Stop.

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Sometimes, I see patients and for whatever reason I get flustered. There might be a few complicating issues, the symptoms aren’t clear, my mind is thinking of possibilities A, B, F, K, and Z, the clock is ticking and the floor is on fire. I feel under pressure and I can’t think straight. And when this happens and I don’t know what to do, I realise that I need to just stop, take a breath and start from the top.

Last Thursday, I had a difficult morning. I started the day with a complicated patient which set the tone for the rest of that morning clinic. My first appointment was a lady with known mental health issues. Midway through, she suddenly flipped and demanded I stop asking questions. She’d been getting more and more agitated and I think she’d just had enough. It put me in a bit of a bind. I examined her but I felt the safest thing I could do was refer her to be seen to rule out a blood clot. This was another mission. By the time I saw the next patient I was just all over the place. Add that with a complicated, slow computer program, that knows exactly when to act up and I started to jet steam from my ears.

Stop, breathe and start from the top.

I get like that occasionally, more than I’d care to admit. Here is another example. More often than not, I know what to do if I just slow down and take a minute to process everything. I know I add on a lot of pressure on myself and I get frustrated. I worry I might be judged by others. Judged by my colleagues or judged by patients for taking too long. I can’t control what other people think of me, but it seems like my own self esteem relies heavily on it. It’s a work in progress.

I was recently listening to an interview by the author of The Subtle Art Of Not Giving A F*ck. I’ve not read it yet, but that book sounds like it was made for me.

But until then:

Stop.

Breathe.

Start from the top.

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The Phone Interview

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I recently applied to be a volunteer at an upcoming ACW event. I had the interview and I got the role. I’m not sure exactly what I’ll be doing, but I’m just excited that I’m going to be a part of it.

Lately, I’ve been thinking about my options which means spending my time Googling. I’ve found myself on the Medic Footprints site quite a bit, especially their blog section. Sometimes, in between patients, I take a quick break and just read through some of the articles. I like reading about doctors who’ve forged new careers for themselves or who’ve adapted their careers in some way to suit their lifestyle.

I find it difficult to openly talk about the possibility of leaving medicine behind. For some reason, it feels like a taboo subject. I know medics are a dedicated bunch with a strong sense of duty, but I sometimes wonder when this starts to become our weakness as well as our strength. It’s still a bit unusual to hear about doctors leaving. I can’t really speak for everyone else, but I do feel obligated to not tread the beaten path, to find a lifestyle that suits me. I’m looking forward to being around other like-minded people who share some of the same internal struggles that I’ve been facing.

I’ll probably be limited to how much I can see and do because I’ll be helping out. But it’s better than nothing. The event takes place in London, over the course of two days. I’ll have to get there a day before, to help prepare.

It’s weird, I knew this was a yearly event so I’d been waiting a while for the event details to be released and then when they were, I was initially hesitant: a) it was in London which meant I’d have to travel down and stay overnight, which is costly b) the ticket prices were more than I was expecting. On its own, I could probably have bit the bullet and paid for them but adding accommodation and travel and no doubt all the other costs along the way meant that I was going way over what I was prepared to spend. Just as I’d made up my mind not to go, I came across a small ‘volunteers’ sign.

I had to do a quick interview over the phone, which I tried to fit into my lunch break. And halfway through morning clinic my phone just turned itself off. Cue: mini frantic crisis. Literally, no warning. Just turned itself off and wouldn’t come back on again. The battery wasn’t low either. I wouldn’t have minded if this had happened on any other day, but seriously, a couple of hours before I’m waiting for a call. Sacré bleu! Long story short, after a lot of troubleshooting, panicking and Googling, I was able to have the interview, wow them and start afternoon clinic on time.

The idea of networking makes me nervous, but I guess that’s not necessarily a bad thing. It’s a skill I don’t have, might be useful to get out of my comfort zone and learn it. If anyone is interested in the event have a look at the Medic Footprints site and I’m also helping to sell some tickets as well here. I’ll probably write a piece afterwards as well to let you all know how it went.

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Medicine – An Art?

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I recently had a long consultation with a patient. He was struggling with a variety of symptoms which he’d been investigated for and despite multiple scans he hadn’t received the answers he’d hoped for. This had started to affect his mood.

He talked about his career briefly and how much he enjoyed his work as a mathematician. He felt it suited his personality as he found comfort in knowing that there were set outcomes for every question. A complex equation could be brought to a definitive answer. Unlike medicine, where often symptoms were left unexplained and the only option was to learn how to cope. All the while wondering: will it worsen? Will it ever improve? Will it become something else?

He said something else that caught my attention, ‘I guess that’s why they say medicine is more an art than a science’. I’ve come across that phrase a few times and I’ve never stopped to actually think what it meant. But after he said it, I felt this dawning realisation. Like the feeling of suddenly working out the answer to an exam question the day after. Just talking to the patient in front of me, and watching him almost crumble under the weight of several uncertainties, it reminded me yet again how important it is to have these open conversations.

Treating a condition goes beyond just treating a part of the body. Every time we try to help, and we dive in with good intentions sometimes we cause more issues. Some therapies don’t work and sometimes there are side effects. So, we trial different treatments and hope for the best. But there has to be a balance, an awareness of the impact that this might have on an individual. I think good doctors are the ones who truly put their patients at the centre of decision making and try to maintain that balance whilst juggling the multiple other issues each patient brings (family, job, finances). That is the art.

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Liking GP?

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Since the beginning of F2, I’ve felt tired. Not the kind of tiredness that goes away with sleep, the kind of tiredness that requires two weeks in the sunshine. That’s the issue with being in a training programme, you just keep ploughing on and on and savour the few days that you get off.

I appreciate being on GP right now and I’m liking the slower pace. But it’s still really hard to get up in the morning. I feel like I have to emotionally psyche myself up and then drag myself to work.

But weirdly, as I start settling into afternoon clinic and I’m between patients, I start thinking that it’s actually not that bad. And it’s happened more than once that I’ve caught myself thinking that.

No one is more shocked than I am. As a student, I found GP placements boring. Sitting in the corner and staring, as people come in and out. Not fun. Now, I see my own patients. I have to think on my feet, but at the same time I feel supported and I feel like I’m learning. And I feel like I’m helping. I have time to talk things through with people.

Before we get carried away, I’m still only a few weeks in. Even though it wasn’t my plan, I’m happy I had this placement first. I’m looking at my A&E rota for my next placement and it looks dire to say the least. 10 hour days, 8 in a row. Eugh.

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A Really Bad Week

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Last week was a series of lows.

I can’t even describe it. It was a case of the proverbial faeces hitting the proverbial fan. Multiple times.

I started the week feeling incredibly tired from the weekend. Nothing unusual, just a tad more Monday blues than normal. But I didn’t think anything of it.

I ran a few errands on Monday and Tuesday: sorted a few things out on eBay, put off writing a blog post, some running. I was slowly beginning to feel a bit overwhelmed with all the things I was juggling. And to top it all off, it felt like I was coming down with something. And instead of really tackling those issues, I found solace in lying in bed watching Youtube videos, just something to take my mind off everything.

Then came Wednesday. I had my morning clinic and then went on a home visit to review an elderly man with back pain. The symptoms had resolved by the time I got there so I made my way to the hospital for the weekly afternoon teaching. I grabbed a Subway on the way, even though I’d been avoiding buying lunches because I am trying to save. But I’d been so tired, I hadn’t prepared anything to bring in to work and eat, I must.

My supervisor grabbed me as soon as I arrived, so that we could have our mandatory introductory session (which we have for the start of each placement). She asked me how I was and all of a sudden I just offload a tsunami of emotions, mostly about how deflated I felt etc, etc. She gave me a funny look: concern/surprise/worry and told me she wanted to see me again in two weeks. I caught her off guard but to be honest, she caught me off guard as well. Saying it out loud made it all seem a bit more real. I’m not sure why it all came spilling out like that and I kept thinking about it, all the way through teaching.  I had some idea in my head that the medical postgraduate team were going to put me on red alert or something and start watching my every move.

By 8, I was fast asleep, I was just too tired and achy to fight it any longer.

I got to work Thursday morning. Settled into my clinic. First patient didn’t arrive and I’d left my GP bag in the car (the one I use on house visits and that I had taken home with me the day before). I quickly went out to get it before the next patient arrived. I couldn’t find it. Weird. I called home and asked if someone had taken it out of the car. No one had.

I looked all around the car, panic rising. Where could it have gone? Eventually, I ran out of places to look and I had to walk back to my supervisor and let her know. I felt so responsible and stupid. I’d only been there (at the GP practice) for 2 weeks, and this really wasn’t the way I wanted to form an impression. I felt like I let them all down.

I went to the police station later on that day. My expectations were low; I knew it’d be unlikely they would find an unmarked generic black bag, but I needed to report it. The policewoman I met made me feel 10 times worse. She had a really accusing tone. One of the questions she asked me: “how do you know the bag was stolen” left me dumbfounded. I stared at her confused, I looked at my mum, and then back at her. I didn’t understand what she wanted me to say. There were other things she said that again made me feel like she was judging me or making assumptions about me. The whole experience was uncomfortable and unnecessarily so.

So, all in all, not a great week.

 

 

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General Practice

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We had a lot of exposure to general practice (GP) during medical school. Usually, I’d have one day a week based at a practice and sometimes a couple of four week blocks would be allocated for general practice alone. So I’ve seen a fair share of different practices, some were better than others. But overall, I felt like I had a better appreciation of what it would be like to be a GP.

Throughout medical school we were told that at least half of us would be GPs. On its own, the statement doesn’t sound bad, but in context, a lot of the time it felt like we didn’t have much choice in the matter. 50% of us would be GPs regardless of whether or not we wanted to. Some people took offense, I didn’t particularly, even though at the time I thought wanted to be a paediatrician.

A few years later, now a F2 on my GP placement, I can see the appeal. 9 to 5 every day plus one afternoon off every week. I don’t have any night shifts or weekend shifts. There’s 30 minutes to see each patient, all the while sat down in a room with plenty of opportunities for tea/coffee breaks. I know this isn’t fully representative of an actual GP but it’s generally a much better working environment than what I’ve experienced so far working in hospital.

So part of me wants this to be it for me. Do GP, have a great work life balance and be financially stable. I really wish I could fall in love with it. At the moment, it just doesn’t excite me. Some of it does. I hear a lot about GPs who have more unusual working patterns, that go beyond seeing patients in a clinic. But if I go for general practice, I want to be really for it, not just the good bits. It’s like buying a cake but only being excited for the icing. And then throwing the cake away when all the icing has been eaten.

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6th August 2017

unprepared

I worked a locum shift during the weekend. Nothing stressful, just an admin shift. I pretty much sat around all day, flicking through paper and typing entries onto a computer. I expected it to be a chilled shift, so I didn’t even bother wearing my stethoscope. This particular shift meant that I was sort of spread across different wards, but I didn’t have any clinical duties, so I wasn’t seeing patients anything like that.

That all changed one minute to the end of my shift. I was called over by a nurse to review an unresponsive lady. I felt so unprepared. Like I said, I wasn’t expecting to do anything clinical, I’d left my stethoscope in my bag. And I know the training that we get gives us what we need to do when a person becomes acutely unwell. I don’t know why, but in that moment I felt really unprepared. I went over and kind of went through the steps of assessing this elderly lady. To me, she wasn’t unresponsive but it’s hard for me to know how well she’d been an hour before. I don’t know how she’s like normally. I try to examine her, whilst giving some instructions to the nurses and dodge around 3 family members. It all felt very haphazard.

The medical registrar came and took over, and he must have thought I was slow or something because he just did everything himself.

Driving out an hour later then I should have been, I just felt deflated. I felt like I could have done so much better. And I use the excuse that I’ve feel like I’m out of the loop after having done surgery for so long but really, is that a reason?

I was thinking about it all the way home. Just picking over the situation again and again.

It’s hard to remember exactly what happened because my mind was somewhere else. So this is was what I think happened: I’m trying to join a dual carriageway with three lanes. I can see two cars, one blue car in the middle lane and another in the furthest lane (right lane). I look right, then left and then start to pull out. Then I break suddenly, to stop myself crashing into the blue car speeding past in front of me. I’m sure it wasn’t there before so I wonder whether it swapped lanes when I looked away.

And I mention this because, it made me think. I was so concerned about how stupid I looked and how I did a bad job. I took that issue which was self contained (the patient was ok, the registrar had reviewed her) and I made it affect my driving to the point where I could have been in an accident. That would have been a much bigger problem and I’m really glad I narrowly avoided that.

So, this really is a lesson for me, more than anything else. Be more careful and don’t make a bigger mess of things.

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The Last Day of F1

The last day was a mix of emotions. Overwhelming gratitude and relief that I’d finished a difficult placement but also a slight melancholy that I was leaving. I was happy, don’t get me wrong, I’d started a countdown midway through the four months. But while I was working through the final jobs, I kept thinking of how everything was coming to an end. Not only was this the end of a placement but it was also the end of the academic year, the majority of doctors would be moving on to new hospitals. The people I’d worked with over the last months, the relationships I’d built, the comradery, it all felt like it was coming to an end.

We had a small get together at lunch with cakes and drinks and it felt like the end of an era.
The hospital can be really sociable. Just walking down the corridor, I’m bound to run into someone I used to work with. I enjoy that aspect of working in hospital.

My next placement is in GP which will be a massive change of environment. It’s always been the one thing that’s bugged me about general practice: the fact that there isn’t that community of peers around you. But I’m still looking forward to the change of scenery. I’m hoping GP will give me some of the learning experiences I’ve felt like I’ve been missing. Plus, surrendering my bleep for the next four months feels like a huge bonus. Not having the constant paranoia/palpitations every time I hear that beep anywhere around me. Immediately looking down at my bleep to see if it’s me that’s being summoned to some unknown problem. I just want to actually learn and do some medicine. Listen to a problem, take my time, explore the issues and be guided and taught as well. All whilst being sat down. I’m really hopeful.

I had the new foundation doctors shadow me on Tuesday and I honestly tried to be as positive as possible. I tried to give them all the necessary information they needed but I know they’ll learn it all as they go along. Luckily, the consultants are lovely so they should be fine.

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A Year In Review

Hey.

All of July, I’ve been doing weekly posts on things I wish I knew before starting F1 or at least advise I could give to someone else starting their F1 post in August. And for the final post of July I had something else in mind. Unfortunately, I’ve been unwell and that particular post would have required a lot of research. Therefore, I’ve opted for something else: a year in review. Taking a step back and reviewing my first year as a doctor as I step into a new one.

It has been without a doubt, the hardest year of my life. Challenging beyond belief. There were so many moments where I felt lost and unsure. I’ve had times where I’ve been incredibly unhappy and more so recently where I’ve been so close to resigning. The hardest situations have been where I’ve felt personally scrutinised, where someone else’s perceptions of me contradicts how I see myself. These have left me feeling hurt and confused and wondering whether I know myself as much as I thought did. It’s often led to a lot of over analysing on my part to the point where I have often questioned something I knew to be true. It’s difficult to explain but I think my confidence in my own convictions has wavered under pressure. I’ve been blamed for issues that haven’t been my fault, I’ve had difficulties with senior colleagues and I’ve found it hard to know who to turn to.

I guess it’s an indication of how much I need to work on.

I know I could have been better. Much better. I could have taken care of myself more. There were times I could have been more honest, where I could have communicated more. I could have spoken up more, I could have taken myself less seriously. I could have stepped out of my comfort zone more. There’s comfort in knowing I’ve become a better doctor, but I question whether all of this has made me a better person.

And at this very moment, looking back through everything I’ve experienced, more than anything, I’m grateful that I’ve made it through. It wasn’t supposed to be easy.  I just never imagined it would be so hard.

Have I enjoyed F1? No. There’s no circling around the answer, I haven’t. I’m glad I’ll soon be able to close the door on those experiences and move on. And part of me wonders whether F2 will change the way I think about medicine. Will being a more senior member of the team shift my views so drastically that I finally realise that medicine is everything I wanted? I doubt it. I think my placements in F2 are more in line with what I want to do. But again, I doubt that will make a huge difference to the way I feel. I think the fundamental issues I have won’t change with a different placement or being at a different stage in my career. Being a junior doctor now feels like it’s tougher than it’s ever been what with how much strain our health service is currently under.

But I think that there is another side to this issue. Me. Medicine isn’t serving me the way I would have hoped. And it comes across in what I write. I would have liked this blog to show a lighter side of medicine, but I’ve tried to honestly depict how I’ve felt in my experiences. There are parts I enjoy but there’s so much that I don’t and it’s this realisation that makes me think that I’ve made the wrong choice.

Medicine was always the career I thought of the most, even though I wasn’t entirely sure what I wanted to do. Out of everything else, it was the one thing I could see myself doing. I’m happy I’ve been able to experience this journey and make a better judgement on what it is I want in a career.

Heading into F2, I pray that I can take all the lessons I’ve learnt and make this year better. I want to focus more on my physical and mental health, my hobbies and a career out of medicine. I think F2 should give me a more definitive answer about whether medicine is for me. Either way, I’m ready to make some changes.

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How To Survive A Night Shift As A F1

How To Survive A Night Shift

I started my set of nights very early, within a few weeks of F1. And though I wasn’t particularly happy about it, I reconciled with the fact that it could have been worse. If this is you and you’ve looked at the rota with horror, I hope you’ll find this post useful. I’ve written two other posts here and here about surviving F1. Take what you think is relevant and throw the rest away. I’ve split it up into before, during and after so it makes more sense.

Before:

  • People have different ways they like to handle the day/night before a night shift. Some people try not to sleep the night before so that they can sleep during the day and feel more awake during their night shift. Some people just go to bed as normal, the night before, and have a small pre-night shift nap. Others wake up in the morning, stay awake all day, work the night shift and then go home and sleep, meaning they’ve stayed awake for 24 hours plus. It might take a while to find a routine that works for you but eventually, you’ll find a routine what works for you.
  • Prepare meals. The last thing I want to do after a night shift is to hit the kitchen and start making food. So, before a week of nights, I usually make a big pot of something that will last me several days.
  • So that your whole routine isn’t completely thrown out of the window, plan when you will run, go to post office, whatever errands that you might need to do, because there’s not a lot of time left over for you to do the things you want to.

During

  • Drink plenty of water.
  • Healthy snacks: dried mangos and nuts for me. It’d be easy to hit the vending machine and buy lots of junk. I’m partial to the odd cookie, but having some good options makes me feel like I’m not completely falling off the wagon. And it’s also cheaper. I can get into this mentality sometimes where I play victim: ‘I’m on nights, I deserve a biscuit’.
  • Take it easy. You’ll be covering a lot of wards and patients. Some nights can be quiet, but on those busy ones, pace yourself. Take breaks. I found when I didn’t, I could be reading the same line in a patient’s notes over and over again and not take anything in.
  • If there’s ten jobs waiting to be done, you can’t do them all at once. You’re going to have to prioritise. Sometimes the messages can be so cryptic it can be hard to make a decision. So call ahead and find out what the issue is.
  • Group the tasks by location. If you’re going to one ward, you might as well branch across the ward opposite if they need fluids prescribing. It’ll save you walking all the way back.
  • Know all the codes to the doors and short cuts. Make your life easy. Keep codes in the notes app in your phone so that you can come back to it. And important bleeps and numbers you need to know, like the medical registrar.
  • Try not to cut corners. It might be your fifth falls assessment of the night and doing a neuro exam on a sleepy elderly lady at 2:30 am isn’t the easiest thing to do. Chances are if someone has fallen in hospital, it could complicate their admission. You could be asked later down the line to explain what happened and how you responded.
  • If a nurse calls to let you know someone is unwell, give them some instructions of what to do before you get there: bloods, cannula etc.
  • Some issues will self-resolve. It’s surprising to me how many people I would be called to see because they weren’t sleeping and would arrive to find said person sleeping.
  • Know trust policy or at least know where to find them on the following: electrolyte imbalance (you’ll be prescribing loads of fluids), agitated patients (which benzodiazepine to prescribe), loose stools, fall management plan etc.

After

  • I’ve found that I feel so alert when I’m walking towards my car at the end of the night shift but 15 minutes later I’m starting to dip. I’ve written about it here. But when I get tired, I stop. It’s tempting to just try to power through and get home sooner. People have died from being tired at the wheel. You’ll still get home, just a little later.
  • Don’t get distracted by anything else. Just sleep. I don’t have an issue with sleeping in bright sunlight, but if you think you might do, get a sleeping mask.

 

Good luck. And enjoy the free time you have left, don’t spend it worrying. Comment below if you have any questions or other suggestions. Thanks for reading.

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