I've written before on the sadder parts of working in paediatrics, and how I think it's ok to find it upsetting (it's entirely coincidence that I wrote that post exactly one year ago). As I've got more senior and been more directly involved with patient care and decision making, I've found that the harder parts of my job have got, at times, even tougher.
I am quite involved with the medical student paediatric society (hi LUMPS) and as part of this I mentor students who are interested in paediatrics. One of the commonest questions they ask is "how do you cope with the sad bits?" - most commonly they wonder how I deal with deaths and child protection issues. The honest answer is that I'm not sure I do, at least not in any way that I can really express to anyone else. Paediatricians, on the whole, are a pretty nice bunch, so there's always lots of peer support. Even very senior and experience colleagues still get upset by horrible things happening, and the general consensus is that it's ok to be sad when sad things happen. Still, I find myself wondering whether it's "professional" to be upset by things I see at work.
Is it ok to feel sad when you see a child who has had injuries inflicted by their own family? Is it wrong to cry when a baby you've looked after since their birth passes away? Do these emotions, or expressing them, make me a bad doctor? I'm a naturally self-critical person and so tend to feel like anything I do, say or feel is an indicator of how terrible I am, and I guess this is just another example of this. In reality, I suspect being upset about a patient is no bad thing, as long as it doesn't influence how you treat the next one. So cry, take 5 minutes for a cup of tea, go home after your shift and have a glass of wine, do whatever you need to. But when the next patient comes along, they deserve the same care and attention as all the rest.
It's not unprofessional to be sad. But it is unprofessional to let that sadness affect the care you provide to others.
Showing posts with label Stress. Show all posts
Showing posts with label Stress. Show all posts
Friday, 7 April 2017
Monday, 10 October 2016
World Mental Health Day
Today, 10th October, is apparently World Mental Health Day. The World Health Organisation apparently endorse this, and I guess it's one of campaigns aiming to raise awareness of mental health and illness globally.
I always find the concept of a topic as vast as mental health being squashed together in one day a little odd, but although there are a vast number of mental health issues which are lumped together under one heading, they do have something in common and I can't criticise anything aiming to improve people's awareness of such a common and yet seldom discussed group of problems.
Any regular readers of my blog will be aware that my own mental health issues are longstanding so I can't pretend I don't have a personal stake in this. For that reason, I always feel slightly guilty pushing the mental health agenda. However, it's an important issue that will affect 1 in 4 of us (I think that's probably a conservative estimate) so I won't avoid talking about it.
My first experiences with mental health problems were back when I was a teenager. The support I received was less than ideal, my parents and school didn't really understand what was happening or how best to help me and even the professionals I encountered seemed out of their depth. A lot of my experiences were covered in this pseudo-anonymous post, which I initially wrote as a presentation to give at work. It's now nearly 15 years since that first consultation in that dreadful old building and I still remember it vividly. I can't ever change that, but I hope that when I meet young people in my professional life who are struggling, they remember their encounter with healthcare in a more positive way - someone cared, someone listened.
Unfortunately, it's not just a teenage problem. Although it's pretty common for mental health difficulties to begin in adolescence, they frequently persist into adulthood. Mine certainly have. Despite my struggles, though, I'm doing ok. I'm in a stable relationship. I'm holding down a (fairly intense at times!) job. Not everyone is so lucky. Mental illness is one of the most common reasons for claiming incapacity benefit. Plenty of people struggle and suffer, and yet stigma still persists.
Once again, my blog has become a ramble with no real direction or structure. I'm not sure it says much. But, if you're reading this and you're struggling, you aren't alone. Help is out there. And remember that just because you've been unfortunate enough to get unwell, doesn't mean you aren't awesome.
-----------------------------------------------------------------------------------------------------------------------------------------------
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 at all times.
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.
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.
Men with any difficulties can use the online chat/email service here
If you're struggling with an eating disorder, Beat can be called on 0845 634 1414 (adults) or 0345 634 7650 (for under-25s)
I always find the concept of a topic as vast as mental health being squashed together in one day a little odd, but although there are a vast number of mental health issues which are lumped together under one heading, they do have something in common and I can't criticise anything aiming to improve people's awareness of such a common and yet seldom discussed group of problems.
Any regular readers of my blog will be aware that my own mental health issues are longstanding so I can't pretend I don't have a personal stake in this. For that reason, I always feel slightly guilty pushing the mental health agenda. However, it's an important issue that will affect 1 in 4 of us (I think that's probably a conservative estimate) so I won't avoid talking about it.
My first experiences with mental health problems were back when I was a teenager. The support I received was less than ideal, my parents and school didn't really understand what was happening or how best to help me and even the professionals I encountered seemed out of their depth. A lot of my experiences were covered in this pseudo-anonymous post, which I initially wrote as a presentation to give at work. It's now nearly 15 years since that first consultation in that dreadful old building and I still remember it vividly. I can't ever change that, but I hope that when I meet young people in my professional life who are struggling, they remember their encounter with healthcare in a more positive way - someone cared, someone listened.
Unfortunately, it's not just a teenage problem. Although it's pretty common for mental health difficulties to begin in adolescence, they frequently persist into adulthood. Mine certainly have. Despite my struggles, though, I'm doing ok. I'm in a stable relationship. I'm holding down a (fairly intense at times!) job. Not everyone is so lucky. Mental illness is one of the most common reasons for claiming incapacity benefit. Plenty of people struggle and suffer, and yet stigma still persists.
Once again, my blog has become a ramble with no real direction or structure. I'm not sure it says much. But, if you're reading this and you're struggling, you aren't alone. Help is out there. And remember that just because you've been unfortunate enough to get unwell, doesn't mean you aren't awesome.
-----------------------------------------------------------------------------------------------------------------------------------------------
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 at all times.
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.
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.
Men with any difficulties can use the online chat/email service here
If you're struggling with an eating disorder, Beat can be called on 0845 634 1414 (adults) or 0345 634 7650 (for under-25s)
Thursday, 7 April 2016
Paediatrics? That must be heartbreaking...
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.
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.
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"
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, 24 February 2013
Workingman's Blues
"You can hang back or fight your best on the front line
Sing a little bit of these workingman's blues"
Ok, so technically I'm a working woman rather than a working man, but I like to think that "man" can be considered to mean "man or woman" in those lyrics.
Working is tough, really tough. I didn't go into medicine completely blind. I've worked at least part time pretty much constantly since I turned 16. I've done my fair share of menial jobs and I'm not unaccustomed to 13 hour shifts or 80+ hour weeks. I suppose, then, I was naive when I thought that that would have prepared me somewhat for the life of a junior doctor.
I was raised with a pretty strong work ethic. My parents drilled the "if you want nice things you need to work hard for them" mantra into me from the moment I was old enough to know what it meant, or possibly before. I distinctly remember my Dad being off sick from work when I was about 4. He hasn't had a sick day since; if he can get out of bed, he goes to work. Even in my £3 an hour job when I was 16, I was aware that I was being paid to do something and therefore I ought to do it properly.
All of this has contributed to my utter shock that some days I really struggle to cope with working. It isn't the job - that's pretty straightforward although it can be busy. It isn't really the people - my seniors are generally very supportive. It's me. I cannot escape the feeling that I make an absolutely terrible doctor. I accept that all juniors feel pretty rotten about their ability at some time or other, but this is totally consuming my mind. I can't escape the feeling that I'm utterly useless. The slightest criticism leaves me close to tears and I'm deaf to any praise or compliments I receive. Even if I'm not terrible right now, it's probably a self-fulfilling prophecy that if I believe I'm awful, I'll slip into despondency, stop trying and really be dreadful.
I'd better start working harder. Not at my job. But at my self esteem. And I'm that only one who can do that.
Sing a little bit of these workingman's blues"
Ok, so technically I'm a working woman rather than a working man, but I like to think that "man" can be considered to mean "man or woman" in those lyrics.
Working is tough, really tough. I didn't go into medicine completely blind. I've worked at least part time pretty much constantly since I turned 16. I've done my fair share of menial jobs and I'm not unaccustomed to 13 hour shifts or 80+ hour weeks. I suppose, then, I was naive when I thought that that would have prepared me somewhat for the life of a junior doctor.
I was raised with a pretty strong work ethic. My parents drilled the "if you want nice things you need to work hard for them" mantra into me from the moment I was old enough to know what it meant, or possibly before. I distinctly remember my Dad being off sick from work when I was about 4. He hasn't had a sick day since; if he can get out of bed, he goes to work. Even in my £3 an hour job when I was 16, I was aware that I was being paid to do something and therefore I ought to do it properly.
All of this has contributed to my utter shock that some days I really struggle to cope with working. It isn't the job - that's pretty straightforward although it can be busy. It isn't really the people - my seniors are generally very supportive. It's me. I cannot escape the feeling that I make an absolutely terrible doctor. I accept that all juniors feel pretty rotten about their ability at some time or other, but this is totally consuming my mind. I can't escape the feeling that I'm utterly useless. The slightest criticism leaves me close to tears and I'm deaf to any praise or compliments I receive. Even if I'm not terrible right now, it's probably a self-fulfilling prophecy that if I believe I'm awful, I'll slip into despondency, stop trying and really be dreadful.
I'd better start working harder. Not at my job. But at my self esteem. And I'm that only one who can do that.
Sunday, 30 September 2012
European Working Time Directive
The current bain of my working life is the European working time directive. Not only are my hours considerably less than someone in my position would have worked a few years ago (yes, that IS a bad thing, but my lack of clinical exposure is a topic for another blog), junior doctors are now subject to "monitoring". This involves having to write down exactly the hours you were working, whether or not you took your breaks and explaining what precisely you were doing if you were late finishing or didn't get a tea break. Should you have the audacity to stay late so as not to hand over a crappy job, or be too busy try to resuscitate a septic patient to go for lunch, you are reminded that you are breaking the law. It is also highly likely that you will be accused of having poor time management skills. I cannot think of another circumstance where commitment to your job, working extra hours for no extra pay and attempting to make life easier for your colleagues leads to criticism. Is it any wonder junior doctors are disillusioned?!!!
Tuesday, 28 August 2012
That's Life, That's What All The People Say...
Well, the past few weeks have been something of an emotional roller coaster. As well as dealing with some very challenging things at work, I've also split with the guy I was seeing (definitely for the best but I'm still gutted) and lost my Nana (we weren't close but I hate seeing my Dad so upset).
My first run of 12 shifts in a row was really quite exhausting. Being able to switch my alarm clock off when I went to bed on Friday felt like a definite luxury. Even though I don't start work particularly early (9am so the alarm goes off around 7), it's amazing how tiring it can feel just knowing there isn't the option of a lie in at all! The weekend in particular was pretty tough as I was working 12.5 hour days on Friday, Saturday and Sunday with very little in the way of senior support.
Being a doctor is much more emotionally demanding than I had anticipated. I'm not sure whether this is because I've also had other stresses in my life or I was just rather naive when I started. I seem to have a lot of patients who are either essentially dying or medically as fit as we can make them but unable to leave the hospital because there are social/care provision issues. I wasn't quite prepared to be discussing end of life care with relatives after only a matter of weeks in the job, nor was I aware that I'd be representing the "medical team" at case conferences and meetings so early in my career.
I'm now on a week of annual leave, which is a bit strange. I hadn't really anticipated having any length of time off so soon after starting work, but we get allocated our leave so someone will always have it in August - and at least I didn't have the first two weeks of the month off like some of my friends did! I'm not doing an awful lot but I get paid on Thursday so maybe I'll do something a bit more exciting when I have some cash...
Nothing more exciting to report, sadly, but my MSc starts in October so I should have something useful to write about then!
xxx
My first run of 12 shifts in a row was really quite exhausting. Being able to switch my alarm clock off when I went to bed on Friday felt like a definite luxury. Even though I don't start work particularly early (9am so the alarm goes off around 7), it's amazing how tiring it can feel just knowing there isn't the option of a lie in at all! The weekend in particular was pretty tough as I was working 12.5 hour days on Friday, Saturday and Sunday with very little in the way of senior support.
Being a doctor is much more emotionally demanding than I had anticipated. I'm not sure whether this is because I've also had other stresses in my life or I was just rather naive when I started. I seem to have a lot of patients who are either essentially dying or medically as fit as we can make them but unable to leave the hospital because there are social/care provision issues. I wasn't quite prepared to be discussing end of life care with relatives after only a matter of weeks in the job, nor was I aware that I'd be representing the "medical team" at case conferences and meetings so early in my career.
I'm now on a week of annual leave, which is a bit strange. I hadn't really anticipated having any length of time off so soon after starting work, but we get allocated our leave so someone will always have it in August - and at least I didn't have the first two weeks of the month off like some of my friends did! I'm not doing an awful lot but I get paid on Thursday so maybe I'll do something a bit more exciting when I have some cash...
Nothing more exciting to report, sadly, but my MSc starts in October so I should have something useful to write about then!
xxx
Subscribe to:
Posts (Atom)