I have been working as a medical doctor now for five years. In this time I have worked or experienced most areas of medicine, which included Obstetrics and Gynaecology, or the beginning of life. Accident and Emergency (A&E), Acute Medicine and General Surgery for when life throws a curveball. General Practice; the everyday of life from beginning, to the end. Oncology and Haematology, or cancer care, seeing life often at its cruellest, but also, strangely, some of the most heart warming times when people are at their absolute best, too. Palliative Care, for when the last grains of sand are all that remain. Throughout this time I have had the honour and privilege to play my small part in the journey of hundreds, perhaps thousands of patients, and through them, I have gleaned some wisdom.

As anyone who works in healthcare will attest to, these roles allow us to have raw, powerful discussions. We get to see people at their best and at their lowest. People to let down their guard, too, trusting us with the brutal honest truth. The cruelty of life is so often placed in stark contrast to the beauty of it all, too.

These experiences have undoubtedly shaped me, changed me, fundamentally and taught me a great deal. I would like to share one such lesson, below, which very recently has come into sharp focus.

Nothing is promised

Life is only often bearable because we do not consider, day to day, how it may come to an end at any given moment. Indeed, most of us life blissfully believing that ‘x won’t happen to me, if it even crosses our mind at all. A car accident? No, that happens to other people. A new, rare cancer diagnosis? Certainly won’t happen to me. The truth is, we have to live like this, to an extent, as otherwise we would be paralysed by the anxiety of what could be. Living in the future, or indeed the past, too often, is a fundamental property of certain mental health disorders. However, when we do examine these thoughts objectively, it is clear that they are entirely false. Much like an ant that you do not notice underfoot as you eviscerate it with a careless step, we too can be wiped from the face of existence in a disturbing number of ways without reality missing a beat, and unless you are a particularly noteworthy person, it is only a matter of years, perhaps decades before you are forgotten to the Halls of Time. This is a sobering thought, but like most people, until I began this job, it was not one I entertained.

Healthcare has us face this reality almost every single day. Many folk have never seen death, never had to come face to face with it, but doctors do, literally. Arrest calls, when a patient’s heart stops beating for a myriad of reasons, can be traumatic, for everyone involved, but it’s not just these adrenaline-infused, acute moments, it’s the quiet ones, too. When you step into a room, with a body that, perhaps only moments ago was a person, to begin the process of verifying death, and you are alone searching for signs of life, with eyes that scream that whoever was in there, is no longer. Rather existential questions can begin to arise, emotions, too, especially when this happens to patients you’ve perhaps come to know well, but before you know it, your job is done and you’re off, back to the bedside of another patient with not a moment to register it all. No, it’s part of the job, you get on with it.

Many people imagine this process to be rather smooth, expected, even, but they’d be wrong. See, many people live their life waiting for ‘the moment’. When I get x, I will be y. When x happens I will finally y. Most often this is something like: “When I retire, that’s when I’ll go travelling. I’ll finally buy the camper I’ve also wanted, we’ll slim down what we have and we’ll just go.” Some of these folk will be mindful of longevity, not quite to the extreme of Brian Johnson, but they might sacrifice a great deal in the hopes that they make it to their time as healthy as possible. Many don’t do this at all, though. Rather, they sacrifice their health, bit by bit, quietly, over years, in order to simply make it through. Fewer still will find the middle road. The bitter irony of both approaches is that life is not at all fair and very frequently it strikes us down just before, or just as this period of enjoyment begins. I can recall many a patient who had such glorious plans for their future, who then found themselves struck down without even a whisper of a warning, watching as it all burned to ashes.

Now, this seems rather negative, I’m sure. However, I don’t think it need be, and it should not be an excuse to resign yourself to hedonism, or from life altogether. In a way, it can be liberating and a method to finding greater depths in the meandering hills of life.

The Stoics discussed the practice of negative visualisation, which, briefly, is taking a small bit of time to contemplate what could happen and what will happen. If you have a family the sad truth is that there is a very good chance you will lose one or more of them before your own death, which unfortunately includes children, too. A parent should never bury their child, but they so often do. Why would you wish to do something so morbid? Well, put simply, it is a direct method of combating our own optimistic bias, our ability to ignore the nastiness of life and to break the spell of familiarity. Humans are incredible at adapting to new ‘norms’ and forgetting what life was like before. This is why we so often take for granted the things and people we most cherish, but when we are reminded of their finite existence, suddenly the veil is lifted. Albeit temporarily. This method allows us to regularly pull back the veil, whilst also going some of the way to preparing us for the worst, too. We can enjoy the now more fully. We can appreciate what and who we have around us with a greater depth. We can live more fulfilling lives when we accept and embrace that one day, perhaps very soon, we will no longer live. Nothing is promised.