“I didn’t know about kids eating dog food for breakfast.” There are many lines that stayed with me once I’d put this book down (after reading it cover to cover in less than 24 hours), but this is the one that won’t go away. I read that sentence three times, trying to visualise that in my head. I couldn’t. But somewhere in New Zealand, a first-world country, there are kids eating dog food. Don’t look away.
Emma Espiner (Ngāti Tukorehe, Ngāti Porou) graduated from the School of Medicine in Auckland in 2020. I remember seeing her at a writers festival a few months into her first year as a doctor. “How’s your first year as a house officer?” I asked. “It’s shit,” she said. “Yes, it is,” I replied – because it’s rare to get any other answer, certainly not “I love it”. I was impressed because Espiner was already at the top of her field as an award-winning writer, broadcaster and political commentator. Medicine needs people like Espiner. Medicine needs diversity, new ways of thinking, a shake-up.
There’s a Cure for This is Espiner’s story, the child of a Māori father and Pākehā mother. “I wear my parents’ wedding on my arm,” is the opening sentence, a reference to the tattoo her uncle inked on her left forearm which combines designs representing her two grandmothers. Her bicultural background gives her insight into both worlds, and a desire to join them into a more cohesive whole, while recognising the mountains we have yet to climb.
Born in Wellington in 1984, Espiner was three years old when her parents divorced. She grew up in Lower Hutt, alternating between her mother’s “purple lesbian state house” and her father’s series of “man-alone rentals”, which “always felt a bit murdery”. I laughed out loud at that, as with many other lines in the book.
This book resonated on many levels, from Espiner’s wild student days in Dunedin, “doing my best to drink Otago dry”, through to the joys and angst of being a new mother, graduate entry into medical school and the subsequent grind of being a junior doctor.
“The first year … is a horror,” Espiner writes, “over a thousand students, mostly vying for the same three-hundred-odd places at medical school.” Once in, the exams were “like fighting progressively more sadistic bosses in a video game … if you fail enough times, you’re gone”. And yet, “medicine felt like coming home … the tohu [qualification], once awarded, can never be taken back”.
The most compelling chapters, however, related to Espiner’s experience as a Māori doctor. There is both hope and disillusionment here: “Here’s this cheerful brown face trying to mihi to you but … she’s still part of the system designed to let us die sooner, sicker, unloved.”
This is an uncomfortable truth, but one the health system needs to address if we are to improve outcomes for Māori. The average life expectancy for Māori men is 73, seven years behind that of non-Māori, and on any health outcome – cancer survival rates, for instance – Māori consistently do worse, even once all other factors (for example, comorbidities, income) are taken into account. If what we are doing isn’t working, why wouldn’t we try to change it?
Espiner debunks the myths around MAPAS, the Māori and Pacific Admission Scheme. No, Māori and Pasifika students don’t get the answers to the exams in advance, they don’t get special resources and they need to in fact be “more resilient, more capable” because they have to pass all the same exams despite having started 10 steps behind, in an education system “that has been proven to discriminate against Māori”. Espiner also explains the importance of waiata, karakia and morning hui, even for non-religious individuals, in improving organisational culture, bringing people together and setting the tone.
There is the particular challenge of entering the medical profession during the pandemic, “seeing my colleagues bleeding for a flawed system”. How I identified with “surely I’ll get Covid soon and have a week off”, along with the horrors of night shift and 12 days on/two days off rosters with multiple 14-hour shifts. And yet, as Espiner says, “On the bright, good days, there’s a chosen family of beautiful, brilliant people … and patients you feel confident you’ve done everything in your power to help.” She speaks of the imperfect system and trying to change from within; about the transformation she has undergone while training to be a doctor and surgeon.
There are many uncomfortable truths in this memoir, but there is also humour, hope and inspiration. To survive in medicine and indeed in this ever-changing, ever-challenging world, we need to find a way to remain optimistic and be there for each other. In the words of the old Persian adage, “this too shall pass”. Such is the power of impermanence. Kia kaha.
There’s A Cure For This, by Dr Emma Espiner (Penguin, $35), out on May 9.
