Reminiscing on residency: Dr. Jacob Pendergrast
Dr. Jacob Pendergrast was living with a family in a small Indonesian village when he decided he wanted to pursue a career in medicine.
He was travelling as part of a youth international experience program after graduating, and received a book by David Werner, Carol Thurman and Jane Maxwell called Where There is no Doctor: A Village Health Care Handbook.
“There was no health infrastructure in this very small village, and I just totally got into this book,” says Dr. Pendergrast.
His goal throughout medical school, inspired by the stories he read in that handbook, was to study tropical disease and work with Doctors Without Borders. A fourth-year foreign elective brought him across the globe again, to Tanzania.
Take a look at his career now, and you might think Dr. Pendergrast had veered off path. After graduating from the Dalhousie Medical School in Halifax, N.S., his flight skewed domestic, to Toronto, Ont., where he completed his training in internal medicine, hematology and transfusion medicine at the University of Toronto.
Since completing his internal medicine residency program, Dr. Pendergrast has held a career at Toronto’s University Health Network (UHN), where he serves as an associate Medical Director of the Blood Transfusion Service. Just over two decades into his career with UHN, Dr. Pendergrast also holds cross appointments with the Department of Medical Oncology and Hematology, and has been seeing patients in Toronto General Hospital’s Red Blood Cell Disorders Clinic since 2004.
“There’s always a billion things that need to get done,” says Dr. Pendergrast, who typically sees patients on Thursdays and deals with hemoglobinopathies like thalassemia, thrombosis, and other inherited blood disorders that affect the hemoglobin in red blood cells.
Beyond that, Dr. Pendergrast regularly publishes research on sickle cell disease, and consults on guidelines and practices for transfusion medicine.
He also teaches at the University of Toronto’s Department of Laboratory Medicine and Pathobiology.
Reflecting back on that year he completed his foreign elective in Tanzania, Dr. Pendergrast says there are some “hero fantasies” that you can develop when you go into medicine.
That fateful trip was in 1999, right around the time that the medical world was beginning to understand how much blood transfusions did to spread human immunodeficiency virus (HIV).
“It became clear to me that if I really wanted to help people in low-resource countries, they didn’t need me. They have expert doctors there that already know more about the disease I was going to treat than I do. With all due respect for the doctors that do this, there’s a bit of neocolonialim in it.”
Inspired by this new understanding of medicine’s role in the spread of HIV, he decided hematology was what he was better suited for as a physician.
“I thought, if I really want to help this problem, I should be looking at the big picture and the policies.”
1. What is the biggest thing that residency taught you about being a doctor?
The thing I started to learn in residency is that you really can’t separate physical well-being from mental well-being. You cannot separate the patient from the environment they’re in.
In medical school the steps to curing someone can seem formulaic: symptoms, diagnosis and treatment. It can be very frustrating when you go out into the real world and the formula doesn’t seem to work. Or when a patient that you just “fixed” comes back in with more symptoms. But you realize that there are so many other things that are leading to those patches not sticking.
Sickle cell disease is a great example of this. It’s a chronic condition, and as a physician you end up following your patients for years and years. There are also so many sociological modulators of the patients’ biophysical diagnosis. All of those external factors: racism, environmental stimuli can affect a person’s outcomes and you learn to be aware of that.
Be aware of all of those external factors. Be prepared to help and advocate for your patients. It can be very demoralizing if you don’t have a large view of things.
2. What is something you've learned further down in your career?
Learn to be efficient and need to learn to prioritize. A quote that’s always resonated with me is “doing an unimportant task well does not make that task important”. Going into medicine, you want to be perfect, but you need to remember to focus and prioritize. You shouldn’t let the urgent things take up so much time and your bandwidth. Carve out time for those important things.
Medicine is group work. As much as we love the idea of the hero doctor, it’s a networked activity and a group undertaking. You need to take care of your group and your network. You need to learn to delegate work. Find people that can help you with things and don’t be afraid to ask for their help. It’s a lot bigger than the idea that a doctor shows up with their bag and fixes a patient. It’s a system. Make sure the system is working well.
3. What is your number one tip for residents
Really lean into being kind to your colleagues. It’s obviously important that you’re kind to your patients. But I don’t think it’s taught as much to be kind to your colleagues. Notice when somebody is struggling. Be the person who says something. It makes an enormous difference.
It’s not easy being a resident. You are sleep deprived, you’re stressed out. You’re always worried you’re making a mistake. What gets you through that is the support of your team. It changes the tone from ruthless competition to one where you’re functioning as a team. You get through by helping each other out. If you see somebody came out of a code and couldn’t save a patient, and you can see that person is not doing well, give them some compassion. If you don’t learn it in residency, you’ll learn that medicine is a cold place to work.
I had some tough things happen during my residency. My partner at the time was pregnant and we had a stillbirth, there are a lot of other details around it that made it tough. I was so sad and angry and bitter about the entire medical system. And I still remember the people that reached out and that were nice to me. I still remember and I still try to be a human being to those people that I can see are struggling.