Wednesday, 10 September 2014

The Black Dog Bites

A few years ago, whilst I was still at medical school, I wrote a post about various mental health issues I'd had over the years. There are ups and downs and these issues become more or less prominent a part of my life at different times. Today, the internet tells me that it's World Suicide Prevention Day, and for this reason I find myself thinking a little more about the black dog.

I wish I were as eloquent as the chap who made this lovely video, but I'm afraid I'm not, so I just find myself rambling and hoping that perhaps something I write makes a little sense.

As many people reading this will be aware, I'm now on a specialty training programme in paediatrics. I'd be lying if I said it was always easy, but on the whole I love it. However, it does mean I frequently meet teenagers who have similar problems to those I had at their age (and, to an extent, continue to have). This is something which I will always find difficult.

Back when I was on my adolescent psychiatry placement, I found myself wondering whether I would ever be completely recovered. I've now concluded that I won't. That may sound negative, and I suppose at times it feels negative, but there's also a bit of relief in admitting that I may never be 100% "better", and that it's ok not to be ok.

As I get older, I get better at recognising what triggers off my lowest moments. Although I can't always do much about them, it's helpful to know that they are there. Currently, I spend some of my time in a job where I do little more than observe. This is really difficult for me, as my mind isn't kept as busy as it likes to be, and I therefore find myself overthinking and drifting into negativity. Whilst this is frustrating, it's also good that I know it's partly the lack of intellectual stimulation which is problematic as it means I can at least attempt to find solutions (in true Learnaholic style, these solutions are at present an MSc dissertation, a systematic review and helping to organise a conference). I've also never been very good at adapting to changes - from crying in playschool when my milk was in the wrong colour cup to feeling nauseated when our high school French teacher said we could sit in different seats as a "treat" - I've always liked routine, so a 350 mile move and a new job was always going to be tough. There's a certain amount of help in just realising that actually, most people would find that hard and that it's ok for me to feel a bit out of sorts for a while.

Interactions with (especially teenage) patients who are having mental health difficulties are always going to be tough for me. One of the things I struggle most with is that I can't hand on heart promise that it gets better - and for that I feel inexplicably guilty. Guilt is, oddly, a very prevalent part of depression for many people. The ironic "you have nothing to be depressed about" comments are unhelpful for many reasons, not least that I *know* I have a good life and already feel guilty that I'm not full of the joys of spring without someone else mentioning it.

Once again I find myself having typed a stream of consciousness which may or may not make any sense, but having retweeted the link to my initial mental health-related post, I felt like a follow-up was overdue. This post wasn't meant to be all doom and gloom, although it seems to have turned out that way. I need to emphasise some of the positive things going on too. I graduated from medical school, completed my foundation training and got a place to train in the specialty of my choice. I'm 2/3rds of the way through a master's degree. I live independently. I am, on the whole, not doing too badly. 10 years ago, I didn't think I would ever get here. I guess, all things considered, I'm doing ok. 

Saturday, 2 August 2014

The End of An Era

After 9 years in the city where I studied for my BSc, went to medical school and then did my foundation training, I will be moving on next week. Just a weekend of night shifts and 350 miles stand between me and the next chapter in the Learnaholic Chronicles.

In particular, I'd like to take this opportunity to reflect on the crazy, stressful, interesting, exciting years that are foundation training. A year ago, I wrote this post as a sort of FY1 survival guide for all the new doctors starting their training. This year, #tipsfornewdocs (started by people much wiser than me, I must point out) seems to have gone viral and everyone from the highly entertaining Medical Registrar on facebook to the British Medical Journal keen to impart their words of wisdom onto the fresh faced new graduates about to be let loose on the wards. With that in mind, this isn't going to be a list of tips - there are loads of them out there. It's just my thoughts on what the last 2 years have meant and what I've learnt.

Setting foot on the wards 2 years ago was the start of a huge learning curve. As I've mentioned before, I had a bit of a difficult time outside of work in the first month of the job, so in particular the first few weeks were pretty tough. Slowly, though, I think I've managed to find my feet.

There are some things that I think I will always remember. There are a lot of firsts for junior doctors, and those tend to be pretty memorable. From the first death I confirmed or the first time I told a relative their loved one had passed away to the first time I did a lumbar puncture or correctly interpreted a CT scan, those "first" encounters tend to be pretty memorable. Some of the memories make me cringe, others I think I dealt with pretty well.

Then there are the people you just won't forget. I'm not sure why certain stories stick with me more, certain patients are more memorable than others. Often it's about timing; a particularly memorable patient is often one who I've spent more time with and got to know properly. Other times, it's been a particularly intense encounter, or a patient who has reminded me of someone I've known personally. From the lady who hugged me and thanked me after I told her her brother was dying to the patient with terrible venous access who I'd have a daily giggle with whilst attempting to get his morning bloods, some people are just etched on my brain.

I've attempted before to try to express how I feel about the encounters we have in medicine. I still haven't worked out exactly the way to say it. I suppose the key thing I've learnt over these past two years is just how much of medicine is about people. I love the detective work involved in working out a new diagnosis. I love the science which helps me to understand why condition x produces symptom y and is treated by drug z. But a doctor who gets every diagnosis right and knows the molecular mechanism behind everything he does will only get so far. I'll admit to having rolled my eyes at the "fluffy" bits at medical school, but if these couple of years have taught me anything, it's that without the fluffy stuff, we're not much use at all.

Sunday, 22 June 2014

(Not) Just A Minion

There is a temptation as a junior doctor to refer to oneself as "just a minion". This is particularly true of FY1s/residents, but it persists a fair way up the food chain. After all, we just go around obeying orders and doing as we're told, right? WRONG.

A junior doctor tends to be the first person to be called to a sick patient, whether a new admission or a current inpatient who has deteriorated. Every day we make decisions about whether to start or stop fluids, analgesia, antibiotics etc. We are the ones who decide whether a new admission can wait to be clerked in by us or whether we need to intervene immediately. When we review patients, we are not robots, simply asking a series of questions. We are interpreting (sometimes vast amounts of) information and making complex decisions based on that information. We have spent many years training to become critical thinkers, analysts, problem solvers. It would be utterly ridiculous to then unleash us into a job where we are simply yes-men. Yes, we have limited experience compared to our seniors, but we are still expected to think relatively independently.

A lot of juniors are also under the (false) impression that senior = infallible. This is clearly not true. Sometimes, as juniors, we are the ones who alert the consultants to something important. Prescribing diclofenac as instructed is not a smart move if you recall the past history of gastric ulceration - something a senior may not be aware of (because you took the history, remember?). Your boss may not have seen the latest blood results and it may be up to you to point out the deteriorating renal function or rising inflammatory markers. There are also occasions where your seniors will make errors. Pointing them out doesn't mean being arrogant or argumentative, but a simple "I'm interested, why did you decide X?" or "I was under the impression that you do(not) do that in situation Y" could prevent a patient coming to harm.

One of the main reasons I (and, I suspect, some of my colleagues) dislike the "just a minion" attitudes is that it seems to remove an element of responsibility from the junior, as if their actions and decisions are meaningless. You worked hard at university for a long time. You are paid an enviable salary. You are a member of one of the most trusted professions there is. So stop with the "just a minion" talk. You're a doctor, and what you do matters.

(Thanks to @drbobphillips for suggesting I write this post) 

Sunday, 8 June 2014

"I Did It!"

Despite filling most of my time with work, academia and general geekery, I do have time for the odd hobby or two. People who know me will be well aware that working with children is something I love, and as well now working in paediatrics, I try to fit in some volunteering with Over The Wall and also help to run a Cub Scout group.

Last weekend, we took the Cubs away for a night camping. We filled the day before and after the actual camping with a variety of activities including archery, crate climbing and of course ending with the legendary soap slide (which may explain some of the bruises on my legs...). Any camp purists will be delighted to know we also had an excellent camp fire, complete with lots of singing and toasting marshmallows.

People often question my sanity when I tell them that I spend my rather limited free time in this way (I was actually quite proud when a colleague called me "completely insane" recently...) and sometimes I struggle to explain exactly why I choose to do these things. At camp this weekend, as the kids excitedly told me how high they climbed on the crates or how many bulls eyes they got, I was hit again by the sense of why I do these things. To hear a child say "I did it!" There is something immeasurably special about helping someone to achieve something they didn't think they could do. As a person who has gone through life convinced (for no good reason, although impostor syndrome comes into it) that they are rubbish and can't achieve anything, helping other people discover what they can do is something I feel I need to do.

I still get tears in my eyes when I remember a child at Over The Wall last year, partially sighted and scared of heights, manage half of the climbing wall she initially didn't even want to try because she "couldn't do it", or the incredibly self conscious teenager finally dare to perform at talent night (and give us all goosebumps with her rendition of Someone Like You).

There is a more selfish element to all of this, of course. There's an episode of Friends where Phoebe is determined to show that you can perform a truly selfless deed - even going to the somewhat bizarre lengths of "letting a bee sting (me) so that he could look cool in front of all his little bee friends" - and finally conceding that every "good" act is tinged with selfishness. I enjoy what I do. I enjoy seeing young people achieve and I enjoy knowing that I've played a part, however small, in helping them to do that.. Facilitating this achievement gives me my own "I did it!" feeling. And it's amazing.

(If you fancy joining in the fun, and sharing the "I did it!" feeling, go and browse the OTW and scouting pages.)