Layla's space

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

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.

5 Comments:

Anonymous Anonymous said...

Hope things pick up for you soon girl.

What does your boyfriend do for a living? Can you talk about your job with him? I'm a physio and my partner is a doctor, so sometimes we sound each other out and it kinda helps. And if he is not medical then maybe it'd be nice to get a fresh outlook on things.

May 04, 2007 7:42 PM  
Blogger Layla said...

Thanks.

My boyfriend is also a doctor, and it does help to talk to him about work. I sometimes don't help matters when I'm stressed or upset though, as I get angry and vociferous and it upsets him, which isn't ideal.

Sometimes it's easier to blurt everything out on the blog, and then he is spared the agony of listening to me rant!

L x

May 04, 2007 8:41 PM  
Anonymous potentilla said...

It would only make you "as bad as they were" if you immediately forgot all about this experience instead of remembering it for when you have a patient with whom it is your job to communicate.

I guess if you're interested in oncology, it's a subject that you will need think about a lot, given how often oncologists' patinets are incurable. I hve a few views, but I won't clutter up your comments box unless you want me to.

May 05, 2007 8:50 PM  
Anonymous Anonymous said...

You should get some general advice from your local Palliative Care doctor - I work in Canada and our unit is superb in providing education and advice for the rest of us.

May 07, 2007 8:32 PM  
Blogger Layla said...

Anon -

yes, our local Palliative Care Team is pretty good at educating when they have the time! I think my Consultants are a bit far gone for that though.

Potentilla -

By all means clutter up my inbox, I'm interested to hear your opinions x

May 07, 2007 11:13 PM  

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