Long weeks

Hi,

So I have been working as a 'Junior Doctor' for about 2 1/2 weeks now, and it has been really busy. For the last 2 weeks I have been in the hospital every day, as I was on call over the weekend. All of these long days, added to the fact that I have only just got internet in my new house have lead to this relative silence on the blogging front, but hopefully this won't be too common (though I have no idea how things will go for the rest of the year busy-ness-wise!)

I am on a vascular surgery rotation for the next four months, and on normal week days my job isn't too hard. I have to stay relatively late sometimes (I am meant to work 7.30/8 til 5, but sometimes need to stay til 8 or 9) but during the day the things that need to be done are not too challenging. Most of the other surgical teams at the hospital consist of an F1 doctor (or several if busy teams), an SHO or two (a doctor who has a year or a few worth of experience), a registrar or two (a relatively experienced surgeon) and a number of consultants (who are the most experienced surgeons and run the theatres and patients in the hospital). Sadly, my team is much smaller, as I am currently at a smaller district general hospital, and most of the vascular surgery is done at the nearby(ish) large teaching hospital. There is myself and an SHO who is a year ahead of me in terms of exprerience (he has done an F1 job already), but other than that we have very little. There is no assigned registrar for vascular surgery (we have to steal another
teams one if we have problems) and the vascular surgery consultants work most of the time at the large teaching hospital, meaning we see one of them once a week for a ward round. All of last week my SHO was on nights, meaning I was left alone to try and organise the ward patients.

While this is a little scary, it isn't as bad as it sounds. Most of my patients are relatively well, and are in the hospital for rehabilitation. This is because most of the seriously ill patients are sent to the teaching hospital for their surgeries (cases like major amputations and ruptured AAA), while my hospital does small, more simple procedures like removing varicose veins, and accepts patients once they are medically well from the large teaching hospital for rehabilitation. This means that I don't usually need to worry about really sick people, and instead need to fuss over blood sugar control in diabetics, and warfarin doses controlling INR. Good practice to start off my F1 job, as it lets me get used to how all these things work, but not too exciting as what I really enjoy is the challenge of diagnosing and treating sick patients. When something does go wrong, though, I am left floundering a little - as there is no-one around to help (for example when I was asked to come and remove a stuck PICC line as an 'expert' [turned out it just fell out])

Despite this, my patients (and I do love saying 'my patients' now, still feels unreal) do tend to stay in the hospital for some time while we treat infections or help them get used to walking again, so I have plenty of time to build up relationships with them. This is something that I have been doing well at, and have had lots of lovely things said to me about my bedside manner by patients and nurses. Always nice to have compliments when you are having to stay 3 or 4 hours past your normal home time to clerk in a patient who was meant to arrive in the morning, but came into the hospital in the evening and needs to be seen.

My on call weekend was very different to my normal day job. Here, there are two F1 doctors (myself and another), who work under an SHO and a registrar to try and run the hospital over the weekend. This is crazy busy, as people get sick at the sme rate, but instead of the normal teams which is probably about 30-40 surgical doctors during the week, there are about 4 of you. The registrar has to spend most of their time in the operating theatre doing procedures, and the jobs come thick and fast. Prioritising is very important, but some wards seem to want to badger you for relatively unimportant jobs while you have more going on. Through a large chunk of Sunday I had to go to theatre to assist the surgeon by providing another pair of hands to hold some of the instruments, meaning the ward jobs built up even further. All you could do was try your best to do the most important jobs, it seems like a very silly system.

After on call and this double week I was feeling very tyre'd...

All in all, I have been happy this week go go back to a more normal job with patients I know, but I am really looking forward to the coming weekend and having some time off! Very thankful that I am not in for the bank holiday Monday though - that is going to be hectic!

Trepidation

Hi,

Here I am, sitting at home, getting ready for an early nights sleep, but anxious about tomorrow. I have completed a few shadowing days working with the F1 who currently does the job that I will be doing from tomorrow onwards as Dr Internal Optimist.

The shadowing days have been a mixed bag. There were a few boring days of lectures, then a big night out with the other incoming F1s on Friday to 'get to know' each other. A good start! This week we have had a couple of days on the ward, following the current doctor doing our jobs - mine was very good - very well organised and had loads of time for the patients. I have to remind myself that he has a years worth of experience on me, and is effectively now an 'SHO'. I hope that I am not expected to be quite as efficient when I start, but I will definitely try!

In the past few days, I have been quite effective, spending a lot of time trying to get patients with problems home from hospital, the most difficult one being someone who is a drug user, has no home, no GP, but we need to discharge while keeping his medications going (so he doesn't turn back to heroin again) and keep his wound dressed. Trying to get a hostel or home to take him was difficult, but he couldn't live in hospital for the rest of his life. He is meant to be going home tonight, hopefully when I go in tomorrow for 'Black Wednesday' he will not be there.

I think it is the things like that where you can make a huge difference by pushing a bit and making an effort, rather than just leaving things to sort themselves out over weeks. I hope I can keep up the good work over the next few months.

Wish me luck, I will keep you updated!

Graduation

Hi,

Firstly, thank you very much for all of the lovely messages on my previous posts - it is nice to feel appreciated. I will keep writing while being a junior doctor, but may take a different format. This weekly format was quite clunky, as some weeks I had loads to say, and some weeks I didn't have very much - perhaps I will change to a 'regular blog' instead, meaning I can update on days when exciting things happen, with shorter posts which are easier to fit into (what is going to be) my busy working life!

I have now graduated, and am due to start work next week. A very scary thought indeed! Graduation was lovely, we had the normal ceremony in the morning, where we came up on stage one by one to be presented with a certificate as part of the main university ceremony, and then in the afternoon we had our own medical students ceremony where we said the (revised) Hippocratic oath (old one not really fit for modern medicine/surgery) and we had our own prizes, speakers and so on. The main event in the morning was a lot more interesting than the one at the university I intercalated at two years ago; it was a lot more relaxed, a lot more fun and a lot less pompous. The event in the afternoon was very informal as well, and much more personalised as it was just for my year. All in all a really enjoyable day, and having this certificate in my hand, and being Dr Internal Optimist is just crazy. When people ask me what I do, I still say that I have just graduated and try and steer the conversation away from that topic. I feel a bit uncomfortable about it, almost as though it isn't right - something that I hope will pass.

Current impression I am likely to make as I start my vascular rotation next week

And it is important that that feeling passes - 'Black Wednesday' is next Wednesday - I start work in less than a week, and have shadowing before that. I am going to have to introduce myself to all of 'my' patients! I have decided on a compromise, which makes it seem less strange. I am going to indroduce myself as "Internal Optimist, one of the doctors looking after your care" rather than "Dr Internal Optimist" as it seems less... strange to me. I don't know why it is - I suppose I have always held those who teach us in quite high regard (yeah, I am a bit of a goody-two-shoes ... or sometimes at least). Having looked up to some very inspirational doctors during my 6 years at medical school, it is very strange having crossed that student-brain-barrier and having entered a position where I could well be the 'inspirational' doctor that medical students see. Sadly it is much more likely that I am the poorly-organised-and-rushing-around-doctor who medical students will not get much help from, but I will try my best.

Anyway, I am looking forward to everything ahead, and while it feels very strange, I think that is a good thing. I will keep posting and keep you all updated. Thank you for being so lovely to me throughout my time posting as a student - writing a blog is good I think. It encourages reflection (and god knows we are told to do enough of that at medical school) and is cathartic to talk about what happened, and look back on how things made me feel. I just wish I had the time (and knowledge) to organise all my old posts in some way to make them more easily findable, and separate them from the 'Dr posts' that will come.

If anyone has any good ideas for a blog title change, please let me know!

Final week as a medical student

Hi,

I would like to apologise for this post being really late, I wrote it over a week ago, then pressed save rather than publish, and went on holiday. The holiday was lovely, but I realise that I need to actually press the right button!

Despite having found out I had passed my finals almost 2 months ago, I have been working as a medical student in the hospital, getting ready for the job of 'doctor' come August. The idea still makes me feel excited and/or scared. However, the gruelling life of a medical student has come to an end for me. This was the last week I am going to spend in hospital as a medical student, and was topped off with my graduation ball. This week I introduced myself as a medical student for the very last time, I did my last referral as a medical student (where, ironically, I got a grumpy doctor who refused to talk to medical students as it was 'inappropriate') and signed myself off as "Internal Optimist, Medical Student" at the bottom of the notes for the last ever time. It is so exciting to think that, after a months holiday, I will be writing "Dr Internal Optimist, GMC *******" at the bottom of the notes instead. 6 years of hard work, not including all of the school work and preparation before university, have gone into this end point. 

But I am not really sure how to feel.

The ending has been a bit spread out; I was really happy to finish my finals, and overjoyed to have passed them, but then I have been working as a medical student for the last 1-2 months. I haven't really had any real 'you are finished forever' moment, which is arguably a good thing. I am so glad after each 'hurdle' that I manage to make it over, I am not sure I would be able to handle all of it at once. Although I will never be introducing myself as a medical student again, I still have one 'hurdle' left - graduation. After graduation, when I have that certificate in my hand, I will feel as though it is well and truly over. It will probably be quite an emotional day, not just for me, but for most of my year.

So I am slightly confused about how to feel at the moment. I am very relieved that I have made it despite friends who were just as able as me dropping out of the course throughout the last 6 years. I am really happy to have made my main 'life goal' over the last 7 years or so. Most of the last 7 years have been aimed at getting into and passing this course, then getting a good set of rotations afterwards, all of which I have managed to achieve. 

But I still feel a bit uneasy. Perhaps it is a sense of 'what now' - having such a long term goal fulfilled leaves me wondering what I should be aiming at now. Perhaps it is the fear of working as a doctor next year; a job where patients put a huge amount of trust in you, and where a simple mistake can have disastrous consequences.

Don't get me wrong though, I really am happy to finish this course and graduate, it is just there is a slight grey lining to my radiant silver cloud. After graduation, I think the only way that I am going to feel more relaxed about this is by starting work in August, and proving to myself that I can do this job. After all, I have spent 6 years preparing for it, I should be ready by now!

Ambulances

Hi,

An interesting week in A&E, the most exciting part being a few days with the ambulance service with the paramedics. 

A&E had some interesting cases, some sad cases and some relatively dull cases. The interesting included someone whose pacemaker was giving the wrong signals, a road traffic accident where a cyclist had been hit by a car, who had then run off (leading to us trying to balance the clinical needs of the patient with the police wanting to question them ASAP to catch the car driver), and someone who had dislocated their shoulder (which I got to put back in, something I hadn't done before). Several of the sad cases involved people coming into A&E and dying of problems like cardiac arrests, and one was a patient who liked to 'fake' seizures to get her into hospital. There are always lots of less interesting cases, and people who come into A&E who should have gone to their GP instead, but I am still really enjoying this placement.

The most exciting part of the week, as I said before, was a few days on am ambulance with a paramedic and a technician. Driving around on blue lights and everyone getting out of your way is very exciting! The saddest case that we saw was a man who had started feeling really breathless and confused while in a supermarket, and the cashier had called 999. He has a strange heart rhythm, which we initially thought was SVT, but was actually fast AF. He was very worried about his car parking ticket running out as we took him on blue lights to the hospital, and I spent the time reassuring him. We arrived, and 10 minutes later he arrested and, despite 40 minutes of resuscitation being attempted, he died. Despite him appearing relatively well in the ambulance, where his main worry was his car, he just died - and we still have no idea why. He didn't seem to have any signs of a heart attack, so we were wondering if it could be a PE. I found it quite upsetting, and I don't think that feeling a bit travel sick from bouncing around in the back of the ambulance at high speed with no windows helped things. We saw a number of other patients including a man who had been found in a very 'compromising' position, who tried to tell us that he had been attacked in his home, though it looked as though the problem had been caused by some kind of strange sex game. 

SVT: regular, fast 






AF can be fast and look similar to SVT, but will be irregular rather than regular in rhythm





While on call with the ambulance guys, I also went into a school full of primary school children and spent some time showing them around the ambulance with the paramedic, letting them turn on the lights and sirens etc. We were still 'on call' whilst doing that, but didn't have any interruptions. I think the point of it was to try and make sure kids are not scared of ambulances if they need to come into hospital, and think they look 'cool' instead! After some of the sadder patients before the school, I didn't really feel in the mood to be very cheerful and upbeat (which you need when talking to children), but it was a nice distraction. 

Seeing a few days in the life of a paramedic was interesting though, as despite there being some interesting things, there is also a lot of calls that they attend that they certainly shouldn't need to; a lot of people misusing the 999 number.

Quite an emotional week, but busy and interesting. My last week next week, then graduation, a little holiday and I start working as a doctor!