THE insistence of a group of teenage girls with cystic fibrosis helped put Susan Sawyer’s career on a path from a nascent career in paediatric respiratory medicine to a world-leading expert on adolescent health.
These days, Professor Sawyer is the Chair of Adolescent Health at the University of Melbourne, and Director of the Royal Children’s Hospital Centre for Adolescent Health. She is President of the International Association for Adolescent Health, and has advised various UN agencies including the World Health Organization, UNICEF, UNFPA, and the World Bank.
“I think of careers as something that we define in retrospect,” Professor Sawyer tells the MJA.
“We look back and can see the career pathway that we went along, but at the time, sometimes, it can be very undifferentiated.
“My default position was always to say yes to things.”
After passing her paediatric exams then-Dr Sawyer “tossed a coin” to choose between paediatric gastroenterology and paediatric respiratory medicine. Respiratory won, and while doing rounds at the RCH, an encounter with the aforementioned teenagers changed her outlook.
“Having done previous rotations on the ward, this group of girls with cystic fibrosis knew me as one of the very few female English speaking trainees, which no doubt gave them the confidence to sit me down and ask a heap of questions about sexual and reproductive health - about fertility, contraception, and pregnancy,” says Professor Sawyer.
“These were really sensible questions, but I had never thought of them as questions, let alone had the answers.”
A trip to the library proved fruitless – “there was zip” – and her seniors were no help.
“My bosses also didn’t have the answers, and disappointingly, failed to appreciate that they were really important questions.”
The median age of death for people with cystic fibrosis had rapidly moved from about 15 years of age while Professor Sawyer was training, to the point where young people were then expected to survive through their adolescence.
“And suddenly all these questions the teenage girls were asking me became much more important. That really led to my interest in adolescent health.”
The COVID-19 pandemic, Professor Sawyer says, has been “really tough” on her cohort of patients.
“The indirect effects are being powerfully experienced by children and young people – their whole lives have been up-ended,” she says.
“Study after study is now demonstrating huge impacts on emotional health and well-being, with dramatic increases in depression, anxiety, eating disorders.
“Think of the 0 to 24-year-old age span – the developmental years – and how critical these transitions are, whether it's the transition between primary school and secondary school or transitions through secondary school.
“We spend a very few years in school. Yet our experiences in adolescence - in terms of how they shape our sense of self and our confidence – are what enable us to step forward into young adulthood, either with a level of confidence about our capabilities or feeling that we're just not adding up in some way.
“Interruptions to these years and the accompanying educational and vocational transitions beyond school, are critical.”
As someone “on the cusp of being an introvert”, Professor Sawyer can see the appeal of lockdowns and isolation, to a degree.
“I know that a number of my patients who have major anxiety syndromes or are on the autistic spectrum disorder have appreciated being away from the rigours of a secondary school environment,” she says.
“But, you know, while the world might seem a tough place, learning to negotiate the social world of the communities in which we live our lives is something that comes through engagement with schooling.”
Looking back on her younger years, particularly as a medical student, Professor Sawyer has no regrets, except perhaps one.
“The number of wasted hours I spent trying to work out what was I going to do in medicine! I was somehow waiting for some godlike character to come down with a magical fairy wand and say, ‘Susan, you're going to be a neurosurgeon’, or ‘Susan, your path is in pediatrics’,” she says.
“I realise in retrospect that I probably would have been very happy in any number of different careers. There is no single right career that I think we should magically think is the only one for us.
“I would be reassuring medical students that there are lots and lots of different careers at which the same person could wonderfully excel.
“Embrace taking time out to do different things, even if it's just a couple of days. You don't have to do a whole rotation of something – spend a day tracking someone in a career that you know nothing about. People would be honoured.
“When I was training, global adolescent health didn’t exist, we carved out this field. So don’t narrowly define yourselves in terms of future careers.”
* Professor Sawyer is a member of the MJA's Editorial Advisory Group.
- Cate Swannell