Dr Hloni Bookholane, Breaking Up With Medicine

Is it okay for a doctor to decide that medicine is not the nucleus of their life?

In this episode of Awakening Doctor, we sit down with Dr. Hloni Bookholane, senior associate at the Boston Consulting Group and author of Becoming a Doctor: Learnings and unlearnings about life and the politics of medicine, to discuss his decision to do just that when he walked away from clinical medicine shortly after completing his community service - a choice he likens to a difficult but necessary breakup.

We explore the transformative moments that defined his relationship to the profession and reflect on the complexity of navigating rigid medical hierarchies, making career pivots and redefining what it means to be a doctor.

We also challenge the deeply ingrained belief that leaving clinical practice is a ‘waste,’ reframing it as an act of self-determination that may signal a need for a paradigmatic shift in how we construct the doctor identity instead.

Whether you’re a medical educator, a student contemplating a medical career, or a clinician questioning your own career path, join us for a candid and thoughtful conversation about the culture of medicine and the courage it takes to carve out a personal identity beyond the hospital walls.

Purchase "Becoming a Doctor: Learnings and unlearnings about life and the politics of medicine" here: https://amzn.to/41JqGdm. Please note this is an Amazon affiliate link, so our podcast fund will receive a small commission (at no extra cost to you) if you make a purchase.

Chapters

• 0:02 Advice for Frustrated Medical Students
• 16:36 Journey into Medicine: Finding a Path
• 52:17 Navigating Medical School During Protests
• 1:09:20 Holding a Human Heart: Transformative Moments
• 1:30:17 From Medicine to Public Health
• 1:56:07 Walking Away from Clinical Practice
• 2:27:00 Treating Medicine as a Job, Not a Calling

Transcript

Dr Maria Christodoulou: 0:00

What advice would you have for a young person who's currently in medical school feeling some of that frustration and helplessness, overwhelmed by the burden of responsibility, challenged by the hierarchy? What would you say to somebody like that today?

Dr Hloni Bookholane: 0:16

It's something I didn't enjoy hearing and I didn't find particularly instructive in the moment when I heard it, but in hindsight it was helpful to know that you're not the only one. Unfortunately, you're not the only one. It would probably be a good thing if only one or a handful of people were frustrated. I think I've also had the benefit and the immense privilege of having seen, much earlier in my medical path, the different parts that exist beyond being a clinician and, in part, the things I was interested in and wanted to do were more that way inclined. So I think that's not so much advice but to contextualize that a) There are different parts to and different ways which we can put to practice everything we learn in medicine, internship and comm serve, even if you, you know, you do medical officer years or you do registrar time.

Dr Hloni Bookholane: 1:12

A lot that we learn and experience and do in medicine is so transferable. It's just a matter of we don't know how to package it in that way. C onstantly managing stakeholders. You're constantly dealing with things that are intentioned. You're constantly managing multiple situations and you see that job ad with someone who can adapt to high pressure environments. Hey, you've managed multiple wards overnight. No one died. You know, you were okay. All of those things are skills and sometimes you don't see it as completely related and useful.

Dr Hloni Bookholane: 1:50

But I don't think anyone should do medical school ever again. But would I do the process and the journey again? 100%, because part of it, I think I blossomed and really grew into myself and who I am today through that. But I think it's important to know that even when people leave clinical medicine and go do something else, there is still the stigma of, ah, what a waste. But it's not because, who knows, maybe you wouldn't have done what you did

Dr Hloni Bookholane: 2:19

if you hadn't done medicine. You wouldn't have had whatever experience that led you to that next thing, and sometimes if you leave for any other reason, that's also okay, because we're becoming more primed to that within medicine that some people don't enjoy it.

Dr Hloni Bookholane: 2:35

Some people find it difficult or find it just the angst and the frustrations and all the things that occur in medicine. They maybe are just like no, actually I can't function in this kind of environment, notwithstanding all the other personality frustrations that occur in other jobs. But it's just like, hey, this is not the job for me. F eeling bad and like a self-deprecating way of thinking that, oh, I'm leaving, but now I had taken someone else's spot. No, you got that, but you were in the spot. Y ou chose to let it go. I f someone else can't take that spot.,..

Dr Hloni Bookholane: 3:11

I don't think that's very helpful for the individual to think like that, particularly when you're trying to justify whether or not this is the right thing to do. But again, to also look around, there are people that are still clinicians who left this, did that, then came back. You don't have to do the path back to back. Med school, internship, commserve, registrar time, t hen you're a consultant. It doesn't have to be that way.

Dr Hloni Bookholane: 3:35

If you have other interests, hold space for that, because unfortunately you don't want medicine or any job to be the nucleus of your life, because if the nucleus is crumbling, then everything is crumbling. And that's my biggest push of like... Treat medicine as beautiful and rewarding and wholesome and all the things that it can be and often is. Treat it not as this calling or this virtuous thing that you're doing. Treat it as a job and this is not to take away from what medicine does have and maybe other jobs don't have, but it allows you as the individual to be intentional, to carve out time outside of medicine, because that's also something that's not drilled into us as a hey, I'm not going to, as medicine, say to medical students or doctors and whatnot...

Dr Hloni Bookholane: 4:22

No guys, if you have free time, go have fun. No, if you're not using it, I will take it from you. Medicine will say okay, come, give me your free time, stay longer at the hospital. Do this, do that. Obviously, it needs to be said, I don't want to be misquoted that... You don't just leave and abdicate your responsibility to go do your personal things, but knowing that the time that you're meant to be there is done, the handovers were done. Go, go, rest, go for the run, go for the hike, choose to work in the hospital or the province that's close to the things you care about, because maybe the hospital you've chosen is the right one for the training, but it might not be for the rest of your life. Do you need to move? Some of these decisions are taken away from us, at least from a commserve and internship role, where the choices are not as open. But I think that investment in the things we care about beyond, are important, because otherwise medicine can unfortunately just take, take, take, take.

Dr Maria Christodoulou: 5:23

Welcome. I'm Dr Maria Christodoulou, and this is the Awakening Doctor podcast, a space where we discover the personal stories of those who work in the medical and health professions. Join me as I explore the hopes, the fears, the aspirations and the real-life challenges of those who carry the title, responsibility and privilege of being a doctor. Joining myself and producer Amy Kaye today is Dr Hloni Bookholane, medical doctor and senior associate at the Boston Consulting Group. A former Fulbright scholar with a master's in Public Health from the Johns Hopkins Bloomberg School of Public Health, and the author of 'Becoming a Doctor, Learnings and unlearnings about life and the politics of medicine.' Welcome, Hloni, it's great to have you with us today.

Dr Hloni Bookholane: 6:14

Thank you. It's good to be here and very lovely to meet you both. You and Amy.

Dr Maria Christodoulou: 6:20

Hello Amy, how are you?

Amy Kaye: 6:22

I'm great. Lovely to meet you too. I'm excited about this one.

Dr Maria Christodoulou: 6:25

So, Hloni, where do we begin to tell your story?

Dr Hloni Bookholane: 6:29

In medicine they always say the best answer is the one that says, it depends. It depends what you're interested in. But since we're talking about medicine and the things that are related to that, we can start with how I ended up in medicine.

Dr Maria Christodoulou: 6:45

Sounds like a good place. So where does that journey begin?

Dr Hloni Bookholane: 6:49

Going through the reflection, post-medical school and thinking about, wow, it's done, it's finished. I had to go back and think well, where did it start?

Dr Hloni Bookholane: 6:58

I was surrounded by a lot of people who either had family members, whether brothers, sisters, parents who'd been through medicine, so they were primed to end up in medicine, among other reasons. I didn't have that. Some people had a... They knew they wanted to do medicine from a very young age. Also didn't have that. So I ended up saying out loud I want to do medicine when I was 17. Before that, there was the goal and idea of becoming a professional squash player. That was the goal. T hat didn't work out, partly because I realized, okay, there's a big gap between myself and the rest of the squash players, never mind the world, but in South Africa, and then you know, having a good, solid academic background was then a good option to have.

Dr Hloni Bookholane: 7:46

It wasn't the worst fallback option to like, oh, I can go and study a good degree and medicine was the chosen option. That's how that started.

Dr Maria Christodoulou: 7:55

What do you think made it the chosen option? What brought it into your awareness, if it was not those things that you've already mentioned that normally bring other people to medicine?

Dr Hloni Bookholane: 8:04

I think, in part, similar to how when you go to a restaurant and you haven't been to that restaurant before you sort of look at the menu, you quickly rule out what you don't want to be doing, right? And then the last few options that I had, based on people I knew... My parents, m y mom's a psychologist, an academic. So is my dad. M y sister was doing finance and I didn't want to do any of those. So those were ruled out up front. And then it was to be a lawyer or engineering, accounting. A gain, options that... they didn't really jump out at me. And then medicine for lack of a better description, that sounds nice. You're engaging with people, not so much the helping people, you're engaging with people in a day-to-day, and it seemed very interesting.

Dr Hloni Bookholane: 8:56

So after that, it was the health sciences. So it was either medicine or physio, and maybe I should have mentioned. So I applied for medicine up front and I didn't get in. So physio was the second option and did that. And then I found, okay, this is very interesting, but physio is a very specialized part of the medical curriculum and I wanted to do more and understand more, and that was the drive and the push to do medicine. A nd in many ways then it became oh, wanting to help people in a more comprehensive way. T o understand medicine and pathology and what you can do as a health practitioner in a more comprehensive way.

Dr Maria Christodoulou: 9:39

So you wrote this book and we'll talk about the book a bit later and the book was a reflection on your time at medical school and you wrote it while you were still an intern. But I'm thinking about that young man who decided to go to medical school and who had this idea of working with people, engaging with people. What did you think medical school was going to be like when you signed up, as opposed to what you discovered it to be like later? What was the fantasy about what you would be doing and what you would be learning?

Dr Hloni Bookholane: 10:08

The fantasy was oh, I know I'd be learning a lot, I'd be studying a lot, I'd be spending a lot of time doing that, and then there would be the oh, got your stethoscope, you're in the hospital.

Dr Hloni Bookholane: 10:21

You're getting involved.

Dr Hloni Bookholane: 10:22

You know, you're doing the things, you're making decisions, or rather you're contributing to the decisions that are made about and with people's health and illness and so on, and I think I always enjoyed being around people and engaging with them, but this was a different kind of engagement and more in-depth, and you know you can't hide in that environment. N one of us can, because you're the most vulnerable in that space, but also you're the most honest, or at least you end up being the most honest, and I think I've spoken about how I ended up into medicine.

Dr Hloni Bookholane: 11:01

But what kept me there was, I keep saying to people, I think I've met the entire spectrum of personalities and types of people within medicine. Both from people that are practicing clinicians, patients, the people that come and go in between that. Y ou see the full spectrum there and that's beyond a pathology point of view. Just the type of person, and I think the idea and the wow factor that I had imagined, I saw that. I experienced that, but definitely that was not the majority of it.

Dr Hloni Bookholane: 11:35

I soon realized that, oh, okay the Grey's Anatomy scenes are few and far between, and if there are many, they are definitely broken up by the regular humdrum of hospitals, of healthcare, of the entire process.

Dr Maria Christodoulou: 11:56

I'm smiling at the comparison to Grey's Anatomy, because I remember when I used to watch Grey's Anatomy thinking, w here was this w hen I was a medical student? I didn't have time for all these making out in on-call rooms and doing all these things that these guys are getting up to.

Dr Hloni Bookholane: 12:17

Well that's the point, right? You see that and then you look at the rooms and the spaces in which doctors that are working overnight get to sleep and put their heads down when the time allows and you're like, I don't even want to lie down on this bed by myself, but they are doing it with each other with fewer clothes. L ike no, that should not be happening. A nd, it's funny, I only watched Grey's Anatomy in its entirety the week after I graduated. S o I binge- watched I think eight seasons and it was, I think I even speak about it in the book.

Dr Hloni Bookholane: 12:54

It was funny for me to be now watching Grey's Anatomy after I finished medical school, before starting internship. A nd I was able to see the forest for the trees and be like, okay, this is the story that you're selling to the person who's sitting at home watching while they're having dinner. Pulling at the heartstrings and all of those things. Yay, great, all the dramatization of things that happen in healthcare, yeah, yeah, yeah, that doesn't matter. B ut the storyline of that informs what becomes sensationalized for the viewer. I've seen that. I've seen that kind of doctor and this is before I started working.

Dr Hloni Bookholane: 13:30

People have taken a personality test after watching Friends, seeing like, which character on Friends would they be. I took one for Grey's A natomy. The first time I did it I got Meredith. T hen the next time I got Derek. But I thought, I could be any one of these people in terms of like the personalities and the person that they bring to their medical specialty, and I think that's true for everyone in medicine. It's like, yeah, depending who you ask, you might be a McD reamy or a McS teamy, or you might be the person they never want to see in the hospital. You could be someone's crush, or someone's nightmare to have to call in the hospital. So it was fascinating watching that after the fact.

Dr Maria Christodoulou: 14:14

That was a few years ago. When you think about medicine today, how does it feel? How does it compare to Grey's Anatomy and/ or your experience?

Dr Hloni Bookholane: 14:24

I don't think it's that different, and I say that because when I was going through it and speaking to my mentors people who had been specialists for 10 plus years, maybe 20 years, some of the reflections I was having with them and sharing with them and frustrations, and even the good things, it was stuff that they were still experiencing or could see. Yes, that hasn't changed. You're going to get that kind of experience today. We got it five years ago, 10 years ago, 20 years ago.

Dr Hloni Bookholane: 14:54

I think what's changing is how people interact with the health system and the doctors, the nurses, the physios, the OTs, p eople are coming in a bit more informed about what the hell's going on, but I think health care, in general, has become not this thing that you need when you're in trouble, or when you're having a bad day, much like lawyers. No one's having a good day when they go see a doctor or a lawyer for the most part. And now it's been thrust into the front of mind, like recently, political elections, political decisions, and covid was a great example of, if we're not paying attention to what's going on out there, the politics, the elections, the geopolitics, all those things.

Dr Hloni Bookholane: 15:41

Don't pay attention, but you're going to see it coming into your hospital dressed in that lady, that man, that person, and you can draw a straight line, if you tune into it, that oh, what's happening with US elections, what's happening with UK elections, or the decisions made at policy levels in these countries, particularly those that give development aid funding, you're like oh wait, that clinic has closed down because they are funded by a particular organization and.... [Dr. Maria Christodoulou: W ho's done their research, got the data they wanted and has now moved on] or I think this week, the last 10 days, really has been, particularly from a US point of view and look, I'm not pointing fingers and calling anyone out, but the reality was that there was a decision made in the new administration and it's had ripple effects across the world. It's scary when it's not completely mind- boggling.

Dr Maria Christodoulou: 16:36

You spoke in the book about, in the early days, naively thinking that medicine was apolitical and that that eventually changed for you, and that's what you're referring to now. So how did that transformation in your thinking happen?

Dr Hloni Bookholane: 16:50

Slowly, but it happened. There's definitely an acknowledgement I need to give to going through medical school and having four years of university protests happening while I was in medical school. I think that was a big catalyst for what might have been already happening for me. P rocessing and seeing how, wait, medicine is political, or at the very least it is directly impacted by politics. A nd the university protests were part of the unlearning, for myself., From a personal, male and social privilege lens, but also realizing that, oh, okay, I have to pay attention to what's going on at the university level, even though med school is this little island in a different place and there is this false pedestal that people still are at med school put on, t hat there's protests happening at the University of Cape Town, but not at the medical school. [Dr Maria Christodoulou: On the main campus]. And you say no, but the problems that are being discussed and the tensions that are occurring,

Dr Hloni Bookholane: 17:51

there are students at medical school who are going through that same thing and there's a tension between well, I'm a medical student and I'm faced with this problem that the university is grappling with, but I cannot, or I don't feel like I can, go and be part of that, and I saw that. P eople at med school, classmates. And then eventually the proverbial wall broke and it clicked and I was like, okay, becoming... Not that I wasn't aware, but there was a version of me who was like look, yes, I'm paying attention, but I think medicine is apolitical. And that was a very young and naive way of thinking, if I'm being very generous to myself.

Dr Maria Christodoulou: 18:37

You spoke about being a student during four years of protest action on the campus. Are there any highlights that stand out for you about that time? Pivotal moments in terms of those shifts in your thinking?

Dr Hloni Bookholane: 18:49

I think it was number one, when the Rhodes statue was removed on upper campus in 2015, there were cameras there, it was on the news, it was being broadcast live and I remember being in one of the hospital clinical education centres, watching it on my phone, and when I looked back at that moment, the penny dropped. I was like, you were there, but you were not there, right? Where you needed to be, just mentally, was, the hospital is going to be okay without a third- year medical student. Just be engaged with what's going on. I was watching it on my phone and I think that was the aha moment, and I'm not saying I have any regrets.

Dr Hloni Bookholane: 19:36

I've come a long way from just actually paying attention to things that might not directly impact me, but they do impact, maybe, things I'm interested in or what I want to be doing.

Dr Hloni Bookholane: 19:47

Also, just seeing how the reporting was done about how students were engaging and how there was confrontation and there was anger and it wasn't civil and people didn't feel safe, but the Health Sciences campus at UCT and how those engagements would be happening. Yes, it was tense, but conversations were happening. T here was progress being made despite the tensions, despite the animosity, despite tears during those plenary sessions, and I'm sure it was uncomfortable at times, particularly if you were the late Professor Bongani Mayosi, who was the Dean at the time, and now your office is occupied. But they found a way to engage and I think it was great to see that in real time. If anything, that has been something that's informed entirely my view of look, we can have a difficult discussion that we are fundamentally disagreeing on, our starting points, but we can have a discussion. There's been benefits that go beyond my role as someone who's a working professional and that I think, even just engaging with other people, it was very helpful.

Dr Maria Christodoulou: 20:56

One of the things you talk about in the book is the notion of intersectionality and how we get so rigid and fixed in our views and perspectives about one particular theme or one particular issue or injustice, and then we blind ourselves to the ways in which we are perpetrators of other injustices in other areas or in other domains, and I thought you were really articulate in how you spoke about that challenge.

Dr Hloni Bookholane: 21:19

I will say I don't remember everything I wrote. I appreciate that reflection and that sentiment. I think it's important. For example, I think, if you consider a romantic relationship, there are numerous examples we have about how to love another person. There's movies, there's books, there's a whole plethora of resources. If you are stuck, how do I show my love to this person, how do I care for this person. But to fight, to fight with love, to fight with love. We don't have examples of that other than the practical.

Dr Hloni Bookholane: 21:53

Okay, this is how I saw people in my family or around me arguing or disagreeing, and that becomes the template that you build this off. And then sometimes the clashes are not because these two people or these two groups fundamentally disagree, it's just the fighting l anguages are just different. They just want to come at you and the others are like, whoa wait, can you book an appointment? And then we have the fight? I'm busy with something else. I think I've grown to develop a bit of patience because I think, just from myself, I know I sometimes, I'll argue like I'm correct, but I've learned and continuing to learn, to listen as if I'm wrong, completely wrong. What's built into the listening when someone else is speaking, when you're hearing the other perspectives, it's okay. Maybe you're completely wrong and this is the gospel. But then it's tennis, it's symbiotic. For that to work out for me, the other person also needs to be at that level.

Dr Maria Christodoulou: 22:50

I'm thinking about the paradox of how we'd like to think about science as empirical and rational and logical, and how there are facts and there is evidence, and that we base our decisions on that. And what you're talking about now is the reality that in most situations, depending on which perspective you take, the facts can be skewed and they can be presented in a multitude of different ways. And so what's true and what's right, is so context dependent and so lens dependent. Which lens are we using when we look at something?

Dr Hloni Bookholane: 23:20

Exactly, but again, that being said, there is also a good faith and a bad faith way of having these arguments, where you come into something thinking, okay, this is going to be a good faith debate and sometimes it isn't. Again, maybe that's how that group or those people, that's how they, it's always in bad faith or whatnot, and okay, how do I adapt to this way of doing things? And then it's for us to decide whether you want to continue.

Dr Maria Christodoulou: 23:45

What do you think it is about you that makes you willing to question your own assumptions and perceptions. What do you think it is about your understanding and experience of conflict that makes you able to step back and say, maybe I need to listen, maybe I need to consider the possibility that I'm wrong, because, again, based on what I just said about medicine, so often the assumption is that you need to be the expert, you need to offer the expert opinion, and your expert opinion is evidence-based and informed. And so, to shift into a space of I'm going to be willing to listen with an open mind and an open heart and consider the possibility that I might be wrong.

Dr Hloni Bookholane: 24:21

I don't know if I'm entirely singular in that, but I think for me it might stem from I really don't like being wrong. I really dislike it, particularly because when I do then make my argument on case, I'm making it fully, backing it like this. I am not wrong, right, so I have to be able to then, okay, if I am wrong, either it's an apology or to adjust how strongly held a particular viewpoint has been and sometimes it's not as simple as right and wrong.

Dr Hloni Bookholane: 24:55

Sometimes it's just that, look, maybe there are other things you need to take into account in this belief you hold with so much conviction. I've been surrounded by, whether it's at home, whether it's at university and everything the people around me that I met in that journey. It was people, and has been people where I did feel like they modelled that kind of behaviour where I could challenge them and not challenge them in like a provocative way. I could ask why, and they explained. And then I'd ask another why, but that doesn't make sense. Then I ask why again. They might get tired of my whys, but I can see that in my thinking and churning, I have a minimum of five whys. I can see then that oh, oh, hold on. They are also firming up what they believe in. And I've seen it in an academic point of view.

Dr Hloni Bookholane: 25:44

Where you go through the peer review process when you submit an article to a scientific journal. We've all, as the group of authors, worked on this. Some of you have done bigger portions of it. Y ou submit it, it gets peer reviewed, it gets sent back with comments and there's all these other questions, and sometimes it's not a question that they're saying it's wrong, but there's a context that they don't have, a nd they're looking at the results you're sharing and they're saying this doesn't make sense. A nd what's required there is oh, actually, I'm not changing that opinion or that paragraph, but it's just about adding the context that then clicks in for the reader to like, oh, this makes sense, fine.

Dr Hloni Bookholane: 26:21

Even in writing the book, you write, you write, write the first chapter or bunch of chapters, submit them, get questions and I'm like no, actually, I want to keep this chapter, but now I need to make it better to justify keeping it. So that's a long-winded way of highlighting how different parts of my life have constantly reinforced that way of thinking, but I can only see it in hindsight. Therapy as well has been great. They hold you accountable there.

Dr Hloni Bookholane: 26:51

[Dr Maria Christodoulou: But you have to be willing to sign up for it, which isn't always easy.] A nd maybe because I was a very naughty child as well, I learned how to say sorry. Well, yes, it was me that broke the plant or that messed up that thing, and there was no hiding, I had to take accountability.

Dr Maria Christodoulou: 27:09

You talked in the book about your schooling and your time at, I think it was Transkei primary school, if I remember correctly, and how you were often in trouble because you were, in your words, a naughty child. [Dr Hloni Bookholane: I think I might have said a naughty little shit, but yes.] I think you did say that actually, I think you did, and then you also contrasted it with your experiences at an elite private boys boarding school in East London. Do you want to say anything about that?

Dr Hloni Bookholane: 27:38

For the public record, correct in saying that the elite private boys school is in brackets, because it's considered as such by depending who you ask.

Dr Hloni Bookholane: 27:48

But I think if you go and google, it's a formal Model C school and that's just semantics. I think the difference, in my experience, from Transkei primary school and the high school I went to, it was co-ed.

Dr Hloni Bookholane: 28:01

I don't know if that really played a role between 8 and 13. It was a very different environment. D ifferent in the sense that there was a particular type of way to be a leader. There was a particular type of way to good-looking considered . Not good looking in the sense of teachers wanting to date you, but it's what's baked into the zeitgeist of those schools, such that when you interact with the girl's school, everyone is now replicating subconsciously what they're being fed in the school. S peaking the way I do, I learned how to speak English way before I went to that school, but I think there's definitely a bad habit that pricked up. I f someone doesn't speak English in a particular way, and particularly a person of colour, there was an inherent assumption of intelligence based on the English accent in which they spoke in. I'm not going to stand and say one hundred percent,

Dr Hloni Bookholane: 28:56

I learned that from the high school, but I can't remember paying that much attention to that pre going to the school. T o a point where, I remember in med school, there was a guy who in one of the... It's called problem-based learning sessions, where you basically go through a case that addresses different parts of the learning curriculum, and they had the answer, and they had a vernacular accent. Very nice guy. But my inherent assumption was that they're probably not going to get this right. And again, that was the unlearning that I was doing. Well, first self-awareness and then unlearning and then figuring out b ut why, why, why did that become a marker of intelligence?

Dr Hloni Bookholane: 29:39

And it's not unique to that school, right? No, absolutely. You see this still, even on the global stage, there's a particular set of unspoken, not standards, but things that we want to see. So, not going to lie and say I regret going to the school.

Dr Hloni Bookholane: 29:55

I think I learned a lot. It wasn't a bad school. I had a good education. I enjoyed boarding school. Got into trouble there as well. But would I send my kids? If I had a son, would I send them to a boy's school? I don't know. Would I send them to that boy's school?

Dr Maria Christodoulou: 30:12

What makes you say that?

Dr Hloni Bookholane: 30:14

Because of my experience there.

Dr Maria Christodoulou: 30:16

I feel like you've been articulate and very cryptic in a way. You've kind of alluded to the fact that there was stuff around race and language and privilege and social stratification that got in the way. Are there any particular stories you want to share?

Dr Hloni Bookholane: 30:30

No, I don't think it's that either. I t's not like there were a minority of black students at the school. But I think the issue that - and I say this in the book as well - the things that were bad at the school were not unique to that boy's school. But I think for me, if I was the sole decision maker of what school they go to and they're a boy, I wouldn't send them to that school because the experience I had there was... It was an environment where people, maybe the teachers, felt like they had gotten to a level in which they should not and were not meant to be questioned or challenged, and I was just like no.

Dr Hloni Bookholane: 31:04

I'm not interested in that. And you know what? Maybe the next boy's school that I would choose, for example, would have the same situation, but it would be agnostic to my experience. It would be a new, different experience here. I've never dealt with this environment. I'm not an old boy, I don't have any of that. And that would be... I'm not saying that it's good, it's better. I wouldn't have to go back there. I didn't have any feelings that I was treated in a racist way at the school. Definitely not.

Dr Hloni Bookholane: 31:33

At least not to my face. I'll tell you that.

Dr Maria Christodoulou: 31:37

So one of the things that you've alluded to and you mentioned it very early on was about being socially privileged, being a male, and that that comes with its own set of privileges. And then you're also a young black South African man and there are a lot of stereotypes and assumptions about black South African young men, and I'm wondering how that played out for you as a medical student, if at all, whether that was something that you experienced as a challenge?

Dr Hloni Bookholane: 32:02

Yoh, what a question.

Dr Hloni Bookholane: 32:06

Look, nothing's jumping out at me up front. I'll preface by saying one, I think I thrived in medical school. I loved medical school. If anything, I think I really grew into myself and the confident version of myself, and the gregarious, and just knowing how to engage different people going through different things. I could go from one environment where it's, okay, life and death situation with this individual and the next one is, oh, this is a happy doctor's visit and that experience was, I think, truly moulded me in a good way.

Dr Hloni Bookholane: 32:41

I think the race, the male privilege, and yes, social. I mean, I've spoken to the social privilege part. I think one, I didn't have a bursary or... M y parents paid for my university fees, so I think that is reflective of how I was thinking about Fees Must Fall protests, in the form that they impacted me personally. But I also caveat that in the book where I had a fight with a friend, where I was engaging with the stuff and thinking about well, this is terrible, that people are being... not academically excluded, but they're being financially excluded, like, is that right? Not having any answers of my own, but this friend, not so many words, says that, look, it's not something that they'll ever have to deal with.

Dr Hloni Bookholane: 33:22

They're not really interested in it and I was like but hold on, if I was financially excluded now, would you care about it because I'm your friend, would you care about it care about it then? And then we had this back- and- forth fight and that's when I left, because maybe, in fairness to them, for me it was oh, I was now grappling with all of this and seeing, well, hold on, you don't have to be poor to care about people that are struggling financially. You don't have to be living in a place that just had the hurricane to care about people that are affected by that.

Dr Hloni Bookholane: 33:54

That's the biggest thing that I took away from medical school that, oh, socioeconomic privilege, because once you're in med school, for the most part, then everyone is, you're all standardized now. T he hardest part is getting in. Once you're in, cool, now you have to study, blah, blah, blah, become a doctor. Yes, race and microaggressions do play a role in the different environments, whether, depending on what medical school you go to, or depending on what patient population you work with, those things come up.

Dr Hloni Bookholane: 34:22

For some people it was more in their face, for others it was just microaggressions, not as overt, and there are the things that happen without you knowing that happened. I can definitely say I didn't have any of the ones to my face.

Dr Maria Christodoulou: 34:37

Right. Well, and I guess, listening to you I'm thinking, I also have to question the assumption that you must have had microaggressions or racist interactions as a young black man at university and again, I don't want to be naive about the world, I'm sure they were there, but there's also, I guess, in the same way that you're saying you don't have to be poor to care about Fees Must Fall, I'm wondering if there's an assumption or an expectation, even on my part as a white person, that as a young black man, you should care whether you have privilege or not, and that there's almost an expectation that, whichever way we want to look at it, white people should care that black people in this country don't have economic privilege and or young black people with economic privilege have to carry some sort of burden of responsibility. I'm just thinking out loud.

Dr Hloni Bookholane: 35:21

Look, I think we can definitely pick up on that when I interview you for my podcast.

Dr Hloni Bookholane: 35:29

But to the point that there's the assumption, consciously or subconsciously, the assumption that, hey, because an individual is x, y, z, they should care. I think a great example of maybe why we shouldn't have that assumption has been the US elections recently, where there was a lot of, you are a woman. If we just use the heterosexual or the binary definitions, you're a woman and you should care that this person is running to be re-elected because they're going to take away woman's health or take further steps to limit access to woman's health care. Or you are a person from South America, name your country, and you're in America. You should care. And it's like, well, actually, what you find out in the different interviews and you say well, some people are like actually, this is good for us because we are not one issue groups of people. Yes, I should care about this one issue, that Hloni's running for president and we disagree on that. But he's going to make Chuckles cheaper and that's what I really care about more. So I'm going to vote for him, because that's more important to me.

Dr Hloni Bookholane: 36:35

Politics aside, it becomes difficult to try and bucket people. I think that's where good conversations are helpful, but also for us to have the grace that, hey, I'm going to make a mistake, you're going to make a mistake. To not assume that it's constantly bad faith that someone misgenders you or someone mispronounces your name.

Dr Hloni Bookholane: 36:57

All these little things, they're not in malice all the time, but it's hard if you are constantly experiencing that in your particular environment and those things are in tension, constantly. I don't have an answer how to solve it.

Dr Maria Christodoulou: 37:11

Well, it's interesting you brought up politics specifically and you said if Hloni was running for president, because one of the questions I wrote down on my notes was, do you have any political aspirations for your future?

Dr Hloni Bookholane: 37:22

Do I have political aspirations? Short answer right now, no. Do I have aspirations for some form of higher office, to be working within a higher office, whether it's global organization or you name it. F rom a national politics role, yoh, I don't know. I think inherently, I'm just a bit too impatient for some of the song and dance that needs to happen. That's part and parcel of that, and maybe the people that end up there were also just like, oh my goodness, there's a performance that is required as part of doing this and it's the soggy tomato in the sandwich that you have to put up with. But I wouldn't write it off. And I say that not thinking like, you know what, I'm not going to admit it now. I don't, but I have visioned myself, I could be your chief of staff or be the spokesperson for that person who has that role, chief person who's just fielding all the questions and making sure no, no, no, no, that was taken out of context.

Dr Hloni Bookholane: 38:21

This is what was said. What interests me, it's more the engagement part of it, where you're engaging with people. You're reporters, cool. You greet the people, you have banter back and forth, and then you see the article that's published. T he next time they come to the press room you're like, but you're always writing what I don't say. What's going on? And maybe that's just me watching too many American TV shows about people in higher office. Short answer, I don't have anything in mind right now.

Dr Maria Christodoulou: 38:47

Tell us about your time in the US.

Dr Hloni Bookholane: 38:50

Loved it.

Dr Hloni Bookholane: 38:59

Travelled to the US at least... since 2015 I think I'd travelled there three times prior to moving in 2019. Medical school was where everything just clicked. Fourth year medical school, we were doing our internal medicine rotation and we were able to spend some time in the renal units. So in the Western Cape, or at least in Cape Town, the renal unit has these meetings where they review people that are potentially eligible for chronic dialysis. But that meeting in which they make this decision, it's a dual decision that's being made.

Dr Hloni Bookholane: 39:29

For you to qualify for chronic dialysis, you need to be a transplant candidate. So basically, everyone who's getting dialysis is a candidate for transplant, and the patients that are presented there... S ocial worker, clinician, dietician... I might be forgetting another aspect that's discussed. T hose elements of the patient are discussed and there's a scoring system and ultimately, I was sitting there and the patient who was discussed was medically fit, qualifying. T heir dietician, t hey qualified on that front, but then they scored too low on the psychosocial element. I stand corrected. I think they might have been unemployed at the time and I think where they lived, those were limiting. I think the criteria was even taken to the South African Human Rights Commission as being not fair, but it withstood that for better or worse.

Dr Hloni Bookholane: 40:18

And seeing that and experiencing that, I was like hold on. Medicine is not just about us being able to give you the medical treatment or the medical device and whatnot. At least in that situation, you needed to be medically fit and medically qualified from your social and psychosocial elements because, should you get a transplant, all of those factors play a role in what predicts the probability of you rejecting that transplanted kidney. And that's how I got into organ donation research, organ donation transplantation and the HIV-associated kidney disease. And obviously, the first HIV- positive to HIV- positive kidney transplant was done at Groote Schuur. So all of these things played a role. I could see it. Oh, hold on. This is not just a clinical problem that requires clinicians.

Dr Hloni Bookholane: 41:09

There's a public health element to this, because transplantation is the only medical service that cannot occur without the public participating. So if someone needs a heart transplant, I need to, as a potential organ donor, say, hey, I'm willing to donate my heart. God forbid something happens to me and you can donate my heart. The rate limiting step isn't medical intervention and medical ability, it's that individual and the broader public knowing about organ donation. S o that research and the publications and the conferences, I met different people. En ded up going to Hopkins to visit and loved it, and I was like, okay, Grey's Anatomy, t hey speak a lot about this place. I mean, I wasn't going to work as a doctor there, but the public health idea, doing a Master of P ublic Health, truly now understand why people get sick rather than you're now dealing with them when they get sick. Then, what I was motivated to understand and learn about and being there was just so, I can't even put into words. It was very exciting. So I applied for the Fulbright Scholarship and applied for the universities and I visited a couple of the universities that I applied to and that's how I ended up in the US. I signed the book contract end of May and then I started writing the book when I moved to the US during my master's. I submitted the first chapter in September of 2019 and loved the experience of being there and I always say to people, why did you love America so much? The people that would ask me that particular question.

Dr Hloni Bookholane: 42:46

I've had a very particular experience in the US.

Dr Hloni Bookholane: 42:49

More often than not, it was in the big cities.

Dr Hloni Bookholane: 42:52

It was around a lot of international groups of people in the US, together with people that are from the US, and it was just a very different experience. M uch like anyone would have when you go, wherever, and I think my experience is around learning with other people that were just as interested in what I was interested in. Young people from different countries, people who are doing the exciting jobs and the things that, oh wait, I want to work in that kind of environment and this person is coming from there to do the Master of Public Health. It was amazing to see that public health isn't... You don't enter public health because you're a clinician or a medical student or a doctor. There were lawyers, there were statisticians, data scientists, people who worked at the White House as interns, and then the roles that come out of there and where these people end up, I was like, oh, this is what I'm talking about, this is where I want to be, and loved it. Loved, loved, loved, loved it, and had love in America, which was also great.

Dr Maria Christodoulou: 43:54

Tell us more about that.

Dr Hloni Bookholane: 43:56

Met amazing people.

Dr Hloni Bookholane: 43:58

Like I said, relationships happened, but they didn't last, unfortunately.

Dr Maria Christodoulou: 44:03

I was about to ask, are those relationships ongoing?

Dr Hloni Bookholane: 44:06

No, no, they're not. They're not ongoing, but the relationship itself still exists. Really good friend. She's from Argentina, married, just had a baby, still in contact, and we're like catching up about how, wow, that was almost six years ago, that experience of being in the US, living in the US, and how different or how similar we still are to those people. But so much has changed. Same, same, but different.

Dr Maria Christodoulou: 44:36

How would you say that time impacted you? How did it change or influence who you are? How did it shape who you become?

Dr Hloni Bookholane: 44:44

From the medicine, being a medical student environment, it enhanced what I was receiving at UCT - Groote Schuur. The people that I developed relationships as, like mentors, and observing how the care exists... F rom lecturers, professors, to students, and what is available when people, given the means that exist here, and then I just saw that an experience that elevated at Hopkins. I had good people and still have good people at UCT - Groote Schuur, and then I got there and met other good people. Those relationships still stand today. The person who ended up being my advisor during my master's, I met her colleague at a running track event. She invited me to a seminar that she was hosting about diabetes and HIV. W ent there and that became my academic home when I was there and still keep in contact. I met up with that professor, actually, when I was in Italy last year and the relationships that are built in different places.

Dr Hloni Bookholane: 45:49

If you were to draw a map and have like one dot and then see things that go to that, there's tethers from all different parts that I still hold attached, that I am forever grateful for those relationships and those people that I've met.

Dr Maria Christodoulou: 46:04

When you talk about that time and I mean you said a couple of times that you loved it and I think you described it at some point when we were chatting last time as one of the best years of your life, and as you talk about it, I have a sense of obviously how expansive and transformative it was for you. But you get quite animated and your energy sort of expands and you talk about all these people and you're smiling. So for our listeners who can't see you, there's a sense of that something opened up in you for that or in that time, and I'm curious how it was to then come back to South Africa, back into your internship year during the time of COVID.

Dr Hloni Bookholane: 46:38

To the animation point, it's 100%. T o the listeners, I feel myself getting animated and speaking to how what was different, or rather the same, it was, you have an idea. And I had people who I could pressure test ideas and thoughts, get challenged, and say no, think about this more, think about it in a different way. There, that was supercharged and there's... I was in an environment that it was, you have an idea. Is it a good idea? How can we... Not, we don't have the resources, we don't have the funds. It was, how can we make it happen? What do you need? What can we do? And, man, when you just have all this energy and you're excited, and what you're hearing is that no, no, this is not going to work. It's more like okay, but how can we make this happen?

Dr Hloni Bookholane: 47:23

Actually, let me introduce you to this person who's working on this and I think fantastic, and the great segue to your question, when I came back to internship with COVID, I think more so to the point about that experience. And then coming back here and you point out, okay, well, not that this is a problem and I'm frustrated and I'm throwing my hands in the air. That wasn't baked into the way of thinking. Again, I'm talking about my peers, not sort of professors and whatnot, and I don't know if I'm being unfair, or rather I was being unfair at the time, just feeling like, I think I've outgrown my peers. They're more clinically advanced than I am now, but the way of problem-solving and thinking about particularly health-related problems, I've advanced further in that and that's in part, because that's what I was doing over a year.

Dr Hloni Bookholane: 48:13

That's what I went to go do. But coming back to a clinical environment and just, the system relegates you to just being the intern or the commserve doctor, and I remember chatting to one mentor, even in therapy, and it was like, you left and went and did the things. Amazing, well done, great. But just remember that, unfortunately, the role in which you're in, in that PERSAL number you have with the Department of Health, the ambit of your roles and responsibilities, is not to think about how can we fix the system, how can we actually develop a better way, and questioning, but this doesn't make sense, rather than just do it. I was in a constant tension with that of okay, fine, this is not my job, but I couldn't switch it off. When you're dealing now with the situation of well, this doesn't make sense, why are we still doing it like this? This is inefficient, this is this, this is that. And it was hard. I t was frustrating, and that was something that I hadn't prepared adequately enough for, because I came back from an environment where, if anything, it was all, we want to hear what you have to say. We're interested to hear what you have to say, we want your ideas, to an environment that didn't really care about that until it was like, oh, you know so and so, you've done this, this and that. Okay, we'll listen to what you have to say. W hich was a bit demotivating, because the idea is still the idea, irrespective of what the person has.

Dr Hloni Bookholane: 49:45

I think a big part of it was there was one part ego. There was one part, I'm not just an intern, w hen I came back. A nd there was one part, okay, yes, this is not my job to think about these things, but how are you not thinking about these things? It's all good and well to say that, look, this is just the way it is, but I felt at my most frustrated that we got to a point where the problem became the justification for not having a solution or not thinking of a solution. Metaphorically hit my head millions of times against the wall. T hanks to my beloved mentors and friends that held space for me when I was just ranting and upset and... I had how to contextualize and say look, it was just like that when I was there. I'm like, that doesn't make me feel better right now. Nothing's changed.

Dr Maria Christodoulou: 50:33

But you know, I guess what you highlight is how certainly medical school training is so focused on a particular outcome, which is to churn out interns and comm-serve doctors who will then go on to become the clinicians of the future, and there isn't much space in that for thinking about anything beyond the day-to-day requirements of the curriculum in terms of the time pressure and the demands on your energy, in terms of night shifts and all of that.

Dr Maria Christodoulou: 51:01

And it feels like you had this unique opportunity to step out of the rat race, to step off the treadmill, and go and put yourself in an entirely new environment and be exposed to people from other disciplines and other countries and, almost like a think tank, and be able to expand your mind and your way of seeing things. You come back with a new lens and fresh perspectives and you see things differently. But now you're expected to be an intern and fit into the same box that you left, and that's really hard. But I also wonder about the value and the benefit of that and if there was space in the medical curriculum for people to step out for a while and immerse themselves in a new environment related to their field, but not the day-to-day demands of training and how new ideas or innovation might emerge from those spaces.

Dr Hloni Bookholane: 51:48

Exactly, and the US has that model in their training of clinicians and people when they're specializing. It's built in. At least, when we're talking about stepping out to go do a master's or stepping out to go do a PhD, it's baked into the curriculum and the system that that is not an anomaly for someone to do that. If anything, it's becoming the norm, and again, in defence of the people that I held frustration and resentment towards, I think the people that I grew up around, grew up as like, through medical school and a lot of what I was surrounded by and ended up being mentored by, I didn't realize that the different things that they did outside of their specializing journeys was not the norm.

Dr Hloni Bookholane: 52:32

Because now I see them and I'm like, oh, actually, you are one of in your specialty, you are one of in this specialty, you're one of in this country, one of five or maybe ten in that, and hindsight, always 2020, it's stepping away allowed me to be like, okay, you know what, I acknowledge these things, but there was also a responsibility on my part that in the frustration, I couldn't see it. But yes to building into the system how to people to take a break. Not take a break to go relax and whatnot, but such that people can explore and think about the different parts of medicine and healthcare. But at the moment that seems like a big ask, given what's happening in the healthcare system, at least from a human resources point of view, it's tough.

Dr Maria Christodoulou: 53:20

So there you are, you come back, you're an intern, you're experiencing all these frustrations, you have ideas, you have to step back a little bit and you're fortunate enough to have mentors who hold space. What came next? What did you do next?

Dr Hloni Bookholane: 53:32

I finished internship and as I was finishing internship I was just gatvol. I thought, you know what, I'm done. I'm not going to do comm serve. It's not worth it for me because, look, I'm probably not going to practice. And this is not because of a lack of love and enjoyment of medicine and being a doctor.

Dr Hloni Bookholane: 53:51

I didn't leave the field feeling bitter and I'll never encourage someone or rather, actively discourage people from doing it, but I was just like no, if you have multiple dimensions and ways of thinking and things that are interesting to you, really think hard if this is the route to take, because here are my frustrations. A nd to that, I think the biggest frustration was, it was a rigid, it still is, a very rigid system. In part, maybe it has to be when you're working right, because it's an apprenticeship model. It's see one, do one, teach one. You can't progress to the next rank and level, particularly when you consider specializing roles.

Dr Hloni Bookholane: 54:30

It's a step ladder, but what I saw, what that came with, was there were people who, the further up they got on that step ladder, it was assumed that the further up they get, the lower the amount of pushback that they need to be getting from other people, or questioning that they need to be getting. T o a point where, when they graduate and qualify as specialists or whatever the thing is that gives them a particular amount of authority, they are now beyond being questioned or challenged or disagreed with. And, look, I told you. Minimum of five whys. The clash was constant. I had those clashes with... I t's to a point where it was.... Someone said, yeah, they'll call their consultant. This is what they've said, and a consultant being like the attending or the specialist doctor. I said, that's fine, call them, but my question is still going to be the question. W hy is this the way it is? And that's not an answer to sort of give someone a well, my mom said so, my dad said so.

Dr Hloni Bookholane: 55:31

Okay, fine, but I need rationale right here because again, maybe it's a me thing. I need to understand why I'm doing this this way, b ecause if I don't understand why, my mathematical calculus is that I'm going to keep questioning it. And if I keep questioning it I'm going to keep getting frustrated and if you're not giving me the answer, my cycle just gets worse and worse and worse. And the way I interact then, with that way of thinking, I become much more prickly in that interaction and often to my detriment, because now I'm getting worked up and frustrated and I can't let things go. And I said this to you before, I think in medical school people become emotionally stunted. T hat, because you're learning so much and so many big things about health and disease and death and dying and you have to mature so quickly relative to your peers doing other degrees, because by the time you start working, man, you've seen and experienced probably the equivalent amount that someone is now experiencing as they start working.

Dr Hloni Bookholane: 56:31

You've experienced that level of stress or angst by the very nature of what medicine and health care degrees are. But now you start working, and because of what's inherent to medicine, it's a step- ladder growth. T hat also then reinforces the authority type thing where the decision- making is at the top, and you've got this anxious overachiever who's now working as a doctor and they just do as they're told, or they choose not to question, or they question not enough, because nature- nurture, the way medicine is. A nd then that cycle just replicates, replicates, replicates, and then you get this weird guy called Hloni, questioning something all of a sudden, and it becomes almost like wait, are you questioning me? And wait, are we not allowed to question?

Dr Hloni Bookholane: 57:20

I'm certainly not saying that these people again, were malicious, that I had frustrations with, and what they represented in my interactions with them and what I saw and experienced. But my goodness, it's hard and what did you find most frustrating?

Dr Maria Christodoulou: 57:42

What did you find most frustrating?

Dr Hloni Bookholane: 57:44

That you could just get dismissed because of the role that you're in. Your place in the hierarchy. Again, maybe that's an ego thing, right, because the way you are in the hierarchy typically follows age as well. So there's also, I was three or four years older than people in my class. So the people that are above me on the hierarchy, sometimes are my age or I'm older, and I mean I couldn't care less about that. But if you're going to bring the hierarchy and I have to work with that, it becomes frustrating t o a point.... I remember in the one hospital, this one doctor said, this is what I need you to do for me. And I said no, you mean do with you, right, I'm not working here for you.

Dr Hloni Bookholane: 58:17

And again, that was me being very snappy in an environment. I was like, no, it might work that way. But I think when you think about what you're saying, just say it slowly. That's not how this actually works. And who knows, maybe if I hadn't done all these other things and went and seen a different experience and had the experiences I had, I might have felt different or the frustrations wouldn't have been as severe. But I've also had the experience. I think this is most important. I've had the experience of working with the most senior, accomplished, whatever people th at you wouldn't be surprised if they had an ego in how they treated people, and you're just no, if this person can do it, I can guarantee you, you can as well.

Dr Maria Christodoulou: 59:02

I have this interesting reaction as you're speaking. We've gone from that space of expansiveness in you and that animated energy of possibility to this kind of quite heavy, almost defeated, frustrated energy, and what keeps popping into mind is a story you told in the book about the first time you... W ell, I don't know if it was the first time, but you were in a surgical team that was removing a donor heart for a transplant patient and the cardiothoracic surgeon gave you the opportunity to hold the heart in your hands. Tell us about that. What was that like? That feeling of holding a human heart that was still beating in your hands?

Dr Hloni Bookholane: 59:41

That was amazing. I think my supervisor asked me if I wanted to go with him.

Dr Hloni Bookholane: 59:48

It was at 5 am and I was like, why not, let's go. Again, look, I'm not operating. I'm just there as the student and watching and assisting where they need me. When he said that, I was like... so I just put my hand over. T he chest is open, the heart has been exposed and I just put my hand on top of the pericardium and he said no, no, put your hand in the pericardial sac. Basically, hug the heart and just feel it, because you know you're all sterile. This is before they clamped the aorta and started doing all the process things and I felt this thing just going du-dum. I hiked up Lion's head that day. I went up on Lion's head by myself. It was like one of those days that all of a sudden becomes cloudy in Cape Town and a bit rainy, but I just went up there and I just sat there being like, yep, that's what I did today.

Dr Hloni Bookholane: 1:00:35

I had no one to talk to, but I just had all this energy and my goodness, look, medicine, man. What a freaking beautiful degree/ career. W hen medicine really just shines and you see like, wow, this is what people are talking about. And I mean, I wasn't even the specialist doing that. This person's probably done this so many times but in the same way that people in Cape Town, who live in Cape Town, on the promenade, when there's a nice sunset, it doesn't get old.

Dr Hloni Bookholane: 1:01:04

That could never get old. A human heart. And there it is. Sad situation of the donor.

Dr Hloni Bookholane: 1:01:10

But seeing the advances and the extent in which this profession that we are in can do and can contribute to, g etting frustrated and some of those little things, that makes it worth it, because you see that we can achieve that. When you fix the little frustrations, you can come home and be late to the party. Oh, flip, where have you been? Sorry, just put in a heart in someone, or I just watched that happen. Good memories, freaking good memories. There was another story. It is the Grey's Anatomy story in the book, where I was visiting the renal unit to speak with the team who ran a study trying to understand the factors that were influencing organ donation consent rates in the Western Cape and we'd been collecting this data and I just went in to check and see if there were any referrals that had happened overnight. I built a relationship with the one nurse and she started treating me like a very naughty but lovable grandchild.

Dr Hloni Bookholane: 1:02:07

She's like we're busy now. We can't entertain your nonsense.

Dr Hloni Bookholane: 1:02:10

And I was like no, no, no, I'm actually here for a serious question. At the time, we were looking at the logistics of getting the team, because there was a donor referral from PE or Gqeberha, and the surgeon needed to fly from here with the transplant coordinators to PE because the recipient for the heart, the kidneys, that would be in Cape Town. And I was like, is there space? Because typically, they either, if they fly commercial sometimes, or they can fly private, and this was one of those where there was donated flights for this kind of exercise. Went to the airport and didn't go to the normal entrance, went to the hangar entrance, got into this tiny but very snazzy plane. Again, donated flights. Flew to Gqeberha, 45 minutes, walked out of there with the cooler boxes of organs in transit, taking it to the hospital. I remember walking in with the team and I was like, this is an episode right here. This is an episode.

Dr Hloni Bookholane: 1:03:09

And we're walking in, and it's happening. My goodness, again, another wow feeling when you end up flying back to Cape Town. Heart transplant happened at the one hospital, liver transplant and the kidneys. It was all in a day's work. T hat one donor, five people, heart, two kidneys, the liver was split in two for two kids. It was epic. You know, get to the airport. Because the surgeon was saying, okay, we're clamping the aorta in Gqeberha. In Cape Town, they can start opening up the recipient, because it's a 45- minute flight, it's a 30- minute drive from the hospital.

Dr Hloni Bookholane: 1:03:46

So by the time we get here, it's quick exchanges, and I remember standing there and hearing the person on the phone saying, yeah, is the plane ready? And said yep, we're just fuelling up and I was like, wait, but is there no check-in counter? We just walked straight past. We walked onto the tarmac at Gqeberha airport and I think I was carrying one of the cooler boxes and I just felt like this is my main character moment. It's amazing.

Dr Maria Christodoulou: 1:04:12

What a story. T his metaphor keeps coming into mind about, like, if we could reach in and feel your heart and transplant that passion into the medical field, like what might be possible? And you told me when we first chatted about the possibility of doing this conversation, there were two things you said that stood out for me. The one was that you don't quite know where you get this chutzpah from. You don't know where you get this confidence to just push back and challenge and ask the why q uestion. And the other thing you said to me was that you somehow always find your own way and your own path, and I'm wondering where the path might take you next?

Dr Hloni Bookholane: 1:04:56

We've established that we don't know if it will take us to run for president. We know that.

Dr Maria Christodoulou: 1:04:57

Okay, I'm not sure you can wield the kind of influence you want to influence as president, but let's see.

Dr Hloni Bookholane: 1:05:08

Hey, if I can sign on the dotted line and health care decisions around the world are affected, you know, maybe, but maybe I'm in the wrong country to do that.

Dr Hloni Bookholane: 1:05:12

I joke about that, but that does influence... I'm happy where I work right now, at BCG. I'm learning a lot about the business side of doing things and how being in medicine, you learn how to deal and work with people, particularly in difficult situations, difficult personal situations. But I think what I'm learning at BCG is that, okay, you know how to work with people and speak with people and translate information to them. What I'm learning here is how to do that in a setting in which you're still managing different stakeholders and different ideas t hat might be in tension, but it's figuring out how to do it in a way that you still get ahead, you still move the needle forward. How to, when there's two stakeholders that are just not clashing and their clashing is the roadblock to the progress.

Dr Hloni Bookholane: 1:06:01

How to deal with very high senior executive people from a point not so much of like, how to speak to them, but to understand, in the organizations and companies at which they are the executives or the executive teams, what is the thinking that goes into decision-making there? What are the data points that they require for that particular company or institution to make a particular decision or to not make a particular decision?

Dr Hloni Bookholane: 1:06:28

What evidence is required to get that decision made or not made and in this environment, what level of evidence and how does it need to be presented? What I see myself doing, 10 years time, potentially, is being in an environment where I understand, for the organization that I work in, this is what we need to make the decisions. This is the level of evidence we need/ I need to inform whether we propose this idea or we don't propose it, or we propose this solution versus another. Because of COVID and you saw how the private sector... very important in the thinking and working around the processing of vaccinations and investigating and studying and processing, and how it wasn't just medically trained people that were doing that, that were instrumental in addressing that pandemic health emergency crisis, right? It was, y ou need to understand how to do project management. You need to understand what is supply chain.

Dr Hloni Bookholane: 1:07:27

How can they be impacted by a global pandemic? Can certain things still function? And I'm learning all of that. I'm growing, I'm enjoying it. If we assume I will not be at BCG in 10 years time, where am I? Probably at a health specific global health organization. Global health is probably going to look different in 10 years time.

Dr Hloni Bookholane: 1:07:47

There'll still be the constants, but I think in terms of how geopolitics influences that, might be very different. There might be less reliance on governments, but I know that I will definitely be running more marathons. I want to ski more and probably increase my certification for one of the languages I'm learning, whether it's Spanish or Italian.

Dr Maria Christodoulou: 1:08:14

I want to remind you that in the book's prologue you said that your ultimate goal is eventually to become an academic or a clinician, or both, within a global community of thinkers and innovators.

Dr Hloni Bookholane: 1:08:34

That is on page 21 m aybe. W ill I be an academic, will I be a clinician? R ight now, I don't think... I'm doing neither of those things. But being in a community and working in a community of global thinkers, that seems to be the path at the moment. If anything, my job in many ways kind of reflects that. T here's a lot of global going on, like what we do, clients we work for. So we'll see. Maybe in a couple of years let's do part two.

Dr Maria Christodoulou: 1:09:04

Because I read the book and I have more insight into some of the stories, I feel like there's so much we haven't talked about. There's so many things we haven't even touched on. E ven just the story of where you are today and earlier you referred to, you made a decision not to do your commserve, because you didn't think you were going to use it. But you did complete your commserve and I'm thinking that a young colleague who might be listening might think, oh, but you left, you didn't stick it out. B ut you did. Y ou stayed, you completed your community service. What advice would you have for a young person who's currently in medical school feeling some of that frustration and helplessness, overwhelmed by the burden of responsibility, challenged by the hierarchy? What would you say to somebody like that today?

Dr Hloni Bookholane: 1:09:48

It's something I didn't enjoy hearing and I didn't find particularly instructive in the moment when I heard it, but in hindsight it was helpful to note that you're not the only one. Unfortunately, y ou're not the only one. It would probably be a good thing if only one or a handful of people were frustrated.

Dr Hloni Bookholane: 1:10:07

I think I've also had the benefit and the immense privilege of having seen, much earlier in my medical path, the different parts that exist beyond being a clinician, and in part, the things I was interested in and wanted to do were more that way inclined. So I think that's not so much advice but to contextualize that a) there are different paths to, and different ways in which we can, put to practice everything we learn in medicine, internship and comm serve. Even if you, you know, y ou do medical officer years or you do registrar time, a lot that we learn and experience and do in medicine is so transferable. It's just a matter of we don't know how to package it in that way. Constantly managing stakeholders. You're constantly dealing with things that are in tension. You're constantly managing multiple situations and now you see a job ad with someone who can adapt to high- pressure environments. Hey, you've managed multiple wards overnight. No one died.

Dr Hloni Bookholane: 1:11:12

You know, you were okay. A ll of those things are skills and sometimes you don't see it as completely related and useful.

Dr Hloni Bookholane: 1:11:22

But... I don't think anyone should do medical school ever again, but would I do the process and the journey again? Hundred percent. Because, part of it, I think I blossomed and really grew into myself and who I am today through that. But I think it's important to know that even when people leave clinical medicine and go do something else, there is still the stigma of, ah, what a waste. But it's not because, who knows, maybe you wouldn't have done what you did if you hadn't done medicine, right?

Dr Hloni Bookholane: 1:11:53

You wouldn't have had whatever experience that led you to that next thing, and sometimes if you leave for any other reason, that's also okay, because we're becoming more primed to that within medicine, that some people don't enjoy it. S ome people find it difficult or find it just the angst and the frustrations and all the things that occur in medicine. They maybe are just like no, actually, I can't function in this kind of environment. N otwithstanding all the other personality frustrations that occur in other jobs. But it's just like hey, this is not the job for me.

Dr Hloni Bookholane: 1:12:28

Feeling bad and like a self-deprecating way of thinking that, ah, I'm leaving, but now I had taken someone else's spot. No, you got that spot. You were in the spot.

Dr Hloni Bookholane: 1:12:39

You chose to let it go.

Dr Hloni Bookholane: 1:12:42

If someone else can't take that spot, I don't think that's very helpful for the individual to think like that, particularly when you're trying to justify whether or not this is the right thing to do. But again, to also look around. T here are people that are still clinicians who left, did t his, did that, then came back. You don't have to do the path back- to- back. Med school, internship, commserve, reg time, then you're a consultant. It doesn't have to be that way.

Dr Hloni Bookholane: 1:13:07

If you have other interests, hold space for that, because unfortunately you don't want medicine or any job to be the nucleus of your life, because if the nucleus is crumbling, then everything is crumbling. And that's my biggest push of like, treat medicine as beautiful and rewarding and wholesome and all the things that it can be and often is, treat it not as this calling or this virtuous thing that you're doing. Treat it as a job, and this is not to take away from what medicine does have and maybe other jobs don't have, but it allows you as the individual to be intentional, to carve out time outside of medicine, because that's also something that's not drilled into us as a hey, I'm not going to, as medicine, say to medical students or doctors and whatnot, no guys, if you have free time, go have fun.

Dr Hloni Bookholane: 1:13:57

No, if you're not using it, I will take it from you. Medicine will say okay, come, give me your free time, stay longer at the hospital, do this, do that. Obviously, it needs to be said, I don't want to be misquoted that you don't just leave and abdicate your responsibilities to go do your personal things, but knowing that the time that you're meant to be there is done, the handovers were done. Go, go, rest. Go for the run, go for the hike, choose to work in the hospital or the province that's close to the things you care about, because maybe the hospital you've chosen is the right one for the training, but it might not be for the rest of your life. Do you need to move then? Some of these decisions are taken away from us, at least from a comms erve and internship role where the choices are not as open. But I think that investment in the things we care about beyond are important, because otherwise medicine can unfortunately just take, take, take, take.

Dr Maria Christodoulou: 1:14:56

You told me the other day that you felt like walking away from clinical medicine was a really difficult breakup.

Dr Hloni Bookholane: 1:15:04

Hundred percent. I think I went through all the stages of grief multiple times because, for the most part, I mean you quoted from the book. My goal and my thinking was this is going to be my lifetime. I'm going to be a practicing doctor, and no different to thinking that this is your partner for life. And the breakup came, where you just realize that, look, the things that I want and care about don't exist here. Like, I still care about you, but the other things in my life that are just as important, if not more than this, they're not... The priority status doesn't exist for them here. And yeah, walking away was hard.

Dr Maria Christodoulou: 1:15:41

I can imagine and, in my own way, I remember somebody asking me if I would contribute to a book t hey were writing about doctors who walk away from medicine and I sat and I thought about it long and hard, and I was like, well, I haven't walked away from medicine. I've walked away from a particular kind of medicine. I've redefined my relationship to medicine. Medicine is still where it's at, it's still what I'm about, but I have a different vision for what that means and what that looks like, and I've given myself permission to follow that. And people might have their judgments and assumptions and perceptions and there's a lot of the social pressure to feel guilty about the needs of the population and all of those things are relevant. But I think, if we don't, those of us who feel a calling to a different path, if you think of it as a breakup from medicine and that you can never go back... I think what you're doing, you're still in medicine, but it's a different path and that maybe it's a new path that we don't fully understand yet. Just to keep it really simplistic, when I started coaching, I'd started my coaching course, coaching was a very new field.

Dr Maria Christodoulou: 1:16:43

People didn't even know it existed in the health context back then, and I remember sending an email to a head of department at Tygerberg who had done some research on Motivational Interviewing, because it was one of the tools they were building into coaching practice, and I said I'm busy with a diploma in coaching and I want to come talk to you, and he was like, coaching, what's that? If somebody had said to me that health coaching or wellness coaching would be a thing one day... It didn't even exist in the paradigm. There was no such concept in the paradigm. It was just beginning to emerge in the business world. And so I'm wondering about things we don't even have names for yet that will be roles in the field in the future, and that you've got to be brave sometimes and step away to follow a new path and trust. As you said, you were in that place. You did not deprive someone else of that place. You hold the place, your seat in that circle, in a unique way.

Dr Hloni Bookholane: 1:17:36

I fully am growing to love the analogy to a relationship where staying because you've put so much time into it doesn't justify staying longer and being more miserable forward, but also leaving at that point and deciding to call it quits and walk away, neither does it take away from the time because, you know, you've grown and learned and... A nd that's what I try and when I've had these conversations, I'm like no, I'm not discouraging anyone to do medicine. I'm just... We didn't get married, that's all. It was a long and beautiful and healthy relationship, but I don't think I would say I fully outgrew the relationship. I'm sure there's a love book or some story. We wanted different things.

Dr Maria Christodoulou: 1:18:22

Tell us about your name. I'm going to try and pronounce it and I'm going to apologize in advance if I get it wrong. I did practice, but for some reason I'm struggling to wrap my tongue around it.

Dr Hloni Bookholane: 1:18:31

It's like 90 percent there. Hlohonolofatso. The easiest thing about it is if you just read the words in the way they are, you know, it's a mouthful. And it's about 14 letters. That's your first name. I have a collective more than 26 alphabet letters. But Hlohonolofatso is my given Sotho name. My dad is Sotho, my mom is Xhosa. One of my dad's sisters gave me the name and it means 'to be blessed' in Sotho. The providence that's in Black African children's names.

Dr Hloni Bookholane: 1:19:05

You sometimes see it. I think I've been blessed with, I think, the experiences I've had, the life that I have, the experiences I still have, and... I'm not a religious person, b ut there's times when I'm just like yoh, things are going really well and I'm just like, yeah, no, I'm blessed. When they're not going well, it's not that I'm not blessed, but I'm like, look, still blessed, but okay, maybe this is the rough patch. L et's roll with it. But I think I've seen and appreciated and continue to see and appreciate the meaning of my name. I often ask people what their names mean, particularly if it's a name I'm not used to hearing because I have this understanding. That's the story. Hloni is the shortened version. My grandmother, my dad's mother, called me that. I f you meet someone whose name is Hloni, you can ask them, is your full name Hlohonolofatso or Lehlohonolo? That is not unlikely. But yeah, I use Hloni for everything, unless it, like, specifies the name as it is in your passport.

Dr Maria Christodoulou: 1:20:16

Yes, well, I also have a thing about names and their meanings, and my daughter's name is Angeliki and you know Angeliki, and it's so frustrating people call her Angles, they call her Kiks, they call her Kiki, they call her Angela, they call her Angie. When she was little, she used to insist that they call her by her full name. Now she just goes with it, because it's just easier. But I think being able to say someone's full name is important.

Dr Hloni Bookholane: 1:20:42

It's the literal version of I see you.

Dr Maria Christodoulou: 1:20:46

Exactly. Amy, y ou've been very quiet for the two hours. Is there anything that you would like to ask or say?

Amy Kaye: 1:20:54

Sjoe. A lot to talk about, a lot to digest, process. I think, if I were to summarize this conversation, it would be that words matter. In the words that you choose, in the stories that you tell, the fact that you're a writer. T hat story that you told of you going up Lion's Head after having this life-changing experience of holding a human heart and there was nobody to tell. And as a storyteller, that is the most painful thing is, you've experienced this thing and you just want to tell somebody your story. But as a writer, that's what you often end up doing. You write the book so that somebody, somewhere can read that story, so that you have your audience, you have your reader. I understand that. Also, I love that idea of you having the vision of you putting the stethoscope around your neck and the white coat on. I just think that's such a lovely childlike image. If you believe in destiny or fate, I think when you're a child you have that moment of like, one day when I grow up, and then you have that vision of your life.

Amy Kaye: 1:21:46

For me, I remember I was five or six, I used to play teacher, teacher all the time with my sister. All I wanted to do was go to school and my sister was older than me and she would get homework and I would always be jealous, because I just wanted to do homework. The image of the stethoscope and the white coat, it makes so much sense to me. But I did have a question. I made my own theory up about, as a storyteller, you needed somebody to tell the stories to. But why a book? Why did you decide to write the book? That's what I'd like to know.

Dr Hloni Bookholane: 1:22:15

I hope it's an interesting story. Interesting but also surprising story. I never planned to write a book. I went to the Franschhoek literary festival in M ay of the year I left to the US, and a friend had written a book and he was on one of the panels and we just went for the weekend. Oh, this is fun. One of the publishers came to say hi to him while we were having wine at the author's lounge and like, once I've had a couple glasses of wine, you saw the energy. I just throw things out there. J ust to see, does that land? Is that like your sense of humour? And I made a joke to the publisher. They were the publishers of Jacques Pauw's book, my President's Keeper, and I said great book, b ut I haven't seen folks publish anything by a doctor. And she asked me two questions. One, are you a doctor? I said yes. H ave you written something we can publish? I said not yet, just tongue-in-cheek. And she's like well, here's my card, let's chat if you're writing something. And again, that chutzpah and like, whatever, let's have the conversation. W ho knows where it leads to.

Dr Hloni Bookholane: 1:23:17

I live in Vredehoek. We were at... I think it's closed down now, the cafe very close to the Gardens Centre. Went there for a cup of coffee.

Dr Hloni Bookholane: 1:23:24

I pitched this idea of some of the journaling I had. I was like, yeah, I could put that into a book, it could be for three different audiences. And she was like, yeah, sounds interesting, I'll pitch it, let's see. Voila. So that was cheeky, plus being in the right place, plus, I guess, just knowing how to talk to people and ,whether it was a joke or whatever it was. But that's how the book ended up... That was the genesis of the book. And then when I started writing, I think what carried me through was, oh okay, this is what I'm doing, which is I'm trying to tell a story of... This was my experience. My parents aren't medical doctors. PhDs and that, but they're not medical doctors. And this was my experience of this. And I think I saw a lot of people who were experiencing this either because, oh, they've done this before. Family member, brother, sister, so they were not new to the process.

Dr Hloni Bookholane: 1:24:17

So it was to understand your loved one, your child, son, girlfriend, boyfriend, whatever is doing medicine. This would be interesting to find out. Most books also written by doctors are looking back on a career of medicine and telling a full arc. I'm doing this now. I've just finished, I'm in the next phase, but let me talk you through. So that was what became the impetus and the driving force to finish the book, which was very different to how we ended up starting to write it.

Amy Kaye: 1:24:46

My closing point would just be please keep asking why. You're definitely a storyteller, whatever form that is. Whether you make a film, whether you write a book, whether you make theatre, whether you write a song, you're a storyteller. So please keep asking why. L ike I said, words matter, the words that you choose. You're so calculated in everything that you say, but in the best possible way, not in a clinical way. You choose them so beautifully. So please keep asking why. I really believe there's a reason why you have the brain that you have. There's a reason why you see the world the way that you do, and the questioning is really important and really beautiful, and you have a gift to be able to take that perspective and turn it into something else. That alchemy of turning the wound into wisdom. So, thank you, I'm looking forward to seeing what stories you tell next.

Dr Hloni Bookholane: 1:25:38

I appreciate that. Thank you, Amy.

Dr Maria Christodoulou: 1:25:41

Yeah, I only echo what Amy has just said, but I want to ask you one last question, Hloni. You said to me when we met that you wonder what book you might have written if you had written it after commserve rather than before. And I'm wondering, if you were to pitch a book idea to a publisher today, what book would you want to write?

Dr Hloni Bookholane: 1:26:04

So the title of the first book was Becoming a Doctor, and the word consultant in medicine is you're the specialist. But I've thought about the idea of saying becoming a doctor and then becoming a consultant, which is a double entendre, depending on... If you're someone who knows medicine and the consulting world you're like,

Dr Hloni Bookholane: 1:26:25

And I mean, I guess it would catch the bit of why the career pivot and probably, again, unravelling this consulting environment that a lot of people, when they hear you're a consultant... Oh gosh, what do you do? And then no one can actually explain what they do as a consultant, and it would probably be, in some ways, tongue- in- cheek, but also probably telling the stories through the types of people and the experiences I've had. I think that's what it would be. Who knows? Maybe. Maybe one day.

Dr Maria Christodoulou: 1:26:57

Well, sounds like a great book. I would read it.

Dr Hloni Bookholane: 1:26:59

Thank you, I had to dig up my copy.

Dr Maria Christodoulou: 1:27:04

What's it like to hold your own book, that you wrote, put your heart and soul and told your story?

Dr Hloni Bookholane: 1:27:08

With my stethoscope in tow...

Dr Maria Christodoulou: 1:27:10

Yes, yes, we'll share a link to your book in the podcast description. What's it like to hold your book?

Dr Hloni Bookholane: 1:27:18

Every time I see it, I'm like, oh, that's nice. Also, I have a mask. Why was I even wearing a mask? It was COVID. During the times. It felt great when I got the first advance copies. I think I got 20 advanced copies and I got six of them and they were delivered to the house and I was at home.

Dr Hloni Bookholane: 1:27:36

I think I was post-call that day, and I was at home and they were delivered here, and I was just like whoa, because I'd seen it in pdf form. But then holding it and... Other than spending time doing groceries at Woolies, the other place I spend a lot of time that is a store is Exclusive Books. Sometimes I'll just walk around there and just like, look at different books, oh, this is nice, this is nice. And then I was like, oh my goodness, I can see the book in the store.

Dr Hloni Bookholane: 1:28:00

So there were times that I figured out where the different Exclusive Books are. W hen I was in Joburg, when I was in Cape Town, when I was in East London I was like, oh, they closed the Exclusive Books here, so where do people buy books?

Dr Hloni Bookholane: 1:28:12

And then we found out oh, there's other kinds of bookstores.

Dr Maria Christodoulou: 1:28:15

Did you walk around Exclusive Books looking for your book?

Dr Hloni Bookholane: 1:28:18

Yeah. Sometimes I'd go in there and say, hi, do you have a copy of... It's a book called Becoming a Doctor? I'm also wearing a mask so they can't really see my full face, and I go and find the book, I take a picture of like where it is, what setting, and then I say, can I just sign 10 of these? And then this one lady looked at me at Cavendish, and said why? Oh my god, you're the author. I was like yeah, yeah, yeah, I am, which was interesting. An interesting experience but it was fun.

Dr Maria Christodoulou: 1:28:49

Hloni, you're inspiring me. I've always said I would write a book and my working title has always been, Who is the doctor? And there's many plays on that. But, Amy, maybe I'll get my act together at some point, who knows? But I certainly am feeling inspired.

Dr Hloni Bookholane: 1:29:05

Good. Who is the doctor? Yeah, who is the doctor?

Dr Maria Christodoulou: 1:29:08

Exactly.

Dr Hloni Bookholane: 1:29:11

Ah, please do it. Please do it.

Dr Maria Christodoulou: 1:29:13

What are you left with at the end of this time of sharing some of your life experiences with us?

Dr Hloni Bookholane: 1:29:17

Like I said, work has just been really busy and I came out of a meeting and had like an hour to just gather my thoughts again and it feels good. Feels good to chat, feels great. I enjoyed this conversation. I think there's a lot of... To Amy's point of like choosing words. I think I'm cautious and thoughtful about it because I've gone through this process of writing a book and... B ut at the same time just observing and paying attention to what matters, and it's not so much that I don't want someone to be offended or whatnot about something I've said.

Dr Hloni Bookholane: 1:29:51

The justification that often people give, ah, it was taken out of context and I'm like, okay, often that statement is not about something that was taken out of context. And I think another thing is that when I left medicine, it wasn't a breakup where I left and threw the toys and I bad mouthed and brought down my experience. There's also a part of it that some people don't know of. Oh, why did you leave? And I think if the initial book was written post-commserve, it would have thrown lots of punches. More than it did.

Dr Hloni Bookholane: 1:30:21

Medicine is taking a bit of a beating at the moment, somewhat necessarily, for just system related things, but it feels good to have this discussion, these discussions, because it also reminds me that it was a good decision for me to leave. L ike I don't have this conversation, feeling like, oh man, I shouldn't have done what I did. No, if anything, I'm like, a) I'm healthy and in a good place, b) I can look back and yeah, I did leave, and c) I don't feel any residual un- worked through emotions about it. I'm going to go for a lovely run now and have a good evening. How do you feel?

Dr Maria Christodoulou: 1:30:59

I feel inspired and I feel touched. The image that's staying with me is the picture of your hand reaching into someone's chest to touch their heart, and I feel like your words do that and I feel like you will do that with your life, and I'm not sure what that means or what it will look like. But I agree with Amy. D on't stop asking why, and you've said elsewhere that we can't afford to give up on hope. Not quite in those words, but it was around ethical leadership and the importance of staying hopeful. Don't get tired.

Dr Hloni Bookholane: 1:31:32

Don't get tired. In the absence of ethical leadership, don't get tired.

Dr Maria Christodoulou: 1:31:35

And so I'm hoping you will take care of yourself so that you don't get tired, so that you hold on to hope and so that you can be a part of the solution for the future.

Dr Hloni Bookholane: 1:31:43

For as long as I can run and see the ocean, see the mountain. I think you could work with that. It's good to be reminded of that and I try to remind myself also, because it's easy to get into a negative spiral and then...

Dr Maria Christodoulou: 1:31:58

At the risk of opening up a whole other topic, you wrote a chapter in your book that said to complain is to be privileged, and so we don't have a right to complain.

Dr Hloni Bookholane: 1:32:06

You know, maybe now, five years later, there was probably a lot of self-righteousness in saying that. You know, you don't get to complain, but a generous take, and probably how I would put that now is that yes, let's complain, but if that's all you do, that's where the privilege is because then you just complain.

Dr Maria Christodoulou: 1:32:28

So do you still have hope?

Dr Hloni Bookholane: 1:32:29

For what?

Dr Hloni Bookholane: 1:32:30

M edicine, life.

Dr Hloni Bookholane: 1:32:33

Do I still have hope for medicine, yes, but there are moments where I've taken some quiet validation when I saw there was an article published, a letter to the editor, to the South African Medical Journal, certain hospital leaders who were saying that they should do away with commserve as a requirement, because the state can't actually afford it..

Dr Hloni Bookholane: 1:32:55

And, I wrote an article at Daily Maverick three years ago saying, in many ways, something like that, and I think it was, Doctors are in limbo while they wait for... something. And I went and saw that article and I was like, I wasn't crazy, but maybe I was just too early. But again, it's a pyrrhic victory that I was taking for myself, but when I saw that article and then I went and read my article, I was like, see, I wasn't just being a frustrated, crazy kid who was fighting with you guys. But, I told you so's don't often get us anywhere.

Dr Hloni Bookholane: 1:33:30

I do have hope for sure, but I think if I could inject anything into that space, it's like, hey, it's okay i f this thing that you're so passionate and want to hold on to for dear life is not something that's going to work. Y ou need to do away with it. Klaar. Finished. Because there's certain things that exist because of just remnants of promises made and ideas during the transition and blah, blah, blah, blah, blah. Free healthcare, this and that, the NHI in and of itself being that sort of idea.

Dr Hloni Bookholane: 1:34:01

You can't even handle the situation now.

Dr Hloni Bookholane: 1:34:03

How are you going to handle it when you're trying to do something even bigger than this? A nd the initial reaction to that is like, oh, you just want to keep private health. No, you're not the people that need to be the ones who are the custodians of creating universal health care for all, when you haven't been able to manage the public health system as it is. I f anything, yes, you inherited some of these problems, but you haven't made it better so, how about we first figure out how to fix this, then... ?

Dr Hloni Bookholane: 1:34:37

You want to buy a freaking.. a Dyson hairdryer, when your electric plugs don't work? My friend, come, fix your plugs first and then you go buy the very expensive hair dryer. But now you want to get the most expensive hair dryer because this is what we've promised. But how is it going to work? How is it going to be sustained? Because you can't even sustain the existing hair dryer you have. And then they just end up in political talk and then people fight, and then we end up having a race discussion and then we call each other names, and then we write the articles. We call each other names in the comment section, and then we move to London and Australia and America, and then we all come back because the health care is cheaper here and better here.

Dr Maria Christodoulou: 1:35:24

I hear some of the despair in everything you just said. I feel like I want to remind you of the advice you said you would give a medical student who was feeling frustrated and a little bit lost in the system, and the first thing you said was, you are not alone. So, you are not alone in the vision that you hold, and I think one of the dilemmas of being... I'm going to use the word visionary, but of having a bigger vision, is that sometimes it can feel like a lonely place, especially when you are walking on the edge of a paradigm. You haven't yet been able to clear the path and see what's next and perhaps if we can get you to a place where you really start feeling at home and you know who your community is, who the global think tank is that's going to help you with these issues, that space you were in in the US of possibility, and rather than going well, we can't do this, begin asking how might we be able to do this?

Dr Hloni Bookholane: 1:36:21

Exactly, and it's not just a money thing, there's so many other things required. H undred percent. I appreciate that. I will definitely take that.

Dr Maria Christodoulou: 1:36:32

Thank you for making the time. Thank you for sharing your story. I look forward to watching and witnessing what unfolds in your future. Every now and again, I want you to put your hand on your heart and remember that it's still beating and that it's got a lot of passion. I'm Dr Maria Christodoulou and you've been listening to the Awakening Doctor podcast. If you enjoyed this conversation, please share it with your friends. Follow Awakening Doctor on Instagram, Facebook and Spotify, and go to Apple Podcasts to subscribe, rate and give us a good review. Thank you so much for listening.