Stronger

Kanye West, the sample-happy multimillionaire rapper, has shot to the top of the pop charts with his new single, Stronger.

With his hand gripping the mike and a deep, earnest look on his face, he croons “Na na na…That that don’t kill me will only make me stronger...”

Now, I respect Kanye’s ability to turn other people’s tunes in platinum selling bundles of 3 minute joy that make him a fortune, but it’s obvious to me that he’s never spent any significant amount of time in a hospital.

I can think of loads of things that don’t kill you but certainly DO NOT make you stronger. Off the top of my head, I can think of:

Herpes
Strokes
Heart Attacks
Schizophrenia
Amputations

Can you think of any more?

The MTAS refugees... Our Story #1

Sumitra is one of the new registrars in the New Town anaesthetics department. Like me, Sumitra is an MTAS refugee. Before the government decided that was perfectly reasonable to force thousands of junior doctors to move hundreds of miles away from their families and friends, Sumitra lived with her husband and four children in a town about four hour’s drive from New Town.

Sumitra is quite a bit older than I am. She decided to take time out from working to bring up her children and she also had a change of speciality along the way as well. Her husband has a career that means he can’t easily move and the eldest of her children is beginning the run up to GCSEs. Understandably, Sumitra isn’t really keen to relocate her whole family up toward New Town because of the disruption it’s going to cause. Added to this, there’s the fact that she doesn’t know this area at all. She doesn’t know which suburbs are nice to love in, or which are the decent schools etc… etc…

I’ve had several conversations with Sumitra about what she’s going to do and she just doesn’t know at the moment. What I do know is that having to move to a place four hours away from her family is going to put a huge strain on Sumitra’s relationship with her husband and her children. Hopefully, they’re a strong enough family to be able to work it out somehow.

A.B.C.

The junior doctors on the intensive care unit are a bit of a boy’s club. Just about all the SHOs and registrars are attractive young men, and most of us are single. I’m blogging about this because this is so unusual.

Hospitals are dominated by women. Fact.

The vast majority of the staff in any hospital are female. The nurses, the domestics, the caterers, the admin staff etc… tend to be almost exclusively female. Back in the day, the majority of young doctors were male but that is no longer the case. The gender ratio of new doctors is about 60:40 if favour of women and, going by the relative numbers entering medical school, the ratio is going to swing even further towards the “fairer sex” in the next few years.

This means that, as a young male in the hospital, I am a bit of a commodity and, when I was first starting out, it made things just that little bit easier for me. I could flirt with some nurses, whilst others would want to “mother” me. Some of the patients, especially the older ones, gave me more respect just because I am a man. I remember being on the ward round with my female consultant when I was a house officer and the patient (a lady in her 80s) asked the consultant to be quiet so she could “listen to what the doctor had to say” - and then looked at me.

It’s not all plain sailing and waving my Y-chromosome in the wind though, there are downsides as well. There are the endless conversations about sunbathing and shopping. (I’m still to fathom out the female obsession with shoes – two nurses and a female doctor once managed to have a conversation about heel height for 40 minutes straight – the mind boggles). Discussions about football end up all about the shapeliness of Frank Lampard’s legs or how Wayne Rooney is dead sexy because quote: “he looks like he’d leave you feeling raw afterwards”. And then there’s the expectations that I’ll act as a spokesman for my gender whenever one of the staff got played around or cheated on or dumped.

Overall though, as a junior doctor, the boys get an easier ride than the girls.

However, I’m finding it refreshing working with mainly other men. Men are funnier than women so there’s more banter on the ward. It’s also nice to have conversations at work about blokey things and not have to save it for the pub.

Call it sexist if you want to, but I think the Anaesthetics Boy’s Club (ABC) is definitely a good thing.

We'll pick you up if you fall... always

Kevin is a man who had been involved in a high speed crash on the motorway and had arrived in New Town hospital fighting for his life. He’d broken both his arms, his jaw, his ankle and his breast bone. He’d had three large tubes inserted into his chest (one placed by yours truly) to drain away the blood that was collecting round his lungs, he had been unconscious on a ventilator for nearly a week and needed four separate operations on various bits of his body.

Kevin had come to us a broken man but, little by little, we’ve slowly put him back together again and Kevin is continuing to improve. It’s a heart-warming story of strength through adversity.

Whilst I was looking at the chart of the patient opposite, I heard Kevin talking to one of the student nurses. He said.

“The best health service in the world this is, the NHS. The way you people have treated me… I couldn’t ask for anything more. Even if I’d paid money, I wouldn’t have been treated like this. Thank you.”

Stuff like that makes you feel warm and fuzzy and really appreciated. Now, if only Kevin was a journalist…

One more joins the fray

I found the Lowly Worm's blog. It's great, you should read it too

MTAS refugees (Friday)

We who have had to up sticks and move hundreds of miles to our new jobs because of the government's fuckups are calling ourselves "The MTAS refugees."

In our department, about 60-70% of the new starters have been forced to move away from where they were previously against their will because of MTAS. From speaking to people in other specialties, it's clear that the majority of the junior doctors who had to negotiate MTAS and were successful have had to move significant distances to find work. I don't think the government could have actually been more disruptive if it actually planned to be

You already know my story, but next week, I'll post about some of the other MTAS refugees.

12 days of anaesthetics (Thursday)

Today is my twelfth day as an anaesthetic trainee, and I'm going to have a look back at what I've done so far...

On the twelfth day of anaesthesia, my duties gave to me:

12 Cannulations
11 L.M. Airways
10 Worried Parents
9 Intubations
8 Angry Surgeons
7 Patient Transfers
6 Gas Inductions
5 Vomitings
4 Bag & Masks
3 Spinal Blocks
2 Chest Drains

and a pair of medium scrubs…

My medical student is flirting with me… (Wednesday)

…and she’s really rather attractive. Her name is Lizzie and she’s currently doing her intensive care/anaesthetics placement.

I’m not one of those men who think that the every female with a pulse is secretly swooning when I walk past, but, as a reformed (wannabe) playboy, I think I have a pretty good idea of when a woman is signalling “I like you.”

It’s the touch that’s not quite necessary. It’s the gaze that lasts a moment longer than needed. It’s the laughter at things that I say that are only vaguely funny. It’s the turning up and coming to talk to me when there’s no need to really… Reading between the lines I’d definitely say Lizzie is flirting like a pro.

At first I wasn’t sure if she was just one of those flirty girls who are like that with everyone, but now I’m pretty sure she’s giving me “special attention”. Like I said before, she’s a very attractive young lady and I admit that I’ve been flirting back a little because, to be honest, I quite like it.

Throughout medical school and into my first year as a doctor, I was very anti work-related relationships. Looking back, I don’t even remember what my reasons were but I’d actively avoid dating/pulling/shagging other medical students, nurses or anyone who I worked with. From this point of view, I’ve mellowed a lot in the last couple of years and am not so dogmatic about it now.

This leads on to the obvious question of is anything going to happen between me and Lizzie?

One of my best friends told me: “Don’t even go there, Mike. Pulling a medical student is just wrong.”

But he’s been going out with the same woman for six and a half years now, so what would he know? You can talk about power and its (ab)uses but it’s not as if Lizzie is a schoolgirl and I’m her teacher is it? She’s 23 years old and I think that makes her a big girl and quite able to make her own mind up.

For now, I’m quite happy to sit back, let her make the moves and wait and see what happens…

Give a little respect to me... (Tuesday)

...sang 80s popsters Erasure and I was chatting with one of the senior sisters on the intensive care unit (ICU) about respect earlier on today. She was telling me that the reason that she much preferred ICU to ward nursing was that, in her opinion, nurses on ICU get much more respect for their job than they do on the ward. She felt that on the general ward, the doctors don’t respect the nurses for what they do and for the role they fulfil and that the hierarchy of doctors above nurses was still very much in existence.

This hasn’t been my experience at all, so I asked her what she meant by this and she went on to say something very interesting.

She said that she thought that when doctors start, they are very “respectful” and ask the nurses lots about how things work etc… but then, after a while, that goes out of the window and the doctors start just commanding the nurses to do X, Y and Z. I think there’s an element of truth to what she said, but I think that what she’s getting at isn’t a matter of respect, but more a matter of experience. She sees it happen on ICU but it happens more often with new doctors, fresh out of medical school.

Let me try and explain.

When you graduate from Med School, you’ll have studied for the best part of the decade, you’ll have been tested countless times and you will have learned a hell of a lot of stuff. However, most of that learning will have been done in seminars, lectures, libraries, your bedroom, and comparatively very little will have been done on actual real patients. Even on your ward placements, the doctors will tend to take you to away from the patients to the seminar rooms to give you a teaching session on ECGs or chest Xrays or whatever.

When you graduate, you’ll have proven yourself and will have earned the right to call yourself “doctor.” However, when you walk onto the ward for the first timeas a doctor, you realise that things are a lot different to being a student. Obviously, a lot more is expected of you and one of the things that you’ll find is that there will be quite a few simple, practical things that you’re either not very good at or just don’t know how to do. I thinking of things like siting a naso-gastric tube or actually putting the leads on for an ECG. These things aren’t difficult but if you’ve not done them very much, you’ll be a bit wary the first few times you do them and it actually matters that you do them right.

The nurses will know how to do these things and they help you and show you how to do them. Some of the nurses will have been working in your field for twenty or thirty years and they will have seen a lot of stuff in that time. Their experience is invaluable. They will have seen and treated hundreds of patients have heart attacks, strokes, pneumonia, appendicitis etc… etc… and will have seen which treatments work for these conditions. As a result of this experience, they’ll try and point you in the right direction when it comes to the patient’s conditions and often, they are correct.

The thing is, after a while, your years of medical training kick in. After the first few weeks, you are no longer fazed by things like placing cannulae, talking to big groups of relatives etc… etc… and you are much more confident about the way your ward works. About this time, you realise that the nurses aren’t right all the time about things. Ultimately, nurses haven’t been to medical school and while they may have more experience about some things, they often don’t have the knowledge about medical conditions that you do to go with it. Thus, you realise that if you’re going to make a decision about what to do with a patient, it has to be YOUR call because, if anything goes wrong, it’s YOUR responsibility.

So, whilst the nurses may say to you, “I think we should put a “Do Not Attempt Resuscitation” order on this patient” or “this man needs thrombolysis” or “we should move this woman to HDU” at the end of the day, their opinions are only opinions because for medical decisions, you have to convinced in your own mind that what you’re proposing to do is actually in the best interests of the patient.

You’ll inevitably disagree with the nurses (and other doctors) from time to time about the management of patients. For example, you might think the patient needs diuretic drugs and the nurse might think he needs fluids but, ultimately, for medical decisions, what you say goes. This is not a matter of lack of respect of nursing roles, it’s a matter of taking responsibility for the decisions you ought to be making because, if it’s the wrong decision, then the fallout is going to be on YOUR head, not the nurse’s.

Like I say, medicine is so complex that disagreements are inevitable. Disagreements about patient care happen all the time between doctors and nurses, between doctors and doctors, between nurses and physiotherapists etc… etc… Ultimately everyone has their own opinions and rightly so. The point is that it’s not the disagreements per sé that leave people feeling disrespected, but the manner in which the discussion is conducted.

Intensive care (Monday)

For the first few months of my anaesthetics training, I’m going to be working on the intensive care unit. This is the area of the hospital where the sickest of the sick people end up. It’s hideously expensive to run (something like £3000 per patient per day) and it’s the place where they have the most staff and the most specialised equipment so we can try to keep people alive.

Patients on the intensive care unit (ICU) are literally fighting for their lives, so much so that often they don’t even have enough energy to breathe for themselves. I’m going to be working as part of the team responsible for helping them in their fight in every way we can.

Today is my first day and I’m really looking forward to it

To be this good takes ages (Thursday)

I was reading the “Introduction to New Town Hospital ICU” booklet in the coffee room when the consultant comes in and says “There’s a new admission from theatres, come and have a look.”

The lady in question had been on the operating table for the majority of the day after having emergency surgery because her bowel was blocked. It turns out that the blockage was probably caused by cancer and she’d had most of her internal organs taken out. Shane, one of the Australian registrars, is admitting this lady to intensive care and he turns to me and says:

“Have you done central lines before?”

Me: “A few, but my last one was a couple of months ago”

“Do you want to do this one?”

“Yes.”

Then the monitor behind us starts beeping as our patient’s heart rate climbs above 130 b.p.m.

Shane: “Could we run that unit of blood through stat and call blood bank and tell them to give us two more please. Michael, I think I’d better so this one because we need this line in a hurry.”

Fair enough.

I stood back and watched him work and he was amazing. I’ve never seen anyone put in a central line so fast. He went:

Local. Introducer needle in. Guide-wire in. Scalpel. Introducer needle out. Dilator in. Dilator out. Line in. Guide-wire out. Flush the lumens. Stitch the line. Tegaderm. Done.

And it took him about four and a half minutes altogether and he didn’t spill a drop of blood onto the pillow.

I was in awe. One day, I’ll be that good too.

Theatre fashions (Wednesday)

Theatre hats are the most unflattering thing in the world. Absolutely nobody looks good in them and I suspect that this is a deliberate ploy to stop the staff in theatres from perving over each other. The things that’s really annoying about them though, is that they are really messing with my hair.

No matter how long I spend in the morning getting my hair into a respectable state for work, I can guarantee that by lunchtime the theatre hat will have transformed it into a hideous bouffant. My hair ends up looking like some sort of 80s pop star gone wrong; think of George Michael’s deformed cousin and you’d be getting close.

Trust me, it’s not good look.

The 3 golden rules of anaesthesia (Tuesday)

1. Oxygen goes in and out
2. Blood goes round and round
3. You can’t make a chicken salad out of chicken shit no matter how much mayonnaise you use.

Trust me... I'm a doctor (Monday)

Mary is 58 years old and she has bad arthritis. So bad, in fact, that she needs an operation to replace her knee joint to allow her to walk properly again and today is the day that Mary will have her surgery. The roster meant that it was my responsibility (along with my consultant, of course) to give her the anaesthetic that allowed the surgery to happen.

Having surgery is a very scary thing.

Having an anaesthetic is a very scary thing.

I’m lucky enough to have never needed surgery for anything but - even after the best part of a decade’s worth of medical training - if I ever were to have an operation, I’d be petrified.

The thing that scares me the most would be the loss of control. In order to have an anaesthetic, I’d have to totally relinquish control of everything. I’d have to put myself in another person’s hands and I’d have no say or influence over what they do to me. I’d have to allow myself to be put to sleep without knowing for sure whether or not I’d ever wake up again. Or not be sure that when I do wake up, that my body will be working like it should. It requires a phenomenal amount of trust to hand over control of your movement, your breathing and your life to another human being – especially one that I’ve met only a couple hours before the operation.

But this is exactly what every single one of my patients does. As an anaesthetist, I literally have their lives in my hands. If I fuck up, people die – quickly. The trust that my patients give me is a huge gift. To trust someone with your life is probably the biggest gift one person could give to another and I promise to always remember this and to never underestimate, undervalue or abuse the faith that they put in me.

We anaesthetised Mary. We gave her lots of painkillers and set her up on the ventilator that pumped oxygen in and out of her lungs to keep her alive. The orthopaedic surgeon was drilling a hole down the middle of her thigh bone and the operating theatre was filled with the high-pitched screech of metal tearing through bone and the smell of charred flesh from the cauteriser.

I knew that Mary couldn’t hear me but that didn’t matter, I leant down and whispered to her, “Don’t worry Mary, I’ll look after you. I’m right here.”

Getting Started (Thursday)

Oooohh I LOVE my new job. It’s awesome! I really feel I made the right choice when I decided to switch to a career in anaesthetics after a couple of years of working as general medicine.

Today was my first day in theatres. Yesterday, I was debating how long it would be before they let me loose with the anaesthetic drugs. The answer was – straight away. On my first morning, I was working on the urology list. I saw all the patients beforehand to explain what the anaesthetic involved and what they’d expect to see and feel when they woke up after the operation.

I got to give the patients their painkiller and then the anaesthetic drugs via the I.V. line I’d put in and watch them for the next 10-20 seconds as they drifted off to sleep. I then had to secure their airway and then they were good to go and the surgeons could do what they had to do.

My job was to look after the patient on the table and, after coming from gen med, it was a bit of a revelation to have all the monitoring right in front of me. I could see exactly what the heart rate, blood pressure, carbon dioxide levels etc were doing and I could correct things immediately if the parameters started drifting out of the “comfort zone.”

All the while I had the consultant anaesthetist next to me, telling me what to do and teaching me how and why certain things are done. In my last job, I didn’t think I was learning very much. My job was looking after the patients on the ward, and because of the sheer numbers of people I was looking after, it didn’t leave much time to study and learn the details of the conditions that I was treating. I found that quite frustrating because, I think I’m a bit of a geek at heart and actually enjoy learning stuff.

My new job is the opposite. Basically, I’m getting paid to learn and it’s great. I actually feel a bit like a medical student again.

Induction day (Wednesday)

On the day that the new batch of doctors starts in a new hospital, we all have an induction day. This is where things like our criminal records and hepatitis status are checked, we get given our contracts of employment, our ID badges and passcodes to various parts of the hospital. It’s also an opportunity for the trust to get various representatives to give us talks. This means we get lectures on things like how to wash our hands, what to do if there’s a fire, how to prescribe medications etc… etc…

I fucking hate inductions.

In theory, they sound really useful, but the reality is that they are a complete nightmare. Today’s was possibly the worst one I’ve ever been to. Because of MMC, there was an unusually large proportion of doctors from outside the region who’d never worked in the trust before. The hospital admin staff were underprepared and understaffed and every little thing took fucking ages. The queues for registration, for occupational health, for ID badges and for parking permits were all huge. I spent the morning in various hot, stuffy rooms just twiddling my thumbs. I arrived promptly at 08:00 like I was meant to and by about 11:30, I think I’d lost the will to live.

The afternoon was better though. This was the introduction to the anaesthetics department where we were told where we’ll be working, who we’ll be working with and what will be expected of us. We got shown how the anaesthetic machine works (which is helpful to know, I guess) and given a pair of theatre shoes (mine are a very cool black) and keys for individual lockers. We got told about log-books and certifications and loads of other stuff that I won’t bore you with. I hadn’t slept well last night and it was a lot to take in, but it seems that I’m going to be very well looked after.

I’m really looking forward to tomorrow, which will be my first day in theatres. I wonder how long it’ll be before they let me loose with the anaesthetic drugs…

Missing Piece (Wednesday)

I got back from Town Hospital to my home in the City and packed up a suitcase before setting off on the long drive along the motorway to the New Town in which I’ll be working for the next 12 months

I was on the road to the new deanery for about 3 and a half hours last night and motorway driving at night time has a sort of hypnotic quality to it, don’t you think? The hum of rubber on tarmac and the shifting glare of the headlights and the moon were conspiring to send me into a bit of a trance and I almost ended up zoning out totally. I had to pump up the stereo and sing some Erasure to stop myself falling asleep.

I’d been badgering the accommodation officer in my new hospital for several days and she had eventually managed to organise a room for me to stay in. I arrived at the new hospital just after midnight and was happy to find my keys were waiting for me at reception. After a brief chat with the receptionist, I headed off to my room.

Did any of you see that T.V. show where Gail Porter, Sean Hughes and Janet Street-Porter had to work as health care assistants? The thing I remember most about that show was when they were shown the hospital accommodation and Janet Street-Porter flat-out refused to stay there and threatened to leave the show altogether if they tried to make her. Hospital accommodation is usually pretty grim and the accommodation blocks at New Town hospital are no exception but I was so grateful that I had somewhere to sleep that night that the stains on the carpet and the sticky surfaces didn’t bother me.

I opened the door to my room and turned on the light and the sight that greeted me took me completely by surprise. There was no bed in the bedroom. I’m pretty sure that a bed is an essential component for a bedroom to have but there was none to be seen. The blankets were neatly folded on the desk but there was no bed!

After the drive, I was pretty shattered and I gave serious thought to sleeping on the floor but common-sense prevailed. I went back and explained the situation to the receptionist and three phone calls and 45 minutes later, I was settling into the emergency accommodation room. The bed was lumpy and uncomfortable, but it was a bed none-the-less and I drifted off to sleep contemplating the day ahead.

to be continued…