After nearly five years in the somewhat intense world of advanced medicine, you get a lot of experience of all levels of the training of medicos, from students dutifully trailing behind specialists, all the way to “I just got a really good posting, goodbye”.
In the middle of this there are a lot of medical registrars. A lot of them: we've had them in gastroenterology, cardiology, immunology, renal – not to mention the suffering and sleepless registrars that staff the emergency departments, and the harried, apologetic registrars in ICU.
Some seem to be merely meat in a sausage-machine of training, but very occasionally, from the patient side, you get to see the genius, the stand-outs that you know can do well, because.
Because they're more thorough than the rest.
Because they care more than the rest.
Because they know more than the rest.
Because they fear more than the rest.
It takes its toll.
You, the public-hospital registrar of yesterday's visit, you are suffering and we see it. You've got too many patients who will die before you get to replace “registrar” with “specialist”, but since it's your third return to the same place, Ms T and I suspect which specialty has caught your passion.
You're young – I don't do well at guessing age, but you're about 30 – and your hair is greying too fast.
Your face should be relatively unwrinkled, but you scowl at your own decisions and doubt your reassurances that things are going well. So it's not.
You try to cover your forehead with your hair, because you don't want us – the patients and their carers – to see how much you wrinkle your forehead when you're fretting about what will go wrong next.
We see this, because we've seen you when our lives were at their darkest.
You once hugged Ms T when you apologised that you couldn't do more.
You fret and frown and add another grey hair when choosing between an X-ray or a CAT-scan (one is less sensitive, the other has more radiation).
You worry and apologise and fret and hug, you think and calculate and worry some more, and it's makes you better and kinder and more loved than those who live their lives in a sausage machine.
You're going to do good, and with a little luck and opportunity, you will be great. But it's going to hurt.
You can't save everyone, and every death will hurt, because that's already the story in your eyes.
But there's this: there will be wins and lives saved and families preserved. Lovers will love, children will grow to adults, and their lives will be your reward.
Your care, your fanatical attention to detail, your shining intellect – one day, a leap of intuition and a guess that “we should check that” will mean someone will send you presents each year because they or someone they loved got a life they didn't expect.
Treasure that, and make that your star and compass.
Ms T and I know that it's more than likely, one day, that someone will have to let a hammer fall. Know that if it's you that pronounces the dread words, says “I'm sorry, but ...”
If someone has to say it to us, we'd not just forgive you if it were you, we'd love you for taking the burden of saying it. We'll still know that we were lucky to know you, because we know you'll do good in the world.
But it's a burden to you, and we know it. We hope the burden doesn't break you, because in your future, the patients you save will love you for it.