Everything but the medicine: A doctor’s tale by Lucy O’Hagan

Life as a General Practitioner (GP) in Aotearoa | New Zealand is challenging and at times overwhelming, says Dr Lucy O’Hagan in her thoughtful and compelling memoir – and she loves it. She’s supported patients at “births, deaths, marriages, break-ups, breakdowns and remarkable recoveries” and her life is richer as a result. And yet:

We could work day and night and never get it all done.

During her thirty years working as a GP at both rural and urban practices, O’Hagan has built a broad set of skills. She regularly speaks at conferences, writes a monthly column, and has developed a podcast. In a typical week she may also be a mechanic, detective, cheerleader, counsellor, complicit observer, taxi-driver, battery-buyer, good cop (or bad cop). She’s a Pākehā doctor learning about te ao Māori, the importance of the collective, and how understanding concepts such as whakawhanaungatanga and vā can strengthen her relationships with Māori and Pasifika patients. Outside work, she’s a partner to Lizzi (the cover artist), a mother, a sister mourning the loss of two brothers – one who died as an infant, and the other swept down a river at age 28 –  and a daughter who’s lost both parents.

Juggling multiple roles is not easy, sometimes requiring “divine intervention” – as well as laughter, little white lies, and letting patients know about legal limits. It’s no wonder that the word ‘complex’ appears frequently throughout the book.

The memoir has four main sections – Patient, System, Doctor, Story – each with around a dozen parts, most a page or two in length. Some reflections are expressed as poems. A glossary at the back of the book defines Māori and some Pasifika terms, and the notes section includes references for podcasts, articles, books and other resources.

O’Hagan’s book complements There’s a Cure for This: A Memoir (Wehipeihana | Espiner, 2023), which also highlights systemic inequities that are not yet addressed, as well as the huge demands placed on medical practitioners in this country. Both authors emphasise the importance of listening deeply to a patient’s story – including for the “faint whisper of some [other] story” that may not yet have emerged.

O’Hagan is open about her vulnerabilities, her family’s experiences with the health system, and the challenges she has faced in both her personal and her professional life. As a young doctor she soon learned that she must “look as though I know what I am doing”.  She describes a lifelong tension between being simultaneously an ‘expert’ and a perpetual learner who allows her patients to teach her.

Consultations, O’Hagan says, are rarely linear in nature, they are often chaotic and complex. Yet within a 15-minute timeslot, GPs are expected to (at least) assess, prioritise, plan, problem-solve, explain, summarise and reassure – while being compassionate and appearing confident even when uncertain. The reality is that some patients live, and some do not. Some are lost to cancer or heart disease, others to diabetes or work-related accidents. Some die surrounded by family, others die alone. O’Hagan describes how she wrestles with whether she could have done more for patients who die by suicide.

Death is final. We battle with ourselves. Did I do everything I could? Did I say everything I needed to say? How can I uphold this person’s mana in the face of their decision? How do we support those left living?

At one point, the cumulative effects of GP work and other pressures resulted in O’Hagan burning out. Large chunks of her brain, she explains, “just fizzled out”. She persevered despite experiencing overwhelming stress both at work and at home. Constantly tired and irritable, and dealing with a separation as well as a mid-life coming out, “the unravelling started”. She sold her practice and stopped work.

When O’Hagan eventually regained confidence and resumed practising, she was more aware of the need to look after herself as well as her patients. Her number one tip for finding “the Zen of general practice”? “Treat yourself with care”. O’Hagan says that boundaries must be drawn, particularly for GPs living and working in rural communities where everyone’s on a first-name basis and there are secrets that must be kept. As a professional in a small community, would you accept an invitation to include your home in a house-tour fundraiser for the local toy library? Or would you, like O’Hagan, decline the invitation, wary of random patients who might want to sneak a peek under the bed?

O’Hagan’s reflections blend elements from different stories so that personal experiences remain confidential and her patients’ identities are protected. We hear of a man just out of prison, starting a new life in a relative’s garage, doing his best to steer clear of gang life. Another carries their possessions in a pillowcase, couch-surfing with alcoholic friends while trying to stay sober. There’s a woman with a violent partner (her “smashed-up face” blamed on a fall down a mountain), and a graceful young woman who repeatedly cuts herself for relief from trauma: she’s a survivor who “one day [hopes] to tattoo her scars in gold”. One patient regularly buys clean op shop clothes because it's cheaper than going to the laundromat.

Some of O’Hagan’s stories are confronting, raising moral and ethical dilemmas. She covers many topics, include inequity, power structures, and colonisation, and ‘wicked problems’ lacking clear solutions. There’s a sprinkling of data in the book, however much of the content relies on anecdotes and observations drawn from decades of practice. She stresses the importance of collaboration – valuing the support received from other healthcare professionals, the skills of ambulance officers, the strong contributions of rural nurses and midwives, and the gumbooted farmers in helicopters who help out before the rescue choppers arrive to a remote mountain town.

A doctor is sometimes a patient – or a relative of a patient – too. O’Hagan recounts with sensitivity, humour and scepticism her experiences as an ED patient with a broken toe. She writes about the evening she had to convince her mother, 300 kilometres away, to get urgent help for a serious nosebleed. When her mother is admitted to hospital, O’Hagan knows that it’s important to charm and engage with the overstretched nurses, as well as to thank them. In My mother is dying, and I am lucky O’Hagan describes the dignity and the indignity of her mother’s final days, beautifully and realistically. “Death is a sort of adventure,” her mother says, and the family agrees.

I am lucky we can care for her at home. I’m lucky my family get on, that we know how to laugh. And cry.

Central to O’Hagan’s memoir are her ongoing efforts to make her humanity visible to her patients, to be more authentic and less grandiose. She tries to make her consulting room a safe and welcoming place for patients – not only by her non-judgemental approach, but also by reducing emphasis on visible “props” such as qualifications, medical instruments, and textbooks.

I have taken down my framed degrees. I have put novels on the shelves. I recently bought a beautiful velvet chair for the patients to sit in. It is in the most impoverished place I have ever worked, the carpet threadbare. The patients can’t believe the red chair is for them. The chair does more good than any prescription I have to offer.  

With my armoury of medicine removed, I find I can listen with my skin.

Aware of how her “white middle-class sensibilities” influence her practice, O’Hagan has integrated alternative approaches. These include Sir Mason Durie’s Te Whare Tapa Whā Māori health model that focuses on four key and interconnected dimensions of wellbeing.

O’Hagan is clear that she does not have all the answers. Decision-making is often not straightforward and confirming a diagnosis may not be in the best interests of the patient.

Does a label help? Or does a label start to define someone and limit their possible futures?

Her memoir raises many questions and is a reminder that GPs are not infallible. They – like us – are often balancing demands at work as well as at home. Perhaps O’Hagan’s tale will prompt us, as patients, to reflect on how we engage with our own GPs, and what we could or should contribute to each consultation. Maybe we need to manage our expectations, become a more patient patient.

The memoir ends with O’Hagan’s messages to her younger self, many of which echo themes emerging throughout the book. “Stop trying to be perfect,” she advises. “You’re not Jesus.”

Reviewer: Anne Kerslake Hendricks  

Massey University Press