Thursday 29 October 2015
Monday 8 February 2010
London Calling
To cut a long and convoluted story short, my plan has now come to fruition. I am now the proud owner of a training number in London and I will now complete the ret of my post-graduate training there. Since Christmas, I’ve spent most of my free time sorting out the practicalities of the move. I’ve been packing, sorting out my paperwork, having multiple conversations with various people at the deaneries
Anyway, after what seemed like an eternity, last week I finally started working in the big smoke and it’s certainly been the case of so far, so good. London hospitals have a reputation for being large, unfriendly and extremely competitive, but the people I’ve met and worked with so far have all been really nice and I feel I’m really going to enjoy working here.
On a more personal note, me and FashionGirl have moved in together and so far, things are going really well.
It’s been a bit of a long haul, but are really slotting into place for me at long last. I’ve got a feeling that I’m really going to enjoy myself over the next few months and years.
Friday 29 January 2010
Perspective
Wednesday 6 January 2010
Unless it is a matter of life and death
Wednesday 23 December 2009
Just a quick note...
I'm dreaming of a white Christmas
Tuesday 22 December 2009
I’m not dreaming of a white Christmas.
At the end October, all the junior anaesthetists in my hospital were given the on-call rota for November to February. The first thing we all looked at was who had to work Christmas and who had to work New Year’s Eve.
Monday 21 December 2009
Two things that made me smile today
The fact that Rage Against the Machine are Christmas number one. Power to the people!
Thursday 17 December 2009
Raising doctors, the "beta" version
Wednesday 16 December 2009
Who is a doctor?
Beep Beep… Beep Beep…
My mobile phone shrills and I casually reach over and pick it up to read the incoming text message.
You have an appointment with Dr Kavelidis at
I furrow my brow in confusion. I haven’t made an appointment with my G.P. in fact I haven’t needed to see him in over a year. Besides, I don’t have a clue who “Dr Kavelidis” is, perhaps he’s a new G.P. at the practice. But it still doesn’t make sense I’m sure the GPs at my surgery are busy enough without having to randomly text people on their practice lists to trawl for business. Was this some sort of new QOF thing? Seems unlikely, I’m a healthy young man. Maybe FashionGirl has the answer.
“Darling,” I say and she looks up at me from the magazine that she’s engrossed in. “Did you make me an appointment at the doctors? I’ve just had a text telling me I’ve got an appointment in a couple of days and I never made one.”
She shakes her head at me and says, “No, I didn’t. Let me see that.” She has a look at my phone and says, “It’s odd isn’t it? Especially as there’s no “from” number.”
None the wiser, I delete the message and continue watching the telly. Last time I went to the GP, I did get a reminder text beforehand, so I assumed there’s been a mix up and I’ve go the text by mistake.
Two hours later, it hits me. I do have an appointment on Thursday, but not with the doctor, with the dentist.
I go over to the fridge where I’ve stuck the appointment card and have a look at the names. Sure enough Dr. Kavelidis’ name is on the card, just below "Dr. Chang" and just above, ironically enough, “Dr Anderson.”
So, it does beg the question, “Are dentists ‘doctors?’” On this evidence, apparently they are. It just seems a bit odd to me. Dentistry is incredibly competitive to get into. Like medicine, you need straight As at A-level and then you have to spend five years studying at dental school before you’ve earned the right to call yourself a “dentist.” So why on earth, after all that, would you want to call yourself “doctor”?
It’s not just dentists that are “doctors.” Apparently, these days psychologists are “doctors,” chiropractors are “doctors”, and even nutritionists are “doctors.”
Slag me off if you want, but I spent five years at doctor school to earn the right to call myself “doctor” when I treat patients and I find it rather annoying (and inappropriate) that people with no medical qualifications get to call themselves “doctor” when treating patients.
I know there’s a feeling in the modern NHS that “anyone can do a doctor’s job,” but it’s simply not true. The way I see it, if you think you can be a real doctor, go to medical school and graduate. That way, you’ll see for yourself how “easy” it is.
Now, I totally agree that a PhD is hardly a walk in the park either, and neither is a dentistry degree and I can see that people who’ve worked hard for years at these should have a title to show their achievement.
The solution, I think is to use a system like the do in the
Dr. Michael Anderson MD
I like the sound of that.
Tuesday 15 December 2009
In which we save money for the NHS
I’m on a morning ward round in the Intensive Care Unit and we’re discussing a patient I’d admitted the day before. Mrs Patel is a lady in her sixties with really bad respiratory failure due to a particularly nasty pneumonia. The previous afternoon I thought that if we gave her non-invasive ventilation (NIV) and adequate intravenous fluids, she may just turn the corner and start to get better.
Unfortunately, I was wrong. She continued to deteriorate and quite soon after she arrives on the ICU, her oxygen levels were still dangerously low despite the NIV so in order to prevent her from dying then and there I had to put her into a medically-induced coma, intubate and put her on a ventilator.
So there I was the next day, recalling this story to the ICU consultant, SHO, ward sister and staff nurse. We look at her blood test results, ABGs, chest X-rays etc… and it’s apparent to all of us that whilst this lady will probably get better, it’s going to take a while and she will need to stay on the ventilator for at least a couple of days.
I turn to Richard, the SHO, and say “Could you change her sedation to midazolam & morphine.”
“Sure,” he says as he picks up the drug chart. He crosses off the propofol & alfentanil and writes up what I requested.
(Basically I’ve asked him to change the drugs that are keeping Mrs Patel in a coma. Propofol & alfentanil are shorter acting, but much more expensive. Because we were going to keep her in a coma for a few days, I changed to the longer-acting but much cheaper midazolam & morphine.)
After scrawling the new prescription (it’s so true what they say about doctor’s handwriting) Richard says, “It won’t make any difference, you know.”
I raise an eyebrow. “What do you mean?”
“I mean, it doesn’t matter how much money we save by doing stuff like this, they’re still going to cut our pay.”
“True enough,” I concede.
“Well, if the other lot get in, they’ll dock our pay even more!” pipes up Julie, the ICU ward sister
“Could we please save the politics for the coffee room,” comes the irritated voice of our consultant. “Now, could someone find the result of this woman’s most recent ECHO?”
Suitably chided, we get back on with the job in hand.
Saturday 12 December 2009
Casualty
I’m not working this weekend, so I’ve been sitting in front of the telly with a can of beer (Grolsch is my tipple of choice at the moment). Disappointingly, there was nothing I particularly wanted to see on the box. Come Dine With Me didn’t appeal, and I detest the X Factor so much that I won’t even entertain the thought of having it on anymore (I’m seriously considering buying Killing In The Name Of…).
I flicked over to the Beeb and was greeted by the Casualty* theme. I can’t listen to that tune without wanting to say “Will everyone stop getting shot!” in a really bad cockney accent. Previously, I’ve said that I was no fan of medical dramas, but for some reason, I thought I’d give it a go. Maybe it’s because I had nothing else in particular to do or maybe it’s because I’ve just spent a month watching seven series of Scrubs, but I thought I’d see if Casualty had gotten any better since the last time I watched it.
I think it’s definitely improved. I was quite pleasantly surprised and even moderately entertained. Back in the day, Casualty always used to be about “guess the really predictable disaster” and tonight’s episode remained true to those roots. I can sum it up with: Man unscrews valve on bus/fluid starts leaking out/bus goes downhill on narrow country lanes/brakes fail/bus goes over cliff. I don’t think it’ll Casualty will ever top the classic “man in field/combine harvester” episode, but it’s good to see the producers continue to try.
It’s also good to see that at long last, the show has recognised the existence of us junior doctors. I’ve spent more time than I care to remember trying to explain to people that “junior doctor” and “medical student” are not the same thing and then explaining what we junior docs actually do all day. I think having us on telly will help a little bit. The juniors on the show all seem to be very attractive, much more attractive than any group of doctors that I’ve ever worked with, if a bit on the numptyish side.
All in all though, it kept me amused for three quarters of an hour or so, so it’s definitely a big step up on the last time I watched a medical drama on the BBC. I might even consider watching it again next week.
If anyone reading this and thinks that I really need to get a life and get out more, I totally agree - Big Ed has just texted me and now I’m off out dancing…
* “Casualty” is such an old-fashioned name isn’t it? I’d be interested to know if it’s still called “Casualty” any hospital in the
Interestingly, more changes are afoot because it’s been decided that “Accident & Emergency” is now not a good enough name, so it’s going to become the “Emergency Department.”
In about 10 years’ time they’ll probably all go back to being called “Casualty” again. Who makes these decisions? What a waste of time and effort.
Monday 7 December 2009
Scrubs
Almost exactly a month ago, one of my colleagues lent me the DVD box-sets of Scrubs Series 1-7.
I remember when Scrubs first started. I was still in medical school and at the time, loads of my fellow medical students were raving about how good it was.
I never really got into it though, mainly because, as far as I can recall, it’s never been on terrestrial TV in the
Until now.
I think the show is absolutely fantastic, and it’s made me laugh out loud more times than I can remember. For those who don’t know, the series basically follows three American doctors as they progress through their training from their intern year through to becoming attending physicians and beyond.
I’ve heard people say that it’s “really realistic.” I wouldn’t go so far as to say that the show bears much resemblance to every day hospital life, but it does have moments that I really recognise. Bricking it at your first cardiac arrest call, trying to make a relationship work despite the demands of the job, the frustration you feel at the patients who just won’t help themselves as well as those who you feel you’ve made a real difference to are all shown at various points.
I realise this is rapidly turning into an advert, so I’ll stop. Anyway, the DVD is calling, I’m half way through series 7 now, so I guess my normal blogging will resume shortly.
Monday 9 November 2009
In which I ask for help
Tuesday 3 November 2009
Sleeping is Cheating
The reason I’m telling you about this is not because I particularly want to share what a group of mates got up to in a Northern city but that tonight I face a similar situation.
So, it looks like I won’t be sleeping for a while, but then again, sleeping is cheating isn’t it?
Monday 26 October 2009
Fuck the BNP
I don’t pay my licence fee for fascists and their followers to come onto political shows on one of the UKs great institutions and spout their hate-filled racist drivel.
Let’s recap some of the BNP’s policies (words in italics are my own comments).
· The forced deportation of 2,000,000 people (or 1 in 30) from the UK. Let’s not forget these will be British passport holders or working here with valid visas. These people will be stripped of their assets including homes and cars on the basis of skin colour.
· Millions of other Brits “of foreign descent” will be “encouraged” to return to their “country of origin.” Exactly what form this “encouragement” will take, I can only shudder to think.
I could keep going with a whole list of thing that these evil fuckers want to do, but I won’t because this post will get too long and I think you get the point already.
And yet, we have so many people who think that the BNP should be given a voice. I had to walk out of the ICU coffee room on Friday because I was so mad with one of the consultants who thought it was right that the BNP should be on Question Time. Fellow bloggers such as The Jobbing Doctor think it’s OK for people to say stuff like “Islam is wicked,” and “There’s no such thing as a Black Englishman” on national television. People who defend the BNP’s right to hate speech seem to have no regard for the targets of the BNP’s vitriol. They have no regard for their fellow citizens, instead they prefer to stand behind the right of the racists even though the very things the racists are saying would deny rights to some of their fellow countrymen based on skin colour.
Why do people in the country find it so hard to say “No.”?
This whole episode is deeply shaming on us as a nation and a lot of people need to take a good look at themselves and be honest about what their values really are.
Fuck the BNP.
Thinking about this is getting me angry again, so I’m going to leave you with the words of a Mr Richard Reynish whose letter was published in The Guardian on Friday.
"As Britain debates the BNP’s appearance on Question Time, it would be a good idea to learn from developments elsewhere, before it’s too late. Here in Denmark, where I have lived for 30 years, we have witnessed the systemic hijacking of a progressive and tolerant culture by the far right dressed in “respectable” sheep’s clothing. In 10 years, Denmark has been transformed into a country where racism is in the mainstream.
Free speech has protected hate speech, and opponents of censorship have consistently defended the rights of unscrupulous populists and incendiarists. When the media take this line, a very wicked circle is started: the inflammatory accusations of racists become self-fulfilling prophecies, as minorities are increasingly marginalised and excluded. Mainstream political parties, attempting to win back voters from the far right, make an endless series of concessions, attempting in vain to demonstrate understanding of the concerns of voters tempted by simple xenophobic policies. But the far right will always have a more extreme policy, and a new provocative proposal, which keeps them permanently centre stage in the media.
The “debate” about immigration – in reality a platform for populist racism – dominates politics, poisons serious dialogue an guarantees one thing: racist dominance of the media and the political agenda. "
Richard Reynish
Copenhagen, Denmark.
Wednesday 21 October 2009
In which I embarrass myself
A more permanent solution is to discharge patients from the intensive care unit (ICU) to make space for the extra patients. If they are well enough, sometimes patients can go to the ward, but on Friday we really didn’t have anyone in that position. Our only option was to transfer one of our patients to another ICU in a different hospital where they did happen to have some space.
Obviously it’s unfair and unsafe for paramedics to transport these critically ill and unstable patients by themselves, so one what happens is that one of the intensive care doctors and one of the ICU nurses travel with these patients in the ambulance to look after them during the journey, and also to hand over the details of their care to the doctors and nurses in the receiving hospital.
And so it is that I find myself in the back of an ambulance taking one of our patients to another hospital.
Anyone who’s ever taken a ride in the back of an ambulance will tell you that the windows are obscured so you can’t see out. Usually I’m not susceptible to travel sickness, but this day was different. We had the heating up to stop our patient getting cold, the ambulance rocked rolled as we went round corners. I hadn’t been feeling well most of the day, I was tired from being on call the day before and hadn’t eaten very much because I had an upset belly.
It was the speed bumps that really did it for me. Andy, the nurse who was travelling with me said, “You’re being unusually quiet today, Michael.”
I looked at him, but couldn’t seem to focus properly. His features swam before my eyes and I knew then that I was going to spew.
“I feel horrific,” I mumbled. “I’m going to be sick”
He raised an eyebrow. “Really?”
I could only nod because my mouth was filling with saliva and I was holding my breath in an attempt to delay the inevitable long enough to grab a sick bowl.
“Here, take this” said Andy as he quickly pulled a cardboard sick bowl from the pile in which it was stacked.
I accepted it gratefully and promptly vomited into it.
“There he blows!” came the amused voice of the paramedic in the front seat as up came the remnant of my cornflakes and the cup of coffee that I’d had just before leaving. But it didn’t stop there, I spent the next quarter of an hour retching bile as the ambulance zoomed through the city with its blue lights on and the siren going. I hadn’t felt so miserable for ages.
I had never felt so grateful to see another hospital as I did when we pulled up outside the A&E of the receiving hospital and I was able to get out into the fresh air. Our patient was absolutely fine though and on the inter-hospital transfer paper work I wrote “Uneventful transfer” in the comments section and, of course, I made Andy promise not to breathe a word about this to anyone else in the ICU.
Sunday 18 October 2009
Credit
Who is the biggest hero of the
decade?
“Nurses, doctors and firefighters”
Friday 16 October 2009
Now I Know
In August, when I started working in Intensive Care the lead consultant, Dr. Cullen, asked me whether or not I wanted to do Intensive Care as a future career. At the time I really had no idea, and told him as much. You see, to us anaesthetists, Intensive Care work is a bit like Marmite in that it we either love it or hate it.
I worked in ICU in my first year of anaesthetic training, but at that time, I felt I didn’t really get a feeling of whether it would be something I’d like to pursue further down the line. I felt that I didn’t know enough stuff to be really useful and I didn’t know enough to actually make a real difference to the patients that I was helping to look after.
I’m now coming to the end of my current attachment in ICU and yesterday Dr. Cullen asked me again if I would consider intensive care as a career. This time I had an answer for him – no.
There are things that I really like about working here, I like it when we’re given a rapidly deteriorating patient, and I can stop their demise and (hopefully) put them on the road towards recovery. I actually like going round the wards and being able to be useful to other doctors who are struggling to look after their ill patients. I like the fact that I can actually do the majority of medical procedures, I’ve done dozens of central lines, arterial lines, intubations, chest drains, difficult venflons etc… etc… and these things no longer hold any mystery or worry for me. I like the fact that the ICU nurses are so switched-on and the fact that there are so many of them means that they can help us doctors out more which means I get to concentrate more on actually trying to get our patients better.
ICU is no land of milk and honey though. There are lots of things I really don’t like. A while ago, I wrote about why doctors get stressed and about some of the ways they cope. I said that simply being around unwell people is uncomfortable for people who have dedicated their lives to trying to make people well. I’m finding this really true of myself. Even when everyone is totally stable and there’s not much happening, I find just being on the intensive care unit stressful. The constant beeps, the almost continual alarms of the infusion pumps, monitors and ventilators, the fact that I know that things can, and often do, go tits up at any moment, all this things conspire to put my blood pressure up.
Our patients are all teetering on the brink of death. Actually, it’s more accurate to say that they’re well past the brink and with our machines we are desperately trying to push them back ONTO the brink so they have a fighting chance of living. This means that one of our patients will frequently drop their oxygen levels or blood pressure to a dangerously low level. They often hallucinate and try to pull out the very tubes that are stopping them dying. While the nurses are very good at sorting these things out, often they’ll need help just to stop the patient from expiring and it’s me that has to go and sort these problems out. Often I feel I’m fighting a pitched battle against the very people I’m meant to be helping. I find it frustrating that I can’t talk to my patients and that they’re often on the ICU for so long with only very tiny improvements to their health each day.
And then there’s the relatives. Seeing your husband/son/mother/grandpa/sister/friend unconscious and hooked up to all our machines must feel horrible. I can’t even imagine how I’d feel if I saw my mother lying their as one of our patients, I shudder at the thought. We try our best to explain what we are doing but I find having these conversations difficult simply because I don’t know what’s going to happen to their loved one. The two commonest questions a relative asks are “Is my loved one getting better?” and “Is my loved one going to die?” And the trouble is, often I simply don’t know if they’re going to live or die and, unlike when I was a physician, often I don’t even have a handle on how likely survival or death is. The uncertainty is often really hard for relatives to understand and deal with. But what I think is even more difficult is the timescale. As I already alluded to, patients stay unconscious with only very slight changes in their condition for days or weeks. We as doctors can see the subtle changes in their inotrope requirement, ventilatory demands etc… but basically, from the outside they look exactly the same. (Actually, as time passes, ICU patients look aesthetically worse as they swell up with fluid and accumulate puncture scars from all the tubes we keep sticking into them.) While we try to explain what’s happening, the seeming lack of progress after such long periods of time is often really distressing because relatives are sort of suspended in a seemingly unending, hellish limbo. Seeing relatives upset in turn upsets me because I too want their loved one to get better quickly, but it’s rarely possible and it leaves me wishing I could do more when I just can’t.
Dealing with other doctors can be wearing as well. There’s a constant trickle of calls for little things like venflons, lumbar punctures, central lines etc…from acopic ward doctors but that stuff doesn’t really bother me. I use my discretion. I help out if the request is reasonable and I’m free and able, if they’re just taking the piss and trying to get me to do their job for them, I have no qualms about telling them where to go. No, there are two things that really get me. Firstly, some doctors seem to have the belief that every unwell person should be looked after by the intensive care team. This really isn’t the case. Sick patients often don’t need Intensive Care, but they need the ward doctors to pay close attention to their condition and give appropriate treatments and sometimes, it’s hard to get ward doctors to understand this. Secondly, there are the group of patients who have been blatantly mismanaged on the wards and then I get a call to see them and am somehow expected to perform miracles. This frustrates me no end too.
And finally, there are the times where it really does all go wrong. There’s the fast bleeps, there’s the trauma calls and there’s the cardiac arrest calls. On average, I go to two or three of these every shift (my record is eleven). These are the situations where people are literally at (or through) death’s door. Sometimes, there’s not much for me to do at these calls, but sometimes there is. Often they’re just a horrible disaster and often the patient dies, sometimes in a more painful and disgusting way than you ever thought was possible.
So all in all, I’m working hard in Intensive Care, but I’d hate to do this forever. There’s too much drama, too much stress, too much politics, and too much frustration. If I had to do this forever, I think I’d end up worrying myself into an early grave, there are far easier ways of earning a living. I don’t think it’s any coincidence that two weeks ago, I found my first grey hair.
Saturday 3 October 2009
Not everyone is happy
Friday 25 September 2009
What is really important?
Dr. Lin our college tutor which means that she is the person in charge of looking after the training of the junior anaesthetists in my hospital. I’ve worked with her a couple of times and she appears a pleasant lady. I want to speak to her about something that I’ve had on my mind for a long time now, but have only recently made a proper decision on.
Dr. Lin regales me with an even look and replies, “Certainly Michael, do you want to come through to my office?”
I follow her through to her little room and she clears a stack of patients’ records off her workspace and asks me “What can I do for you?”
I’ve been over this moment many times in my head and I figured the best thing for me to do is to just come straight out and say what I want to.
“I’d like to leave the rotation.”
I state the words simply. This is one of the biggest professional decisions I’ve made in my career and, to me, it feels like I’ve lit the blue touch paper. But there’s no fanfare, no fireworks, just a slightly surprised look in Dr. Lin’s brown eyes. I fill the silence.
“You see, my other half, she works in fashion and, as you can imagine, there’s been lots of job losses in retail over the past year or so. Anyway, she’s had to leave her job here and none of the retail firms are recruiting at the moment. She’s actually managed to get herself another job – one that’s actually better than the one she left – but it’s not here, it’s in London. London’s where all the big retailers have their head offices. She’s searched for a job round here and there really isn’t anything that she wants to do. So, she’s taken the job in the capital. She’s moved there already and I’d like to follow her.”
Dr Lin breaths out slowly, during one of our days working together, I chatted to her about my girlfriend and what she does, so she sort of knew a bit about our situation already. She takes her glasses off, slowly rubs her nose and speaks.
“You know Michael, I understand where you’re coming from. I think from my point of view, it’ll be a real shame to see you leave here. The other consultants and the secretaries all say good things about you, but if you want to leave…” her voice tails off and she sits back in her chair and sighs.
“You probably aren’t aware of this but one of my good friends was diagnosed with cancer a few months ago and is now off work, probably for good. When something like that happens to someone you really know, it brings a lot of things home. It really makes you think about life and what’s really important. And I’ll tell you what’s important…” She’s more animated now, she sits forward in her chair and jabs her glasses in my direction.
“Health, happiness, love… these are things that are important. Turning up here at the hospital to work every day, that’s not important, not in the long term, but love is. So, like I say, I totally understand why you want to go and be with your girlfriend, you two have been together a while now haven’t you?”
I nod.
“So of course I’ll support you when you want to leave.”
“Thank you,” is all I can say.
“Have you told the deanery about it yet?”
“Yes,” I reply. “I’ve already asked them what I need to do to transfer my number and I’m going to fill in the application form this weekend.
“Good.”
“Could I put you down as one of my referees?”
“Yes, of course you can.”
“Thank you very much Dr. Lin” I say once more and stand up and head for the door. I’m half way out when Dr. Lin says
“Oh, Michael.” I turn to see her with a conspiratorial smile playing on her lips. “Do you think that she’s the one?”
I give her a broad grin in return and say, “We shall see…”