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Wilkommen to my blog - if you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. Comments and thoughts welcomed!

Tuesday, 15 April 2014

Being a doctor being a patient.

 A mix of emotions from top left clockwise - how I feel now,
how I felt a lot of my night shifts, how I felt when occasionally
panicking, what I spent the first half an hour after
my shift feeling like i.e. ahhhhh!
Apart from slightly losing my marbles circa 6am, and perhaps again at 9.15am, I have survived the first two weeks of my new job as the medical SHO which have thus far consisted of night shifts and nothing else.  Finishing yesterday morning was another great wave of half-relief-half-nausea, relieved somewhat by having a cuppa with some of my old lab chums.  Remember how I said clinical medicine seemed the comfortable norm?  Hmmm... rose tinted glasses, much!  Although I must say I kind of enjoyed it (Kind of, in the sense that it is tough to say your enjoyment is complete when you are at work over an entire sunny weekend, sleeping during the day and up all night). 
The last fortnight has been completely insane.  Apart from a bunch of night shifts, I've also done a day-and-a-half of exams, written an assessed essay, work on a conference agenda, done prescribing-related teaching for all the house officers and then an afternoon of simulation teaching.  I managed to catch up with some of my favourite university people in between these various studious things, before you think I'm a total social loser.  

But actually the weirdest thing of the last fortnight is that I had a flavour of being a patient.  

I've had a couple of health worries on my mind and the first of these I found out about via a poorly timed (by me) phone call to my GP surgery.  It was really quite unfortunate and perhaps my fault that I ended up finding out over the phone that I needed to have some more tests done.  I wondered whether it was more worrying because being a doctor means knowing a bit too much about the worst case scenario.  I guess I was also a bit distressed because I'd like to think I am quite particular about the when/where/who/why of any news I am dishing out to patients, and realised that because the news breaker probably didn't realise they were 'breaking news' I wasn't given that sort of consideration.  I then found out I had a second medical issue that needed investigation, and within a fortnight I found myself with two hospital referrals and a whole bunch of worry.  

Any social recluse-ing I've been guilty of recently has been a genuine apathy symptom of compartmentalising stress.  I'm quite an open person, and it's strange having things that you don't feel able to share with friends and family.  I felt quite irrational as I knew that it was all cautionary really, but also perhaps felt that by vocalising my worries, it made it all more real.  Even sitting in the waiting room is a bizarre and lonely experience.  It's a bit like being in a massive herd of cattle, waiting to be picked out and painted.  Once you're in the room, it turns out the 'so what do you do for a job' question is pretty much numero uno, so there was no hiding my professional identity.  It's pretty weird going to see a doctor in the place that you also work.  I accepted that I might know them - in the event I was quite glad I didn't as it made it easier to slot into the patient role, although I must say everyone I encountered was excellent without exception.  

Anyway, as expected everything was absolutely fine and dandy with nothing further needed, and I could worry about my night shifts in peace.  But there's nothing like experiencing what it's like on the other side before being on call for a whole weekend to remind you that every patient is a human being with worries, fears and a life.  

Excepting the odd panic moments, it was these thoughts that kept a smile broadly stuck to my face the whole weekend, hopefully staying cheerful and providing a chuckle or two as I dashed across seven floors of a hospital.  

Friday, 4 April 2014

'Hi, it's the medical SHO on nights...?'

I feel a strange combination of hungover, awake-and-wired and fretful panic.

It is this joyous phenomenon I love to hate - the 'I've just finished nights' effect.

I've now been awake since 7pm yesterday evening (it's now 4pm), having done a twelve-hour night shift in between.  I've tried to nap, but every time I close my eyes I have a nauseating wave of 'oh... wait... did I do that right'?  Here's a night in the life of a medical SHO.

9.30-10.30pm-ish - Arrive at work and enjoy a splatter of bleeps, phone-calls and face-to-face meetings with people I've never met wanting to hand stuff over.  I cover a myriad of random medical specialties on nights - geriatrics, gastroenterology, cardiology and a smattering of new admissions (they're in many ways the most fun - because they have a tendency to be moved in the middle of the night, leading to another fun game - 'hunt the patient').  Some people give me things to check (blood tests, x-rays etc), others tell me about patients they want me to review during the night, and some do the triple whammy of giving me a bleep too.  By the time handover is done, I've got three bleeps to receive calls on, and a couple of pages of things to do.  I try to remember who has given me what and which patient belongs to which teams - after all, in twelve hours, I have to hand them all back.
I am not a person... I am a bleeping machine...

10.30-00.30 - the worst time, I find.  This is usually when any immediately sick patients tend to be discovered, as well as drips ceasing to function (thus needing to be replaced) and it's usually when you'd be keen to cast an eye over the sick patients you were asked to review.  If only you could be in three places at once!

00.30 - 04.00 - this is when the night shows itself i.e. if it's going to be a complete disaster or not.  By 2am, usually all the immediately unwell people are dealt with, and you have made a plan that will last for the next few hours.  Hopefully.  You return to the list and it might be the first chance you've had to check those blood tests or scans you've been asked to chase.  Every finger is crossed that they are normal, or abnormal in a way that is manageable overnight e.g. prescribe some fluids or a medication that will stabilise things.  What is less ideal is when they are abnormal in a way that requires intervention overnight - that is ultimately what I am there for, but sticking needles into people to do repeat blood tests at 3am is not a speedy way to make friends.  Another surprise entity is when you are hunting down tests results that never seem to appear - cue some detective work to sniff them out!

04.00-06.00 - if you're in luck, this is your chance to grab a quick sandwich and drink of water.  I've found that carrying a bottle of water around with you is absolutely essential, and certainly an error I made in my earlier night shifts - it helps to keep your head clear, and a loo-break is also reassuring from the point of view of knowing your kidneys are still working.  One of my night shifts I even had time to go and help the take (i.e. new patients coming into hospital) and clerk someone in.  The key for this time is to get everything done by 06.00 i.e. any bloods you need to do for the day teams, any patients you wanted to review.  Because what happens at 06.00?  Nursing rounds.  And that's when the next round of unwell patients/failing drips etc tend to be discovered, ready to keep you busy until handover.

06.00 - 09.00 - it's hard to keep perspective about the fact that your shift is nearly over.  In fact, that's not as frustrating as being so UNBELIEVABLY close to normal working hours that if you actually want to speak to a specialty or get something done urgently, it doesn't require an inordinate amount of persuasion.  Everything is starting to get a bit hazy as fatigue starts to set in.  I sit down quietly for a rest for a cumulative time of about 5-10 minutes in the average night shift.  Keeping your list attached to your person and up-dated is the only way you're going to make sure nothing gets missed and all the jobs get done.

09.00-10.00 - hurrah!  Handover time! Or... time to play 'hunt the doctor team'.  Everything you received (bleeps, patients, etc) must be handed back; the question is, who is who?  You walk up to a team of doctors, looking quizzically around their little circle - 'which team is this?' you enquire timidly.  Everyone looks slightly aghast, as if it is both obvious and scandalous that you didn't know that this was Dr so-and-so's team.  You are relieved when you recognise a few faces and can at least get some direction.  Sometimes it is easier just to bleep the people directly or just go to the ward to hand people over.  It's actually quite scary handing patients back - ultimately, in the cold dark of night you have to make the best decision you can with the information you have at the time. You didn't hear that Mrs Smith always has that funny turn at 2am and that it's perfectly normal.  You weren't aware of exactly what number of crackles on the lungs are normal for Mr Bloggs, because until that night shift, you've never listened to his chest before.  You weren't there for that discussion about Mrs Jones about just how aggressive to be with the intravenous fluids.  Obviously you look for trends in patient notes, but you have to have a bit of confidence in your thought processes, obviously with a healthy dollop of humility.

Starting a new job on night shifts was never going to be easy, but it is definitely one of those times where I think - 'next time I'm NOT on nights and go to greet the night doctor, I'm going to make an extra effort to be nice, sympathetic and helpful'.  I do have a propensity to be a worry wart about these things, but all doctors, myself included, have made mistakes.  It's really not a 'what if', and rather a 'when'.  I hope I did a good job, and I forgave myself for calling the registrar for advice on the basis that doing your first night shifts in a year after four months away from clinical medicine was probably not the time to attempt heroics.  Equally, I hope I start to build a little confidence, as I really think that's half the battle.

Exams next week, and then more nights next weekend.  Bring. It. On.  

Saturday, 29 March 2014

25 and still revising

I am cross.

I never get cross.

But I am 25 years old.  It is a beautiful Spring day outside.  Where am I, and what am I doing? I am revising.  Again.  This concept has raised a bit of confusion for various people, quite understandably, and is often backed up by the question; 'so, when do you actually qualify?'.  Mate, I'm qualified.  It says 'Doctor' on my badge.  That doesn't mean it's over.

But apart from just getting these post-grad exams out of the way, I've timed it to hopefully aid my transition back into clinical medicine after four glorious months in the lab.  Monday and Tuesday will be the last with my beloved spheroids, and then, boom, Wednesday I'm back to hospital with a bump on night shifts.  Nothing like easing back in gently, is there?

It's been a funny couple of weeks of not being very well (I'll save that for another post) which has also made all motivation for revision go out of the window.  It's been a potent reminder that while I bulldoze my way through work and study and the rest, I haven't really left a lot of slack in the system for when the wheels fall off.  Henceforth, I shall try to embrace the terror of night shifts, give this two-day exam-a-thon a high five (and hope it high five-s back) and then leave some space for some serious 'me' time.

After all, all that's really at stake for this exam is pride and £500.  

Saturday, 15 March 2014

The trouble with money is...

We British find it very difficult to talk about money.  Those who have lots are content enough to go on spending it.  Those who have little want more.  Those who have some feel bad about it.

This week the government announced a 1% pay rise for public sector workers.  Of course, with inflation, this is actually a pay cut.  EvidenceUK cite a nearly £5000 pay cut in real terms for junior doctors since the coalition came to power, and Unison claims that most NHS staff are 10% worse off over the same time course.  Throw into that the pensions reforms and other joyous interventions like the loss of free accommodation for junior doctors, and you've got yourself one disgruntled workforce.

I think it's quite difficult for junior doctors like myself to know how they feel about this.  Without wanting to seem like I'm polishing my halo, I am not in this for the money.  Frankly, there are easier ways to do that, I would imagine.  You accept the long hours.  You expect to do free overtime.  You forgive getting your rota so late that you can't plan beyond the next fortnight.  You see quality improvement, auditing and the rest as part of the job, even if that means lots of work beyond the 9-5. That's the deal, right?

I'm also obviously very conscious that I'm lucky to have a job at all.  At the end of university I went straight into a hospital job, which will be a two-year post lasting until this August.  After six years at university, where most of my non-medical peers are used to knowing how much is a 'normal' salary, it's simply quite exciting to have a salary at all.  I have funding for a research year next year, but I'm fairly sure I could have found a job of some sort or other if I'd been stuck.  I talk to my colleagues from overseas in my lab, and think how lucky we actually are with our working hours.  Ok, so I have to do 12 days in a row, or 13-hour night shifts for a week, or whatever.  But I don't have to do 24-hour on calls as a junior, like in the 'bad-old-days' (although I know some of my colleagues elsewhere in the UK do).

But some people counter this with - um, yes, six years at university.  That was a long time to pay for everything on borrowed pennies, and that was before £9000 tuition fees.  My much-loved but haggard old car (called Poppy, for anyone who's interested) that I bought to get me to my placements from third year onwards was a financial drain in it(her)self.  In this academic year I will have spent £1000 on postgrad exams alone.  In my first job as a doctor, I had my first near-miss accident in my car driving home from a night shift, because my job was a 45 minute drive away from the city (where all my other jobs were subsequent to this), and to get hospital accommodation would have essentially meant paying rent twice.

But frankly, so what?  Lots of people have to work long hours, pay for exams, commute, move house, study for a long time, etc etc etc.  I grew up in a family of teachers.  I know what all of that looks like.  And I love the NHS! Watch this if you want a reminder of what we stand to lose without free, accessible healthcare.

How do you balance all of these?  I really don't know.  I certainly don't feel I'm 'owed' something by society or the government just because I studied for a really long time.  I don't feel I should be immune to the cuts necessary in times of financial austerity.  But equally I feel like an easy target.

I expect a barrage of everything from 'how can you not stand up for your fellow doctors' to 'how dare you expect to be paid so much in a caring profession'.  I am very much still counting the pennies.  And contrary to popular belief, I still hunt down a good bargain at Tescos (other supermarkets are available).  But when it comes to money, it's all just a bit awkward, isn't it?  

Friday, 28 February 2014

Scientific frustrations (and putting it into perspective)

First of all - big love to you, reader, who is taking the time to read my blog.  Over 6000 reads - I never expected that!

It is quarter past 7 on a Friday and I am just leaving work.  I'm still in the lab for another month, and have so much to do.

Almost every day something happens where I feel I have regressed to the amateur scientist I know I really am, and I crave my clinical life a little - a life I think I know and am comfortable with.  In the lab, I am the human being equivalent of a toddler.  Occasionally, I manage to walk, even picking up some speed from time to time.  Then my feet forget where they are and I fall on my bum again. Often it's my own pride and frustration at not wanting to ask twenty thousand ever-more-ridiculous questions that gets me there. And of course it's never major stuff.  But it's enough to land me a deep sigh, a very long day and sometimes a return to square one.  They say 'that's science' but dang, it's tough to bear.  Kids, research is not glamorous.  It makes what you (think you) know that bit more appealing - in this case, being a clinical doctor.
But a friend reminded me of the world I will be re-entering in a month's time, and how I need to ditch the rose tinted glasses about clinical medicine.  Today the biggest mistake I made was nearly putting the wrong reagent into a 96-well plate.  In contrast, I got a message from a friend saying they really needed to vent about something that happened on their night shifts this week.  Now, I have no idea what has happened, but it reminded me of what is at stake when I am on clinical duty, and the number of times I have left a medical shift with a sort of manic panic in my belly.  I am a very junior doctor, and I often have uncertainties, as all doctors do, about the best course of action.  It is easy to forget about this side of clinical practice when you've been away from it for a couple of months.  

Sometimes I think back to when I was at school, when some people in my GCSE classes would throw all their toys out of the pram when they couldn't do something.  And here I am, aged 25 with both a medical degree and science degree in my hand, still floundering and getting stuck!  But that's kind of why I love it - it stops you getting complacent, and also keeps that feeling and familiarity of 'not knowing' fresh in your mind when you encounter others on their way up the ladder.  I think it's crucial for a doctor to be comfortable with knowing what they don't know, and be willing to ask for help.  Pride is probably a doctor's greatest downfall.  

So I am off home to be a listening ear to my friend, and learn to accept that it's OK to be OK at something while you've got the learner plates on.  And on a positive note, I managed to sort out my dearth of cells pre-spheroid creation, and work out why the PCR machine wasn't working.  So perhaps I am able to work some things out for myself after all.  

Wednesday, 19 February 2014

It's nice to be important (but it's far more important to be nice)

The fire is crackling, I'm tucked under a woollen blanket and all is well!

Because I had my interview. And I did my presentation.  But the thing that has made this week AWESOME is how people who are quite important are also incredibly nice.

I once had the misfortune of working with some peers who were wholly and solely driven by getting ahead, and today was further evidence of why this is so misguided.  One of the professors who I have long held in very high esteem came to the presentation I did today. Apart from being incredibly nice about my mid-presentation epic technology fail, and asking detailed but not scary questions about my talk, he then stayed behind afterwards to discuss my interview and various other things.  This is someone I didn't know at all before I moved here 18 months ago, and is directly responsible for how I came to work in the incredible lab team I work in now.  And I am a nobody.  He is definitely a somebody.  What a complete legend.

I hope I can become someone as awesome as that when I grow up, and just be as good a person as I can be in the mean time.

(The interview, incidentally, was fine. I have no idea whether it was good, or bad, or what.  I had a great time though, and it was a great experience - nothing lost! Further evidence that you should just go for things.)

Sunday, 16 February 2014

Taking chances

Perhaps it's a bit childish but the (very little) jewellery I wear is my reminder that taking chances is what life is all about. I only wear three things without interruption - my ear cuff (to remind me that I AM adventurous, even when I worry about secretly being quite boring - I had the piercing done after a particularly horrific set of uni exams), my silver thumb ring (to remind me of my adventures - the ring itself was about £4 which I haggled for in Kuala Lumpur) and my celtic silver middle finger ring (to remind me of why we must have adventures - I bought it in Edinburgh after finishing the Team Triathlon we did for my friends who died in the avalanche). My new glasses are a separate story photographed below - geek at heart, and ready to embrace it. 

I have an interview tomorrow, you see! Maybe that seems like quite an underwhelming 'chance' but given that it's for my year out across the pond, the stakes are reasonably high. Last week I was off skiing, throwing myself down snowy slopes in the Alps and taking only a few (if painful) tumbles.  Perhaps that was more of a chance taken - every time I heard an avalanche cannon go off, it was a painful reminder. I am not ashamed to say a couple of tears were shed. But it was wonderful to be in the clean air, with (interchangeably) the sun or snow on my back.  Since the start of 2014, I have seen friends await the arrival of a baby, two wonderful people get married, nearly got blown off the top of a mountain (billed as a hill - the weather made it seem otherwise), swam in an ice-cold lake and tinkered with various chemicals in a lab.  In the next few weeks there are other chances, adventures and escapades.  You can make a lot of things into chances for something awesome. 

So maybe I shouldn't worry so much about the interview. In my last interview some 2 years ago, I rocked up in a smart but nonetheless blue-with-wooden-beads dress that rattled when I walked. I'm pretty sure I was the only one there without a black suit on, girls included. I chatted with a friend until the interview started and made friends to share the taxi back to the station with. And hey, I got the job. So here's to embracing the unknown (with my trusty trio of cheap jewellery, of course!).