The greater the difficulty, the greater the glory in surmounting it. Skilful pilots earn their reputation from storms and tempests.
Writing this column for the last 17 years has been both a great honour and an onerous duty, addressing family doctors all across the UK, projecting my prejudices and lamenting my uncertainties.
But writing for a magazine with so many excellent clinical articles and informed opinions has been a daunting challenge. How do I make my column stand out amid this excellence? How do I shout loud enough that my voice be heard, because shouting too loud can be a perilous jade.
I write by stream of consciousness; the quirk, the caprice, the knights-move thought, the harsh imagery, something to grab the reader and make them read on and assimilate the message. Humour can be a potent weapon of subversion, but sometimes this can be too successful; the medium becomes the message, and the outre quote, the perverse jest commands all the attention and becomes a literary cuckoo; the real theme of the article gets bucked out of the nest.
General practice has never been more difficult; learning more and more new stuff, and more importantly, unlearning more and more old stuff. And the more successful healthcare is, the more impossible it becomes; there is a disconnect between (1) what we were trained for (2) what society needs from us (3) what society expects from us (4) what the system allows us to do.
But if it was too easy there would be no challenge; ‘Plenty and peace breeds cowards: hardness ever/Of hardiness is mother.’
Tensions, irreconcilable conflicts and irresolvable dilemmas are the spice of every surgery; an ordinary life is not our destiny. Stale sweat and urine, blood, vomit, all may be the bouquet of a family doctor’s life, but there are million stories in the naked surgery, and each day is an epic, full of tragedy and comedy, good and evil, despair and hope.
So much idealism, like Brexit, is poorly concealed envy and rancour and fear and egotism. But doctors have a different standard; illness can touch the heart, remind us of our primal fears, induce in us a humble appreciation for our own condition and existence and embody the rage we sometimes feel when we are forced to consider the cold indifference of this imperfect world.
I’ve never lost my reverence for good colleagues, warriors who battle ceaselessly against the night, and who fought the long defeat beside me. And sometimes, perhaps, we make things better for others, if not always for ourselves.
- Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell
Footnote; I’d like to thank everyone at GP, and especially my editor Emma Bower, for their support over the years.