A Doctor’s Tale of Adventure and the Challenges of Coming Home
Dr Stephen Fabes / ED Middle Grade / St Thomas’ Hospital
In 2010, Stephen took a rather large step off the medical conveyor-belt and embarked upon a six-year cycle-tour covering 75 countries and more than 53,000 miles; exploring the social context of health and disease through a blend of travelogue, memoir and human stories. Following the publication of his book, ‘Signs of Life’, he shares with us the difficulties he faced in returning home and how he overcame this to step back into the medical world.
In early 2016, my life – when I considered its objective facts – wasn’t looking so great. I was a thirty-something, balding, unemployed, single blogger, in debt to several friends, cohabiting with his mum. My credit card was maxed out and the Student Loans Company were sending me threatening letters as if they were about to send round bailiffs and repossess my shoes. For lunch I ate own-brand baked beans with alarming routine; the kind that taste like salty cork. I’d once been a junior doctor in a prestigious teaching hospital, surrounded by friends, in a city I loved. It was just hard to apprehend how it had all come to this, the spectre of loan sharks and scurvy.
Whatever the case, I supposed I only had myself to blame – myself and my entirely voluntary life choices. These are choices, I should add, that I mostly celebrate as plucky now, or at least reconcile as personally apt. There is no gnawing regret about the path I took, just a minor one: my blindness to its cost.
After medical school I skipped up the ranks in typical fashion and then spent two years happily in the process of Core Medical Training at Guys and St Thomas’ in central London. The other trainees, my friends, were about to reach up and grasp for the next hold on the towering wall of medical training, desperate for that dizzying overhang: Medical Registrar. I was excited about the prospect of greater responsibility too, but gradually other appetites felt overpowering. My greatest hunger of all was for uncertainty. I wanted a life less mapped out than my career ladder seemed to allow. And so I dared myself to leap away from the wall completely, hoping that I was still somehow attached, that the rope would hold, that I might swing into my old life once again should the adventures end, or not work out. The 5th of January 2010 was the day I blew up my life. I did so with the best intentions, and adventure on my mind.
It’s perhaps not important why I chose an adventure on two wheels. That cool January morning I was standing outside St Thomas’ Hospital, waving goodbye to colleagues, friends and family, sat astride a heavily loaded touring bicycle. With my new life contained in four bulging panniers, I was set to begin a journey around the world. I had no definite route or time frame in mind as I wobbled off across the hospital forecourt, tacking around tourists on Westminster Bridge. My only thought: “Whoa! It has begun”.
For the tale of the mountains, the dirt, and the wild ride I will refer you to my book, because I want to fast-forward now to another winter day six years on when I cycled back onto Westminster Bridge. I could just make out the huddled figures of my friends and family collected outside the hospital, this time to welcome me home.
After hundreds of nights camping in ditches and by roadsides and after months of inching across assorted landscapes – from wind-lashed hills to hushed stretches of desert – I recognised in me a feeling of deep, intractable fatigue. I was tired of waking in my tent, confused momentarily as I mentally pursued my place on the planet. I missed the people who had once lovingly populated my life and I thoroughly missed my job as a doctor too (if you’re reading this at the blurry end of a night shift I appreciate that this may be an imaginative leap too far but I promise, it is possible). I was glad of the adventure, but glad that it was over, and glad as well to be home.
This feeling, of course, didn’t last. Over that final meandering year on the road, hosts and fellow travellers alike had often asked me about my future, curious about how I’d cope when I finally returned home. Often there was a hint of concern, an implication perhaps, that I was a condemned man. I too wondered if I’d become institutionalised to ‘The Road’. Perhaps I’d cope with coming home by going away again. Perhaps one morning, during my short commute through London, I’d simply go missing. My mum might receive a phone call: the police had found a panicked man meeting my description 260 miles away, trying to construct a lean-to in a ditch using his scrubs and some tourniquets.
Change was inevitable in my absence. Friends had moved on, sometimes literally, jetting off to work in Australia; or by virtue of partnering up, investing in homes and painting conservatories. More than one had a golden retriever and when I made jokes about joining the parish council there were awkward laughs, as if to say: actually, not a bad idea. Even Tony Skank, my rapping friend, was now Mr Wall, Head of Geography.
There are so many obvious pleasures and boons to adventures in foreign lands that it feels slightly redundant to list them here, preaching to the converted. While I came home somewhat deficient in CPD, I had an abundance of experiences and stories instead. Not that I was entirely deskilled either: I was a writer and a public speaker now, skills refined through necessity – both were means to earn money as I moved. Though my personality had been fairly well set by my departure, at age 29, my perspective had been altered quite radically, not least through visiting a host of remote medical projects along the way. I felt blessed for what seemed to me a glut of time, time to consider the forces shaping the landscape of health and disease. I travelled with no phone and I found that time without technology was time to ponder the world at large and the larger questions therein. It was more valuable than I could have guessed. I discovered that wild places are stirring in a way that Dalston is not. I knew that now, home again, I’d miss the meditative hum of my wheels, and those slap-happy days, days luxuriously or agonisingly long. But always so long.
After a few months I was back at work in St Thomas’ and knowledge resurfaced more easily than I expected. My mind though, had meandered unbidden for years, so at first concentrating on a particular task seemed a challenge too far. Determined that adapting was a battle I would win, and now with a phobia of routine, I made variety my new goal, squeezing in as much as I could, terrified any less would feel like sinking. Newly passionate about my work, I took locum shifts at two hospitals across three specialties, mixing up my shifts so that they fell on different days and across different hours. I consoled myself that I was free to book a flight to Lesotho at 0300 in the morning if the mood took me (it never did). I joined four dating apps and five running clubs, the former resulting in further singledom, the latter in half marathons in less than 75 minutes.
Here’s the thing: I had neglected to prepare for the fact that life would be quite different on my return. I’d left home in my twenties, unwilling to accept that opening some doors closes others. I was young and credulous. I believed the advertisers, social media blowhards and all the other glib correspondents of modern life when they said that you can have whatever you want free of charge. That’s bunk, obviously. You can’t have the light without the shade. Recently I attended a clinical skills course in Leeds. A refresher. Quickly, it was revealed that I’d spent years out of medicine to travel and investigate healthcare in remote settings. ‘You did what?!’ Envy was roundly declared. I didn’t mention the living-with-my-mum-part or the own-brand baked beans.
For many doctors, myself included, it can feel as though life is one long chain of accomplishments to tick off, and that you should 1. Keep ticking and 2. Be grateful that this tick-list exists. For a few doctors I know, the weight of parental expectations remains a millstone well into adulthood. But for any of us quitting a job, vacating a training number or taking voluntary erasure from the medical register – ie. blowing up your life – will feel rather tricky to pull off. It takes a kind of deliberate stupidity: be naive enough to start and stubborn enough to finish.
But keep a portfolio. Ten years ago we were less fussed with evidence but there is no excuse today. Make the rocky road home less rocky, this is in your control after all and so much is not. Practicing as a doctor, advancing forward, must always involve a process of silent, self-directed pep talks whereby you muster the self-confidence to proceed. Some of us are more capable of this than others and clinical capability itself has nothing to do with it. Expect that leaving medicine or practicing overseas might knock your confidence for a while when you get home, so be kind to yourself and do whatever it takes to regain it. Perhaps that’s enrolling in courses, scribbling revision notes, or landing a less than full time job with good supervision and plentiful support. But if you’re anything like me, you will revalidate feeling only half valid to begin with.
I have been back at work for four years now and I have still not progressed in the official sense. I’m still a middle grade but I have a book out (I’ll mention this again soon, it’s a tic), I have balance where there was once momentum and I have a plan. Those I trained alongside, my CMT peers at St Thomas’, are now consultants and I am subordinate to doctors who were once foundation level on my team. I do feel a pang of anxiety about this apparent inertia every now and then, but I remind myself that this is as much to do with the culture of medicine: relentlessly forward pushing, competitive and at worst adversarial, than it is to do with me. (Plus: I have a book out).
It’s understandable, I suppose, during the greatest health crisis seen in generations, to want to be part of the effort on home soil – to feel purposeful, to do what you’ve been trained to do and, of course, so that you have some war stories in thirty years time when nobody will care if you went ziplining in Costa Rica. But this will pass, borders will reopen, adventure will propose itself once again and adventure medics will be required in many corners and on many expeditions. There will still be sacrifices to make if you jump from the wall: perhaps financial, perhaps career and perhaps personal. Whether you can square these depends on your dreams and desires, your circumstances, and much more besides. They’re particular to you, like the specialty you choose, or the people you love.
There are procedures in medicine that are technically easy but may be hard because you don’t think to perform them or don’t have the courage to do so. A needle decompression for a tension pneumothorax. A front of neck when you can’t intubate or ventilate a patient takes nerve. I would like to include here a bike ride around the world. I’m not advocating this specifically (the saddle sores for one thing) only suggesting that it’s worth seeing time away from the UK and formal medical training as a possibility. I could restate here my own lack of regret but I’m aware that we all like to think this way. ‘I make wonderful life choices’ makes life more palatable. I only know that I am grateful for getting what I asked for, uncertainty galore, and for the wild, surprising adventure which I recall from time to time, in the quiet hours, then yearn again and smile.
‘Signs of Life’, by Stephen Fabes was published in August 2020.
Available on Amazon: Signs of Life: To the Ends of the Earth with a Doctor
Stephen’s website: stephenfabes.com