The August Lowdown

What happened in August?
I thought it was pretty appropriate that I finished my night shift on the morning of the 1st August which meant I had a brand new month to start my clean slate.  So as I welcomed August, I said goodbye to my work place, my colleagues and my old job. I’ve touched on it before, but the first couple of weeks, I was weaving through a mix of emotions: excitement, fear, confusion, worry. I think it was just me coming to terms with this new stage in my life. But all of that aside, I needed to start making some I decisions.

Moving?
One of my biggest decisions is whether or not I stay in my current city. I’ve been toying with the idea of moving to London for a while. I live in the North West of England and I’ve been here for nearly 10 years. It’s been great, but I can’t shake the feeling that it’s time to move on.

I have a friend that I met at an event last year who lives in London and was looking for a flatmate. Lucky for me, she had a spare room free which I stayed in whilst I visited London. And it was also a mini test run to see how well I liked the area. It really was perfect timing.

She was really busy with shifts (she’s a medic) during my stay which meant I had the place to myself a lot of the time. A lot of alone time. Maybe too much? Sometimes, I’d just have to leave and go to a coffee shop to stop me from rocking back and forth. Cabin fever, I think it’s called. Eventually I came to the conclusion that though her place was lovely, it wasn’t for me. So, I’m still non the wiser about where I’ll be living but it’ll all work itself out in the end.

Notting Hill Carnival
I timed my visit to London so that I could go to the infamous Notting Hill Carnival. It was my first time and for those who’ve never been, it’s an annual event that’s hosted on the bank holiday weekend in August. It’s a celebration of Caribbean culture, so think colourful costumes, lots of feathers and sequins. It’s a two day event which starts very early and finishes very late. There’s a large parade that’s good to watch and then there’s a bunch of other small pockets of live stages, sound systems and then there’s food stalls dotted around as well. It really is incredible.

My advice is to go early and leave early. It becomes increasingly more busy as the day wears on. Streets are cordoned off and barricades are put up to protect neigbouring houses which means there’s less space. By late afternoon, everyone becomes crammed into one solid mass of bodies, and you just have to go with the current. Don’t fight the current, there are easier ways to die.

But still really fun though.

New Hair
My hair was a bit worst for wear after months of just not giving it the attention it required. I wanted to cut it all off and start afresh. Have a physical manifestation of me shedding the old me. Plus, I’m sure it’s a requirement that you have a hair cut when you’re going through a big change, or else how will anyone else know that your having some sort of life crisis.

I don’t go to the hairdressers often because I tend to do my hair myself, but this time I wanted a professional. Plus my hair is immensely thick so I’d rather pay someone else to deal with it.

Five minutes into sitting in the chair and I knew it was going to be a disaster. There was a lot of tugging and pulling at my hair which I wasn’t expecting. I mean, I researched the salon to make sure that it would be able handle my sort of hair. You might be thinking I should have just left, but that would be immensely un-British. So, I reconciled with the fact that I was cutting it off anyway and accepted my fate. I mean I wasn’t totally mute, I made same minor suggestions then kept quiet.

In the end, I thanked her for the hair that looked nothing like the picture that I showed her. Obviously left a tip even though the price was already extortionate and I could have had it done at the barbers for a 1/5 of what I paid. I either laugh or cry. I should have just been more upfront and asked her to keep the yanking to a minimum.

Bought Myself A Present
As much as I love books (admiring the front covers, the new book smell, the gazing at them from my bookshelf and not getting around to opening them) they take up space. And with me travelling next month, it just doesn’t seem feasible to be logging about a suitcase full of books.

I thought a kindle would be the most appropriate purchase. I bought myself one and it took me a while to get used to. It reminded me of the Nokia 3310 circa 2000 with the black and white monochrome display. It wasn’t till someone reminded me that this was supposed to be better on the eyes that I finally started to appreciate it a bit more. Now, I actually like it. I mean it’s way lighter, it always keeps my page and it doesn’t fall onto my face as often. I got the original version, this one in black (amazon link). The first book I bought was Everything I Know About Love by Dolly Alderton, which I enjoyed reading. I thought it would be a bit of light reading, but it was an incredibly raw account of the author’s experiences which kept me hooked enough to finish it within a few days.

 

The next few months are a bit up in the air. I’ll be travelling for the whole of September but I don’t know what’ll be happening after that. I’m trying to worry less and not be so uptight about having to have control over everything. Which might explain why I’ve not got a schedule as to what I’ll be doing.

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Learning About Money

learning about money

Philip Veater

Over the last two years, I’ve been making a conscious effort to learn more about money. And like most subjects in life, you start with a basic understanding and work your way up. A bit like medicine. To study medicine, I had to cover a wide range of topics like physiology, pathology, pharmacology in order for me to  be able to understand conditions enough to educate and treat those that were less informed. So, when it comes to money, I’m  one of the less informed. But I guess a lot of us are. We’re definitely not taught much in school, apart from maybe estimating how much the groceries will add up to when we’re stood waiting at the tills at Tesco.

When I decided to take a break from medicine, money definitely helped to drive my insecurities. Deciding to step away from what was a regular paycheque was difficult. Especially for someone like me who likes to make calculated safe decisions. But here was my conundrum: stay in something I wasn’t very happy with but get paid orleave and find something else that could make me happier and face a temporary drop in income.

So, I’m currently adjusting to this sudden change in direction. And the question I’m left pondering is: how can I provide for myself and help my family whilst I search for the next big thing?  Because let’s be real, we all need money.

Fortunately for me, I recognised that I should save as much as I could whilst the cheques were coming in, which means now I have savings to help cushion me for a bit. This buys me time to try a few things out.

I mentioned in my previous post that I was starting to feel a bit restless and so I’m looking forward to working on a few side projects. It’s great to have something external to focus on, and I can convince myself that I don’t need to worry.

One of the projects is this blog. It’s weird because I can’t even remember my initial reason for starting a blog four years ago. I think I decided that I wanted to start writing again and this was my way in. Medicine gave me endless material for writing. Now that I’m not working on the wards, I’ll need another muse. I’ll figure it out. I think the next few years are going to be really interesting so I’ll be writing about it. The good and the bad. Hopefully, this comes as solace to others at similar stages in their life. Or it could just be entertaining. I’ll be playing around with all the ways I can earn with this blog in a way that’s authentic and helpful. So, thanks in advance for bearing with me. It’ll definitely be a learning curve.

Blogging ties in nicely with freelance writing. I’ve been dabbling a bit here and there and it’s been well received so far which is encouraging. Plus, it’s great to get feedback on a piece of work and get it to a point where everyone is happy.

A few more projects that I’ve jumped into and who knows where they might lead.

All this being a long-winded way of saying that I’m looking for different ways I can create an income without having a stethoscope around my neck. The more I read, the more I realise that two incomes are better than one, three is better than two etc.  I won’t be calling myself a financial guru any time soon, but I do enjoy learning about all of this. And I’ll be sharing as I go along, because knowledge really is power.

In the meantime, let me know if you have any questions or thoughts.

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Gap Year Begins

After several weeks off, you might be wanting to hear about all the things I’ve been up to. Waiting in anticipation for tales of mayhem worthy of Instagram hashtag quotes #livingmybestlife. Unfortunately, I’ve not got anything to report. The last few weeks I’ve been mainly watching back to back YouTube videos and Amazon prime TV shows. If I was planning to take it slow, then I’ve really outdone myself.

It’s not the flying start into my new chapter that I thought it would be. I think I underestimated a) how tired I was and b) life in general. Occasionally, I’ve been able to work up the strength to leave my house altogether. I’ve had several ‘catch ups’ with friends I’ve not seen in years. I think I’ve seen more people in the past three weeks than I have the last 2 years.

I’m at a point now where the smugness that comes from lying in bed whilst everyone else is at work is starting to wear off. There’s a growing internal nagging that tells me I should be doing something. It’s starting to feel unnatural not having anything to do. I’m used to rushing about and having so many things to get done in a day, that now that I’m not in that state anymore, I feel strange.

Now that I’ve rested, I’m ready to start doing again. But here lies my struggle: if I’m not ready to go back to work, then what do I do in the meantime? Leaving behind what I’m familiar with in search of something arbitrary like happiness and fulfilment is a foreign concept to me. There’s no map or instructions to follow. How do I get there? What should my next step be?

And then there’s also realising that cabin fever is very real. Being stuck inside isn’t good for me. That’s when I start worrying and my mind starts looking for a fight. Going out for a walk, working at a coffee shop all these things put me more at ease. And I can remember that my problems are very small in the grand scheme of things. Plus, I’ve also found comfort in realising that other people feel the same way. My struggle isn’t really that unique.

Also, I watched this video below that was on my YouTube home channel page in prime position to catch my attention and God did I need it.

All this to say, that I am looking forward to this gap year and having the chance to explore different things. I’m aware it’s going to bring about a new set of challenges, which is going to require me to be a lot more patient. But I guess I’ll just deal with them as they come.

PS. I’ve not had the chance to welcome all the new F1s! I hope the first month has been at the very least manageable. Let me know how it’s gone so far.

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3 Weeks Left

weeks

3 weeks left and the excitement is reaching fever pitch. The finish line is in sight.

But first I’ve got to get through the rest of this month and July is a very busy month. Thanks to some swaps I made earlier on in the placement, I have two weekend on calls and some nights coming up. I must have been thinking that I could just do it, then just sit back and relax in August. I’m now thinking this was an error in judgement. Oh well.

To start it all off, I’ll be on call this weekend. But once I get through this weekend, I’ll be one step closer. I’m just trying to will myself to have the motivation, but it’s hard to sustain any amount of energy for so long. Especially when I’m at the end of a placement. I seem to get bored very easily. Everything feels repetitive. Usually by month 3, I’m ready to move on and start the next placement.

In other news, I’ve booked my tickets for North America. I’m travelling solo which is both exciting and slightly terrifying. I’ve gotten to the point where I’ve realised that there might not always be someone available to do the things that I want to do. I either do it on my own, or not do it at all. That’d be a shame. Thankfully, my mum has given me her blessing which in itself is a miracle I would be foolish to waste.

So, there’s lots to look forward to. I just need to keep my head down and keep going.

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Compassionate Leave

Just a quick one this week. One of my colleagues was off on Monday and I found out the next day, she had gone to be with her family because one of her grandparents had passed away over the weekend. To get the day, off she had to use one of her annual leave days because she was denied compassionate leave. Apparently, you only qualify for leave if it’s an immediate family member.

That to me doesn’t sit right. Not all families look the same. You can be very close to different parts of your extended family and want to have that time to mourn their passing. It just seems like another example of where the compassion and empathy we’re taught to deliver to our patients, is not inclusive of the staff.

The staff is the NHS’s greatest asset. But if we’re not treated as such then one day you wake up and realise that we’re short of 10 000 doctors and nearly 35 000 nurses. Because resentment builds slowly. I don’t think it’s ever one thing that makes someone decide to leave their job.

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Documenting

Marie Bellando-Mitjans

Recently, I’ve been thinking more and more about documentation. I mentioned it on my last post here, where I was told off by the A&E registrar for something I’d written. I’ve been mulling it over the past few days: the reasons for documenting, how clearly I’m documenting and the possible downfalls.

I remembered a situation that happened several weeks ago whilst I was on nights. I was part of the on call team which meant I was clerking patients coming in from A&E as well as doing ward jobs for the rest of the patients on the acute assessment unit. Plus I was holding the crash bleep (and responding to any arrests). We have a system during out of  hours where nurses will put on tasks that need doing onto a computer system. So when I log on I’ll have tasks spread across the different wards and then I will personally triage the tasks depending on clinical priority. What tends to happen is the moment you walk on the ward, the jobs seem to multiply, ‘oh since you’re here, could you just…’

On one of the night shifts, I was on the ward tying up the last loose ends before the end of my shift. There must have been 20, maybe 30 minutes left on the clock, when a nurse comes to me to let me know that one of her patients is complaining of worsening numbness in their feet. 2 things annoyed me a) she decided to let me know 20 minutes to the end of my shift when I’m pretty sure she would have been aware of this earlier in the night and b) when I looked in the notes literally after the she’d put it down, she’d written something along the lines of ‘informed the junior doctor’ and time stamped the entry at 4 am. So if you read it back, it looked like she’d informed me at 4 o’clock in the morning rather than at 07:40.

And it’s annoying because we’re always told that if we’re called to coroner’s court that documentation holds the most weight, then it’s the patient’s testimony, then it’s the doctor’s testimony. Therefore, documentation is key. But if the documentation isn’t even reliable to begin with then that can cause all sorts of trouble. But yet, it’s what you’re supposed to rely on when things go pear shaped.

I think it’s impossible to be able to document everything at every moment in time, especially if the patient’s notes are a physical copy and not an electronic copy and can only be in one location at a time. If you’re a registrar and get bleeped multiple times an hour for advice for any patient that’s on a hospital bed then it’d be impossible to run around and write in each of their notes. Instead you’d have to rely that a) you’ve been given accurate enough information to be able to come to the most appropriate decision and b) that the person on the other end is translating what’s been said appropriately in the notes.

Over the last two years, I’ve noticed that nurses will alert me about some change in a patient’s condition (could be something, could be nothing) just so that they document that they’ve informed me. And it feels like it’s to pre-emptively shift blame in case anything goes wrong. To be fair, I can’t really blame them especially if you’re not sure if something is significant or not. But there have been times I have literally heard a nurse say to a colleague ‘just wanted to let you know that this patient is scoring an 8, but you don’t need to do anything’ (probably because the patient has been scoring an 8 for the last 3 days). I empathise with the fact that the culture seems to be leaning towards being held accountable and that’s filtering down to individuals. It just feels disingenuous. And as a doctor it makes it feel like you are inundated with a sea of ‘just to let you knows’ and you have to wade through it all to find what is relevant.

If you think about it, the moment you write your name down in a patient’s notes then you’re an identifiable clinician in that patient’s medical journey. If that patient should unfortunately pass away and the coroner wants to request an inquest, they look through the notes and call back the relevant people. If your writing is illegible you’re less likely to be called, if you never make an entry then the probability is even lower.

Then there are some of my colleagues that make sure that they document the slightest thing. If a blood test is late being processed, they’d document it. It feels a bit overboard to me, but perhaps they have the right idea. I just don’t like feeling like I’m always trying to cover my back.

My conclusion: you’re damned if you do and you’re damned if you don’t. Really though, I think clear documenting can be a life saver. Twice I’ve been asked to give witness statements by the coroner’s office and thankfully my documentation has been clear enough for me to be able to do it. I’d be hard pressed to be able to write from memory my involvement in a patient I saw on a random on call shift four months ago.

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Getting A Senior Opinion

help

Lukas Juhas

I know that some of you are starting F1 at the end of July and I like to think that I’ve been able to prepare you in some small way. Hopefully, through my writing, you get a good sense of what not to do. So when the time approaches and you’re thrust headfirst into chaos, you can avoid some of my mistakes. I bring my lessons as a warning, like a town crier from Medieval England.

One lesson that is definitely worth learning is when to seek help. It’s drummed into us from day 1 and though I feel more confident than I did as an F1, I still regularly ask for advice when I feel unsure. It can be tricky sometimes, depending on whose around to ask, but the bottom line is still the same, if you need help, you need to ask for it.

A few months back, whist I was on A&E, I was in a bit of a situation. I was nearing the end of my shift with only a couple more hours left. Maybe I was exuding a certain glow that comes with having freedom so dangerously within reach, maybe that’s why the nurse singled me out. She made a beeline towards me and waved an ECG under my nose. I looked at it and my heart sank. It was so obviously abnormal.

The patient the ECG belonged to didn’t speak any word of English. He was accompanied by a relative who could manage a few phrases. There was mention of a cough, feeling unwell, fever and chest pain. And that was as much as I could gather. It was frustrating to say the least, because here I was with a clearly abnormal ECG and I was struggling to get more information. And to complicate things further his ECG seemed to point in one direction and his symptoms pointed in another. His observations were all bad: his heart rate was high, his respiratory rate was high and he was feverish.

I asked one of the registrars for help and he came to review the patient with me. We managed to get a bit more of the story which sounded largely respiratory. The registrar explained to the patient that we needed to do a few more tests and that he’d probably be going home later on that night.

I thought I’d misheard. I cast an eye over the observation sheet again (feverish, high heart rate and respiratory rate). I waited until we left the patient’s side and I pretty much said I didn’t think the patient could go home because he looked unwell and his observations weren’t great either. I could tell that he disagreed but we compromised on the fact that all the test results hadn’t come back yet, so the decision to go home or not could be reviewed then.

That was my last patient of the shift so I handed him over to another doctor and briefly mentioned that last conversation I had with the registrar.

I was on the next day as well. And as the night team came on (at the end of my shift), the night registrar started questioning me about this patient. How could I even think about sending him home, he was obviously too sick to go anywhere. I tried to explain but he wouldn’t listen.

He made a point of my documentation where I wrote something along the lines of ‘discussed with (registrar’s name), query home after review of results’. His point was that I shouldn’t have documented it if I didn’t believe it. I guess that’s a valid point. I should have made it clearer that this was the registrar’s advice. And I know that it seems pedantic but it is a lesson on how clear documentation needs to be. Especially if it’s something I might have to stand by at a later date.

Plus, the patient’s condition was a lot more complicated than I thought. During the night, he was transferred to a specialist ward and later had a month-long admission. At the time, all I knew was that he was too unwell to go home. You hear stories of patients being sent home and either representing after deteriorating or worse not making it into hospital at all. He was admitted so there wasn’t any harm here. But had it of played out differently in another scenario, how strongly would I have stood my ground?

I think I’ll always remember this patient. I’ve disagreed with senior colleagues on minor issues in the past but not to the degree where I physically feel uneasy. But I appreciate it was a tricky situation (language barrier, incomplete information, outstanding results, busy shift), I didn’t know what to do so I asked for help. It felt a bit – I don’t know – disingenuous? hypocritical? to ask for advice, then shun it because it wasn’t what I wanted to hear. This was definitely a teaching moment for me.

I still feel some level of guilt just thinking that there was even the smallest possibility that he could have been sent home.

It would be interesting to hear your opinion or what you might have done differently.

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Difficult End Of Life Discussions

Ilyass SEDDOUG

There’s quite a lot of support on this current placement, but at the same time, the consultants are quite happy to just let us get on with it. Once ward-round is over, they go do whatever it is they do and then we carry on the with the jobs that need to be done.

A lot of the time that includes discussions with family. I’ve never thought of myself as being articulate, particularly in speaking. Sometimes, I find it difficult to translate what I’m thinking to what I’m saying. I think, overall, I’ve become much better at explaining things to patients, whether it’s their diagnosis or their medication. It’s probably easier to talk about something I’ve learnt, because I’m just reworking an idea that has been drummed into my subconscious. In that way, I’ve probably become more confident having those types of discussions.

The conversations I have now, however are much more morbid. I’m more likely to be telling family members that the outcome is poor or discussing end of life care and DNACPR. Essentially, I’m preparing families for the worst thing imaginable.

It took some time to get used to and I was more nervous in the beginning. I remember being asked to discuss DNACPR with a patient’s wife quite early on in the placement. He wasn’t responding to treatment and it looked like the end was fairly close. I was nervous. I heard the wife could be difficult and previous discussions had not gone well. So, I wasn’t putting any bets on my chances, but actually, it was fine. I explained what we were doing and where we were at and why resuscitation wouldn’t be in his best interests. She understood, agreed and thanked me.

I think resuscitation discussions are difficult to have. Family might see it as doctors giving up hope on their loved one. And I’ll be honest in medical school, I didn’t really understand it either. It took me a while to realise that DNAR didn’t mean withdrawing treatment and that’s exactly what I try to explain to families now. I really try to make sure that they understand that it changes nothing in their management.

Other discussions, I’m having more regularly is palliation, telling loved ones that we have tried everything and that the best thing now would be to allow a peaceful parting. A lot of the time, families can see it coming and it’s just reaffirming what they already know.

I think it’s important to really consider palliation when necessary. I recently had to do a death certificate for a patient and had to go through the notes. It seems that when the patient continued to deteriorate, the night team had tried interventions and ordered more tests, which turned out to be futile. And I don’t blame the night team because it’s hard to take over the care of a patient you don’t know. You can only hope that the documentation is clear enough for you to understand everything that has gone on prior to you being called to review. You try to act in the best interests of everyone on several wards whilst also reviewing new patients at the same time. I think it was up to us, the day team, to make a clear decision on palliation and let his last moments be more comfortable.

Actually, getting to the decision of palliation can be difficult because each consultant will have their own way of starting the process. Some want to have the chat with the family first, then palliate. Some will want to try antibiotics for a certain number of hours then palliate. Others will wait for the palliative nurses.

Anyway, I don’t mind having these discussions. It’s an incredibly important part of the role and it’s why we spend so much time in communication classes during medical school. In an ideal world, we wouldn’t need to, we’d fix everybody and send them off home. But unfortunately, that’s not how it works.

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Bad Feedback From Consultants

Patrick Brinksma

Sometimes I wonder whether consultants and other senior doctors have forgotten what it’s like to be less experienced. I imagine every junior doctor has a story about someone belittling them or remembers a time they were made to feel stupid. I actually have a running list in my head of certain people I try to avoid running in to. That means averting my gaze when passing said person in the corridor. Or even one time quickly diverting onto a random ward to negate any interaction.

I remember once I was asked to stay behind after handover*. The consultant wanted to talk to me about someone I clerked in. She told me that I should have ordered a troponin** because the patient could have had a heart attack. I’m not going to lie, it didn’t feel good to think I could have missed something potentially serious. But I appreciated the consultant giving me that feedback and doing it in the way that she did.

On a more recent shift, I was in handover with another consultant and his approach was different. He started questioning me right in the middle of handover (which I wasn’t expecting) about why I’d ordered a troponin** (I can’t win) on one of the patients I’d seen. It felt like I was getting told off. I thought it was condescending and unnecessary. Especially as I remember agonising about what to do with this patient earlier on in the day, not because I was worried about them, but because their symptoms didn’t fit properly into a category. I wasn’t sure what the appropriate next step was, so I chose what I thought was the safest.

And to be fair that situation wasn’t all that bad, because there’s been worse. And some might think I’m making a bigger deal out of it than necessary. It’s definitely a learning point, I just think there’s better ways to go about it. At the end of the day, I am not a consultant cardiologist. I don’t have the level of experience that comes with having many years of seeing the same presentations again and again. I’m much more anxious about missing something potentially fatal and so naturally I’m more proactive in trying to rule those things out.

I remember it being worse on surgery especially on the post take ward-round in the morning. Often the surgical SHO*** who’d been on-call overnight, would present their patients to the consultant in front of a team of at least 6 other doctors. Picture an old school ward-round with everyone crowded around the bedside, standing over the patient and that’s exactly what it was like. (I also felt sorry for the patient). Depending on who the consultant was would depend on the kind of inquisition the SHO would get and it could get uncomfortable very quickly. I would avoid presenting as much as possible and dread the rare moments when it was my turn.

Surgery has a stigma for having a particular type of attitude and a way of doing things. It seems to me this type of treatment is seen as a rite of passage. Or maybe it’s a learnt behaviour: ‘this is how I was taught so this is how you will be taught’ sort of thing. Seeing that made me feel even more sure that surgery wasn’t for me.

Maybe it’s just a sign of older times and archaic attitudes, where you’re taught by a process of humiliation and degradation. But medicine has undergone so much change in the span of people’s careers. The way the current consultants were trained is poles apart from the sort of training we receive in medical school. Maybe they need to enrol some consultants in communication classes where they all have to act out different scenarios like we did. It would be entertaining at the very least. Or maybe it’s just a case of allowing these older behaviours to slowly filter out with retirement. Who knows?

I should probably just not let it get to me as much. Sometimes, I write the details of the patients that have been pointed out to me and I check back to see what happened after a few days. I can’t tell you how smug I am when the consultant turns out to be wrong and I’m right. Like the first patient I mentioned did not have a heart attack (thank gosh). And another patient I reviewed did not have a PE***** (like I suspected). I’m not right all the time but it’s good to revel in the times when I am.

* handover: (where the team that’s been on-call during the day hand-over patients to be aware of or jobs to do to the receiving team who are just starting their shift).
** troponin: cardiac enzyme released in heart attacks
*** SHO: senior house officer (step up from foundation doctors)
**** Registrar: middle grade doctor. In between a junior doctor and a consultant
***** PE: pulmonary embolism

If you have any questions feel free to email me here: info@mindthemedic.com

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What Are My Plans?

plan

Nearly two months till the end of my foundation programme and after counting down for so long, it feels really really close. Every so often, I get this wave of nostalgia when I start thinking about all the moments that led me here. It’s not just the end of two dedicated years as a doctor, but it’s the culmination of all the other things that led to this point. All the necessary hoops that I had to jump through. All the studying, moving houses, moving schools. Years of focus to get me to and through medical school. And here I am, ready to press pause and change direction. Turn away from what I’ve been working towards for many years. It’s difficult to fathom sometimes, because even though I can’t wait till the end, I’m also dreading the emotional backlash that could ensue. And the fact that I’m liking this placement makes those feelings of doubt even more pronounced. I wrote about that here.

I’m trying to slow down and take it all in, be present, enjoy what could be my last training post in medicine. But it’s becoming more and more apparent that I need to think about my next step. It’s all well and good counting down the seconds and hours, but what do I do when the countdown finishes? And it’s a constant question that people keep asking me. At the moment I don’t have a plan. No carefully co-ordinated 6 stage process. I’ll suddenly have all this free time, and it’ll be up to me to choose how I spend it. I’m so used to ticking off a specification list or trying to hit all the targets on my portfolio for ARCP.

So what will I do instead?

I’m pretty sure I’ll travel. My travelling experiences in the past haven’t been great, whether it’s being dragged across half the world by my mother or being dragged in a group of 8 around south Asia. Neither of these left me wanting more. It begs the question of whether I actually enjoy travelling or whether I’ve just had less than ideal experiences. So I’m planning to travel on my own. Yes, it’s a scary decision for me but I think then I can finally answer the question once and for all. Do I enjoy travelling or do I enjoy watching others travel on Instagram. And I’ve sort of had a test run by travelling to Edinburgh on my own last year.

Will I locum? Initially, I wanted to have at least a 4 month clean break from medicine (if not a year), to see whether I missed it. But now that I’m thinking of travelling, I absolutely want to be able to afford whatever I do. Finances has always been a worry for me. I get a lot of anxiety around money which I’m trying to let go of. I really want to stop making decisions based on a fear of money and see how far that takes me. That doesn’t mean running wild. I’ll be sensible. But rather than forcing myself to pick up locum shifts because I’ve made up a narrative that ‘I need more money, I should work more’, maybe I can just make smarter decisions. Do I actually need more money, or would I just feel better if I had more money? Plus, I’m interested to see how else I can make other streams of income besides medicine. I enjoy being creative and not just writing so this is something I definitely want to explore.

I’d like to read more, actually hold a book and spend time in it. Learn about something else, discover a new author, critique a writing style, improve my writing style. Write more of my own fiction. Find new hobbies. Anything to bring back creativity and spontaneity back into my life.

Will I be bored? I really don’t want to be bored. It’s weird how frightened we are of being bored now. We have to have something stimulate us every ten minutes. At least I do. I don’t want to be so bored that I rush back to work, begging to be put back onto the medical rota. I’ve heard the first few weeks of F3 are great until reality sinks in and people can’t deal with suddenly having so much free time and as a result throw themselves back into what they’re used to: work. This is why I need a plan.

Overall I think I’ll be taking it slow. But I’m excited to see what happens. Feel free to join below for updates. And let me know if you have any ideas for what’s essentially a gap year.

 

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