Layla's space

With all its sham, drudgery and broken dreams it is still a beautiful world.

Tuesday, May 15, 2007

MMC interview

Had my MMC interview (medicine ST2) this morning. It was OK, I think, though rather rushed. Three panels consisting of two people each, each 'station' lasting ten minutes.

First station - clinical scenario. 'A man is admitted to CCU with an acute ST elevation myocardial infarction. You are the ST2 on call, and your F1 [note their use of the new 'sexy' terminology] is on CCU when the patient comes in. He is still in pain, and has had 5mg of diamorphine in A+E. However, your F1 [monkey] doesn't realise this, and gives him another 5mg of diamorphine. The patient suffers a respiratory arrest. He panics [surely not!] and calls you to the patient urgently. What do you do?'

A reasonable scenario, I thought. I think my answer was OK. I'm not sure a normal sized adult male would actually have a respiratory arrest after 10mg of diamorphine, but I didn't say that.

And actually come to think of it, I don't know if there are any F1s who would dare give diamorphine to a patient without checking with their SHO (sorry, ST2), their mum and their medical defence union first.

Second station - why do you want to do medicine? What specialty do you want to go into eventually? Have you done any audits? What research have you done? What makes you a good doctor?

All very fair questions. I did manage to get in the fact that I have PACES and am starting an Oncology SpR job next week at the beginning, but worryingly the interviewer forgot this information within two minutes and asked, 'So, what are you going to specialise in? Gastroenterology? Cardiology?', and then said, 'Have you got your MRCP?' at the end. Hmmm. I wonder how much of the rest of my answers he managed to retain.

Final station - going through my application form 'creative writing' answers. Thank God I re-read my form before the interview - I'd forgotten some of the drivel I wrote back in January. The thought of it makes me want to vomit. But I think that station went OK as well.

So, must now sit tight until June when we (allegedly) find out if we are to be welcomed into the big happy MTAS family, or chewed up and spat out - 'Sorry, fuck off to Australia, we don't care if we've spent tens of thousands on training you. Go on, piss off!'.

I have been interrupted by my colleague, who tells me MTAS is to be scrapped! See link :

So what the fuck happens now?

Saturday, May 12, 2007

Moving on to bigger (and scarier) things

I have five days left in my current job. I have accepted a three-month Oncology registrar job at a London teaching hospital, and I am excited, scared and sad about it.

Excited - finally having a taste of what I want to do, at a level of seniority which I have not yet experienced.

Scared - oh my God, I'm going to be a registrar. The person I'm replacing is leaving to become a Consultant. I'm going to rock up, 26 years of age with a face that still gets me ID'd at clubs and off-licences, and say 'Hello, I'm the replacement! My, that's a shiny radiotherapy machine...'. Gulp.

Sad - I have worked at my friendly little District General Hospital for nearly two years. It is the place where I really cut my teeth as a doctor, where I learned much of what I know about the practicalities of hospital medicine, and where I have a bunch of great friends. I know all the nurses, physios, OTs and porters by name, as well as a number of patients who are 'frequent flyers'. I feel like I've grown up here, if that makes any sense.

The job is not part of Mangling Medical Careers - it is temporary, a stop-gap. I assume it will be filled by a shiny new 'ST3' person at the end of August. I have my one guaranteed MMC interview on Tuesday, also in London. Yet another ridiculous consequence of the new system is that, because I applied to MTAS prior to taking my final MRCP exam, I had to apply at ST2, ie SHO level. The fact that I now have MRCP, and am indeed about to start working as a registrar, doesn't matter. I can't change what level I have applied to, so if I get the MTAS job, I will effectively be resigning my registrar job a month early in order to take up a medical SHO job for another year. Resigning my registrar job to go back to doing what I have already been doing for two years.

How fucking stupid is that?! Every single doctor who passed PACES at the same time as I did will be in the same position - forced to remain at SHO grade for an extra year. And 'they' said MTAS would help to 'streamline' training, ensuring that nobody spent too long stuck at the same level. Priceless.

Surely it is some kind of enfringement of employment law, only being able to apply to four jobs per year? Surely everyone should be able to apply for as many jobs as they like, as many times a year as they want to, at the most appropriate level of seniority? There are so many stupid, probably illegal, foolish fuckwittish elements to the whole system, I don't know whether to laugh or cry. Why the haemorrhaging fuck is it still going ahead??!!

I started this post intending to describe my feelings about changing jobs, but I have ended up on MTAS, again. Ho hum.

Friday, May 04, 2007

On feeling crap

I've been feeling shitty all week. No hangover, no 'flu, no summer cold, just generally, inexplicably shit. This job is doing my head in. I'm a senior SHO - during my previous medical firm I had a house officer, with whom I went round the patients every day. I made most of the decisions, and occasionally discussed things with my registrar or consultant. I was responsible for my house officer, and I enjoyed it. We got on well, and I was able to give her teaching which we both enjoyed and benefitted from.

Now I am the sole junior on a ward-based Haematology team. I go round every day on my own, which is fine, but I'm barely allowed to make any decisions, as everything is too 'specialised'. If anyone has a 'medical' problem, I endeavour to investigate it and sort it out. I get no recognition for this - my grossly communication skills-deficient consultants come round once in a blue moon and all they can say is, 'She's had a chest x-ray. What did you do that for?', in an accusatory manner, as if any non-haematological investigation were a form of grevious bodily harm.

I present all the patients at a large, multi-disciplinary ward round once a week and all I get is snide comments about how I haven't described precisely what chromosomal translocation each and every patient has, or that I've slightly mislabelled a condition about which I know little but that nobody can be arsed to teach me about. They look at my list, which I try to compile meticulously, and titter to each other about the changes I've made to the format (it is chiefly my list and I like to use it to help me remember salient facts and investigations which need chasing). They look at me sadly and suggest that perhaps I might like to change it 'back to how it was before you started the job'.

Lately they have tried to co-erce me into attending their journal club, which is a) deeply boring and b) means I have to spend my lunchtimes with them, being laughed at if I ask what they consider to be stupid questions. I went once. I prefer to spend my lunchtimes sat round a big table with my friends, talking about things that normal people talk about, thank you very much.

I took two days off last week to visit my grandmother in hospital. My God, the bitching and moaning that went on behind closed doors (it all filters down to me in the end)! One Consultant sent a snotty email to medical staffing, who sent me a snotty email which they snottily copied to various other snotty people...Fuck them. Fuck them all. I don't need a reference from them, they treat me like crap and don't acknowledge my presence or value to them when I am here, and then they have the balls to bitch about me not being there when I go home to see my sick grandmother, for fuck's sake. Did anyone ask me how she was when I got back? Take a guess. Perhaps they assumed the fact that I didn't take time off to attend a funeral meant that she was OK.

I was on call last weekend and one of our patients, a 29-year-old man with relapsed leukaemia, became very ill. I got him transferred to Intensive Care, but he died on Monday morning. His poor mother, who has nobody else in this world, was shattered. It was clear when the consultants did the ward round on the previous Thursday that this scenario was a very real possibility. In fact the decision was taken to make him not for resuscitation in the event of a cardiac arrest, because such resuscitation would be very unlikely to succeed (plus he had no platelets at all, ie could barely clot his blood despite being given infusions of other peoples' platelets every day, ie he would almost certainly bleed to death from the trauma of cardiopulmonary resuscitation). Plus he had relapsed leukaemia and severe sepsis and had an absolutely dire prognosis. He and his mother had no idea that this was the case. I know that there are certain circumstances where discussing CPR decisions is too upsetting/deemed detrimental to patient care, but in truth these are rare. People need to know what the hell is going on and if it looks bleak, it is important that they know this before things go too far. I realise some people may disagree. The literature I have read (and yes I also realise this is an emotive issue and stuffily talking about research and literature may seem inappropriate) all seems to conclude that patients and relatives want to be told the facts, by and large, and want to know when resuscitation decisions are being made. It is us, the doctors, who have the problem, not them.

Perhaps I should have said something. But I am only a 'baby haematologist' - I just didn't see myself going in after my knuckle-dragging consultants have just breezed out saying, 'We'll just carry on. I'm sure things will start looking up soon...', and sitting down with the man and his mother and telling them the truth. I just couldn't do it. Does that make me as bad as they are? Probably. I just know that when we did sit down and talk to the mother, when he was deteriorating before my eyes and ITU were on their way to assess him, she was utterly shocked and devastated. Should we keep hope alive until the very last minute and then bring them crashing to the ground? Or should we tell them what we are thinking from day one?

Anyway, the week started with the weekend and the weekend was bad. So the week was bad. The mother came into the ward on Wednesday to thank us for helping her son. She looked bloody awful. I felt like shit. I spoke to my boyfriend on the phone that evening (he was away for two days) and had a completely pointless wobbly which has buggered things up between us at the moment, so now I feel worse. I went out drinking last night and had an OK time, but now I'm hungover (again), so now I feel even worse (yes, yes, self-inflicted I know).

Oh, bollocks. And the weather's fucking shite and all.