Saturday Night

Things a 16-year-old girl should be doing at 9pm on a Saturday night.

• Voting for her favourite person to win X-Factor
• Arguing with her parents who tell her “You are NOT going out dressed like that.”
• Chatting with her mates and explaining why her new boyfriend is so fantastic
• Posting pictures of her cat on Flickr
• Downloading the new Kings of Leon song
• Getting excited as she sits in the cinema and the opening credits of High School Musical 3 come on the screen
• Chatting to her Irish friend on Bebo
• Standing nervously in the queue to get into the new bar in town and hoping the bouncers don’t spot her fake I.D.

Things a 16-year-old girl should NOT be doing at 9pm on a Saturday night.

• Lying cold and lifeless on an A&E trolley as the priest reads her last rites.

Through the darkness

I’ve been working as a doctor for a few years now which means that I’ve a few years of working night shifts. You’d think that after all this time I’d know the best way to re-adjust my body clock so I can work through the hours of darkness but this is really not the case.

The trouble with working all through the night is that you invariably end up deprived of sleep, no matter how hard you try to sleep during the day. On top of that, it’s actually pretty difficult to eat properly. You don’t really feel hungry when you’re on nights, but a couple of nights in, you’ll start to feel really weak, irritable and spaced out and you’ll realise that it’s probably because you hardly eaten anything for 48 hours.

I’ve tried various strategies to get me through. I’ve tried forcing myself to stay awake the night before, I’ve tried trying to sleep whenever possible, I’ve tried sugar, I’ve tried caffeine, I’ve tried exercise and I’ve come to the conclusion that there is no good way to flip your body clock to working nights and then flip it back again.

My current strategy is to eat two largish meals – one before I set off for work in the evening and one before I leave work in the morning. I’ll also try and eat something at around 01:00 and if it gets quiet, I’ll try and snatch some sleep. I don’t think getting through nights becomes any easier, but I would say that these days, I’m more prepared for how crap I’ll feel.

On a roll

Now I’ve passed my exam, it means that I’m going to be an anaesthetic registrar in less than a year’s time. This means that out-of-hours I’ll be the most senior anaesthetist in the hospital and have to look after just about everything with no immediate back-up. It’s quite a scary prospect, so for the next few months I’ve decided to try and get as much exposure as I can in the aspects of anaesthesia and intensive care that I feel I don’t have much experience in. Effectively this is just about everything at the moment, but right now I’m trying to concentrate on specific procedural skills, so I’ll feel much more willing to do things out of hours. Specifically, I’m focusing on spinal and epidural anaesthesia.

This is one of the many aspects of anaesthesia that I find truly amazing. Basically, with an injection in the back, patients can have their operations and be completely awake and lucid throughout. You can sit next to them and have a conversation about gardening whilst they have their leg sawed off or their womb sliced open and they are completely pain-free throughout the whole operation. It’s really quite incredible if you think about it.

I know this link makes it look very simple but actually giving the injection into the right place is very tricky though because you can’t see where your needle is going. I have to rely on my knowledge of anatomy and previous experience to get it right.

A while ago, I posted about having a bit of a crisis of confidence. I basically felt that I wasn’t as good as I’d have liked to be at some aspect of my job. Well, it’s now a month later and I feel rather different, I've got over myself a bit and now just want to get as much experience I can at stuff so I can get better at it.

I clearly remember being a house officer in my first few months of my medical job. We had an elderly gentleman, Mr B., on the ward who had terminal cancer. He needed a venflon so we could give him some IV fluids to prevent him getting dehydrated. I tried once; I failed. I tried again; I failed. I must have looked really dispondent because he said to me, "Son, if you fall of a horse, the first thing you must do is get back on it again." The third time, I succeeded in getting a venflon in. Unfortunately, Mr B died of his cancer a couple of weeks later, but his words have stayed with me to this day.

A couple of months ago, I often just could not do spinal anaesthetics. I’d attempt and fail and then have to ask the consultant or registrar to take over. In the last few weeks, however, I’ve got much better at it. All of my last five attempts have been successful. All five patients had no pain for their operation whilst being awake. I’m on a bit of a roll and am feeling a bit pleased with myself at the moment.

On another note, I feel that my getting the exam out of the way early is going to be really beneficial for me. Now, I really do feel like all the pressure is off and I can get on with the business of learning to be a really good anaesthetist. Also, from a career point of view, it gives me time to get involved with audits and teaching. This is good because I really enjoy teaching and it will look good on my CV. All-in-all I feel that for the next few months, at work I can relax a bit and really start to enjoy myself.

A shot in the arm

For those of us who work in the NHS, it’s something that divides opinions as neatly and effortlessly as Bob Dylan or Marmite. It comes around at roughly this time every year and the chatter I hear around the wards and operating theatres suggest that this year is no different. You hear snatched snippets of conversation that go like…

“Are you going to do it? I’m not sure if I should I know Adrian’s doing it but he’s a bit older than me”

“There’s no way that I’m going to do it – I don’t see the point and I’ll just feel rough afterwards.”

“The way I see it is that it’s there to help us so we may as well take the opportunity while it’s there.”

“I can’t believe you’re going to do it, why on earth would anyone want to do that to themselves?”

I’m talking, of course, about the annual flu jab. This gets offered around this time of year to all health care workers as we are deemed “at high risk” because of our exposure to sick people. There is a problem though. The flu vaccine will inevitably make you feel really rough for a couple of days. You’ll get a runny nose, a cough, achy joints – in short, you’ll feel just like you’ve got the flu. It’s not as bad as the real thing though. I remember one Christmas when I was in my mid teens and I came down with the flu really badly. It was horrible. I literally couldn’t get out of bed for a couple of days and I felt hideous for about a week.

As a result, I see things like this: actually getting the flu is far worse than feeling rough for a couple of days. If the shot in the arm helps prevent me from the misery of the virus, then I’m all for it.

Needless to say, I was at the front of the queue when the Occupational Health Department opened their doors today.

200

I would like to say a huge thank-you for your messages of congratulations on my last post.

You know, I went into the city centre on Sunday afternoon. I took the bus in and I walked around for a bit. Not for any reason in particular, just because I could. I really feel that there has been a huge weight lifted from my shoulders. I was actually laughing to myself when I was walking through the park. I was laughing because I didn’t have to go home and try and remember the breakdown products of sevoflurane or the pKa of fentanyl or anything like that. What felt even better was that I didn’t feel guilty about not studying and didn’t get stressed that this was time I was wasting in which I could be learning those crucial few factoids that could make the difference between a pass and a fail. It felt great.

This is my 200th post on this blog.

I started this blog back in spring 2007 (halcyon days according to the politicians and financial experts, though I think several thousand junior doctors would disagree) and I honestly didn’t think that I’d still be doing it a year and a half later. There was no political motivation behind the blog (there still isn’t), I just started to write because I enjoyed writing for writing’s sake. I still do enjoy writing, and I guess, I’ll keep blogging as long as it’s fun for me.

Back when I started, I wasn’t to know just how spectacularly I’d be dicked around by MMC and I was probably pretty keen to continue working in general medicine, but had started to think seriously about switching to anaesthetics. My life has changed a hell of a lot since I started this blog (generally for the better, I think) and I think I’ve changed rather a lot as a person too.

I’m clearer about what I want from my career and my life in general. I’m less willing to be pushed around by others who want to make their own lives easier. I’m also much less scared now. I’m less scared by what I could potentially be asked to deal with. When I first qualified as a doctor, we used to joke about the tag line from the old Dr Pepper ads – “What’s the worst that could happen?” because we were really scared about being harming our patients or being powerless to prevent their demise.

Now, after being an anaesthetic SHO for a while now, I’ve seen “the worst thing that could happen” again and again and again. I’ve seen people vomit blood and keep on vomiting until they die because they literally have no blood left. I’ve a little girl rushed into A&E but amid the drama and the frantic activity, there is one unchanging fact – the baby is dead. I’ve seen people with the most horrific injuries from accidents (including a partial decapitation) and every time something this awful happens, I’ve seen the hospital staff try to move heaven and earth to help these people who come to our door. The point is, I’ve had to cope with it and I have to try and be of some use to these people. Every time the on call pager goes off and I get the “Could you please attend A&E resus immediately” I know that “the worst that could happen” is probably already happening and they’re calling me to help them out.

This post seems to have turned a bit more introspective than I intended it to. Being a doctor isn’t all doom and gloom and blood and guts – it’s actually quite fun. I enjoy chatting to the patients and the staff every day. I enjoy feeling that there are a number of people walking around the UK right now whose life is better in some way because of something I’ve done. I enjoy feeling that every day I make a difference sometimes in a big way, but more often in a small way.

I may bitch and moan about things that frustrate me about my work but, at the end of the day, I love my job and, all-in-all, I wouldn’t really want to do anything else.

Anyway, enough blabbing, I’m off to bed – I’m on call again tomorrow.

Results Day 2

Friday 12:48
I’m sitting having lunch with a couple of the other doctors that I work with.

“What time do you find out if you’ve passed?” Helen says to me
I look at my watch for the hundredth time. “In seventy-two minutes.” I reply
“I can’t believe you’re so calm about it. I’m really nervous about your results and I didn’t even sit the exam!”
“I’m not actually that calm about it at all, I’m just forcing myself to not think about it.”
“I’m sure you’ll be fine though – I have faith.”
“Thanks, but we shall see. It’s like VJ was saying earlier, I think with this exam, the first attempt has to be the best one. If I fail, I’ll have to do it again in January and the thought of having to do all that revision again is one of the most depressing feelings in the world.”
“And then there’s all the money that you paid to sit the exam in the first place,” adds VJ
“Yes, that as well,” I reply. “And also there’s the pride as well. I’ve made such a flipping song and dance about doing this exam that if I have to go round and tell everyone that I’ve failed, it’ll be just so embarrassing.”
“I wouldn’t worry about that,” reassures Helen, “not many people pass this exam first time, we’re just keeping everything crossed for you.”
“Cheers,” I mumble. “I appreciate that.”

Friday 14:00
I’ve started the afternoon gynaecology list with one of the consultants.

“Do you mind if I go see if the results are up?” I ask.
“Of course not, you go ahead.” I head towards the theatre doors and he says, “Michael, when you come back, I expect you to be smiling.”

I walk round towards the staff room where the computers are. I wasn’t really calm earlier on. I’ve been bricking it all day and now my heart is hammering in my chest and I’m absolutely petrified. I enter the password that allows me to access the internet at work and type in the web address for the Royal College of Anaesthetists. I find the results page and click the link you download the .pdf file containing the pass list.

I slowly scroll down to where my number ought to be. I remember doing this last time, but had forgotten just how horrible the moments just before you find out your result are. This time, I’d remembered my number off by heart so I knew exactly where it ought to be.

My number was up.

I’d passed.

It felt different this time. I didn’t shout or punch the air. I felt a huge wave of relief sweep over me. I sank my head into my hands and had to take a few big breaths. I’d worked so hard for so long and now it was all over. I couldn’t believe it was all over. I’d done it. I’d achieved what I set out to do. I’d done what so many people had failed to do and what so many people doubted I could do. I’d passed the FRCA primary at the first attempt, six months ahead of schedule. I think at this point I may have even shed a tear.

Then I started to smile and then to laugh and then to laugh even more. I stood up with a huge smile on my face and went off to let everyone know that I’d passed.

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I’d also like to say a huge thank-you to everyone who wished me luck online. Just before the exam I really did feel like everyone, I mean everyone - family, friends, work colleagues and commentors on this blog - was rooting for me and I think knowing that really helped me on when the exam got really tough.

Thank-you

Leaving everything on the track

So this is it.

My bags are packed, my shoes are polished and soon I’ll be heading off to the capital to sit the second part of the FRCA Primary exam. Two oral exams and one 90-minute OSCE stand between me and the “pass” that I need to go on to become an anaesthetics registrar (or ST3 in new money).

I have to say that I’m not feeling too frightened or nervous by the prospect of having my knowledge picked apart by the RCoA examiners. I’ve been working incredibly hard over the last couple of weeks and to be honest with you, I’m REALLY fed up with it all. I’m sick of the sight of my textbooks and I can’t wait for it to all be over – for better or for worse.

With this exam I’ve realised that I’m not going to be able to know everything that they could possibly ask. I reckon that you could spend half a lifetime studying physiology and still get flummoxed by a question on some random cytokine and same applies to pharmacology. My simple aim has been to try and know enough about enough subjects to pass this exam. I have to say that I’m feeling quietly confident about it at the moment and I reckon that if I manage to keep my composure (easier said than done!), with a little bit of luck I should hopefully be OK. Of course, I’m just speculating – I won’t really know this until the results are published at 2pm on Friday.

I remember watching the Usain Bolt breaking the legendary Michael Johnson’s 200m world record in the summer and in an interview afterwards he said something really telling.

“The night before that 200 metres final I told my room-mate,
Maurice Smith, ‘I'm going to leave everything out there on the track
tomorrow,'”

He “left everything on the track.” He gave it his all and didn’t hold anything back at all.

In some ways I too feel I’m giving this exam my very best shot. I’ve used all my study leave and I’ve racked up over 100 hours of study in the last three weeks alone. I’ve really tried my hardest to cram as much as I can into my skull, but despite this I’m all to aware that there is a hell of a lot that I still don’t know. I’m going to give this my very best effort and I hope that it will be good enough.

The problem with “leaving everything on the track” is that I don’t know what I’ll do if I fail this exam. Like I say, I could hardly have worked harder for it, so failure kind of leaves me with nowhere left to go. But I’m not really contemplating failure at the moment to be honest, the prospect of having to pick myself up and put myself through all this again makes me feel physically ill. I’m not really into rap music but I think Eminem spoke volumes on “Lose Yourself” when he said “…success is my only motherfucking option – failure’s not…”

Whatever happens, I shall be glad when it’s all over.

No such thing as a free lunch

Back near the start of the year, I was feeling a little poor. Like a lot of people, I’d ended up being a little overgenerous at Christmastime, and I started the new year feeling a tad broke. One morning, I noticed a poster saying there was a free lunch for junior doctors that day in the doctor’s mess. I’m all in for a bit of free food, so I made sure I was in the mess at 12:30 to tuck into the M&S sandwiches.

The lunch was sponsored by one of these Independent Financial Advice (IFA) companies. This meant that, while we munched away, we had to listen to their reps talk to us about the state of our finances and what we needed to do to “help secure our financial future.” I’d heard similar things from similar companies several times since my med student days and I’d become rather cynical about what these people say.

Basically they bang on for about 20 minutes telling us loads of stuff we know already, then they start talking about how expensive university/mortgages/living costs are and then they try and flog us payment protection insurance. Daniel and Jane, the IFA reps, were no different. They were very charming, very attractive, wore nice suits and had expensive-looking haircuts and I could see how you could get swept along with all the “wise” words that they were saying.

Like I say, I was feeling a bit broke at the time and I was a bit more willing than normal to listen to any advice about how to make the money I earn go a little further. I booked an appointment and with Daniel a week or so later to discuss the state of my finances. I’ve heard for a long time from many sources that “over the long-term shares are a better investment that property” so I was quite interested in how the whole “investing in the stock-market” thing worked. Daniel and I met and I batted away his hard-sell of payment protection insurance and then I had a look at the share portfolio that he had put together for me.

He said that he’d selected “the investment funds that most suited my ambitions” and gave me a lovely portfolio containing lots of nice graphs and lots of stuff like “MultiPEP” and “+113%” and “convenient and tax-efficient way of investing” and there were lots of pages with lots of names and lots of numbers in very small print.

It all looked very impressive, but my problem was I still had no bleeding idea how it all worked. As far as I could see, the deal amounted to me giving Daniel £50 to £100 each month and then I may or may not get more or less money back at some point in the future… perhaps. I really didn’t “get” how investing in shares worked, so I was a little loathe to put my hard-earned money into something I really didn’t understand.

I have a few friends who work in the financial markets and when I meet them they seem to be very successful but when they start talking about “P&L accounts” and “asset ratios” I get lost very quickly. I’m sure it’s not actually that complicated, but I’m basically not at all interested in it, so I either tune out very quickly or change the subject back to women and football.

Anyway, the long and the short of it is that I didn’t buy any shares and put my £50 each month into an ISA instead. To his credit, Daniel agreed that that was probably the wisest idea at the time.

Fast-forward now to last Thursday evening. It’s about 18:30 and I’m just arriving home from work. I look around my place and it’s an absolute tip. I will confess that I have a tendency to go to seed a bit when I have a big exam coming up but I decide enough is enough and dedicate the rest of the evening to tidying up. Guess what I find? Yup, the share portfolio that Daniel put together for me all those months ago.

I’ve been following what’s been happening in the financial markets with a dispassionate interest (I want everyone who feels sorry for the city bankers to put their hands up now… anyone?... anyone at all?.... I thought not) so I thought I’d look on the internet about what happened to the funds that Daniel had advised me to invest in.

Guess what? Every single one of them was down by between 15% and 40% over the last year. If you include Daniel taking his fee and the fund managers and taxmen taking their cuts I would have been left significantly out of pocket. Now despite what you hear in the press, I don’t actually earn a vast amount of money and I would have been seriously pissed off if I’d decided to invest at the start of the year, especially knowing that my money had probably been spent by City Boys pouring Kristal over stripper’s arses in some lapdancing club in Soho.

Now, from what I understand, banks like Northern cRock, Lehman Bros and HBOS got themselves into trouble basically by investing in thing they don’t understand and as I sit here typing this, I feel like patting myself on the back for not making the same mistake that they did.

The other point I want to make is that it is Daniel’s job to pick the best places for me to invest my money. I have no idea if he’s still doing that job and I have nothing personal against the guy, he appeared to be a really nice bloke but he’s meant to be an expert. He earns a living and buys expensive suits on the basis of his “expertise.” The question is… If he can get it as badly wrong as he has done, do I really think that he’s competent in his job? If I did as badly in my job as he’s done in his, I shudder to think what might have happened.