Dr Max Pemberton: Author and Columnist

Originally published on Work:Ethic. All photos courtesy of Matt Piper.

Max PembertonBefore I met Dr Max Pemberton, author of Trust me, I’m a Junior Doctor, its follow up, Tell me where it Hurts and columnist for the Daily Telegraph, I expected some hardened veteran Doctor, with a thousand yard stare to send chills down your spine.

Here was a man who wasn’t afraid to tell the rest of the world how utterly out of his depth he felt during his first year as a Junior Doctor. Not only that, he didn’t give a shit if his bosses or the government didn’t agree with his opinions, or the way he portrayed the NHS.

When I was a kid I always thought that being grown up would somehow feel different. There would be a certain feeling of authority that would suddenly develop in me around my early twenties, leaving me feeling in control of every situation. To date, this has not happened, so I still find myself considering other people to be “grown ups”. Like firemen, or Lawyers.

But especially Doctors.

When I turn up at his flat in The Barbican it turns out Max is a bit of a laugh, candidly honest about everything and more than willing to talk about subjects that would usually result in most interviews coming to an abrupt halt.

I’ll get the obvious question out of the way first – what made you want to become a doctor?

I suppose I always wanted to be a doctor, well, when I was being sensible. Before that I wanted to be a marine biologist. Then someone explained to me that it mostly involved swimming and counting molluscs and I thought, “that sounds absolutely shit”. On the same day my sister had been to the doctor and I remember sitting in the bathroom afterwards thinking that I’d quite like to do that. It looked quite fun. So it was basically borne out of relative ignorance. The more I thought about it as I got older the more I felt that it was what I wanted to do. I quite liked science, but never wanted to be a scientist as it’s quite intrinsically dull, but with being a doctor you get to interact with people, hear their stories, that kind of thing.

Your first Book “Trust Me, I’m A Junior Doctor” showed how life as you knew it had been consumed by your job. Where did you find the time to write?

Well, I didn’t write it during that first year [laughs], but I was still writing for the Daily Telegraph, which I did find incredibly difficult.

I just sat there thinking “Oh God, not again”. I would start worrying about my column days before it was due in, certainly for the first couple of months because I just had no time to do it. I would get home and it would be 11 o’clock, I’d have dinner at 12 and then I’d have to sit down and write and THEN I’d have to be at work at 6.30 the next day. It’s like, when do you do that? I’d only have about two hours sleep on those days so it was really stressful.

Then I got used to it and the way that I thought about things shifted, so I started to really enjoy it. I mean, I always enjoyed it but it stopped being such a massive concern and chore as I started to get better at it. The first couple [of columns], when I read them now I think they’re laughable, but they took me a long, long time to write. I sat there for a couple of hours trying to work out how to phrase things, but now . . . it just sort of comes out.

Max PembertonWhat attracted you to The Barbican as a place to live?

I just love the place. I love the architecture, the Brutalism – even though lots of people tend to hate it. I love its architectural honesty and the very subtle things you notice as you walk round. In the Barbican Centre the walls curve down into the floor. It’s little tiny things like that I love. The gardens, having the Theatre so close – which I’m really passionate about. There are 3 cinemas and an art gallery – It just seems to me to be the absolute perfect place to live. So when I was thinking about where I wanted to buy my flat The Barbican just seemed so obvious. Once they’re here, people never leave.

With so many distractions on your doorstep you must have to literally chain yourself to your desk. How do you stay focused?

I’m not really good at that [laughs]. You could ask any of my editors and they’ll all tell you.

I don’t have a TV, which I would say is the absolute number one big thing in my life that helps me stay focused. Well, slightly more focused than I would be otherwise. If I had one I would just sit around all day and watch it. But then, I always write very late at night. I can work during the day, but everything always takes me about three times as long, whereas at night it will just flow out of me. So I tend to procrastinate during the day and leave things right up until it’s getting really late, then just sit there and kind of blurt it out really quickly.

You’ve no doubt seen some horrendous things as a Doctor. How does that affect your outlook on life?

I would say it makes me more positive, in a slightly weird way. You just think “God, I could be dead tomorrow”. I used to work in paediatric palliative care, which is horrendously depressing, and I worked with adolescents, which is, in a way, worse than dealing with tiny children who are dying. Tiny children don’t really have any concept of what’s going on and there was this sense that all the family would come together – it was all just a very different experience. There was no pondering. Kids tend to get cancer at 2 – 4 or in their early teens (for some reason, that’s just the way it is) and I tended to deal more with the older teens because I’m young, male, a little bit quirky – I’ve got bleached hair, so I can chat to them, even though I did discover that 15 years is still a big age gap.

It was really difficult because they’re dying, but they were also teenagers so they’re still quite moody, and they wanted to go out and get drunk, stuff like that so it’s very difficult having to manage their being a teenager with them also dying of cancer. It was awful because you’d get really involved.

Particularly I think working in central London helps, seeing crappy social issues. You just think, “Wow, I’m not homeless. I’m not addicted to crack. Yay! [laughs] that’s actually really good going”.

Max PembertonYou’re dealing with mental health and substance abuse patients on a daily basis. What’s the best way to help these people maintain some semblance of a “normal” life?

I would say you should treat them like normal people, which is actually much harder to do within the system than it sounds. I think there’s a lot – especially with heroin addiction – of bending over backwards, sometimes, to help them, and you accept a lot of behaviours that you wouldn’t do with normal patients. I don’t think that in the long term that that is at all helpful, so I think if people shout at you, they should be asked to leave. The fact that they may be going into withdrawal, and will get worse if they don’t get their heroin script is not our problem if they can’t behave. I suppose it’s just putting up the normal parameters around peoples behaviour. I can understand why you have to have these slightly shifted boundaries, because it’s a different type of relationship and [addicts] have to feel they’re able to open up to you, but then, conversely, I’m very strict with the idea that people have choices. Some people’s choices are monumentally harder than others, but they are still a choice. Every time you choose to inject a drug, it’s a choice. There are some people who, for whatever reason, decide to wake up one day and go “actually, I’m not going to use [heroin] anymore” and they will actually go through withdrawal, (which is harsh, but it doesn’t kill you – it is horrendous though) and they’ll just do it on their own. I wanted the readers to know that it is possible to do that, that if you’re that determined, you can. Not to advocate it necessarily, because, you know there are easier and less painful ways of doing it, but I wanted to show it is still a choice, no matter how hard it seems. Also, the flipside of that, treating people as though they’re just people, is also quite a nice way of doing it – it’s quite a normalising, stabilising thing for them. Quite often patients would be quite surprised when you say “you just swore at me, that’s not very nice” and they’ll reply, “oh yeah, you’re right” and almost be quite grateful that you’re reminding them what it’s like in society. So I think [the idea] has positive implications for lots of reasons.

I would say at the moment there’s a preoccupation with the pharmacological side and, actually, what they need is psychotherapy. There’s a particular drug called Subutex, which basically stops you having any buzz from Heroin, it blocks the receptors, and it stops the withdrawal. You’d put people on it and they’d come in and still be testing positive for heroin. You’d ask, “Why are you still taking it? You’re not getting any buzz from it, and you don’t need it”. Then you’d realise it’s more complex than addiction . . .

It’s almost like a ritual.

Exactly! It’s an expensive and really weird ritual to have. It’s so fundamental for them, and all you’ve done is anaesthetise them a bit, but they’re still going to do it because they’ve still got that ritualistic drive there. Things are so much more complicated and all of the best responses come from people who are seeking help for the physical withdrawal but also with the underlying psychological aspect.

What I realised working there is drug addiction is a symptom of something else. That’s what I think most people fail to appreciate. There are other things going on that cause people to be addicted to drugs – people aren’t stupid. They don’t sit there going “Hey, I know! I’m going to inject heroin. I wonder what that’s like? Oh shit. Now I’m addicted”. It just doesn’t happen like that.

Where do you stand on decriminalisation?

There are certain things I don’t particularly have an issue with. People can do what they want, and the state should interfere as little as possible, but I think people as human beings have a moral obligation as to what they buy into.

Things like E – I don’t actually have an issue with at all. It’s mostly a cottage industry and I think it’s quite a bit safer than other stuff like, well, alcohol to be honest. In a way by criminalising ecstasy we’ve created more problems, because now it just gets cut with crap. I think it’s really interesting. Because GHB was left legal and so was plant food.

Mephedrone – meow meow?

Yeah, I mean you can find it in Soho. You can buy it for twenty quid a bag. It’s like E basically, but I think it’s probably worse. I’ve tried GHB – it’s absolutely brilliant! It’s fantastic, but now they’ve made it illegal because, well personally I think because a couple of stupid people didn’t know how to handle it.

Most doctors, in my experience, aren’t even aware of GHB.

Exactly. And there are two types – there’s GHB and GBL. I was on call when GBL – which you have to take a tenth of a dose compared to GHB – first came out. It was really funny: we were all standing there when a kid from G.A.Y. was brought in, in a coma. Then another person was brought in, and then someone else was brought in from the Charing Cross road – and this happened again and again. “Why are all these people in a coma from Charing Cross Road, specifically all with G.A.Y. stamps on their hand?” In the end we had to close ITU because it was just full of clubbers. Somebody had bought this new GBL and was selling it in G.A.Y. and people were taking ten times the dose and passing out. We called the poisons unit at Guys and St Thomas’ and they had somehow managed to get a tip off that this was happening. We ended up intubating them, then a couple of hours later they just woke up going, “where’s the party? Oh wait, hang on. Something’s gone wrong, hasn’t it?”[laughs].

So, to get back on track, I think it kind of depends what drug you’re talking about. If you were going to make one legal I’d say make ecstasy legal.

I think what’s really interesting is everybody thinks that [cannabis] is ok because those people who do become psychotic, and who may or may not develop schizophrenia later on, they’re totally invisible. You see alcoholics all the time, bumming around on the streets. You never see people who go psychotic from cannabis abuse because they’re almost immediately locked up in psychiatric hospitals so it gives us this false sense of security.

I didn’t have a particular feeling about cannabis, one way or the other before working in mental health. Now, I think it’s really serious. I can see us opening up this whole hideous Pandora’s Box if we legalise it.

Have you got any advice for anyone starting their first year as a junior doctor?

Yes. Stock up your fridge. Stock up your freezer. These are the two major things. Try and get a year’s worth of food into your freezer. That’s your aim. That’s key because I didn’t see that coming and me and my flatmates just kept living on the food from the 24-hour garage, which was just horrendous.

We always seemed to have lots of condiments in our fridge for some unknown reason, and that’s all we had. You’d open the fridge, starving, and there’d be mayo, HP sauce, “This isn’t food! I can’t cook with this. What can I do?”

So, number one – get lots of food in. Because you’ll get back late, all the shops will be shut and you’ll be physically too tired.

I would also say write everything down. So get a notebook, or clipboard and write down absolutely everything anybody tells you to do. Because you’ll think that you’ll remember something, and at that moment Mrs such and such’s blood test will be incredibly important, but 10 seconds later you’ll turn around, deal with someone else and forget.

If your consultant tells you to do something, you HAVE to do it. So make that your priority.