I count myself lucky that I still love my job. Despite the occasionally insurmountable challenges of working in the South African public sector, I'm very aware of how cool it is that l'm placed in a unique position to use science and a bit of care to help people in distress.

I'm grateful that through a strong support network I have come out the other side of my medical training at least partially sane, with an intact sense of morality, and with a patched-together semblance of my former empathy.

I wish I could say the same for what I fear is a majority of my friends and coworkers.

This profession has crushed us and stripped us of our humanity. We have been faced with gender-based violence, suicide, child abuse, death, death and more death. We have counselled patients on terminal diagnoses, loss of loved ones, loss of foetuses. We have removed limbs, shaved baby's heads to find their last veins, and stabbed endless needles through sensitive skin. All this while being quite unsure that what we're doing is the right thing, with subpar supervision and ruthless treatment should something go wrong.

We have witnessed so much pointless suffering. We have witnessed a disorganised, self-serving government shamelessly allow our patients to die in crumbling hospitals.

All this time we have dealt with a healthcare system dominated by a toxic culture of abusive hierarchy and intolerance. We have been unjustly blamed, shamed and lambasted. We have been expected to work hours far beyond those deemed safe for us or our patients.

Initially we felt this all deeply.

But more horrifying has been the apathy. The apathy of our seniors, the apathy of the Department of Health, the apathy of patients' parents and families; at times it seemed like the apathy of the world.

Finally we have been faced by our own apathy. It crept up on all of us, day by day, helping us cope, but leeching away at our passion for medicine. We became annoyed, short-tempered, and deeply demotivated. We began shouting at our patients. We began snapping at our colleagues. We stopped crying completely.

And then some of us recovered. Some of us met mentors who helped us to see that despite the suffering we witness, there are so many cases who succeed, who leave these dark hospitals to lead functional lives thanks to our work.

Some of us met grateful patients. You'd think this is common - it's not. They surprised us when they thanked us, and a small bit of our humanity reignited.

Some of us witnessed senior doctors fighting with endless determination, and deep-seated respect for their patients, and we felt inspired to hold on to our battered, dwindling passion. But this is some of us.

A huge number of my graduating class wish to leave medicine. I can't blame them even for a second. Some are leaving clinical medicine. Some are leaving the public sector. And now, thanks to poor planning by the DoH and an inability to fund the posts necessary to run the public sector, many are leaving the country.

To parents:  Do not force your children into this profession. Do not even suggest it. Do not glamourise it. If they express interest, make them shadow a public sector doctor - not an ENT who specialises in aesthetic ear lobe reduction surgery - an intern, junior MO, or registrar. They must do a 24 hour shift, watch a Caesar or two, and witness a neonatal resus. They must read the House of God, Karma Suture and the other non-glorified accounts of this lifestyle. Acknowledge that it is not a golden magical profession. Look at your child, and be realistic: will they get through this? Will you be able to help them through this? Will you, as a parent, get through this? And then if after all of that they still want to do it, never take your eye off them. Support them as much as you can, feed them and pray for them. And know that if you force them into it, you have sacrificed your child for your own pride.

To government, HPCSA, SAMA:  Do better. You are failing. Shame on you.

To patients:  Many of you have made me want to leave medicine, one of you made me consider suicide. One of you drove me nuts, but thanked me in a newspaper once, and unknowingly started me on a road to recovering my humanity. The majority of you allowed me into your personal space, trusted me, and accepted my apologies when I felt l'd failed you. A few special ones showed incredible grace, let me sit with you in your suffering, and taught me lessons in strength of character and dignity. For all these things, I wish I could thank you more.

To my colleagues: I hope we learn to hold strong while staying gentle. I hope we can look back on these three years and feel like we achieved something. I hope you're still able to feel empathy. If you aren't, I hope you recover before you try to push on. You're under no obligation to keep punishing yourself for a choice you made when you were 18, but I hope that if you stay in medicine that the joy returns. When the time comes (sooner than you'd think), be the senior you wish you'd had, don't take your frustrations out on those you're meant to nurture and teach.

Break the cycle. Crush this hierarchy and patriarchy. All the while, love and help each other.

~ written December, 2020