So, over a lot of chit-chat and coffee, I come to think that the analogy is somewhat like going to administer aid in a disaster-prone region of the world. You calculate what the trouble is worth, then you decide on a minimum cost, to the last cent, and it is sponsored (for better or for worse) by an indigenous tycoon. So far so good. The mission is on. Few of your peers can see a good reason to tag along. None wish to accompany you.

Once on the ground, you organise available resources, and within months a hospital has been established. Still, given available talent, much training is required. Sometimes the work is easier, but the hours are rarely short. Much of it depends on the weather and the habits of the locals which predetermine their rates of illness. Some illnesses are familiar, others are not. Never mind the competition of local witch doctors.

Your second task is to establish logistical control to ensure a sustainable operation, in your eventual absence - everyone knows the natives are spear-happy, and visitors sometimes just go missing. Every now and then, rumours go out that dark magic is afoot, and a mob comes in to prove to their peers "here, there is no real illness, we should be building farms instead." You wait for them to go away, clean the facilities, dust off your new colleagues, and say "don't worry, I told you they wouldn't get it." And then you carry on.

On a run like this, there are two things you listen for, very carefully, every second of the day. The first is "fire!" because it is important - either you have to shoot something, or something is about to consume you and you must drown it. The second is "mission terminated," because it means you can start running in the other direction.

You study yourself, and find that your motivations are not moralistic, your interest is not especially piqued by physiology, and while each patient is intellectually interesting, you don't really empathise with most of the first-timers.

After a while, you ask yourself why you bother, and the same thought recurs. You just happen to like being a doctor. That's what your training suits you for, and so it is what you do for a living. Also you are easily bored, and so the hospitals of suburbia simply don't cut it. Well there we go. A homily to chide oneself before the new year begins...

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