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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!

Monday, 13 October 2014

Learning American music, making a good cup of tea and Fall

Despite Eva Cassidy singing about 'Autumn Leaves', it is most definitely 'Fall' in New England; we were marvelling today at how we probably have all the same foliage in Europe but somehow it just looks so much more beautiful here… perhaps the lack of rain?!

Anyway, the culture shock (and I mean that in a positive way!) continues as I adapt my British/German ways to my new American environment.  This week's highlights:

- I started playing in an orchestra this week.  Easy, I thought - the international language of music.  WRONG.  I grew up with bars, crochets, quavers, semi-quavers.  Here they have measures, full beats, half beats, quarter beats.  My desk partner probably thought I was heading for the exit when I had no idea what was going on at the start of the rehearsal and initially didn't play a note.  Two and half hours of sight reading later, I hope I managed to redeem myself.

- Milk.  Again, a surprise complication. In the UK we have full fat, semi-skimmed (green top, for some reason the one most people drink) and skimmed (white water). Here, there is whole milk, half and half, skimmed, 4%, 2%....  And yes, it does matter which one goes in your tea.

- The pancakes are indeed as big as your face, but damn, they are good in the USA.  Don't get me wrong, I love a crepe, but how do they get buttermilk pancakes so fluffy?! This weekend I managed a double dose; I fear this may become a regular habit.

- Fall foliage really is amazing.  Here are a few snaps from East Rock running, and West Rock walking this weekend.  This meant we also braved the bus, which in a land with very subtle bus stop signs felt like something of an achievement.  It was so good to get some fresh air, and we were blessed with some glorious New England sunshine as you can see.  Although if post-grad medical exams are to be believed, I will be catching Lyme Disease at any moment.  I’ll keep you posted.

I am excited to have a VERY important visitor (my bestie!) this week.  I have done some baking specially (although this was also a mixed success – again there are certain ingredients e.g. flour I wrongly assumed would be the same! But hey, the first round still tasted good and simply means I will have to make more) and have cooked a batch of butternut squash soup. And I will be hopefully make some lab progress.  CRISPs(R), anyone?

Tuesday, 7 October 2014

How To Be a Brit in America

Greetings, dear reader, from this side of the pond!  I write to you from my new HQ in Connecticut, which I will be calling home for the next 9 months.  It's been a rather insane week since my violin and I upped sticks and landed here.  But my bags are well and truly unpacked, I have a bank account and a 'cell' number - frankly, my green card must be just around the corner (I jest, of course)...  Although it's very early days, I thought I would share my first reflections whilst they are fresh.  Perhaps they will prove useful to those considering a similar venture overseas, or will ring true to those who have made a similar move.  I'm sure I will laugh at these in months to come!

1) In the UK, I love black tea with milk.  You can buy tea in the USA.  Perhaps this is obvious.  The thing that is trickier is finding a kettle!  I have a whistling kettle in my flat that sits on the hob and makes me think of camping trips whenever I use it.  The thing other Brits and I have decided is distinctly absent is squash (to American readers - diluting juice?).  If anyone has a source in the USA, PM me!

2) Brits are (I believe!) famous for being very (overly?) polite.  Most Americans I have encountered are also incredibly polite - just about different things.  For example, I was profusely apologised to when the ATM I was asked to use to activate my bank account had a technical fault, and thus I had to move a WHOLE TEN FEET to a different ATM.  Conversely, it has made me realise how silly some of the things we apologise for in the UK are - e.g. the thing where if you are walking towards someone and will bump into them if one of you doesn't move, which brits feel the need to apologise for.  When really, no-one is at fault!

3) If going to the USA, always have a few spare dollar notes for tipping.  In the UK I was used to habitually tipping in restaurants (10%, usually), unless the service was truly awful.... and that's about it.  In the UK, I might round up a taxi fare if it was easier, or if the chat was good.  Some British people tip their hairdresser, or at a coffee shop if they have change, but again I wouldn't say it's expected.  Thus it is rather a culture shock to have to tip even the grumpiest taxi driver, and a rather heftier 15-20% in a restaurant.  It has been explained to me that tips are a notable part of peoples' pay, and as such, if I have under-tipped anytime this week, I can only deeply apologise.  I will improve!

4) I keep forgetting that tax is added to the price listed in shops.  This means I am never ready with the right cash - big sorry to anyone who has been kept waiting behind me in the queue this week.

5) Having a washing machine in your flat is a novelty in the USA (I have one in my flat.  Grateful ++.  I am way not organised enough to coordinate myself around taking it all to a launderette).

6) I'm sorry, but queuing really is a British art form.  This is based on not only this, but other world travels.  Queues happen here too, but sometimes people barge in, and then everyone gets really angry.  These two latter phenomena are simply not commonplace in the UK.  And even if someone did barge in, we would probably look at our feet, mumble or grumble a little (and quietly) and that's about it.

7) Open-ness and friendliness are definitely two of the best adjectives I can use to describe the Americans I have met so far here.  Despite me asking many moronic questions about how cell phone contracts work, how rental cheques are organised and how to send a letter to Europe, everyone has been incredibly helpful.

8) Getting some contacts together before I came here has been key to my early happiness.  I didn't know anyone in this part of the USA before I moved here, and just told everyone and anyone I met in the preceding months that I was moving here and was searching for friends!  It has been completely amazing how many people try and create contacts for you if you just ask, both before you arrive and once you're here; and I was amazed where such contacts ended up coming from.  My first few days have been completely 'made' by such contacts, and I have been blown away by their friendship and kindness; and ultimately many of these were also new to the area and keen to explore, so it's a double win - new friends, and someone to explore with!

9) Say yes to everything.  Thus far, I have met NGO workers at a cooperative BBQ I was invited to, painted in the middle of New York and drunk margaritas at the birthday party of someone I met that evening.  Random, and wonderful.

10) Sometimes it's bloody lonely.  It rained a flood on one of my first days here and I could barely leave the house.  I didn't really have anyone to call at that stage, and no-one wanted to go outside anyway.  I knew my family were busy.  I didn't want to simply call a friend in the UK within four days of arriving - I didn't think that was a good coping mechanism so early on.  But hey, that feeling passed.  And I ended up having a wicked evening with new friends.  I'm so lucky with what I'm doing, and I am trying to surround myself with reminders of that for future sad moments (which are inevitable, at home or away!).

I have, I guess, also been super lucky because as a Fulbrighter, I have access to the worldwide Fulbright community and more specifically the UK Fulbrighters based in nearby NYC who I met a few months ago.  What an awesome bunch of people!  I count myself as a very fortunate bean to be able to call them friends, and look forward to many more adventures over the coming months.  However this could definitely be YOU!  I didn't think I had a hope of getting a Fulbright, but it just shows you must TRY!  So give it a punt!

Overall, I think the main reflections from my fellow UK immigrants and I are a new appreciation of how it feels to be a 'foreigner' and how we are determined to bring the 'international hand of friendship' back to the UK.

In the mean time, I could not be more grateful for every email or message I have had from friends and family, wherever they are in the world, and to all the new friends I am making.  Perhaps a good reminder to all of us to send a greeting to someone we know somewhere in the world, or someone we haven't spoken to for a while, and say hello to that new person at our place of work.  It's never too late!

Saturday, 20 September 2014


So the time is nearly upon me to pack up my stethoscope and the NHS and leave the UK for American shores.  After over a year of emails, phone calls, panic and excitement, I can't believe in two weeks time I will be calling the USA home for nine months.

This blog so far has charted the ups and downs of my final months at medical school and the whirlwind first two years as a qualified doctor.  I have decided, as many do at this stage in their training, to tag out of training.  I am trading my stethoscope for a lab coat.

I am not alone: A third of UK doctors take a 'gap year' between their foundation years and specialty training.  I have to say, from personal experience I'd say that statistic is even higher.  Why?  A number of reasons really.  The last time I made a radical decision about my life was when I was applying to medical school as a teenager.  OK, so I took a year out to live in London and do a science degree, and had to apply for my first doctor job, but these were very much with the tide of my peers.  Finishing foundation (the UK name for these first two years) is the first time you actually have to decide a) what sort of a doctor are you going to be and b) where am I going to live for the next 5-10 years?!  It's quite odd hitting that sort of milestone in your mid twenties having made few major decisions in the interim aside from 'how am I going to make sure I actually have food in the house throughout my 12-day work stretch'?  Plus job applications come just after you've finished your first year of work and I certainly felt it was too soon for the big commitment of geography in particular.  And for some people they are still unsure about which specialty to commit to; if paeds is your hunch, it's a minimum 8 years of training - yikes if you're not 100% sure!  I love my job, but I'm also exhausted.  Sure, being a doctor is tiring, but so are all jobs - I think when you are a junior doctor, there is the added emotional, inexperienced stress factor which is all the more draining.
A few from recent countryside runs.

Plus, frankly, why not?  There's a big old world out there and in an age where so many people seem obsessed with nationalism and national pride, I am quite content to have my own pride about being a citizen of Planet Earth.  Life is short and I am keen to explore...

Little English town...
So I am meandering Stateside to Yale University for the year, and was lucky enough to get a Fulbright scholarship to help fund a brain tumour research project.  Being a Fulbrighter has already been an incredible experience and I haven't even gone yet - my fellow scholarship people and I had an induction session a few months ago and I just couldn't believe what an awesome bunch of people they were.  I think we shared disbelief that we had somehow got through the application process and felt unbelievably lucky.  As a medic, it was also hugely exciting and refreshing to meet these inspiring people from such a range of disciplines, given that my world is so often just about medicine.  I am excited about all these new friends and colleagues I am yet to meet, and all that I will learn about in a new area of science.

I'm saying my goodbyes, packing up my things and preparing for one hell of an adventure.  Recent events have reminded me once more that you just never know what wonderful things are around the corner, and that's a hell of a blessing.  America, be nice to me!

I shall miss you!

Wednesday, 3 September 2014

'Is there a doctor in the house?'

We juddered to a halt - I, along with the other tourists and commuters, struggled to stay on our feet.  A siren gave its intermittent noises indicating that the emergency stop button had been pressed.  I did a little harumphing and sighing, as did most of us.

But then I heard the words that chill you to your very bones the second they give you your medical degree.  

'Someone's unwell, we need some help'.

I was on my way to sort something out for my American travels - a strict appointment that I had been told in no uncertain terms I couldn't miss.  I was in jeans and a jumper with a casual canvas bag, earphones plugged in listening to my generic music device.  I could not have looked less like a doctor if I tried.  I waited a few seconds to see if anyone else was making any moves, peering to see if anyone else appeared to know what was going on.  Realising that no-one was doing so, I pottered over (I should add - there was no screaming or hysteria suggesting anything truly awful had happened.  I wouldn't want you to think I saunter in this fashion to all medical emergencies).

Again, reassess.  Man on floor.  Definitely awake, talking.  Also, it definitely appeared there there were no nurses or doctors or medical types around. Here we go...

'Um... can I help... I'm a doctor...'

Cue mass relief - 'make room, there's a doctor here'.  Weirdly, it was like a tension in the group of passengers who had crowded to help the gentleman was suddenly released, as if I had some kind of magic wand.  A quick ABC told me there was little I needed to do immediately.  I asked a few questions to rule out some of the worse things running through my mind and felt reassured.  I did by pure chance have my stethoscope in my bag but we were literally perched in the middle of the public transport network with everyone staring, so I decided to leave that.  Confidentiality and privacy had gone out of the window as it was.  We just needed to get moving to the station.  

Once we had made it to a station, I waited with the gentleman until relevant people came to get him to hospital.  Of course by this point I didn't care that I might be late for my appointment, but for what it's worth, I was perfectly on time.

There were a few interesting reflections from this.  One is how Londoners totally get an unfairly harsh reputation - everyone around this gentleman was trying to help.  When I asked if anyone had any water for him, about five people reached into their bags and someone even found a cup from somewhere. A few other people waited with me and were hugely apologetic when they had to head off.  

Another is, I guess, a more personal one about how crazily calm I felt despite having an entire crowd of strangers staring at me, hanging on my professional opinion.  It was like the ultimate OSCE.  I obviously don't know what happened to this gentleman, but I felt really comfortable with what I was doing and thinking.  That was... unexpected.  Does this mean in my two years as a qualified doctor, I actually have some experience to offer, and confidence in myself?

It is very strange to think that when I head to the USA in a few weeks, 'doctor' is a role I will be hanging up, along with my stethoscope, for nine months.  It's moments like this episode that make me realise that being a doctor is as much who I am as what I am.  And that is a very strange thing to accept.

Wednesday, 27 August 2014

Singing songs and other human things

On popping home recently, I bumped into a very old friend - someone I hadn't seen for years. I always find myself embarrassed by myself in these situations - there's something about saying 'Um... so I'm a doctor' that has the potential to feel like you've dropped a bomb.  Out of the resulting crater can spill out a whole bunch of emotions, as it did in this instance.  My friend had close family who were going through the complex map that is NHS-and-social-care and they were deeply frustrated.  Doctors crooking their heads and telling them what they thought was best, despite being a quarter of the age of the patient.  An a-amotional stream of medical types who had fifteen minutes maximum per day devoted to each of their patients (ward of 20 patients, 8 hour day - you do the maths).

There is always a question in clinical medicine (and I have previously written about the pros and cons of the so-called game face in medicine) - how much of 'you' do you reveal?  Particularly when you're a junior doctor, and, dare I say it, particularly when you're a female junior doctor?  When does 'being yourself' just become unprofessional?

I find myself increasingly leaning more on the human side of things than others might.  My friends roared with laughter when they heard that I sang an entire song from my childhood to a patient (and their family) because I thought it might make her smile at an otherwise rather difficult time.  I regularly tell tales and memories of my grandparents, and my (still living and going on mightily aged 93) grandmother is frankly famous from the number of patients I have told about her as an example of age just being a number and focusing more on what people can do rather than the date on their birth certificate.  If patients or relatives sigh at me and say 'you doctors just don't know what it's like' with complex discharge planning regarding their elderly relative who lives 300 miles away from them, I am willing to share their frustration with my own family's experience of exactly the same thing.  I talk German to my patients who are German.  I only introduce myself as 'Dr Purshouse' when the situation requires it (e.g. official-dom) - the rest of the time I'm 'Karin, one of the doctors'.

You're probably reading thinking I'm marking myself out for sainthood, but these are not beliefs and practices held by everyone.  Some people (and my colleagues) want doctors to maintain a more professional manner.  One of my colleague always introduces himself as 'Dr So-and-so' so there is no confusion later on about who he is, and to a degree also set the tone - he is a professional, giving his professional view.  Frankly it can be just confusing to patients, and a more formal approach can make it easier to understand who everyone is.  Some doctors prefer to keep their private lives to themselves, absolutely all of it, and part of that is also self-preservation and not getting too emotionally involved with their patients.

Trying to be a 'serious doctor'.
My take on this?  I am a doctor, and I ask for the same professional respect as I afford every human being (patients, colleagues, anyone), but if I wanted to be an emotionless robot, I would have picked a different job.  Obviously I judge every situation on its merits, and being super-casual is not what showing your human character is about.  Sometimes I think I should be a bit more formal at highlighting my role though: one of the questions on a confusion questionnaire screen is 'what is my job' - and if I had a nickel for every time someone said 'secretary'....

Hmm.  Perhaps I should try it for a while.  Keep the singing, but instead do a trial of 'Hello, I'm Dr Purshouse but please call me Karin' as a compromise?

Oh, it's tricky being a doctor and being human!

Tuesday, 19 August 2014

Open Access, Closed Door

Earlier this week, I got some exciting news - an article I wrote is going to be published! It's a small online journal with a teeny impact factor, but for baby doctors like me, it is great to just get some experience of the whole process.  It's an article on novel therapies for small cell lung cancer that I wrote for my Masters, if you're interested...

But here's the big hurdle: how to make it Open Access?

Now anyone who reads journals will be familiar with the difficulty of reaching journal articles stuck behind massive pay walls.  It's very frustrating - you find the article on Pubmed (other search engines are available) that promises to tell you everything you want to know about a topic, or explain the method for a certain experiment you want to do, or could outline a study you thought was novel but has actually already been done.  They problem?  You either have to hope your institution has access (that is, if you have an institutional affiliation) and if not, it's tough cheese unless you want to fork out some big bucks to read the article.  Which might turn out to be useless, but of course you don't know that until you've read it.

And this is all despite the fact that research is largely publicly funded and undertaken by scientists who get paid relatively diddly squat to do ground breaking research.  Journals are supplied with articles from said scientists, and then the refining and peer review process happens by other scientists in the same field who do not get paid to do so.  Most journals these days are predominantly read online.  So the main overheads for journals are for editing, formatting etc... Um... so why do journal subscriptions cost so much...?

Especially in the UK, there has been a real drive towards Open Access, and encouraging journals to make their publications freely available.  One method to cover the overhead costs is to charge a publication fee - and herein lies my challenge.  For a little journal like the one I'm publishing in, it still costs a few hundred dollars to meet that fee.

Who pays for that?  Me.  I pay for that.  Because institutions can often only support those who are funded through specific funding bodies who usually ring fence some of their monies for that purpose (e.g. Wellcome, RCUK).  This reflects well on these organisations, but you're a bit stuck if they're not your funders.

Doesn't this just become a thing where people who can afford to pay get stuff published (in this scientific world that is already ruled by a 'he who survives must publish' mantra?), thus devaluing the whole process into one driven by money?  And what about those in the developing world - how do their research groups publish in even the smaller journals with these kinds of fees?  And what hope is there of reaching some of the bigger, more expensive journals, who have much higher publication fees? And what about journals that are a mix of open access and pay-for articles - if you have to pay a subscription fee for the whole lot anyway, don't you just end up paying twice - once to publish and another to read?

I'm totally team Open Access, but it feels a bit like some journals are winning a game where old boundaries remain and new ones have been created.  Hmm.  I don't like those sorts of professional games.

As a complete aside and nothing to do with the above, my new-found employment freedom has given me a bit of brain breathing space which I didn't even realise I needed.  The kind of breathing space that actually winds you quite majorly when all those squashed parts of the soul get some air time.  Without wishing to get too heavy with you, dear blog reader, I will instead say that I can most heartily recommend such pauses, and share with you the view from the lake I went swimming in yesterday.  Pretty sweet, huh?

Sunday, 10 August 2014

Black Wednesday

It's official - I am one of the unemployed masses.  Well, sort of - available and willing to locum at a hospital near you!  And that's what I've been doing this week, weathering the perceived storm that is 'Black Wednesday'.

Black Wednesday instils fear in Joe Public and junior doctors alike - the first day of work for thousands of newly qualified doctors, and simultaneously changeover day for most doctors in training (i.e. everyone from a senior house officer to senior registrars).  It's hard to imagine any other job where on a Tuesday you could be working a 13 hour shift in Exeter, and expected to rock up to your new job in Inverness the next day.  The finger is often pointed at the newly qualified ones as to why the death rate is allegedly higher on Black Wednesday; I think you could make a strong case for the mass move of all junior doctors as a bigger factor.

Although you get an induction, every hospital has different computer systems, different parameters for certain blood tests, different ways of requesting tests, different ways of managing some acute medical problems, different departments available on site...  And hospitals are big places!  Running to a crash call in a hospital you don't know is rather tricky when you don't know where you're going and you don't know who anyone is (sometimes it's useful to know that the guy running next to you is the anaesthetist).  The whole week is an upheaval - the above scenario of moving across the UK is not uncommon, and is seemingly rarely considered in rota planning.  I know a number of my colleagues who only got their rotas the week before starting their new job in a new place.  This means sometimes working a 19-day stretch if you're unlucky enough to finish one job having worked the weekend, and start the next scheduled to work the next.  And that's before you throw night shifts into the equation.  In one case my friend has been rota'd onto nights the weekend she is supposed to be getting married!  Given that changeover day is exactly the same every year and the rota itself can only likely change very slightly, this all seems a little ridiculous.  The flexibility in the system is created by junior doctors themselves - swapping last-minute on calls and cross-covering to allow someone an afternoon to at least move house.

I offered to do extra night shifts on Wednesday and Thursday nights, thinking I must be the craziest person in the NHS.  Given how many night shifts I have already done in the last four months and how completely frenzied they often are, the thought of doing them on a week where no-one knows what's going on seemed foolhardy at best.  But actually it was great - certainly at my hospital they threw a lot of doctors at the situation of handover week, and gave a bit of purpose and use to doctors already working in the hospital such as myself who are doing 'F3' (i.e. finished their first two years of clinical practice and now taking a year out).  We offered the continuity of those logistical uncertainties that come from simply working in a new environment, as well as being an extra person to call upon for the newly qualified doctors.  Well, at least I hope I did...  For me it was a useful combination of learning to advise junior docs and continuing to gain more clinical experience as a junior doctor myself.  In my job, every day is a school day.  Pretty great, huh?

People get very worried about the medical knowledge of new junior doctors.  But this week's experience tells me that while new junior doctors may lack experience, crucially they know how to ask for it.  Perhaps people should focus a little more on easing the transition between jobs of the thousands of doctors in training at the rungs higher up the ladder.  After all, they're the ones that all these newly qualified doctors will turn to on their first days when things get tough.

In the mean time, I'm off to get my life back before Fulbrighting begins.  Can you believe it?  A year ago it was just a pipe-dream, and now I'm about to move to Connecticut for 9 months.  But more on that later.