A British physician-writer reflects on her topsy-turvy medical training emphasizing the mental and emotional burden of becoming a doctor. In 22 brief chapters with titles including "The Darkest Hour," "Buried," and "The Wrong Kind of Kindness," a struggle between hope and despair furiously plays out - in patients, hospital staff, and the narrator.

Dr. Jo (as one patient calls her) remembers interviewing for medical school admission, the difficulty dissecting a cadaver, starting lots of IV's, dutifully toting an almost always buzzing pager, and breaking bad news. She shares with readers her own serious car accident with resulting facial injuries. She comments on the underfunded UK National Health Service (NHS) that is "held together by the goodwill of those who work within it, but even then it will fracture" (p104).

Anecdotes of memorable encounters are scattered throughout the narrative: a fortyish woman in the emergency department who describes a fast pulse and sense of impending doom diagnosed as having an anxiety attack who ten minutes later suffers a cardiac arrest, a man with severe schizophrenia, a suicide, an elderly blind person, a young woman with metastatic breast cancer.

But the lessons that have stuck with her are primarily dark and somber ones. "Sacrifice and the surrender of the self are woven into the job" (p77). She realizes that "perhaps not all good doctors are good people" (p125) and that as wonderful and essential as the virtue of compassion is, "compassion will eat away at your sanity" (p16). She chooses psychiatry as a specialty where kindness, empathy, creating trust with patients, and careful listening work wonders for people. "I learned that saving a life often has nothing to do with a scalpel or a defibrillator" (pp13-14).


The making of a doctor is a lengthy, strenuous process that can exact a heavy toll - mentally, emotionally, physically, financially - on trainees. It is no wonder then that memoirs of physicians-in-training (and plenty have been published) often read as a therapeutic exercise for the author, sometimes an emotional catharsis. Joanna Cannon vividly describes the emotional maelstrom that medical school and residency training were for her. She ponders power relations, uncertainty, boundaries, and the power of words (to heal or to hurt). She believes burnout and emotional breakdown are cumulative processes. Little episodes of misery and failure accrue until their collected weight overwhelms an individual. She reminds doctors that it's okay, actually imperative, to care about their own well-being too.

Primary Source

Breaking & Mending: A Junior Doctor's Stories of Compassion and Burnout


Profile Books Ltd in association with Wellcome Collection

Place Published

London, England



Page Count