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Diary of a CT1 – The Hardest

November 13, 2016


I stand atop Ysbyty Rhywle’s roof, stare grimly into the setting sun, gripping an IV stand tightly, and utter “Brace yourselves. Winter is coming.”

Winter is a terrible time to be sick. The cold bites in arthritic joints. Freezing blood struggles through atherosclerotic coronaries, until finally waylaid by thrombus and plaque.  The spectre of influenza stalks the streets and the old man’s friend, pneumonia creeps in with every cough and sneeze.

Winter is a terrible time to work in the NHS. While “bed pressure” and capacity (and lack thereof) have become perennial problems, the cold and dark months seem especially bad. Heaven help you if your lot is the emphysematous and bronchitic, the asthmatic and bronchiectatic, who Jack Frost singles out for extra punishment.

Heaven help me.

Personally, Winter started a few weeks back at the end of October. It was Friday. It had been a busy day but we were nearly done. One of the nurses asked me to review a patient. They had been very unwell, but stable, earlier. Now everything had changed. Blood pressure down,  heart rate up, all the numbers in the wrong order. I asked my SpR for help but I knew that this patient was dying, and there was nothing left that we could do but keep them comfortable. The SpR made their assessment and said as much. I called the family and prescribed comfort medicines.

It’s a narrow, selfish thought but  – what a way to finish the week! But the beast that is Medicine wasn’t done with us yet. The nurse came back and asked us to review the patient next to the patient we had just seen. My SpR and I shared a glance – “Really?” Again, this patient had been sick but stable earlier in the day – and now was actively deteriorating in front of us. We made our assessment and came to the same conclusion as before. We could do nothing but witness – and comfort where possible.

Death is something that comes with the job, grimly. I’ve seen plenty of it by now and have grown somewhat inured to it – but seeing it in stereo felt particularly brutal that Friday.


I felt a lot like this. No defibrillators were harmed.

I was doubly fortunate in that first, there was Twitter, with a few words of support and gifs of wine, and then second, I got to spend the weekend with a close friend and find my way back to humanity.

I wanted to write this blog a few weeks back, closer to the raw rage and despair I was feeling. It’s probably better that I didn’t. In the interim, my thoughts have had time to cool and ferment.

When I started out as a doctor, it was hard because of all the running around, taking bloods, siting cannulas, et cetera. Then the next year was hard because I had to do actual medicine-y stuff, while still doing the runaround stuff. This year is hard because I’m expected to know the medicine-y stuff (knowing it last year was a bonus) while leading ward rounds with the F1 and medical student. Medicine doesn’t get any less hard but the particular way in which it is hard changes, with the physical gradually replaced by the mental, runaround gives way to responsibility.

But it is and always will be emotionally hard. Every time I’m at risk of forgetting this, that beast called Medicine finds a way to remind me of this.

Winter is coming. And this year, it’s going to be cold and dark and brutal. It’s going to be hard physically, harder mentally and hardest emotionally.

I wanted to write this blog when I was sad and angry. I didn’t and I’m glad because here’s a postscript. A very important postscript and in a year like 2016, perhaps the most important postscript there is.

It gets better. Medicine, like all things, ebbs and flows. It gives and takes away. It gets better. The drugs do work. Patients heal and improve and they leave hospital through the front door.

It. Always. Gets. Better.

Winter is coming and it’s not going to pull its punches on me or my patients, but I’m going to keep on working until Spring.

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