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Diary of a CT1 – Where and Elsewhere

October 1, 2016

Eight years ago this weekend, we packed up my life into the back of my dad’s Ford Focus and headed to London and the start of medical school. For someone with a geographically stable childhood, univsersity was a big upheaval in more ways than one. I’m sure I’m not alone in this. I imagine most people who go to university end up away from their family, away from home, away from their comfort zone. When you’re 18, everyone has got good advice for getting used to a new surrounding, making new friends and not feeling so lonely.

But what gets neglected is what comes next.

From London, I moved to the south coast, and from there I’ve moved now to south Wales. Why? Because medicine, that’s why. My first training programme as a doctor covered a region from the south bank of the Thames to the English Channel. Living and working in London one year then relocating to a different hospital, perhaps 100 miles away overnight. That’s right. I finished at St Elsewhere’s, London, on a Tuesday and started at Worthwhile General on the south coast on Wednesday.

This August, I played the same game again. Finished at Worthwhile General on Tuesday, then a 150 mile journey through the night (it was a dark and stormy night) so I could start at Ysbyty Sant Rhywle the very next day. That I was starting on a night shift meant I had to readjust my body clock as well as my compass.

But why can’t you just stay put in one hospital or one NHS trust? I hear you ask. Because I need to finish my training and because of the centralised oversight of these training programmes, my choice in these matters is somewhat limited. I could work in a staff grade (i.e. not a training post) in one place for years – I’ve met people who’ve done just this – but that means I don’t get any closer to the golden McGuffin of post-graduate training, a Certificate of Completion of Training, needed for becoming a consultant.

So my Hobson’s choice is between geographical instability and training inertia. BUT WAIT THERE’S MORE!!


She will cut you up good.

Let me introduce Eve, my wife and light of my life. We met in medical school and I’ve grown quite fond of her. She makes me smile and pop songs make sense when I’m with her. A doctor, like me. So take all the hurdles I mentioned above – and double them. 

We were lucky starting out. We linked out FPAS applications and the South Thames deanery honoured by placing in reasonably neighbouring hospitals, both in London and on the south coast. Things have grown more difficult since then as every career move one of us makes is made with one eye on what the other is doing. Our compromise this year means she is working 50 miles away – for someone who doesn’t drive and with major railway engineering in the area – that is one hell of a compromise.

When she is on-call, she stays overnight in hospital accomodation because it is not worth the time, money or effort in coming home before heading back for another day. She is on-call this weekened. When she’s home next weekend, I’m on-call. She’s lonely, I’m lonely. This is the happy-ever-after of a medical marriage.

But it could be worse. My SpR works, obviously, in Ysbyty Sant Rhywle while her husband works in Scotland. Yes, that Scotland. Compounding this, she is looking after their young child by herself, effectively a single medical mum. Whenever she explains this domestic situation, she is met with unanimous incredulity.

Yet no-one ever tells you about this. All through medical school, it was renin-angiotensin-system-this and vascular-supply-of-the-colon-that. No-one ever says to get used to living out of suitcases and avoid putting down deep roots in any one place. In fact, if they had told us that in medical school, it would have been too late. This is caveat emptor-type stuff. Kids, if you want to do medicine – Buy a caravan.

It’s not strictly true that no-one ever told us this. I remember as a fifth-year student, still with plenty of time before stressing about applying for jobs, our consultant on an Oncology placement stressed the importance of planning ahead and planning your career around your home life. I wish I’d paid more attention back then…

I don’t want this to sound like I’m whining. I am whining, but I don’t want it to sound that way. Work is stressful but I enjoy it, I’m in the training programme I want to be in, I have a beautiful, smart and compassionate wife who I love (and whom I would dearly love to see). My point is, much has been made of low morale and burnout in the NHS at present, and every year final year medical students stress about where to start their careers as doctors. I just want to get it out there that the where (and the with whom) is just as important as the what.

P.S. My SpR has completed her training and secured a job as a consultant in Scotland, where she can re-unite her family. This is the silver lining; this is the golden ticket I’ve got my sights on. As film critic Mark Kermode often says, it’ll all be alright in the end.

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