* Health, Work

The Emergency Physician

Mya Cubitt reflects on her pathway to becoming an Emergency Physician

When I was little, my younger sister required significant medical care, from in-utero to then premature baby and then with childhood asthma.

Consequently, I spent a lot of time in the care of my aunt, Barbara Mathews, one of New Zealand’s pioneering child play therapists. Of course, a young Mya thought that this seemed like a pretty awesome job. My mother however, a fierce advocate for learning and education, stepped in sometime around primary school and gently encouraged me towards a higher degree, and with that, I remember always wanting to be a paediatrician.

Always wise, around the age of 16, my mother pointed out that if I really wanted to get into medical school, my effortless coasting through education would need to evolve into a more directed effort at actually learning how to learn. And who knew – learning is really hard! My mother taught me to get up in the morning and build learning into my routine. She taught me skills like mind-mapping and how to link pieces of knowledge. She also taught me how to run regularly with her and my Dad in order to consolidate, blow off frustration and get out of my chair. She taught me to love the process of learning, to be curious, and to the annoyance of everyone I’ve ever met, constantly ask questions. She taught me to navigate the inevitable frustrations towards some kind of rewarding aha! moment. She coached me to discover and pursue my aspirations, pushed me to gather the skills to reach for them and guided me towards authentic mentors along the way. She still does.

Inevitably, with aspiration, comes another of life’s lessons, the need to constantly reframe failure and success.

I didn’t get anywhere near the marks required for Auckland medical school and I was thrown into that pit of despair familiar to many who have navigated the popular definition of medical system “success”. Ever the central figure in my story, Mum pulled me from my sorry state with an application form for a gap year programme, where New Zealanders are subsidised to spend a year in Europe assisting in a school and holidaying, on the proviso that we will return to a NZ University. I spent a year reframing (ahem!) in Europe with other adventurous kiwis – many of whom remain my good friends today.

I returned to Otago University with a renewed sense of curiosity and set about a religious devotion to learning all over again. I was rewarded with a reputation for being studious – you’ll appreciate, a reputation not common for first year Otago University students, and also entry into Otago University Medical School.

I met my husband, Dr Bjorn Makein in my first year of medical school and we navigated a pathway towards Emergency Medicine together. I am grateful to have had his companionship and advocacy along the way. We completed our internship and first year as doctors at Hastings Hospital in the stunning – and world leading wine region – Hawkes Bay. In this small New Zealand town, with many itinerant and international doctors, we made life-long friendships with doctors who have gone on to do amazing things all over the world. Being exposed to their experiences and different paths, we were empowered to consider medicine outside of New Zealand. The $200 000 student debt of two doctors compared with attractive Australian locum rates was a helpful push too. We spent the next four years working in small towns in Australia, working for about nine months of the year and travelling worldwide the rest.

Emergency Medicine was one of the few specialties that recognised our peripatetic choice and it was a natural fit for the lifestyle we had chosen. It was an exceptionally rewarding period in my career. We would arrive in fascinating small towns for weeks to months at a time, with hospital staff and patients grateful to have us, and bumble our way through, occasionally feeling like we had advocated well for patients. The learning curve was steep and without a great deal of leadership and support – but we felt safe doing it together. We will always be grateful to Dr Alan Tankel and the Coffs Harbour Base Hospital team for the mentoring and teaching they gave us in our early adventures in Emergency Medicine. It was their department that we regularly returned to and where we signed on as trainee Emergency Physicians.

To this day, I am constantly asked how I can work a shift alongside my husband without it ending in tears or shouting. Honestly, I wonder how I would get better in my role without him.

It’s always easier to try scary things with your failure friend in tow. I know that when things go wrong fast, I can rely on his skills. When I’m flailing, I know he will gently and without judgement let me know and help me be better. He is my staunch advocate, as I am his. Recently, we have gone back to working together one shift a week – initially to solve a childcare issue, but since maintained as we realised the privilege of the incidental and requested observation of each other’s practice. It is the safest feedback and in-situ learning I will ever have. I am privileged to have him.

While locuming, we completed our primary exams, taking time off to study full time and enjoy learning in a friend’s house in Ohakune, offset with trail runs in the NZ bush. In 2009, we moved to Perth to the advanced training support of the wonderful team at Sir Charles Gairdner Hospital – at the time, led by the inspiring Dr Debra O’Brien. I realise now how lucky I was to land in a department with such a skilled and inspirational female leader. I am privileged to still call her a mentor today. Other profound friendships were made, and I recommend this city to anyone looking for a sea change. I have fond memories of adapting to the demanding life style of an advanced trainee, for example fine dining and wine at 2am after shifts. Shift work is a unique view of the world, and we love it.

There have also been harder times. The run up to the fellowship was where we realised our styles had started to diverge. While the half-time job share approach we took turned out to suit me very well, Bjorn struggled and in retrospect would have been better off working full time. It was also our first year as parents and our first year in Melbourne – enough said really. The day that the (very expensive but very necessary) nanny quit, two months prior to our fellowship exam, will go down as one of the biggest meltdowns I’ve ever had.

Navigating the discovery that we were unexpectantly having twins just as we became consultants was also pretty darn overwhelming (read nervous disclosure – why else the phrase “pretty darn”….). I remember going to consultant interviews with my abdomen literally strapped up, trying to hide my absolute terror that my hard-fought and much-loved career was over. I just couldn’t see how anyone would hire me over absolutely anybody else once they knew – or how I could truthfully say that I would be back at work ever again. I can, a few years on, with healthy children (yes, yes, I catastrophised my twins into some awful illnesses during that pregnancy) and enough consultant work to pay the bills, admit to the social media pages that I spent most of this pregnancy in therapy, with what my psychologist described as “extreme adjustment disorder”. It makes me cringe now, but at the time, it was very difficult for me to see my way forward. I am forever grateful to Dr Treena Quarin for helping to pull me back into the workforce during some of the toughest challenges to my confidence and career. Initiatives that help support people returning to work are a precious thing.

As I write this, I am also remembering my husband’s often unseen and less applauded period of adjustment. He supported me through weeks of hospitalisation in constant or not quite labour, then weeks of us traipsing back and forth between SCBU to our premature babies, and survival mode with our 3-year-old at home. He navigated all of this while trying to prove himself as a new consultant in two different jobs, in a newish city, with no family – except when my Mum and Dad flew in from NZ, which mercifully, was often. With their support, and very dear friends, we both got through – and learnt to cope with life on much less sleep!

I’m proud to say, with much persistence and a few setbacks along the way, that I am now thriving in three complementary part-time roles across a public and private Emergency Department appointment and within an Acute Medical Unit. This unique combination provides opportunities for collaboration and learning from a diverse and talented range of specialists. I also pursue projects outside of paid clinical hours to keep me sane. They offer autonomy, expand my network and keep me engaged and thinking, and along with privileged patient interactions on every clinical shift, are why I love my job.

Dr Mya Cubitt is an emergency physician based in Melbourne, Australia