Following my Heart

by Dr. Brian Kaplan
[Extract from the book Passionate Medicine by kind permission of Jessica Kingsley Publishers.]

Childhood
“Black with milk, please.” said Uncle Louis, our beloved  family general practitioner. He had just accepted my mother’s offer of a cup of tea and had been asked whether he wanted it ‘black or white’. It was a typical comment from a warm-hearted man whose affection for our family was obvious. He had brought my mother, my two sisters and me into the world  – so he knew us pretty well. We were made to feel special but living in the small seaside town in which I grew up there were many others who were made to feel ‘special’. After a while it started to dawn on me that it was he, Uncle Louis who was special – a special doctor.

But what was so special about him? I guess he had average clinical ability as a physician. No special qualifications, although he did personally deliver a lot of babies. I guess he really loved being a GP, loved being a doctor, loved being able to be of service, just loved. And we were just another family who loved him back. Eventually our lives diverged and we left town, but I was very proud of the letter of recommendation he wrote for me when I applied to become a medical student.

Medical School
So I grew up with only one idea of a doctor. One of a smiling, gentle, helpful and effective man who loved his work. Looking back I can now see that he was the only person I knew who loved his work so much. It was this enthusiasm for the job and the love of his patients that made me want to become a doctor.

Getting in to medical school was the easy part. I just had to get good grades at school, which wasn’t difficult.When I got there, I learned that the reality of becoming a doctor was very different from my fantasy of what it would be like. I’d followed my heart but not my head and when you do that you don’t always arrive where you expect! If I’d given it any thought, I would have realised that it was totally unrealistic to be expected to be taught how to be a good doctor by a bunch of Uncle Louis’s! And I certainly wasn’t!

I was fortunate enough to be accepted into one of the two best medical schools in South Africa. However my elation soon ended after one year on campus. As soon as we started learning anatomy by having to dissect a cadaver, I began to lose enthusiasm for the whole experience. I now see it as an important part of my education but at the time, dissection seemed a million miles away from the reason I had become a medical student. Committing long, complicated cycles of physiological chemistry to memory was even worse. I simply did not understand the necessity for all this detailed study of cells, tissues and organs. Five years of the six-year programme were awful for me because I couldn’t articulate why I was so unhappy there. After all, I was pursuing my dream of becoming a doctor, wasn’t I? So why was I so miserable? Miserable or not, I still managed to pass every exam without ever having to re-sit one. This was no mean feat considering that I found the material somewhat less than inspiring.

It would take me a decade of two to realize that I was unhappy because I’d entered into the arena of medical science where patients of doctors were effectively treated as objects of science. We were advised to avoid doing this but were taught little but science. That was the problem for me. Had there been some talk of how we were feeling about becoming doctors, how we felt about medical school and all its travails or how we felt about death and disease, things might have been different. Nobody seemed to care about how I felt about anything. Why should they? They had their own careers to nurture. An honest registrar confided to me about how things worked in the major teaching hospital at which I was attending ward rounds: “Everyone here licks the arse of the person above them and kicks the backside of the person below them!” What a place to learn to become a healer! But where else was I to go?