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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. I'm currently a doctor/research trainee in the UK after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Sunday, 27 December 2015

#ImInWorkJeremy Junior Doctor Christmas Special

Working late but looking great! 
I think it would be hard to find someone more excited and happier this festive season. What a year 2015 has been!  I can hardly believe this time last year I was calling America 'home'.  A Masters thesis was written... Gary the brain cancer cell was born... Many, many adventures were had - so many adventures! And halfway through the year I returned to my little island, and spent a great deal of time feeling like a resident alien on home soil.  But this extra-terrestrial feels a lot like she's come home, whatever that means, even with a bunch of Christmas night shifts.

Sometimes I just can't believe how lucky I am to be a doctor.  No matter how much I might miss the relative freedom of research (in terms of planning your own time - not necessarily fewer hours!), the last few weeks in particular have been an absolute joy.  And that's despite a solid dollop of challenging professional situations - flying solo as ward doctor for a week and a half, a number of difficult deaths, countless complicated medical situations to tease apart, diagnose and manage, many 'I don't think your relative is going to make it' discussions, several complex family set-ups to navigate, new procedures to learn, and some really sick people during my Christmas night shifts.  Of course I've not been alone, working with other junior doctors (could you ever meet a more committed, fun, all-round awesome bunch of people?) and nurses, and of course the awesome consultants for whom I've been working - no matter how miserable the situations we've had on the ward, we've found a way to laugh ourselves silly everyday and I'm learning an enormous amount. Surely the wonderfulness of working in a hospital is exemplified at Christmas time - no-one is grumbling when they're leaving late on Christmas eve, and no-one is whining when they arrive for their 13 hour shift on Christmas morning.  What a special place to work!

Christmas, honest!
A key part of this is clearly balancing your life outside of work too, and on that score I *think* I'm finally getting the balance right.  From art galleries to string quartets, climbing walls to more than a few mulled wines, I am so lucky to have friends old and new with whom to share these adventures.  I started the year a scientist in America, and I finish it a doctor in the UK - and the life that has embellished that transition has been a rollercoaster of a ride.

I am celebrating Christmas and New Years with a stethoscope around my neck, working my way through the holiday season with many other junior doctors, consultants, nurses, physiotherapists, occupational therapists, radiographers and many other hospital workers.  In the nicest possible way, I hope I don't see you - instead, I hope you're sharing some good vibes with the people you love.  Merry Christmas and a Happy Hogmanay! 

Friday, 18 December 2015

Til Death Do Us Part

I see bodies at the very edge of life.  

I see bodies when the hearts within them are barely able to send the blood they pump to the tips of fingers and toes.  I see bodies whose lungs are squashed, scrunched and crispy from a lifetime of whatever air and debris has reached and settled within their alveolar spaces.  I see bodies riddled with cancers that are known, and I’m the one who’s broken the news, and those that will never be known about because the owner of the body is happier not knowing.  I see bodies full of infection, which in older people often means an associated delirium which renders the recipient a different, distressed version of their known self.  I see bodies of patients who cannot get out of bed without people or equipment to help and look into their eyes as they beg me to let them go home.   I see bodies that have long since lost the memory of who they are, who I am and what this world is that they inhabit.   And, finally, I see bodies where life has gone completely and their last medical rite is for me to confirm that this is so. 

Of course, these are not bodies.  These are people, wonderful human beings, with all the laughs, frustrations, tears, joy, sadness and adventures that life has thrown at them.  Most of my patients are around 90 years old.  If I have a patient in their 70s, that’s young.  I often remind my parents of this; retiring in your 60s, you still have at least 50% of your life to do again.  I may have romantic notions of adventuring and then growing old in a house by the sea, reading, painting, playing my violin, writing, playing games and drinking tea, all surrounded by family and friends until one day I simply fall asleep, never to wake up.  But you don’t know what your old age is going to look like.  To look after older people is to consider your own life and death, because you are experiencing that of others on a daily basis.  

So when I read that I’m supposed to be having an epiphany about giving ‘individual’ end of life care, I can only assure the rest of the world that this is no epiphany at all to any junior doctor.  Who could love a job like mine, where so much of it requires looking death in the face, were it not for the care of the individual?  If I am lucky I will be able to do discuss a patient's diagnosis with them and plan their final weeks, days or hours as they would wish.  But I, and they, am not always so fortunate.  I recently was called to see a patient who was clearly going to die within minutes of my arrival - as the on-call doctor, we were meeting for the first time.  That did indeed require a 'snap decision' that meant I could give this patient the dignified death they deserved.  It meant I could look the relatives in the eye and say truthfully that their loved one had died in peace and without pain.  It meant that this patient had two of us holding their hands when death parted our worlds.  I know the conversations I had with the family during and after that time will never be forgotten - strangers before, I am now and forever part of that life.  

People often think I’m a bit weird for wanting to be an Oncologist because of the close professional proximity I will have to death.  This belies the fact I already look death in the face in some capacity on at least a weekly, if not daily, basis.  Each conversation and experience is different because each patient is different - that’s what being a doctor requires in life as well as in death.  Perhaps I should be relieved that there is a bit of government guidance that tells me to do what my colleagues and I are already doing?  Instead I feel a little bit of my heart sink; a disappointment that patients from my past might think that I didn't see them as individuals because only now am I being explicitly told to do so. 

Don't tell me I don't know what death looks like.  I see bodies at the very edge of life and see the individual underneath.  I'm not sure my fellow junior doctors and I were ever in any doubt about the importance of that.

Tuesday, 1 December 2015

The Second Thanksgiving

Saluting an amazing life :)
‘I’m not afraid.  I’ve lived a wonderful, happy life.  I’ve made a few mistakes along the way, done some things I’m not proud of.  But I can’t complain and I wouldn’t change a thing.  All I want is for my family to be ok, to be happy.  When it’s my time, I’m ready’.  

Thankful, much? One of my patients recently had us in pieces every ward round, reminding us how a life should be lived and appreciated.

Homemade pie, y'all?
I read back my post from this time last year (The First Thanksgiving) - gosh blimey, how time has flown! And I'm bloody exhausted (hence the brevity of this, but aware that my little blog is being woefully neglected) - 12 days in a row, including a 7 day stint halfway through where I did over 80 hours in the hospital, and I look forward to a rather disgusting slog of days and nights (we're already discussing Christmas jumpers and head-gear...) before I hit the relative finish line of Christmas.  And then I'm back for New Years!  Party's at the hospital, chaps and chapesses!

I wrote a lengthier scribble but decided for once in my life to be concise, mainly because every bit of my thanksgiving chatter was about the same thing - people.  Friends old and new, family, my patients, the patients' relatives who expressed their support to junior doctors this week, my non-junior doctor colleagues who did the same, the man laughing at me singing in my car en route to work, the hospital coffee shop chap who gifts me free coffee - oh so many human moments big and small - they've all made me want to give life the massive air punch it deserves on a daily basis. And we haven't even talked about OpenCon2015 yet!

High five, people.  You make me glow! And for that I am thankful :)  

Friday, 16 October 2015

The Art of Procrastination

There is a myth I am always keen to dispel about doctors and academics.  

Yes, we work hard.  But my, are we also experts in the Art of Procrastination.  

If there were an award for procrastination, I surely would be up there as a worthy candidate.  There is virtually no limit to where my mind can wander when I have things to do.  Today alone I read about Mendlessohn, caught up on world news from a variety of different newspaper sources, wrote a couple of cards (including an overdue one to Granny Deutschland  *hangs head in shame*), explored the 'related artists' relevant to the composer I was listening to on Spotify and hit refresh on my emails about 30 times.  
Surely a wonderful place to procrastinate?
BUT.  I also rearranged a spreadsheet and finished a paper I've had on my 'to do' list for weeks - hurrah!  I procrastinated my heart out in the USA - plotting my travels, writing long emails to family/friends in between incubations, scribbling in my journal, reading good things, reading utter crap, listening to new music, listening to music I haven't listened to since I was a teenager.  This had other side effects. I was extremely prompt with answering emails.  I was more on the ball with my family and friends' lives.  I was infinitely less stressed.  I allowed myself time to feel happy or sad or crazy or sloth-like.  I came to really appreciate the value of what some might consider *wasting time*.  No-one EVER believes me when I talk about my procrastinating tendencies, but I promise that it's true.  I am Queen of Ruminations, Princess of Thinking and Great Dame of Ponderances.  

I've just come off a pretty intense seven week spell at work and I feel like I've become a terrible friend, rubbish daughter/sister/auntie, unreliable academic correspondent (it sounds like such a lame excuse when you write 'I'm on call' for the millionth time) and frankly boring in the process, despite all best attempts to sustain musical, cultural and generally human activities during my free time.  Is my lack of procrastination time to blame?

Apparently procrastination is an entire topic of interest for psychology scholars, and I found this article really tickled my guilt around day dreaming.  Authors write of choosing current enjoyment over work - prioritising pleasure now over pleasure in the future, or 'failing to identify fully with your future self'.  Hmm.  I'm not sure I agree.  Of course one needs to find a way to stay on track - I'd never get anything done if my sole activity was procrastination - but by allowing some 'air time' between intense academic thoughts, perhaps we stay more whole as people. Some of my best science ideas came over a procrastination chat with friends, or a musing had whilst reading a random editorial.   Ultimately, procrastinating hasn't really done me any harm; if anything, I feel the opposite.  In contrast, clinical medicine offers little space for procrastination.  There is barely time for emotions, let alone reading or exploring (well, certainly not during working hours).  I worry that makes us forget that getting lost in your feelings and thoughts is important and 'allowed'.  I guess our clinical moments of procrastination are treasured in between seeing patients and during precious tea/food breaks.  I've just come off another bunch of nights and it is amazing how you spend 13 hours with people that start off as colleagues, and by the end of it are at the very least acquaintances and more often than not friends.  But I'm not sure that's really procrastinating - perhaps just staying sane and injecting some much needed giggling into our nocturnal existence!

Procrastinating during my post-nights zero hours/annual leave is proving most fruitful.  I'm uncertain, I'm uncentred, I'm still lost, and I'm still working out how this eye-opened doctor is supposed to fit as a brick in the wall of the NHS.  But strangely, I'm taking the slowness of my reacclimatisation to the UK and life as a doctor to be a positive thing - life has generally taught me that the things that are the hardest are generally the things that offer the greatest reward.  So perhaps I'm 'failing to identify fully with my future self' with full and unashamed procrastination through a variety of media - perhaps that's because I'm still working out who she is - 'my future self'!

Saturday, 26 September 2015

The Truth about being a Junior Doctor

I haven't really said very much about the Junior Doctors' Contract furore that is currently dominating every thread of social media I participate in.

You know why? Ironically, because I'm either at work, or exhausted from being at work.

I have always maintained that doctors are not special cases when it comes to the argument of 'we work hard, we deserve to be rewarded for that'.  I also hate whining or all-round negative vibes.  So instead I will stick with my realities and let you decide.

I am twenty seven years old.  I qualified as a doctor when I was twenty four (pretty much on the dot!).  In that time I have been bled on, urinated on, nearly hit by confused patients, shouted at by other stressed colleagues, performed CPR on dozens of chests, stuck needles in hundreds of arms, tried to make life-saving decisions at every hour of the day and night, kept patients comfortable in their final days and hours, been present at or confirmed more deaths than I care to think of, and looked into the eyes of the confused, weary, sick, dying and hurting and tried to find the right words and actions to ease their pain.  I have missed weddings, birthdays and Christmas.  I have cried out of pure tiredness, in frustration and in absorbed grief from the clinical situation in front of me. I have done quality improvement projects, audits, presentations, research papers, teaching (bedside, lectures, tutorials, ward rounds... you name it), exams (yes, postgraduate exams continue) and further training courses around all of that, often at my own expense both financially and time-wise.  A Consultant asked me recently what other work activities I was doing outside my clinical job - these extra things are not for 'bonus points' - they are seen as essential and the norm.

Time away from this has made me see that that's all not very normal, and I think the reason junior doctors are so angry about the new Junior Doctors' Contract is the same reason why teachers get so frustrated by the latest change in their curricula or contracts.  I heavily resent being told by someone who has never faced the situations I have outlined above (often at 3am, or at the end of a 13-hour shift) what my job is 'like' or what it's 'about'.  I *think* I am good at it; I try very hard to be, and to get better.  I don't choose my hours to earn more money, or pick which of the 1-in-4 weekends I'm at work, or which of the evenings each week I stay at work til 10pm (plus any additionals that just sort of 'happen' if people are sick).  I go to my job because I love it, but you don't experience the challenge of treating very sick people and looking death in the face and the distress of peoples' families without giving something that government ministers cannot convince me they understand.
I reiterate, this is not a moan, more a reality check from the perspective of one junior doctor.  The negativity in hospitals amongst junior doctors is tangible, and yet they still give 100% to their patients because it is good and right to do so.

When I was working over a weekend recently, I found myself with a cluster of other junior doctors on the same ward all dealing with separate but sick patients.  It was 9.30pm on the Sunday evening, and we had all been working all of the previous week (plus an additional evening), 13 hours on the Saturday and were reaching the end of another 13 hours on the Sunday.  We all had a full week plus at least one additional evening on call ahead of us.  And there we were, a bunch of twenty-somethings, giving it 150% to make these patients better - organising blood tests and X-rays, talking to families, calling other specialties for advice, giving drugs and waiting to see if they worked before making the next intervention - working with passion and pushing past the fatigue.  In between phone calls and writing in the notes, we would share a little of our current clinical dilemma and the day we had had, and try and find a few smiles and giggles to keep us going.  I felt so, so proud at that moment to be a junior doctor.

And I am proud, not just of me but of the NHS.  I am twenty seven years old.  I am a junior doctor.  I love my job and all the things it makes me feel and see.  It is an absolute privilege.  But I also have a brain, and I'm not afraid to use it.  

Thursday, 20 August 2015

Glorious Insignificance of the Medical SHO

There is a school of thought that you are either a soul of the mountains or a soul of the sea.

I still can't work out which category I fall into.  When I think of the mountains, I think of feeling lost amidst Milky Way-speckled nights in the Andes, or many, many hikes, soaked to the skin but somehow gloriously refreshed, up various British hills and mountains. But then, I think of times spent by the ocean - perhaps most pertinently the Pacific, once upon a time diving in, as well as more recently gazing upon and swimming in - where you also feel marvellously insignificant.  I like that plenty too.

After a week and a half back in the NHS as a junior doctor (for those who want to pin point it - a Core Medical Trainee, or Academic Clinical Fellow if we're being fancy) - I'm once again Dr Karin Purshouse.  I'm exhausted and full of some sort of viral plague but amazed at what my little brain has been able to retain despite ten months away from having three bleeping machines attached to me, people hollering 'DOCTOR! Doctor!' and not (at least significantly) eating/drinking/peeing for 14 hours.

And really, I can completely feel the difference a year away from it all has made.  I am about ten thousand times more relaxed, and feel calmer, nay, wiser, about the things I do and don't know about clinical medicine.  As predicted, I'm every bit the OCD check-a-holic I was pre-USA, but I'll just believe my lovely zany colleague who commented, 'well Karin, that's what makes you a medic'.  It's a little like getting into a time machine though - colleagues who were junior to you are now your equal in seniority terms; those who were middle grades like me are now registrars, registrars are now consultants (do I call them by their first names like I always did, or Dr So-and-so?!).  Simultaneously, nurses remember you, and you them.  The same nurses are the ones you trust to be your eyes and ears across the multiple wards under your lone responsibility at night time; the ones you will always come running for if they say you need to start running.  The same ones will hand you the patient's notes with one hand and a cup of tea with the other as you approach the end of your night shift, brain and vocal ability only just about still intact.

I am not the same, it turns out, as those who stayed when I left.  For one thing, I'm still smiling - my supervisor marvelled at how happy I looked a week in, despite various administrative disasters making my return a little more complicated.  I'm the crazy SHO who high-fives the nurses when we've kept three really sick patients alive together all night, or asks even the hospital canteen staff 'hi there, how are you' (this is VERY American, it turns out), or, shock horror, goes to a yoga class, dinner with new friends or a concert AFTER WORK.  Life seems extremely colourful once you decide to approach it America-style.

I still feel like a tourist in my own country, but that's ok - I'm finding plenty of new chums with whom to enjoy the ride, and equally finding moments of peace in the American books I am still working my way through, perching time by/in various waterways or nerding out at science seminars.  You can feel pretty insignificant in the NHS, but then, perhaps it's like when you feel insignificant in the mountains or the sea - it's about how you choose to approach and interpret that insignificance, and rather marvel at the greater structure you are part of.  Sure, it's a bit of a change going from the mind-boggling world of glioma gene editing to worrying about Mr Bloggs' bowel movements, but you know what? That's important too.  And the great thing about being a clinician scientist is that each side of that professional coin informs the other, and helps you keep your perspective on the coin as a whole.

I've stolen this from Freckle Volume 1, and I think it's pretty bloody wonderful.
West Coasting - where ocean and mountains meet!
'Society, as we have constituted it, will have no place for me, has none to offer, but Nature, whose sweet rains fall on unjust and just alike, will have clefts in the rocks where I may hide, and secret valleys in whose silence I may weep undisturbed. She will hang the night with stars so that I may walk abroad in the darkness without stumbling and send the wind over my footprints so that none may track me to my hurt - she will cleanse me in great waters, and with bitter herbs make me whole' - Oscar Wilde, De Profundis

Disclaimer: Mr Bloggs is obviously not a real patient name. 

Tuesday, 4 August 2015

Red, White and Blue Wednesday - not Black Wednesday!

Tomorrow I go back to school.  My American tax return is finally filed.  My American bank account is closed.  My American phone contract has expired.  I have packed up my remnant things (which essentially amount to a significantly-culled selection of clothes... photos... books... my violin... and my trusted collection of international fabrics) and am back where it all began to start again, again.  My stethoscope, now entering its 10th year of life, is in desperate need of replacement (perfectly functional, you understand, but a girl can dream of a Cardiology Littman upgrade...) but shall, as it always has, see me right as I re-enter the clinical world on Black Wednesday.

This junior doctor has been re-acclimatising to this drizzly, chilly but occasionally sun-kissed, sparkling land.  I feel a little like a tourist in my own country, but this period of 'tourism' and catch-ups with very special friends and family, as well as all-important solo reflections, have helped focus the mind for the next part of my little life journey.  I return to a beautiful city with a refreshed outlook on what's important and renewed resolve to listen to myself a little more.  Eek.  I am more than a little daunted about another fresh start - strangely way more scared than when I moved to the States!  I have enjoyed celebrating the joys of the lives of wonderful friends and family before and since my time in the USA; now it's time for me to get on with my own.

A most wonderful friend soon to start her own overseas adventure reminded me recently amidst a small anxious moment re 'returning home' - nothing, including stress, is permanent; it is just a state of mind and a reaction to a situation, and this will pass.  And with that; I will keep some important words in my mind - Gold Guide, and Out Of Programme Experience....  Perhaps this is why people shouldn't take gap years - once you pop, it's hard to stop!  
Citadel and a Ghanaian reunion
Mussenden, NI
Sunset at Helen's Bay, NI
Womad! Chai, Senegalese dancing and a serious dose of mud. 
10 months on - Wiltshire's still looking all green and great :)