...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.
Saturday, 18 August 2007
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
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
Sunday, 12 August 2007
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.
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.
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.
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.”
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.”
Sunday, 5 August 2007
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.
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…
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…
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…
Tuesday, 31 July 2007
Until the fat lady sings
Yesterday was my last day on call for general medicine and today was my last day on the wards.It was a really nice day. We only had one very sick patient so I was ale to say goodbye to everyone I’ve been working with for the last six months. Dr Fletcher has given me an excellent reference and told be that I was a loss to medicine but was sure I’d do very well as an anaesthetist.
I brought in cakes and chocolates as a goodbye gifts and everyone said they were sad to see me go. I got lots of hugs from the nurses and lots of heart-felt “thank-you”s from the patients. It was all very touching really; it feels nice to be cared about.
I put on the radio as I drove away from Town Hospital for the last time and the fat lady was singing her heart out.
-------------------------------------
It’s 9pm and I’ve packed my stethoscope, clothes, food, portfolio into a bag and am about to set off on the 200-or-so mile journey to my new job.
As always, I'll keep you posted
Monday, 30 July 2007
There’s people on the pitch…
That’s it.
It’s all over bar the shouting. Today, I finished my last ever on call shift as a doctor working in general medicine. Back when I was a PRHO (remember those?), just out of medical school, I the abiding memory of my first ever on call shift was an overriding sense of fear. I’ve learnt so much since then and so much has become routine for me, that I think I’ll remember my last ever shift for being… well, for being pretty unmemorable, really.
All in all, I’ve liked hospital medicine. I’ve liked the patients I’ve met, the stories I’ve heard and the staff I’ve worked with. I feel that every day I’m making a difference – whether it’s literally bringing someone back from the dead or just taking the time to sit and listen to one of the elderly patients for five minutes or so. I’ve loved my job.
But there’s so much about the job that I don’t like. There’s so much of the overwork, constant hassle from various sources (often simultaneously), there’s the general expectation that I can be in four places, doing six different things all at the same time. I can’t remember the number of times I’ve wanted to shout out “THERE’S ONLY ONE ME!” I hate the fact that everything seems to be my responsibility. If a patient has broken their spectacles or if the MRI scanner has broken down, somehow, I’m supposed to sort it out. I’ve hated my job.
The last patient I’ll ever admit to Gen. Med. was a woman in her mid-forties who was sent up from A&E because they suspected she had a deep-vein thrombosis (a blood clot in her big leg vein). It wasn’t an exciting, it wasn’t glamorous – but to be honest, hospital medicine rarely is. I walked off the unit with a wry smile and I think that that lady’s swollen leg will forever hold a certain place in my memories.
Anyway, I’m off to a new specialty in a new area. I’ve really been looking forward to the career change and I’m really excited by the new challenges that lie ahead.
I leave hospital medicine with countless memories. Some make me smile, some make me feel proud, some bring a lump to my throat and some make me shudder. I really believe that the grass is greener away from Gen. Med. and I’m going enjoy my new specialty more, but either way, I’ll keep you posted.
I’m a medical SHO no more. My new name badge will read:
All in all, I’ve liked hospital medicine. I’ve liked the patients I’ve met, the stories I’ve heard and the staff I’ve worked with. I feel that every day I’m making a difference – whether it’s literally bringing someone back from the dead or just taking the time to sit and listen to one of the elderly patients for five minutes or so. I’ve loved my job.
But there’s so much about the job that I don’t like. There’s so much of the overwork, constant hassle from various sources (often simultaneously), there’s the general expectation that I can be in four places, doing six different things all at the same time. I can’t remember the number of times I’ve wanted to shout out “THERE’S ONLY ONE ME!” I hate the fact that everything seems to be my responsibility. If a patient has broken their spectacles or if the MRI scanner has broken down, somehow, I’m supposed to sort it out. I’ve hated my job.
The last patient I’ll ever admit to Gen. Med. was a woman in her mid-forties who was sent up from A&E because they suspected she had a deep-vein thrombosis (a blood clot in her big leg vein). It wasn’t an exciting, it wasn’t glamorous – but to be honest, hospital medicine rarely is. I walked off the unit with a wry smile and I think that that lady’s swollen leg will forever hold a certain place in my memories.
Anyway, I’m off to a new specialty in a new area. I’ve really been looking forward to the career change and I’m really excited by the new challenges that lie ahead.
I leave hospital medicine with countless memories. Some make me smile, some make me feel proud, some bring a lump to my throat and some make me shudder. I really believe that the grass is greener away from Gen. Med. and I’m going enjoy my new specialty more, but either way, I’ll keep you posted.
I’m a medical SHO no more. My new name badge will read:
Dr Michael Anderson
ST1 Anaesthetics
ST1 Anaesthetics
Bring it on.
Wednesday, 25 July 2007
Happiness begins at home
My consultant, Dr Fletcher, was in a particularly foul mood today. I don't know why, exactly, but I have a theory...
Tuesday, 24 July 2007
Sabotaging my relationship
Now I know that I’m leaving Town Hospital, I’ve been thinking about the things that have happened to me whilst I’ve been working here. My mind keeps coming back to Gemma. Things never did work out between me and her. We went out a couple of times and I’m she was really keen. The reason it didn’t work out was 100% my doing. I had other things on my mind. The most obvious of which was that I knew that if we did get together, there was a high likelihood that I’d have to move far away from her in a matter of weeks.
Long-distance relationships haven’t worked for me in the past and I didn’t want to start something with so much uncertainty around regarding pretty major life stuff like my employment status and where in the country I’d be living.
It is a shame though, if I were to write down a list of things I’d look for in a girlfriend it’d go something like this:
Intelligent
Sexy
Funny
Caring
Outgoing
Sporty
Sociable
Likes me too
Gemma definitely ticks all my boxes – in fact she was the first girl I’d met for ages who seemed to.
I’m going to make the effort to stay in touch with her and hopefully we’ll become good friends. Time will tell
Long-distance relationships haven’t worked for me in the past and I didn’t want to start something with so much uncertainty around regarding pretty major life stuff like my employment status and where in the country I’d be living.
It is a shame though, if I were to write down a list of things I’d look for in a girlfriend it’d go something like this:
Intelligent
Sexy
Funny
Caring
Outgoing
Sporty
Sociable
Likes me too
Gemma definitely ticks all my boxes – in fact she was the first girl I’d met for ages who seemed to.
I’m going to make the effort to stay in touch with her and hopefully we’ll become good friends. Time will tell
Monday, 23 July 2007
It's a hospital, it's not a prison
“Can I go home, doctor?”
This is a question that patients frequently ask me. Hospitals aren’t prisons and patients are free to come and go as they please, I always tell my patients this and it turns out that most of the time, what they’re really asking is:
“Do you think I’ll be OK at home, doctor?”
which is obviously a totally different question. I’ll give my opinion and if I think he or she should stay in hospital, I’ll say so and the patient can choose to follow or ignore my advice as they wish. At the end of the day, it’s their life and they can decide what to do with it so I don’t generally get het up when patients ignore what I say and discharge themselves against medical advice.
Sometimes though, when I REALLY believe the patient could get into serious strife if they leave, I’ll do my best to try and persuade them to stay.
Let me tell you a story about a man called Jack.
Jack liked to have the occasional beer or 12 and he was the kind of guy who just loved regaling you with stories about the fights he’d been in. Jack came to my ward after having a seizure. The day after his seizure, Jack felt totally fine again. Dr Fletcher, the consultant, wanted to get a CT scan of Jack’s brain to help decide if Jack’s seizure was related to alcohol, epilepsy or something else, like a brain tumour.
Unfortunately, the CT scanning machine broke down so Jack had to wait a couple of days to get is scan. Jack wasn’t too happy about being stuck in hospital while he felt fine but was willing to wait to have his scan just so long as he was home in time for his daughter’s 8th birthday.
The day before the birthday, Jack got his scan and the scan result was not good news. It was not good news at all.
The scan showed that Jack was bleeding into his brain.
This meant that he was at a massively increased risk of stroke, paralysis, coma and death. I picked up the phone and spoke to the neurosurgeon on-call and his advice was to get a more detailed (MRI) scan and then send him the films so he could decide if brain surgery was to be recommended.
I went back to Jack’s bedside and explained what the scan showed. I also explained what might happen to him and that we’d like him to stay with us so we could get the more detailed scan and ask the brain surgeons to see him.
Jack furrowed his brow and said, “I’m not staying doctor. I promised my little girl I’ll be there for her birthday, so no matter what – I’m going home tonight.”
I again told him that he was at risk of dying from the bleeding in his brain and that it was much safer for him to be in hospital where we could keep a close eye on him and act quickly if anything happened.
Jack responded “I hear what you’re saying, doctor, but I’m not staying here tomorrow - I can’t.”
As doctors, we have to respect our patient’s right to make decisions about their treatment even if we strongly disagree with them. At the end of the day, it’s THEIR body and THEIR life and this means it’s THEIR decision, not mine.
I went and got Jack a “discharge against medical advice” form, which he signed gladly. I made sure he knew what symptoms to look out for and asked him to come back to hospital immediately if he had any numbness or weakness, if he developed a headache or had any problems speaking or any problems with his vision. I then shook his hand and wished him all the best. I then called up the MRI department and organised an urgent outpatient scan for Jack.
As I watched Jack walk off the ward, it struck me that in this life we must all make our choices and it’s the choices we make that shape how our life develops and ultimately, who we become. I hope Jack made the right choice and I hope he enjoyed a great day with his daughter. Deep down, my gut feeling is that Jack is going to be alright.
I hope I’m right.
This is a question that patients frequently ask me. Hospitals aren’t prisons and patients are free to come and go as they please, I always tell my patients this and it turns out that most of the time, what they’re really asking is:
“Do you think I’ll be OK at home, doctor?”
which is obviously a totally different question. I’ll give my opinion and if I think he or she should stay in hospital, I’ll say so and the patient can choose to follow or ignore my advice as they wish. At the end of the day, it’s their life and they can decide what to do with it so I don’t generally get het up when patients ignore what I say and discharge themselves against medical advice.
Sometimes though, when I REALLY believe the patient could get into serious strife if they leave, I’ll do my best to try and persuade them to stay.
Let me tell you a story about a man called Jack.
Jack liked to have the occasional beer or 12 and he was the kind of guy who just loved regaling you with stories about the fights he’d been in. Jack came to my ward after having a seizure. The day after his seizure, Jack felt totally fine again. Dr Fletcher, the consultant, wanted to get a CT scan of Jack’s brain to help decide if Jack’s seizure was related to alcohol, epilepsy or something else, like a brain tumour.
Unfortunately, the CT scanning machine broke down so Jack had to wait a couple of days to get is scan. Jack wasn’t too happy about being stuck in hospital while he felt fine but was willing to wait to have his scan just so long as he was home in time for his daughter’s 8th birthday.
The day before the birthday, Jack got his scan and the scan result was not good news. It was not good news at all.
The scan showed that Jack was bleeding into his brain.
This meant that he was at a massively increased risk of stroke, paralysis, coma and death. I picked up the phone and spoke to the neurosurgeon on-call and his advice was to get a more detailed (MRI) scan and then send him the films so he could decide if brain surgery was to be recommended.
I went back to Jack’s bedside and explained what the scan showed. I also explained what might happen to him and that we’d like him to stay with us so we could get the more detailed scan and ask the brain surgeons to see him.
Jack furrowed his brow and said, “I’m not staying doctor. I promised my little girl I’ll be there for her birthday, so no matter what – I’m going home tonight.”
I again told him that he was at risk of dying from the bleeding in his brain and that it was much safer for him to be in hospital where we could keep a close eye on him and act quickly if anything happened.
Jack responded “I hear what you’re saying, doctor, but I’m not staying here tomorrow - I can’t.”
As doctors, we have to respect our patient’s right to make decisions about their treatment even if we strongly disagree with them. At the end of the day, it’s THEIR body and THEIR life and this means it’s THEIR decision, not mine.
I went and got Jack a “discharge against medical advice” form, which he signed gladly. I made sure he knew what symptoms to look out for and asked him to come back to hospital immediately if he had any numbness or weakness, if he developed a headache or had any problems speaking or any problems with his vision. I then shook his hand and wished him all the best. I then called up the MRI department and organised an urgent outpatient scan for Jack.
As I watched Jack walk off the ward, it struck me that in this life we must all make our choices and it’s the choices we make that shape how our life develops and ultimately, who we become. I hope Jack made the right choice and I hope he enjoyed a great day with his daughter. Deep down, my gut feeling is that Jack is going to be alright.
I hope I’m right.
Sunday, 22 July 2007
New Beginnings
I have a job.
MMC has meant months and months of dark days, heartache and stress for myself and thousands and thousands of other junior doctors. The powers that be have shown their colours and have fed us and the public misinformation and lies time and time again. There have been many tears shed and thousands of lives have been changed forever this travesty which went all the way to the highest court in the land.
Since the computer said “No” after round one, I have contacted hospitals in New Zealand and Australia and received some very positive feedback regarding job opportunities. I’ve joined two locum agencies so I could earn some money in the meantime. I’ve written a non-medical CV and asked some friends in London about how I’d start a career in finance. I didn’t want to do any of the above but felt I had to formulate plans B and C because the spectre of unemployment was looming larger and larger hour by hour.
I really feel like I’ve managed to snatch victory from the jaws of defeat. Like I’ve scored a last-minute equaliser or gained a death-row reprieve. I feel kind of shocked that, for me at least, all this hassle is over. No more frantically checking NHS jobs and BMJ careers every single evening for positions that come and go faster than fireworks on bonfire night, no more endless hours filling out sprawling application forms, no more trying to explain to perplexed people why I was going to be an unemployed doctor. The bitter shame is that MMC has left thousands of doctors just like me still fighting and desperately trying to find a job or deciding what they’re going to do when our contracts end next week.
You know, the ultimate irony in all this was just how straight-forward the round two interview was. They looked at my CV and my other achievements. The interviews and the exam took about an hour and a half altogether. I didn’t say anything stupid and at the end of it all, they decided that they liked me and offered me a job. Easy.
It does raise the question that how on earth could something so simple turn into such an unprecedented disaster?
So, here it goes. A week on Wednesday, I start a new job in a new deanery a couple of hundred miles from where I’m living right now. A new start, a new challenge, a new specialty – I can’t wait.
Bring it on.
MMC has meant months and months of dark days, heartache and stress for myself and thousands and thousands of other junior doctors. The powers that be have shown their colours and have fed us and the public misinformation and lies time and time again. There have been many tears shed and thousands of lives have been changed forever this travesty which went all the way to the highest court in the land.
Since the computer said “No” after round one, I have contacted hospitals in New Zealand and Australia and received some very positive feedback regarding job opportunities. I’ve joined two locum agencies so I could earn some money in the meantime. I’ve written a non-medical CV and asked some friends in London about how I’d start a career in finance. I didn’t want to do any of the above but felt I had to formulate plans B and C because the spectre of unemployment was looming larger and larger hour by hour.
I really feel like I’ve managed to snatch victory from the jaws of defeat. Like I’ve scored a last-minute equaliser or gained a death-row reprieve. I feel kind of shocked that, for me at least, all this hassle is over. No more frantically checking NHS jobs and BMJ careers every single evening for positions that come and go faster than fireworks on bonfire night, no more endless hours filling out sprawling application forms, no more trying to explain to perplexed people why I was going to be an unemployed doctor. The bitter shame is that MMC has left thousands of doctors just like me still fighting and desperately trying to find a job or deciding what they’re going to do when our contracts end next week.
You know, the ultimate irony in all this was just how straight-forward the round two interview was. They looked at my CV and my other achievements. The interviews and the exam took about an hour and a half altogether. I didn’t say anything stupid and at the end of it all, they decided that they liked me and offered me a job. Easy.
It does raise the question that how on earth could something so simple turn into such an unprecedented disaster?
So, here it goes. A week on Wednesday, I start a new job in a new deanery a couple of hundred miles from where I’m living right now. A new start, a new challenge, a new specialty – I can’t wait.
Bring it on.
Friday, 20 July 2007
Sunday, 15 July 2007
The drugs don't work
The other doctors and duty had just popped off the Medical Assessment Unit to grab a coffee and I was just finishing writing a drug chart when Sarah, one of the nurses comes up to me and says “Could you take a look at Mrs Edwards, she appears to be having a seizure.”
Mrs Edwards is a 78 year old woman who a few minutes previously had been letting anyone who would listen know her views on NHS food. “Disgusting slop that I wouldn’t feed to my dog” were the words she used, I think.
I walk over to her bed and indeed, Mrs Edwards is having a fit. I wasn’t overly concerned though because the doctors in A&E had put a venflon in her arm so she could have drugs that act quickly to stop her seizures.
I ask Sarah to give her some IV Diazemuls (a strong drug that stops fits) and took a look at her notes. Mrs Edwards had come in with a urine infection and had no known epilepsy. Sarah gives the drugs to Mrs Edwards and they reduce her movements a little but the seizure continues. This is very strange. The vast majority of fits stop by themselves and of those that don’t, the majority will stop if you give the patient Diazemuls. I ask Sarah to give her another dose and ask one of the HCAs to check her blood sugar reading because low blood sugars can sometimes cause fits. The blood sugar level is normal and Mrs Edwards’ seizure continues despite the second lot of Diazemuls.
By this stage she’s been fitting for about 15 minutes and I’m getting worried. I ask Sarah to give Mrs Edwards some high flow oxygen and say “let’s try 4mg of Lorazepam (an even stronger drug)” and asked for Jane, the Medical Registrar to come and lend a hand. I give the Lorazepam and Jane arrives with Margaret, the ward sister. I explained what had happened and what I’d done so far. Mrs Edwards is still having her seizure. Whilst the drugs had reduced her movements slightly, she was still fitting and would have shaken herself off the bed had it not been for Margaret’s well placed knee. Jane asked the nurses to organise a phenytoin infusion (the strongest drug on the unit) while she goes off to call the anaesthetist.
I have to write up the dose of phenytoin on Mrs Edwards’ drug chart before the nurses can give it. I’m not very familiar with the dosage, so I look the dose up in the British National Formulary (BNF). Here’s what the BNF says about pheytoin infusions:
“Dose: By slow intravenous infusion, status epilepticus, 18mg/kg at a rate not exceeding 50mg per minute, as a loading dose.”
Mrs Edwards isn’t particularly big so I guesstimate her weight to be about 60kg. If you’ve ever tried to do arithmetic whilst standing in front of a woman having a seizure with nurses and doctors talking around you and the monitor bleeping away, you’ll realise it’s not an easy thing to do. It takes me a couple of minutes, but I work out the right dose and the nurses go off to set up the drug while I say a silent thank-you to my GCSE maths teacher for schooling me well.
The phenytoin does nothing.
Mrs Edwards is still having her seizure. She’s become very sweaty and her heart is racing at 150bpm. By now she’d been fitting for about 35 minutes and the anaesthetist arrives. She, Jane and I talk about what to do and we decide the plan should be to sedate Mrs Edwards, stop the seizures with powerful ICU drugs so we can get her to the CT scanner to image her brain and see what’s causing the seizures. The anaesthetist performs a rapid-sequence induction and sets up a Propofol infusion. (Propofol is an anaesthetic agent and only anaesthetist with years of specialist training can give it because of the close monitoring it requires).
Mrs Edwards continues to fit.
The anaesthetist is more than a little surprised and asks for a Thiopentone infusion to be set up. She says “I’ve never seen anyone continue to have seizures on Thiopentone.”
Mrs Edwards continues to fit.
This is amazing. Mrs Edwards has now had large doses of five different anti-seizure medications of increasing power and toxicity, yet she was still having her seizure. Her seizure had been going on for about an hour and a half and was still ongoing. At least the ICU drugs had reduced her movements enough to get a reasonable image on CT scan, so we took her down to the scanner where the radiographer was waiting for us.
Mrs Edwards had a stroke. There is no sort of surgery and no sort of medication that could fix it. We sent her to the Intensive Care Unit where a machine could breathe for her and we could support her circulation in the hope that Mrs Edwards’ body could fix itself.
All we can do now is pray.
UPDATE: The seizures never stopped. Mrs Edwards never recovered consciousness and she died on the Intensive Care Unit.
Mrs Edwards is a 78 year old woman who a few minutes previously had been letting anyone who would listen know her views on NHS food. “Disgusting slop that I wouldn’t feed to my dog” were the words she used, I think.
I walk over to her bed and indeed, Mrs Edwards is having a fit. I wasn’t overly concerned though because the doctors in A&E had put a venflon in her arm so she could have drugs that act quickly to stop her seizures.
I ask Sarah to give her some IV Diazemuls (a strong drug that stops fits) and took a look at her notes. Mrs Edwards had come in with a urine infection and had no known epilepsy. Sarah gives the drugs to Mrs Edwards and they reduce her movements a little but the seizure continues. This is very strange. The vast majority of fits stop by themselves and of those that don’t, the majority will stop if you give the patient Diazemuls. I ask Sarah to give her another dose and ask one of the HCAs to check her blood sugar reading because low blood sugars can sometimes cause fits. The blood sugar level is normal and Mrs Edwards’ seizure continues despite the second lot of Diazemuls.
By this stage she’s been fitting for about 15 minutes and I’m getting worried. I ask Sarah to give Mrs Edwards some high flow oxygen and say “let’s try 4mg of Lorazepam (an even stronger drug)” and asked for Jane, the Medical Registrar to come and lend a hand. I give the Lorazepam and Jane arrives with Margaret, the ward sister. I explained what had happened and what I’d done so far. Mrs Edwards is still having her seizure. Whilst the drugs had reduced her movements slightly, she was still fitting and would have shaken herself off the bed had it not been for Margaret’s well placed knee. Jane asked the nurses to organise a phenytoin infusion (the strongest drug on the unit) while she goes off to call the anaesthetist.
I have to write up the dose of phenytoin on Mrs Edwards’ drug chart before the nurses can give it. I’m not very familiar with the dosage, so I look the dose up in the British National Formulary (BNF). Here’s what the BNF says about pheytoin infusions:
“Dose: By slow intravenous infusion, status epilepticus, 18mg/kg at a rate not exceeding 50mg per minute, as a loading dose.”
Mrs Edwards isn’t particularly big so I guesstimate her weight to be about 60kg. If you’ve ever tried to do arithmetic whilst standing in front of a woman having a seizure with nurses and doctors talking around you and the monitor bleeping away, you’ll realise it’s not an easy thing to do. It takes me a couple of minutes, but I work out the right dose and the nurses go off to set up the drug while I say a silent thank-you to my GCSE maths teacher for schooling me well.
The phenytoin does nothing.
Mrs Edwards is still having her seizure. She’s become very sweaty and her heart is racing at 150bpm. By now she’d been fitting for about 35 minutes and the anaesthetist arrives. She, Jane and I talk about what to do and we decide the plan should be to sedate Mrs Edwards, stop the seizures with powerful ICU drugs so we can get her to the CT scanner to image her brain and see what’s causing the seizures. The anaesthetist performs a rapid-sequence induction and sets up a Propofol infusion. (Propofol is an anaesthetic agent and only anaesthetist with years of specialist training can give it because of the close monitoring it requires).
Mrs Edwards continues to fit.
The anaesthetist is more than a little surprised and asks for a Thiopentone infusion to be set up. She says “I’ve never seen anyone continue to have seizures on Thiopentone.”
Mrs Edwards continues to fit.
This is amazing. Mrs Edwards has now had large doses of five different anti-seizure medications of increasing power and toxicity, yet she was still having her seizure. Her seizure had been going on for about an hour and a half and was still ongoing. At least the ICU drugs had reduced her movements enough to get a reasonable image on CT scan, so we took her down to the scanner where the radiographer was waiting for us.
Mrs Edwards had a stroke. There is no sort of surgery and no sort of medication that could fix it. We sent her to the Intensive Care Unit where a machine could breathe for her and we could support her circulation in the hope that Mrs Edwards’ body could fix itself.
All we can do now is pray.
UPDATE: The seizures never stopped. Mrs Edwards never recovered consciousness and she died on the Intensive Care Unit.
Friday, 13 July 2007
So tired...
The weather seemed to be affecting the mood on medical assessment today. It was gloomy and rainy me and the other doctors were all feeling pretty glum. For me, I think I’m just tired. I’m having to work 18 days in a row and I’m doing long days (12.5 hrs) for 9 of them. I can’t be bothered to work out how many hours that adds up to but it’s a lot.
Tiredness affects different people in different ways. I think we all get a bit short-tempered and grumpy when we’re tired but I’ve noticed that when I get a bit worn down, it really affects my emotions. Generally, I think I’m a pretty emotional person, I get upset about things, I get angry about things, I laugh a lot. One of the things I’ve learned is how to show these emotions in a way that helps people engage with me and this is standing me in good stead in my personal and professional life. I’m not scared to show that I’m upset by something, or that I’m stressed or angry or nervous or happy.
Usually, when I’ve been working long shifts or nights and I feel really tired, I get upset more easily than normal and tend to dwell on things.
Today I felt different. I just felt like things didn’t matter to me as much and I just wanted to get through the day. I almost felt cold.
Things continued to happen like they always do in hospital. For example, there is a man on the High Dependency Unit because he has GI haemorrhage and DIC. This evening he had a heart attack, therefore going into multi-organ failure meaning he’s highly likely to die. It kind of washed over me. Of course I did all the stuff that was expected of me – I organised transfusions, I explained what was happening and the likely outcome to this man and his relatives - but it felt like I was going through the motions and I know that’s a horrible thing to say but it’s true.
I think I just need to sleep so I'm taking myself off to bed.
Goodnight.
Days to unemployment=19
Tiredness affects different people in different ways. I think we all get a bit short-tempered and grumpy when we’re tired but I’ve noticed that when I get a bit worn down, it really affects my emotions. Generally, I think I’m a pretty emotional person, I get upset about things, I get angry about things, I laugh a lot. One of the things I’ve learned is how to show these emotions in a way that helps people engage with me and this is standing me in good stead in my personal and professional life. I’m not scared to show that I’m upset by something, or that I’m stressed or angry or nervous or happy.
Usually, when I’ve been working long shifts or nights and I feel really tired, I get upset more easily than normal and tend to dwell on things.
Today I felt different. I just felt like things didn’t matter to me as much and I just wanted to get through the day. I almost felt cold.
Things continued to happen like they always do in hospital. For example, there is a man on the High Dependency Unit because he has GI haemorrhage and DIC. This evening he had a heart attack, therefore going into multi-organ failure meaning he’s highly likely to die. It kind of washed over me. Of course I did all the stuff that was expected of me – I organised transfusions, I explained what was happening and the likely outcome to this man and his relatives - but it felt like I was going through the motions and I know that’s a horrible thing to say but it’s true.
I think I just need to sleep so I'm taking myself off to bed.
Goodnight.
Days to unemployment=19
Wednesday, 11 July 2007
Dr Anderson is back in the game!
Days to unemployment=21
I got an email today informing me that I have a round 2 interview next week.
It's not over yet...
I got an email today informing me that I have a round 2 interview next week.
It's not over yet...
Tuesday, 10 July 2007
The most disgusting thing I've seen
Days to unemployment=22
Last night, I went out with a friend and I met his new girlfriend for the first time. She’s a nice enough person and we were chatting away amiably when she asked me “What’s the most disgusting thing you’ve seen at work?”
Now, as you can imagine, these eyes of mine have seen quite a few things that would make your stomach turn, but after taking a few seconds to ponder, I told her the story of what I believe is the most disgusting thing I’ve seen at work – nay, the most disgusting thing I’ve seen EVER.
I was working in A&E and I went to see a man in his mid-fifties called Steve. Steve looked like an old hippie, you know the type – long hair, beard, wearing tie-dye and several “ethnic” necklaces. I introduced myself and asked him what I could do for him.
Like many of people, Steve didn’t like hospitals. Steve also didn’t like doctors very much, in fact Steve didn’t like the entire concept of modern medicine and was a great believe her in alternative therapies. This is all fair enough, we’re all entitled to our opinions and I must say that I have no strong feeling either way when it comes to alternative therapies.
Steve, however, hadn’t done his research and Steve was trying to treat his diabetes with yoga. In my opinion, yoga is great, anything that encourages people to do some exercise and stretch their limb a bit is surely a good thing but, unlike Steve, I really don’t see how on earth it could have any impact on improving a poorly-functioning pancreas.
Unsurprisingly, Steve’s self-therapy with yoga wasn’t working and Steve had come to A&E because of a problem with his feet.
“Let’s take a look at them,” I say and Steve slowly unlaces his big black boots and pulls them off.
I think the stench hits me first. My stomach literally turns over as the foul, fetid funk of rotting flesh reaches my nostrils. Steve’s foot was rotting. The end of it and his toes were non-existent. Instead, they had been replaced by a black, putrid, squishy, partially liquefied stump with maggots crawling in and out of it. His other foot was even worse.
I took a couple of steps backward, told Steve that I think he needed to be seen by the surgeons and walked back to the ward station as quickly as was dignified.
To this day, I can’t believe that Steve allowed his foot to get into that state.
Yuk.
Last night, I went out with a friend and I met his new girlfriend for the first time. She’s a nice enough person and we were chatting away amiably when she asked me “What’s the most disgusting thing you’ve seen at work?”
Now, as you can imagine, these eyes of mine have seen quite a few things that would make your stomach turn, but after taking a few seconds to ponder, I told her the story of what I believe is the most disgusting thing I’ve seen at work – nay, the most disgusting thing I’ve seen EVER.
I was working in A&E and I went to see a man in his mid-fifties called Steve. Steve looked like an old hippie, you know the type – long hair, beard, wearing tie-dye and several “ethnic” necklaces. I introduced myself and asked him what I could do for him.
Like many of people, Steve didn’t like hospitals. Steve also didn’t like doctors very much, in fact Steve didn’t like the entire concept of modern medicine and was a great believe her in alternative therapies. This is all fair enough, we’re all entitled to our opinions and I must say that I have no strong feeling either way when it comes to alternative therapies.
Steve, however, hadn’t done his research and Steve was trying to treat his diabetes with yoga. In my opinion, yoga is great, anything that encourages people to do some exercise and stretch their limb a bit is surely a good thing but, unlike Steve, I really don’t see how on earth it could have any impact on improving a poorly-functioning pancreas.
Unsurprisingly, Steve’s self-therapy with yoga wasn’t working and Steve had come to A&E because of a problem with his feet.
“Let’s take a look at them,” I say and Steve slowly unlaces his big black boots and pulls them off.
I think the stench hits me first. My stomach literally turns over as the foul, fetid funk of rotting flesh reaches my nostrils. Steve’s foot was rotting. The end of it and his toes were non-existent. Instead, they had been replaced by a black, putrid, squishy, partially liquefied stump with maggots crawling in and out of it. His other foot was even worse.
I took a couple of steps backward, told Steve that I think he needed to be seen by the surgeons and walked back to the ward station as quickly as was dignified.
To this day, I can’t believe that Steve allowed his foot to get into that state.
Yuk.
Sunday, 8 July 2007
In which you have to read between the lines
"Where did I go wrong?
I lost a friend somewhere along in the bitterness.
And I would have stayed up with you all night, had I known how to save a life."
- The Fray
I don't feel like writing much today. Sometimes things just get to you a bit you know...
Days to unemployment=24
I lost a friend somewhere along in the bitterness.
And I would have stayed up with you all night, had I known how to save a life."
- The Fray
I don't feel like writing much today. Sometimes things just get to you a bit you know...
Days to unemployment=24
Saturday, 7 July 2007
Life-long learning
Days to unemployment=25
It’s the first day for ages that the sun has shown its face, but rather than having a picnic in the park or sipping cocktails watching Wimbledon, I’m on call for Medical Admissions.
I don’t feel too disheartened about having work whilst others play though because I haven’t worked a weekend for a few weeks and today was a good day. I felt I really helped several people, actually saved a life and learned loads.
Due to the ever-changing nature of modern medicine, we doctors have to be committed to what the GMC terms “life-long learning.” One of the great things about my job I that patients and events can always surprise you and just doing the job means that you’re constantly learning stuff. Sometimes the surprises are good, sometimes hey are bad, but it’s impossible to know EVERYTHING and this I reckon this keeps the job interesting.
Obviously, the people we learn from most are our patients. We learn how the same disease manifests itself in different ways in different people (I had a man who came in with right shoulder pain and it turned out he’d had a heart attack), and how different people respond differently to the same treatment.
Here are five things that I learned from my patients today
1. The “D” in “D-Day” (6th June 1944) stands for “Deliverance.”
2. It is possible to have a heart rate of 18 beats a minute and still hold a conversation.
3. Rugby is a sport for “pansies”
4. Sometimes, the drugs don’t work
5. Severe hyperkalaemia can cause muscle weakness and spasms
It’s the first day for ages that the sun has shown its face, but rather than having a picnic in the park or sipping cocktails watching Wimbledon, I’m on call for Medical Admissions.
I don’t feel too disheartened about having work whilst others play though because I haven’t worked a weekend for a few weeks and today was a good day. I felt I really helped several people, actually saved a life and learned loads.
Due to the ever-changing nature of modern medicine, we doctors have to be committed to what the GMC terms “life-long learning.” One of the great things about my job I that patients and events can always surprise you and just doing the job means that you’re constantly learning stuff. Sometimes the surprises are good, sometimes hey are bad, but it’s impossible to know EVERYTHING and this I reckon this keeps the job interesting.
Obviously, the people we learn from most are our patients. We learn how the same disease manifests itself in different ways in different people (I had a man who came in with right shoulder pain and it turned out he’d had a heart attack), and how different people respond differently to the same treatment.
Here are five things that I learned from my patients today
1. The “D” in “D-Day” (6th June 1944) stands for “Deliverance.”
2. It is possible to have a heart rate of 18 beats a minute and still hold a conversation.
3. Rugby is a sport for “pansies”
4. Sometimes, the drugs don’t work
5. Severe hyperkalaemia can cause muscle weakness and spasms
Friday, 6 July 2007
A puzzling question
Days to unemployment=26
Why do patients say "Thank you" to me after I take a blood test from them?
It's very nice to hear and all but I'm never quite sure what they're thanking me for. I walk up to them, I tie a band round their arm and then stab them with a metal needle with the intention of making them bleed.
It's not the sort of thing that you'd think a person would be thankful for but the "Thank you" is usually forthcoming afterward. It puzzles me.
Thursday, 5 July 2007
Belly's gonna get ya!
Days to unemployment=27
7:16 am and I’m drying myself after my shower. I look down. I frown. I walk over to the mirror and look at my naked body. I turn myself sideways. I suck it in. I let it go. I suck it in again. I stare for a moment and realise that I can no longer deny it. It’s there. I have a paunch.
As a teenager, I was always skinny and wiry and at medical school I filled out and often got told during pillow-talk that I had a “great body.” Nowadays, there are some bits of me that are holding their own (arms, legs, bum) but the middle bit’s definitely much saggier than it used to be.
With these thoughts in mind, I took a good look at the other doctors and nurses I bumped into at work today. I have to say, it wasn’t pretty – on the whole doctors and nurses aren’t in good shape at all. Other health professionals like pharmacists and physiotherapists fare much better than we do. Considering our business is healthcare, you could say that it’s deeplyhypocritical ironic that we are so unhealthy ourselves. Thinking about it, it’s easy to understand why. Long hours spent at work, shift patterns, working evenings and nights mean that it’s difficult to find time to prepare healthy meals and even harder to join a sports team or go to the gym regularly. The total lack of healthy food facilities in Town Hospital for staff means that when you’re on a tough part of the rota like I am now means that often on call you have a choice between getting a take-away and going hungry… blah… blah… blah…
I could think of 100excuses reasons why I am now officially a “man with a paunch” but I think at the end of the day, it comes down to my motivation (or lack of). Remember those old Reebok adverts that went “Belly’s gonna get ya! Belly’s gonna get ya!” It seems like Belly is catching up with me but I’m not going to let it catch me. So, at 7:16 pm, I was running down the city streets, through the pouring rain and now, as I sit here typing this – I feel tired but fantastic.
As a teenager, I was always skinny and wiry and at medical school I filled out and often got told during pillow-talk that I had a “great body.” Nowadays, there are some bits of me that are holding their own (arms, legs, bum) but the middle bit’s definitely much saggier than it used to be.
With these thoughts in mind, I took a good look at the other doctors and nurses I bumped into at work today. I have to say, it wasn’t pretty – on the whole doctors and nurses aren’t in good shape at all. Other health professionals like pharmacists and physiotherapists fare much better than we do. Considering our business is healthcare, you could say that it’s deeply
I could think of 100
Wednesday, 4 July 2007
Things are getting easier
Days to unemployment=28
I think that some time last year, things changed for me. Everything became easier. As doctors we spend more than half a decade in medical school, but that doesn’t at all prepare you for your first day on the wards when the nurse runs up to you and says
“The patient in room 4 is vomiting again, could you place an NGT, site a venflon and write him up for an antiemetic.”
But, the training does kick in, and with experience everything becomes easier. There was a lot of stuff going on with my patients today.
A man developed an irregular heart beat and became breathless and dizzy – I knew what to do.
A lady with emphysema “dropped her sats” to 72% whilst on oxygen – I knew what to do.
A man who was dying became distressed and agitated – I knew what to do.
A woman started vomiting blood – I knew what to do.
To me, stuff like this is easy to handle now. Stuff like this just doesn’t stress me or worry me like it used to. Occasionally, I find myself in situations where I feel out of my depth, but these are becoming fewer and less frequent.
I think that some time last year, things changed for me. Everything became easier. As doctors we spend more than half a decade in medical school, but that doesn’t at all prepare you for your first day on the wards when the nurse runs up to you and says
“The patient in room 4 is vomiting again, could you place an NGT, site a venflon and write him up for an antiemetic.”
But, the training does kick in, and with experience everything becomes easier. There was a lot of stuff going on with my patients today.
A man developed an irregular heart beat and became breathless and dizzy – I knew what to do.
A lady with emphysema “dropped her sats” to 72% whilst on oxygen – I knew what to do.
A man who was dying became distressed and agitated – I knew what to do.
A woman started vomiting blood – I knew what to do.
To me, stuff like this is easy to handle now. Stuff like this just doesn’t stress me or worry me like it used to. Occasionally, I find myself in situations where I feel out of my depth, but these are becoming fewer and less frequent.
Tuesday, 3 July 2007
29 days to unemployment
I took a break from work and from blogging just to get away from it all for a while. To be honest with you, I’m tired of job applications. It’s endless. I spent god knows how many hours doing it last year and right now, history is repeating itself.
Some application forms for round 2 jobs run to 30 pages and they’re each taking me at least four hours to complete. The rota has me working between 68 and 72 hours a week every week this month and I resent spending ALL my free time on applications. But it has to be done because as it stands, I have 29 days to unemployment.
The thoughts going through my mind are:
I don’t want to move to far flung areas of the country to get a job. I’m especially loathe to do this for a non-training position. I’ll be destroying my life outside medicine leaving my family, my sports club, my friends etc… and then I’ll probably have to do it again in a few month’s time so is it actually worth it?
Unemployment doesn’t actually scare me too much from a non-career point of view. I’m a bright lad and I live in a capitalist society. There’s always ways and means of making money – plus I have no wife or children to look after.
What I AM worried about is my career. MMC have repeatedly said that August 2007 is my best chance to get a training job. If I don’t get one now, then everything becomes orders of magnitude harder next year. With this in mind, I realise that if I don’t get at least a trust grade (non-training) job, then I’ll be more or less unemployable come this time next year and this is very worrying indeed.
To quote the recent single by electro-popsters Unklejam, “What am I fighting for?” Trying to get our ward to run smoothly is – not to put too fine a point on it – fucking hard work. I have to work overnight on a regular basis. I have to give up my weekends and I there’s lots of stuff I’d like to do outside work that I’m not able to simply because I don’t have time. The job itself is hard work. It’s very rewarding but it’s sometimes very tough and I find that I have to try my best to be all things to all people. Like any job, there’s bits I enjoy about it and bits I don’t but at the end of the day being a doctor isn’t SO AMAZING that I’m willing to give up my entire life for it. Willing to move away from my family, friends and hobbies for, willing to move to a whole different COUNTRY for – forever. I honestly believe that if I was in a different career or profession, then I wouldn’t make those sorts of sacrifices for my job, so I’m not sure if I’m prepared to for hospital medicine.
So I’m in a quandary. I’m continuing to use my free hours to apply for jobs but after nearly a year of bullshit doled out by the government, I feel like my “fight” left me. I feel let down. The people who dreamt up the MMC system, the people who thought it would be a good idea, have either been sacked or resigned but at the end of the day, the MMC system marches on and it’s left this junior doctor with only 29 days to unemployment.
Some application forms for round 2 jobs run to 30 pages and they’re each taking me at least four hours to complete. The rota has me working between 68 and 72 hours a week every week this month and I resent spending ALL my free time on applications. But it has to be done because as it stands, I have 29 days to unemployment.
The thoughts going through my mind are:
I don’t want to move to far flung areas of the country to get a job. I’m especially loathe to do this for a non-training position. I’ll be destroying my life outside medicine leaving my family, my sports club, my friends etc… and then I’ll probably have to do it again in a few month’s time so is it actually worth it?
Unemployment doesn’t actually scare me too much from a non-career point of view. I’m a bright lad and I live in a capitalist society. There’s always ways and means of making money – plus I have no wife or children to look after.
What I AM worried about is my career. MMC have repeatedly said that August 2007 is my best chance to get a training job. If I don’t get one now, then everything becomes orders of magnitude harder next year. With this in mind, I realise that if I don’t get at least a trust grade (non-training) job, then I’ll be more or less unemployable come this time next year and this is very worrying indeed.
To quote the recent single by electro-popsters Unklejam, “What am I fighting for?” Trying to get our ward to run smoothly is – not to put too fine a point on it – fucking hard work. I have to work overnight on a regular basis. I have to give up my weekends and I there’s lots of stuff I’d like to do outside work that I’m not able to simply because I don’t have time. The job itself is hard work. It’s very rewarding but it’s sometimes very tough and I find that I have to try my best to be all things to all people. Like any job, there’s bits I enjoy about it and bits I don’t but at the end of the day being a doctor isn’t SO AMAZING that I’m willing to give up my entire life for it. Willing to move away from my family, friends and hobbies for, willing to move to a whole different COUNTRY for – forever. I honestly believe that if I was in a different career or profession, then I wouldn’t make those sorts of sacrifices for my job, so I’m not sure if I’m prepared to for hospital medicine.
So I’m in a quandary. I’m continuing to use my free hours to apply for jobs but after nearly a year of bullshit doled out by the government, I feel like my “fight” left me. I feel let down. The people who dreamt up the MMC system, the people who thought it would be a good idea, have either been sacked or resigned but at the end of the day, the MMC system marches on and it’s left this junior doctor with only 29 days to unemployment.
Saturday, 16 June 2007
When the numbers don't add up...
Mr Adams is a lovely old man. I was speaking to him one day and he said, “you look tired, do you want a sweet?” and offered me one of the Werther’s Originals from the packet on his bedside table. I thought this was so sweet and I gratefully accepted and said thank you. This was a week ago, and since then every day, after I see him on the ward round, he offers me one of his Werther’s Originals. It’s our “thing.”
Mr Adams’ liver isn’t working.
When patients have liver failure, the majority of what we do for them as doctors is dependent on what their blood test results. So, at 09:40 every morning, Mr Adams has his blood taken by the phlebotomists. The sample is sent to the pathology laboratory where it is tested and just after lunchtime, the results are put up on the hospital’s intranet as a collection of numbers. Back on the ward, I use the intranet to access his results so I can alter his medications/drips as necessary.
Mr Adams’ blood results were holding for a while, but on Tuesday they were very worrying. They showed that his kidneys had stopped working meaning he had what we medics call “hepato-renal failure.” This is very, very bad news indeed.
My consultant, Dr Fletcher, spoke to Mr Adams and explained, as sensitively as possible, what was happening. He told him that he had only a 1 in 20 chance surviving and that while we’ll give him all the right treatment so he had the best possible chance, prognosis was bleak and it would probably be a good idea to put his affairs in order if he hadn’t done so already.
Mr Adams was as stoical as ever and told us that his affairs had been put in order a long time ago and that he’d do his best to fight his illness. “I’ll tell you what’s funny doctor,” he said. “I feel better now than I’ve done in weeks.”
Mr Adams told me that he wanted to live to see his grand-daughters 5th birthday next month. Over the next couple of days, his kidneys improved and his numbers got better and I started to hope. I started to hope that we’d made a mis-diagnosis and this wasn’t “proper” hepato-renal failure. I started to hope that the numbers would continue to get better and that Mr Adams would improve. I started to hope that Mr Adams would be in the lucky 5%. I started to hope that Mr Adams would be able to see the smile on his grand-daughter’s face as she blew out the five candles on her birthday cake.
I was wrong. I got into work yesterday morning and Sue, one of the staff nurses, asked me if I could come and see him.
Mr Adams was taken a major turn for the worse. He was gasping and every time he took a breath you could hear this horrible gurgling sound from his lungs. Doctors and nurses call this the “death rattle” and it really is a sign that there’s no way back. Sitting around his bed were five members of his family, whom the nurses had called in the early hours of the morning.
I asked them to please give me a moment with Mr Adams and then did a quick assessment to try and see what his level of consciousness was. I then stopped all the medications on his drug chart and prescribed him only morphine (for pain), a sedative and a drug to dry up the secretions that were dripping down the side of his mouth.
I went into the quiet room with his family members – his wife of 43 years, his two daughters and their partners – and I explained to them what they could already see with their own eyes. Mr Adams is dying.
His wife started crying, then one after the other his daughters started crying too. I really liked Mr Adams and I felt myself welling up as well. But I had to be professional; it’s not my place to join their grief. When the asked me how long he had left, I had to take some deep breaths to keep my voice even. I said that, while it’s impossible to give an exact time frame, I thought it would be a matter of hours rather than days.
I was right. Four and a half hours later, Mr Adams took his last breath and died. After the family members left, I went into his room to certify him dead. As I was leaving Mr Adams’ room for the last time, I noticed a half-finished pack of Werther’s Originals still on his bedside table.
Rest in Peace, Mr Adams.
Mr Adams’ liver isn’t working.
When patients have liver failure, the majority of what we do for them as doctors is dependent on what their blood test results. So, at 09:40 every morning, Mr Adams has his blood taken by the phlebotomists. The sample is sent to the pathology laboratory where it is tested and just after lunchtime, the results are put up on the hospital’s intranet as a collection of numbers. Back on the ward, I use the intranet to access his results so I can alter his medications/drips as necessary.
Mr Adams’ blood results were holding for a while, but on Tuesday they were very worrying. They showed that his kidneys had stopped working meaning he had what we medics call “hepato-renal failure.” This is very, very bad news indeed.
My consultant, Dr Fletcher, spoke to Mr Adams and explained, as sensitively as possible, what was happening. He told him that he had only a 1 in 20 chance surviving and that while we’ll give him all the right treatment so he had the best possible chance, prognosis was bleak and it would probably be a good idea to put his affairs in order if he hadn’t done so already.
Mr Adams was as stoical as ever and told us that his affairs had been put in order a long time ago and that he’d do his best to fight his illness. “I’ll tell you what’s funny doctor,” he said. “I feel better now than I’ve done in weeks.”
Mr Adams told me that he wanted to live to see his grand-daughters 5th birthday next month. Over the next couple of days, his kidneys improved and his numbers got better and I started to hope. I started to hope that we’d made a mis-diagnosis and this wasn’t “proper” hepato-renal failure. I started to hope that the numbers would continue to get better and that Mr Adams would improve. I started to hope that Mr Adams would be in the lucky 5%. I started to hope that Mr Adams would be able to see the smile on his grand-daughter’s face as she blew out the five candles on her birthday cake.
I was wrong. I got into work yesterday morning and Sue, one of the staff nurses, asked me if I could come and see him.
Mr Adams was taken a major turn for the worse. He was gasping and every time he took a breath you could hear this horrible gurgling sound from his lungs. Doctors and nurses call this the “death rattle” and it really is a sign that there’s no way back. Sitting around his bed were five members of his family, whom the nurses had called in the early hours of the morning.
I asked them to please give me a moment with Mr Adams and then did a quick assessment to try and see what his level of consciousness was. I then stopped all the medications on his drug chart and prescribed him only morphine (for pain), a sedative and a drug to dry up the secretions that were dripping down the side of his mouth.
I went into the quiet room with his family members – his wife of 43 years, his two daughters and their partners – and I explained to them what they could already see with their own eyes. Mr Adams is dying.
His wife started crying, then one after the other his daughters started crying too. I really liked Mr Adams and I felt myself welling up as well. But I had to be professional; it’s not my place to join their grief. When the asked me how long he had left, I had to take some deep breaths to keep my voice even. I said that, while it’s impossible to give an exact time frame, I thought it would be a matter of hours rather than days.
I was right. Four and a half hours later, Mr Adams took his last breath and died. After the family members left, I went into his room to certify him dead. As I was leaving Mr Adams’ room for the last time, I noticed a half-finished pack of Werther’s Originals still on his bedside table.
Rest in Peace, Mr Adams.
Thursday, 14 June 2007
A small diamond in the dirt
I have a brief reprive. The people who are running the MMC have said that junior doctors like myself who have jobs at the moment will be able to continue working in our current positions "while we progress through round 2."
Reading between the lines, this means that I won't be forced to sign on in six weeks' time, but witll have probably until the middle to end of October to try and get a job. Obviously, I'm really relieved by this because it means that I can continue working and treating patients for a while longer and have a bit longer to try and save up some money to tide me over if I don't get job this year. It's one thing less to worry about.
This is the only piece of good news that I've had from the MMC people.
Reading between the lines, this means that I won't be forced to sign on in six weeks' time, but witll have probably until the middle to end of October to try and get a job. Obviously, I'm really relieved by this because it means that I can continue working and treating patients for a while longer and have a bit longer to try and save up some money to tide me over if I don't get job this year. It's one thing less to worry about.
This is the only piece of good news that I've had from the MMC people.
Wednesday, 13 June 2007
Little things sent to try us
The vagaries of the rota meant that I was the only doctor on the ward today covering our 35 inpatients. I knew it was going to be hellishly busy before I arrived at work but sometimes, I think events conspire to make life even more difficult that it is already.
All of the following happened today.
- Our boiler broke down meaning I had to start the day with a cold shower.
- The hospital was having a bed crisis. This meant I had the Matron and the discharge planner hassling me to send patients home all day long. You’d think that they’d realise that
- The lifts to the ward broke down meaning two patients couldn’t go for important scans.
- Four patients decided to go outside together for a cigarette and stayed out for about an hour and a half in the morning. This meant they missed the phlebotomists (blood-taking team) which meant I had to take all the blood samples myself.
- There was a problem in the laboratory (I think a centrifuge broke or something) that meant that all today’s blood test results were delayed until half four in the afternoon.
- Two nurses phoned in sick meaning that we were (even more) understaffed nursing-wise so lots of things just didn’t get done.
- After doing a discharge letter and medication list for a patient, some clown lost it so I had to re-do it. This happened twice.
- My man with renal failure’s drip stopped working. He has hardly any accessible veins left and it took me 20 minutes to eventually get one into his foot. God knows what we’ll do when that one stops.
I’m usually a very calm person but when I eventually left work at 18:40, I have to admit I felt more than a little stressed out.
Let’s see what tomorrow brings.
Monday, 11 June 2007
Slowly... slowly...
One of our patients, James, is a heroin addict with H.I.V. and he’s in hospital with an abcess infection that’s spread to his blood stream (septicaemia).
He is as sick as a dog. He has a fever of 41°C (106°F) and as the infection courses through his veins, it causes him to shake (rigors) and, quite understandably, he feels awful. Over the weekend we were treating him with powerful antibiotics given straight into his blood stream via a drip. Like I mentioned, this guy injects smack and over the years that he’d been shooting up, he’s knackered all of his veins and this morning we finally ran out of veins that we could use to put the drip up.
He needed a central line.
A central line is a plastic tube going into one of the large (jugular) vein in the neck. Inserting a central line into a person involves (not to put too fine a point on it) lying your patient down, turning their head away from you and then stabbing them in the neck with a metal spike roughly the length of a child’s forearm. It’s one of the things that really highlights the sky-high levels of trust that our patients give us as doctors.
As you can imagine, there are lots of thing that can go wrong with central lines so we try to avoid put them lines into patients unless it’s absolutely necessary. Because not many patients have them, junior doctors like me don’t get to put them in very often. So when Dr Fletcher, our consultant, asked us which one of us wanted to put the central line into James, I jumped up and down with my hand in the air and shouted, “Pick Me! Pick Me! Pick Me!”
So I got to do a central line… on a H.I.V. positive drug addict with who was having rigors. My mother always used to say that you should be careful what you wish for.
I haven’t put in a central line for several months so, after I’d explained the risks and benefits to James and he’d agreed to let me do it, I asked one of the anaesthetists to help me do it an a master-and-apprentice fashion.
Now, I’m no psychic, but I reckon that if there was a mind-reader watching me put a the central line into James’ neck, he or she would have possibly overheard something along the lines of this:
------------
Me: OK, I’ve got to absolutely spot on with this. This guy is covered with sweat and he keeps shaking, I can so see this going horribly wrong if I make the slightest error. Slow and steady is the way forward.
James: I feel like shit. It’s like my whole body’s on fire. I want to puke but this doctor won’t let me. He’s a nice enough bloke, but I just wish he’d get on with it so that nurse can give me my medicine and I can start feeling better.
Me: So, I’ve got my gown, mask and sterile gloves on, I’ve got my sterile field set, all the equipment is ready, I’ve cleaned his neck with iodine, OK I’m ready to go.
James: I’m so going to spew if this guy doesn’t stop playing with that machine and start doing something and why does he have that stupid looking gown on? I know I've got H.I.V. but surely this is a bit O.T.T. - he looks like someone from a bad sci-fi film.
Me: The local anaesthetic’s in now. I’ve got the ultrasound machine ready so I can see the needle-tip, it’s time for the big needle
James: Whoa! What the hell is that!?! He wasn’t kidding when he said it was a big needle that’s the biggest needle I’ve ever seen in my life! And I’ve seen a hell of a lot of needles!
Me (out loud): “OK Sir, now it’s REALLY important that you keep REALLY still for this bit.”
James: Too right I’m keeping really still. That thing is like an offensive weapon and I can see your hands shaking. The end of that needle is moving all over the place. I’m just going to close my eyes and pray.
Me: OK, success, I’ve got the needle in the right place, now I’ve got to pass the guidewire down into the jugular vein.
James: …thy will be done on Earth as it is in Heaven…
Me: Slowly… slowly… OK, it’s in now I need the dilator.
James: …though I walk through the shadow of death, I shall fear no evil…
Me: That the hard bit done, now I’ll pass the actual central line over the guidewire, then all I’ll have to do is stitch it into position and it’s all done.
James: I feel sick again.
Me: All done! That was actually not too difficult and not even very messy. Well done me!
He is as sick as a dog. He has a fever of 41°C (106°F) and as the infection courses through his veins, it causes him to shake (rigors) and, quite understandably, he feels awful. Over the weekend we were treating him with powerful antibiotics given straight into his blood stream via a drip. Like I mentioned, this guy injects smack and over the years that he’d been shooting up, he’s knackered all of his veins and this morning we finally ran out of veins that we could use to put the drip up.
He needed a central line.
A central line is a plastic tube going into one of the large (jugular) vein in the neck. Inserting a central line into a person involves (not to put too fine a point on it) lying your patient down, turning their head away from you and then stabbing them in the neck with a metal spike roughly the length of a child’s forearm. It’s one of the things that really highlights the sky-high levels of trust that our patients give us as doctors.
As you can imagine, there are lots of thing that can go wrong with central lines so we try to avoid put them lines into patients unless it’s absolutely necessary. Because not many patients have them, junior doctors like me don’t get to put them in very often. So when Dr Fletcher, our consultant, asked us which one of us wanted to put the central line into James, I jumped up and down with my hand in the air and shouted, “Pick Me! Pick Me! Pick Me!”
So I got to do a central line… on a H.I.V. positive drug addict with who was having rigors. My mother always used to say that you should be careful what you wish for.
I haven’t put in a central line for several months so, after I’d explained the risks and benefits to James and he’d agreed to let me do it, I asked one of the anaesthetists to help me do it an a master-and-apprentice fashion.
Now, I’m no psychic, but I reckon that if there was a mind-reader watching me put a the central line into James’ neck, he or she would have possibly overheard something along the lines of this:
------------
Me: OK, I’ve got to absolutely spot on with this. This guy is covered with sweat and he keeps shaking, I can so see this going horribly wrong if I make the slightest error. Slow and steady is the way forward.
James: I feel like shit. It’s like my whole body’s on fire. I want to puke but this doctor won’t let me. He’s a nice enough bloke, but I just wish he’d get on with it so that nurse can give me my medicine and I can start feeling better.
Me: So, I’ve got my gown, mask and sterile gloves on, I’ve got my sterile field set, all the equipment is ready, I’ve cleaned his neck with iodine, OK I’m ready to go.
James: I’m so going to spew if this guy doesn’t stop playing with that machine and start doing something and why does he have that stupid looking gown on? I know I've got H.I.V. but surely this is a bit O.T.T. - he looks like someone from a bad sci-fi film.
Me: The local anaesthetic’s in now. I’ve got the ultrasound machine ready so I can see the needle-tip, it’s time for the big needle
James: Whoa! What the hell is that!?! He wasn’t kidding when he said it was a big needle that’s the biggest needle I’ve ever seen in my life! And I’ve seen a hell of a lot of needles!
Me (out loud): “OK Sir, now it’s REALLY important that you keep REALLY still for this bit.”
James: Too right I’m keeping really still. That thing is like an offensive weapon and I can see your hands shaking. The end of that needle is moving all over the place. I’m just going to close my eyes and pray.
Me: OK, success, I’ve got the needle in the right place, now I’ve got to pass the guidewire down into the jugular vein.
James: …thy will be done on Earth as it is in Heaven…
Me: Slowly… slowly… OK, it’s in now I need the dilator.
James: …though I walk through the shadow of death, I shall fear no evil…
Me: That the hard bit done, now I’ll pass the actual central line over the guidewire, then all I’ll have to do is stitch it into position and it’s all done.
James: I feel sick again.
Me: All done! That was actually not too difficult and not even very messy. Well done me!
Sunday, 10 June 2007
Computer says, “No.”
So here we are. The offers have all been made by the deaneries and I don’t have a job. Come 1st of August, I shall be unemployed.
Gutted? You bet I am. After all that has happened since February regarding my career, the prospect have having to do it all again is soul-destroying. After all the time and effort I put into the application process, I have achieved fuck all and have gotten nowhere.
The prospect of unemployment has been hanging over me for several months and now it’s actually happened I don’t feel as gutted or distraught as I thought I would. Don’t get me wrong, I’m not exactly singing from the rafters but I appreciate that things must move on.
I’m quite lucky that I have no big ties. A few years of ignoring my parent’s banging on at me to get onto the property ladder has actually worked in my favour as I now have no mortgage to pay. My previous (wannabe) international playboy lifestyle has meant that I’m not in a committed relationship and I have no children. Most importantly, I’m still young enough to retrain in a different career if it all goes really wrong and I decide to stop being a practicing doctor.
I’m not willing to move just anywhere. There are things in my life outside medicine that mean I’d try my hardest to stay where I am but I’m more flexible than some and, should push come to shove, it’s relatively easy for me to move if I have to.
There’s still a chance I could get a job this round because re-offers are being made up until 22nd of June, but I’m not putting my hopes on it. To use a quote from military strategy theory, “If plan A doesn’t work, you should move to plan B and NOT to plan A repeated.”
I have a plan B.
Hopefully, the next round of applications will be less random and hopefully they won’t disregard a year’s worth of experience as “irrelevant” like they did last time.
If you take a step back and look at it objectively, the situation seems even more bizarre. Right now, I’m working as an SHO on an incredibly busy firm and doing my job well. MMC are basically saying that I’m not good enough to do the job that I’m already doing. I applied for the job that I’m doing last year and they decided at the time that I was good enough to do it. Given that I now have several months MORE experience, have done MORE audits and MORE courses, can do MORE procedures and have learnt so much MORE than I knew then, it’s seems bizarre for them to say that I’m no longer good enough.
But computer says no so there’s no job for me – tough titty.
I was short-listed four times for interview back in March (round 1a)
Working harder
This last week has been manic. Our team has been so busy. We’ve had several really sick patients to look after and we’ve also had several patients who aren’t that sick but needed lots of stuff sorting out for them. Two doctors are away on annual leave, so we’ve been working with skeleton staff. It’s been really tough. Tough in terms of the mental stress of trying to treat our very poorly patients whilst at the same time being vigilant about the rest of the ward and making sure everybody has a plan and that said plan is working. It’s actually been really physically tiring. Every day this week, the other SHO and I have been turning up to work early and leaving late.
On Friday, our consultant took us to one side and told us
“You guys have done really well this week. It’s been really difficult and I can see you’ve been working very hard. All in all, most things have got sorted out and I’m really pleased. Well done guys.”
It’s really nice when the bosses say stuff like this. It’s really nice to be appreciated and when you do a job well, it’s nice to be told so.
Let’s hope next week is more sedate.
On Friday, our consultant took us to one side and told us
“You guys have done really well this week. It’s been really difficult and I can see you’ve been working very hard. All in all, most things have got sorted out and I’m really pleased. Well done guys.”
It’s really nice when the bosses say stuff like this. It’s really nice to be appreciated and when you do a job well, it’s nice to be told so.
Let’s hope next week is more sedate.
Tuesday, 5 June 2007
Dealing with emotional situations
One of the nurses discusses a comment in her student’s coursework book:
Staff nurses often have to deal with highly emotional situations, but rarely have any formal training about how to deal with them…
“You know, I’m a really emotional person, me. Give me a film or a sad story on telly and I’ll cry my eyes out, but at work it’s different isn’t it? It’s weird, because obviously we see loads of really sad things on here [the ward] but no matter how bad the situation, or how upset the patient or relatives are, you won’t see me crying at work. I won’t even go home and cry about it.
“If you think about it - it’s strange because obviously here it’s all real and you’d think I’d get more upset than I do about anything on telly. I think what it is, is that when it happens in front of you, it’s not fair if I, as their nurse starts getting upset about it is it? It’s their grief, it’s their lives, not mine. If I start sobbing, it’s like it’s putting the focus onto me, and really it shouldn’t be about me should it? It should be about the patient and their family.”
Staff nurses often have to deal with highly emotional situations, but rarely have any formal training about how to deal with them…
“You know, I’m a really emotional person, me. Give me a film or a sad story on telly and I’ll cry my eyes out, but at work it’s different isn’t it? It’s weird, because obviously we see loads of really sad things on here [the ward] but no matter how bad the situation, or how upset the patient or relatives are, you won’t see me crying at work. I won’t even go home and cry about it.
“If you think about it - it’s strange because obviously here it’s all real and you’d think I’d get more upset than I do about anything on telly. I think what it is, is that when it happens in front of you, it’s not fair if I, as their nurse starts getting upset about it is it? It’s their grief, it’s their lives, not mine. If I start sobbing, it’s like it’s putting the focus onto me, and really it shouldn’t be about me should it? It should be about the patient and their family.”
Monday, 4 June 2007
Getting Nervous
I’m getting nervous now.
I haven’t posted much about MMC or MTAS because, let’s face it, it’s pretty well covered elsewhere in medical blogosphere but it’s getting me down again. The application process has been dragging on and on and on since December and I’m just tired of it. Last week and this week, the deaneries actually started making job offers via email... at different times to different people. This means that some people have secured a job already – good on ‘em – whilst others are still waiting.
I’m still waiting, I’m still hoping, I’m still checking my inbox two to three times a day for any news, still wondering if I mis-typed the email address on the application form, still gob-smacked at being told by one of the consultants that interviewed me that a year’s worth of SHO experience in A&E and surgery was “irrelevant,” still staring down the barrel of unemployment in 57 days.
As each day passes, I get euphoric texts and calls from my doctor friends who have been made a job offer or two. While I’m really glad that my friends don’t have to worry about it anymore, every text message brings more sharply into focus the fact that I have nothing.
This is horrible.
It feels like A-level results day in that you know your future for the next five years is going to depend on the letters in that white envelope. That day, emotions were running high and it seemed that everybody was either ecstatic or distraught.
For me, this is much, much worse than that day. At least then, you knew you were going to get an answer. Now, I just don’t know. If I haven’t got a job, I won’t know until the 20th of June. The not-knowing is sickening and it’s getting me down.
I’m going to try and get some sleep and I’m hoping I feel better about it in the morning.
Goodnight.
I haven’t posted much about MMC or MTAS because, let’s face it, it’s pretty well covered elsewhere in medical blogosphere but it’s getting me down again. The application process has been dragging on and on and on since December and I’m just tired of it. Last week and this week, the deaneries actually started making job offers via email... at different times to different people. This means that some people have secured a job already – good on ‘em – whilst others are still waiting.
I’m still waiting, I’m still hoping, I’m still checking my inbox two to three times a day for any news, still wondering if I mis-typed the email address on the application form, still gob-smacked at being told by one of the consultants that interviewed me that a year’s worth of SHO experience in A&E and surgery was “irrelevant,” still staring down the barrel of unemployment in 57 days.
As each day passes, I get euphoric texts and calls from my doctor friends who have been made a job offer or two. While I’m really glad that my friends don’t have to worry about it anymore, every text message brings more sharply into focus the fact that I have nothing.
This is horrible.
It feels like A-level results day in that you know your future for the next five years is going to depend on the letters in that white envelope. That day, emotions were running high and it seemed that everybody was either ecstatic or distraught.
For me, this is much, much worse than that day. At least then, you knew you were going to get an answer. Now, I just don’t know. If I haven’t got a job, I won’t know until the 20th of June. The not-knowing is sickening and it’s getting me down.
I’m going to try and get some sleep and I’m hoping I feel better about it in the morning.
Goodnight.
Sunday, 3 June 2007
The importance of being idle
Wow, it’s amazing how good I feel after having a break and getting away from it all. I think I didn’t realise just how much I was wound up until I had the chance to just… stop… and do… nothing. It feels great.
There have been times in the last few months when I’ve felt like I’m spending my whole life in the hospital. In the time when I wasn’t at work, I was buzzing around like a bee trying to organise seeing and speaking to friends. This last week has really given me chance to pause and I’ve really enjoyed having time to chill.
I found that I’ve been revelling in doing the little things. Here are some of the things I’ve really enjoyed doing in my week off:
Sitting down and having a cup of tea whilst reading a newspaper
Talking to my friends for hours on the telephone
Making the effort to go and visit my parents for dinner
Dusting off my bicycle and going for a bike ride in the coutryside
Sharing a pint with a good friend in the afternoon
Dancing like a fool in a club
Meeting my brother’s new girlfriend and having a polite conversation
Reading a book
I’m enjoying myself and I have a feeling that this summer is going to be fantastic. Heads up though because work begins again tomorrow.
There have been times in the last few months when I’ve felt like I’m spending my whole life in the hospital. In the time when I wasn’t at work, I was buzzing around like a bee trying to organise seeing and speaking to friends. This last week has really given me chance to pause and I’ve really enjoyed having time to chill.
I found that I’ve been revelling in doing the little things. Here are some of the things I’ve really enjoyed doing in my week off:
Sitting down and having a cup of tea whilst reading a newspaper
Talking to my friends for hours on the telephone
Making the effort to go and visit my parents for dinner
Dusting off my bicycle and going for a bike ride in the coutryside
Sharing a pint with a good friend in the afternoon
Dancing like a fool in a club
Meeting my brother’s new girlfriend and having a polite conversation
Reading a book
I’m enjoying myself and I have a feeling that this summer is going to be fantastic. Heads up though because work begins again tomorrow.
Wednesday, 23 May 2007
Have a break, have a Kit Kat
I'm off on holiday for a (well deserved) break.
I'll be back in a few days.
I'll be back in a few days.
Tuesday, 22 May 2007
The BMA
So, James Johnson, the head of the British Medical Association (BMA) has been forced to resign over MMC. The feeling is that the MMC fiasco and the BMA’s position of support for it is completely at odds with the opinions of the vast majority of doctors.
You know, it’s never been clear to me what the BMA actually do. To be a BMA member you have to pay about £300 a year. This is a sizable amount of money but I’ve never had a good idea what you get for your cash. When I pose this question to doctors, I get replies like “it’s important to be a member because they’ll support you if there’s a problem with your employer” and “the BMJ is a good journal to get.”
I’ve never been wholly convinced by this line. I mean, what protection does BMA membership give you over and above standard UK employment laws? I don’t know, maybe someone can answer his question but I don’t think it’s much if any. And, to be honest £300 for a magazine subscription is a little steep, especially considering the BMJ is available to read in every single hospital library in the country for free.
The only valid reason for being a BMA member I could think of was that if the shit really did hit the fan and the government properly tried to screw us over, then the BMA would be there fighting our corner.
MMC is the government trying to screw me, and thousand of other junior doctors across our land, over in a big fashion. I expected the BMA to be standing up and fighting against a system that nobody seems to want. Were the BMA fighting our corner?
Were they bollocks. The silence was deafening. The complicity is sickening.
£300 a year.
What a waste of money.
You know, it’s never been clear to me what the BMA actually do. To be a BMA member you have to pay about £300 a year. This is a sizable amount of money but I’ve never had a good idea what you get for your cash. When I pose this question to doctors, I get replies like “it’s important to be a member because they’ll support you if there’s a problem with your employer” and “the BMJ is a good journal to get.”
I’ve never been wholly convinced by this line. I mean, what protection does BMA membership give you over and above standard UK employment laws? I don’t know, maybe someone can answer his question but I don’t think it’s much if any. And, to be honest £300 for a magazine subscription is a little steep, especially considering the BMJ is available to read in every single hospital library in the country for free.
The only valid reason for being a BMA member I could think of was that if the shit really did hit the fan and the government properly tried to screw us over, then the BMA would be there fighting our corner.
MMC is the government trying to screw me, and thousand of other junior doctors across our land, over in a big fashion. I expected the BMA to be standing up and fighting against a system that nobody seems to want. Were the BMA fighting our corner?
Were they bollocks. The silence was deafening. The complicity is sickening.
£300 a year.
What a waste of money.
Monday, 21 May 2007
Saying Thank-you
As I was leaving work today, I took a second to pause and read some of the cards that are pinned up near the entrance to our ward. These cards are from patients and the relatives of patients that we’ve had on our ward. There were four new ones that I hadn’t seen before. Two were from former patients and two were from the relatives of patients who had recently passed away. The thing that struck me while reading these cards was the sensitivity that was expressed and the gratitude that was shown to the nurses and to the doctors who had looked after people during their stay. I felt genuinely touched that people had taken the time just to say thank you.
The NHS gets a bad rep in the press and from the public at large. But, to be honest, all the stories of neglect, of uncaring staff, of MRSA and dirty wards are not at all what I see. When I meet up with my non-medical friends and they start repeating bad press stories like this to me, I tell them that I wish they could come onto a ward in an NHS hospital. I wish they could just spend an hour or two on the ward talking to the patients there and just ask them how they felt about the way they’ve been treated. I’m confident to say the vast majority of the patients would say that they’re very happy with their treatment and it’s a shame that the good experiences don’t get anywhere near as much press as the bad ones.
Last year, my father had to be taken into hospital and I have to say that I couldn’t ask for anything more from the health professionals who dealt with him. The paramedics, the A&E staff, the surgical doctors and nurses were all fantastic. It was strange being on the other side of the service, but everything got sorted out and he was treated with the utmost care and respect. I was glad.
A recent news article showed that, in fact, the vast majority of people were happy with the care that the NHS provides, and that seemed to be borne out by those cards pinned up near the entrance to our ward.
The NHS gets a bad rep in the press and from the public at large. But, to be honest, all the stories of neglect, of uncaring staff, of MRSA and dirty wards are not at all what I see. When I meet up with my non-medical friends and they start repeating bad press stories like this to me, I tell them that I wish they could come onto a ward in an NHS hospital. I wish they could just spend an hour or two on the ward talking to the patients there and just ask them how they felt about the way they’ve been treated. I’m confident to say the vast majority of the patients would say that they’re very happy with their treatment and it’s a shame that the good experiences don’t get anywhere near as much press as the bad ones.
Last year, my father had to be taken into hospital and I have to say that I couldn’t ask for anything more from the health professionals who dealt with him. The paramedics, the A&E staff, the surgical doctors and nurses were all fantastic. It was strange being on the other side of the service, but everything got sorted out and he was treated with the utmost care and respect. I was glad.
A recent news article showed that, in fact, the vast majority of people were happy with the care that the NHS provides, and that seemed to be borne out by those cards pinned up near the entrance to our ward.
Sunday, 20 May 2007
A Clean Sheet
I’m stating the obvious when I say that hospitals are full of very sick people. After working in such an environment for a while, and seeing so many people die, you get the impression that death is part of the furniture. Some people die slowly, some suddenly, some go peacefully and some die in great pain and indignity.
Some deaths are an expected inevitability whilst others are preventable and it’s our job as doctors to recognise those at risk of dying unecessarily and doing all we can to stop the preventable deaths from happening.
This weekend, between the hours of 17:00 on Friday afternoon and 00:00 Monday morning, nobody in Town Hospital died.
Nobody.
Between us, me, Ben, the house-officers and the night team have managed to keep every single in-patient alive. I’m not sure how often this happens, but I don’t think it happens very often. There were some close calls though. There was an old lady who came in with blood poisoning from a urine infection who we thought was on her last legs but rallied round amazingly after we gave her antibiotics and IV fluids. There was a man with kidney, heart and lung failure who we thought was going to die but perked up well with oxygen and fluids. And of course there was Jim, who actually did get to watch the FA Cup final on CCU and when Drogba scored, I’m sure he was the happiest man alive.
Through a combination of good luck and good judgement, everyone who was here on Friday is still here now, along with everyone who was admitted over the weekend.
A clean sheet.
Some deaths are an expected inevitability whilst others are preventable and it’s our job as doctors to recognise those at risk of dying unecessarily and doing all we can to stop the preventable deaths from happening.
This weekend, between the hours of 17:00 on Friday afternoon and 00:00 Monday morning, nobody in Town Hospital died.
Nobody.
Between us, me, Ben, the house-officers and the night team have managed to keep every single in-patient alive. I’m not sure how often this happens, but I don’t think it happens very often. There were some close calls though. There was an old lady who came in with blood poisoning from a urine infection who we thought was on her last legs but rallied round amazingly after we gave her antibiotics and IV fluids. There was a man with kidney, heart and lung failure who we thought was going to die but perked up well with oxygen and fluids. And of course there was Jim, who actually did get to watch the FA Cup final on CCU and when Drogba scored, I’m sure he was the happiest man alive.
Through a combination of good luck and good judgement, everyone who was here on Friday is still here now, along with everyone who was admitted over the weekend.
A clean sheet.
Friday, 18 May 2007
Football isn't a matter of life and death, it's much more important that that
Ben, the cardiology registrar, is a really nice guy and I like him a lot. Trouble is, every time me and Ben are on call at the same time, we have major drama to deal with.
This evening, I admitted a man called Jim into hospital. Jim is 85 years old but still independent and lives by himself. In the afternoon, Jim had been to the post-office and as he was leaving, Jim passed out. Now, I don’t know if any of you have recently been to the post-office but I have to say that every time I visit one, I end up seething with rage or in tears. Why does it have to take the best part of the day just to post a parcel? Mr Angry knows how I feel and, to be honest, I don’t blame Jim for passing out.
Jim was a little embarrassed by the whole episode, but felt pretty much back to normal. Jim is a big Chelsea fan and was desperate to get out of hospital so he could watch tomorrow’s FA Cup final. I asked Sharon, the nurse, to do an E.C.G. recording that showed the Jim had an irregular heart rhythm that Jim had had for donkey’s years. But it also showed that Jim’s heart was beating very, very slowly indeed. I figured that this was probably a side-effect of some of the medications he was on and, as a precaution, I asked for Jim to be put on a cardiac monitor so we could keep an eye on his heart rhythm.
I’m seeing my next patient about half an hour later and Jim’s cardiac monitor starts beeping. Sharon says “I’ve just walked away from him, he’s fine – the monitor’s faulty, I’ll go turn off the siren” and leaves the room to see to Jim’s monitor.
A couple of seconds later I hear Sharon shout,
“CAN I HAVE SOME HELP PLEASE!”
Jim wasn’t fine at all. The siren was going off because Jim’s heart had stopped beating. Jim was dead.
I run to Jim’s bay and commence CPR with Sharon and another nurse goes off to get the crash trolley. The other members of the cardiac arrest team arrive and we start advanced life support, as we’ve been trained for.
We shock Jim. Basically we electrocute him in the hope that his heart will start beating again.
It works.
Jim gets a pulse back. Slowly, over the next 20 minutes or so, Jim becomes more and more responsive until he is able to utter the words “Where am I?”
Those words made me feel happier than any words have made me feel for a long time. We saved Jim’s life. If this had happened in the Post Office, Jim would have been dead. If Jim hadn’t listened to the advice of the paramedics to “have it checked out,” he’d be dead. If I hadn’t asked for Jim to be put on a cardiac monitor, he’d be dead.
As it is, when I finished the shift, Jim was sat chatting to his daughter on the coronary care unit. While he probably won’t get to see the FA Cup final, he’ll at least be alive to listen to it on the radio and, as Ben told me, “you’ve go to be happy about that.”
(For those medics among you, the initial ECG that Sharon did showed A.F. with bigemeny at an effective rate of 36 bpm. He had a VF arrest and reverted back to bigemeny after one shock.)
This evening, I admitted a man called Jim into hospital. Jim is 85 years old but still independent and lives by himself. In the afternoon, Jim had been to the post-office and as he was leaving, Jim passed out. Now, I don’t know if any of you have recently been to the post-office but I have to say that every time I visit one, I end up seething with rage or in tears. Why does it have to take the best part of the day just to post a parcel? Mr Angry knows how I feel and, to be honest, I don’t blame Jim for passing out.
Jim was a little embarrassed by the whole episode, but felt pretty much back to normal. Jim is a big Chelsea fan and was desperate to get out of hospital so he could watch tomorrow’s FA Cup final. I asked Sharon, the nurse, to do an E.C.G. recording that showed the Jim had an irregular heart rhythm that Jim had had for donkey’s years. But it also showed that Jim’s heart was beating very, very slowly indeed. I figured that this was probably a side-effect of some of the medications he was on and, as a precaution, I asked for Jim to be put on a cardiac monitor so we could keep an eye on his heart rhythm.
I’m seeing my next patient about half an hour later and Jim’s cardiac monitor starts beeping. Sharon says “I’ve just walked away from him, he’s fine – the monitor’s faulty, I’ll go turn off the siren” and leaves the room to see to Jim’s monitor.
A couple of seconds later I hear Sharon shout,
“CAN I HAVE SOME HELP PLEASE!”
Jim wasn’t fine at all. The siren was going off because Jim’s heart had stopped beating. Jim was dead.
I run to Jim’s bay and commence CPR with Sharon and another nurse goes off to get the crash trolley. The other members of the cardiac arrest team arrive and we start advanced life support, as we’ve been trained for.
We shock Jim. Basically we electrocute him in the hope that his heart will start beating again.
It works.
Jim gets a pulse back. Slowly, over the next 20 minutes or so, Jim becomes more and more responsive until he is able to utter the words “Where am I?”
Those words made me feel happier than any words have made me feel for a long time. We saved Jim’s life. If this had happened in the Post Office, Jim would have been dead. If Jim hadn’t listened to the advice of the paramedics to “have it checked out,” he’d be dead. If I hadn’t asked for Jim to be put on a cardiac monitor, he’d be dead.
As it is, when I finished the shift, Jim was sat chatting to his daughter on the coronary care unit. While he probably won’t get to see the FA Cup final, he’ll at least be alive to listen to it on the radio and, as Ben told me, “you’ve go to be happy about that.”
(For those medics among you, the initial ECG that Sharon did showed A.F. with bigemeny at an effective rate of 36 bpm. He had a VF arrest and reverted back to bigemeny after one shock.)
Wednesday, 16 May 2007
Trapped in a closet
In my time, I've been in some pretty hairy situations because I've done things that I should have thought twice about. Someone thought I'd enjoy this story and I did.
Hip-Hopera - it's fucking hilaious.
http://www.youtube.com/watch?v=FCXlCkY4Y5g&mode=related&search=
Hip-Hopera - it's fucking hilaious.
http://www.youtube.com/watch?v=FCXlCkY4Y5g&mode=related&search=
Tuesday, 15 May 2007
Everyone has an opinion on the NHS
Bill is a man in his eighties with dementia. Dementia is a condition that means that people forget who theyare, where they are and who people are around them.
Bill's not particularly concerned by this though and he wanders round the ward quite happily in his own little world. He needs supervising though because his dementia means that he gets himself into trouble and if there's nobody watching him, then bad things happen.
Yesterday, one of the staff nurses noticed that the door to the Ward Matron's office was ajar. She pushed it open and found Bill squatting down with his pants round his ankles having a shit in the middle of the floor!
I know shouldn't laugh but I thought it was hilarious. It seems everyone has an opinion on the NHS! Matron, on the other hand, was very angry indeed...
Sunday, 13 May 2007
Alcoholics II
Last week, I posted about an alcoholic patient that I treated on the Medical Admissions Unit. I was replying to a comment that a medical student wrote, but my reply got so long I figure it deserves a post of its own. You can read the original post here.
-------------------------------------
JB said...
I'm a final year student, and to be honest, I hope I never talk to a patient like that. Yeah, blah blah blah tough love, but to me that sounds like a good excuse for a dose of old-fashioned, hideous paternalism and moralising. Your patient probably doesn't need her face rubbed in the mess of her life, it's only likely to compound whatever emotional crap she is using drink as an escape mechanism from. I really like your blog and think you sound like an ace doctor (and everyone is to be forgiven for moments of getting annoyed with patients) so don't think I'm being mean, it's just my viewpoint on how I'd approach it.
11 May 2007 23:22
----------------------------
JB,
You make a valid point, and one that I’ve thought about loads since that conversation with Joy. I don’t feel proud or happy about making her cry, it was not my intention to make her feel bad or to “rub her face in the mess of her life.” I could have been less dogmatic in what I was saying but the whole situation made me feel sad and angry and I felt I had to say something about it. All I did was spell out the truth.
Let me explain;
My anger stemmed from frustration. Like many addicts, I don’t think Joy thought she had a problem. I don’t think Joy could see how much hurt she was causing. I’m certain Joy didn’t have an idea of what the future would hold is she continued to neck a litre or two of spirits a day i.e. that she would die before her time in a messy, ugly and probable painful way.
Joy has got herself into a cycle of helplessness where she EXPECTS everything to be done for her. She EXPECTS that her mother will come round and pick her off the floor. That her mother will clean up her vomit, clean her bathroom and make sure her flat is habitable. She EXPECTS that the paramedics will be there every time she feels hungover. She EXPECTS that the doctors and nurses in hospital will make her feel better and help her over the symptoms if withdrawal.
Joy is RIGHT to have these expectations, these things have happened many times before and will probably happen many times in the future. I don’t think Joy saw any need to change her ways.
The point I was trying to make to Joy was that it is not FAIR to expect all these things. I wasn’t thinking about the medical side of things - after all, me, the nurses and the paramedics have been trained to deal with this sort of thing and we get paid for it. I was thinking about the grief that Evelyn (Joy’s mother) and Joy’s children were going through every single day. Joy just didn’t care about her family, and her family obviously cared deeply about her. That’s what made me mad, that’s what makes me sad. Joy continues to lie, to manipulate, to get drunk then call her seventy-something year old mother at 2am saying she’s fallen over etc… etc…
JB, obviously you are entitled to you opinions as I am mine. Yes, I was moralising. Yes as was being paternalistic, but in this particular case, do you honestly think this is a bad thing? I appreciate that it’s easy for me (a non-addict) to tell Joy to give up her addiction and I appreciate that I don’t have first hand experience of what it involves, because I’ve never had to do it. Joy has her reasons to drink and while I can sympathise that life is hard, I also recognise that there are millions of people on this earth for whom life is hard but do NOT turn to drink and manipulate those trying to help them. At the end of the day, we all have to take responsibility for our own actions and Joy was not taking ANY responsibility for hers.
I’m sure Joy had her reasons to start drinking, I was trying to make her see some reasons to stop.
Was I wrong to at least attempt to make her see how much drinking is destroying her life and the lives of those who care about her?
You’re a final-year medical student, so you probably don’t need me to tell you that alcoholic liver disease (ALD) is one of the very few medical conditions that is totally reversible. Unlike diabetes or heart failure or emphysema or cancer, people with ALD can get better, they can actually cure themselves – but only if they stop drinking.
In the last fortnight, I’ve seen five people die from decompensated alcoholic liver disease. Five dead people who would still be living today if they had stopped drinking. Of those five people, only one had family around them when they died. Four died alone, surrounded by strangers on a hospital ward.
This makes stories like Joy’s so much more tragic. It’s like that train crash that you can see coming but feel you can do nothing to prevent. I was just trying to prevent Joy from crashing, but I suspect – like so many before me – that I’ll fail.
-------------------------------------
JB said...
I'm a final year student, and to be honest, I hope I never talk to a patient like that. Yeah, blah blah blah tough love, but to me that sounds like a good excuse for a dose of old-fashioned, hideous paternalism and moralising. Your patient probably doesn't need her face rubbed in the mess of her life, it's only likely to compound whatever emotional crap she is using drink as an escape mechanism from. I really like your blog and think you sound like an ace doctor (and everyone is to be forgiven for moments of getting annoyed with patients) so don't think I'm being mean, it's just my viewpoint on how I'd approach it.
11 May 2007 23:22
----------------------------
JB,
You make a valid point, and one that I’ve thought about loads since that conversation with Joy. I don’t feel proud or happy about making her cry, it was not my intention to make her feel bad or to “rub her face in the mess of her life.” I could have been less dogmatic in what I was saying but the whole situation made me feel sad and angry and I felt I had to say something about it. All I did was spell out the truth.
Let me explain;
My anger stemmed from frustration. Like many addicts, I don’t think Joy thought she had a problem. I don’t think Joy could see how much hurt she was causing. I’m certain Joy didn’t have an idea of what the future would hold is she continued to neck a litre or two of spirits a day i.e. that she would die before her time in a messy, ugly and probable painful way.
Joy has got herself into a cycle of helplessness where she EXPECTS everything to be done for her. She EXPECTS that her mother will come round and pick her off the floor. That her mother will clean up her vomit, clean her bathroom and make sure her flat is habitable. She EXPECTS that the paramedics will be there every time she feels hungover. She EXPECTS that the doctors and nurses in hospital will make her feel better and help her over the symptoms if withdrawal.
Joy is RIGHT to have these expectations, these things have happened many times before and will probably happen many times in the future. I don’t think Joy saw any need to change her ways.
The point I was trying to make to Joy was that it is not FAIR to expect all these things. I wasn’t thinking about the medical side of things - after all, me, the nurses and the paramedics have been trained to deal with this sort of thing and we get paid for it. I was thinking about the grief that Evelyn (Joy’s mother) and Joy’s children were going through every single day. Joy just didn’t care about her family, and her family obviously cared deeply about her. That’s what made me mad, that’s what makes me sad. Joy continues to lie, to manipulate, to get drunk then call her seventy-something year old mother at 2am saying she’s fallen over etc… etc…
JB, obviously you are entitled to you opinions as I am mine. Yes, I was moralising. Yes as was being paternalistic, but in this particular case, do you honestly think this is a bad thing? I appreciate that it’s easy for me (a non-addict) to tell Joy to give up her addiction and I appreciate that I don’t have first hand experience of what it involves, because I’ve never had to do it. Joy has her reasons to drink and while I can sympathise that life is hard, I also recognise that there are millions of people on this earth for whom life is hard but do NOT turn to drink and manipulate those trying to help them. At the end of the day, we all have to take responsibility for our own actions and Joy was not taking ANY responsibility for hers.
I’m sure Joy had her reasons to start drinking, I was trying to make her see some reasons to stop.
Was I wrong to at least attempt to make her see how much drinking is destroying her life and the lives of those who care about her?
You’re a final-year medical student, so you probably don’t need me to tell you that alcoholic liver disease (ALD) is one of the very few medical conditions that is totally reversible. Unlike diabetes or heart failure or emphysema or cancer, people with ALD can get better, they can actually cure themselves – but only if they stop drinking.
In the last fortnight, I’ve seen five people die from decompensated alcoholic liver disease. Five dead people who would still be living today if they had stopped drinking. Of those five people, only one had family around them when they died. Four died alone, surrounded by strangers on a hospital ward.
This makes stories like Joy’s so much more tragic. It’s like that train crash that you can see coming but feel you can do nothing to prevent. I was just trying to prevent Joy from crashing, but I suspect – like so many before me – that I’ll fail.
Space to breathe
It's funny how you don't realise how tired you are until you stop. I went to bed a 21:30 on Friday and slept all the way through to 11:30 on Saturday. I woke up and felt fantastic.
Over the weekend I've been revelling in doing not much at all. Meeting up with friends, reading the newspaper, watching telly - it's been really, really nice.
I'm back at work tomorrow but this weekend has given me space to breathe and for that, I am grateful.
Over the weekend I've been revelling in doing not much at all. Meeting up with friends, reading the newspaper, watching telly - it's been really, really nice.
I'm back at work tomorrow but this weekend has given me space to breathe and for that, I am grateful.
Tuesday, 8 May 2007
I have a dilemma
I was driving home from the hospital last night and there’s a couple of lorries in the lanes ahead of me. They both put on their hazard lights and slow right down. I slow down too and move to overtake them. When I pull out into the overtaking lane, I see why they were slowing down.
Up ahead there’s been an accident. A silver car is resting against the central reservation with its bonnet all smashed up. There are no emergency services around.
I have a dilemma.
Should I drive on, like the rest of the traffic, or should I stop and see if anyone is hurt and try and help?
One voice was saying: “Michael, you have no experience of handling out-of-hospital emergencies, you have no equipment AT ALL. All you have is your bare hands, what use do you think you can be? Stopping would be pointless.”
Another voice was saying, “Look, you may not have been trained in this kind of thing but you are a doctor and you have managed trauma in A&E, you know the basics and you’ll undoubtedly know more than anyone else there. You should stop and try to help.”
I’m getting closer to the car now, I can see a man standing near the car. I make up my mind.
I stop.
“Hello, my name’s Michael, I’m a doctor on my way home from work. Are you OK? Is anyone hurt?”
It turns out that the man and his girlfriend were both fine. They were obviously shaken up, but they were both out of the car, walking around and talking to me. After a couple of minutes, the police arrive on the scene and I decide to leave and take myself home to bed.
What made me stop was the fact that IF there had been someone hurt, there MIGHT have been something I could have done to help. If there was the possibility I could have saved someone’s life and I’d driven on and ignored them, then, I would have felt so guilty that I would not have been able to sleep at night.
Last night I slept like a log.
Up ahead there’s been an accident. A silver car is resting against the central reservation with its bonnet all smashed up. There are no emergency services around.
I have a dilemma.
Should I drive on, like the rest of the traffic, or should I stop and see if anyone is hurt and try and help?
One voice was saying: “Michael, you have no experience of handling out-of-hospital emergencies, you have no equipment AT ALL. All you have is your bare hands, what use do you think you can be? Stopping would be pointless.”
Another voice was saying, “Look, you may not have been trained in this kind of thing but you are a doctor and you have managed trauma in A&E, you know the basics and you’ll undoubtedly know more than anyone else there. You should stop and try to help.”
I’m getting closer to the car now, I can see a man standing near the car. I make up my mind.
I stop.
“Hello, my name’s Michael, I’m a doctor on my way home from work. Are you OK? Is anyone hurt?”
It turns out that the man and his girlfriend were both fine. They were obviously shaken up, but they were both out of the car, walking around and talking to me. After a couple of minutes, the police arrive on the scene and I decide to leave and take myself home to bed.
What made me stop was the fact that IF there had been someone hurt, there MIGHT have been something I could have done to help. If there was the possibility I could have saved someone’s life and I’d driven on and ignored them, then, I would have felt so guilty that I would not have been able to sleep at night.
Last night I slept like a log.
Monday, 7 May 2007
On autopilot
I'm tired. I know junior doctor's hours these days are a walk in the park compared to what they used to be but, still, I've worked 13 hour shifts for four days on the bounce now and I'm tired.
Luckily for me, I've got a holiday coming up and I'm really lookin forward to it. It's like a big beacon at the end of the tunnel and there were times this afternoon when dreaming of Europe was the only thing that was keeping me going.
Thankfully, this bank holiday weekend has been relatively quiet. I suspect it's because people are away from home and wanting to enjoy their holiday and so don't come into hospital with vague symptoms. I'm probably wrong about this but it suited me fine. The doctors and nurses on duty actually got time to sit down and have a cup of tea together, which is very nice and makes work a more enjoyable place to be.
Today, I clerked in
2 people with a urine infection
2 people with a chest infection
2 people with mini-strokes
1 person with a paracetamol overdose
1 person with an irregular heartbeat
1 person with worsening angina
It was a steady stream of patients that kept me occupied but it wasn't really a particularly exciting or interesting shift. I felt like I was on autopilot for most of it and I think that is due to the tiredness.
I'm going to bed.
Luckily for me, I've got a holiday coming up and I'm really lookin forward to it. It's like a big beacon at the end of the tunnel and there were times this afternoon when dreaming of Europe was the only thing that was keeping me going.
Thankfully, this bank holiday weekend has been relatively quiet. I suspect it's because people are away from home and wanting to enjoy their holiday and so don't come into hospital with vague symptoms. I'm probably wrong about this but it suited me fine. The doctors and nurses on duty actually got time to sit down and have a cup of tea together, which is very nice and makes work a more enjoyable place to be.
Today, I clerked in
2 people with a urine infection
2 people with a chest infection
2 people with mini-strokes
1 person with a paracetamol overdose
1 person with an irregular heartbeat
1 person with worsening angina
It was a steady stream of patients that kept me occupied but it wasn't really a particularly exciting or interesting shift. I felt like I was on autopilot for most of it and I think that is due to the tiredness.
I'm going to bed.
Sunday, 6 May 2007
Alcoholics
The longer I work as a doctor, the less patience and sympathy I have for alcoholics. If ever there was a group of people who are self-absorbed, manipulative, lying ingrates who abuse and manipulate the people around them, their families and the healthcare system - it’s them.
I used to feel sorry for alcoholics. I used to listen to their stories about how life is so hard for them and about how nobody cared about them and about how they are really going to change and I used to feel sympathetic. But honestly, the more I see the way they constantly drain the will of those who are trying to help them, the less I feel sympathetic and the more I feel (whisper it) disdain.
Joy is a 44 year old woman who came to Medical Admissions today from A&E. Joy has alcoholic neuropathy. Basically, she’ drunk so much that she’s killing the nerves in her feet and this means her legs are weak and she falls over a lot. Joy has come into hospital because she couldn’t get up and started having alcohol withdrawal symptoms because she couldn’t get to her vodka. The physical symptoms of alcohol withdrawal can be treated quite easily and very effectively – this was not the issue.
Scratch the surface and I find out that in the last 7 days, Joy has called the ambulance out 3times and her GP out twice, each time refusing treatment when the health professionals arrive.
Joy’s mother, Evelyn, and Joy’s two children ask to speak to me. The story comes out that Joy has had many, many admissions to hospital recently because of her drinking. Each time, she comes in, her symptoms get sorted out and when she’s discharged, Joy is fine for about three or four days. Then Joy will start drinking again. When Joy drinks, she doesn’t look after herself, she doesn’t clean or wash herself, she dangerous when she tries to cook, she doesn’t eat and she gets verbally and physically abusive towards her own family. Evelyn is in her seventies and is not in the best of health herself. She is coming to the end of her tether because she just doesn’t know what to do with Joy. Evelyn is up all night worrying about her daughter. Worrying that Joy is going to hurt herself or that Joy is going to accidentally set fire to her block of flats.
Evelyn, along with Joy’ children asked me if there was any way that we could detox Joy and get her better so that she’s the daughter (and mother) that she once was.
The trouble is, and I explained this to Evelyn, if Joy doesn’t want to stop drinking, there’s not a great deal we can do. Sure, we can patch her up when she falls down but unless she’s made her own mind up to give up the booze, any help we try to give will be wasted. Is there any point making her an appointment to see a behaviour specialist if she never turns up because she’s pissed again?
It’s sad. Here I a woman in her mid-forties who has family that obviously care about her and love her, but Joy doesn’t see that. Joy doesn’t care. This is what is going to happen: Eventually, Joy will drive them away and her family will give up on her. In the future, Joy will be in hospital telling young doctors like me about how her life is so hard and how nobody cares about her and how she’s really trying to change.
Joy is drinking her life away and it’s so sad.
A bit later on, I was siting a canula in Joy’s arm so we could give her some intravenous vitamins to help improve her symptoms and she says to me.
“You just don’t think that this (weak legs) is going to happen to you, do you doctor?”
I could not believe that she actually said that. I looked her in the eyes and said.
“Joy, you KNOW why this happens. You’ve been told again and again why this happens. It’s happening because you keep drinking. How many times have you been to hospital or A&E this year because of your drinking? How many times have you been told you need to stop? You’ve been told by doctors, by nurses, by your own FAMILY to stop drinking but you just carry on. Your legs are weak because the booze is rotting the nerves in your feet. Soon, it’ll start rotting your brain as well. You are 44 years-old! You should be living life to the maximum, but instead you have to live in a warden-controlled flat and it’s all because of the booze. I’ve just been speaking to you family, Joy. You have a great family that love you and that care for you and that worry about you. Do you know how lucky you are to have that? There are people in here, on this ward right now, who would give anything to have a family like yours. Your mother is not a well woman and she’s making herself ill because she’s worried sick about you Joy. Do you think that’s fair? Do you think it’s fair that she has to come round and clean up after you when you’re drunk, to make sure you’ve eaten? You’re a grown woman for Christ’s sake. Why are you doing this to her? She’s in her seventies! Why are you doing this to yourself? If you don’t stop drinking Joy, you are going to die. Don’t think I’m saying that just to scare you, I’ve seen it happen so often – it’s the truth. But it doesn’t have to be like that. Your legs will get better if you stop the booze. All this will get better if you stop the booze. You could be out enjoy life if you stop the booze, but you’ve got to want to stop, Joy. The only person who can make this better is you, so you have to ask yourself – What do you want to do?”
By this time, Joy is in tears and she says
“I’m an idiot, aren’t I doctor”
“Yes you are. It’s time to change”
I don’t feel great about upsetting my patient and making her cry, but selfish, manipulative people like her make me so angry, especially because so many people are trying to help her and she’s throwing it all back in everyone’s faces.
What do you think? Was I too harsh? Does my lack of sympathy for Joy make me a bad person? Does it make me a bad doctor?
I used to feel sorry for alcoholics. I used to listen to their stories about how life is so hard for them and about how nobody cared about them and about how they are really going to change and I used to feel sympathetic. But honestly, the more I see the way they constantly drain the will of those who are trying to help them, the less I feel sympathetic and the more I feel (whisper it) disdain.
Joy is a 44 year old woman who came to Medical Admissions today from A&E. Joy has alcoholic neuropathy. Basically, she’ drunk so much that she’s killing the nerves in her feet and this means her legs are weak and she falls over a lot. Joy has come into hospital because she couldn’t get up and started having alcohol withdrawal symptoms because she couldn’t get to her vodka. The physical symptoms of alcohol withdrawal can be treated quite easily and very effectively – this was not the issue.
Scratch the surface and I find out that in the last 7 days, Joy has called the ambulance out 3times and her GP out twice, each time refusing treatment when the health professionals arrive.
Joy’s mother, Evelyn, and Joy’s two children ask to speak to me. The story comes out that Joy has had many, many admissions to hospital recently because of her drinking. Each time, she comes in, her symptoms get sorted out and when she’s discharged, Joy is fine for about three or four days. Then Joy will start drinking again. When Joy drinks, she doesn’t look after herself, she doesn’t clean or wash herself, she dangerous when she tries to cook, she doesn’t eat and she gets verbally and physically abusive towards her own family. Evelyn is in her seventies and is not in the best of health herself. She is coming to the end of her tether because she just doesn’t know what to do with Joy. Evelyn is up all night worrying about her daughter. Worrying that Joy is going to hurt herself or that Joy is going to accidentally set fire to her block of flats.
Evelyn, along with Joy’ children asked me if there was any way that we could detox Joy and get her better so that she’s the daughter (and mother) that she once was.
The trouble is, and I explained this to Evelyn, if Joy doesn’t want to stop drinking, there’s not a great deal we can do. Sure, we can patch her up when she falls down but unless she’s made her own mind up to give up the booze, any help we try to give will be wasted. Is there any point making her an appointment to see a behaviour specialist if she never turns up because she’s pissed again?
It’s sad. Here I a woman in her mid-forties who has family that obviously care about her and love her, but Joy doesn’t see that. Joy doesn’t care. This is what is going to happen: Eventually, Joy will drive them away and her family will give up on her. In the future, Joy will be in hospital telling young doctors like me about how her life is so hard and how nobody cares about her and how she’s really trying to change.
Joy is drinking her life away and it’s so sad.
A bit later on, I was siting a canula in Joy’s arm so we could give her some intravenous vitamins to help improve her symptoms and she says to me.
“You just don’t think that this (weak legs) is going to happen to you, do you doctor?”
I could not believe that she actually said that. I looked her in the eyes and said.
“Joy, you KNOW why this happens. You’ve been told again and again why this happens. It’s happening because you keep drinking. How many times have you been to hospital or A&E this year because of your drinking? How many times have you been told you need to stop? You’ve been told by doctors, by nurses, by your own FAMILY to stop drinking but you just carry on. Your legs are weak because the booze is rotting the nerves in your feet. Soon, it’ll start rotting your brain as well. You are 44 years-old! You should be living life to the maximum, but instead you have to live in a warden-controlled flat and it’s all because of the booze. I’ve just been speaking to you family, Joy. You have a great family that love you and that care for you and that worry about you. Do you know how lucky you are to have that? There are people in here, on this ward right now, who would give anything to have a family like yours. Your mother is not a well woman and she’s making herself ill because she’s worried sick about you Joy. Do you think that’s fair? Do you think it’s fair that she has to come round and clean up after you when you’re drunk, to make sure you’ve eaten? You’re a grown woman for Christ’s sake. Why are you doing this to her? She’s in her seventies! Why are you doing this to yourself? If you don’t stop drinking Joy, you are going to die. Don’t think I’m saying that just to scare you, I’ve seen it happen so often – it’s the truth. But it doesn’t have to be like that. Your legs will get better if you stop the booze. All this will get better if you stop the booze. You could be out enjoy life if you stop the booze, but you’ve got to want to stop, Joy. The only person who can make this better is you, so you have to ask yourself – What do you want to do?”
By this time, Joy is in tears and she says
“I’m an idiot, aren’t I doctor”
“Yes you are. It’s time to change”
I don’t feel great about upsetting my patient and making her cry, but selfish, manipulative people like her make me so angry, especially because so many people are trying to help her and she’s throwing it all back in everyone’s faces.
What do you think? Was I too harsh? Does my lack of sympathy for Joy make me a bad person? Does it make me a bad doctor?
Saturday, 5 May 2007
How old is old?
Today, I admitted a 97 year old woman to hospital with dehydration due to diarrhoea.
Ninety-seven.
This woman is seriously old.
When I was eight years old, I couldn’t even conceive of being so old that my age had double figures. When I started high school, to me, the fourth years were grown ups weren’t they? When I started medical school, aged 18, I though 60 was old because, you’re nearly retired.
Since starting work as a doctor, my perception of age has changed yet again. If I see a 55 year old patient, I describe him as “young.” A 66 year old retired woman is still “quite young.”
I don’t start thinking of people as being “old” until they’re about 75 to 80.
It’s funny how your perceptions change as you go through life. I think when I was eight years old, I wouldn’t have believed you if you told me that there were people who were still alive at 80.
Still, to have lived 97 years makes you bloody old.
Ninety-seven.
This woman is seriously old.
When I was eight years old, I couldn’t even conceive of being so old that my age had double figures. When I started high school, to me, the fourth years were grown ups weren’t they? When I started medical school, aged 18, I though 60 was old because, you’re nearly retired.
Since starting work as a doctor, my perception of age has changed yet again. If I see a 55 year old patient, I describe him as “young.” A 66 year old retired woman is still “quite young.”
I don’t start thinking of people as being “old” until they’re about 75 to 80.
It’s funny how your perceptions change as you go through life. I think when I was eight years old, I wouldn’t have believed you if you told me that there were people who were still alive at 80.
Still, to have lived 97 years makes you bloody old.
Friday, 4 May 2007
Bank Holiday Weekend
Things to look forward to over the bank holiday weekend:
Drinking in the sun with your friends
Taking the time to visit your family
Long lie ins
Playing sports
Going to see your favourite campsite/beach/theme park/garden centre/grandparent
Things not to look forward to over the bank holiday weekend:
Working four 13-hour shift on consecutive days on Medical Admissions
Oh the fun that awaits!
Drinking in the sun with your friends
Taking the time to visit your family
Long lie ins
Playing sports
Going to see your favourite campsite/beach/theme park/garden centre/grandparent
Things not to look forward to over the bank holiday weekend:
Working four 13-hour shift on consecutive days on Medical Admissions
Oh the fun that awaits!
Tuesday, 1 May 2007
Hospital Radio #1
…by department:
Birth Suite – I see you baby (Groove Armada)
Orthopaedics – Break Stuff (Limp Bizkit)
Coronary Care Unit – What becomes of the broken hearted? (Jimmy Ruffin)
Endoscopy – I want to be sedated (The Ramones)
Eye Clinic – Blurry (Puddle of Mudd)
Respiratory Medicine - Take my breath away (Berlin)
Mental Health Unit – This troubled mind of mine (Johnny Tyler)
Birth Suite – I see you baby (Groove Armada)
Orthopaedics – Break Stuff (Limp Bizkit)
Coronary Care Unit – What becomes of the broken hearted? (Jimmy Ruffin)
Endoscopy – I want to be sedated (The Ramones)
Eye Clinic – Blurry (Puddle of Mudd)
Respiratory Medicine - Take my breath away (Berlin)
Mental Health Unit – This troubled mind of mine (Johnny Tyler)
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