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.

Stop The Clock!

I have a job offer.

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.

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

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...

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.

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

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

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.

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 deeply hypocritical 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 100 excuses 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.

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.

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.

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.

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.

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.

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!

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.

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.”

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.