I can clearly remember forming the thought, on my first clinical attachment as a medical student, that I’d never know enough to be a medical registrar. These awesome figures, holding everything in the hospital together, seemed simply beyond my reach. During the same surgical attachment, the existential crisis I briefly thought I was experiencing in the student accommodation, as I read Sartre’s Nausea, turned out to be the consequence of a late-night kebab I’d grabbed from a van outside Leytonstone station. I also thought it would be a good idea to get a few extra minutes sleep after a heavy night out by skipping breakfast, and nearly fainted while watching a vasectomy reversal. The anaesthetist noticed that I had gone a bit grey and sweaty and sent me off to get some tea and biscuits before I toppled into the operation. Somehow, I made it, though with decades passed I’ve gone full circle and now probably no longer know enough to be the Med Reg.

With the resumption of non-essential retail, and in an attempt to understand my children’s enthusiasm, I’ve acquired some Taylor Swift albums, hence the title quote. Many of the songs are written in a key of anticipatory nostalgia—problems of life and love are acknowledged and shared. There’s a sense that difficulties will be lived through and looked back on when older and wiser. Swift has also, in Best Day, written one of most appreciative songs about parenting ever. 

With more of my life now behind me than ahead, anticipatory nostalgia gives way to recollection. It’s too late to take my own advice, but for anyone starting out in medicine I’d say that I regret the injustices I let pass much more than the ones I stood up against. It’s good to follow the “HALT” advice from Alcoholics Anonymous to be extra careful when you’re hungry, angry, lonely, and tired. It’s better still to challenge, where you can, the structures that put you in those states, both within medicine and in broader society. The system isn’t supposed to be that way—compassion and respect are fixtures in mission statements. Take it at its word, find allies—older people want it to be better too—and help it to fix itself.

Also, try not to skip breakfast.

Nicholas S Hopkinson, reader in respiratory medicine, National Heart and Lung Institute, Imperial College, London, medical director of the British Lung Foundation and Chair of ASH. @COPDdoc

Competing interests: none declared.