Reflections on a life in medicine: What I wish I had known

As one approaches the twilight of one’s career, the words of Soren Kierkegaard (1813–1855) ring true: ‘life can only be understood backwards but it must be lived forwards’. After a career of 50 years in medicine, I ponder on what I wish I had known.

There is a quote from the Upanishads, which is a part of the sacred scriptures of the Hindu religion written more than 2000 years ago, that is apt:

Stan​ding still he overtakes those who run.¹

To understand where I am now, I want to look back over my life. I am a first-generation Australian; my parents were migrants who spoke Croatian at home, so when I started school, I did not speak English. My grandfather came here in 1927, and it took him 10 years to earn enough money to bring his family out. One of his daughters was my mother.

I grew up listening to the stories of the challenges and the difficulties of not speaking English. In my work as a general practitioner (GP), I listen to the stories that people tell me. This includes stories from Bosnian refugees who speak to me in their language.

My cousin and I were the first in our family to get a university education. At my 20-year reunion in 1995, I was at a magical stage – school, university and hospital training were behind me, and I was well established personally and professionally; life was mostly good.

However, it is not all smooth sailing as one moves into the next phase of life’s journey.

As they say about the executive who climbed to the top of the corporate ladder, when he got there and looked around, he realised it was leaning against the wrong wall.

Although I could reflect on some success in the first half of my life, I was then coming to the threshold of the second half of life. What makes one successful in the first half will not necessarily work in the second. The first half of life is about ‘doing’, about getting things done and about getting established in the outer world; the world in which we live, work and play, which is often about power, possessions and privilege. However, we tend to ignore our inner world, which is where the joy and purpose of our lives comes from. It is about ‘being’ as opposed to ‘doing’.

The outer world is like a tree; you can see the branches and leaves and admire them, but you cannot see the internal world such as the roots and internal structures without which the tree cannot survive. The ladder we climbed in the first half of life might not serve us so well in the second half. We might need to climb down that ladder to move towards ‘being’. Remember, we are ‘human beings’ not ‘human doings’.

To cultivate our inner world, which is like a secret garden inside us, requires a different approach. It is about making space for your authentic self and your feelings. It requires silence and simplicity and living in the present moment, and a sense of wonder at the mystery of life.

When I was at the 20-year mark, I was the State Director of the College of GPs training program in Western Australia (WA). It was a wonderful experience and combined my love of teaching and my love of general practice. Over the next six years, everything changed. The Federal Government took general practice training from The Royal Australian College of General Practitioners (RACGP). There was a lot of angst and interpersonal conflict as this process evolved, and I felt lost and dislocated.

Dante Alighieri (1265–1321), the famous Italian poet, said in his poem, ‘The Divine Comedy’:²

In the middle of life’s road,
I found myself in a dark wood,
The straight way ahead lost.

That is where I was.

In the pressures of what was happening to me, the idea of going on a retreat came to me, and I found a place in Bridgetown, WA, and went on a one-week retreat. This involved quiet time, so no mobile phone, no internet, no TV, no radio and no newspapers. It was a profound experience, and it helped me to reorientate myself, to align with my internal compass.

I returned to general practice after the RACGP Training Program was shut down and had the difficult task of letting go and moving on. The quote at the beginning is relevant. Those who stand still can reorient themselves and so will have fewer detours. Those who are running might look busy but might not be going in the right direction for their lives.

I went back to being a full-time GP, and my practice has evolved. Although I have reduced my hours, I do sit-down consulting and look after people in residential aged care and Silver Chain palliative care. The palliative care work involves looking after people at home who are in the last three months of their lives. I love the work, and my time as Director of general practice training in WA has enhanced my understanding and enjoyment of both general practice and palliative care.

As one enters the second half of life, one can see glimmers of mortality on the horizon. From the perspective of mortality, I consider these to be two important themes:

• The regrets of the dying.
• What can the dying teach us.

There is a book titled, ‘The top five regrets of the dying’;³ the most common regret was about not being true to oneself. Many people regret that they have done what others expected of them and not fulfilled many of their dreams. It is important to honour some of your dreams or you might become angry and bitter. Other regrets are about working too hard and not having time for the important people in our lives. People wished that they had had the courage to express their feelings and wished they had kept in touch with friends. Many dying people regret not keeping in touch with friends and looking after their important relationships.

Another perspective is that of considering what the dying can teach us. There are five universal truths that I have taken from the writings of Richard Rohr,⁴ a Franciscan monk.

The first lesson is that life is hard. Suffering is a part of life, and many people have been wounded by life events, including childhood trauma, and they carry these wounds. Many people try to avoid the pain of these wounds by working hard or becoming addicted. We must grieve our losses.

Another lesson the dying can teach us is that we are not that important. Each of us is one of eight billion people on this planet, and each one of us matters. From the perspective of eternity, we are here for such a short time. Our ego wants us to stand out and be special, but remember, each of us is one thread in the vast tapestry of life.

Another lesson the dying can teach us is that your life is not about you, you are about life. Gabriel Marcel (1891–1973) said, ‘life is not a problem to be solved, but a mystery to be lived’.⁵ We are a part of something greater than ourselves. Ponder these questions: what is my aim in life?; who am I?; what is my purpose in life?

Is your goal the pursuit of pleasure or the mastery of desire?

Another important lesson the dying can teach us is that we are not in control. In this culture, we grow up with the idea of being in control of our lives. We grow up being told we are the masters of our destiny, the captain of our soul. However, as we move into the second half of our lives, we move from the illusion of certainty to the certainty of illusion.

There is a wonderful joke in which someone asks, what makes God laugh? The answer is ‘people making plans’.

As we move into the second half of life, our perspectives start to change, especially working in general practice. We start to realise there is no certainty in life. We see changes in our health, or relationships break down, or major diseases catch us unawares, and if not us, we can see these things happening to our loved ones. Our scientific training helps us understand what is happening to the body. Medical training teaches us that predictability is good for science, but it is not helpful for the soul. Remember, powerlessness is the path to wisdom.

The final lesson that the dying can teach us is that we will all die. We live our lives as if we will be here forever. Irvin Yalom, the famous American psychiatrist and psychotherapist, said that the physicality of death destroys us, but the idea of death saves us.⁶ What he means is that living with the awareness that we are not here forever helps us be focused on what matters and so helps us make better decisions. He also said that death anxiety is inversely proportional to life satisfaction.

In moving to the second half of life, the focus shifts from the outer world to the inner world as we confront events beyond our control. Mortality is on the horizon. Our success in the outer world can make us blind and deaf to our inner world, which is like a secret garden that needs to be tended. We must not forget that the joy of life and our sense of meaning comes from our inner world. How do we cultivate that part of our lives? It is by listening to our feelings, having space and silence in our lives and living in the present moment. The key is listening to your heart; it whispers softly, so you have to listen closely.