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Diary of an FY2 – Bleeding Out

April 7, 2016

Today I’ve been on the picket line outside of Worthwhile General, protesting the Department of Health’s imposition of a new contract for junior doctors. It was cold but mercifully dry, and the vast majority of the public passing by gave us their support. Meanwhile, those providing emergency cover persevered inside the hospital.

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“Do you hear the people sing? Singing the song of angry men~”

This is the fourth such industrial action this year, and the second since Jeremy Hunt decided that he was done with negotiating and imposed the contract. Seven weeks later, and the proposed contract was written published. Since then, the BMA and the junior doctors have attempted to re-open negotiations – with nil effect. Meanwhile, there are two campaigns to drag the contract and Jeremy Hunt through the law courts.

Now there’s only four months until that contract comes into effect – And where exactly are we?

The beginning of the year was a blur. So many hot takes, clamouring to leave their opinion on top of the pile, amidst the daily onslaught of news and mis-news. Since then, the facts have begun to settle, and perspectives have had time to solidify. We’re told we’re getting a 13% pay-rise…but on a cost-neutral pay-packet. There’ll be more doctors around on weekends…but there won’t be any more doctors, so that means there’ll be fewer doctors during the week.

And what exactly are 7 day services?

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The BMA have been trying hard to restart negotiations with the Department of Health for a fairer contract, but from Jeremy Hunt’s point-of-view, why should he? He’s got what he wants – the junior doctor contract has been sealed, and work is underway on the consultant contract. What is there for him to gain? He is so toxic as a Health Secretary that, I think, there is nothing he can realistically do to placate the junior doctors.

But the industrial action must be putting pressure on the Government, I hear you cry. But…have they? The Department of Health remains as entrenched as it was in February. Outpatient clinics and elective operations have been postponed, but what real impact have these days of industrial action had? Is Jeremy Hunt feeling the heat? What heat?!

Maybe things will change with the next strike. All-out walk-out. I know a lot of doctors are finding that hard to act on in good conscience, worrying for their patients. Others accept a temporary risk now to protect their patients in the future from a contract that is unfair and unsafe. For others, it is their last resort against a government proving itself stubbornly deaf. A play not without risk but worth it if it can open new negotiations.

But it is a risk that our patients have to pay.

Based on previous experience, I don’t think today’s industrial action will change anything. And I have my doubts that even the all-out walk-out will have the desired impact. Some commentators have described these strikes as a Micawber play – keeping the issue alive until “something turns up” (from elsewhere; the judicial review one hopes?).

It’s hard not to feel a little deflated. The zombie junior contract continues to drag on without any convincing signs of life, and the prognosis doesn’t look set to change.

It would be galling to concede defeat in this junior contract fight. It has been the touchpoint for various grievances of junior doctors and there is a real sense that the profession has joined together in union. Everyone is so passionately convinced that this new contract will be awful, for all sorts of reasons. “We are right and we must fight!” the rallying cry goes out. And Jeremy Hunt replies, “So what?” Where is the value in continuing to fight when the outcome is not going to change?

Could there be anything more demoralising than giving up the fight when you’re convinced you’re in the right? After all the emotion, enthusiasm and passion that has been sunk into this fight, I think submitting to this contract would cripple junior doctor morale.

Of those that don’t head off to Australia/New Zealand/Canada (Delete as appropriate)

Of those that don’t leave medicine altogether.

I really don’t want to be right about this. But so far, there’s been nothing to convince me otherwise. But hey, something might turn up. Right?

Diary of an FY2 – We Regret

March 13, 2016

So the Core Medical Training have made their decision. I don’t have a job come August.

I found out when I absently checked my phone, in the middle of a busy surgical ward. The FY1s were fretting over ECGs, the nurses were bustling to and fro, and a few patients were taking their IV stands for a walk. But all that faded into the background, replaced by a keening white noise when I opened my emails and saw the words, “We regret.”

I’m not sure why admissions teams think they need to bother with full emails or letters. After the words, “We regret,” everything else is filler. I’ve already got the jist, already read everything I need to read. And I’ve read it before.

2007: After an abortive interview at Cardiff, and no other offers, my aspirations to go to medical school are over.

2014: While everyone else around celebrates passing finals and completing medical school, I stare numbly at the email indicating failure instead of success.

2016: And now, my shot at Core Medical Training and up my SHO game has been stymied.

I’m beginning to see a pattern here.

I’d be lying if I said I wasn’t upset. It hurts. All my plans have been thrown into disarray. Now what do I do? Try and get a staff grade job? Locum around? Take a “sabbatical” and go travelling? With the guillotine blade of Jeremy Hunt’s contract for junior doctors poised to drop in August, do I even bother with medicine anymore?

I could run away and join a bookstore. I could have a series of text-based adventures. (Sidenote: Mr Penumbra’s 24 Hour Bookstore by Robin Sloan is a charming little book on that exact theme. Check it out)

That timeline above shows a depressing cycle. Apparently, first impressions are not my forte. However, that timeline is incomplete. Let me now fill that in:

2008: Interviews at Imperial College and Nottingham University. Then, an unconditional offer to study medicine at Imperial College, ranked consistently higher than any medical school I applied for the year before. There, I met some of my closest friends and my soon-to-be-wife. And one guy who occasionally pelted me with oranges…but it was mostly good.

2014: PACES-Focussed course then re-sat that exam. And then…well, you know what happened next.

2014: Stood up in front of 200 high school students and explained how I got my medical mojo back by re-applying to medical school.

2016: And now.

And now. And now, I apply to Round 2 of Core Medical Training applications. Because filling all those SHO jobs is so tricky, I’ve got a second chance to grab capricious fate by the scruff of its neck and make it see eye-to-eye. And I fully intend to do just that.

Humans are story-telling creatures. It is a fundamental, quintessential part of what makes us us. We use the events of our past to tell stories to make sense of who we are. Call it your personal brand if you want. If you look at the first timeline, my story would be that of a failure, marked again and again by “we regret”. But if you look at the second timeline; it’s a different story. Resilient is a word you could use. I’d prefer to say stubborn and pig-headed. Point is, I suck at first impressions but second impressions are a different story.

And that’s my story.

Diary of an FY2 – #LikeALadyDoc

March 7, 2016

So here’s a thing that happened a few weeks ago.

Post-take ward round with the consultant surgeon coming off on-call (Let’s call him Mr Black). There’s the registrar, the other SHO (Let’s call her Linda) and me on his team, striding through the hospital like a pack of scalpel-wielding sharks. On the surface. I know I’m not a surgeon and I’ve made this fact known to most of the surgical team. Likewise, Linda has no desire to cut, slash and heal. In fact, we both hanker after a career in microbiology.

Mr Black knows this about us and has accepted us for who we are, not his kin but still part of his team. Because this consultant isn’t a hackneyed stereotype from days gone by. He comes off as stern at first but he’s fair and honest and not without a sense of humour. Mr Black’s a good surgeon – he knows when and when not to cut. I’ve got a lot of respect for him.

But I digress. Back to the ward round. As we stalk down the corridors of Worthwhile General, going from one ward to the next, he turns to me and mentions a good idea for an audit into perioperative antibiotics. It’s simple, should be quick and he offered help on getting it off the ground. I readily agree. A little later on, he mentions to me a patient with an uncommon abscess that might make for a good case report. Again, I agree and think “Great!”

However, something doesn’t sit right with me. Mr Black has offered me these after-school activities because he knows they’re relevant to my interests. But to Linda, who he knows shares those interests, he says…nothing. Not even the whiff of an audit.

After the ward round, everyone splits off to their own duties but I pull Linda aside and ask, “Was that a bit sexist?”

If you have to ask, the answer’s yes.

Getting publications and quality improvement projects under my belt is a real good way of getting ahead in medicine, and the reality is that having a senior colleague tip you onto these things is a real godsend. Medicine isn’t the Old Boys’ Club that it once was but the uncomfortable fact remains that it’s 2016 and I can get ahead of Linda by the virtue of my Y chromosome.

I offered to share the CV-boosting work with Linda as an incomplete penance for not speaking up for her on the ward.

It’s 151 years since Elizabeth Garrett Anderson became the first woman to qualify as a doctor in the UK and doctors who are women are everywhere now. In January, #LikeALadyDoc and #ILookLikeASurgeon showed just how numerous they are, and how varied their careers are. But despite making up around 50% of doctors (and y’know, the population), they are still the scapegoats for all the NHS’ woes.

In 2014, Prof Meirion Thomas wrote in the Daily Mail that, after being trained at great taxpayer expense, women were more likely to quit medicine, go part-time and/or avoid the most demanding specialties. Women, he advised, need to “lean in.”

In 2015, Dr Max Pemberton wrote, again in the Daily Mail, that specialties over-represented by female doctors (Paediatrics, Obstetrics and Gynaecology) were being crippled by the cumulative sum of part-time working and maternity leave. Medicine should be a vocation, women, and the harsh reality is that your patients need to your priority.

And this year, we’ve already had Dominic Lawson writing in the Times (Paywall) that again, female doctors are a poor investment, due to maternity leave, retiring early and not working weekends (?!) and are clearly contributing to the rising waiting times in A&E. Those pesky ovaries!

Are these problems the fault of women doctors? Or are these the fault of a healthcare service and a society that could see these problems coming for decades…and did nothing?

It’s 2016 and women doctors are simultaneously being overlooked and over-blamed. Despite making up ~50% of the workforce, woman are taking the rap for not adhering to the default setting – male – and employers are still left agog by their attempts to be actualised human beings rather than emotionally wrecked burnout husks.

I don’t think women are going to stop taking maternity leave anytime soon. And nor should they! Not only are women, on the whole, more compassionate doctors (and safer), their striving to reach the top/navigate training programmes/seek work-life balance/experience a portfolio career/or whatever other shape their goal may take is an example for all to follow, regardless on how many X and Y chromosomes Life dished out.  I believe that any real solution to Medicine’s “Women Problem” will result in a better deal for everyone. I am unsure how that will work out with the guillotine of the new contract for junior doctors about to fall…

But I know it doesn’t start with blaming women.

Diary of an FY2 – Continue?

February 11, 2016

I wrote recently about how I’ve set my course for Microbiology. I recently did a Taster Week in the specialty and, even when it was boring (authorising 50 MSU results in a row), I thought, yeah, this is my kind of boring. This is the job I want to do when I grow up.

That would involve two years of Core Medical Training, then 5~6 years in Combined Infection Training. Now I’m more than halfway through FY2, I’ve applied for CMT and I’ve a date for an interview that will hopefully secure my future for the next two years.

Meanwhile, the Department of Health and the BMA have spent the last 6 months arguing over a new contract for junior doctors. I’m not going to get into the details (There’s already been far too much written about it, including my own poorly-written hot-take). In short, the DoH proposed a increased basic rate of pay, but cuts to the premium paid for working nights and weekends. There’s more (a lot more!) but that’s the basic jist.

The arguments have flown back and forth, including two days of strike action by junior doctors. And today, Jeremy Hunt, Secretary of State for Health, has had enough. He’s gone nuclear and decided to impose a new contract on junior doctors.

Do I think this contract is better than my current contract? Nope.

Do I think this contract will be good for my training and professional development? Nope.

Do I think that negotiations for a better deal had been exhausted? Nope.

But that’s the thing about the Health Secretary. He doesn’t care what people like me think.

The reaction among junior doctors on Twitter is akin to having Norovirus – the reaction has been immediate, profound and distressing. I’ve seen people saying, that’s it, they quit, or they’ll refuse to sign the contract when they next rotate jobs. I’ve seen people say they’re off for Australia, New Zealand or Canada now. According to one survey, 90% of junior doctors are going to leave…

 

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The promised land?

Even if only a fraction of these tweeps follow through, that’s going to stretch the hospital doctors left. We’re already plagued by rota gaps and questionable levels of staffing as it is. Whatever happens, I predict August will not be fun.

But August is 6 months away! That’s a long time in medicine and in politics. It might be cliche but though the battle is over, the war is not. Let’s see what the BMA and the junior doctors do next.

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So where do I go now?

I could quit right now. And punish the junior doctors left in Worthwhile General with a rota stretched even further, for a contract they didn’t impose. Nope, that’s not my style.

I could emigrate. I envy those with the self-confidence and bravery to up sticks to pastures green. Selfishly, too much of my life is here – including my fiancee.

I could leave medicine in August. I wouldn’t be leaving any colleagues in the lurch. I could stay in the same country as my friends and family. And do what? It’s a scary option…but it’s not like I’m unqualified. I do have two degrees and I can nail an ABG at 3am. I don’t know what I’d do but I’m smart – I’d think of something.

Or I could carry on. Fingers crossed, I get a CMT post. Two more years as an SHO, then the great leapt forward into Combined Infection Training. All under the doubtful auspices of the new contract. It would be a brave new world…but some things would stay the same. There would be patients, every one unique, often surprisingly so, and I might be able to make them better, if I’m smart and lucky. And hopefully, there will be other SHOs (providing I’m not the only doctor left in the country) to work with, share with, laugh with. There will be FY1s and medical students to teach, to keep them from repeating my mistakes, while letting them make their own.

I enjoy medicine. I think I’ll keep doing it for now. There’s likely stormy seas ahead with the new contract but I’m not ready to jump ship just yet. Until then, I remain a doctor.

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Diary of an FY2 – Gotta Catch ’em All!

February 11, 2016

As you probably know, I’m doing my time as an SHO in General Surgery these days. It’s alright – the people are good but the on-calls are rough – but it’s not for me. So last week, I took the opportunity to do a Taster Week in something I want to do.

I dream of being a Microbiologist.

When the drugs don’t work, I want to be the doctor at the end of the telephone line with an idea of what antibiotics to try next. I want to hack my way through agar and biofilm to uncover the microscopic culprit behind a patient’s pneumonia/abscess/septicaemia. I want to wander around the microbiome, knowing the quirks of each bacterial species, with a scrapbook of Gram stains like a goddam Pokedex!

Basically, it’s bugs, drugs and rock ‘n’ roll!

This glorious vision of the future did not arrive fully assembled. Instead, it’s something that has been slowly growing, slowly forcing up shoots into my consciousness. At the start of FY1, I was toying between Psychiatry and Paediatrics – but with jobs in neither. Instead, I rotated through Urology, Respiratory Medicine and Haematology. Three very different specialties…

Urology – Drains. I became proficient in inserting catheters to the point that passing the tip beyond a swollen hyperplastic prostate now gives me a Zen-like rush of fulfillment. Kidney stones were a fun lesson in pain management. And of course there were UTIs. Some were entirely inconsequential while some resulted in horrific sepsis. That was where I first met Pseudomonas aeruginosa.

Respiratory Medicine – In the winter. Very busy. Asthma, COPD, Bronchiectasis…with gratuitous sputum everywhere. Steroids, nebulisers, carbocisteine, chest physio and BIPAP. A myriad of tricks for easier breathing. And Pseudomonas returned, again and again, in some of our recidivist patients. Weeks of IV antibiotics or fumigating the patinet with colomycin nebulisers.

Then Haematology – This was where I realised I needed to do smart medicine. Medicine in amongst the cells, with CD marker and cytogenetics. Medicine down the microscope. I considered Haematology as a career. Then, after we blasted our patients’ bone marrow with chemotherapy, out came Pseudomonas again, with all its cronies against an immune system of precisely zero.

At the end of the year, I knew I wanted to do something near a lab. Smart medicine. I liked the idea of providing advice (That probably says something about my ego) and working things out (the puzzle-solving cliche is irritatingly accurate). Symptoms + Bug = Give This Drug.

But I would be lying if I said this itch started last year. Even in medical school, I enjoyed putting the bacteria in their pigeonholes (Gram stain, coccus, bacillus) and I got a real kick out of how antibiotics work. And why they don’t work. Why this drug will treat this bug and this bug – but not that bug.

It was only recently that I realised why this geekish, stamp-collecting approach appealed to me so much. It was bedding down on existing schemas in my mind, flowing freely along well-trodden neural networks. The idea that everything has a type, can be categorised, and can be treated on the basis of those categories.

Pokemon.

Yes. That cultural phenomenon that went global in 1996 and ignited my 7-year-old mind. I obsessed over my copy of Pokemon Blue, striving to catch ’em all (to train them was my cause!). As the schoolyard trends and popular culture moved on, I did not. I devoured Pokemon Silver then Pokemon Sapphire and so on, as more Pokemon were added and more complexities layered on. To this day, I remain in Pokemon’s thrall. All those hours, all those Pokemon battles, countless pokeballs – They’ve worn a track in my mind and now Pseuodmonas has covered it in a biofilm.

Part-Microbiologist, Part-Pokemon Master. It’s all bugs, drugs and rock ‘n’ roll!

 

Revisiting Doctor Who – The Ninth Doctor

January 7, 2016

A few weeks ago, Eve and I were discussing Doctor Who. Not unusual, this often happens – It was one of the things that brought us together in the first place – but for some reason, I had gotten thoroughly worked up and was ranting off evangelically about the changing face of Doctor Who. Eve took this all with good humour and a lot of patience (as she often does) but she kept having to stop me to ask “Wait, which one was that?” or “I don’t remember that one,” or “Rhys, you’re scaring me.”

That was when we decided to rewatch all of Doctor Who since its regeneration in 2005 to catch up and have a fully-informed conversation (because informed fun is the best kind of fun). So, consider this the minutes of our thoughts on this fantastic journey through time and space.

We’ve recently finished watching Season 1 of the regenerated series, concerning the Ninth Doctor, played by Christopher Ecclestone, and Rose Tyler, played by Billie Piper. This blogpost will take us up to The Christmas Invasion.

  • The first thing that struck us about this first season was just how cheap it looked. 2005 was a long long time ago and this season has not aged well. However, it is equally cheap to judge the season on that in 2015. This was a brand new show and could easily have flopped after a 16 year hiatus.
  • The same goes for some of the acting and writing. Again, this is a fledgling show that had a lot to live up to. It had to make its mark but not overstep it. Some of the ideas in season 1 crop up again later on and get tackled with far more nuance and depth by a show and production far more confident in what they’re about.
  • You could’ve told me this was CBBC and I would’ve believed you.
  • And another thing! Dalek – fun episode but you know it’s got a Dalek in it from the start. There’s the title obviously, and you see the Dalek in the preceding week’s trailer. Why was that not kept a secret, a twist, a reveal? A perfect opportunity wasted!

Let’s have a look at the Doctor.

  • I also thought the Ninth Doctor was under-rated. Rewatching season 1, I am even more convinced of my opinion. Emerging as a loner, a survivor of the Time War, I read this season as the Doctor learning to be the Doctor again. He is superficially happy-go-lucky but with a lot of (thinly-buried) rage to deal with. In Rose, he can barely give a damn about people, especially Rose’s family. However, his hearts melt to the point bleeding by The Empty Child/The Doctor Dances and Bad Wolf.
  • And he is still a violent Doctor. Rose opens with him running around with a bomb, and his first reaction with the Dalek in Dalek is to find the biggest possible gun he can.
  • I knew The Empty Child/The Doctor Dances were the best story of the Ninth Doctor (but I didn’t know that they were by Stephen Moffatt but of course they were). Its creepy, it’s got human depth and, importantly for this Doctor, “Just this once, everybody lives!”
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  • Also noteworthy episodes, for us at least, were Father’s Day and Boomtown, which keep the Doctor in one place  and forces him to confront/examine the experience of having all of time and space to play with. This two episodes hint at what this show could be, more than just a monster-of-the-week pulp sci-fi flick. (Boomtown also improves vastly on Aliens of London/World War Three by dropping all the fart jokes)

…And his companion.

  • I really don’t like Rose as a character. In season 1, I can’t see that she does much more than play the damsel in distress. I await character development.
  • Yes, I know she’s the Bad Wolf. But it took an entire season before she did anything significant (Apart from triggering the events of Father’s Day, which as I’ve said, is quite a worthwhile episode)
  • Do you know who is a better companion in season 1? Lynda-with-a-Y in Bad Wolf. She and the Doctor pair together for one episode but she does more and generates more chemistry with the Doctor than Rose did in the previous season! Give us Lynda!

Lastly, on The Christmas Invasion.

  • I’m sad we didn’t get more time with the Ninth Doctor. So much of season 1 was baby-steps, re-establishing itself. Just think what adventures could have been had with the Ninth Doctor with all the fun and confidence the show gained after the first season. We can only dream.
  • But now David Tennant! This was a development Eve was very much looking forward to…
  • …and he spends most of the Christmas special asleep. Wasted. Meanwhile, Rose does…nothing. The Sycorax rightly mock her for parroting the names of all the aliens of season 1.
  • Then David Tennant wakes up and starts having fun. I think he has more fun in the last 15 minutes of The Christmas Invasion than Christopher Ecclestone had in 13 episodes.
  • Finally awake, the Tenth Doctor tries to figure out what kind a man he is. Great! The crux of every regeneration and a narrative idea that I can really groove on. And it’s done as one long monologue in the last 15 minutes. Wasted. Absolutely wasted.

So in summary, season 1 of the regenerated Doctor Who was a bit of a diamond in the rough for Eve and me. There are some notable stories here and I feel there could be more, or even exceptional, if the show wasn’t simultaneously trying to find its feet, sometimes fumbling the delivery. But I can’t be that harsh. What show ever had a perfect first season, especially when trying to deliver cult sci-fi fun?

Firefly but that’s for a different blogpost.

For what its worth, Eve now understands why I bang on about The Empty Child/The Doctor Dances and why I’m always ready to defend the Ninth Doctor, while I can now fit Father’s Day and Boomtown into a much larger story about a strange man with a blue box.

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On to the Tenth Doctor and season 2! Allons-y!

Diary of an FY2 – Going Solo

December 23, 2015

I am not a surgeon.

I think I’ve always known this. I met quite a number of surgeons I respect and admire, the dramatic impact their calculated butchery can have on patient’s lives. But I couldn’t do it myself. Two left hands? I’ve always seen myself as more a Dr Sparrow rather than Sir Lancelot Spratt.

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“Don’t forget. To be a successful surgeon, you must have the eyes of a hawk, the heart of a lion, and the hands of a lady.”

And now I find myself as surgical SHO, a curious state of affairs. When I was an FY1, there was only so much difference between surgical and medical specialities – one discharge summary is much the same as any other. But now I’m an SHO, I find myself with responsibility. People come to me asking questions about stomas and bowel obstructions and so much bleeding from the rear end.

The on-call shift is really something else. As a medical SHO on-call, I would clerk patients as part of a team, directed and supported by the Medical Registrar. Even night shifts, so alien and anti-circadian, were a team effort fuelled by a strong sense of camaraderie. As the surgical SHO on-call at Worthwhile General, I take the referrals and see all the patients. There is a registrar and a consultant  who review the patients and who I can call on for advice. But mostly it’s just me.

And then there’s the night on-call. Oh lord, that was an experience!

Same rules as the daytime on-call, except the surgical registrar and consultant go home. They’re still there at the end of a telephone call, but probably asleep. And as well as the surgical admissions, I also have to clerk the orthopaedic and urology admissions. If the sum of my surgical knowledge could fit on the back of envelope, all my knowledge of orthopaedics could fit on the postage stamp. But what I do know is how to keep patients safe, and I can do that until the sun comes up. Really, that’s what my night shifts boil down to.

I'm so lonely...

The nocturnal on-call teams for Medicine (Above) and Surgery (Below)

So that’s what a night shift is like. The workload is highly variable; it depends on how much the surgical and orthopaedic teams handover from the daytime, how many surgical patients get admitted overnight, and how many surgical patients on the ward decide to get unwell overnight. On most nights, yeah, it is actually doable by one doctor.

 

But it only takes a little bit more work from each of those streams to really get a doctor down. This is what happened to me on a recent night shift:

It’s 2AM. I get called by the A&E registrar. He’s got a patient in Resus who he wants me to see. The story is brief but he impresses on me how sick the patient is and how I need to see this patient sooner rather than later. I have a list of patients stacking up to clerk – it’s already a busy night – but I bite. This patient sounds sick.

The A&E registrar wasn’t kidding. The patient is not quite in extremis but they’re on their way there. I get a quick history and I check what the A&E team have already done…no bloods, no imaging, no IV fluids, not even a cannula.

Just as I’m about to ask for a hand sorting out this patient, Resus is flooded by the medical on-call team, ITU doctors and A&E nurses and doctors. Far from my A-Team, they’ve come for an inbound patient with a cardiac arrest. From across the bay, I hear a flurry of activity – meanwhile, I run around by myself: Cannula in, bloods out, fluids in, repeat in the other arm. I am hyperacutely aware that my patient is OK for the moment but that the situation, like the patient, is very fragile.

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Did the A&E registrar ask me to see this patient urgently, knowing that there was a cardiac arrest patient on their way in to the hospital? I don’t want to dwell on that question…

After a while, a Resus nurse was released from the crash call. She helped me get the drugs I needed into the patient. On advice from the A&E registrar, I phoned my registrar. Sleepily, he reassured me that I had done everything I could and he had nothing else to add. He asked me how the night was going. I told him the truth.

“Oh wow. That sounds really stressful.” He said non-chalantly.

“Yeah, it is.” I agreed, feeling so much better for that validation.

Night shifts on Surgery are obviously quite lonely. Gone is the camaraderie of the medical team. Just me and my stethoscope. Fortunately, I’m comfortable in my own solitude – I get on quite well with my own company. (Now who’s pitying the only child!!) However, though lonely, I am still not alone. My registrar is still there in spirit, like Obi-Wan Kenobi. And I am surrounded by angels in blue tunics. They’re called nurses.

On the same night as the Resus Patient, I arrived on a surgical ward to review a patient with hyperkalemia. The Ward Sister took one look at me and said, “Doctor, would you like a cup of tea?”

 

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I have seen the hope of my salvation.

What glorious words! What a compassionate sentiment! It’s no exaggeration that that gesture, and that tea, restored me and kept me going that night (especially as I didn’t have time to eat anything that night).

I am a stranger on a strange ward, but somethings remain the same. Despite no longer working in a nocturnal Avengers-style medical team, and despite only having my footsteps for company, I am not alone. I still have registrars on whom I can rely, providing I have phone signal, and I am supported by a host of nurses. There’s tea, and where’s there’s tea, there’s always hope.

I might be going solo but I’m never alone.

Being a surgical SHO is harder than being a medical SHO. It’s stressful and a great deal more responsibility than I’ve had before. I’m out of my comfort zone, but I’m learning. By God, I am learning! That can only ever be a positive thing.

I’ve been on-call a lot this month. Normally, I’d say I can’t wait until Christmas – but I’m on-call then too. You’ve got to pay your dues to play the blues.

P.S. If you want read more about surgical training, my blog is obviously the wrong place. You may want to check out Direct Red by Gabriel Weston instead.