Awakening Doctor
The Awakening Doctor podcast explores the personal stories of those who work in the medical and health professions. Each episode aims to highlight the humanity of an individual doctor or healer, and thereby challenge and transform social perceptions of the profession and the individuals who practice it. Join Dr. Maria Christodoulou as she meets with colleagues, leaders, and educators in healthcare to reveal the human side of being a medical professional.
Awakening Doctor
Dr Danielle Botma, A Junior Doctor
Have you ever wondered what it’s like to endure the sleepless nights and emotional highs and lows of being a doctor? In this episode of the Awakening Doctor podcast, Dr. Danielle Botma offers an intimate glimpse into the life of a junior doctor in South Africa's public healthcare system.
Through the lens of her personal story, we’re made aware of the stark contrast between the idealism that drives young students into medical school, and the challenging realities they face in practice. Dr Botma speaks candidly about the ongoing pressure to excel, the personal sacrifices she has made, and the profound influence of impactful patient encounters.
Together, we explore the complex social and cultural factors that shape perceptions of what it means to be a doctor and reflect on Dr. Botma’s journey to embrace aspects of that identity. We also delve into the pervasive stigma surrounding mental health in the profession and peel back the layers of perceived perfection to reveal the humanity and vulnerability beneath the white coats.
Join us for a heartfelt conversation that strives to give voice to the passion and commitment of junior doctors dedicated to improving the lives of fellow South Africans. Whether you're a student considering a medical career, a practising professional, or simply curious about the insider’s perspective, Dr. Botma's story is sure to resonate.
If you enjoy these conversations and would like to support our work, please consider donating to our podcast fund using the link above. Your contribution helps us cover production costs and keep bringing you great content. No amount is too small and your support means the world to us. Thank you!
Credits:
Hosted by Dr Maria Christodoulou
Produced and edited by Amy Kaye
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Website: https://www.awakeningdoctor.com/podcast
Thank you for listening!
So one of the reasons you and I are having this conversation is because my daughter shared an Instagram post that you had made and in that post you had a plea. In essence, you wrote a letter to all South Africans about things you wanted them to understand about what it's like to work as a young doctor in this country. I know the letter caused a little bit of a controversy and it was very widely shared and stirred up a lot of emotion. When you think about what you would like people to know and understand about what it is like to be a CommServ doctor working in the South African public health care sector, what would you say now?
Dr Danielle Botma:What I tried to say and what hurt me when the whole video came out and the comments about how bad the state is of some of the public hospitals is that people assume that everyone working in that facility or for that facility is bad, and so video was put out about a hospital in the public sector and you saw that video, read about the controversy and it brought up something for you, right?
Dr Danielle Botma:Yes, because obviously we get complaints daily. What that video was about... We hear that on the daily, and I think it hurts sometimes when you're just trying your best, and people don't know how it is to be on the side of doctors working in the state sector, or all doctors for that matter, and I just wanted to share just an insight, or like a small little glimpse, into what it feels like to be a doctor. And then I didn't actually, at the time, think about what I wanted out of my post. I was just venting and writing stuff down. I think doctors just needed a voice as well, and I think that's why it resonated with people.
Dr Danielle Botma:We're also just human. We're not some kind of elite group of people that can never make mistakes and are always ethically perfect and morally perfect, and even though we must aim to be that, it's just impossible. We also have off days, combined with a very difficult and emotionally taxing job. I think we must just meet each other in the humanness. You're human, I'm human, let's just try and get you healthy. But we aren't God. We have difficult jobs. I think that was actually what I was just trying to say, is that most people that I know, 99%, like I've said, from cleaning staff all the way through to management, are really trying their best. I've really rarely met people that are doing what they do, especially being a doctor and seeing all the things we see, for anything else other than being truly passionate about what they do.
Dr Maria Christodoulou:Welcome. I'm Dr Maria Christodoulou and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor. Joining myself and producer Amy Kaye, today is Dr Danielle Botma. Welcome, Danielle, it's lovely to have you with us.
Dr Danielle Botma:Thank you so much for having me. I really appreciate this opportunity.
Dr Maria Christodoulou:So there's a lot of different things we can talk about today, but I'm curious about where you would like us to start?.
Dr Danielle Botma:I think the reason why I'm doing this is to give a voice to young doctors in South Africa. E ven if it can reach one person and they feel that there's a like-minded soul out there. And,ja, if we can put the message out there about how it is working as a young doctor, about the things we go through, the experiences, what I would like other young doctors to know, or maybe people considering becoming a young doctor in South Africa, then that's already worth it for me. So that's my vision and mission for this episode.
Dr Maria Christodoulou:Fantastic, so maybe let's start with your story. What took you to medicine?
Dr Danielle Botma:I think there's a nice version where you say that you just want to help people, and I think that's also true. But I think that if you achieve academically, then there's pressure to choose one career path or a few specific career paths, and that's, I think, how I ended up in medicine, and the only reason why I highlight that is because I think sometimes people choose medicine without actually wanting to choose medicine and without having all of the information about why they want to go into the career of medicine and become a doctor. I think that is half of what happened to me, and then the other half is that I really wanted to connect to people in this country. I love this country so much and I love the people and the colourfulness of the people, and I wanted to do a job where I can reach as many people, and maybe if I can help one person, then that's already a win. But ja, I wanted to spend time with the people of my country. So that's how it all started for me.
Dr Maria Christodoulou:Right. Who or what was putting pressure on you to consider medicine?
Dr Danielle Botma:I think, mostly me. I think if you achieve academically from a young age, you want to prove to yourself that you can be the cream of the crop, and that's what they always tell you when they say, okay, you're now in the class of medicine, okay, you are now the cream of the crop. [Dr Maria Christodoulou] R ight. I remember that even in my day. [Dr Danielle Botma] Exactly, it's mostly myself, I don't think my family really did or anyone else, maybe some teachers here and there. I think mostly you put that pressure on yourself and I think that kind of continues right throughout med school and even as you become a doctor, you want to still then, in that elite group of people, prove that you are still at the top of that group of people and that becomes a motivating factor instead of just wanting to do your job, do it well and do it for the right reasons.
Dr Danielle Botma:[Dr Maria Christodoulou] Right. D o you feel like you're the cream of the crop? [Dr Danielle Botma] I don't think that's something you ever feel like you achieve. That's the problem. I think it's you wanting to prove to yourself that you can do that, but then you don't ever arrive at that destination. So I think that's also what creates this like culture of doing extra courses and paying for extra things and then trying to Cum Laude all of those courses, and then trying to Cum Laude your degree and etc. Etc. Etc. But then, even if you do all of those things, you never really feel like you are the cream of the crop. Someone else will then be doing something different and excelling in that.
Dr Maria Christodoulou:What do you wish you had known about medicine back then, when you were still at school?
Dr Danielle Botma:I wish I knew myself well enough, even though it's impossible at that young age, but to know what I would be, what you'd have to give up in order to do this job well. I wish I knew if that was going to be worth it. For instance, missing Christmases, missing birthdays, I know it's not like that forever and being an intern is especially hard and a junior doctor, but I think you really have to be passionate about what you do and do it for the right reasons to make that worthwhile. I mean it's difficult because at 18, you think you're going to be the next brain surgeon and you have all of these extremely high expectations and ambitions. I thought I was going to be a paediatric brain surgeon when I was 17 years old, and I thought that I would never get married or have children and I thought missing Christmases was so cool.
Dr Danielle Botma:Giving up on all of those things to save lives, it sounded so amazing to me at that age. So I wish I knew myself better to know that I'm going to not want to do that, but obviously that's not possible. So I think realistically, w hat I just would want people to know is what the sacrifices are, and choose medicine for the right reasons and not because of wanting to achieve academically and not because of wanting to prove anything to anyone.
Dr Maria Christodoulou:So what are the right reasons to do medicine?
Dr Danielle Botma:That's a difficult question, but I think the right reason to do medicine is, firstly, you must have a passion for people and enjoy working with people and enjoy expressing empathy. I think there's a lot of doctors in our community that study medicine and do what we do because they want to prove something, or there's different reasons why people become doctors, but I think we need more doctors that want to work with people, that enjoy working with people, that are passionate about people. There are less interesting things like enjoying problem solving, enjoying hard work, having a good work ethic, et cetera, et cetera. People lose their empathy and they have empathy fatigue. But I really think people should consider studying medicine if you're willing to sacrifice things because you love people that much.
Dr Maria Christodoulou:And I think the thing that always comes up for me when people say they want to help people is that they often certainly at 16, 17, 18, don't realize that it's different to help people who are suffering or who are ill or who are often at their worst or experiencing some of the most terrifying moments in their lives, and it's not quite the same as just helping people to be their best. There's a very big difference when you're helping people who are ill.
Dr Danielle Botma:Exactly. It's difficult, so you must really get a kick out of that. You must be able to be with people in their worst and then sometimes not even see a positive outcome. That mustn't be why you do it. It should be because you want to help there, in the trenches of someone's situation, and you enjoy that. There's this thing where they say that a lot of narcissists become doctors because you want to help people to feel good about yourself. I think that's also a very dangerous pathway t o want to become a doctor. You want to have this God complex, feel good about yourself, but then at the end of the day, that won't be fulfilling at all because, like I've said, you're going to have to give up so much.
Dr Maria Christodoulou:What have you had to give up?
Dr Danielle Botma:I'm still a junior doctor, so a lot I think. W e get rostered for Christmas and New Year's and birthdays etc. So obviously those small things. S leep, exercise, eating well, but I think the most important thing that I've thought about that
Dr Danielle Botma:I have had to give up, not only now but since s tarting to study medicine is, a big part of your identity, because studying medicine, it's a full-time job, and then becoming an intern and a Comm Serve is extremely exhausting and full-time. Y ou miss out on things that you used to do and things that used to be part of who you are. It's impossible, like, just to use an example, I love being in choir. I was a choir girl and that was part of my identity. I love choir music. I loved going and that was a big part of who I thought I was.
Dr Danielle Botma:But then being on call and the call roster being what it is, this week you'll be on call Tuesday. Next week Thursday, the week after that, Friday. So you can't do any organized activities outside of medicine r eally. Y ou never know when you're going to have to work late, because if the resuss comes in, then you also don't want to organize something and then you never pitch up. I think a big part of who you always thought you were gets lost. Even socializing, if you used to be a very social person, that's almost impossible to really maintain. So I think that's a lot of what people give up and I do think you eventually are able to get it back at a later stage in medicine, b ut I think that's what a lot of young doctors struggle with specifically.
Dr Maria Christodoulou:Right. So where exactly are you in the medical journey right now? You spoke about being a junior doctor. Tell us what that means.
Dr Danielle Botma:I'm almost finishing my community service. So after finishing med school, you have two years of internship and then one year community service, and then you go out into the great big world of being a doctor, which is scary in its own. You have to get a job. At this stage, I'm still, in a way, lucky that I have a job at the moment. I'm almost at a point now I have to start applying for jobs next year. So that's a whole different fear and story. [Dr Maria Christodoulou] What's the fear about that?
Dr Danielle Botma:Well, firstly, there aren't enough jobs for everyone in the state sector, especially not if there's something specific you want to do, like if you want to go into paediatrics, or if you're specific about what you want to do, then those posts are very few and far between. And then, I think what people don't always know is that you can't specialize in the private sector. If you want to specialize in something, you have to stay in the public sector and get a registrar post and then specialize. A lot of people tell me, then just go private and become a paediatrician. I can't do that. That doesn't work like that. So you're forced to be in the public sector, b ut then there also aren't jobs and it's just extremely, extremely competitive to get into those posts. I know of people that are consultants working in medical officer posts just because they have a job. So then there's me, post-comm serve competing with a consultant to get a job. So it's tough.
Dr Maria Christodoulou:I also know that you've had a baby recently.
Dr Danielle Botma:Yes, I did. He's three months old.
Dr Maria Christodoulou:Congratulations. I'm curious about what it's been like to have a baby in your Comm Serve year.
Dr Danielle Botma:It was tough. I think now, retrospectively, it was more tough than I thought at the stage when I was pregnant. But I think the exhaustion, especially like the brain fog and the fatigue, it's not only that you're feeling exhausted while you're standing there. I think it did a bit of damage to my reputation. I wasn't as bright and as quick and I didn't feel as smart as I felt before I was pregnant.
Dr Danielle Botma:It sounds so bizarre to say it out loud, but I think I want to be an intern or a Comm Serve that people say, oh, she's good, she's bright, she has a big future ahead of her, especially now, before you apply for a job next year. But I think if you're pregnant and you're slow and you're always chronically exhausted and some people are in pain and some people are stressed and have difficult pregnancies, I luckily, I didn't, but you so badly want to be your absolute best. So I had to struggle with that a bit. I went from an internship where I felt like yo, I'm at the peak of my abilities now and now I went to not being that anymore. That was tough for me. Even now when I go back I feel like I'll put a lot of pressure on myself. Okay, now I have to show them who I really am not pregnant. So ja, we'll see how that goes.
Dr Maria Christodoulou:So when you were talking about things you've had to give up, you were talking about how being a junior doctor and a medical student often gets in the way of normal social activities. And yet here you are. You've got married i n the last few years, you've had a baby. Like, how did you maintain that part of you?
Dr Danielle Botma:It wasn't easy to maintain that part. You again have to make sacrifices. I think at the end of the day, you just have to choose what's most important and then focus on that. I think to maintain healthy relationships and study medicine, you need a very understanding partner, firstly. Someone that understands the hours. I'm lucky that I had that.
Dr Danielle Botma:But I think just prioritizing, forcing yourself to do social things, exercise, go for a run, maybe with your partner, because you can get stuck in a hole and I definitely did also at some periods of my studies where I didn't do anything and it was hard, and then luckily, I got out of them again and then you start calling up friends you haven't spoken to in months and making plans. But I think it's important that you know that you have to force yourself, because there is also a very real possibility and I've seen it happen, of you just sitting and studying every single day and then people lose friends. E ventually, like I said, that part of your identity gets lost as well. S tudying and not coming out of my house for days and looking transparent. Y ou have like important people in your life that, I used to tell, you have to tell me. If I am in a conversation and I can speak of nothing else than medicine, then please, you have to pull me out of that, because I don't want that to become my entire life.
Dr Maria Christodoulou:Maybe you can tell us what it's like to be a junior doctor or a comm serve doctor, because that's where you are right now.
Dr Danielle Botma:It's difficult to explain to someone how it is to be a doctor. to people that aren't doctors, the things we see every day. It can get overwhelming for sure. I really enjoy my job.
Dr Danielle Botma:I think the difficult parts of it is working with people, then working with patients, working with staff, and I think if you are exhausted, then also all of that people management and team dynamics gets very complicated.
Dr Danielle Botma:So I think for me at the moment, that's what I'm struggling with most. B eing confident enough in myself, even as a junior doctor. Just that confidence to say what I want to say and then be seen as an equal in the team, that I have worth in the team. I think we know seniors in medicine is always a difficult topic, not because we have mean seniors or anything like that. It's just difficult as a junior doctor to be confident in what you're saying and stand in your own worth, and when you know someone else knows so much more than you, it's always a very vulnerable situation. So that's what I'm struggling with at the moment the most, and the working hours we all know is crazy, I think, the most difficult part and when I speak to my friends as well, that's what they struggle with, to just feel like you are not only a workhorse but a valuable member of the team.
Dr Maria Christodoulou:And I'm sure there are some who would argue that as a junior doctor you are actually the core foundation of the team in some ways, because without you a lot of the work wouldn't be happening.
Dr Danielle Botma:Ja, that is true. The best times I've ever had in medicine is when you just feel like you're actually making a difference and when the people in your team makes you feel like you are making a difference. When, even though you are doing the drips and, not that that isn't important, but the not so 'high level' jobs, but when you're made to feel like you did that well, then when it's not just seen as like, you know, it's easy or whatever, and when people encourage you to try something new or practice a skill you've never practiced, or present in a meeting, or when they force you out of your comfort zone and they make you feel like, well, you are helping people, that's when I think people flourish. It's when they feel like they are being seen for what they do. Then medicine is so much fun. If it's a whole team and everyone's working together and it's a well-oiled machine, everyone feels worthy and confident and everyone feels like they're contributing, then I feel like that's what I want to do.
Dr Danielle Botma:Then I get this feeling that I'm doing what I'm meant to do and I can do it for the rest of my life. Sometimes I want to be a paediatrician, sometimes I want to be a physician. I change my mind all the time, but it's also very much based on the experience you have at a specific time and place in your career. If you work with someone that you loved working with in orthopaedics, for example, well, maybe I can be an orthopaedic surgeon one day. I think people have a very big impact on junior doctors. I think it can really form you. I don't think people know the impact they have sometimes.
Dr Maria Christodoulou:And I think there's evidence to show that actually, one of the biggest determining factors of what path a medical doctor's career will take is a significant role model. Exactly. S o who have been some of the significant role models in your path so far?
Dr Danielle Botma:If I have to think back, there have been teachers in school. One of my grade two teachers told me... he like pulled me aside and said I have such potential. And I mean, I was eight years old at that point and I still remember that exact moment. From school, there's been many teachers.
Dr Danielle Botma:In medicine specifically, I think there was a Dr Dale Peterson. He was a registrar when I did internal medicine and he was very pro-learning and we had all of these academic ward rounds and he would ask questions, but then he wouldn't get upset when you got the answers wrong. He would explain, and he would explain pathophysiology, and it was just such a nice environment and we worked so hard in that block of ours. We were so exhausted but I was on such a high because it was just such a positive, non-toxic learning environment and I think people that study medicine like learning. That was an important one, because it wasn't specifically that he was being overly nice. He was very nice as well, but it was just such a nice working environment. You felt like you were learning things, doing things.
Dr Danielle Botma:And then in my internship I had many very good role models. I'm so thankful for the ones that... I think now, if I reflect, it's just the ability to learn in a non-toxic environment. As a senior, you create that safe space where you can make mistakes. All of those doctors are some of my role models and people that give positive critique as well as negative critique. You can get seniors, as well, that only point out the negative. At a stage, if you only point out the negative things over and over again, then it starts to feel like you get so down on yourself and then that one little compliment can make such a difference.
Dr Maria Christodoulou:What are some of the compliments that stand out for you?
Dr Danielle Botma:I think that a recent one is that I work very hard. I think that's always very nice to hear. I don't know if that might be toxic, now that I reflect on that.
Dr Maria Christodoulou:I'm wondering if you need someone to tell you that you work very hard. It sounds like you know that you work very hard.
Dr Danielle Botma:And then just what's very nice actually is if patients compliment you, especially in front of your team. I f they're like no, I want her to be my doctor, or if they thank you. It never gets old if you get thanked by a patient or their family. It means so much. You can ride on that high for quite a while actually, especially if you went out of your way to help that patient, or sometimes if you don't even expect it at all. If it's just that you greeted them or that you spent a little bit of extra time listening to them. I think those are actually the best compliments.
Dr Maria Christodoulou:What's been some of the worst or harshest criticism or feedback that you've received? [Dr Danielle Botma] I have to think. [Dr Maria Christodoulou] I'm glad you have to think.
Dr Danielle Botma:The most difficult to deal with is when you feel like it's undeserved. When there's a hierarchical system where if you get criticized about something you don't think is deserved, you can never stand up for yourself in any way that's acceptable to your team.
Dr Danielle Botma:But the harshest outright, I think, is probably when you're criticized on just something personal, something that's not to do with your job. About maybe seeming indifferent or, I think, as an introvert it's interesting. I've gotten the criticism a lot of times, where people have said that I am disinterested because I'm not the one always talking in the group, always yelling out answers or volunteering to do things or volunteering to do the bloods or whatever. But I think when you're a bit reserved as a person, then you get criticized for being disinterested or reserved. Some of my female friends specifically that are also a bit more timid and reserved, we've spoken about all receiving that criticism. You're not the one. You seem like you are maybe aloof or you don't want to manage your patients, whatever, but actually you're just shy maybe. [Dr Maria Christodoulou] R ight, and who's that feedback coming from most of the time?
Dr Danielle Botma:[Dr Danielle Botma] I've gotten that criticism from nursing staff. I've gotten that criticism from senior members, from colleagues. I must say, it's mostly during your studies and internship when it's expected of you to want to learn. They always say that in medical school you kind of have to... If they ask who wants to put in this drip, you have to jump out of your shoes to show that y ou want to be the one to put in that drip, and even if I wanted to, that's not my personality to take that away from someone else. I always feel like, okay, no, it's fine, you can do it. And then by doing that, I seem as if I am not keen.
Dr Danielle Botma:But I think it's maybe a woman thing also, being very polite. [Dr Maria Christodoulou] Say more about that. [Dr Danielle Botma] A s women, I'm not speaking on behalf of all women, obviously, but I think there is a culture of being very polite in women. We get taught to be nice, especially in medicine. You get hardcore like, I don't know if I'm allowed to say, but like badass women in medicine. I think we do get taught to be polite, be quiet, know your place.
Dr Danielle Botma:Don't fight too hard, don't be rude. I think sometimes that can backfire in a career where you really have to fight.
Amy Kaye:Yeah, do you think the fact that you come from an Afrikaans background, do you think this influenced you in that way?
Dr Danielle Botma:I think so. It's difficult for me to say because I'm not from an English background. I'm not exactly sure what the cultural teachings are for them, but definitely for an Afrikaans girl. You get taught this. You only have one name. You have to protect that name with everything you have. I mean that was drilled into me. I come from a very Afrikaans school. I love my school, but we were taught that our dresses must be a certain length. We have to be very polite, we have to talk softly and be respected and be respectful. So I think it's difficult to then get out of that head space and now be this loud surgeon telling everyone in the room to keep quiet. It's hard. I was always motivated to be what I want, but there is a culture where you are forced to be very subdued in your personality.
Dr Maria Christodoulou:So what was medical school like for you?
Dr Danielle Botma:Terrible. I think, to be quite honest, it was dark. I still now... If the question is going to be... the follow-up question, why and how we can fix that, then I don't know, because I really spent time thinking about what can happen to make med school less absolutely horrible for everyone.
Dr Danielle Botma:But it's just so stressful and so all-consuming and so, I don't want to say... so one-dimensional. You get into this phase where you just sit and there's just so much work that you have to sit and study. You become this very robotic kind of person. And I was so depressed in med school. I gained so much weight. I had to start taking medication and I know that's the same for a lot of people that I study with. It's a dreadful time and then final year is the absolute worst of it all. Y ou work hours as if you're an intern and then still have to study. It's seen as a rite of passage, so you can't complain about anything, and I also don't know how they could possibly fix it.
Dr Danielle Botma:Like I said, I don't know what the solution is, but for me it was absolutely difficult and terrible. I have friends that are final year now and they speak about the same things, about not having balance. We get taught to have balance and like, okay, go for a 40- minute walk every second day, go to the movies with a friend. I think balance is... I don't know if it's achievable in med school, h onestly. T here are those very A-t ype personality people that... I don't even know if they get it right, but there are people that seem to have it more put together.
Dr Maria Christodoulou:I remember one of our previous guests saying that at some point she did the exercise of adding up how many hours were needed for her to get to everything she wanted to do, and she needed like an extra 12 hours in a day or something ridiculous.
Dr Danielle Botma:Exactly. I thought somewhere in my life I would be young, wild and free, you know. L ike, I thought I would go to festivals.
Dr Danielle Botma:Then you go straight from school, b eing a straight A student and, I mean, it doesn't start in grade 10. It p robably already starts in primary school, where you study hard. And then you go straight from school to university, study medicine, get out of medicine. You want to specialize. Now you have to start doing all extra courses and work, work, work, work, work until you specialize, then you're 50 with kids and you never get any time. So that was a difficult realization for me. I went through a very difficult period trying to make peace with what I lost. I never got to be carefree and careless and that was difficult, especially being on a different campus. You don't have that first year period that other students have. It's not everyone I know, but for me that was also a difficult thing to deal with.
Dr Maria Christodoulou:Ja, I remember that and I've spoken to lots of people who have that same experience, and even the sense of isolation that happens when your peers who are the same age, maybe even studying one of the allied health professions, have a very different social experience to yourself. And then the realities of the demands on your time and energy that make it unrealistic to have that kind of social life.
Dr Danielle Botma:And it's just the moral thing as well. Like, now you're becoming a doctor, you're not allowed to do anything immoral. You have to be on this like high horse all the time. You are supposed to be the epitome of a healthy life. Don't smoke, don't drink, be healthy, exercise, eat well. You're young. You're 18 years old when you start studying medicine. I think that's such an impossible and ridiculous expectation to have of 18 year olds. T hat was also difficult to deal with.
Dr Maria Christodoulou:Where was that pressure, or where was that expectation coming from?
Dr Danielle Botma:it's difficult to pinpoint, but it's kind of like... it's maybe also self-inflicted. It's you want to now be in this elite group and now you have to prove to yourself that you are now in that group. And now... I think a lot of it also comes from the seniors. I remember having lectures about our campus is smoking free, it's alcohol free, so that's already like, the other campuses is not like that. Then also having lectures about, it was said that for us to have balance, you have to go for a milkshake with your granny on Tuesdays for like half an hour. I remember that so well. Like, see family, have milshake with your granny. And I was like, oh all, right. [Dr Maria Christodoulou] W as that actually said to you in a lecture? [Dr Danielle Botma] We had a module about how to develop into a good professional doctor. Then they give you this breakdown of like how to be more balanced. I was just like, oh no, I don't want to do any of those things right now.
Dr Maria Christodoulou:You went to Stellenbosch, right? What was it like to be a white Afrikaans girl at Stellenbosch University in this day and age.
Dr Danielle Botma:S tellenbosch is still very Afrikaans, though they don't want you to believe that. I'm very thankful I went there as an Afrikaans person. I think it was still very protected. [Dr Maria Christodoulou] P rotected in what sense? [Dr Danielle Botma] Protected... you could still speak Afrikaans. I did my first year in Afrikaans and then swapped over to English. So I think, in that sense, for me, it was protected. But I think as I became older I realized that for other people studying with me that might have been difficult, a ctually. I'm not exactly sure how other people experience it. There is some changes happening at the moment. I enjoyed the environment at Stellenbosch University. I think as a white Afrikaans person, I'm probably the ideal person for that university, but obviously, as a woman, I've already spoken about that. I can't say that it was more difficult for me than some of my colleagues.
Dr Maria Christodoulou:Were you a student already at the time of all the sort of #FeesMustFall, #RhodesMustFall, #MeToo movements that were happening?
Dr Danielle Botma:I was first year. So, I did one year of BSc first and then I studied medicine. When Open Stellenbosch happened, and I think that was in my first year, straight out of high school, I wanted to go to the whole Afrikaans women's residence. I was excited for the initiation. F or me, I was excited for all of those things and then I went there and it was the complete opposite.
Dr Danielle Botma:I always say like, I was brought up in a very Afrikaans household. I'm Christian, white, Afrikaans. Both my parents are Christian, white Afrikaans. My brother is. I went to an all- girls Afrikaans Christian school. I don't have any people of other races in my family. I don't even have anyone that's not Afrikaans in my family, I I think. I was brought up in a certain way. N ot that I was brought up specifically conservatively. My parents are actually pretty free-thinking people, but it's just what I knew. C oming to Stellenbosch University, t hat was a whole culture shock for me that year. I'm so incredibly thankful that that happened to me. I think I would have been a much worse doctor if I hadn't broadened my horizons, and it scares me that some people become doctors without having their thoughts tested and them having to do some introspection. It was, at the time, not very nice.
Dr Maria Christodoulou:Are there any stories or experiences you'd like to share about what that was like or the type of things that, in your words, broadened your horizons?
Dr Danielle Botma:I think I had a mentor and before all of those things happened... S he was a very powerful black woman. She was one of our HK members, She was just so fashionable, and so smart and everything, was very pro Open Stellenbosch and #FeesMustFall, and I felt so hurt by that. A ttacked. And we had a lot of very difficult conversations, the two of us, and for a long time I was really angry and I felt betrayed, But I had to check myself, obviously and I was still very young at that point, so I don't think I really did at that stage. But as I became older, I realize now I think about it often, about things she said, and now it like rings true to me, and I actually... I thought tthat I should reach out to her and say, like, you know, I'm such a different person now.
Dr Danielle Botma:I think if I had to read some of those old conversations I would be so embarrassed about questions I had and things I didn't understand. I mean, I'd never heard of some of the things that were being said, things that are now extremely cringeworthy, like saying but I have black friends, I'm not racist. It's so cringey now to me, but I was that person at 18 years old. Now I would like die if I had to hear someone say that. T hat was hard but it was so... I'm so, so, extremely grateful for people like her in my life. She didn't have to have those conversations with me, because I'm sure it must've been very painful, the things I also said and asked, but she was willing to sit and speak to me about and explain to me, and that was so... I can't thank her enough for that.
Dr Maria Christodoulou:So one of the reasons you and I are having this conversation is because my daughter shared an Instagram post that you had made and in that post you had a plea. In essence, you wrote a letter to all South Africans about things you wanted them to understand, about what it's like to work as a young doctor in this country. I know the letter caused a little bit of a controversy and it was very widely shared and stirred up a lot of emotion. When you think about what you would like people to know and understand, about what it is like to be a Comm Serve doctor working in the South African public health care sector, what would you say now?
Dr Danielle Botma:What I tried to say and and what hurt me when the whole video came out and the comments about how bad the state is of some of the public hospitals, is that people assume that everyone working in that facility or for that facility is bad. S o a video was put out about a hospital in the public sector and you saw that video, read about the controversy and it brought up something for you, right?
Dr Danielle Botma:Yes, because obviously we get complaints daily. That video was about... We hear that on the daily, and I think it hurts sometimes when you're just trying your best and people don't know how it is to be on this side of doctors working in the state sector, or all doctors for that matter, and I just wanted to share just an insight or like a small little glimpse into what it feels like to be a doctor. And then I didn't actually, at the time, think what I wanted out of my post. I was just venting and writing stuff down. I think doctors just needed a voice as well, and I think that's why it resonated with people. We're also just human. We're not some kind of elite group of people that can never make mistakes and are always ethically perfect and morally perfect, and even though we must aim to be that, it's just impossible. We also have off days, combined with a very difficult and emotionally taxing job. I think we must just meet each other in the humanness. You're human, I'm human, let's just try and get you healthy, but we aren't God. We have difficult jobs. I think that was actually what I was just trying to say, is that most people that I know, 99%, like I've said, from cleaning staff all the way through to management, are really trying their best.
Dr Danielle Botma:I've really rarely met people that are doing what they do, especially being a doctor, and seeing all the things we see, for anything else than being extremely passionate about what they do.
Dr Danielle Botma:Even if they have not the best bedside manner. I'm not excusing bad bedside manner at all. T hose people will still read articles at night, stay up all hours of the night trying to figure out the best surgery... I'm not a surgeon but the best way to cure your disease, or reading extra articles or... D octors, I know, are extremely like...
Dr Danielle Botma:They go the extra mile for their patients all the time. You don't always see it, but I just want people to know that I don't think it's true what people are saying, that... B ecause people have responded to my posts and say, ja, but you care, but you are one of the few, and I don't actually agree with that. I've not seen that. I'm experiencing the exact opposite and I've worked in a few places now. So I think we can communicate better, always, as doctors. That's also what I learned from this whole thing is to communicate better, but I also just want the public to know that your doctors, 90% of them, care a lot and they want to go above and beyond, and that's I think, what I wanted to say, is that we must just understand each other better.
Dr Maria Christodoulou:I think it's such a paradox because that conditioning, that isn't just something one puts on oneself. I think it's a societal thing, that conditioning of you are the cream of the crop, and so that aspiration to be the best of the best and the messages that get promoted even from first year, you are the best of the best and, yes, it takes a certain level of academic achievement to get to graduate from medical school, but there's something in how that sets us up for an environment where our humanity isn't as welcome. I don't know about you, but I found it really hard. Like if I was supposed to be the best of the best, then I couldn't make mistakes and I couldn't be vulnerable and I couldn't not know things and I couldn't be exhausted or burnt out, and if the patient was being difficult or if I was rude to a patient, it was because they deserved it. Like not being able to necessarily own my own humanity.
Dr Maria Christodoulou:And then all that stuff you were saying about how you've got to be this role model for perfect health, and I mean to this day, I'm 58, i f I do a workshop or facilitate something, people will check what food I put on my plate in the mealtime because they want to see, am I eating healthily or not? Or they ask me, what is my exercise routine or what supplements do I take? Or if they find out that I'm on a medication of some sort, then it's somehow it's a failing or a weakness that I need to be on that. And so, there's this really interesting dilemma of, on the one hand, we experience being human all the time, but on the other, it's actually not allowed. We don't allow ourselves, but society also finds it very difficult to accept that we are human.
Dr Danielle Botma:No for sure, and it was so obvious in Covid time when people stood on balconies and like clapped hands and ... It made me uncomfortable. O bviously very thankful, and I don't want to say that it wasn't appreciated, but somewhere deep inside I just felt like, no, what we're doing is really hard, it's tough, and I think 90% of the doctors didn't want to do it. It's not normal to want to go and put your family at risk. P utting that hero... It dehumanizes doctors. It's like a cloak of perfectness and then at some stage, we also take that on and then we also think we have that and it all ties in together. It starts in med school when you feel like you're not allowed to be young and wild and free, maybe, and then it ends up here, and then I think we can't connect anymore to our patients. We feel like if you're so high and so like perfect and so this, then you can't connect anymore. And I don't think it's true. I think we're all just the same and I don't think people should see us as anything else than human.
Dr Maria Christodoulou:You shared some examples of patients you had worked with and things you had experienced in that post and I was really struck by those. They really touched me and and they brought up memories for me of things that I had witnessed and experienced. When you look back now on your time in medical school and in the last couple of years of internship and Comm Serve, what are some of the stories that stand out for you?
Dr Danielle Botma:Well, those two, I wrote about them so they're close to my heart, I think...
Dr Maria Christodoulou:I'm actually just sitting here thinking, I've now mentioned this post. I'm sure everyone's going to be scrambling to find your Instagram feed to read this post. How would you feel about reading the post to us?
Dr Danielle Botma:Sure. I can do that. Okay. Hopefully I don't get emotional. I was very emotional while I wrote this post.
Dr Maria Christodoulou:Five minutes ago or two minutes ago, we were talking about being human and then you said hopefully you don't get emotional. What does it mean if you get emotional?
Dr Danielle Botma:Oh, then I won't be able to talk. Letter or plea to all South Africans. I've been reading people's comments on the recent viral video at Helen Joseph Hospital and I must say I'm overcome with a deep sadness and very heavy heart. I sent this picture of myself crying in the on-call room to my husband in 2022. My 23- year- old patient died of TB. He didn't have any family in the country and the last thing he saw was my face telling him everything was going to be okay. I still have his picture on my phone and I look at it sometimes and wonder if his family in Malawi ever found out what happened to him. If they never do, I will carry his memory in my heart for them.
Dr Danielle Botma:I think about the four-year-old girl that was shot in the head by gang members and I can still hear her mother's cries. There are so many examples I can't even get myself to type out. I think about them often. I pray for their families. I question myself over and over and over again about what I could have done differently to save them.
Dr Danielle Botma:I wonder if you know that we have meetings where the staff sit and we talk about each death and how we can improve future care. I wonder if you know that we work overtime that we aren't paid for. I wonder if you understand that some doctors and nurses give some of their own money to buy supplies for their patients. Do you know we fight for you? We fight with management for more resources almost daily. Some doctors fight so hard they get suspended. We miss Christmas with our families, we miss our best friend's wedding, we get spat on, slapped, insulted, assaulted, threatened and disrespected daily. Some get UTIs because we don't use the toilet often enough or get ulcers from the stress, and I know of too many doctors getting into car accidents after a long call and, sadly, being a doctor increases your risk for suicide more than any other career.
Dr Danielle Botma:I chose this career and will choose it again. I'm not complaining. I'm explaining. E xplaining why you might think we don't care when, in fact, we care too much and we are burnt out from caring in a system we can't change. Seeing you say, I hate doctors in this country, hurt. We are all fighting a broken system. It's us, me and you against it. Please don't be convinced otherwise. I've read that so many times, over and over again. It still wakes up that feeling in me again that I had when I wrote that post, I was thinking of all the things I've witnessed in my career.
Dr Maria Christodoulou:How old are you now, Danielle? [Dr Danielle Botma] I am 27. [Dr Maria Christodoloulou] I think you've probably witnessed things that some people will never witness in a lifetime.
Dr Danielle Botma:It's very hard. Reading people's comments where they actively hate you is very, very difficult. I sound a bit more angry there than I am now, but I wasn't angry, I was just... I felt a little bit hopeless and helpless that this career I chose, where we see so many things, that you have to do it because you really are passionate about people, and you give up so many things, and then to be hated for that by some people. It's difficult. I understand it, but it's difficult to be the scapegoat sometimes.
Dr Maria Christodoulou:Ja, I feel almost... What does one say to that? How does one carry on from there? You said you were more angry then than you are now. How do you feel about it now? How do you feel about all those things?
Dr Danielle Botma:Now, I've had so many conversations with colleagues and people online and I've read so many comments that I think I also said after that, that the post wasn't meant to invalidate people's experiences, because obviously, I also know that the system is failing people. Someone asked in one of the comments, like how would you feel if it was your sister or your mother getting some of the suboptimal care that people are getting? I've softened up a bit too. I understand people's anger. I did before I wrote the post also, so I think I've just... I've mellowed out a bit about my post. I still think that what I've learned from all these discussions I've had is that we can have better communication.
Dr Danielle Botma:I think patients want to see that you care. From their side, we're also human. We also want to feel your emotions and we also want to feel appreciated. We also want to feel seen, and I think someone else in the comments said, when last did someone ask you how your day was? A patient. I know it's not their job, but I was taken aback once when a patient said, How are you doctor?
Dr Maria Christodoulou:There was a time when that kind of question would make me quite anxious, like it was always unexpected, and then I didn't know how much of myself it was professional to reveal.
Dr Maria Christodoulou:Was I supposed to be honest, because I pride myself on honesty. Was I supposed to be honest and say I'm having a shit day, or was I supposed to say, I'm very well, thank you, and be polite, but untrue.
Dr Danielle Botma:Ja, I've learned a lot, but I think what I'm going to do personally, is just talk more, communicate better with my patients, especially if they're unhappy. Sometimes you can't and people are angry and you can't fix what they're angry about. But I think if we can meet each other somewhere in the middle, then that's what I'm going to try and do. I'm going to think of myself more as a human that studied medicine. I think my patients will be able to relate to me better, a nyway. We'll see how that goes.
Dr Maria Christodoulou:So what do you think is going to make that possible? I mean, what do you think it takes to shift from the idea of this God- complex and perfection, to just being human in relationship to another human?
Dr Danielle Botma:I think, not expecting things of myself that I wouldn't expect of someone else. Firstly, coming back to the team dynamic and being a valuable team member, already thinking of myself as one and not trying to prove myself. Seeing yourself on the same level as your patients. It sounds like I didn't do that before, but to be honest, you don't. Not that I think I'm better, but you just feel like a little bit removed from them. I'm going to try approach every consultation like that.
Dr Maria Christodoulou:I think what I've learned over the years is that that's not always possible because, even though you may have that intention, sometimes patients, in terms of their own need or their own developmental stages, are needing you to be on the pedestal, are needing you to take them by the hand and tell them what to do. And in fact, in my experience, it's often harder with the patients that don't need that and don't want that, because then most doctors don't know what to do. They don't know how to deal with a patient who's difficult or who is very educated and informed and is challenging their medical opinion.
Dr Danielle Botma:Maybe it's then just in how you see yourself, because that at least you can manage. But I think if you just see yourself as human, even if to your patient you're the doctor, then see yourself as just someone that can make mistakes and can learn from them, and in your team environment, see yourself as a valuable team member that are still human and can make mistakes, and maybe that'll rub off in your consultations with your patients as well. [Dr Maria Christodoulou] Have you made any mistakes that you'd be willing to talk about? [Dr Danielle Botma] Recently, I made a time management mistake that was quite difficult to deal with because I think you just try and do as much as possible with the time you have available and sometimes I think, especially if you're a junior, it's difficult to prioritize what you should do in your available time. And if you don't prioritize, then in medicine that's very catastrophic, and I was very hard on myself for a very long time about what happened in that specific case. It didn't turn out well in the end for the patient and there was a time management mistake, but just a difficulty for a junior doctor to prioritize exactly what to do first in a situation.
Dr Danielle Botma:But I've learned a lot about it, learned a lot about myself through all of that. I've spoken to my colleagues and to more senior doctors, and then also just to family about the difficulty of making a mistake at work. I've learned to firstly fix the clinical things, but then also to understand that I'm still junior. I can't be on the same level as someone with 40 years experience. It's just impossible. Even if I want to be, I can't.
Dr Maria Christodoulou:But there's also, I think, in that, an assumption that after 40 years of experience, you won't make mistakes. You might not make that mistake. You are likely to still make mistakes. T hat's the very nature of being human.
Dr Danielle Botma:That is very true. I didn't think about it like that. You always think that you're going to reach some pinnacle of your career at some point, and you're never going to make any mistakes, ever again. I think that's also an important thing to remember, because otherwise you'll have chasing your tail your entire career.
Dr Maria Christodoulou:So I mean it would be quite easy, listening to you and hearing about some of the things you've been through and some of the things I know to be a reality in our public sector, to kind of think, why on earth would you do this? And yet here you are. You have a husband and a baby at home, you are going back after maternity leave, you are staying in a public sector hospital, you're talking about getting a job next year. Like, what keeps you doing this? What keeps you waking up in the morning and going to work?
Dr Danielle Botma:It's very mentally stimulating and I miss that part of medicine. But mostly I just miss the people. I miss my patients and joking with them, and seeing them, and I miss my team. I think that's what I love about medicine, especially in working in public, is that it's a team. I think if you go more into private, I think even then, but it gets less and less. But working in public health care is fun because it's teamwork and that comes with its own challenges. At the end, I like that. I like collaborating to try and solve a problem. So that's mentally fun for me to do.
Dr Danielle Botma:You can make a difference. I think in the beginning I wanted to change the whole world, but now, for me, it's just nice to know that maybe I made one person feel better that day. I miss my job. It sounds terrible all the things that we're saying, but I didn't want, with my post, to necessarily be pitied, at all, and I didn't want to make it sound like our job is bad. It's difficult and there's challenges. The reason I'm speaking about it is because I think we can make positive changes, but I love what I do. I love being a doctor. There's nothing else I want to do and I want to continue doing this.
Dr Maria Christodoulou:I agree with you.
Dr Maria Christodoulou:It's why we do this podcast, and I believe that by telling the stories we can begin to shift perceptions and that that may contribute to the changes, because it's so easy to talk about the system as though it's some nameless, faceless entity.
Dr Maria Christodoulou:But the system is you and me, the patients and us. And one of the things that I found fascinating when I started having conversations with doctors and about 10 years ago I was thinking about doing a PhD and I put together a proposal and I went back and looked and I had logged, at that time, about one and a half thousand hours of one-on-one conversations with doctors. Now it's probably closer to 5000 hours of conversations with doctors, but the thing that stood out for me was that almost everyone I spoke to really was doing this from a place of really wanting to be part of the change and wanting to make a difference and deeply caring about their patients and about wanting to improve this world of ours. So that was not the perception that the public had of us, which I think is still true, and so hopefully, by having these conversations, we begin to change that a little bit.
Dr Danielle Botma:I think it's sad that we go into this job because we care so much and then we work so hard that we get empathy fatigue and then we don't care at all. So I think that's a bit ironic. But I also think by just talking about it more... that's why I'm doing this. The only reason is because I think that we can make a change if we just communicate better and talk to each other.
Dr Maria Christodoulou:So at the beginning you said that you hope that people listening to this would have a different understanding and that maybe if there's somebody out there who's feeling the way you were feeling, they will take some hope from all of this. How are you feeling now that you've had a chance to share some of your story with everyone?
Dr Danielle Botma:I'm nervous that people listen to it and think that's not how I feel at all, but I think that's always the fear and that's exactly why I have to do it, because that's unlikely, and it's more likely that people will also feel the same way and then not feel as lonely anymore. I'll say I'm excited. Let's say that's still a nervous feeling, but....
Dr Danielle Botma:[Dr Maria Christodoulou] Well, there's a vulnerability to putting yourself out there and telling your story. [Dr Danielle Botma] T here's always a chance for people to have negative feedback, but I think that's also alright with me. I think you can always still learn from the negative feedback or you can just go through all the positive things and then hopefully, as a community of doctors, we can feel less alone, more seen. Maybe I inspire someone else to tell their story. I felt relief after I made the post initially. It just feels nice saying what you feel.
Dr Maria Christodoulou:Right. Is there anything we haven't talked about that you'd like to share?
Dr Danielle Botma:Just one thing is that I kind of mentioned it earlier and it ties in with not having to be perfect as a doctor, i s that mental health for doctors and being on medication for your mental health. That's such a difficult topic because people want their doctors to not have health issues. But then the conditions we work in and I think the personality that gets selected, that ends up in medicine, they're already more vulnerable and then add on all the working hours. W e all know and we've all heard of colleagues that we've lost to suicide and I think it's important that we start talking to each other and be more receptive of people with mental health problems in the healthcare sector. Be there to support each other and not judge each other for mental health issues. P atients as well. But I think that's more difficult. I think we can start by just supporting colleagues first.
Dr Maria Christodoulou:So you mentioned earlier that you'd been on medication. Did you feel supported when you needed to be on medication? Are you still on medication?
Dr Danielle Botma:I'm still on medication. It's difficult when... there's this thing in medicine where, if you say mental health, it's kind of like, snowflake. I t's a thing for our generation and the older generations think we're so weak and it's like an excuse to take days off work and unfortunately, that is the case, I'm assuming, sometimes, and that also makes it difficult. But for me that was the difficult part. B eing embarrassed, not wanting to seem weak, not wanting to seem unstable. Actually, I think that's the exact opposite. I think if you have a problem and you actively seek help and you speak to someone and you drink your medication, then you'll probably be more stable and healthy than the person that's just trying to avoid all of that. It doesn't always mean if someone has a mental illness or is taking medication, that they are weak or not able to look after themselves. I think sometimes it's the exact opposite.
Dr Maria Christodoulou:The stigma of that runs really deep. I mean I'm sitting here thinking about how brave am I going to be in this conversation? And I've spoken, I think, before in the conversations with others about depression having been a part of my journey. And when you said you hated medical school and you were depressed, I mean I totally, I can relate to that too, and I've cycled through periods of major depression at different times in my life and I've been on and off medication at different stages. And even now today, sitting here talking about vulnerability and encouraging you to be human and vulnerable, and before I asked you the question of are you still on medication, I was like, if I'm asking that question, I have to be prepared to admit that I'm also on medication.
Dr Maria Christodoulou:There's still something that makes me feel ashamed to admit that, even though I know that being on it makes me feel better, gives me more energy, makes me feel stronger.
Dr Maria Christodoulou:I've got all these lovely intellectual things about how the idea of being depressed in response to the world is a very healthy, very sane response to the chaos of the world that we are living in right now and it's, I think, in some ways, those of us who are very relationally inclined, very attuned to the environment and the people around us are going to be feeling that even more, because there is so much chaos in the world right now, and I had an argument with my psychiatrist about this a few years ago. I said to her you're medicating me to cope in a dysfunctional world. We need to change the world. When you tell me that at 27, you've been on medication and you've been through the things you've been through and witnessed some of the things that you've witnessed, I'm like I really honour and appreciate your resilience, and I hope that the younger me can also hear that, because medication has saved my life at different times of my journey.
Dr Danielle Botma:Mine too, definitely, and I was kicking back so hard against medication. Fought it so long. I'm going to exercise, I'm going to be healthy, I'm going to sleep more, I'm going to do all of these things. I went to therapy and I was fighting so hard to just cope. I was so exhausted doing all of these things just to get by. My psychiatrist was like, just try the medicine. You can always go off the medicine. Just see how you feel. And the sun came out at some point and, obviously you still struggle, b ut I could feel normal emotions again. B e sad when I'm sad, be angry when I'm angry, be happy when I'm happy, but not have this constant cloud over me. A nd I could stop fighting so hard. I think that's the important thing. S top fighting to just cope. I think there's a lot of people that I speak to now that are struggling so much, and then when you say, but why don't you just go see someone? Maybe you should just go on some medication? They're like no, definitely not.
Dr Maria Christodoulou:There's a lot of stigma and prejudice about that. I know. For me, I got involved in alternative and integrative medicine and complementary therapies and I know a lot about natural and indigenous medicines and I've tried everything at different times and I have come off the medication. But accepting my own humanity has meant accepting that I cycle through phases of depression and that in those times, and they're often triggered by external events, b ut it's a combination of environment and individual context. It's never one thing in isolation. Medication helps.
Dr Danielle Botma:It really does. So does speaking to people and opening up about it and really being brave enough to tell some of the darkest inner thoughts of your brain to someone else. That was also very difficult, but I think it is important to just mention that if you're feeling like you're struggling and you're fighting very hard, then maybe to just go see someone and speak to someone.
Dr Maria Christodoulou:Absolutely. So, personally, I'm feeling quite nervous about the fact that we've spoken about this.
Dr Danielle Botma:Also nervous, ja, especially having to apply for jobs, t hen you're always scared that that's going to count against me, but if it does, then it's not the job for me, so I'm just going to have to like sit in that for a while.
Dr Maria Christodoulou:Well, I think it's unconstitutional to discriminate against you for something like that, but at the same time, I want to acknowledge two things. I want to acknowledge myself for wanting so much to be a good role model and mentor that I couldn't lie in this conversation, and I want to acknowledge you for having the courage to be open and honest about that in response to my question, and hopefully, there is one person out there who might listen to this conversation and go okay, so it's not just me. Or okay, so it's okay to need some help.
Dr Maria Christodoulou:I do remember the third time I went back on medication, going through a period of about three months of feeling like a complete failure, and then, when I began questioning where that comes from, then that's the whole conditioning. We're supposed to be perfect, we're supposed to be on top of this, supposed to be able to use our knowledge to fix these things, and then, well, hello, here it is. You're human, you can't fix everything, and as human beings, we have developed these tools to help ourselves
Dr Danielle Botma:And it's better than some of the other coping mechanisms, that's also the other argument. But I thank you also, for making me not feel so alone in this conversation, and it would have been lonely to be the only person, and I think the more we just acknowledge... E ven like sometimes I, because I'm never going to lie about being on medication, but if you admit to it and then other people are like, me too, even that conversation is so healing in a way, because then it's not just me, and sometimes if someone more senior than you admits that, someone you think, oh, that person is so amazing, they've got everything put together.
Dr Danielle Botma:That has happened to me once and that really made me feel so much better about myself, less broken, because that's how you feel when you have to admit that you need help.
Dr Maria Christodoulou:Exactly. I was listening to Dr Gabor Mate this morning talking about how depression is not a Prozac deficiency and he was admitting that he too has been on medication at different times in his life. And then he gave the example of how somebody who is nervous or anxious in social settings and then has a glass of alcohol and feels more relaxed, it doesn't mean that they were nervous or anxious because they had an alcohol deficiency. But at the same time the medication can help you navigate circumstances differently, and that's certainly been true for me. And looking at the roots of depression, I think is a complex thing. I think it's generational, I think it's familial, I think it's environmental. I do firmly believe that it's a sane response to the chaos of the world.
Dr Danielle Botma:I understand it. But the stigma against medication is just... Sometimes, I don't believe in medication, necessarily, without therapy, and I think it's important to speak about the things t hat's the problem. But then I also feel like you don't need to fight the medicine so hard. It has side effects, but not that many. It's quite safe. You can get some that aren't even that expensive. I had to ask myself at some point like, why am I fighting this so hard and I couldn't really come up with a good answer.
Dr Maria Christodoulou:Well, when I realized that I was more open to the possibility of chemotherapy... not that I ever needed it, but I was doing a lot of work with cancer patients and somehow the idea of chemotherapy was far more acceptable to me than antidepressants, as insane as that may sound. But there was something about mental health issues being not physiological and again, I don't think any illness is primarily physiological. I think there's a combination of factors. But I had to really stop and think. Why would it be easier for me to say yes to chemotherapy than to antidepressants? What's that saying about my conditioning, about the world that we live in, about our attitude to mental health issues? It's hard to be human, right.
Dr Danielle Botma:Ja, I just wanted to bring the mental health up.
Dr Maria Christodoulou:Thank you for saying that. I want to maybe take a moment to acknowledge... You mentioned your husband and you mentioned how important it is in this profession to have a partner who is understanding of the circumstances and the working hours and the conditions. I'm curious, is he also a health professional or is he outside of the field?
Dr Danielle Botma:No, he is in a whole other, completely different field, but I like it that way. It gives me a little bit of variety in my life. I speak about something else, something different than medicine when I get home, because he just faints when he hears the word blood, and so it forces me to speak about something different and be a different person, be a different version of myself at home than I am at my job.
Dr Maria Christodoulou:Coming back to this idea of how medical school and medicine requires a shift in identity. What would you say is the biggest difference between the Danielle who finished school and entered medical school and the Danielle I'm talking to today?
Dr Danielle Botma:Hmm. It's difficult. When I left school, like I said, I was very sheltered. So when I think back to that Danielle, I feel like 'cute' to myself. W hen I look back at her... V ery ambitious and young, but a girl still. Now, after school is when the difficult parts of my life started, when I had to go through med school and had to change, when I had to go through the culture shock of being in a new environment, being in a relationship, getting married and having children. I suddenly, just now, felt proud of myself for a little second there. [Dr Maria Christodoulou] I love that.
Dr Danielle Botma:But I think now I feel more like a woman. Gone through difficult things, but can still say that I'm quite satisfied with where I am as a doctor, a s a mom, as a wife. Quite happy with that, with what I've achieved so far.
Dr Maria Christodoulou:What do you think lies ahead? I know we can never really predict, but what are you hoping the future might hold?
Dr Danielle Botma:I'm hoping to do something meaningful with my career. I don't want to be just another person in the system that's trying to keep the water from falling out of the small, tiny millions of holes. I don't want to get stuck in that rut of just seeing patient and patient and patient, patient, patient, and then feeling just burnt out. I'm thinking of ways that I can contribute to medicine, maybe in a broader sense, maybe in a public health sense, and somewhere I feel like I can really make a difference. And for everyone that's different, but for me they'll probably be systems, and so I'm thinking about that.
Dr Danielle Botma:I'm really trying to let my mind go. But in the near future I think, for the beginning of of next year, I'm just going to try and turn the pace off a bit so that I can focus on what I want to do. I think next year my plan is to slow down a bit, refocus, maybe get some energy again so that I can go forward. That's if I'm able to turn my mind off like that, but hopefully... [Dr Maria Christodoulou] I s there anything you'd like to ask, A my?
Amy Kaye:I didn't know anything about the Instagram post, so it was actually really nice hearing it directly from you, because often you see these things completely out of context. Especially with social media, it is often just a place for people to project their stuff. They're having a bad day and then, okay, this person's going to get my wrath because they had a bad day. Social media can be so incredibly cruel because it's the power of being anonymous, so you can be as hectic as you want to be, and then there's nobody there to stand up to you and these wide reaching effects and it's just you trying to express yourself and then everybody else trying to have their two cents. And how dare she say that, or how dare she think that? Or she doesn't know me. Whatever it is, it's interesting because one of the things you mentioned was I'm not as angry as I was then, or something to that effect. I think I'm misquoting you, but it didn't come across as angry. That wasn't the feeling I got at all. The way you said it, the words you used. Anger was not the emotion at all. I just felt like it was somebody who was really hurting. It was somebody that was really hurting and was trying to express that hurt and say, hey, I'm a human too, and have you ever thought that maybe we as doctors have feelings? And as somebody who is not in the medical field and is not a doctor, it's always interesting to see that perspective and to remember that we're all just humans and we're all just trying to figure this thing out and all the things that you both have mentioned today. But I just think it's incredibly cool and incredibly brave that you put the post up. I think there should be more people doing that.
Amy Kaye:People put stuff up on Instagram for all the wrong reasons. It's all for clout and fame and getting ahead and screwing people over and money. And it's very rarely a place where people do it just to be vulnerable, just to go hey, I'm experiencing this and I'm thinking this. Is anybody else thinking and experiencing this? I think that's why podcasting is one of the few mediums that is left where people are kind of just trying to do that. This is what we're thinking and feeling. Are you thinking and feeling this too? Let's have a conversation about it. It's one of the few pure ways of people expressing themselves that are left, without there being this whole agenda around it.
Amy Kaye:So I just want to compliment you on that. It was a very brave and hard thing to do. I'm sure there were lots of repercussions. You mentioned that you're a perfectionist and you try and be this ideal doctor, whatever you have in your mind, I think it's really phenomenal. You're so young, you've got a husband and a child, you're studying, you're working, you're doing it all. You mentioned somebody else was this badass woman. I look at you and I go, How, how are you being such a badass woman? You're phenomenal.
Dr Danielle Botma:Thank you, that's so nice.
Amy Kaye:You might not get it, but you really are. You are juggling a lot of balls and it's amazing and the fact that you've spoken openly about your mental health struggles and I'm sure your patients really appreciate you. And if there are people in your world that are not appreciating you, don't worry about them. You're doing a phenomenal job. And just my first impression of you is, it's so wonderful that there are young doctors like you and that if this is the next generations of doctors in South Africa, then we'll be fine. We'll be fine if you're in charge. We'll be fine if you are the next generation, because I love the fact that you mentioned that you love this country so much and you love its people so much. We're so damn resilient. I think we still have a lot of hope and we still have a lot to give and you are definitely an example of that. So thank you, thank you for sharing the story today.
Dr Danielle Botma:Thank you so much. I appreciate it. I think that's what I aim to be. I think badass woman is going to be my new goal.
Amy Kaye:You've already achieved it. It doesn't even have to be something you're looking to achieve. You are doing it. There's nothing more you have to do. J ust be who you are right now, and that's it. I don't know what you're pushing for. You're there. Whatever you're trying to get to, you're there.
Dr Danielle Botma:Thank you so much.
Dr Maria Christodoulou:Before you said that, Danielle, I was thinking I was going to ask you, because one of the questions at the back of my mind always, and the question that has informed the podcast but also some of the research I did at the faculty, was, who is the doctor? And so often in these conversations, I'll say, so, who is Dr Danielle Botma? And I almost want to say badass woman, that's who Dr Danielle Botma is. But maybe I should ask you, how would you answer that question? W ho is Dr Danielle Botma?
Dr Danielle Botma:I'm someone that loves this country and the people in it with my whole heart, and someone that's really going to dedicate my career to fight for bettering the lives of the people in this country and hopefully do that while maintaining some balance, whatever that is. M ostly being happy with who I am, and being proud of who I am, so I'll keep on being vulnerable. I think that's the most important.
Dr Maria Christodoulou:I love that. Thank you, Danielle. I think I agree with Amy when she says people like yourself are the future of this country and it gives me hope.
Dr Danielle Botma:Thank you, that makes me happy.
Dr Maria Christodoulou:Well, I also want to say thank you for trusting me enough to come on this platform. F or sharing your story. I'm really, really grateful that, after meeting with me, you felt able to come on here and tell us your story, and for me, it's very much that telling the stories is how we change this. So thank you for your courage and thank you for your commitment and your dedication and, most of all, thank you for your vulnerability.
Dr Danielle Botma:I just wanted to say thank you also for meeting me. I'm excited, and thank you so much for caring enough about young doctors and doctors in general that you guys are doing this podcast in the first place, creating a platform.
Dr Maria Christodoulou:I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends. Follow Awakening Doctor on Instagram, Facebook and Spotify, and go to Apple Podcasts to subscribe, rate and give us a good review. Thank you so much for listening.
