Out Of Sync

A&E rota

When my colleagues, complained about the A&E rota, I thought it wouldn’t bother me as much. They moaned about how tired they felt etc. I secretly thought I’d be able to weather all of this because of my gift. I can fall asleep anytime, any place.

But now, I feel their pain. Not only am I tired all the time, I’m just out of sync. I was on nights last week, Monday to Thursday. Usually, I’m able to get myself back into day-mode relatively quickly. It’s a week later, and I’m still out of it. I haven’t had a full night’s sleep for 5 days. And I know I need to sort it out sooner rather than later, hold off sleeping too early and not succumb to a few random hours here and there, but I’m just too weak.

And I’m just too tired to do any of the things on my to do list, so I nap, but then I’m up at the early hours of the morning and I can’t sleep. As if I wasn’t already falling behind on my emails. I’m awake when the rest of civilisation is asleep, I’m sat at my screen wondering if 2 o’clock in the morning is a weird time to respond to a work email.

All I can say is, I don’t know how people do this long term. I certainly don’t know how people are doing this and looking after children/household. Any tips on getting me back on track would be highly appreciated.

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Second Impressions of A&E

second impressions

Joseph Greve

I’m half-way through the placement now and I feel more settled, I wrote about my first impressions of A&E here. It just takes time for me to get used to a new place and I remember it being the same for GP as well. In some ways I’ve found GP and A&E quite similar: both general based specialties with loads of opportunity to work independently.

I’ve found A&E more difficult because the level of risk is higher and there’s so much I don’t know. I felt with GP, I regularly managed coughs and colds, UTIs, musculoskeletal pain and other times I could rely on my intuition/common sense. Whereas A&E, I’m suddenly presented with a foot x-ray and I’m supposed to work out whether there’s a fracture or not. It’s a huge learning curve.

As part of the department we have a paediatrics area. And though I love kids, I do get a tremor every time I’m sent around to that side. Fortunately, it always turns out better than I expect and I’m able to get through them quite quickly. It’s usually more pleasant; the parents are more often than not able to give clear histories, the kids are happier, funnier and smell nicer. I’m learning to be more confident on paeds but I still find it difficult. I’m often wondering how I would treat an adult in a similar situation which I know is not an ideal approach, but again there’s always someone around to ask.

There are always seniors around, always. The trick is knowing who to ask. I’ve got a good idea of who to go to and who to avoid. Most are really helpful and will listen and give advice. Some will do it reluctantly and others will snap just having looked in their direction. I do sometimes have an internal conflict I go through every time I want to ask a question. On one hand, I’m a foundation doctor and not an emergency medicine trainee and really I’m there to learn and gain the skills to be a better doctor, but on the other hand I need and want to be an independent clinician. Personally, I feel like my main priority (alongside amazing patient care) is learning and one of the ways to do that is by asking questions. It might just be me projecting my internal issues onto others.

The shifts are long. And I know long shifts are part of the territory in medicine, my body just doesn’t agree. The upside of longer shifts is that we have more off days, but still, my body doesn’t care. In the first half of the shift I’m all ready to go, lots of energy, and towards the end I’m slower, yawning and repeatedly looking at the clock. And this is why a) I don’t book any locum shifts and b) I can’t see myself doing this long term. I’m not really fussed about the effect on my social life. I’m more concerned about not being able to put basic meals together. Or do laundry. Or write.

Plus, there’s a whole lot of running around and being on the ball. It’s like you have to be at least 80% alert at all times, not like on a ward-round where you could twiddle your thumbs whilst you followed the consultant around.

I have liked how social the department is. There are loads of junior doctors plus locum doctors as well. If ever there is a lull it’s really nice to have people around to talk to.

I’m 2 months down, just 2 more to go.

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I’m Glad January Is Over

I’m glad January is over, seemed to last forever.

I know the new year always brings this huge gusto of inspiration and motivation, which I’d admit I was feeling for the first few days. Then I fell sick and all motivation took a dive from there. Whilst I was already feeling rough, it felt like an appropriate time to dwell on personal issues, family issues, media stories, rubbish weather and just be generally miserable. It was no wonder I was feeling even less inspired to do anything.

But whilst I was riding this downward wave, I decided that I might need help to get my ‘mojo’ back, so I wandered into Waterstones and had a look at the self-help section. It’s funny how I wouldn’t even have glanced at a self-help book when I was younger, but I guess those were simpler times. (Take me back…)

The books I bought: F**k It: Do What You Love, The Subtle Art Of Not Giving A F*ck, Rich Dad Poor Dad

                    

 

There’s no theme, these were entirely random purchases. I am not having a quarter life crisis.

I tend to read several books at a time, so whilst I’m halfway through F**k It: Do What You Love, I’m also reading Nocturnal Animals. I’d watched the film during a plane ride back to the UK and I enjoyed the dark and creepy storyline matched with the beautiful cinematography so I thought I’d do what I never do: read the book after watching the film. Unconventional.

So, the year might not have gotten off to a great start, but I’m looking forward to turning it around.  Hope January has been good for all of you.

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Decisions Decisions

Whilst I’m falling down the rabbit hole of Youtube, I stumble on a video that describes a recent realisation I wrote about here. The video gives a much better explanation.  It talks about how we can make decisions either based on growth or fear and when we choose the latter it generally comes from a need we have.

Here’s the video:

If I look at all my past decisions and pick one, let’s say: deciding to live at home during university. I spent a lot of time weighing up the pros and cons,  but in the end I thought I’d save a lot of money by living at home, which I did. However, deep down I was scared. I remember thinking about the horror stories of university halls: roommates from hell, constant fire alarms and so I chose the safe option. And every year after, I had an opportunity to flee the nest but it was never the right time. I guess my fear stemmed from a need to feel secure/safe which makes sense, I find that at the root of most of my decisions is that same need to feel secure.

Let me know if you can relate to this? I sometimes wonder if I’m the only one who likes to over-analyse things…

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6 Months Left

6 months left

Literally 6 months left.

It’s pretty sad that I’m counting down but it’s just how I’m feeling. And at a time when morale is already low, the Bawa Garba situation probably isn’t going to improve confidence. Rachel Clarke writes a piece well worth reading here. This case really is a watershed moment and the effect it’s had on the workforce is palpable.

The widespread sense of shock amongst the medical community truly reiterates how much this case isn’t a one-off occurrence but a reality throughout the NHS. It reflects our daily struggles. We’ve all been in similar situations trying to do the best with little resources. We work shifts time and time again that are understaffed. It’s the norm. But it’s the dawning realisation that not only is our best not good enough, we also run the risk of being punished for matters that are outside of our control.

Maybe as a workforce we are just too agreeable. Our concern for our patients comes first so we do what we can with the little we have. Maybe we need to kick up more of a fuss every time we’re expected to work understaffed shifts. It’s gotten to a stage where we’re expected to just get on with it.

At a time where I’m reconsidering my path in medicine, this just seems to be another heavy nail in the coffin. I just keep thinking about the risks we take as doctors just by turning up to work. I never want to make a mistake, but that’s an impossible standard to try to reach. So far the question I’ve been asking is whether the value I get from being a doctor is worth the physical and emotional toll. But to add to that, I now have to consider the overwhelming reality that I could also be held responsible for the failings of a struggling system.

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Feeling Stuck

feeling stuck

Andy Grizzell

Oh My God. I feel stuck. I mean I’ve known it for a while now. But it wasn’t till I was part way through a YouTube video that I had this dawning realisation that I actually feel really really stuck. Like the kind of stuck that is self-imposed because I know what I’m unhappy about but I can’t won’t change the circumstances just yet.

I’ve said it before that I know I need a break and the end of F2 (August) is the natural time to take it. So that’s where my goal post is and it’s where I’m heading towards. And at the finish line is where I expect to suddenly feel free and un-stuck.

I mean I could quit now, but my stubbornness and my pride just won’t let me. Not to mention the overwhelming guilt I’ll feel if I leave the hospital short one trainee.

And then I got to thinking about how I got here. It’s hard to realise that it’s all my decisions that have led me to this point and that I made the bed that I’m now in. I think about decisions that I made out of fear, the times I wanted to do things but I turned away and took a safer route. All of those turns, have led me to where I am now.

And hand in hand with that, is me not trusting myself. I don’t trust myself enough to make decisions. I regularly listen to the advice of others, mainly family, before my own. I’ll give someone else the power to make decisions for me, and then wonder why I don’t like the outcome. I know a big part of it is that I’m scared of making the wrong choice but how easy and boring would life be if we were right all the time?

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The First Month of A&E Was Tough

The first month of A&E was tough. It reminded me of the beginning of F1: the sudden rise in responsibility, having to make important decisions, picking apart complex situations.

It was a difficult adjustment from GP. I was stepping away from a job that involved me sitting in an office for several hours with help just an arm stretch away and stepping into a busy Emergency department at the worst time of the year, in the midst of a bed crisis. Adding to all that, I had to quickly become familiar with all the new parts: learning new names, learning to code patients, learning what was OK and not OK.

Suddenly, I was responsible for making difficult decisions. Not that I never made decisions before. I made management plans for patients all the time in GP, but there the patients were rarely very unwell and the issues tended to be chronic. But those same patients would present to hospital, now acutely unwell. They’d come confused and disorientated. I’d find it difficult to understand exactly what was wrong and often I’d start treatment without the luxury of test results and very little to go on. I struggled with deciding who to admit. Who did I think would be safe to discharge back to their homes, where they lived alone, where there was no supervision? And that would weigh on me. It really felt like a judgement call, looking at each person and wondering what would happen if I sent them home. I’m still struggling with this.

The first time I ever cried at work was during that first month. It was a bad combination of a busy shift, an unwell patient and senior doctors I was nervous to approach. I was struggling to look after this elderly lady whose heart rate was over 140, the machine kept beeping, a few times, she’d suddenly slump over  for a few seconds whilst I examined her. My mind went blank. I didn’t know what to do. I felt clueless and I could feel myself panicking. I felt like I wasn’t doing right by this elderly patient who remained sweet and cheerful despite being so sick. It turned out OK in the end and we managed to bring her heart rate down slightly. I calmed down when I realised she wasn’t dying. But that feeling of panic and confusion stayed with me for a long time afterwards.

Christmas brought its own pressures, several bank holidays meant few other places were open and we saw an influx of even more people. The department was overrun: patients in corridors, waiting areas crowded and minimal hospital beds. When I eventually finished the shift and left the chaos, I walked out to a sea of ambulances. Row after row of neon yellow striped vans, waiting sombrely in the cold. And all I could do was be thankful I didn’t have to go back in.

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First Impressions of A&E

It always takes me a bit of time to get used to a new placement. That awkward settling in period, trying to learn the ropes and get to grips with ‘how things are done’, is never easy. Plus, A&E was bound to be a difficult transition:  high turnover and volume of sick patients, coupled with low numbers of staff. I knew that it would be very very different from GP.

For some reason, I had this idea in my head that A&E would run like a well-oiled machine, that it would be efficient. I don’t know why I thought that, because the reality is often very different.

The department is small which means it overruns with patients very quickly. All of a sudden there’s no where for us to see anyone. We have to squeeze people into every nook and cranny for a quick examination and then send them back to the waiting area until a bed becomes free. Then it all becomes disjointed. You can’t start treatment and you can’t really observe the patient because they’re back in the waiting area. The nurses won’t take responsibility for the patients in the waiting area which is understandable, because they have their patients that they’re already looking after. The most I can do is take bloods and beg the co-ordinator to find them a bed.

For the ones that do have a bed, I have to run around and look for the nurse responsible for them which is hard. I have to look high and low, far and wide. There are times when the response I get is: ‘you can do that yourself’. Yeah, I could do it myself. I could do it all myself, but then that takes away from me doing what I’m actually supposed to be doing. It feels like a tug of war sometimes, and I do end up doing things that other healthcare professionals could do. And when there’s a growing pile of patients to be seen, I can only hope that I’m not scrutinised for being slow, but what can I do?

My third eye is on the clock because of the four hour targets. A&E departments are supposed to see and treat patients within 4 hours or else they’re penalised. It’s something I’ve not really looked into, so I have a very blasé understanding of its incriminations. On the first day, after the consultant gave us a mini tour she pointed me towards the list of folders each representing a different patient and told me to start seeing people. I asked her whether I needed to be wary about the times. And she looked at me and asked pointedly, ‘what do you mean?’. I remember thinking I should chose my next words very carefully. ‘I mean the four hour targets.’ Her reply was, and please imagine the icy cold stare she gave me whilst she said this, ‘your concern should be patient safety’.

Maybe I was wrong, maybe the four hour wait thing wasn’t a big deal. Until I realised that every time a patient passed the three-hour mark, nurses, consultants and registrars would descend upon me  and want to know my plan for said patient.

But… it’s still early days, and I’m still adjusting.  I’ll just have to see what the next few months will bring.

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To Break Or Not To Break

busy

A&E gets busy. That’s not news. I expected A&E to be jam-packed, especially during winter. It’s cold, it’s slippery, people are more likely to get ill, which means more patients coming in.

During our induction, we were told we got an hour for our breaks because of how long the shifts are. The advice was to split the breaks and ideally have two 30 minute breaks instead.

Obviously, breaks are important, but I often find that there’s this catch 22. When it’s not busy, it’s much easier to take breaks but I don’t really need one. With less patients to see, I’m sat down more, I remember to water myself and have bathroom breaks. When it’s busy though, I’m running around a lot, trying to do several things at once. I get tired more quickly and that’s when it’s harder to take breaks, but that’s when I need them the most.

When it gets busy, we pick up the pace to make sure patients are seen. That’s when our sacrificial tendencies kick in and we drive ourselves to do as much as possible, as quickly as possible. Sometimes that means doing away with breaks (water/food) altogether.

It’s unhealthy but subconsciously it’s encouraged and respected. I feel like it’s either the culture amongst health professionals that we are taught or pick up from watching others do the same, or it’s the innate nature of the type of person who comes into this line of work anyway. And though it’s admirable, I wonder whether it’s actually more harmful in the sense that a) we’re more exploitable as a work force and b) more mistakes are made.

When it’s busy, my train of thought is more difficult to follow, I’ve touched on this before here. I’m more distractible, I end up doing the same tasks again and again, running around, chasing my own tail, racing everywhere but not getting much done. So, for me, taking a break is necessary.

Lately though, I feel like I’m extra conscious about taking my breaks. One passive aggressive comment in passing is making me rethink my stance on taking time out. I don’t want to feel guilty when I go on a break when there’s still a lot of people to be seen. But I know that I don’t have it in me to work myself to the ground. Especially in a department like A&E when a quiet shift is the exception.

Sometimes I feel like I’m barely keeping it together. And those small moments that I can take to give myself a breather are really necessary. So, I’ll continue to take my breaks, because I can’t do my best for patients or myself otherwise.

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End of 2017

For some reason, the thought of this year coming to an end was starting to make me feel a bit low. Mainly because I felt like a whole year had gone by and I hadn’t accomplished anything.

I started scrolling through my pictures absent-mindedly. And it was while I was scrolling, that I looked at all the pictures I’d taken this year and the experiences I’ve had. Some of the things I’d done, felt like they were from a different year entirely. I’d forgotten that earlier on in the year is the first time I’d travelled. On my own. It’s so easy to look back on the last 365 days and think how quickly time has gone, even though I know and remember the times it felt like time was slowing down.

And as I kept going through all the memories I’d forgotten, I was able to remind myself of how many new things I tried. For example, I…

– Joined an art class
– Bought a Macbook
– Moved my blog, changed the name and bought a new domain
Travelled on my own for the first time
– Started selling on ebay and made extra cash
Completed F1
– Downloaded and deleted dating apps
– Joined a martial art class
– Joined Linkedin
– Started alternative career planning
– Attempted a side business

I’ve attempted to come out of my comfort zone and made moves to create different opportunities. Each single line doesn’t give each experience enough justice. It doesn’t factor in the amount of self-persuasion and effort it took for me to get these things done.

So for 2018, I’m praying for more bravery and courage to help me to continue to find more amazing experiences.

How about you, what are your plans for 2018?

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