profession- al capacity and skill. As I see the work I left behind thriving now, I am grateful that I was made aware of the need of consolidating the work during the retreat.
The latter years in our medical career are distinctly different from the earlier years. The years of work, interactions and involvements would have made us wiser, incisive and skilful. This can become a big advantage for the younger people in the team. We are under the obligation to pass on our skills to others in the team for enabling them to take over from us. It is good to have the vision that the colleagues we leave behind should do better than us in taking forward the work we leave behind.
This would involve doing less by ourselves and enabling others to do more, while we are still around in the pre-retirement years. A senior friend spent over a year helping his colleague to learn the ropes so that his successor could effectively take charge after his retirement. He took his colleague through all the nuances of budgeting, planning, mentoring, organising, scheduling of the activities, conducting examinations, etc. so that the transition was smooth and easy with hardly any dislocations.
This is also the season in most homes, when the time is ripe to entrust more responsibilities to children and support their abilities to take responsibilities to plan for themselves. By this time, the children would either be married or in the marriageable age. To step back a little and to let children take a leading role in family matters is a valuable transition we ought to foster in the pre-retirement years. Building their self-esteem, enhancing experience in decision making and fostering the leadership skills is a necessary aspect of healthy parenting.
Most of us would have been involved in leadership roles in professional bodies, non-government organisations, church congregations, etc. Having been in some governing boards during my earlier years, I realised that it is a good practice to hold positions for a while and then to leave the positions even before being asked to do so. It is a good practice to let others experience leadership roles and support them in their efforts.
During this season we make an effort to plan for the continuity of the various activities in which we were earlier involved. Jesus of Nazareth practiced this in a most effective way by delegating and empowering his disciples. One such instance was the miracle of feeding the five thousand people, in which Jesus got his disciples involved (John.6.1-14). Jesus first asked the disciples to find food and later to seat the people who were to be fed. He then blessed and multiplied the barley loaves and fish and asked them to distribute them to the people and then to collect the fragments left over. He involved His disciples at every step. Those to whom we hope to bequeath our responsibilities need the exposure and experience while we are still there to give them the confidence to carry on the good work in our absence.
There is a wealth of insight we have by the time we come to our pre-retirement years. It is not common for health care professionals to write down their experiences in the form of articles or biographical sketches. Among the many outstanding Christian health care professionals in India, only a few have attempted to summarise their life experiences. This is a loss for young people. It is a good practice to prepare a readable or watchable presentation of one’s life, while we are healthy while the memory is fresh.
It is also a time when mentoring of others can take a precedence. Our experiences bring maturity and qualify us to be mindful of others who are at different stages in life’s journey, when they have more questions than answers. To let others reach out to us and learn by being with us is an authentic way of mentoring. There can be meaningful self-disclosure in an ambience of trust in this form of interaction. The pre-retirement period is also a time for wise financial planning for the retirement years.
5. The Retirement Years
Most of us retire from our regular work while we are well physically. Some will continue the earlier professional role and some others move on to something altogether new. Let me share the insights over the last five years since my retirement.
It is a time of unsettlement. Every change is prone to produce stress and call for adjustment. There is a sense of loss when one leaves the place and job, which gave us identity and acclaim. We can turn to a trusted friend to accompany us during this time of transition.
A break of a few months will allow time for adjustment before we take up another assignment and give us time to deepen our ties with family and friends and do all that was postponed during the pre-retirement years. We can then enter into the new responsibility with ease. When we do not have a monthly pension from our earlier job, we may feel the pressure to take up jobs that meet our financial needs. This is a risky approach, if the demands of the job place added stress on us leading to health related challenges.
It is a time of celebration. Whatever might have been our experiences at work, we can be glad that we have lived well and run the professional race faithfully. This must gladden our hearts and bring joy and gratitude. It is a time that can push some into cynicism or purposelessness. The antidote for this is to recollect the memories and stay grateful. A retired person who is not pleasantly occupied can become a burden to the family and others. It is essential to view life ahead as being productive and purposeful. Work after retirement is often a crown in one’s life with even greater fulfilment.
It is a time for renewal. As we view life through the optic of faith, the anxiety of ‘what we shall eat, or where we shall live or what we shall put on’ recedes to the background. We find a new inner strength and affirmation that takes life to a higher plane of fulfilment. There is enough time to engage in hobbies and activities of leisure. Many use this time to catch up with what was not possible earlier. It is also a time to reconnect with children grand-children and old friends.
It is a time of revising life-style. There are steps we can take to prevent some of the age-related health challenges such as an unhurried pace of life, daily exercise, healthy food habits and a quiet and meditative way of living. These steps can bring healing and a restorative touch in our consciousness.
It is a time to learn to live with a sense of presence and coherence. It is a season when others come to us to receive inspiration and guidance. For this to happen we need to be free of our own preoccupations.
It is a time to ‘let go’. We are habitually beholden to things, family, position, etc. We chose the way we walked in this journey of life, but when we are older, we are under obligation to let others lead us. Jesus reminded Peter of this reality. There are some retired people, whom others avoid visiting, because they like talking about themselves. On the contrary there are others who receive frequent visitors because they are effective listeners open to the stories of others. The blessings of listening are innumerable. One way to self-regulate how much to speak and how much to listen is to stay confined to the questions others might ask of us and avoid talking for more than three minutes at a stretch. Conversations with regular in between pauses and silences are more meaningful. It is good to practice this way of conversing as a couple so that it becomes a pattern.
I have presented an overview of life as I experienced it thus far. I am grateful to have arrived in the sixth decade of life and I feel more expectant about the future. Some medical students, who came to visit took time to look at the photographs hanging on the wall. They wanted to know the context and stories behind the pictures. It was an hour long informal meeting, where they took the lead and directed the conversation. At the end of the conversation, one of them said, “We want to come back for more talks, because we are free to direct the content and direction of the discussion.”
This is the call of life, to live freely and fully and to bless others by being ’present’ to them. God is then present in such encounters.
M.C.Mathew (text and photo)
( The above reflection authored by me first appeared in VOICE, Vol.12.1 in March, 2014. Posted here with acknowledgement)
Dr Denis Parsons Burkitt (1911-1993) served in Kenya and Somaliland during World War II. After the war he moved to Uganda and stayed in Kampala. In 1957 he observed a couple of children with swelling of the jaw and began to investigate these jaw tumors'. Burkitt had an intensely enquiring mind. He took the details of these children to the records department and found out that jaw tumours were common in children in Uganda
Bukitt kept elaborate notes and 'concluded that these apparently different child- hood cancers were all manifestations of a single, hitherto unrecognized tumour complex' and he published his findings in the paper, ‘A sarcoma involving the jaws of African children’. The newly identified cancer became known as 'Burkitt's lymphoma’. He went on to map the geographical distribution of the tumour and together with Dr Dennis Wright, published a book entitled 'Burkitt's Lymphoma' in April 1970. Burkitt’s second major contribution was his work on diet and lifestyle. He wrote a book ‘Don't Forget Fibre in your Diet’ encouraging high fibre diet. Burkitt on many themes. His famous quote on “Ättitudes” is given below.
'Attitudes are more important than abilities
Motives are more important than methods
Character is more important than cleverness,
And the Heart takes precedence over the head.'
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