It's not unusual for people, on hearing that I work in paediatrics, to ask how I can do it. "Gosh," they say, "isn't that really upsetting?". When I mention that I have a particular interest in children with cancer, they start to look at me like I've sprouted a second head. Even medical colleagues of mine, who deal with illness, pain and sufferring on a daily basis, sometimes struggle with the idea of these things happening to children. My response, generally, is a little blase. "Oh but it's so much fun!", "I get to cuddle babies as part of my job!" or "Well the tough bits are tough, but they're so rare!". What I don't think I ever say is "Yes, it is. I love what I do but it breaks my heart".
There's a lot of talk about burnout and resilience at the moment. I find it difficult to understand what's really meant by either term, but I certainly find myself worrying that admitting things are tough is somehow suggesting that I'm not cut out for this. I know different people mean different things when they talk about being "resilient", but I have to say that a lot of the time when I read headlines saying we need to "improve resilience" amongst doctors, it feels like someone in an ivory tower is telling us to "man up". I know a lot of people say that isn't what's meant by it, but I also know that I'm not the only person who hears it that way.
Increasingly, I'm realising the need to be honest about how tough my job can be at times. I'm not complaining - I love it and I genuinely can't see myself doing anything else - but downplaying the stresses and strains does no one any favours.
There are phrases that make all paediatric trainees break out in a cold sweat. "Category 1 section, obstetric theatres" - something has happened during a delivery and they need to get the baby out now. You sprint to theatres, check the oxygen is working, get out tubes and catheters in varying sizes. Someone hands you a white, floppy, lifeless baby. You hear an anxious parent ask "why aren't they crying?" as your anaesthetic colleague tries to reassure them that sometimes babies born by Caesarian are a little bit shocked and take a while to wake up - and you know they're trying to convince themselves as much as the parents. Mostly, it's ok. You dry the baby off, position their airway, sometimes give a few breaths, and then they gasp, cry and pink up. Except the times they don't. The times they stay white. The times the heart rate doesn't improve and you start chest compressions and give adrenaline and do everything totally right and it just doesn't work. Maybe you detect a heart rate after 10, 15, 20 minutes. You start trying to explain cooling and neuroprotection and know that nothing you're saying will be taken in because up until half an hour ago, these people were having a healthy baby - a normal thing that millions of people do - only it's not quite gone to plan. Sometimes, a well meaning senior tells you to get a sense of perspective. Your day was pretty bad, but nothing compared to what those poor parents are going through...
It's not just the very sick children that can upset you. Part of our role as paediatricians is in child protection; assessing children who have been abused or neglected, usually by the very people who were meant to love and protect them. You might be treating a child for a chest infection and realise that this three year old, ill and in pain, turns not to his own mother for comfort, but to a doctor or nurse he's never met before. You might be listening to his chest when you see a hand-shaped bruise on his back. You could be just walking into the room when you realise he's malnourished and dirty. You have to act to protect this child in the best way that you can.
There are so many things that can get to you as you go about your work. Sometimes, it's seeing a parent struggling to come to terms with a horrible situation and realising that you can do nothing more than offer a hug, a listening ear and a cup of tea. Other times, it's watching a child undergo futile and sometimes painful treatment because their family aren't yet ready to accept that nothing more can be done to help them. It might be being hugged by a gorgeous little one and then finding out that Mum is actually foster Mum and she doesn't understand why no one will give him a forever home.
The point of this post is not to attract pity, sympathy or praise. I chose this career with my eyes open and it's a wonderful, rewarding, fulfilling one. But it can be difficult, and admitting that should be something that it's ok to do. Would you want your child to be cared for by someone who didn't care? If you can deal with the situations I've mentioned above (and yes, all of them have happened to me over the past couple of years) and not be saddened, I would genuinely wonder whether you were in the right career. I once described paediatrics as "the little girl, with the little curl", a reference to an old nursery rhyme...
There was a little girl
Who had a little curl Right in the middle of her forehead; And when she was good She was very, very good, But when she was bad she was horrid.
I still feel like it's the best way of summing the job up. When it goes well, when good things happen, it's brilliant. And when they don't go so well, it's fairly dreadful.
Paediatrics? I love it, but it breaks my heart. And that's ok.
Showing posts with label Doctor. Show all posts
Showing posts with label Doctor. Show all posts
Thursday, 7 April 2016
Friday, 25 December 2015
Christmas Reflections
Christmas, for many reasons, is a time of year when I always feel particularly contemplative. I'm not a religious person - I was raised in a "respecting all religions but following none of them" kind of household and seem to have continued along that path into adulthood - but there's still something about Christmas that seems special. There's no denying that, as a little girl, at least part of the excitement was about presents, but I think it's always been about more than that. My Daddy used to finish work at lunch time on Christmas Eve, we would probably see friends and cousins who we didn't see often, there would be lots of people visiting and, of course, no school for us or work for our parents, so we spent lots of time together as a family. Overwhelmingly, though, what sticks out in my memories of my childhood Christmases is that everyone was happy. It was simply a time of seeing the people you loved and enjoying being together.
During my teenage years, as many of you will know, I had a rather difficult time with my mood. A time when everyone was so cheerful, and the general attitude appeared to be "you should be happy, it's Christmas!" suddenly became difficult to cope with. The general tolerance for misery seems to drop at this time of year, and anyone who isn't feeling full of the festive spirit not only has to contend with their own difficulties, but also with accusations of bringing everyone else down and spoiling Christmas.
Now, as an adult, I enjoy Christmas again, but a combination of my teenage difficulties and work and family circumstances mean I'm all too aware of how difficult this time of year can be. I'm working again this year, but come Monday when I have some time off, I'll be heading up to see my parents and sisters before spending New Year with my boyfriend. I'm lucky to have not only a job that I genuinely enjoy and that pays me enough to be able to spoil the people I love, but (more importantly) people I love close by, happy and healthy.
Working over Christmas in a hospital is an odd experience which brings with it a strange combination of emotions. I still smile when I remember the sweet nonagenarian who burst into tears of happiness when Santa came around the ward and gave gifts to all the inpatients. The same day, I had to tell a lady that the symptoms her son had brought her to A&E with were likely due to metastatic cancer. Another year, I got a Christmas kiss on the cheek from a very mischievous older gentleman patient before discussing end of life care for someone else. Last year, I saw babies and children spending their Christmas in hospital - for some it was their first Christmas, for others it would be their last; for a few it was both.
Whatever you're doing this Christmas, spare a thought for those who aren't enjoying the festivities in the usual way. My colleagues in the health service, from the domestic staff keeping the wards clean to the consultant surgeons performing life-saving operations, will be there to ensure you and your family are well looked after. Those in the fire service and police force are making sure our streets and homes are kept safe. Thousands of hospitality workers are spending today serving up countless turkey dinners and glasses of prosecco to help other people have a merry day. To everyone working this Christmas - thank you.
If Christmas is a challenge for you, know that you aren't forgotten. Those struggling to get through the day without a loved one - be it for the first or the fiftieth time - I feel for you. If you're spending the day in the hospital, either as a patient or visiting a loved one, I hope Christmas is comfortable and that the New Year will be brighter. If you simply feel overwhelmed and are struggling, there are people who care and who will listen.
Merry Christmas, everyone, stay safe and I hope 2016 brings health and happiness to all xxx
There are a number of places you can get help should you need it. The services I've listed are free to call and open 24/7. A more comprehensive list is available through the NHS choices website, but not all services are free or open over Christmas.
If you're struggling today, or any day, the Samaritans are there to listen for free - call 08457 90 90 90.
Children and young people can contact ChildLine on 0800 1111 whilst adults who have concerns about a child can call the NSPCC helpline on 0808 800 5000.
If you feel in danger of hurting yourself and don't have a crisis plan, please call 999 or go to your local A&E department.
For those who need help with domestic abuse, contact Refuge on 0808 2000 247.
If alcohol is a problem, you can call Alcoholics Anonymous on 0845 769 7555.
If you need help with drugs, you can speak to Frank on 0800 77 66 00.
During my teenage years, as many of you will know, I had a rather difficult time with my mood. A time when everyone was so cheerful, and the general attitude appeared to be "you should be happy, it's Christmas!" suddenly became difficult to cope with. The general tolerance for misery seems to drop at this time of year, and anyone who isn't feeling full of the festive spirit not only has to contend with their own difficulties, but also with accusations of bringing everyone else down and spoiling Christmas.
Now, as an adult, I enjoy Christmas again, but a combination of my teenage difficulties and work and family circumstances mean I'm all too aware of how difficult this time of year can be. I'm working again this year, but come Monday when I have some time off, I'll be heading up to see my parents and sisters before spending New Year with my boyfriend. I'm lucky to have not only a job that I genuinely enjoy and that pays me enough to be able to spoil the people I love, but (more importantly) people I love close by, happy and healthy.
Working over Christmas in a hospital is an odd experience which brings with it a strange combination of emotions. I still smile when I remember the sweet nonagenarian who burst into tears of happiness when Santa came around the ward and gave gifts to all the inpatients. The same day, I had to tell a lady that the symptoms her son had brought her to A&E with were likely due to metastatic cancer. Another year, I got a Christmas kiss on the cheek from a very mischievous older gentleman patient before discussing end of life care for someone else. Last year, I saw babies and children spending their Christmas in hospital - for some it was their first Christmas, for others it would be their last; for a few it was both.
Whatever you're doing this Christmas, spare a thought for those who aren't enjoying the festivities in the usual way. My colleagues in the health service, from the domestic staff keeping the wards clean to the consultant surgeons performing life-saving operations, will be there to ensure you and your family are well looked after. Those in the fire service and police force are making sure our streets and homes are kept safe. Thousands of hospitality workers are spending today serving up countless turkey dinners and glasses of prosecco to help other people have a merry day. To everyone working this Christmas - thank you.
If Christmas is a challenge for you, know that you aren't forgotten. Those struggling to get through the day without a loved one - be it for the first or the fiftieth time - I feel for you. If you're spending the day in the hospital, either as a patient or visiting a loved one, I hope Christmas is comfortable and that the New Year will be brighter. If you simply feel overwhelmed and are struggling, there are people who care and who will listen.
Merry Christmas, everyone, stay safe and I hope 2016 brings health and happiness to all xxx
There are a number of places you can get help should you need it. The services I've listed are free to call and open 24/7. A more comprehensive list is available through the NHS choices website, but not all services are free or open over Christmas.
If you're struggling today, or any day, the Samaritans are there to listen for free - call 08457 90 90 90.
Children and young people can contact ChildLine on 0800 1111 whilst adults who have concerns about a child can call the NSPCC helpline on 0808 800 5000.
If you feel in danger of hurting yourself and don't have a crisis plan, please call 999 or go to your local A&E department.
For those who need help with domestic abuse, contact Refuge on 0808 2000 247.
If alcohol is a problem, you can call Alcoholics Anonymous on 0845 769 7555.
If you need help with drugs, you can speak to Frank on 0800 77 66 00.
Sunday, 1 November 2015
I'm Not A Lousy Doctor - But I'm A Lousy Friend
If you've read this blog before, you'll probably be aware that I'm a prolific tweeter. In fact, I'd be surprised if you were reading and had come across this post via anything other than seeing me tweet about it. One of the things I love about Twitter is that it makes the world a smaller place. One of my favourite Tweeters is the lovely @dr_ashwitt; although she is as far from me as is basically possible (Melbourne, if you were wondering), I frequently read her tweets and think "oh my God, me too!". Recently, Ash re-posted a link to a post she wrote a couple of years ago about her experiences of depression. She urged other doctors to post their own 140 character experiences of mental health issues, and #MH4Docs got a fair number of tweets which Ash has collated here. I haven't actually tweeted yet, but I've been pretty vocal about my own issues over the years and it's good to see that people feel they can open up about these things. The thing that really made me think, though, was the sentence she used to link to her blog.
"I have depression, but that doesn't mean I'm not a good doctor."
I think a big part of the reason that a lot of health care professionals (and non-health care professionals, come to think of it) are reluctant to open up about mental health issues is the fear that their abilities at work will be called into question. I know that one of my major fears when I "admitted" to having depression was that people might think I was unable to do the job I love and have worked for for a long time.
My mental health problems don't mean I'm not a good doctor. I have a need to be busy which means that I will crack on with as much work as I can, and I'll find non-essential tasks which just "need doing at some point" to keep me occupied. Focusing on other people means I'm not thinking about myself and my own emotions, so I'm unlikely to slip into a spiral of despair. My lack of self esteem and constant impostor syndrome mean I'm keen to please and make an extra effort to be friendly and polite. Work makes me feel better and I think my own issues mean I will always work as hard as I can. Possibly I'm at risk of burnout, but it's nothing I've ever felt close to, and the other hobbies I've developed to occupy myself and prevent negative thinking mean I have outlets outside of medicine.
No, depression doesn't mean I'm not a good doctor. It does mean I'm not a good friend, though. Being nice and polite to people can be frankly exhausting. After a whole day smiling and engaging in banal conversation and generally giving the impression that I'm a functional human being, I am absolutely worn out. I very rarely agree to after-work plans because I know I'll be too tired to be good company. If I've made arrangements, there's a good chance I'll flake out at the last minute because I just can't face being around people any more. Finally living alone rather than with flatmates is a Godsend because it means I can have meltdowns in the living room and kitchen rather than being restricted to my bedroom. On nights out, I'm renowned for disappearing without telling anyone after being consumed by an overwhelming wave of misery and wanting to get away before I spoil anyone else's night. As for relationships, I am probably one of the worst girlfriends out there. I take insecurity and anxiety to ridiculous levels, any compliment is analysed repeatedly to ensure it isn't actually a heavily veiled insult and "I love you" is not infrequently followed not with "I love you, too" but "..really? Do you actually though?".
So yeah, I have depression, and that doesn't mean I'm not a good doctor. But it does mean I'm not a good friend. If you've stuck around anyway, thank you. I may not say it with nights out or long conversations, I may cancel half of our arrangements and you might feel like you're walking on eggshells when we talk, but you are loved and appreciated.
Monday, 6 July 2015
Survival Tips For Medical Students
Tonight I noticed a tweet asking for top self-care tips for medical students, and (unsurprisingly) I felt I had too much to say to fit it into 140 characters, so I thought it might be worth a blogpost. Being a medical student is an amazing experience, but it can also be incredibly difficult for lots of reasons. This post isn't supposed to be in any way comprehensive. I'm not an expert, by any stretch. This is just a collection of suggestions and ideas based upon my own experiences and those of people I know.
Work hard.
Medicine is hard work. Most of it isn't intellectually particularly stretching, but there's a vast amount of stuff to learn and the majority of people will have to do a reasonable amount of work to keep on top of it. I'm not advocating becoming a hermit, but going to most of your lectures, showing up on the wards and keeping up with reading will mean exam season is far less stressful. If you have to actually learn everything from scratch, rather than just revise it, you'll be giving yourself a far more difficult task than is necessary.
Play hard.
It's also important to make the most of being a student. Go to toga parties. Play pub golf. Go clubbing whilst dressed as a giant chocolate bar or do garlic and chili body shots from the Med Soc president. Or don't, if you'd rather not. But don't feel like doing an academically demanding degree means you have to miss out on the student experience. A boss of mine once said "you can resit an exam, but you can't resit a party". I'm not sure that's the most sensible advice, but find a balance that makes you happy. Whether it's partying, music/sports/drama societies, volunteering or just reading novels and watching trashy TV, doing fun stuff is important. Keeping up with friends and enjoying yourself is an essential way of dealing with the stress you will feel from time to time. Speaking of friends, they're really important. Make sure you keep up with those outside of your course, too. Non-medics are brilliant for allowing you to properly relax and giving you a sense of perspective (medic friends are great and can relate to a lot of what you've experienced, but have an awful habit of talking shop so you don't truly escape medicine around them).
But don't forget to sleep.
Seriously, sleep is really important. When you're trying to balance partying and studying, sleep can seem like something you don't have time for, but it's essential. Everything seems worse when you haven't been sleeping well. As a medical student, you've embarked on a pretty awesome journey, but you need to be on top of your game to make the most of it.
Eat well.
OK, so it's boring, but it's another essential. If you're spending long days in lectures and then going out drinking, it can be tempting to sustain yourself on Pot Noodles and Red Bull, but there's no way you'll be at your best if you aren't getting a decent amount of vitamins, minerals, fibre etc. Sorry guys, your Mum is right about this one.
Exercise.
Similar to the above, exercise is useful for both keeping you physically at your peak and helping beat stress. As a naturally lazy person who would rather exercise by lifting a spoon from ice cream tub to mouth than go anywhere near a gym, I totally get that this is not top of some people's agendas, but it's amazing how much more energy you have after a swim or run. Even a brisk walk around the block is better than nothing.
Cry.
Sometimes you will see things that really resonate with you and upset you. This is absolutely OK. Allow yourself to be upset. Talk to a friend. Have a cry. I still get upset about cases from years ago (such as this one), Remember that if there ever comes a time when sad things don't bother you in the slightest, you probably want to think about a change of career.
Take a break.
OK, so this might go a little against what I said earlier about working hard, but it's important. Sometimes, things will get on top of you (see previous point). You might be unwell. You will have stressors in your life outside of medicine. If you're struggling, give yourself permission to take a sick day. There's no point dragging yourself in when you aren't going to be properly concentrating. Doctors are absolutely terrible for going into work when they're unwell. It does noone any favours. Learn now to spot when you aren't well and sort it out early. Even if you're cruising along fine, don't spend more time working than you have to. If your registrar says you can leave early, do. Don't spend the holidays in the library. Having time off is vital to your emotional and physical well being.
Don't let the b*st*rds grind you down.
There are horrible people everywhere. Some of them will be in your year, some will be your seniors, some will be non-medical colleagues. Giving you a dressing down if you're rude or you really don't know your stuff is fine, but nobody should be bullying you. If they are, report it. Snide remarks, sniggering behind your back, deliberately telling you lies about teaching sessions or criticising your appearance or personality is not acceptable. People who do this are, frankly, arseholes. They're probably covering up their own insecurities by pointing out yours. They may well be jealous of how awesome you are. Either way, it's not cool. Don't let it get to you. (But if you're actually being bullied, tell someone. There is help to stop this kind of thing from happening.)
Be the best you you can, not a second-rate someone else.
This is more general life advice I suppose, but in medical school where you're surrounded by brilliant people it's easy to constantly compare yourself to other people. Try not to. The people who may seem the best at uni are not necessarily the ones who make the best doctors. Focus on your weaknesses, by all means, and work on improving them, but don't assume that anyone who really understands the kidneys or can do a super-slick neuro exam is better than you at everything. Maybe you have a really lovely manner with confused old ladies or perhaps you know intricate details of the coagulation cascade. Whatever it is, you'll have something you're awesome at too. Remember what it is you do well, feel proud of it, and work on improving other stuff so that you become the best doctor you can be, not so that you can beat someone else in an exam.
That's a very brief run-down, but those would be my top "survival" tips. Most of all, remember to enjoy it. You're on your way to doing the best job in the world, and you're going to be awesome at it.
Work hard.
Medicine is hard work. Most of it isn't intellectually particularly stretching, but there's a vast amount of stuff to learn and the majority of people will have to do a reasonable amount of work to keep on top of it. I'm not advocating becoming a hermit, but going to most of your lectures, showing up on the wards and keeping up with reading will mean exam season is far less stressful. If you have to actually learn everything from scratch, rather than just revise it, you'll be giving yourself a far more difficult task than is necessary.
Play hard.
It's also important to make the most of being a student. Go to toga parties. Play pub golf. Go clubbing whilst dressed as a giant chocolate bar or do garlic and chili body shots from the Med Soc president. Or don't, if you'd rather not. But don't feel like doing an academically demanding degree means you have to miss out on the student experience. A boss of mine once said "you can resit an exam, but you can't resit a party". I'm not sure that's the most sensible advice, but find a balance that makes you happy. Whether it's partying, music/sports/drama societies, volunteering or just reading novels and watching trashy TV, doing fun stuff is important. Keeping up with friends and enjoying yourself is an essential way of dealing with the stress you will feel from time to time. Speaking of friends, they're really important. Make sure you keep up with those outside of your course, too. Non-medics are brilliant for allowing you to properly relax and giving you a sense of perspective (medic friends are great and can relate to a lot of what you've experienced, but have an awful habit of talking shop so you don't truly escape medicine around them).
But don't forget to sleep.
Seriously, sleep is really important. When you're trying to balance partying and studying, sleep can seem like something you don't have time for, but it's essential. Everything seems worse when you haven't been sleeping well. As a medical student, you've embarked on a pretty awesome journey, but you need to be on top of your game to make the most of it.
Eat well.
OK, so it's boring, but it's another essential. If you're spending long days in lectures and then going out drinking, it can be tempting to sustain yourself on Pot Noodles and Red Bull, but there's no way you'll be at your best if you aren't getting a decent amount of vitamins, minerals, fibre etc. Sorry guys, your Mum is right about this one.
Exercise.
Similar to the above, exercise is useful for both keeping you physically at your peak and helping beat stress. As a naturally lazy person who would rather exercise by lifting a spoon from ice cream tub to mouth than go anywhere near a gym, I totally get that this is not top of some people's agendas, but it's amazing how much more energy you have after a swim or run. Even a brisk walk around the block is better than nothing.
Cry.
Sometimes you will see things that really resonate with you and upset you. This is absolutely OK. Allow yourself to be upset. Talk to a friend. Have a cry. I still get upset about cases from years ago (such as this one), Remember that if there ever comes a time when sad things don't bother you in the slightest, you probably want to think about a change of career.
Take a break.
OK, so this might go a little against what I said earlier about working hard, but it's important. Sometimes, things will get on top of you (see previous point). You might be unwell. You will have stressors in your life outside of medicine. If you're struggling, give yourself permission to take a sick day. There's no point dragging yourself in when you aren't going to be properly concentrating. Doctors are absolutely terrible for going into work when they're unwell. It does noone any favours. Learn now to spot when you aren't well and sort it out early. Even if you're cruising along fine, don't spend more time working than you have to. If your registrar says you can leave early, do. Don't spend the holidays in the library. Having time off is vital to your emotional and physical well being.
Don't let the b*st*rds grind you down.
There are horrible people everywhere. Some of them will be in your year, some will be your seniors, some will be non-medical colleagues. Giving you a dressing down if you're rude or you really don't know your stuff is fine, but nobody should be bullying you. If they are, report it. Snide remarks, sniggering behind your back, deliberately telling you lies about teaching sessions or criticising your appearance or personality is not acceptable. People who do this are, frankly, arseholes. They're probably covering up their own insecurities by pointing out yours. They may well be jealous of how awesome you are. Either way, it's not cool. Don't let it get to you. (But if you're actually being bullied, tell someone. There is help to stop this kind of thing from happening.)
Be the best you you can, not a second-rate someone else.
This is more general life advice I suppose, but in medical school where you're surrounded by brilliant people it's easy to constantly compare yourself to other people. Try not to. The people who may seem the best at uni are not necessarily the ones who make the best doctors. Focus on your weaknesses, by all means, and work on improving them, but don't assume that anyone who really understands the kidneys or can do a super-slick neuro exam is better than you at everything. Maybe you have a really lovely manner with confused old ladies or perhaps you know intricate details of the coagulation cascade. Whatever it is, you'll have something you're awesome at too. Remember what it is you do well, feel proud of it, and work on improving other stuff so that you become the best doctor you can be, not so that you can beat someone else in an exam.
That's a very brief run-down, but those would be my top "survival" tips. Most of all, remember to enjoy it. You're on your way to doing the best job in the world, and you're going to be awesome at it.
Tuesday, 30 June 2015
The Drugs Don't Work, They Just Make You Worse
From time to time, I find myself "borrowing" song lyrics to title my posts. This is in part because I'm not hugely creative and partly because I'm usually listening to music of some sort whilst I'm writing, but mostly because if someone else has said it well before, then there's little chance of me saying it better.
Trying to describe how depression feels is almost impossible. Years and years ago, when I'd never met anyone else who had depression in "real life" and my support network was almost entirely a (sadly long-gone) forum, we used to tell each other "for those who understand, no explanation is necessary; for those who don't, none will suffice". It's cliched and horribly over-used, but there was an element of comfort in realising that you'd probably never fully make other people understand how you felt, so you were as well saving your energy and not bothering. One particular thread, however, which I recall over a decade later, was entitled "The Sounds of Depression". I don't recall exactly how it started, but we started to share song lyrics (as well as other literary sources) which summed up our feelings. We were unable to express exactly how we felt, but many of our musical heroes did a fine job of it. Years after I first heard them, I find some songs are still better able to describe my feelings than any words I could write. Tonight, I'm thinking of The Verve.
"All this talk of getting old
It's getting me down, my love
Like a cat in a bag, waiting to drown
This time I'm coming down"
Some days, this is exactly what it's like. You fumble through your existence, not ever being entirely sure what the point is. The inevitable drowning that you feel sure awaits means that attempting anything seems like a waste of effort. You won't be able to get out of the bag that encloses you, so maybe it'd just be easier to succumb. Settle down, drift off to sleep and let yourself gradually suffocate. The eventual result will be the same, only with less pain in the meantime.
It's no coincidence that, as well as summing up how I sometimes feel, these lyrics are from a song called "The Drugs Don't Work". Yesterday, I read a very well-written piece by the lovely @katiehodgie about cognitive behaviour therapy and how it doesn't always work, which got me thinking about my experiences of treatment.
I've mentioned this sort of thing in the past, but in different contexts. I described my first contact with mental health services in my post on adolescent mental health. If you happened to read (or hear) the grand round I gave on the same topic, you may recognise it. That's because it was copied and pasted directly from that blog. "Suzie" was, of course, me. I don't mind if people who heard the talk guessed, but I didn't want to just stand and talk about myself openly because it felt somewhat indulgent, and may have detracted from the fact that I wanted to emphasise the importance of understanding mental health for all of our current and future patients, not just myself.
You can see that my first experiences of the psychiatric team were less than ideal. Over the many years which have passed since that appointment, I have had numerous other attempts at treatment. The list of medications I've tried resembles the formulary of a major psychiatric unit. I went for CBT and tried seeing a psychologist. I've met several psychiatrists. Despite all of this, and despite being a qualified doctor, it sometimes takes me by surprise when I remember that depression is a chronic problem. I have to remind myself, and other people, that I might dip again. It's a bit of an apology and a bit of a warning, summed up by John Mayer.
"Suppose I said
I am on my best behaviour
And there are times
I lose my worried mind
Would you want me when I'm not myself?
Wait it out while I am someone else?"
I'm never sure when the best time is to explain that I may be "not myself" for a while. Does it put people off getting to know me? Possibly. Are some people none-the-less shocked by it and unable to cope with it? Absolutely. I think this experience of negativity is one of the reasons I find myself wanting depression to be a transient phenomenon. The idea that friends won't have to "wait it out" again is appealing. Sometimes, I even believe it will happen.
When I am in a "good" phase, I convince myself it was something that happened once before, but something I am now over; a dreadful nightmare from which I have thankfully awoken. When I'm at my lowest, I am like the aforementioned cat, trapped and suffocating in a bin liner wondering when the water will finally wash over and take it all away. But there is a middle ground. The days when I first suspect it might be back. The mornings I wake inexplicably early, feeling anxious about nothing in particular. The evenings I cannot focus on whatever book I try to read. The afternoons where I suddenly feel like going out with my friends later is an insurmountable task. These are the times when I start thinking there might be an answer. Maybe another pill. Perhaps a different kind of talking therapy. Eating better, exercising more, filling my time with positive things. Maybe, this time, it will stop. Sarah McLachlan explained it pretty well.
"Spend all your time waiting
For that second chance
For a break that would make it OK"
I wonder, during these days, what it will be that makes it OK. I live in a kind of limbo, hoping that eventually I'll find and answer. Someone, somewhere will snap their fingers and it will all be OK.
In my case, the drugs do work, at least a little. The appropriate dose does mean that my eating is under better control. I have fewer binges and feel less compelled to consume everything in sight. Although I have dips, it's a long time since I put myself in any real danger or tried to do myself any sort of major harm. So, they help a bit. The psychological therapies I've tried have given me a better understanding of myself and some of my quirks, but haven't really enabled me to deal with things in a different way or had much impact on how I live my life. I have no doubt that for some people, one or a combination of treatments will actually completely cure them. For most, though, I suspect things help a little, but never make it completely go away.
I sometimes feel like it would be easier if I never experienced the better days. There are times when I start to think happiness is a myth, that I will forever experience the world through a sort of grey fuzz. During these times, I start to accept the lowness. I forgive myself for having no energy and allow myself to wallow. I stop looking longingly at "normal" people and decide that's not how I'm supposed to be. I accept that a sort of ambivalence about whether I life or die isn't too bad.
And then there are the better days. I wake up as my alarm goes off, feeling like I've had enough rest. I genuinely enjoy the simple things - my morning cuppa, a sunny drive to work, chatting to an old friend. The fog seems to have lifted. I put the bad days behind me and get on with living. And then, out of nowhere, the black dog comes again. Happening at times when I can so vividly recall normality makes it all the worse; the sheer contrast with the way things have been is brutal. I'm stealing more lyrics now, this time from James.
"Now I've swung back down again
It's worse than it was before
If I hadn't seen such riches
I could live with being poor"
This is sometimes the worst thing of all. Those good days are reminders of what I'm missing. Without them, I could almost settle into the grey and accept things. It's those good days that make me wish for a magic wand, some kind of switch to make it all go away. Of course I don't wish I didn't have good days, but sometimes I think it would all be much easier not to be reminded that there's an alternative existence out there.
If you happen to meet me on a grey day, you may not notice. But if you do, if I seem distant or like I'm not listening, or if I make excuses not to meet you, please don't take it personally. Bear with me. I'll have another good day eventually. Matchbox 20 explain it better than I do.
"I'm not crazy, I'm just a little unwell
I know right now you can't tell
But stay awhile and maybe then you'll see
A different side of me"
Trying to describe how depression feels is almost impossible. Years and years ago, when I'd never met anyone else who had depression in "real life" and my support network was almost entirely a (sadly long-gone) forum, we used to tell each other "for those who understand, no explanation is necessary; for those who don't, none will suffice". It's cliched and horribly over-used, but there was an element of comfort in realising that you'd probably never fully make other people understand how you felt, so you were as well saving your energy and not bothering. One particular thread, however, which I recall over a decade later, was entitled "The Sounds of Depression". I don't recall exactly how it started, but we started to share song lyrics (as well as other literary sources) which summed up our feelings. We were unable to express exactly how we felt, but many of our musical heroes did a fine job of it. Years after I first heard them, I find some songs are still better able to describe my feelings than any words I could write. Tonight, I'm thinking of The Verve.
"All this talk of getting old
It's getting me down, my love
Like a cat in a bag, waiting to drown
This time I'm coming down"
Some days, this is exactly what it's like. You fumble through your existence, not ever being entirely sure what the point is. The inevitable drowning that you feel sure awaits means that attempting anything seems like a waste of effort. You won't be able to get out of the bag that encloses you, so maybe it'd just be easier to succumb. Settle down, drift off to sleep and let yourself gradually suffocate. The eventual result will be the same, only with less pain in the meantime.
It's no coincidence that, as well as summing up how I sometimes feel, these lyrics are from a song called "The Drugs Don't Work". Yesterday, I read a very well-written piece by the lovely @katiehodgie about cognitive behaviour therapy and how it doesn't always work, which got me thinking about my experiences of treatment.
I've mentioned this sort of thing in the past, but in different contexts. I described my first contact with mental health services in my post on adolescent mental health. If you happened to read (or hear) the grand round I gave on the same topic, you may recognise it. That's because it was copied and pasted directly from that blog. "Suzie" was, of course, me. I don't mind if people who heard the talk guessed, but I didn't want to just stand and talk about myself openly because it felt somewhat indulgent, and may have detracted from the fact that I wanted to emphasise the importance of understanding mental health for all of our current and future patients, not just myself.
You can see that my first experiences of the psychiatric team were less than ideal. Over the many years which have passed since that appointment, I have had numerous other attempts at treatment. The list of medications I've tried resembles the formulary of a major psychiatric unit. I went for CBT and tried seeing a psychologist. I've met several psychiatrists. Despite all of this, and despite being a qualified doctor, it sometimes takes me by surprise when I remember that depression is a chronic problem. I have to remind myself, and other people, that I might dip again. It's a bit of an apology and a bit of a warning, summed up by John Mayer.
"Suppose I said
I am on my best behaviour
And there are times
I lose my worried mind
Would you want me when I'm not myself?
Wait it out while I am someone else?"
I'm never sure when the best time is to explain that I may be "not myself" for a while. Does it put people off getting to know me? Possibly. Are some people none-the-less shocked by it and unable to cope with it? Absolutely. I think this experience of negativity is one of the reasons I find myself wanting depression to be a transient phenomenon. The idea that friends won't have to "wait it out" again is appealing. Sometimes, I even believe it will happen.
When I am in a "good" phase, I convince myself it was something that happened once before, but something I am now over; a dreadful nightmare from which I have thankfully awoken. When I'm at my lowest, I am like the aforementioned cat, trapped and suffocating in a bin liner wondering when the water will finally wash over and take it all away. But there is a middle ground. The days when I first suspect it might be back. The mornings I wake inexplicably early, feeling anxious about nothing in particular. The evenings I cannot focus on whatever book I try to read. The afternoons where I suddenly feel like going out with my friends later is an insurmountable task. These are the times when I start thinking there might be an answer. Maybe another pill. Perhaps a different kind of talking therapy. Eating better, exercising more, filling my time with positive things. Maybe, this time, it will stop. Sarah McLachlan explained it pretty well.
"Spend all your time waiting
For that second chance
For a break that would make it OK"
I wonder, during these days, what it will be that makes it OK. I live in a kind of limbo, hoping that eventually I'll find and answer. Someone, somewhere will snap their fingers and it will all be OK.
In my case, the drugs do work, at least a little. The appropriate dose does mean that my eating is under better control. I have fewer binges and feel less compelled to consume everything in sight. Although I have dips, it's a long time since I put myself in any real danger or tried to do myself any sort of major harm. So, they help a bit. The psychological therapies I've tried have given me a better understanding of myself and some of my quirks, but haven't really enabled me to deal with things in a different way or had much impact on how I live my life. I have no doubt that for some people, one or a combination of treatments will actually completely cure them. For most, though, I suspect things help a little, but never make it completely go away.
I sometimes feel like it would be easier if I never experienced the better days. There are times when I start to think happiness is a myth, that I will forever experience the world through a sort of grey fuzz. During these times, I start to accept the lowness. I forgive myself for having no energy and allow myself to wallow. I stop looking longingly at "normal" people and decide that's not how I'm supposed to be. I accept that a sort of ambivalence about whether I life or die isn't too bad.
And then there are the better days. I wake up as my alarm goes off, feeling like I've had enough rest. I genuinely enjoy the simple things - my morning cuppa, a sunny drive to work, chatting to an old friend. The fog seems to have lifted. I put the bad days behind me and get on with living. And then, out of nowhere, the black dog comes again. Happening at times when I can so vividly recall normality makes it all the worse; the sheer contrast with the way things have been is brutal. I'm stealing more lyrics now, this time from James.
"Now I've swung back down again
It's worse than it was before
If I hadn't seen such riches
I could live with being poor"
This is sometimes the worst thing of all. Those good days are reminders of what I'm missing. Without them, I could almost settle into the grey and accept things. It's those good days that make me wish for a magic wand, some kind of switch to make it all go away. Of course I don't wish I didn't have good days, but sometimes I think it would all be much easier not to be reminded that there's an alternative existence out there.
If you happen to meet me on a grey day, you may not notice. But if you do, if I seem distant or like I'm not listening, or if I make excuses not to meet you, please don't take it personally. Bear with me. I'll have another good day eventually. Matchbox 20 explain it better than I do.
"I'm not crazy, I'm just a little unwell
I know right now you can't tell
But stay awhile and maybe then you'll see
A different side of me"
Friday, 2 January 2015
Frequent Flyers
As it's winter, we are once again inundated with headlines about the impending NHS "disaster". There are no beds, more and more people are turning up at A&E and services simply can't cope. There is, of course, some truth in this. A particularly cold winter or an unusually aggressive strain of influenza can result on unexpected pressure on health-care services. That said, services are almost always under more pressure in winter so I'm not sure why the press jump on this like it's a new phenomenon.
As the pressure on health-care services mounts, people naturally start looking for "quick fixes" in order to relieve this. Recently, there has been a lot of talk about "frequent flyers" - an unpleasant term used to refer to patients who access health-care services more than others. There is a suggestion going around that if these greedy so-and-sos learned to self-manage better, the NHS would be in much better shape.
Although I've only been a qualified doctor for 2 and a half years, I've met a number of so-called frequent flyers. I recall a young girl with cystic fibrosis who I looked after during my respiratory rotation who had multiple admissions during the 4 months I worked there. I'm pretty sure that if she had an option, she wouldn't have been in hospital, but multiple spontaneous pneumothoraces are pretty hard to manage at home. There was a middle-aged gentleman who I met during my gastroenterology job. Despite everyone's best efforts, flares of his inflammatory bowel disease repeatedly landed him in hospital. Now I'm working in paediatrics, I can think of several patients who bounce in and out of hospital. A viral upper respiratory tract infection is generally something that can be managed at home, but if you have a rare metabolic disorder, chronic lung disease or a complex cardiac condition then it can be deadly. I can't think of a single "frequent flyer" who had multiple admissions for any reason other than that they were unlucky enough to have an unpleasant chronic disease.
Yes, keeping frequent flyers out of hospital would definitely relieve pressure on hospitals. Now, if the people who come up with these soundbites could come up with the medical advances required to cure these patients so that they don't need to keep coming in to hospital, then that would be wonderful. I'm pretty sure the patients would appreciate it too. In the meantime, let's stop blaming patients for pressure on our services and look at ways to better deal with increased demand.
As the pressure on health-care services mounts, people naturally start looking for "quick fixes" in order to relieve this. Recently, there has been a lot of talk about "frequent flyers" - an unpleasant term used to refer to patients who access health-care services more than others. There is a suggestion going around that if these greedy so-and-sos learned to self-manage better, the NHS would be in much better shape.
Although I've only been a qualified doctor for 2 and a half years, I've met a number of so-called frequent flyers. I recall a young girl with cystic fibrosis who I looked after during my respiratory rotation who had multiple admissions during the 4 months I worked there. I'm pretty sure that if she had an option, she wouldn't have been in hospital, but multiple spontaneous pneumothoraces are pretty hard to manage at home. There was a middle-aged gentleman who I met during my gastroenterology job. Despite everyone's best efforts, flares of his inflammatory bowel disease repeatedly landed him in hospital. Now I'm working in paediatrics, I can think of several patients who bounce in and out of hospital. A viral upper respiratory tract infection is generally something that can be managed at home, but if you have a rare metabolic disorder, chronic lung disease or a complex cardiac condition then it can be deadly. I can't think of a single "frequent flyer" who had multiple admissions for any reason other than that they were unlucky enough to have an unpleasant chronic disease.
Yes, keeping frequent flyers out of hospital would definitely relieve pressure on hospitals. Now, if the people who come up with these soundbites could come up with the medical advances required to cure these patients so that they don't need to keep coming in to hospital, then that would be wonderful. I'm pretty sure the patients would appreciate it too. In the meantime, let's stop blaming patients for pressure on our services and look at ways to better deal with increased demand.
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.
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.
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)
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)
Friday, 22 November 2013
Empathy
empathy, n.
Pronunciation: /ˈɛmpəθɪ/
The power of projecting one's personality into (and so fully comprehending) the object of contemplation.
Definition from the Oxford English Dictionary
Following on from my recent quality improvement blog, I've been thinking a lot about patient centredness and what patient centred care really means. I stated (probably more than was strictly necessary) that I believed that so long as we aimed to provide high quality patient care, quality improvement would naturally occur. I also used a definition of quality which included the term patient centred. I think, therefore, that it is pretty important to reflect on what patient centredness actually is.
I don't actually think patient centred care is a difficult concept. It's all about providing care which focuses on the patient and what they both want and need. What is trickier is working out how to go about actually doing this.
At this point, I'd like to share a favourite video of mine. It's from the Cleveland Clinic in Ohio and, like many things I am likely to blog about, I was first shown it during my MSc teaching. It is slightly "American" in tone, so for those of you who feel you'd prefer a "British" alternative, there is a very similar version produced by Wrightington, Wigan and Leigh NHS Foundation Trust. Both videos end with a quote: "If you knew how they felt, would you treat them differently?".
I don't know who first said "Everyone you meet is fighting a battle you know nothing about. Be kind, always" - it's been attributed to so many people, from Plato to the Dalai Lama. Regardless, I think it sums up the essence of those videos nicely. It is all too easy see a patient's illness in isolation, without considering what else may be happening in someones life. If you don't at least attempt to understand an illness in the context of a patient's wider life, how can you even attempt to work out what they want and need from their healthcare interaction?
I think that really, empathy is what patient-centred care is all about. The most important person in any healthcare setting is the patient. Empathy is a crucial quality for any healthcare professional to possess. Without it, ascertaining what a patient wants and needs (and therefore providing patient centred care) becomes almost impossible.
I'll end this post with a challenge: next time you're about to get frustrated with a patient who has turned up late to an appointment or not taken their medications as directed, just stop and think about what else could be going on in their lives.
Pronunciation: /ˈɛmpəθɪ/
The power of projecting one's personality into (and so fully comprehending) the object of contemplation.
Definition from the Oxford English Dictionary
Following on from my recent quality improvement blog, I've been thinking a lot about patient centredness and what patient centred care really means. I stated (probably more than was strictly necessary) that I believed that so long as we aimed to provide high quality patient care, quality improvement would naturally occur. I also used a definition of quality which included the term patient centred. I think, therefore, that it is pretty important to reflect on what patient centredness actually is.
I don't actually think patient centred care is a difficult concept. It's all about providing care which focuses on the patient and what they both want and need. What is trickier is working out how to go about actually doing this.
At this point, I'd like to share a favourite video of mine. It's from the Cleveland Clinic in Ohio and, like many things I am likely to blog about, I was first shown it during my MSc teaching. It is slightly "American" in tone, so for those of you who feel you'd prefer a "British" alternative, there is a very similar version produced by Wrightington, Wigan and Leigh NHS Foundation Trust. Both videos end with a quote: "If you knew how they felt, would you treat them differently?".
I don't know who first said "Everyone you meet is fighting a battle you know nothing about. Be kind, always" - it's been attributed to so many people, from Plato to the Dalai Lama. Regardless, I think it sums up the essence of those videos nicely. It is all too easy see a patient's illness in isolation, without considering what else may be happening in someones life. If you don't at least attempt to understand an illness in the context of a patient's wider life, how can you even attempt to work out what they want and need from their healthcare interaction?
I think that really, empathy is what patient-centred care is all about. The most important person in any healthcare setting is the patient. Empathy is a crucial quality for any healthcare professional to possess. Without it, ascertaining what a patient wants and needs (and therefore providing patient centred care) becomes almost impossible.
I'll end this post with a challenge: next time you're about to get frustrated with a patient who has turned up late to an appointment or not taken their medications as directed, just stop and think about what else could be going on in their lives.
Tuesday, 6 August 2013
FY1 in blog form!
How time flies - I have just got home from my last shift as an FY1! As I mentioned earlier,
I was one of the poor sods who started on nights. This seems to be a
pattern for me - as I started my second job on nights too, and tomorrow I
start my first FY2 job on nights... Despite this run of frankly
appalling luck in the rota department (I also did long day Christmas day
and nights over New Year), I have had a pretty good year. I have no doubt that newly qualified doctors up and down the country are now anxiously preparing for starting work tomorrow, so I thought I'd write down a few survival tips which I've found useful.
In no particular order, my #tipsfornewdocs
- Ask where things are early on. In a difficult/stressful situation with a sick patient, you don't want to be running around like a headless chicken trying to locate the ECG machine/resus trolley/cannulating equipment etc. Hopefully all of the new FY1s will have done some shadowing on the wards they will be working on so should know this, but for future jobs, find out where all useful things are as soon as you possibly can.
- When a consultant/registrar asks you to request an investigation, clarify exactly what they are looking for. You are unlikely to convince radiology to perform a CT scan unless you have a very good reason - and "my consultant asked for it" is not a good reason!
- If inserting a new cannula or taking a gentamicin level at 5am, check whether the patient is due any other bloods in the morning - they'll thank you for taking them off at the same time and avoiding them being stabbed a second time!
- Find time to eat/drink. You may think you're being efficient by working through lunch but if you then end up fainting and having to go home or being admitted to hospital with urosepsis (and yes, those things have happened to F1s I know) things will be a whole lot more behind than if you'd just taken 20 minutes to have a sandwich and a coffee.
- Keep up with your friends and maintain a social life. Sometimes rotas will mean you don't see friends for months at a time, and working nights and weekends means you'll have to turn down invitations to nights out. Make an effort to socialise when you can. Whilst I wouldn't advocate getting horrifically drunk the night before a shift, popping out for an hour or two rather than missing out entirely may just keep you sane.
- Invest in some decent curtains. There is nothing worse than being exhausted between night shifts but not being able to sleep because it's too bright.
- Be nice to the nurses. Sometimes you won't see eye to eye on things, but be polite and friendly anyway. They're the ones who can make your life a misery if they so choose! Also, they're often very experienced and will have a good idea of what particular consultants like doing in certain situations, so befriend them and listen to their suggestions.
- Feed people. Specifically, your senior colleagues. If you become known for bringing in cupcakes or sweets on a regular basis, people tend to look more favourably upon you.
- If you are asking for an urgent review from another specialty, saying you're phoning on behalf of Prof/Dr/Mr Consultant gets you taken a whole lot more seriously than just saying you're the FY1 (once resulted in the grumpy neuro reg sending his consultant to review someone in 20 minutes).
I'm sure I'll think of many more - feel free to leave other suggestions as comments and I'll edit this and add them in (with credit to the author).
Best of luck to everyone in their new jobs tomorrow, but especially the new FY1s - you'll be great!
In no particular order, my #tipsfornewdocs
- Ask where things are early on. In a difficult/stressful situation with a sick patient, you don't want to be running around like a headless chicken trying to locate the ECG machine/resus trolley/cannulating equipment etc. Hopefully all of the new FY1s will have done some shadowing on the wards they will be working on so should know this, but for future jobs, find out where all useful things are as soon as you possibly can.
- When a consultant/registrar asks you to request an investigation, clarify exactly what they are looking for. You are unlikely to convince radiology to perform a CT scan unless you have a very good reason - and "my consultant asked for it" is not a good reason!
- If inserting a new cannula or taking a gentamicin level at 5am, check whether the patient is due any other bloods in the morning - they'll thank you for taking them off at the same time and avoiding them being stabbed a second time!
- Find time to eat/drink. You may think you're being efficient by working through lunch but if you then end up fainting and having to go home or being admitted to hospital with urosepsis (and yes, those things have happened to F1s I know) things will be a whole lot more behind than if you'd just taken 20 minutes to have a sandwich and a coffee.
- Keep up with your friends and maintain a social life. Sometimes rotas will mean you don't see friends for months at a time, and working nights and weekends means you'll have to turn down invitations to nights out. Make an effort to socialise when you can. Whilst I wouldn't advocate getting horrifically drunk the night before a shift, popping out for an hour or two rather than missing out entirely may just keep you sane.
- Invest in some decent curtains. There is nothing worse than being exhausted between night shifts but not being able to sleep because it's too bright.
- Be nice to the nurses. Sometimes you won't see eye to eye on things, but be polite and friendly anyway. They're the ones who can make your life a misery if they so choose! Also, they're often very experienced and will have a good idea of what particular consultants like doing in certain situations, so befriend them and listen to their suggestions.
- Feed people. Specifically, your senior colleagues. If you become known for bringing in cupcakes or sweets on a regular basis, people tend to look more favourably upon you.
- If you are asking for an urgent review from another specialty, saying you're phoning on behalf of Prof/Dr/Mr Consultant gets you taken a whole lot more seriously than just saying you're the FY1 (once resulted in the grumpy neuro reg sending his consultant to review someone in 20 minutes).
I'm sure I'll think of many more - feel free to leave other suggestions as comments and I'll edit this and add them in (with credit to the author).
Best of luck to everyone in their new jobs tomorrow, but especially the new FY1s - you'll be great!
Sunday, 23 June 2013
The Impact Factor
As a budding academic, I hear all too often about the importance of the 'impact factor'; that is, how likely articles from a journal are to be referenced in a later article. It's a somewhat controversial measure of how "good" a journal is, but the journals with the biggest reputations (eg Science, Nature) do seem to have the highest impact factors anyway. Frankly, at my stage, I'm still happy enough if anyone seems interested in publishing something I've been involved in writing so it doesn't particularly bother me if the impact factor is 0.01, but no doubt if things progress then at some point I'll probably have to start choosing to submit to higher impact journals.
Despite just writing a paragraph about it, this blog entry wasn't meant to be about the impact of journals and articles. It was about the impact we have on patients. Sometimes, I think it's easy to get wrapped up in the numbers and figures. A busy day of surgical receiving becomes 4 query appendicitis, 6 diverticulitis, a renal colic, the stab wound in A&E and 3 from GP still to be seen. Another 5 blood results awaited, 3 abdominal films to chase and would radiology please hurry up and report that CT scan. Yes, we care about our patients deeply, but sometimes what we do becomes so routine that we may forget that although this is our 24th acute abdomen, for the patient it's the first time in hospital or the most terrifying thing they've ever experienced. Even for those patients who we see regularly - the chronic pancreatitis after another alcohol binge, the poorly controlled Crohn's disease desperate to avoid a stoma - their interaction with the health service is likely to have a significantly greater impact on them than it does on us.
I was recently in a bar with a colleague when a lady approached us. "I know you" she said to him. He looked momentarily embarrassed and I assumed he had no idea who she was. Her next sentence took me (although I suspect not him) by surprise. "You're the doctor who saved my husband's life". I didn't go into details with him about what had happened, but it was clear that in the course of going about his daily work he had made a huge difference to this family (and, I suspect, many others). She was very pleasant, updated him with how things were, wished us a good night (and said it was great to see that doctors were humans who you saw drinking in pubs in town like normal people - but that's definitely a different topic...) and went on her way. I was surprised by how very uncomfortable my colleague seemed with this. He muttered something about "just doing my job" to me and returned to his pint.
The "just a job" attitude is an incredibly difficult one to get right. After more and more guidelines about what we can say on Twitter or the photos we shouldn't put on Facebook, many doctors have become fed up with the constant attempts to control our out of work lives. This has resulted in many of us (myself included) taking the staunch position of "it's only a job". I don't think that this is wrong. I go to work, do my job and hopefully do it well, and then I go home to the kind of social life I choose. I don't believe that drinking more than my recommended alcohol intake or (god forbid) having a cheeky cigarette makes me less competent at what I do. Where this attitude falls down, though, is that it makes us more likely to forget how important what we do is. We're privileged enough to be involved in some of the most important times of families' lives. Let's not forget the impact each of our interactions will have on a patient and their loved ones.
Sunday, 7 April 2013
2 Out Of 3 Ain't Bad...
Or so Meatloaf would have us believe.
Despite what my blog would have you believe, I have actually really enjoyed my first 8 months of working.
My first job, which was in medicine, was tough as there wasn't a lot of senior support and out of hours there was sometimes noone to call other than the consultant if I had concerns - something quite intimidating for a newly qualified junior. However, I worked with mostly lovely people, learned absolutely loads and felt like I really developed as a doctor.
My second job (the one I finished last week) was also medical, and was fantastic. There were a few issues, mostly with other juniors not pulling their weight, but that aside I loved it. I got on especially well with one of the registrars and 2 of the SHOs, but all of my seniors were fantastic. Again, I learned lots and am definitely much more confident in my abilities than I was before I started. I also had chance to get involved with some research, which is great given my academic ambitions.
And now, I have most to general surgery. Eugh. Despite not wanting to be a surgeon, I had thought I would enjoy this rotation. Numerous friends who are medics through and through had told me how much they'd loved their FY1 surgical post. I don't think I will be jumping on that bandwagon though.
A few months ago, I was chatting on Twitter about how I felt I needed to revise some surgery, as after 8 months working in medicine I was a bit rusty. A surgeon on there, who I get on with pretty well, had said I didn't need to know any surgery. I totally unintentionally upset him but saying that I wanted to be able to suggest differentials for emergency admissions so I could order appropriate investigations. I was genuinely confused when he was so angered by my comment that surely I ought to be ordering targetted investigations to confirm or refute a diagnosis and not just going on a fishing trip for information. After all, that's what we were repeatedly taught throughout medical school and it was definitely the case in my medical jobs. It appears that things are slightly different in the surgical world. At induction for this job, we were told that everyone gets the same set of tests ordered and we shouldn't try to work out which were indicated and which weren't - and then I realised that my comment on Twitter had unwittingly criticised the way huge numbers of surgeons expect their juniors to behave (and by implication, criticised them I suppose). It's a big change in the way I think.
I am struggling with the mindlessness involved in this job. A few days in, and I have already discovered that "chase the bloods" literally means "write the results down in a folder". In my previous jobs, I would have been criticised for not acting on results. Now, I'm not expected to act on anything. Yesterday I was chastised for prescribing further NaCl for a patient who had already received several bags. No-one cared that my reason for doing so was that the patient was (still) borderline hyponatraemic and I had checked the blood results before deciding which fluids to write up. It seems I shouldn't try to use my brain, I should just write everyone up for Hartmans, Hartmans, Hartmans.
Of course, there is the distinct possibility that my seniors are just being super-cautious because I have only just started working there. Maybe I will discover that, actually, I am quite happy doing this repetitive kind of work once I adjust to the change. I could settle in and find that actually I love my new job. If not, I've enjoyed 2 of my 3 FY1 jobs. And 2 out of 3 ain't bad.
Despite what my blog would have you believe, I have actually really enjoyed my first 8 months of working.
My first job, which was in medicine, was tough as there wasn't a lot of senior support and out of hours there was sometimes noone to call other than the consultant if I had concerns - something quite intimidating for a newly qualified junior. However, I worked with mostly lovely people, learned absolutely loads and felt like I really developed as a doctor.
My second job (the one I finished last week) was also medical, and was fantastic. There were a few issues, mostly with other juniors not pulling their weight, but that aside I loved it. I got on especially well with one of the registrars and 2 of the SHOs, but all of my seniors were fantastic. Again, I learned lots and am definitely much more confident in my abilities than I was before I started. I also had chance to get involved with some research, which is great given my academic ambitions.
And now, I have most to general surgery. Eugh. Despite not wanting to be a surgeon, I had thought I would enjoy this rotation. Numerous friends who are medics through and through had told me how much they'd loved their FY1 surgical post. I don't think I will be jumping on that bandwagon though.
A few months ago, I was chatting on Twitter about how I felt I needed to revise some surgery, as after 8 months working in medicine I was a bit rusty. A surgeon on there, who I get on with pretty well, had said I didn't need to know any surgery. I totally unintentionally upset him but saying that I wanted to be able to suggest differentials for emergency admissions so I could order appropriate investigations. I was genuinely confused when he was so angered by my comment that surely I ought to be ordering targetted investigations to confirm or refute a diagnosis and not just going on a fishing trip for information. After all, that's what we were repeatedly taught throughout medical school and it was definitely the case in my medical jobs. It appears that things are slightly different in the surgical world. At induction for this job, we were told that everyone gets the same set of tests ordered and we shouldn't try to work out which were indicated and which weren't - and then I realised that my comment on Twitter had unwittingly criticised the way huge numbers of surgeons expect their juniors to behave (and by implication, criticised them I suppose). It's a big change in the way I think.
I am struggling with the mindlessness involved in this job. A few days in, and I have already discovered that "chase the bloods" literally means "write the results down in a folder". In my previous jobs, I would have been criticised for not acting on results. Now, I'm not expected to act on anything. Yesterday I was chastised for prescribing further NaCl for a patient who had already received several bags. No-one cared that my reason for doing so was that the patient was (still) borderline hyponatraemic and I had checked the blood results before deciding which fluids to write up. It seems I shouldn't try to use my brain, I should just write everyone up for Hartmans, Hartmans, Hartmans.
Of course, there is the distinct possibility that my seniors are just being super-cautious because I have only just started working there. Maybe I will discover that, actually, I am quite happy doing this repetitive kind of work once I adjust to the change. I could settle in and find that actually I love my new job. If not, I've enjoyed 2 of my 3 FY1 jobs. And 2 out of 3 ain't bad.
Sunday, 12 August 2012
Working Girl
Apologies for the unintentional hiatus in posting recently. Things have been rather busy recently. I have moved into a new flat, graduated, been away for a week and started work since I last posted (there's also a boy on the scene but I shan't bore you with the details).
My graduation was absolutely lovely. I was lucky enough to graduate on the one day where it wasn't absolutely tipping it down with rain. Lots of close friends were there and it was a very happy occasion with plenty of wine and Pimm's too. The icing on the cake was my friend's boyfriend proposing to her just after the ceremony - very exciting and I'm delighted for them :-)
I've also had another week away with Over The Wall. Anyone who has read my posts from last summer will be aware that I'm something of an OTW evangelist. Once again I had an amazing week and met some really inspiring kids. I hope I can arrange my leave/days off so that I'm able to go next year - I'd be absolutely gutted if I couldn't. After a wonderful but tiring and emotionally draining week, it's sometimes easy to forget the real reason we do this, but the comments from some of the kids and their parents after they'd got back just sum it up so well. These are two of the quotes which really made this year worthwhile for me.
"I have just recently came back from the 2012 Tulliallan "over the wall" camp, i would just like to say thank you now because i did not have time to do it before i left.
Thank you for.....
Helping me push myself beyond myself beyond my limits
Making me enjoy at first seemingly immature songs :).
Letting me feel Normal for once"
"Thank you so much for letting me join you again this summer, for another amazing camp. This past week has been the best week of my life. I will never forget the laughs, songs, the dances, the tears (emotional/happy ones!), and the memories that have come out of it. I have met some fantastic people that will inspire me everyday for the rest of my life. It is truly impossible to put an Over The Wall camp into words. From the staff and volunteers, to the campers: every single person at Over The Wall is just incredible. Your camps are the highlight of my year and heaven on earth for me. I look forward to seeing the photos that were taken this past week, which I will treasure forever. Leaving camp this morning was so difficult and emotional for me - but that shows what a great time I've had there.
What you do is wonderful.
Thank you."
I'm feeling quite emotional reading those back. I know both the kids who wrote them and they are really wonderful young people who have overcome some really tough challenges but are none-the-less bright, talented, enthusiastic and kind.
I could talk about camp all day (in fact, I pretty much do) but I should move on to what I imagine is more exciting for most people who read this: starting work!
I was one of the slightly unfortunate people who drew the short straw and my first ever shift was a night shift. Although it was pretty nerve-wracking and hard going, I feel like in only two shifts I learnt an awful lot and am already much more confident than I was before starting. I've also now done 5 day shifts on the ward where I'm based. I'm quite lucky in that the other doctors are very supportive and helpful and our consultants are happy to be contacted if we have any queries or concerns. The nurses, therapists etc are also all lovely, which makes the whole process of settling into the job a lot easier.
Without giving away anything confidential, I have seen and done a real mixture of stuff. I was really worried about practical procedures as my last student placements didn't offer much opportunity for practising, however, I have successfully managed venepuncture, cannulation, arterial blood gas sampling and catheterisation in the past week. Hopefully this means that my colleagues won't think I'm incompetent should I struggle with a few difficult patients in future. I have also confirmed death and filled in death certificates - rather morbid but something every junior doctor needs to get used to doing.
Whilst it's true that being an FY1/JHO/lowest of the low is largely about organisation and paperwork rather than medicine, I have found I've had plenty of opportunities to assess sick patients, prescribe, examine and generally use my brain - something I was worried wouldn't be the case. In true Learnaholic fashion, I have also found myself some research to be getting on with, and my MSc starts in October.
Right, I must head to bed as tomorrow is day 1 of 12 and I need to get enough sleep!
Goodnight xxx
My graduation was absolutely lovely. I was lucky enough to graduate on the one day where it wasn't absolutely tipping it down with rain. Lots of close friends were there and it was a very happy occasion with plenty of wine and Pimm's too. The icing on the cake was my friend's boyfriend proposing to her just after the ceremony - very exciting and I'm delighted for them :-)
I've also had another week away with Over The Wall. Anyone who has read my posts from last summer will be aware that I'm something of an OTW evangelist. Once again I had an amazing week and met some really inspiring kids. I hope I can arrange my leave/days off so that I'm able to go next year - I'd be absolutely gutted if I couldn't. After a wonderful but tiring and emotionally draining week, it's sometimes easy to forget the real reason we do this, but the comments from some of the kids and their parents after they'd got back just sum it up so well. These are two of the quotes which really made this year worthwhile for me.
"I have just recently came back from the 2012 Tulliallan "over the wall" camp, i would just like to say thank you now because i did not have time to do it before i left.
Thank you for.....
Helping me push myself beyond myself beyond my limits
Making me enjoy at first seemingly immature songs :).
Letting me feel Normal for once"
"Thank you so much for letting me join you again this summer, for another amazing camp. This past week has been the best week of my life. I will never forget the laughs, songs, the dances, the tears (emotional/happy ones!), and the memories that have come out of it. I have met some fantastic people that will inspire me everyday for the rest of my life. It is truly impossible to put an Over The Wall camp into words. From the staff and volunteers, to the campers: every single person at Over The Wall is just incredible. Your camps are the highlight of my year and heaven on earth for me. I look forward to seeing the photos that were taken this past week, which I will treasure forever. Leaving camp this morning was so difficult and emotional for me - but that shows what a great time I've had there.
What you do is wonderful.
Thank you."
I'm feeling quite emotional reading those back. I know both the kids who wrote them and they are really wonderful young people who have overcome some really tough challenges but are none-the-less bright, talented, enthusiastic and kind.
I could talk about camp all day (in fact, I pretty much do) but I should move on to what I imagine is more exciting for most people who read this: starting work!
I was one of the slightly unfortunate people who drew the short straw and my first ever shift was a night shift. Although it was pretty nerve-wracking and hard going, I feel like in only two shifts I learnt an awful lot and am already much more confident than I was before starting. I've also now done 5 day shifts on the ward where I'm based. I'm quite lucky in that the other doctors are very supportive and helpful and our consultants are happy to be contacted if we have any queries or concerns. The nurses, therapists etc are also all lovely, which makes the whole process of settling into the job a lot easier.
Without giving away anything confidential, I have seen and done a real mixture of stuff. I was really worried about practical procedures as my last student placements didn't offer much opportunity for practising, however, I have successfully managed venepuncture, cannulation, arterial blood gas sampling and catheterisation in the past week. Hopefully this means that my colleagues won't think I'm incompetent should I struggle with a few difficult patients in future. I have also confirmed death and filled in death certificates - rather morbid but something every junior doctor needs to get used to doing.
Whilst it's true that being an FY1/JHO/lowest of the low is largely about organisation and paperwork rather than medicine, I have found I've had plenty of opportunities to assess sick patients, prescribe, examine and generally use my brain - something I was worried wouldn't be the case. In true Learnaholic fashion, I have also found myself some research to be getting on with, and my MSc starts in October.
Right, I must head to bed as tomorrow is day 1 of 12 and I need to get enough sleep!
Goodnight xxx
Sunday, 17 June 2012
Dr Learnaholic, at your service
That's right, I have passed finals and am thus Doctor Learnaholic! Extremely happy and relieved to have got to this point after seven years of pretty hard slog at university. I will be starting work as a very, very junior doctor on July 31st, with a week of shadowing beforehand. This also means that I've got on to my MSc (in paediatrics and child health), which I'll be doing part time over the next couple of years. Well, I need to justify calling myself the learnaholic, don't I?!!!
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