Razan Ibrahim Alhoqail is an Assistant Consultant and Teaching Assistant at King Saud University, Saudi Arabia. She is currently an International Clinical Fellow at Guy’s and St Thomas’ Hospital in London.
It’s interesting how certain moments in life push us toward growth long before we realize it. For me, this journey began in the most ordinary way: opening my clinic schedule each morning. I would scroll through my list of patients, and the moment I spotted more than one person above the age of 70, I felt a familiar mix of anticipation and challenge. Despite my deep affection and special connection with older adults, I often found myself struggling, especially with complex medication decisions, dementia assessments, and the delicate conversations that come with them.
There were days when I felt anxious before starting a memory assessment, second-guessing whether initiating a medication was truly the right step. Even with all the studying I had done, I would revisit side effects, weigh risks, and wonder whether my choice would genuinely improve their lives. My limited exposure to these cases made the hesitation even stronger. Yet these exact moments quietly shaped my passion for geriatric medicine and helped me realize how deeply I wanted to support these patients with a more thoughtful, patient-centred approach.
Leaving Saudi Arabia and the university that raised me both personally and professionally was one of the hardest decisions I’ve ever made. It was the place that shaped me as an undergraduate, continued to guide me as a postgraduate, and where I proudly belonged as a faculty member. Stepping away from that safe, familiar story felt like walking into a new and uncertain chapter. I had spent years in an environment I deeply loved, surrounded by mentors, students, and colleagues who made learning and teaching truly fulfilling. Walking away from all of that was painful, and fear was loud and persistent. But so was the belief that growth often requires stepping into discomfort, trusting that the journey ahead will shape me in new ways.
The first month was a whirlwind, emotionally and socially intense. I began with a series of neck-of-femur fracture cases, and they taught me more than I expected. I learned how each fracture is not just an injury but a window into a patient’s overall health, frailty, and future risk. Working with a multidisciplinary team, including physiotherapists, occupational therapists, and social workers, showed me how powerful teamwork can be in ensuring a safe and well-supported discharge.
One moment that stayed with me happened during rounds with my supervisor. She reviewed a patient’s long list of medications, paused, and said, “Sometimes, to truly help your patient, you must be brave.” She then thoughtfully discontinued several unnecessary medicines. Her clarity, courage, and unwavering patient-first perspective still echo in my mind.
I was also deeply inspired by one of the clinical nurse specialists. Watching her counsel patients, especially during advance care planning, felt like witnessing compassion in its purest form. She spoke with honesty, empathy, and warmth, as if she were speaking to a close family member. Her leadership and the care she invested in every detail left an impression on me.
My experience in the Perioperative Medicine for Older People Undergoing Surgery (POPS) clinic opened another door of understanding. At first, I questioned why a pre-operative assessment was even necessary. If a patient and surgeon were ready for surgery, and the anaesthetist would see them anyway, why add another step? What could we possibly add?
But during my very first clinic, the purpose became beautifully clear.
Every consultation began with two simple, profound questions:
“What do you really want?”
“Why do you want to undergo this procedure?”
Those questions changed everything. They shifted the focus from the medical problem to the person: their goals, fears, and values. I began to see how frailty can shape outcomes far more than the diagnosis itself. I learned how essential it is to understand the whole patient before making major decisions.
This experience touched me deeply because it reminded me of my closest family member. She underwent surgery without a pre-operative assessment. From a surgical perspective, she was “cured,” yet her functional, cognitive, and emotional recovery was never considered. These aspects, which were not issues before surgery, eventually became complications that perhaps could have been anticipated with the thoughtful approach I witnessed in POPS.
These months taught me that in geriatric medicine, every careful decision, every honest conversation, and every moment of empathy can change the course of someone’s life, reshaping a patient’s future and independence. Sometimes, in the rhythm of daily routine, it’s easy to forget just how profoundly our actions can affect others. These lessons will stay with me, shaping not only the doctor I am becoming but also the lives I hope to touch and knowing this continues to guide me every single day.
