Sunday, 30 December 2012

Christmas #2 - the depressing side of the season

Although I wasn’t working on actual Christmas day, I was working on Christmas Eve, and as mentioned previously, a 12 day stretch in the run-up to Christmas. Christmas around the hospital can be a pretty depressing affair, not because people have to stay in over Christmas and "isn’t that sad?" – it is, but family visiting can make up for it, and when patients are properly ill they seem content to be in the right place and receiving intensive medical intervention, even if the timing is a bit rubbish. It’s depressing because of the patients who want to be there, because hospital at Christmas is the best they’ve got.

I’ve come across a number of patients recently (it’s more of an issue in general surgery than it was in gynae) who are in hospital more because they want to be than because they need to be. I can imagine the outcries of “how is this possible, the NHS is stretched enough as it is!” but the difficulty is that it is very difficult to boot patients out, kick them out and onto the street. Discharge is a collaborative process, and requires the patient’s input, or if the patient has no capacity for this input, then the family or nursing home etc are involved.

There are the patients who were content at home, but came into hospital for surgery, and rather enjoy the multi-bed ward and socialising with other patients, the being cooked for, the lovely nurses and the nursing care, and suddenly realise that home is desperately lonely and they don’t like it anymore. This manifests itself as them realising, or proclaiming, that they need care at home, and it then falls to the hospital to try to organise this, which is a very lengthy process. 

The time taken for this is why many patients, particularly in an elderly care ward, will have days of “MFFD” recorded in the notes – medically fit for discharge, i.e. awaiting the social situation to be sorted out. Obviously sometimes this is absolutely essential, such as for elderly people with a very high care requirement and complex medical needs, which cannot be catered for in many care homes so it takes time to find the right one. But there are others for whom the care given is less essential, they coped without it previously and they are hardly less able to cope now, but it’s become understood that it is required.

A specialist nurse I work with believes the cuts to day centres have led to an increase in the number of patients who decide to stay in hospital because home is lonely. If they could go to a regular day centre, home wouldn’t be as lonely, and therefore hospital wouldn’t be as appealing. Yet another example of how cuts can lead to increased costs elsewhere…

There are the patients who can’t possibly go home because the problem they came into hospital with has not been fixed; they are still suffering with pain or sickness or whatever brought them in. As much as I love the idea that we can fix everyone who comes in the door, solve every problem, and make everyone feel better, that is sadly not how it works in reality, but sometimes is how it works in a patient’s head. It’s a sad thing, an unpleasant situation, to send a patient home still suffering, and with an end to that suffering not necessarily in sight – but sadly we are not magic. 

Explaining to the patient that our thorough and extensive investigations have shown no cause for their pain, there is no acute or life-threatening problem, there is no cancer, there is no obvious disease, there is essentially, nothing that can be fixed by a hospital stay, and nothing that can’t be improved by some pain relief, regular review with the GP, and community-based input such as physiotherapy, is not always a fruitful exercise, and some patients end up staying longer in hospital because they think they should be there. 

Those patients are slightly less likely to stay in hospital over Christmas, because they may eventually have somewhere better to be, once they have realised that there really is nothing more that the hospital can do to “fix” them, and being in hospital over Christmas is not the best thing that life has to offer them, and the benefits of going home start to outweigh the (perceived) benefits of staying in hospital.

The most depressing thing is the patients for whom staying in hospital, or even worse, being readmitted to hospital following discharge, is the best thing life has to offer them at Christmas. Their family either don’t want them, or don’t make it clear to the patient that they are wanted, so the patient has the sense of being a burden on the family, even if they aren’t (this seems to be a depressingly common occurrence amongst the elderly). So having a hospital bed over Christmas is the nearest they can get to seasonal happiness.

That doesn’t reflect well on us as a society. Look after your old people – if only for the sake of keeping the hospital beds free for the people who really need them.

(I realise this may come across as hypocritical following my complaints about my grandmother in my previous post, but she has never spent Christmas alone. The responsibility is shared between my relatives, not because she is a burden, but because we have a sense of duty to ensure she feels welcomed and as happy as possible each Christmas, and regularly throughout the year.)

Wednesday, 26 December 2012

Bah, humbugs. Minty!

(NB This was written around the 22nd, but not finished and edited til Boxing Day)

I am not really feeling Christmas this year. I am never a massive Christmas fan, since it often involves my granny, who is acceptable in small doses but beyond that her sickly sweet manipulativeness and inability and unwillingness to cope with my sister's complexities (mostly her autism/Asperger's) get too much. Or it involves balancing my family and my other half's family so that we see both families and still see each other (one of the rare times I'm glad our families live near each other). Or it involves going mad getting stressed out on the high streets trying to buy EVERYTHING.

On the day, I do enjoy it, that I get to spend time with my family (parents and sister) and the other half, and there seems to be a Christmas tradition that a load of my home-friends, from the various schools I attended, go out on Christmas eve so there's a general catch-up which is great. So there are good bits. And I enjoy the proper time off - always at least two weeks, as a student, even though last year that was spent stressing about finals, and most years it involved a couple of days working in my wonderful job in my wonderful museum, which even though it was work, was still a break.

This year I have two days off, Christmas day and Boxing day, and since I've just worked a very difficult and draining 12 days in a row (someone insert a joke about the 12 days of Christmas here please) I'm not going to be the life and soul of the party. That takes more energy than I have! I'm just hoping that I get to the party/Christmas eve gathering in the pub at all, and that I don't finish work so late that I've missed everyone by the time I get there.

Today, 22nd, is the first time I've done any proper Christmas shopping - I've picked up the odd thing here and there, the first was in June (be impressed) but I haven't had any time until now to actually shop for anything. It's rubbish that not having time for Christmas shopping is such a big deal - Christmas shouldn't be about the shopping. Or the presents. Or the commercialism which is massive and horrific and all-pervasive.

This year, having seen something on facebook a while ago denouncing the commercial nature of Christmas and encouraging shoppers to support small businesses in their Christmas shopping. It was only a facebook thing but I took it to heart. I have bought three things from a chain shop, the rest from festivals or Christmas market stalls or Amnesty International online shop, and it feels wonderful. My money has gone to small and independent business, who actually pay their taxes (Amazon, you aren't getting any money from me, tax-avoiding scumbags, even if it is legal!). I'm really happy about this, and I like the idea of continuing this in future years.

Work, being a very junior doctor on a new rotation where I know nothing yet do everything, means that my energy for doing and enjoying Christmas is at an all-time low. The first time I actually have money and might therefore be expected to buy decent presents, I have no time or energy to do so. On the plus side, it means my expectations for Christmas are non-existent. All I want is a break, and the chance to spend some proper time with my family, time when I'm not meant to be busy doing something else. I am so, so looking forward to that. I don't care about the turkey, it's too much effort and takes time away from just spending time together.

I feel I've neglected my family - the last time I spoke to them was on day 1 of 12, and day 12 was yesterday. So two days where it's just me and my folks, and some of the time the other half, and maybe some friends on Boxing day, sounds amazing.

So on the one hand, I'm not in the Christmas spirit in any way. On the other hand, I am massively looking forward to it. And to getting some proper sleep for a night or two. Father Christmas better not wake me up.

A post-script: I did get out of work in time to travel home and get to the pub on Christmas eve, although the older we get the more people have moved away and the fewer friends are there, but it was fun nonetheless. I then fell asleep on the sofa after the pub, and my mum had to wake me up and make me go to bed. I woke up late on Christmas day. My sister and I made a dedicated and concerted effort to spend all of Christmas day in our pyjamas, because we could, so we did. I was knackered and had a head-cold (still! stupid virus) but that was no big deal. Working 12 days in the run-up to Christmas, with the weekend off being busy and full of Christmas preparations, clearly took its toll.
But Christmas was pretty much everything I had hoped for. Lovely.

Tuesday, 20 November 2012

Remembering our Dead

Today is Transgender Day of Remembrance, and we remembered our dead. We remembered and celebrated the lives of 265 people who have been killed due to having a gender identity or gender presentation perceived to not be “normal”. 265 in the last year.

Many of them will not have been remembered or celebrated on any other day, or by anyone else, except for the day of remembrance. Some didn’t even have recorded names, only recorded brutal manner of death.

We remembered, and acknowledged that those transgender people who are more likely to be killed are women, people of colour, those who don’t live in Western Europe, and particularly those who live in Latin America, and those who were sex workers – usually due to the above factors combining to make it very difficult for them to be accepted in any other line of work. Whatever the factors, none of them deserved to be brutally murdered.

Today I remembered with about 200 other people (a rough estimate – generally LOTS, the chairs ran out) in London. The last time I went to the service in London was four years ago, and we fitted into a much smaller venue then. To have a bigger service with more people paying their respects is significant. Sadly although the numbers of participants and audience in the service has changed, I think there has been little change in the number of names read out. Just to give an idea of the scale, reading out the name, age, and location of each person murdered in the last year, takes about an hour in total – no breaks.

It also required readers who were adept at Spanish and Portuguese pronunciation – a vast majority of those murdered had lived in Latin America, specifically Brazil and Mexico, and some in Venezuela. Countries further south in America, such as Chile and Argentina, were not represented in the names in any number.

I can’t help but wonder what on earth they must be doing to Brazilian boys and young men to instil a culture in which gender conformity is everything and anyone who disobeys society’s gender rules deserves to die, and it is their right to ensure this happens. What goes on in a society to cause that to be commonplace? And what can be done to counteract this?

I don’t imagine this blog has any Brazilian or Mexican readers, why would it, but just in case it does: look after your country’s trans people, and do all you can to create a culture in which gender diversity is not only not stifled with death, but actually accepted. Love each other – if only love could stop murder.

It sounds strange, but I found it almost difficult to be moved by the service. So many, many names, they start losing their meaning and stop being people, if you don’t engage your brain and emotions and register what’s actually been happening to them and what’s being said. Today’s service didn’t include mode of death – it did a few years ago and some of the youngest participants at the service were understandably very upset. But on the other hand, it forces people to acknowledge the horrors that have happened and not just allow the hundreds of names to wash over them. I forced myself to really think about it, and even then it’s impossible to fully comprehend the scale of systematic transphobic murder that’s taken place – I’m lucky and privileged enough to not be able to get my head around it.

I try every year to attend a trans day of remembrance service – I didn’t two years ago, I went on holiday, and it felt a bit wrong. That was one of the first blogposts I almost wrote (but didn’t quite) about how important it was to me, even though I hadn’t attended. The other half and I even attended the service in Berlin, six weeks after arriving there, and we added some words to our German vocabulary, that we had never wanted to add (e.g. geschossen = shot). Attending today’s service was one of the deciding factors in me taking today as leave and being in London. Even though I find some of the more upbeat parts of the service slightly difficult to swallow given the juxtaposition with the sombre nature of the service (some feel it’s also a celebration of life/want to ensure people don’t go straight from the service and into the Thames because it’s so harrowing), I’m glad I went.

Here’s to a shorter list next year. And every year thereafter.

Just to dispel some misconceptions, which I picked up on in the comments of this Guardian article from last year: TDoR does not commemorate trans people who have died by suicide. There are many – being trans is a significant risk factor for experiencing mental health problems, self-harm and suicide, but TDoR is specifically for trans people who have died at the hands of others, not their own.

It has nothing to do with Remembrance Day or poppy day or Remembrance Sunday at all, except that both are to do with remembering dead people. The trans people who we remember at TDoR did not fight for us or die for us, they simply lived their lives, tried to be themselves, and were murdered for it. Nothing whatsoever to do with soldiers and war and Remembrance Day.

Also, although I refer to “service” there is nothing religious about it. Some people may choose to bring a spiritual element to their remembering, but it is not a church service and is not religious.

To finish, because sometimes art speaks better than prose, and because it was such a poignant and appropriate piece to have in the service, I am sharing the poem Elaine read out, with her permission. It makes the reality hit home further.

It’s not about us.
It’s not about those of us sitting here, standing here, living here.
It is about those who cannot be here.
Those who should be here with us, somewhere in the world.
Those who are gone.
It’s about them.

It’s not about us.
Yes, we have many things to say, and many things that need saying, and maybe our voices are often ignored but we can still speak.
It is not for us to put words in the mouths of those who have had their breath stolen from them.
Those who should still be able to tell the world who they are.
Those who were taken from this world for who they are.
It’s about them.

It’s not about us.
I stand here white, middle class, here in London with a warm bed to return to.
It's not about us.
Because this world finds so many ways to hate, to silence, to erase those it deems less worthy.
Their race is not incidental. Their work is not incidental. Their nationality is not incidental. These things are not incidental but integral as this is intersectional.
And did we pay them any attention before they were gone?
It’s about them.

It’s not about us.
We are still fighting battles, personal and cultural and political. And these are battles to be fought but
These people are not martyrs, these people did not die for a grand cause.
Their deaths are pointless, senseless, symptoms of violence and racism and misogyny and the ways we casually turn people into nothings.
Their deaths should not be our politics.
It’s about them.

It’s not about us.
We are not here for us.
We are here to remember and to mourn and to mark those who society finds so easy to overlook.
We are here for them.
These people are so much more than names, a photograph, if we even have those to remember them by.
These people deserve to be remembered but far more they deserve to still living their lives, telling their truths, laughing and crying and dancing and smiling but they are dead.
It’s about them.

And not just the people on the list, all 265 of them when even 1 would be too many.
It’s about those people who are not on the list because nobody noticed, nobody knew, or nobody even cared.
Those who were further erased in death, identities taken and torn apart from those no longer able to defend themselves.
Those who never even made a footnote in the paper.
Let us think of them.
It’s about them.

It’s not about us.
We can always have tomorrow.
It’s about them.
They don’t even have a today.

It’s about them.
And next year, may the list be shorter.

Monday, 22 October 2012

Once a faily student, always a bit faily (or ex-faily)

Was thinking yesterday* how my final exam fail (and other final exam near-fail) probably contributes to why I dont have as much clinical confidence as I'd like, and explains why I'm not as methodical as I should be. Or rather, my lack of logic and method explains why I failed.

Meeting with educational supervisor:

Supervisor: foundation years are a steep learning curve, especially when you've probably always done really well and never failed anything...
me: actually, I failed a final exam...
ES: really? Why on earth did we give you an academic job then?!?!
me: you gave me the job before I failed
ES: oh well, it's not the end of the world
me: it certainly seemed like it at the time!

I guess it's something that I'll never forget about, but the significance will hopefully fade over time. It should stick with me long enough to prevent me getting much too big for my boots anytime in the next few years- I know I could still be capable of screwing up.

However, some days after this conversation, I had a potentially good idea: I know, and documented extensively on the previous blog (here and here) how horrible it is to fail a final exam and to have confidence shattered and to get totally burnt out and have to find some way of picking yourself up and carrying on (or relying on others to pick me up and carry me on – I am still so, so thankful to the wonderful people who helped me prepare for my re-take).

Maybe I can help other faily students to pick themselves up and carry on, help motivate, help practice, help them realise that help might be there for the asking (if their fellow students are as wonderful as mine were). A little investigative work tells me the number of students currently retaking final year at the place where I’m working (I’ve got an academic foundation job – it should come as no surprise that I’m working at a hospital involved with a medical school) reaches double figures, so perhaps there’s a market for this concept, for want of a better word. I just need to work out who to contact about it, and see if the other openly faily F1 doctor (who has of course, now passed, that’s why they’re an F1) wants in on this.
I don’t have training in motivating people, but I think personal experience that would be relevant here. Watch this space…

* Not yesterday, actually ages ago, but that’s how long it takes me to write a blog these days.

I'm not dead, just being a doctor

Sorry it's been forever (well, 6+ weeks) since I last posted. Or not sorry (I did once blog about how I shouldn't feel obligated to blog... but then I also planned to blog three times a week).

I'm not dead, just been busy working. Which is very busy. Though apparently will get worse when I'm working in surgery and moved on from generally-reasonably-well-supervised gynae.

A three day weekend seems to have got my creative blogging juices flowing again, slightly.

Also, I STILL have lack of internet to blame, partially, for my lack of blogging - thanks Tesco totally rubbish Home Pho-one and Broadband (yes I still find it odd and mildly entertaining that the woman on their phone message pronounces phone with two syllables... I have spent FAR too much time listening to her!).

Here's to the blog. Or not.

Monday, 3 September 2012

Amazing day, awful day

Today had some amazing bits and some awful bits.

Amazing: at the Paralympics, watching the incredible Pete Norfolk, GB flagbearer, and his doubles partner play fantastic tennis and get to final, watching 7-a-side football, goalball and basketball, watching swimming on big screen, wearing a Union flag as a cape all day, other half wearing 8 mini flags and Union Jack tie, soaking up the atmosphere, the beatbox, not getting sunburned despite super sunny weather, the wonderful Games Makers, and the impressive diversity of Games Makers, the accessibility of the park and the enormous number of (visibly) disabled people spectating at the Paralympics.

Awful: supporting something sponsored by ATOS, selling a ticket to a friend but forgetting to give friend said ticket until we were halfway through Olympic park and friend was stuck back at mobility, unable to get through security without his ticket*, missing GB's football match, Tesco totally useless broadband & Homepho-one (call them and listen to the introduction lady. "Phone" apparently has two syllables!) and BT engineer not turning up to install phoneline and internet, so very helpful friend sat in our house for 5 hours for nothing, leaving Olympic park at the same time as athletics ended and stadium emptied, huge queue for train, not boarding train in first-arrived order, javelin train we got on being delayed, being made to queue through the entire length of St Pancras station after getting off train, all causing me and other half to each miss our respective trains so arriving at home around 2.30am, both working tomorrow morning, realising I had no keys as given to friend waiting for phone engineer and having to wake flatmate to let me in, using all my phone battery on useless London 2012 spectator travel website which said today is not valid as not during paralympics, and Waterloo and Riverbank Arena not valid locations, then gave useless info anyway (journey duration and number of changes, but not where to change I'd how to get there), therefore phone dying in early afternoon, being conned for pricy phone charger in dodgy offlicence, sore neck back from the number of jumpers in my bag in case of bad weather - it was 26C...

The awful list is far longer, and we'll both feel rubbish tomorrow, but I think it was worth it.

Would I do it all over again? I'd have left the park slightly earlier to avoid stadium crowds and missing train, but ultimately, yes. Emphatically and resoundingly, yes.

*this really happened. I gave ticket to friend, he gave me money, he needed help due to broken wrist so I held his ticket while he sorted his bag, I did not give ticket back. I went into park with ticket, and only discovered half an hour later when I saw the many missed calls. I went all the way back through park, out exit, gave ticket to friend, I got back in with spare ticket we hadn't managed to sell (lucky!).

I can't be trusted with a ticket, yet I am daily trusted with people's lives... this is a little concerning.

I blame it on having just done the weekend on call. Yesterday's shift was 13 1/2 hours, with no lunch, just banana and cake. In future, I should spend my post-on call weekend Mondays sleeping, nothing else. The Paralympics was the exception. In future, sleep, no responsibility.

Regardless, best day ever. Or for a long time. Now planning our trip to Glasgow 2012 Commonwealth Games. Do the Commonwealth Games have Para-Commonwealth Games?!?!?

Monday, 20 August 2012

Like a baby log

Not sleepy, but totally exhausted. I had two nights in a row where I’ve fallen asleep before I’m ready for bed. One night I slept the whole night with only half my pyjamas on because I fell asleep whilst getting changed. That kind of total exhaustion only ever happens after exams (occasionally), and always for one night only.

I have not been this exhausted since the weekend after Freshers’ week when I first started university seven years ago. That was a week of moving house (into halls), new experiences, meeting new people, getting my head around the work, just as the last few weeks have been. Except this time it’s a lot less social, and a great deal more work focused. To say this is the most tired I’ve been in seven years is no understatement. Jetlag is nothing compared to the past week.

I have been an Olympics-aholic the past few weeks, watching every possible moment in the evenings and at weekends, following TeamGB on Twitter, and yet I was so exhausted that I slept through half of the closing ceremony. I was gutted – I wanted to watch the whole thing, but no matter how hard I tried, it wasn’t going to happen.

This kind of tired will wear off – it has to, doctors couldn’t function like this long term! Once I get more confident in what I’m doing, and once the voice in the back of my head saying “ohmygod do I know how to do this/am I allowed to do this/do I know what this drug is/can I prescribe this medication/what the hell is wrong with this patient and what can I possibly do about it” every time a nurse asks me to do something has decreased in volume, the job will be less mentally exhausting. I will be less tired – I am determined to be. I have to be.

Wednesday, 15 August 2012

Human again

I've just been out for a lovely dinner with my new colleagues. Suddenly I feel like a person again, like there is so much more to me than being a doctor, once again. There is more to life than being pestered over patient discharges.

I laughed more this evening than I have in ages. It's lovely to feel more normal again. I need to remember this next time I'm worked to the ground (ie next weekend I'm on call, if not sooner).

But now that I'm unfrazzled, I'm no longer totally shattered, and emotionally and mentally tired. So I can't sleep.

Tuesday, 14 August 2012

Down at Frazzle Rock

I've now been a doctor for two weeks. It's not been the best two weeks of my life. I am totally frazzled, exhausted and mentally drained.
The on call weekend was 38 hours work in three days, much of it on my own; the three other doctors away on other wards, at emergencies, and in operating theatre. There was too much work for one F1 junior doctor to manage, including emergency assessments patients of my own. Some pushy nurses didn't help, but kind and helpful nurses can make all the difference.
I'm sure it will get better. I'll improve my clinical skills (like blood taking and cannulation - I haven't had a single successful cannula yet), learn to see patients more quickly - hopefully without spending less valuable time with patients, learn to call for help more promptly and to recognise when I need help. And learn to take a break, drink, and eat lunch. I didn't eat til 5.30pm the other day, having started at 8am.
It will get better, at some point.
This week's been good, however. More SHOs (slightly less junior doctors) means work is spread more evenly and I leave work at a sensible time. Long may that continue.                          
* Frazzled = exhausted, knackered, not burnt out but going in that direction.
Fraggle Rock = muppets-like TV show. I was once told I look like a Fraggle...                                          
The picture isn't a Fraggle, but it's near enough!

Sunday, 5 August 2012

The first emergency

My first emergency as a qualified doctor did not come, as one might suspect, in the hospital, but instead on the street, at night, in a different city.

It was a horrible "oh god I think I need to stop... don't I? should I?" moment, not quite sure what to do but thinking I probably should do something. I walked past as if to scout out the situation, and a bystander was on the phone, clearly to an ambulance. When I heard them say "... seizure..." my heart sank as I realised it wasn't just some drunken japes and I would need to get involved.

I was relieved to realise I recognised one of the bystanders, the person on the phone - a medical student who I'd got to know a few months ago, when they were in third year. This meant that hopefully anything immediately lifesaving that needed to be done, such as opening the airway, would have already been done. That's a nice emergency to arrive at.

Though it was all under control, I stayed around, partly because once you've arrived you can't really leave, and partly because I thought the others might want me to stick around. Much as I was relieved to see medical students there, I imagine they were considerably more relieved to see me - if I was a third year medical student attending an emergency, I would have breathed a huge sigh of relief if a medical student or junior doctor two years my senior turned up. So I guess that was a nice role to play, even if I didn't do a great deal medically, except stop the patient from rolling over, check every now and then that he was still responsive (ish) and talk to his relative.

The patient and relative had recently left hospital, and I can't help but wonder if the fact they were still wearing hospital pyjama trousers meant they had self-discharged... I think it's likely, which made me a bit more clued up to the situation.

For some reason the police arrived before the ambulance, even though the students called the ambulance, (maybe they send police to anything that might be alcohol related?). Another thing I don't understand is that the ambulance people on the phone said to roll the patient onto his left. He was nicely in the recovery position on his right hand side, and since rolling him onto his left would have involved rolling him into the road, they left him as he was, but I have no idea why the left would be better.

Anyway, the ambulance person arrived and was happy for us to go, so we left, after I'd had a bit of a catch-up with the medical student I knew, and I hope I made clear to them both that they'd done a good job. I realised later that I didn't tell the ambulance person that I'm a doctor, and maybe, since they were on their own, they might have wanted me to stick around and help had they known that, but never mind - they're experienced at working on their own I'm sure.

Despite the anxiety whilst walking up the situation, I'm quite relieved by the quiet, mild confidence I felt whilst looking after the patient - hopefully that will stay with me when something more traumatic happens in the hospital.

Saturday, 4 August 2012

The small things

Yesterday, my sister, who is autistic, got a bus for the first time since being diagnosed with epilepsy. Yes, she's got buses on her own before, for the last year or two, but not since her seizures.

This is an important step towards regaining, and continuing to develop, her independence. It's a small thing, getting a bus, but at the same time it's a big thing. 

I think in the medical profession, we're often quick to overlook the small things, the life things, the less directly medical things, and never notice that to patients (and their families) they can be big things.

Tuesday, 31 July 2012

Grey Wednesday?

Tomorrow is “Black Wednesday”, the day when all the brand new doctors start. I should be terrified, but I’m not – tomorrow I have an all-day induction. I may be on call for two hours after the induction, but with at least one other new doctor and the evening on calls seem fairly quiet anyway.

On the one hand, a comprehensive induction is great. On the other hand, it’s just delaying the nervousness until tomorrow evening. I feel like I’m missing out on something – spending the evening with other new F1 doctors, who don’t have induction and therefore tomorrow is their first dose of responsibility and first real opportunity to accidentally kill someone, there was a sense of nervous, slightly excited anticipation. I don’t really have that. Partly because I’m not really starting tomorrow, and partly because in gynae, we’re not really trusted with being allowed to do that much, most things have to be approved by a senior. There is a great deal of discharge summary writing. But, it’s a very nice way to ease into the job.

We realised that we’ll never have this feeling ever again. Never again will we be brand new terrified doctors. Whenever we start a new job in the future, it will just be the next thing, not the whole big new thing. Never again will we be not-quite-doctors and then suddenly actual doctors. One of my new flatmates said she wanted to savour this feeling forever, this moment to last forever, and I wouldn’t quite go that far, but it is an interesting time.

So for me, tomorrow is perhaps Grey Wednesday. For all those new F1s for whom it really is Black Wednesday, good luck, don’t be scared, and remember to breathe. For anyone who has the misfortune to fall ill tomorrow, or in the next week, I honestly wish you the very best of luck, though hope with all my heart that you don’t need it.

Monday, 30 July 2012

Service update

I've just moved house - it was essential for the job. I don't yet have internet or recently, much time, so although I've got a few posts in my head relating to shadowing week, I won't get them all up before shadowing week ends and proper scary actual doctor work begins.

I'll probably play around with the scheduling settings, but please ignore if the posts seem out of sync - that is why. I hope it will be clear.

Me and my shadow...

This week is compulsory shadowing week, where we learn how to do the job before we have the terrifying responsibility of doing it. Theoretically, it should reduce the mortality rate on “Black Wednesday” – the first Wednesday of August, when every brand new junior doctor (F1, or foundation year 1 doctor) across the country starts working. Our lack of experience is, apparently, evident in the number of patients who die on those first few days, compared with the rest of the year.

I wasn’t particularly nervous before the start of shadowing week. I feel like I should have been, meeting all those new people, starting a new job, even if the actual responsibility isn’t added in for another week. But I’d had no time for nerves – I was at camp, far too busy having Serious Fun to worry about suddenly being a doctor. For anyone who is likely to be nervous about starting F1, or any other scary job, I’d definitely recommend doing something amazing before starting, partly to take your mind off it, and partly to remind yourself that there are more important things in the world (like campers) than work.

Shadowing week is interesting in that we’re not actually allowed to do anything. Anything that involves procedures, signatures (our own, rather than hassling someone else for one – will make a nice change!), or even almost touching a patient. It’s bizarre, for this one week in which we’re all qualified and about to do the job, we’re allowed to do a lot less than we were a few weeks ago as medical students. We’ve signed to confirm this, but as usual not everybody sticks to it. Some new F1s have a “never mind that” approach. I’m a little more cautious – we’re not allowed to do anything because we’re not insured to, apparently, and wouldn’t necessarily be covered for a needlestick injury. I’d rather not have one of those (touch wood) but if I did, I’d like to be properly covered for it and get the post-exposure prophylaxis (PEP*) as required.

So really nothing much has happened during shadowing week. I’ve learnt a bit and sat through lots of “this is how we do things here” lectures, but I imagine most of the learning will be on the job. Which is a bit terrifying.

* PEP, or post-exposure prophylaxis, is the term for a 28-day supply of anti-retroviral drugs to prevent you contracting HIV if you might have been exposed to it, for example through a needlestick injury. It’s not just for doctors and medical staff, however, anyone who could have been exposed to HIV through unprotected sex (with someone of a high risk group), needle sharing etc, can receive PEP from A&E or some genito-urinary medicine/sexual health departments, if you go there within 72 hours of exposure. It’s an unpleasant 28 days as the drugs have numerous side effects, but it’s better than a life of HIV, even if that does mean a chronic disease rather than a death sentence these days. And it’s only a chronic disease if you know about it – undetected and untreated it could very possibly be a death sentence, so get tested!!

Friday, 27 July 2012

Another obligatory introductory post

Hello, I'm trying to be a very junior doctor. I've just finished five years of medical school with two extra years (the scenic route), and for the last nearly two years I've been Trying to be a medical student. However that's no longer an appropriate blog title, since I'm no longer a medical student... so welcome to Trying to be a junior doctor.

It's called this because years ago my younger sister (about whom I blog now and then) said told someone I was "trying to be a doctor" when she meant training to be a doctor. It's kind of stuck. And of course, because I am a junior doctor, and I can’t do that without trying. I’m hoping that sometimes I’ll succeed, but even when I don’t, I’ll still be trying (hard) to be a good junior doctor.

So here's where I'll blog about any struggles and more interesting aspects of life as a (very) junior doctor, and anything particularly interesting about the National Health Service, hospitals, patient care and research.

I also like to blog about other things that might be interesting and are relevant to me - there's more to me than just medicine! This might include: feminism and gender, autism, disability and my sister, maybe politics, my other half (who is NOT a medic!) and the newly long-distance relationship, and potentially anything else that takes my interest, in addition to the medical side of things.

I may yet make occasional posts over at Trying to be a medical student, if anything particularly student-related comes up. I’ve got a few revision course reviews and textbook reviews that have a been a long time coming, and the student blog is probably the best place for them.

As before, I blog anonymously, and will publish a separate post explaining this (link to follow). I therefore don’t write about the exact place that I’m working, other than that it’s in England, or the medical school that I trained at, which was also in England. That’s all you’re getting!

I have no intention of becoming a whistle-blower, or of highlighting problems. I just blog about what I do and what I see and my thoughts about it all.

I fully anticipate that the next few weeks and months of being a very junior doctor will be challenging and trying, so bear with me. Welcome to the blog, and do have a read of the previous blog if you haven’t already.