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Diary of an FY1 – All Change Please!

July 12, 2015

December is an interesting month in which to be a junior doctor. For one thing, I lucked out and the fey rota spirits allowed me to celebrate Christmas Day in peace. I will surely pay for this hubris in the years to come – watch this space in Diary of an FY2. As advent pressed on, artificial Christmas trees sprang to life on St Elsewhere’s wards and registrars revealed their extensive collection of Christmas knitwear. It is quiet Christmas miracle just how much festive cheer these traditional-to-the-point-of-cliché decorations can bring to the watershed between bureaucracy and humanity that is the NHS. Meanwhile, I went around the ward telling patients to be good – otherwise Dr Christmas will put coal in their TED stockings.

But an event perhaps even bigger than Christmas occurred on December 3rd. All across the country, FY1 doctors changed jobs for the first time. The host of FY2 doctors and other trainees who also changed jobs adjusted to their new roles with barely a shrug but I was taken aback. For the past four months, I had built myself up as an FY1 in Urology, the pee-whisperer with a 24-French catheter holstered on his belt. That façade, that identity was torn from me on December 3rd and I found myself, recast from clay, newborn and naked once again as a Respiratory FY1. Deep breath.

Still, onwards and upwards, as they say. Most definitely upwards. I moved from a team of no fixed abode to an aerie of a ward on the top floor of the hospital. My first day in this brave new ward was an education. So many patients! All together! With CURB65s and IECOPDs and CPAPs and BiPAPs. Compared to the streamlined swiftness of a surgical ward round, I was amazed to find that we still hadn’t finished our ward round at four o’clock, and it was dark, and I hadn’t had lunch. Part of me blames the patients, coming in with all their co-morbidities and lived experiences – how dare they! Medicine in the real world is…messy. It almost feels like for the first four months, I’ve been playing on tutorial mode and only now is the real game getting started. At least I knew how to use the computer system this time around.

Except the fax machine. Damn fax machine.

Fortunately, I am not alone. My SHO has just rotated to this firm as well. I like him. He used to work in Renal medicine – In my previous life in Urology, we drew battle lines over the loop of Henle. Now we are united above the diaphragm. We’re only one wacky registrar short of a sitcom. But part of me knows this cannot last. Come April, I will disintegrate and reform once again, as something else again.

Next year, I will move on from St Elsewhere Hospital entirely. Then, core medical training or run-through training and who knows where that might be? And who knows what shape my training will take once the Shape of Training report is through with it? (If you don’t know what the Shape of Training report is, I’d find out if. It’s a storm on the postgraduate horizon and it’s heading towards you guys)

Is this my life now? Patchwork postgraduate training punctuated by transitions and scene changes? Am I destined to reinvent myself more times than Madonna?

Not that the nomadic life of the doctor in training is without its benefits. It breeds adaptability, flexibility, and a distinctly groovy outlook on life. This is best expressed in a WWII home front slogan that has been since mass-produced beyond the point of parody. I have the advantage of working with several potentially great teams, instead of just one, and carry good practices with me from one job to the next, like shrubbery cuttings from garden to garden, at the cost of roots of my own.

Even if December 3rd felt like the first day of high school all over again, this perpetual game of musical chairs and find-the-lady guards against complacency and inertia. I’ll never become the doctor I want to be by training in just one specialty. As I dredged the cobwebbed recesses of my mind for facts on COPD not exercised since medical school, I felt myself being stretched. After weeks of dual-wielding catheters, I found myself fumbling after pulses for arterial blood gases. It might just be the masochist in me but it kind of felt like growth, or the start of it at least.

A further reason to move on is, in the words of U2, I still haven’t found what I’m looking for. Even after six years of medical school, I remain stubbornly indecisive over which direction to point my ship of determination. I’ve liked many specialties that I’ve rotated through but hardly any have grabbed me by the devotions. The closest I’ve come to a decision is a tie between paediatrics and psychiatry – logically, that places my in child and adolescent psychiatry in that Venn diagram – and some specialties have been entirely crossed out, like surgery (due to my two left hands and general lanky clumsiness). Until I can make a decision, I need to fill my sails with as much and as varied experience as I can find. At least medical school prepared me for this frequent tacking.

Anyway, these are the things I tell myself as I am faced with more patients and sicker patients than I’ve seen before. I’ve swapped my Foley catheter for an ABG syringe. They’ve said that if I can survive this rotation, I can survive anything medicine can throw at me. So unto the breach, Level 2 begins now. Deep breath, I tell myself. And my patients too.

Written December 2014

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