Layla's space

Sympathy for medical students

2011-07-23T15:12:00.002+01:00

Hello. Long time no post. Just got out of the habit I suppose. However I am now revising for exams (yet again) and thus am always eager to find ways to waste time.

My dad forwarded me some old emails that I had sent to him and my mum when I was on elective etc. Hidden amongst them was one I'd sent them when I started my 1st clinical attachment as a 3rd year medical student. Reading it made me resolve to be more sympathetic to the confused, gormless looking types I see wandering around these days:

'....we are killing time at the moment as the doctor we were supposed to have a ward round with this morning didn't know we existed, so buggered off and did something else. We have something at 11 in another part of the hospital which we don't know how to get to, then Urology this afternoon and then a tutorial in X Community Hospital later (we went to that yesterday only to be told we were supposed to be there today, then we couldn't get back into the hospital because we didn't know the code for the door, so wandered round for half an hour being faced by barbed wire fences at every turn before we finally made it back to the front entrance). X Community Hospital is approximately 5,024 years old and smells like it is older. Main Teaching Hospital isn't too bad though, although we don't know where anything is....

'So you see I haven't really done anything yet. We don't have a timetable for the term yet as our Consultant doesn't start work til next week, so I don't know what things will be like yet. I don't know what study module I'm doing yet either, but I do know we have lectures on Wednesdays - this week's goes under the exciting title of 'Pathology Symposium' (now we're clinical students we have 'symposia' instead of lectures, but they are basically still lectures)....

'Should be an interesting year. I have to go wander around aimlessly now, so I will leave it here.'

To any 'surprise' medical students I've been stroppy with for pitching up in my busy clinic, I apologise. I remember now.

Why do you love me?

2010-05-20T17:17:00.004+01:00

I'm a real sod to live with. I've been having a rare episode of navel-gazing, which unearthed the following truths:

I have 2 gears -

1) full-on caffeine-fuelled manic - I drive too quickly, walk too quickly, eat too quickly and talk too quickly. I do everything at 100 miles an hour. I get palpitations and heartburn. I have a resting hand tremor. I talk to myself and laugh madly at random things that no-one else thinks are funny.

2) catatonic staring at the TV or engrossed in a book - I am utterly unwilling/unable to communicate with anyone or engage with the real world. A slack-jawed, dozy sloth.

I cannot tolerate anyone disagreeing with me. When annoyed I swear a lot and raise my voice in an attempt to browbeat the other person into submission.

I have a phobia of organising things and planning. It makes me stressed. Difficult when your boyfriend is on the OCD side of the spectrum.

I'm a bit of a slob. I get home, the place is a mess, I notice the place is a mess, but I really cannot be arsed to do anything about it and so flop on the sofa with a glass of wine instead. Fine when you do it once in a while, but every night is a bit much for the person you live with if they have a lower 'mess threshold' than you.

Mood swings. Sometimes I'm inexplicably happy, cheerful and smiley. Then I'll suddenly start to go on a downer, often triggered by something very minor (or sometimes by nothing at all), and I'll feel like crap and get snappy and sullen. Like this morning. I woke up feeling horribly anxious and stressed out for no particular reason, then burst into tears and refused to get out of bed for half an hour. I was late. When I got to work I felt strangely serene and was in a pretty good mood for the rest of the day.

Pessimism - I always imagine the worst possible outcome, just so I won't be disappointed if/when it happens. This could be taken as realism/pragmatism, but I work myself up into a hyper-anxious state and convince myself that this is how things are going to turn out. Usually they don't, but I do it every time.

Short temper - I get annoyed so damn easily, say horrible things I don't mean and then cool down soon afterwards and feel awful about it. I sometimes make a conscious effort not to bring something up that's annoying me, as I realise it's petty/minor/silly, but then it inevitably builds up and up in my head until I randomly explode and make much more of a fuss about it than I would have done if I'd just said something to start with.

It honestly puzzles me deeply why any man in their right mind would want to go out with, let alone share a house with, a person like me. I wouldn't want to live with me. I'm impossible. I have insight into this, but can't seem to do much about it. I do try (intermittently) to behave like a sane, rational human being, but unfortunately I don't happen to be one.

I do love him. Very very much. But I worry that he'll get fed up and leave. Or worse, meet someone who's sane, fall in love with her, and then leave.

I really must try to stop being such a total arse.

On a lighter note....

2010-03-04T16:30:00.002Z

Dr Grumpy posted a very sad (and unfortunately familiar) story on his blog today - read it here.

Reading it, for some reason, reminded me of a joke I heard a while ago which, in the absence of anything profound or interesting to write, I reproduce here:

2 haematologists are looking down their microscopes at a bone marrow aspirate. They get very excited - it shows that the owner of the bone marrow, Mr Jones, has acute lymphoblastic leukaemia.

'Quick!', one says. 'We must go and find Mr Jones, and save his life!'

They run down to the medical ward, frantically searching the bays for Mr Jones, who is nowhere to be found. They run up to the ward sister.

'Nurse! Quick! We must find Mr Jones, he has leukaemia and we need to save his life!'

'I'm sorry doctors,' says the sister. 'Mr Jones passed away.'

'No! That can't be true, we can save his life! Quick, where is he?'

The ward sister tells him that Mr Jones was taken to the mortuary. So off they run to the mortuary, and pounce on the mortician.

'Where is Mr Jones? He has leukaemia, but we can save his life!'

The mortician, mystified, tells them that he thinks Mr Jones is in the Chapel of Rest.

The haematologists burst into the Chapel of Rest, and search high and low, but there is no Mr Jones to be found. They turn to the chaplain.

'Where is Mr Jones?!'

The chaplain tells them that Mr Jones was taken to the cemetary already, and was buried that morning. Undeterred, the haematologists leave the hospital and drive at breakneck speed to the cemetary. After a bit of a search, they find Mr Jones' grave. They pick up a couple of conveniently located shovels and dig up the coffin. They prise the lid off....

The coffin is empty. In place of a body, there is a note:

'GONE FOR DIALYSIS'

On becoming a cantankerous old sod

2010-01-23T21:53:00.003Z

I really am incredibly intolerant.

I think (I hope) that most people (patients and colleagues) who meet me in a professional capacity think that I am pleasant, relatively patient and sympathetic to their problems, as well as being fairly helpful most of the time. My friends, whom I think (hope) feel that I am a reasonably good and sympathetic listener, know that I nonetheless have a fairly serious moaning habit and that I can be rather bitchy at times. Perhaps the more charitable would say that I do not suffer fools.

My internal monologue, however, is a total bitch. A miserable, intolerant, cantankerous, curmudgeonly old bugger. And it is becoming increasingly vociferous. When I was a bit younger I used to empathise very much with most patients, and people in general, and give them the benefit of the doubt. Whilst I've always had a quick temper, I would generally not make snap judgements about people, and if I was speaking to anyone about a problem I would usually feel genuine sympathy. I also used to be a bit more willing to help people out, do people favours, you know - and I would genuinely enjoy helping on most occasions (even if only for brownie points).

Now? Forget it. Don't get me wrong, I do sympathise with people having a genuinely shit time, e.g. young patients with horrible brain tumours who have months to live (and most of them are just so bloody nice), but whinging fucking people who really don't have much to whinge about do my fucking head in. And this internal voice of mine is getting louder and louder.

Breast cancer patient (cured, under follow up): 'Right I've made a list of things I need to ask you'...clears throat....

Me: smiling 'Oh, that's very organised of you!'

Internal monologue: 'I'm going to poke my own fucking eyes out.'

Patient: 'When can I start dyeing my hair again? Because I always used to dye it this lovely brunette colour you see, and now it's all grown back kind of grey, and I have this salon I used to go to, and....'

Me: nodding encouragingly...'Yes, that's a common question'...cue standard speech about hair dyeing post chemotherapy

Internal monologue: 'Do I look like a fucking hairdresser? DO I??!!'

Patient: 'OK, next thing....would it be OK for me to go back to my Pilates class? Because my abs have really gotten flabby and....'

Internal monologue: 'Shut. The. FUCK. Up. And fuck off with your greying hair and your flabby abs.'

A recent telephone conversation with one of the Consultants:

He: 'Layla, are you busy?'

Me: 'Er, yes actually, I'm in clinic with Dr X at the moment.'

Internal monologue: 'Don't you dare give me anything else to do, I've had a bucket of espresso and I can't even hold a pen.'

He: 'Is it a busy clinic?'

Me: 'Well, fairly busy, yes'

Internal monologue: 'How long have you worked in Oncology, dumbarse?! Of course it's a busy clinic, clinics are always fucking busy, you chuck a wobbly if I just ask you to sign a chemo script when you're doing your clinic because you're so busy, for FUCK'S SAKE.'

He: 'Have you got many people waiting at the moment?'

Me: 'A couple, yes, but do you need me to do something for you?'

Internal monologue: 'Get to the fucking point, arsehole, you're going to make me do something anyway so just FUCKING WELL ASK ME AND STOP WASTING MY FUCKING TIME!'

He: 'They've called me about Mrs So-and-So on the chemo unit, apparently they've lost her consent form so another one needs doing, only I'm busy in planning and you know my registrar's away this week, so....'

Me: 'OK, no worries. I'll nip round now shall I?'

Internal monologue: 'You are a total fucking wanker and I hate your guts.'

It's not just at work either. I was at a conference the other day, where there were a lot of other registrars, most of whom I knew. I saw a registrar wearing a suit and tie, who I didn't recognise. He did nothing but walk past me, but my internal voice said, clear as day:

'I wonder who he is? He looks like a twat.'

I'm a little worried that the internal monologue will externalise at some point and I'll end up seriously offending people. I do tend to be a bit more vocal (some would say nasty on occasion) when I'm drunk. In vino veritas - I really am horrible then.

Possibly the worst thing (or the best, depending on how you look at it), is that for the moment I'm quite good at covering my utter disdain and impatience with smiles and encouraging gestures. The breast cancer patient I mentioned above (who went on to ask me about underwired bras, holidays and dairy-free diets before I spontaneously combusted) seemed very pleased with my demeanour and the way I answered her questions. When I went out to call the next patient after she'd left my room, I overheard her talking to the Breast Care Nurse:

'That doctor is so lovely - will I be seeing her again next time instead of the Consultant?'

If only you knew lady, if only you knew.

Working in the sticks

2009-12-14T08:12:00.002Z

I moved jobs a few months ago (or 'rotated' as the Deanery would have it) and am currently working in a District General Hospital just outside London. When I told a few friends and colleagues where I was going to be working, there were a few sniggers (including from me) and jokes about local yokels, chavs etc and generally about the contrast between this place and the large London teaching hospital I was working at previously.

Actually, I much prefer it here. In my (relatively limited) experience, large teaching hospitals are rather dysfunctional. The administration side of things at my previous place of work was a nightmare - the secretaries were off sick half the time (and they were pretty piss poor when they were there). There are far too many people with their heads up their arses in a lot of these big places, who are only out to puff up their own over-inflated egos. More 'lowly' staff are demoralised and bored, and have no incentive to do a good job. They therefore tend to be monumentally unhelpful and trying to get anything done/ordered/chased up is a major drama. If you need to order a slightly unusual test, or get something done urgently, you get put on hold umpteen times and pushed from pillar to post, department to department, because it's not anybody's responsibility. 'That's not my job' is a favourite phrase.

Here, however, I have found almost everyone to be incredibly friendly and helpful. There is more of a sense of community I suppose, everyone knows everyone else (or it seems that way, though it's not that small a hospital) and therefore seems more inclined to help you and point you in the right direction. If you need an echocardiogram result, for example, you just call up Maureen in Cardiology and she'll fax it to you. My old teaching hospital? Forget it - there was never anyone to answer the phone in the echo department, they refused to fax results and tended to lose most of them anyway. I used to go to the department myself and look through their (useless) filing system until I found the result I needed.

In the Oncology Department, people are generally a bit saner. In my (again, rather limited) experience, Oncology Consultants in teaching hospitals are generally mad. Usually very good at their jobs, but mad as a bag of cats. Mad, and they all hate each other, which results in a horrible, snidey, competitive atmosphere in the department. Here, amazingly, they all seem to get on. They seem to actually care about their trainees (ie us), and seem to be relatively sane (there are, of course, exceptions).

There are downsides to working in a DGH, of course - mainly lack of resources. So for example, getting urgent scans can be difficult due to staff shortages, machines breaking down, etc. There is a 'longer than there should be' wait for treatment in the Radiotherapy department at the moment as they've just laid off a few radiographers (yeah, smart move Mr Chief Executive - you've saved money on their salaries but now we're going to get fined millions for not hitting cancer treatment targets - well done you).

But anyway, all in all, I feel less stressed out (now I've said that I'm undoubtedly going to have a really stressful day today), more appreciated and generally happier at work. Oh, and did I mention that I usually leave work on time these days?

Just call me Dr Local Yokel - I'm a total convert.

Empathy for Dr Grumpy

2009-10-15T10:31:00.006+01:00

A patient called our secretary today asking for someone to give her advice. She had a large tumour removed from her bowel almost a year ago, and was taking imatinib (a non-chemotherapy 'anti-cancer' tablet) to reduce the risk of recurrence. She was supposed to be taking it for a year in total, and was due to complete the course in early November.

The message the secretary gave me was that the lady was puking up the imatinib (and her other medications) whenever she took it, so she wanted to know if it was OK to stop the imatinib as she was nearly finished the course anyway.

I called her. I had to speak to her via her lobotomised husband as she was too ill to come to the phone. I eventually managed to get out of him that she had been throwing up for 2 days, not keeping anything down, had crampy abdominal pain and had not opened her bowels for 2 days either. Their only concern was about the imatinib and whether they could just stop it.

Me: 'Have you been to see your doctor about the vomiting and stomach pains?'

Mr Lobotomy: 'Er...no, no, you see, last year she had the exact same symptoms and we were told they were brought on by stress, so you see she just needs to rest in bed for a while and all we want to know is can she stop the imatinib?'

Me: 'You mean she had the same symptoms just before she was diagnosed with a large tumour in her bowel and had to undergo extensive abdominal surgery?'

Mr Lobotomy: 'Er, yes. But she's sure this is all due to stress. We've just moved house, you see. So what about the imatinib, is it OK to stop it?'

Me: 'I think she's already stopped it, hasn't she? Seeing as she's not keeping it down? I don't think that's the main problem here, I'm worried your wife may have a blockage in her bowel, either related to the tumour she had before or possibly from adhesions from her previous surgery. She's probably very dehydrated now too. Are you able to bring her to hospital so we can assess her?'

Mr Lobotomy: 'Oh, er, I don't know about that, she's not very well, she might throw up in the car.'

Me: 'OK, if she's not well enough to come in the car I would advise you to call an ambulance to bring her to A+E and I will see her there.'

Mr Lobotomy: 'Oh, er, um, I don't think she'd like that very much....'

Eventually I managed to get the patient on the phone. She sounded very unwell. I explained that she might have bowel obstruction, which was potentially very serious, and that she should come into hospital. She said she couldn't come today, she needed to rest in bed. She might come tomorrow, and could she have my phone number in case she decided to come tomorrow?

The end result was that they agreed to a home visit from their GP, so at least a doctor would examine her today. Mr Lobotomy assured me he would contact the GP surgery to ask for a home visit. I felt sure that his wife would veto that as soon as he put the phone down to me, so I told him I would call the surgery as well to make sure they had details of her medical history.

I called the surgery. I spoke to the receptionist, explaining who I am, and asked if I could speak to the duty doctor regarding the patient (her own GP was no longer with the practice) and to request a home visit.

Receptionist: 'I'll just put you on hold and ask Dr Smith if he can speak to you.'

Me: 'OK.'

After holding for several minutes....

Receptionist: 'I've spoken to Dr Smith, he's busy at the moment I'm afraid.'

Me: 'Well can he please call me back as soon as he's free? It's rather urgent.'

Receptionist: 'Oh, I don't know about that....hang on...'

Several more minutes of holding...

Receptionist: 'What symptoms is the patient experiencing?'

Me: 'Pardon?'

Receptionist: 'Dr Smith asked me to find out from you what symptoms the patient has.'

Me: 'He wants you to take a history for him?!'

Receptionist: 'Yes. What symptoms has the patient been experiencing?'

Dull thud as my head hits the desk.

I gave the history to the receptionist. Eventually a GP (not Dr Smith) called me back (asking to speak to a completely garbled version of my name - I'd even spelled it for her), I told him the details, and he's gone to see the patient at home.

I need a stiff drink now.

'Clapton is God'

2009-05-27T23:22:00.007+01:00

I went to the Albert Hall recently to see Eric Clapton. When I told people at work that I went, they were like, 'Oh, that sounds cool. Did you enjoy it?' To put it in context - the guy is my idol, he is a legend, I have been listening to his music since I was about 14 and I just could not believe I was there actually watching him play. Yes, you could say I enjoyed it.

Our seats were amazing - I could have walked over and touched him in about 10 seconds (I didn't try). I've never seen a live performance so close (apart from dodgy local bands in my home town). For the 1st couple of tunes I was a bit overwhelmed I think - I literally just sat there with my mouth open and tears in my eyes, and all those years of listening to his stuff over and over again on my Walkman on the way to school, in my room, in the car, etc were running through my head and it was like oh my God Eric fucking Clapton is standing right in front of me playing a Fender Strat! Don't wake me up from this dream!

Thankfully I did calm down a bit after the 1st couple of songs. As predicted, he made that guitar sing. The band were amazing as well - Andy Fairweather-Low had a couple of great guitar solos himself, Chris Stainton and Tim Carmon were phenomenal on keyboards (a couple of great solos there too), as was Willie Weeks on bass, Steve Gadd on drums and the backing vocalists (Michelle John and Sharon White) were pretty powerful. One of his old band members (Doyle Bramhall II - great name) was playing in the support act (Arc Angels) and he joined them for Layla, Cocaine and Crossroads at the end of the set.

I actually looked up the set list from reviews of previous nights and was a bit disappointed that he made 'Layla' part of his acoustic set, but hey, it sounds lovely on the acoustic guitar anyway. But on the night we went he played the full on, storming electric guitar version - I couldn't fucking believe it (cue me welling up like a big girl again). They seemed to have fattened up the sound of the long, meandering piano/guitar bit at the end of the song, which I enjoyed (I always used to fast-forward that bit - a bit long), and then they segued straight into a stonking rendition of JJ Cale's Cocaine - cue all the middle-aged people jumping out of their seats and having a bit of a boogie :)

He did a couple of Cream numbers - 'Badge', which he'd jazzed up a bit so it had a massive sound - loved it, and Crossroads, which was the encore song. I would have loved to hear 'White Room' or 'Sunshine of Your Love' as well, but the guy has a massive back catalogue I suppose, can't please everyone completely.

All in all, Eric rocked his 'front room', as he likes to think of the Albert Hall. I was a bit worried when I read a couple of reviews before the show - they didn't pan it or anything but they did say it was a bit pedestrian and that he looked 'too comfortable'. One of them criticised him for being too casual and turning up in his 'gardening trousers'! Well they can shut it, quite frankly, because he was sublime. I don't know what they expect from a 64-year-old guitarist - acrobatics? Playing the solos with his teeth? He's never been amazingly energetic on stage - he lets his guitar playing speak for itself. And I didn't go there to check out his designer gear - who gives a toss what he wears? Jeans and a shirt are fine with me - and he did look very comfy in his loafers :)

Muppets

2009-05-12T20:42:00.009+01:00

At the risk of sounding like some crusty old fart saying 'in my day...', WTF is happening to house officers and SHOs these days?

There seem to be a lot more incompetent/lazy/unprofessional/downright SHIT ones working at the moment. Is it MTAS? Is it the EWTD? Is it just a general change of attitude and loss of professionalism on the part of doctors in general?

In Oncology, for example, the ward SHOs should generally be expected to have done a reasonable amount of general medicine so that they can deal with medical problems which (frequently) affect Oncology patients. I am not on the ward very often - I spend most of my time in Outpatient clinics, often in other hospitals. I need competent SHOs to deal with the ward patients most of the time, with telephone advice from me whenever it is needed. I expect them to know all the patients, to know what's happening with their schedule of investigations, what their blood tests are doing, what their vital signs are doing, and what the plan is regarding their treatment and eventual discharge. I also expect them to get the important jobs done - and this means that if it comes to 5 o'clock and the important jobs are not done, they fucking well stay until they are done, or they hand over to the SHO on call who should get them done. I did that job less than a year ago - I know these are perfectly reasonable expectations that are relatively simple to fulfil.

One of my SHOs is fantastic. He doesn't know very much about Oncology - that is fine, that's my job. But he is a good general medic and he is safe. He gives a shit too, which is becoming increasingly uncommon. The other one, less so. I came to the ward the other day around 5pm (yes, late, but clinic finished at 5) and asked this SHO to sit down and quickly run through the patients with me before I saw them (I wasn't going to make him stay late and go round them, I just wanted to talk over each one briefly). He just sat there, all attitude, blatantly pissed off that he was having to stay one second beyond 5pm. Told me complete bollocks about the patients, e.g.

Me: 'Was her renal function any better today?'

Him: 'Yeah, fine'

Me: checking result on computer 'Actually, it hasn't been done and she was in renal failure yesterday'

Him: shrugs

I eventually got fed up and told him to go home. I then spent 2 hours seeing everyone and correcting his fuck-ups. For example, a lady with an electrolyte imbalance who was losing calcium, potassium and magnesium by the bucketload and needed constant topping up via a drip. She had a 12-hourly bag of plain saline (no additives) running, was dry as a crisp and also had carpopetal spasm and a positive Chvostek's sign - suggesting a dangerously low calcium level. Her bloods showed very low calcium, potassium and magnesium levels. He hadn't fucking checked them. He hadn't written up any fluids or additives to replace her electrolytes.

Having a very low potassium can kill you. This is something medical students know. Writing up intravenous fluids and replacing electrolytes is something the lowliest, greenest house officer in their first week on the job should know how to do. It isn't fucking rocket science - and that's the point. It's not that he wouldn't have known how to sort out this patient's electrolyte balance. He just didn't care.

When I was an SHO (here we go...yes I know it was only a year ago), I would have been mortified if my registrar had to go round writing up fluids for my patients. I would be almost insulted if they checked the bloods on a ward patient - that was my job.

I had a call from an A+E SHO the other day:

SHO: 'I have a man here in A+E. He was diagnosed with skin cancer in March. He's 63. He came in because he's not very well. He's acidotic and I've given him oxygen and some fluids and I think he should be transferred to the Oncology ward.'

Me: 'What kind of skin cancer does he have?' (Thinking, perhaps metastatic melanoma, post-chemotherapy, neutropenic sepsis perhaps...)

SHO: 'I don't know.'

Me: 'Well, has he had any Oncology treatment? You know, like radiotherapy or chemotherapy?'

SHO: 'I don't know.'

Me: 'OK...what's your working diagnosis? Do you think he's septic? Or could he have had a pulmonary embolism maybe? Has he had a chest x-ray?'

SHO: 'Er...he doesn't look like he's had a PE, but I'm waiting for the bloods to come back. I haven't ordered a chest x-ray. But he has cancer and he's going to breach soon [ie about to hit the 4-hour limit in A+E] so he should really go to the Oncology ward.'

Me: beginning to lose it slightly 'Hang on...so you have this guy, you don't know what's wrong with him, you think it must be related to his cancer or his cancer treatment because you're referring him to me, but you don't know what kind of cancer he has or if he's had any treatment for it, and you want me to sort him out for you?'

SHO: 'Er, yes.'

Me: sounding a wee bit terse now 'Get your registrar to look at him, get a working diagnosis, find out some information about his Oncology history, and call me back.' Click.

Me: 'AAAAAAAAAAAAAAAAAAARRRRRRGGGGGHHHH!!!!'

I mean, WTF?? You make a referral to someone, you get the relevant information and have it in front of you and get your fucking story straight before you pick up the fucking phone! Our letters are on a computer system - even if the patient was confused and had no relatives with him his clinic letters would all be there at the click of a mouse. And at least have an idea about what might be wrong with the fucking person before you try and send them to me to sort out.

For the record, I spoke to the A+E registrar later. He was apologetic. The patient had pneumonia and was admitted under the respiratory team. His cancer diagnosis? He had had a BCC (very slow-growing, usually innocuous skin cancer) removed from his forehead by a dermatologist in March. Never been seen by an oncologist - did not need to see one.

I know, these could be isolated cases of someone who is just shit and someone who just doesn't care. But I have seen the same kind of stuff again and again. My colleagues tell me similar stories (and much, much worse). The over-riding impression I get is 1) junior docs are less competent these days and 2) they don't give a shit.

Are we losing our professionalism? Have we as a profession decided that we're sick of thinking of medicine as a 'calling', sick of papering over the cracks in the system by staying late without being paid to and by sacrificing our personal lives? Do we just want to do a 9-5 job? Perhaps, and perhaps enough is enough for some of us. But that doesn't explain the shitty attitude of doctors who have barely been qualified for five minutes. Surely they haven't had time to become that jaded. Who knows?

I know the system is far from perfect. I know that to deliver the care that patients expect and deserve in today's NHS, you often have to sacrifice your personal life. You have to stay late, go in early, bust a gut. And actually, why should we? How is the system going to improve if we keep 'covering' for it? Fine, so we fire-fight. We make sure we are safe, that we are not negligent, that patients get treated and of course 'first, do no harm'. But we do not go the extra mile to make things perfect. I can understand that approach.

But I'm sorry, there is no excuse for being fucking shit.

Better things

2009-03-06T14:38:00.002Z

I have finished my sentence with my dysfunctional, irrational, erratic yet sometimes stangely pleasant boss....and I survived. More than that, I think I did a good job and managed to impress him. I learned a hell of a lot, and I've had some great feedback from nurses, CNSs and radiographers as well as from my boss. Most importantly, I'm still sane (just about!) and I think I'm a better oncologist. So, mission accomplished I suppose.

My new boss is absolutely lovely. Pleasant, normal, keen to teach, enthusiastic....I feel much less stressed, despite having started a new tumour site which I haven't got much experience of yet and having to prove myself all over again, which would normally send me into paroxysms of paranoia and tension (as you may have guessed, I am not the most laid back person on the planet). I just feel better.

And the weather's getting warmer, I've already booked my annual leave for the summer (2 weeks!!), my salary hasn't been cut (yet - not until September) and I'm going to start running again once it's light enough in the evenings. Better, better things.

AND The Apprentice is starting soon...:)

To someone I never knew

2008-12-01T23:12:00.002Z

I met you three times. I spoke to you once since then.

You were professional, and seemed wise beyond your years. You were efficient, and explained the process clearly and compassionately.

When the day finally came, you were there. Sombre, and wholly appropriately dressed, with an appropriate expression. You followed us in one of the appropriately sombre cars.

When we entered the chapel, I heard the music for the first time as it was meant to be heard - aloud, across a large space. Suddenly there were people turning to look at me, kindly, but wondering when I would lose it. I could feel their curiosity, compassionate though it was. At the end of the aisle was her coffin, covered in flowers. Stark.

Suddenly I was unbearably, baldly, nakedly in that moment. Suddenly I knew exactly where I was, why I was there, and what I would have to do in front of all these people. I turned around, whether deliberately to look at you, or to escape, I don't know. But I turned, and you were right behind me. You caught my panicked expression and held my gaze. It took a split second, but I knew you understood exactly how I felt in that awful reality-check moment, as my world shattered around my ears for the second time. You looked at me, and you just knew. You looked at me, you nodded, and you said 'Okay?'. That's it. With that single word, and that look, I was suddenly strong again. I walked dry-eyed to the front and listened to the rest of her music. I stood before my family, her friends and my friends and I spoke about her, about who she is and was and what she meant, and I didn't cry, I didn't lose it, I stood up straight and told them.

That was because of you. You didn't know it, and now you're gone too. Younger than me, and you're gone.

I can't think what else to say, except, belatedly, thank you. Far, far too late, thank you for what you did for me and for so many others. I hope, when your loved ones are walking down that hideous aisle toward your coffin, that they have someone behind them to catch their eye and ask, 'Okay?'.

RIP ADG.

Slightly less hysterical now....

2008-11-01T16:13:00.002Z

Many thanks to Michael and Charakan for your supportive comments. I must admit the idea of buggering off to New Zealand was tempting!

Things are better. My background stress levels are still fairly high but I'm on much more of an even keel at the moment. I think I have finally 'settled in' after 2 months in the job. I am, of course, still very much a small and very junior fish in a big pond, but I'm learning.

As for my boss...well, he's OK I suppose. I've learned to read his moods a bit better and have developed a slightly thicker skin in that, if I need to interrupt him in clinic and ask a question, I just brace myself and do it. I ask perfectly reasonable questions and I do so in order to provide better care for our patients, so if he wants to be shitty about it that's his problem. Well, that's what I tell myself anyway.

Anyhoo...just wanted to make a note that things are indeed better and I'm a bit less mad. I still have the feeling that there's an invisible anvil hanging above my head just waiting to fall on me though. I constantly question my decisions and worry about whether I've done the right thing, but actually that is probably going to make me a better oncologist. So that's fine. Now I just have to work on not thinking about work when I'm not there and not dreaming about it so much. Will keep you posted, and will also try and find something more interesting to write about than my state of mind. I'm even boring myself.

And so it begins....

2008-09-04T21:40:00.002+01:00

I started my Oncology SpR job on Monday. I managed to have three whole weeks off after my SHO job finished, which was lovely. I was totally relaxed and chilled out (well, as relaxed and chilled out as I get anyway). Now, however, I'm wound up tighter than a very tight thing. Already.

I feel, how shall I put it? Totally out of my depth. I feel like a moron 90% of the time. I didn't go into this expecting to know everything, not by a long chalk, but my God I didn't expect this. I feel totally stressed out and anxious pretty much all the time and sometimes it's a struggle to keep the hysteria out of my voice when I talk to people. I cry when I get home each night (and this evening I actually cried on the Tube, which was embarassing).

I don't know what I expected. I mean, if you spend 4 years doing medicine as an SHO you get pretty confident I suppose, so that when you're thrown into a 'new' specialty at a relatively high level it's a shock. But I've done plenty of Oncology as an SHO, not to mention a locum SpR job at a large London teaching hospital, so I kind of thought I had a head start I guess.

OK, OK, I know. Starting a new job is stressful. Starting a new job at a more senior level is stressful. Starting a job in a specialty when you're not really a specialist yet is stressful. Understanding why it's shit doesn't make it any less shit though.

Plus I think that I'm so freaked out by the new place, by learning how the system works, by coping with the new seniority and by the (very) steep learning curve, that I'm not performing at my best. I'm getting flustered by situations that would not have flustered me had they happened to me in my old job 3 weeks ago. I can't fucking THINK straight.

I just don't want to screw up. I want to be good, I want to learn fast and I'm trying but it's so fucking hard and I feel awful and I can handle that for a while but I'm so worried it's going to be like this forever, or for a long time anyway. I can't do that, I really can't.

My Consultant isn't thrilled to have been landed with a 1st year SpR, I can tell. He's pleasant enough most of the time, but whenever I ask a question, or for clarification of something he's said, he gets really abrupt and I can tell he's annoyed. He explains things at 500 miles an hour and expects me to understand and retain every single word, and if I ask him about the same subject later on because I've not remembered all of it he gets snappy - 'As I said before....'.

Well FUCK YOU. I'm fucking trying here, OK. I am NOT going to get upset in front of you, or anyone at work. I am going to keep my fucking head, I am, I have to, and I am going to be good. Just give me a bloody chance, you bastards.

Nights, blah....

2008-04-24T02:51:00.005+01:00

*sigh*

On nights, ho hum. Not a bad lot so far (though I've probably just jinxed myself by typing that). Steady for the first few hours then a lull until around 6am when the same dude from ward X wakes up with chest pain (he has a soft tissue sarcoma, and as a consequence has two large masses in his chest, and they hurt, unsurprisingly - as far as I can tell there's nothing wrong with his heart). I'm hoping his team have managed to sort out his pain medication by now so that when he wakes up later this morning he's not in pain for once.

I had a call about half an hour ago regarding a patient who was having rigors. She's just had a nephrostomy inserted because she has a big pelvic tumour which is blocking off one of her kidneys, and probably has a (fairly severe) urinary tract infection. They wanted me to prescribe pethidine for her rigors. Pethidine is fucking horrible, a dirty little drug which is nonetheless used (mainly by the surgeons) for pain relief. I've never heard of it being used in rigors, and it's not licensed for that in the BNF. Anyone come across that one?

Anyway, call me old-fashioned but I tend to give people paracetamol if their temperature is so high they're shaking uncontrollably, followed by a thorough examination to establish the likely cause of the infection, some blood and urine cultures and finally a dose of intravenous antibiotic. The patient's nurse was not happy about my refusal to prescribe pethidine. 'But she's had the paracetamol now and she's still rigoring...'. Yes, that's because she's still got a raging infection and rigors are a consequence of that. They will stop eventually, they're usually pretty short-lived, and you're not helping matters by jumping around like a cricket in front of the patient when I'm trying to reassure her that the rigors will stop, that they're unpleasant but not dangerous and that she's just had her first dose of antibiotic which will take a little time to start working on the infection. For fuck's sake.

Other jobs have included writing up laxatives ten billion times (why do they not notice that someone hasn't opened their bowels for 5 days until 11 o'clock at night?!), refusing to write up an anti-hypertensive for a patient with a slightly raised BP who looked and felt absolutely fine and re-writing drug charts (why, why, why do my colleagues never notice that there are no more days left on the drug charts and just bloody well re-write them during the day?).

Boring, routine crap mainly. Once I'd finished the boring, routine crap I watched 'The Apprentice' on iplayer (love iplayer, love it!), and checked emails etc. It's 0320 now and I could try and get some sleep, but the trouble is I can't stand being woken up by the bleep. I think it's partly a hangover from my very first house officer days when being on nights scared the hell out of me, and the sound of the bleep sent a bolt of pure terror through my heart. 'Oh God, I have to go see a patient, and there's no one else here to ask for help if I don't know what to do....'. That terror has long gone, thank God, but I must have developed a sort of Pavlovian response to the sound of a bleep. Also, it's never nice to be jolted out of a deep slumber by a piercing noise, particularly a piercing noise that means you're going to have to get up and do some work.

Technically, we're not allowed to sleep on nights anyway, as we're now shift-workers like nurses rather than being on call for 24 hours straight like in the bad old days. The managers at my old hospital used to get very shouty when they discovered blankets in the doctors' mess left over from the night - 'You're NOT supposed to be SLEEPING!'. Actually, it was fucking cold in the mess because the heating didn't work, so even if you weren't sleeping you needed a blanket just to sit in there having a cup of tea at 2am, but that's beside the point.

The managers think that being on night shifts is just like being on day shifts, it's just a simple matter of reversing your sleep cycle and...hey presto, 3am feels just like 3pm does in a normal work day. Well, it fucking doesn't. For a start, it is extremely difficult to sleep during the day for a number of reasons. Even if you are fortunate enough to be able to get a good 6-8 hours of sleep during the day (which I usually am actually), it is not the same. The body is not built to do that. You feel fucking knackered all the time, especially if you do several nights in a row which we do. So why the hell shouldn't we be allowed to snatch a couple of hours' sleep if there's no work to do? I'm sure it improves performance not to be quite so utterly knackered. 'It's not fair to the nurses - they're shift workers too and they're not allowed to sleep on nights either...'. Well, they bloody well do, or they do everywhere that I've worked. They have breaks, and during those breaks many choose to snatch some sleep. Difference is, they won't be disturbed 5 minutes into their slumber by that piercing sodding bleep....

*yawn*

Got it!

2008-03-14T23:10:00.002Z

I got it, I got it, I got it, I got a job! Get in!

The Clin Onc interview was fucking scary, 7 people sat round a table staring at me and taking it in turns to interrogate me with gems such as:

'Where do you see radiotherapy going in the next ten years?'
'What are the advantages of intensity-modulated radiotherapy?'
'Why is research important to the NHS as a whole?'

Thank God I worked my arse off for this. I can't say the answers tripped off my tongue exactly, but at least they were there.

I am so relieved. 5 years of employment sorted (as long as I pass the exams).

Of course, London is a big city and the London rotation also includes several posts in places which are clearly not part of London, such as Brighton. They didn't ask us to rank our preferences for which rough geographical area we would like to work in, let alone which hospitals. We'll move around every few months. I could end up with a mammoth commute for part of the rotation at least.

Oh I don't give a fuck. I've got a job.

Mr E's Beautiful Blues

2008-03-09T10:39:00.004Z

A good shift last night. Nice and quiet. Got some interview stuff done.

I was on Ward X doing some jobs when I got a bleep. It was Nurse A calling from one of the other wards.

'I have a gentleman on the other line who's had some tingling in his fingers after cisplatin chemotherapy. He wants to talk to a doctor. Can I put him through?'

Numbness and tingling in the hands and feet after platinum-based chemotherapy is common. It's troublesome but not dangerous.

'Can you please take his number and tell him I'll call him back in 15 minutes?' I said. 'I'm in the middle of something at the moment.'

Plus I hate it when nurses just put people straight through without giving me a chance to look up the patient's medical records first (we have them all on the computer system, so this doesn't take long anyway).

Nurse A sighed exaggeratedly.

'Fine. Get off the line then.' And she hung up on me.

Nurse A only ever works nights. I have found her invariably difficult, prickly and often downright rude. This is the general consensus amongst the SHOs, as well as some of her nursing colleagues. Just one of those things I guess.

Anyway, I went down to Nurse A's ward soon after and found her sitting at the nurses' station. I asked her for the patient's contact details. She wordlessly shoved a bit of paper at me on which she had scrawled the name and number.

I peered at it. 'Mr E...illegible....t', it said.

I looked at Nurse A, genuinely puzzled. 'Mr.....Elephant?' I asked.

She stared at me, stony-faced. Then she smirked. The smirk cracked her wooden face. Then she started to shake. Then, to my utter astonishment, difficult, prickly, downright rude, downright miserable Nurse A threw back her head and roared with laughter. There were tears running down her face.

Speechless with mirth, she clapped me on the back and walked off to the treatment room, still giggling, her shoulders shaking.

It's funny how we misjudge people.

Mr Elephant, incidentally, was fine.

I must be a mass murderer, and as for the Dr Rant team....

2008-03-06T15:55:00.004Z

Mother: So, what did you learn at nursery today?
Excited four-year-old girl: Fuck! Fuck! Fuck-fuck!
Mother: Every time you say that, one of Santa's elves dies, you know.

Courtesy of the brilliant 'Overheard Everywhere' site.

Interviews!

2008-03-06T15:55:00.002Z

I have interviews! Yes, yes, yes! Thank you God.

I have an interview for Medical Oncology on Wednesday 12th, followed 2 hours later by my Clinical Oncology one. Clin Onc is the really important one so I'm glad I've got the Med Onc one first as a kind of practice run.

Oh the relief.

I have my nose to the grindstone at the moment preparing (well, I'm trying to keep it to the grindstone but it keeps wandering off to do other things like make food and write this). I am again marvelling at my good fortune in having these days off to prepare - no work til Saturday night, plus I have Monday and Tuesday off to recover from my weekend shifts before the interview.

The 'interview suit' is hanging in the wardrobe looking at me, and the 'interview shoes' are daring me to twist an ankle when I put them on. Oh bugger, do I have any stockings without holes in them? Better get down to M+S later.

Oh please please please lovely interview panel, please give me a Clin Onc job.

What a night!

2008-03-05T07:34:00.002Z

Coming to the end of that night shift now. Bloody hell, it was busy. Non-stop from 9pm last night until now, and of course I didn't manage to get any sleep during the day yesterday. I was hoping to stay up today and do some interview stuff but I'm totally shattered and am just going to go straight to bed when I get home, hopefully just for a few hours. I'll try and haul my arse out of bed by 3pm or so to get stuck into some serious work.

I talked things over with my other half yesterday evening, and he helped to soothe my guilty conscience a bit. Apparently if I hadn't accepted the night shift they would have had to get my colleague to do the shift himself and then go straight to his interview in the morning. I can barely see at the moment I'm so tired, so if he had done this shift prior to his interview I'm pretty sure he would have been in no fit state to perform well today. Apparently a night shift before an interview cannot be taken as 'interview leave' so a person in that situation either has to swap the shift or do it themselves.

Finding out about those rules made me feel a lot better, and having done a pretty hideous shift on behalf of my colleague makes me feel better still. I actually helped him out, and I'm glad.

Insomnia

2008-02-19T17:31:00.004Z

Correction - this post was written on 4/3/08, not 19/2/08 as was originally given by dodgy blogspot thingie.

*sigh*

Can't sleep. Probably because it's four in the afternoon. I got up at 7am and went to work, but was contacted by a panicky medical staffing person at around 10am begging me to do the night shift tonight. The SHO currently on nights has an interview tomorrow, and despite the fact that he informed them of this a few days ago, they haven't found anyone to do his night shift. Actually, I'm pretty sure they hadn't looked for anyone. All fairly typical.

Why didn't I tell them to sod off? Not through any attempt at philanthropy, I'm afraid - they bribed me. I'm preparing for interviews next week (although I still haven't heard whether I've got any yet - more about this in a bit), and am doing Friday, Saturday and Sunday night shifts. So my immediate thought was, no way, this will totally screw up my interview preparation, bugger off. But then they said:

'Go home now, do the night shift tonight, then you can have Wednesday, Thursday and Friday off. The other SHO (who has his interview on Wednesday) will do your night shift on Friday, so you only need to do your Saturday and Sunday nights, and we'll still give you Monday to Wednesday off next week as you would get anyway after nights.'

My interviews, if I have them, should be on Tuesday and Wednesday next week. Three whole days off to prepare! Fan-bloody-tastic!

I checked with the other SHO on my firm (who had been on nights herself during my hepatitis escapade, which was the reason for all the panic about cover at that time), who said it was fine with her. I checked with the SHO with the interview, who was just grateful they weren't going to force him to come and do the night shift himself and was happy to do the Friday night. I then grabbed it with both hands and high-tailed it out of there.

I've been home since noon. I've watched Ashes to Ashes, Freaky Eaters and 2 episodes of Bizarre ER on iPlayer (the last three were complete bollocks but filled the time). I've had lunch and made Eton mess (along with an impressive mess in the kitchen). I'm going to attempt to have a nap again but I have to be up at 7pm. Ho hum.

I'm starting to feel a bit guilty and paranoid about doing this now. All I've got in my head at the moment are these interviews, the Clin Onc one in particular (if I've even got one). If I don't do well at it, I'm essentially fucked jobwise. I need to get a Clin Onc training number, in London, at this attempt. So hence when I heard the details of this 'deal' I pretty much jumped at it without thinking. I didn't check with my SpR or Consultant, not that it should matter to them as there is still an SHO covering the team and this level of cover happens regularly due to normal night shift patterns. I did check with the other SHO, but now I'm thinking it's a bit shit for her as she'll obviously be busier without me there, and she should have interviews next week as well which she's preparing for. Plus the SHO with the interview shouldn't, technically, have to do my Friday night shift in return for my doing his Tuesday night - as far as I know it should count as interview leave. But getting him to do it means that medical staffing don't have to pay me locum rate as I'm still doing three night shifts in total. Hmmm.

Well, it's done now. I just need to do this night shift and then work my arse off for the next three days. I also need some fucking interviews.

The MMC process remains ridiculous and unfair. Basically, everyone who was allocated an 'ST2' job (based, remember, on a thoroughly flawed application system - the late, unlamented MTAS) has first dibs on the SpR numbers in London (OK, OK, ST3 jobs, whatever).

A couple of weeks ago we had to rank three specialties in order of preference (despite the fact that myself and most SHOs I know only want to do one thing). We then had to fill in extensive application forms for each of these three choices in the space of a week. Fun fun fun.

The interviews for my chosen specialties take place in one week, and I've heard bugger all. No-one else that I know who has applied for those specialties has heard anything either, so I'm not too concerned. I just have no idea if I'm going to be attending one, two or three interviews next week, or none at all. I don't know which of the three quite different specialty interviews I should be preparing for, if any. There is a shitload of work to be done to prepare for each if I want to do well. I'm fed up of the uncertainty.

I'm basically only preparing for a Clinical Oncology interview, my first (and realistically only) choice. That's the one I don't want to bugger up. But I may well find that I've not got an interview for that, but have one for my second and/or third choice specialty, and have to re-prepare all over again at very short notice.

Oh bollocks. Now I feel guilty, stressed and angry. Time for a nap.

Sod the SlimFast, get hepatitis!

2008-02-19T17:31:00.002Z

I have lost nine pounds in weight over the past week.

NINE POUNDS! Cue ridiculous little dance....

The downside is, my liver hasn't been working. It's a longish story so I'll cut to the chase: ate some oysters, felt flu-like for a few days, then started throwing up, then went to A+E with hideous right upper quadrant (ie liver) pain. Seen by A+E SHO (sorry, ST1) who didn't enquire as to the severity of the pain or offer me pain relief, didn't examine me properly (kind of an OSCE-style examination, ie going through the motions without the aim or ability to pick up any clinical signs) and fucked up my blood test (I have HUGE veins, this is pretty hard to do and indeed has never been done before). Lo and behold, my blood tests come back and my liver enzymes are up the spout. ST1 is rather bemused, but is coming to the end of her shift and clearly wants rid of me so packs me off to my GP so he can organise my ultrasound and referral to a gastroenterologist.

Long story short, I still don't know what it is. It's not hepatitis A, B or C, it's not CMV or glandular fever. Still waiting for ultrasound and gastro appointment. Feeling better, starting to eat, back at work tomorrow.

About work. I imagine that if one of my colleagues called me to say they had hepatitis, felt like crap and could I cover their patients that day, I would say 'Of course! I hope you feel better soon, please don't worry about work, we'll sort it out.' I would, I'm sure I would. Even if I had a million things to do and was too busy to cover, I'd tell them that and then go and find some other colleagues to help with the cover. My experience was:

'Oh. Well I'm really busy on my firm at the moment, so I don't know if I'll be able to cover for you.'

I suggested a couple of other SHOs who might be able to help, emailed her my patient list/jobs list and gave her the bleep number of my SpR. What did she do? Fuck all. Didn't see any of my patients, didn't use the list, didn't ask for help. I spoke to my SpR later (I'd already called to say I wouldn't be in that day but called again to say I'd been signed off for a week):

'Oh. Well the SHO you asked to cover hasn't done any of our work, the patients haven't been seen and they're not getting us a locum.'

Well, what do you want me to do? I'm so fucking sorry my liver doesn't work, I can't eat and I feel like shit. Shall I come in and vomit on the patients? Would that help do you think? Shall I come in and make a hideous chemotherapy prescribing error and kill someone?

It made me so fucking angry. Mainly from the obvious lack of concern and support from fellow doctors, but also because it made me feel guilty and actually consider whether maybe I should just go in.

Why are doctors a) awful patients and b) so bloody unsympathetic to their colleagues? We don't take our own advice when we're ill, we have to be on death's door to take a day off sick, and if somebody does go off sick we act like the entire hospital is going to implode because of it. I know we're spread as thinly as possible, there is very little 'give' in the system to allow effective cross-cover in the case of illness and it is therefore always challenging if we're short-staffed. It's just the bloody attitude. From the 'caring profession'.

I'm not looking forward to tomorrow. They found a locum to cover some of my days off, but I know there'll be a pile of crap that hasn't been sorted out. It's the same in any job. The main thing I'm not looking forward to is seeing the people who made me so bloody angry last week.

Obviously, not all my colleagues behaved in the same way. I've had calls and texts saying 'Come back when you're ready, everything's fine here, don't worry, get well soon'. I wish everyone was like that.

Oh, and one more thing:

Don't eat raw oysters, boys and girls. It's not big and it's not clever, and it nearly killed Michael Winner.

Incadescent with rage

2008-01-24T02:05:00.000Z

First, a disclaimer: I am on nights, I am tired, and my contact lenses are sticking to my eyeballs (in a painful way, not in a stopping them from falling out way).

I have been watching and waiting, patiently I might add, for any sightings of the rare and elusive 'Clinical Oncology ST3 posts' which have yet to appear in my deanery. Apparently those of us fortunate enough to get randomly allocated to an ST2 post will have 'first dibs' on the ST3 posts, and may indeed even be allocated directly to an ST3 post without the need for any of those tedious interviews or references or CVs. Note that's 'an ST3 post', ie any old post, be it in Allergy or Immunology or Public Health, as this will allow those clever MMC bods to claim that they have honoured their promise to provide us with 'run-through' training now that we're in the system, despite the fact that it is clearly going to be 'run-through' to a job you would never have considered applying for in a million years but if you don't accept it you're out on your ear.

Anyway, so, yes, here I am, waiting patiently. I have a spare five minutes for a cup of tea and a bit of a browse on the net, so I decide to have a look at that masterpiece of spin and changeable yet universally useless information, the MMC website. Still no sign of those pesky jobs. Let's have a look at the person specification for Clin Onc ST3 (SpR equivalent, allegedly). Last year when I applied to the late, lamented (snigger) MTAS system I had just taken the final (practical) part of the MRCP but did not yet have my results. The person spec at that time for Clin Onc ST3 said, quite rightly, that an essential requirement was the full MRCP qualification. At that time I had passed the exam, but didn't yet know it and in any case didn't have the certificate. I double-checked with those helpful folks at MMC enquiries or whatever they were calling the automated response generator at the time. Yes, I had to apply for ST2 in 'Core Medical Training' as I didn't have MRCP. No, I most certainly would not be allowed to change my application from ST2 to ST3 if I subsequently found out that I had passed the MRCP. Sorry, but that's the way the cookie crumbles, you've got to be an SHO for another year, you can't go applying for SpR jobs when you haven't got MRCP (even if, er, you actually have MRCP).

OK, fine, I thought. Never mind. So I'm an SHO for another year, no big deal. I managed to do 3 months as a locum SpR in Clin Onc anyway, which was a bonus, even though I am now back to SHO level. All good experience. I got over it.

So then (finally, this is the source of my rage), imagine my reaction when the first thing I spy on the Clinical Oncology ST3, ie Specialist Registrar, ie dear Lord no you can't possibly apply without the full MRCP even if you actually have it, Person Specification, is:

ENTRY CRITERIA

ESSENTIAL QUALIFICATIONS

MBBS or equivalent medical
qualification

MRCP (UK) Part 2 (written) or
equivalent by August 2008

So now, all of a sudden, for no obvious FUCKING reason, it's OK to be a Specialist Registrar without the full MRCP. The practical part can, apparently, be done later when you're already an SpR despite the fact that you will be simultaneously studying for and trying to pass Part 1 of the FRCR exam (Fellow of the Royal College of Radiologists exam - means you can give radiotherapy).

So the sticking point, the sole reason why, come August, I will have been treading water for a year for the sake of the shiny new fucking system, has inexplicably been taken away, the goalposts moved, 'Sorry Layla, we were just fuckin' with ya, you could have been well into the system by now instead of spending another year wondering whether you would be employed by Christmas, ha ha ha!'.

Fucking arseholes.

One year later

2007-10-22T23:56:00.000+01:00

My, it has been such a long time. I've changed jobs twice since I last posted - having done my brief stint as an SpR I am back to plain old SHO these days, courtesy of MTAS, and am currently doing plain old SHO nights. Ho hum. I'm just relieved to be in work, to be honest.

I've passed the one year mark since my mother died suddenly in the summer of 2006. I still feel the same, I suppose. 'The same' being perfectly fine most of the time but prone to random episodes of sadness and an acute sense of loss, which can hit me at the most inconvenient moments. Normally when I'm sitting eating my lunch or on a Consultant ward round. Nobody notices, which is good. Often I will just suddenly recall with total clarity the moment when my father told me she had died. Most of the time, I can recall his exact words, and what I was doing when I found out, but the emotions I felt at that exact moment escape me. But every so often it comes back to me perfectly, and I feel exactly as I did then. For a moment, then it's gone. How would I describe it? Well, how you would expect I suppose. Nothing ground-breaking or new to anyone who has experienced it. Nothing surprising to those who have not. Shock. A sensation similar to plunging several floors down in a lift (or on one of those totally pointless fairground rides which give you a similar experience).

How exactly are you supposed to feel?

I miss her. I miss her whenever something really funny happens, because I know she'd have laughed. I miss her when something good happens in my life, because I know she'd have been pleased. I miss her when I learn something new, when I'm ill, when I'm happy, when I'm sad, when I just need my mother and she's not there and I can't fucking stand it.

But mostly, as I said, I'm fine.

MMC interview

2007-05-15T15:02:00.000+01:00

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 : http://www.bma.org.uk/ap.nsf/Content/mtas150507

So what the fuck happens now?

Moving on to bigger (and scarier) things

2007-05-12T19:20:00.000+01:00

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.

On feeling crap

2007-05-04T15:01:00.000+01:00

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.

An update

2007-04-17T15:41:00.000+01:00

My, it has been a long time. I'm not sure what I've been doing, really. Stuff, I suppose. There's always stuff.

Well, the march had a good turnout, didn't it? 12,000 junior docs and supporters - about 1/3 of the junior doctor workforce - pretty impressive. I was disappointed that the press coverage wasn't more impressive though - Channel Four News gave it the best airing, but failed to interview anyone from RemedyUK formally (or perhaps RemedyUK failed to get itself onto Channel Four News?). David Cameron jumped on the bandwagon for a while (I must confess to clapping during his speech - it did make me feel rather soiled though) but seems to have moved on to other things. However, Patsy has now apologised 'unreservedly' for the whole fiasco. The whole party seems to be apologising this week, not great for the polls. I think we will soon have a Tory government. There is no way in hell I could ever vote Tory however. In fact I am seriously considering spoiling my ballot for the general election unless the Lib Dems can summon some teeth before then (quite literally in the venerable Ming's case, I feel).

We are waiting to find out how exactly we are going to be given our one 'guaranteed' interview - apparently arrangements will begin next week, though they are fast running out of time to re-convene interview panels and interview an extra few thousand doctors before round two begins (I think there's still going to be a round two - to be honest I've given up trying to keep track of the whole sorry mess).

Oh, and somehow I managed to pass PACES. So it's Dr Layla MBBS MRCP now, thank heaven. What a relief that was. I have never been too scared to check my exam results before - a friend actually frog-marched me to a computer and forced me to enter my exam number. My two 'study-buddies' who took the exam with me didn't get it this time, unfortunately, which made things a bit awkward when I just wanted to jump around with a big grin on my face (makes a change from sobbing on the ward about being unemployed). Even more awkward is that I've been pressed into teaching one of them for his re-sit, which is very strange indeed.

And I finally went on holiday to somewhere hot last week with my sweetheart. It was fantastic, and I still feel relaxed despite being back and drowning in orders for platelets that never get here when they're needed (the joys of Haematology).

And I'm back on the Slim Fast (see very first post) - must fit into lovely green dress for Summer Ball in June.

The sun is shining, the weather is sweet...and we might just get an interview after all

2007-03-15T16:12:00.000Z

Everything just feels better when the sun is shining, doesn't it? Even though the wards seem to smell more than ever, and it's a bit stuffy on the Unit upstairs, and you can't see the X-rays on the screen properly because it's too bright.

The 'review' of the MTAS debacle continues, and the DoH review committee have gone so far as to issue us with this tantalising tidbit (9th March - running behind the times again) :

'The review has identified concerns that some excellent doctors may have been overlooked. The group has recommended all applicants who have not been invited to an interview should be given the opportunity to have their application form reviewed by a trained advisor. This may result in the offer of a first round interview.'

We are still waiting to hear how exactly that is going to work, when we can expect our applications to be reviewed, and what the definition of a 'trained advisor' actually is - it doesn't conjure up the image of a competent Consultant, more that of a trained monkey. But we shall see....

Worryingly though, the final report isn't due out 'til the end of March, which doesn't give them much time to review all the application forms they lost, sorry, fucked up, sorry...how best to put it? Overlooked? In any case, the second round of applications starts at the end of April, so they have a month to look at the forms again, re-shortlist and interview. I don't think that will work.

The statement (found in full on the MMC website) continues:

'Significant changes will be made to improve selection in the second round. This will include changes to the application form and the scoring system.

'The Department has accepted the need for change and the revised approach will now be tested with junior doctors, selectors, deanery recruitment teams and employers, and agreed with the Medical Royal Colleges, Deans, trainee and consultant representatives and employers before they are introduced.'

I thought they said that the original format of MMC/MTAS was developed with the full support and input of junior doctors and the Royal Colleges? Someone's been telling porky pies.

Some people have been whispering that this review represents a capitulation, that everything will be OK and there's no need to march in protest against MMC on Saturday. No, you fools! This does not get you, or the government, off the hook. It is vital that we do march as planned on Saturday - we must keep the pressure up. I agree, the response and fuss that we have had is more than expected, but we must must must keep pushing. We cannot stand down until the entire mess is sorted out, and one review and a couple of Royal Colleges standing up to MMC do not a revolution make.

So put some scrubs on, daub some paint on a big piece of cloth and get your arses down to London. Saturday 17th March, 1030am at the Royal College of Physicians (Great Portland St tube) - I will see you there.

How has it come to this?

2007-03-12T15:19:00.000Z

I have just had a very stupid argument with one of my work colleagues, let's call him John Smith. He is someone I regularly go out drinking with, and I enjoy his company. He has three MTAS interviews to my zero, but apart from a good-natured 'let's throw things at John because he got interviews' session, we've haven't let this fact come between us.

I haven't got much on this afternoon for a change, so I thought I'd make a start on a case report my previous Consultant asked me to write up for a well-known American medical journal. He asked me to write it up about six weeks ago, just before I changed onto another medical firm. I got the patient's notes and was reading through them when I found a consent form, from said American medical journal, signed by the patient and witnessed by my friend Dr Smith. 'How odd,' I thought. 'I'll just bleep John and find out what's going on.'

The conversation started fine - it transpired that my Consultant had also asked John to write up the case report. Unfortunately, this journal only allows two authors and our Consultant would have to be one of them. What followed was a rather prickly, unpleasant exchange. Examples as follows:

'I was on the firm when she was in.'
'So was I - we changed over halfway through her admission.'
'Well I clerked her in.'
'No you didn't - you only reviewed her after the F2 clerked her in.'
'I saw her on the ward.'
'So did I.'
'To be honest, if I get a job I might not bother.'
'Well I don't have a job. What do you want me to do, wait until you know if you have one or not?'

It was just stupid. I am annoyed at the Consultant for asking us both - surely he knew there might have been some disagreement? Apparently he also asked my previous registrar, but she couldn't be bothered. So one less person for silly arguments I suppose. And yes, I feel bad for bringing up the interview/job thing. I just felt provoked by the 'if I get a job I won't bother' line - I mean, who needs this more?!

It's ridiculous, fighting over scraps from the Boss' table. Desperate for anything that might give you extra points on your CV. Falling out with friends over a few lines in a journal.

Anyway, we decided to ask the Consultant who he wants to do it. John said, 'I'm sure he'll say to let you do it.' Let me do it? What am I, a charity case? I suppose I am really.

Flat

2007-03-09T16:51:00.000Z

I feel flat.

I can't really describe it any further. The dust seems to have settled over the whole job thing, the shock has been absorbed and, worryingly, the outrage has faded. That longtime friend of the British medical profession has reared its head yet again - apathy. 'What is the point?!' it asks. 'We all know the march will achieve bugger all, even if it is well-attended, which, knowing us, it won't be.'

I must say, I agree with apathy on that point. I was part of the one million strong crowd who marched against the 2nd Gulf War - fat lot of good that did. If this Government can ignore one million people, from all walks of society, on such a wide-reaching issue, it can sure as hell ignore a small sample of one part of society on an issue that, let's face it, the general public don't really know too much about. I don't think people see how it will affect them, really.

I was disappointed at David Cameron's long-awaited reply to the issue. I think that's as much as we'll get out of him now. I can't believe I actually put some faith in the Tories, of all people, to help us (I am a bleeding heart liberal, I'm afraid).

Oh God, I feel like shit. Everyone's being so fucking lame about the march. I'm trying to organise a minibus to take us down to London on the morning. We will probably have to leave around 8am, and I can just hear the moans. 'Oh, it's too early, I was on call yesterday/I went out last night/I made plans already/blah blah blah'. Half the people who have said they'll attend will be in London already and have said they will meet us there. I'm not anticipating a huge turn out from those ranks either. 'Oh, I overslept/I'll probably meet you later/I made plans/I can't be bothered/it won't make a difference'.

Now, I agree, it won't make a difference. But at least we will have tried. At least then we won't just be taking it, like we usually do. So I, for one, will be there with bells on. I wish I could say the same for my colleagues.

Please, please, please, come to the march. Come and shout and stand up for what you believe in for once. Make a stand - what have we got to lose?

And another thing....

2007-03-07T20:26:00.000Z

It seems I am behind the times already, having missed the DoH press release yesterday and only come across it now after having spoken to one of the Consultants. Actually, I'm not behind the times, I'm just really sodding busy.

Anyway, I have read it, and welcome it. I have a few issues with it however:

'Recruitment into specialist training is, and has always been a very competitive process.' - No shit, Sherlock. But at least with the old system one had as many opportunities as one wished to apply to a variety of jobs, advertisements for which came out at different times. You can't say, 'Oh it's always been competitive', and then hope to address that by making everyone apply for everything at the same time.

They will be discussing, amongst other things, 'eligibility criteria including IMGs and HSMP'. Anyone care to tell me what these are?

'We have stressed to those interviewing in round one that they should not appoint unless they are absolutely satisfied with the calibre of candidates.' Surely if 'those interviewing' had been involved in the shortlisting process they would be more likely to be satisfied with the 'calibre of candidates'?

'With around 18,000 new competency-based specialty training programmes available this year in England alone, MMC is working towards having more qualified doctors working within clinical teams, providing the majority of front-line, safer patient care.' Hmmm. Bit ambiguous, that. 'More qualified doctors' meaning more doctors in general? Why cut posts then and fail to fill vacancies? Or do they mean 'doctors who are more qualified'? How do they plan to achieve that by shortening (oh, sorry, 'streamlining') our training and producing generalists at the end rather than specialists (as evidenced by the dropping of the 'Specialist' from the 'Certificate of Completion of Specialist Training', which new Consultants gain at the end of training). Also, with the European Working Time Directive restricting hours from 56 to 48 in 2008, new Consultants will have clocked up far fewer hours of training when they gain this certificate than their predecessors.

So yes, I welcome the DoH review of MTAS. But I have a nasty feeling we will end up with a very similar steaming pile of horseshit to the one we have been buried in already.

Must go, my patient with a potassium of 7.8 has arrived. That is a very dangerous level of potassium to be carrying around, Mrs Hewitt. My patient will certainly die from it if I don't treat her correctly. I hope for your sake you never end up in my hospital with acute renal failure.

God bless the surgeons....

2007-03-07T10:22:00.000Z

Fantastic, fabulous effort by the West Midlands ST3 surgical interview panel! They cancelled their interviews on the basis that the whole MTAS application process was a steaming pile of horseshit. Well, actually,the reasoning of the panel is lengthy and well thought out, and can be read in full on Dr Crippen's blog. Basically they said, 'We want to be able to shortlist our own trainees, not just interview whoever the muppets at MTAS deem suitable for higher surgical training'.

My favourite line was 'it fails to distinguish adequately between candidates, giving credibility to creative writing skills rather than hard evidence of competency'.

Bloody brilliant. I am so pleased, inordinately so I suppose as I'm still stuck in the same position as before. I hear other regions may be following suit - we shall see. From what I hear of the interviews so far, it seems that they have been almost as shambolic as the application process - people turning up to find they didn't have an interview after all, people who went in to find that the panel had not received their application form and had no idea who they were or why they were there....

They seem to have shortlisted an unprecedented number of arseholes (see Dazed and Confused's experience). Presumably arseholes are inherently talented at bullshitting, blowing their own trumpets and using buzzwords. I can almost imagine the breaking bad news scenario of one of these brand new MTAS recruits:

'I'm sorry, but your mother is dying. I must say, I'm feeling extremely empathic towards you and your family at this difficult time. Did I mention that I teach communication skills to local convicts? This illustrates my dedication to improving my CV and showing my motivation to rise to the top over the bodies of my fellow applicants. I mean doctors. Anyway, I've ticked all the boxes so far, don't you think? I found a quiet room, left my bleep with my house officer, sorry, with my F1 monkey, and brought an agency nurse in with me to wipe up the snot and tears afterwards. Anyway, the EWTD tells me that I have only thirty seconds left before I have to finish work, so any questions you may have should be quick. Otherwise you can contact the on-call ST1 if you like. They've never done on-calls or nights before and so will probably be too busy running around with their arms in the air to speak to you, but hey ho, needs must I suppose. Oh, while you're here, could you fill out one of my 360 degree assessments? Don't bother reading it, everyone just ticks 'excellent' and nobody reads it anyway but I need to send out 500 of them to the re-validation centre in Milton Keynes before tomorrow so that they can be filed in the round file marked 'bin'. Thank you for your time.'

Shock and awe

2007-02-28T19:59:00.000Z

I have just been shocked and appalled (and I thought I couldn't become any more so today) by something I saw on Dr Crippen's blog. An amazingly talented, dedicated, extremely qualified gastroenterologist has been chewed up and spat out by the MTAS machine. That is just further proof that the whole thing is one enormous lottery. I re-read my own application form today, and honestly could not see what else I could possibly have put on it to make it better. I 'ticked all the boxes' - I have distinctions from medical school, audits, national and regional presentations, publications and an SHO rotation with a good reputation. I have no career gaps and have taken my postgraduate exams as quickly as I possibly could have - I only became eligible to take PACES (experience-wise) a month before I took the exam.

So I thought my CV was good. But this guy's...bloody hell. I am speechless.

What a stupid stupid country we live in.

Still wittering....

2007-02-28T12:00:00.000Z

I don't know who came up with this, but it is beautiful:

Choose MMC. Choose MTAS. Choose a region. Choose a career. Choose a f***ing big lottery, choose portfolios, on-line application forms and years of uncertainty. Choose a cut in training posts, career choice and job security.

Choose FTSTA’s no one knows anything about, middle grade rotas being run by juniors who’ve never worked in the specialty before, foundation programmes you have no control over, and hospitals you don’t want to work in. Choose being treated by ‘trained doctors’ rather than ‘doctors in-training’, even though the average consultants training hours have been cut from 40,000 to 10,000.

Choose Hospital At Night and no-one knowing the patients anymore.

Choose being an SHO lost in the middle of it all, with nothing but a sparsely updated web-site to inform yourself. Choose seniors who know nothing about the system and seem powerless to influence it. Choose an internal office with no windows in your brand new PFI hospital while the doors fall off and middle managers sit in their swanky boardrooms munching on biscuits that your taxes are paying for. Choose paying £10 a day for the privilege of parking at your work-place while you work non-compliant rotas and get bullied into lying on your EWTD monitoring forms.

Choose sitting at that PC filling-in mind-numbing, spirit-crushing objective assessment questionnaires. Choose PMETB-approved curricula and competency-based assessments no-one has properly validated. Choose your third choice career path and wondering who the f*** you are on a busy post-take ward-round morning.

Choose rotting away at the end of it all, pushing your last in a miserable Non-Consultant Career Grade post, nothing more than an embarrassment to the under-experienced, ‘fit for purpose’ FY’s you’ve trained to replace yourself.

(Don’t) choose your future. Choose MMC…

There is also the 'hamster' theory of how MTAS allocated the interviews, but it is rather long and complicated (and fantastic). Or the 'monkey' theory (two monkeys shut in an office with all the application forms, left for a few days, whichever forms they don't eat/wipe their arses with/destroy are selected for interview).

Please please please, if anyone reads my drivel, read this: come to the march in London on Saturday 17/3. It's organised by Remedy UK (details here). I have no doubt that it will make not the slightest bit of difference to anything, but at least we'll be able to do some shouting, which always makes me feel better anyway. And then we can all go down the pub afterwards.

You fucking bastards

2007-02-28T09:45:00.000Z

I am unemployable. I did not get shortlisted for any interviews, despite casting the net as wide as I could, despite applying for a job that I'm already doing, at a level that I am, if anything, slightly overqualified for (I couldn't apply to the next level up as no MRCP yet). Most of my friends will also be jobless come August. We are all very depressed and I burst into tears in the middle of the ward yesterday, which was embarassing. Then I went out last night and got pissed. Now I'm hungover and demoralised. I can't fucking believe it. Don't get me wrong, I didn't expect various London teaching hospitals to be clamouring to give me a job. I didn't expect to get my 1st choice of hospital or region. But I did expect to get at least one fucking interview, one chance to justify my existence and prove that I am worth employing by actually speaking to my potential employers face to face.

If I were single I would be on a plane to Australia now. As it is, I'm facing the prospect of accepting any bone the MTAS fuckers choose to throw me, be it 'career grade' or 'FTSTA' (AKA Staff Grade, AKA career suicide and contractual wasteland where they can pay you as little as they like and where you get no training whatsoever). I have a feeling this bone will be cast several hundred miles from my beloved's SpR training rotation. I honestly don't know if we can survive another long distance stint (we've done it before but I don't know how long we could manage it for again).

So, MTAS, you stupid jobsworth foolish monkey fuckwits, you educationally subnormal soulless bastards, not only have you effectively sealed the fate of my career and future livelihood, you've also decided the fate of my relationship. My entire fucking life. You cunts.

Mangling medical careers, part 2

2007-02-23T18:03:00.000Z

I woke up in a good mood today. I didn't feel like having a cigarette (and I managed to resist smoking on Wednesday night, despite being very drunk - I just remember shouting, 'Stop smoking, you pigs!' at my smoking friends). I had had a good night's sleep and it was mild outside. I wore my favourite boots to work.

I was humming to myself as I checked somebody's blood results when a friend of mine walked onto the ward with a face like thunder. 'Have you checked your email?!' he spat. I replied that I hadn't. 'They've extended the fucking deadline for MTAS shortlisting. Which means they've shortened the amount of notice we get about interviews. I might find out on Monday that I have an interview in Yorkshire on Tuesday and have to beg for the time off, pay five billion pounds for a last minute train ticket and turn up at the interview with no time to prepare!'.

I agreed that this was pretty crappy and sympathised (the furthest away I have applied is Norwich, but I do have a car - nonetheless it is extremely irritating, though I have been feeling fairly apathetic about the whole thing of late).

My irate friend is an excellent doctor. He passionately wants to become a gastroenterologist and would make a very good one. He wants this job more than anything. But this morning he looked me in the eye and said, in all seriousness, 'Fuck them. They don't give a fuck about us. They treat us like schoolchildren. Why should I turn up and beg for a job when they won't tell me where I will be working, how many hours I need to work, what training criteria I need to meet and how much I will be paid. I'm going to go there, give them the finger and say "Fuck you all, I'm going to Australia". I can't be arsed with this shit anymore.'.

I don't blame him one bit. I do think he's serious about what he said and that this deadline change was the last straw after the whole MMC/MTAS/Hewitt nightmare of the past few months. I've just seen him printing out application forms for Australian medical job agencies.

I feel like shit now.

Done and done

2007-02-21T16:38:00.000Z

I have done my exam. It wasn't brilliant, but wasn't hideous either. I was slightly concerned by the fact that I didn't have a clue what the respiratory case was. I was also concerned that I couldn't understand the questions I was asked by the examiners in the 'Ethics and Communication Skills' station. Neither of them had English as a first language and both of them had very heavy accents. Now it may well have been nerves, but I couldn't understand them. I am concerned that these people, who cannot communicate effectively with me, are put there to judge how effectively I communicate with patients. I await their respective judgements with bated breath.

I have also stopped smoking. I haven't had a cigarette since Saturday 17th February at 1825. I feel I am still experiencing physical withdrawal symptoms, but I may be imagining this. How long are they supposed to last for?! I went for dinner in London yesterday and had to run through the train station to get straight on the Tube in case I found myself in the tobacco shop. I am also going out for dinner tonight with friends (two of whom smoke) - I am worried but confident, if that makes any sense. I feel like I'm nearly through the physical cravings so don't want to 're-set' everything by smoking tonight. God I really really want a fag though....

Smoke on the water

2007-02-10T11:49:00.000Z

I am a smoker. I started smoking at school and developed a 30-a-day habit at medical school. I gave up in May 2000 and didn't touch a cigarette for six and a half years, but then at the end of 2006 I suddenly started smoking when I was drunk and out with friends who smoked. A bad day in November made me think it was a good idea to buy a pack of twenty and I've been smoking ten a day ever since. I did try to give up around New Year but soon started again. The trouble is, I enjoy it. I like the solitude and space that going out for a 'fag break' brings. It also confers a kind of weird solidarity between fellow smoking pariahs - for example, I went on a PACES course recently and found myself chatting to a man with Eisenmenger's syndrome and an acromegalic while we stood outside having a quick fag.

I don't like the smell, which sticks to my clothes and hair and makes my breath like an ashtray. My boyfriend hates it. And there is, of course, the whole lung cancer thing. I don't know whether the large warnings on cigarette packets actually deter anyone from smoking - I can't imagine anyone asking for twenty Marlboro lights and then saying to the sales clerk, 'Oh my God, it says 'SMOKING KILLS' on the packet. I had no idea. I won't buy them after all.'.

I am giving up, for real this time, on the day of my PACES exam. After the exam, of course. There will be a lot of drinking and celebrating the week after, which may throw a spanner in the works as it did in January. But we shall see. I can't be arsed with patches or gum or anything. When you haven't smoked for very long the physical withdrawal symptoms aren't really too bad, and are over within 48-72 hours. I think nicotine replacement just prolongs the withdrawal period. It's the psychological side of things that's the real bugger - you want to want one. Especially after a few glasses of wine.

I can't carry on like this though. It really does get to my boyfriend, who is vehemently anti-smoking. He's also a doctor and therefore knows as much as I do about the health risks and has probably treated more lung cancer patients than I have.

I'm not sure what I make of the upcoming anti-smoking legislation. It will be nice to come back from the pub and not stink of smoke. I'm not sure if it extends to smoking in the street - I think that would be a little Draconian to say the least. Our hospital Trust is now 'smoke-free', so we have to either be discreet or walk off hospital grounds to smoke. I do agree with it in a way - it probably helps patients who've come in with a heart attack to stop if they don't see a gaggle of nurses standing outside puffing away. I do think it's cruel, however, to force terminally ill patients to stop. What is the point? We are very bad at providing nicotine replacement to these patients, many of whom have smoked for years and therefore have nasty withdrawal symptoms. We are rather good at treating alcoholics with withdrawal from booze, so why not smokers? It is nigh on impossible to get nicotine replacement from the hospital Pharmacy - we tend to ask patients' relatives to bring it in. I think that's disgraceful.

Anyway, seven days til I give up. I don't want to end up as a pink puffer or a blue bloater. I don't want to exsanguinate horribly from an eroding bronchial carcinoma (I've seen that happen - it is not nice). If I give up now and don't start again, I have a good chance of not getting any of the above. Of course, I may already have contributed to my ischaemic heart disease (particularly in view of my family history), but that should reverse itself in time. I will be able to tell patients they should give up smoking without being a hypocrite.

Oh, did I mention I want to be an oncologist when I grow up? Smoking is most definitely not part of the plan.

10 days to PACES....

2007-02-07T20:08:00.000Z

I have ten days until my PACES (Practical Assessment of Clinical Examination Skills) exam. I am scared. It will be very embarassing. Not because I'm a crap doctor, and not because I haven't worked hard. I am a good doctor. I get on well with my patients. I have good clinical skills and I have done a lot of work. I have invested more money in this exam than I have in any one thing before (exam fee, courses, hotels for courses, travel to courses, books). It's just that so much of this exam depends on lady luck. She has been good to me in the past, but she tends to abandon people on PACES day for some reason.

I should be studying now but I feel too wired. All I want to do is chain-smoke and play 'Spider Solitaire' - I keep getting into a cycle of 'I'll stop playing and do some revision when I win a game', but then inevitably I lose game after game and suddenly it's 1am and I have to be at work at 8am and oh dear it's too late to study now and I'm tired anyway never mind....

One thing that pisses me off is that this exam will be scrapped within the next few years, presumably to be replaced by some kind of super 'mini-CEX' and 'DOPS' extravaganza thanks to the fuckers in charge of 'Mangling Medical Careers'. I finished my application form last week to MTAS (AKA pick a random doctor's name out from a hat, give them a job anywhere between 5 and 5000 miles of the one they applied for and hope they can speak English) (I couldn't think of anything clever starting with M, T, A and S). The application form was basically like a submission to a creative writing competition, except 1st prize is a job (just a job, anywhere - if it happens to be several hundred miles from your house, who cares, it's a job! Be thankful to Mrs Hewitt, boys and girls).

For the uninitiated (you lucky bastards), MTAS is the new application 'service' for doctors. From the newly qualified to the nearly-Consultant, from now on ALL doctors in the UK can only apply for jobs once a year - that is every single doctor and every single doctor's job in the UK. You can apply for up to four different specialties - which it encourages, to 'maximise the chance of success'. Never mind the fact that you want to be a cardiologist and you end up working as a dermatologist - hey, you got a job and therefore MTAS is a success. Or, if you really want to be a cardiologist, you can apply to up to four areas (or 'units of application'). Never mind if you live in Devon, you should 'maximise your chances' and apply to areas as diverse as London, Kent, Surrey and Sussex (ALL one single unit of application), Eastern (AKA Norfolk), West Midlands (AKA Birmingham) and Wessex (AKA Southampton and Portsmouth). Bad luck if you're Scottish - the WHOLE of Scotland, from the northernmost Scottish Isles down to Edinburgh, is ONE unit of application. So theoretically you could apply when living on the Scottish/English border and end up in Wick. And remember you must MAXIMISE those chances, so you should also apply to the whole of the north of England (one unit), Yorkshire (one unit) and, oh I don't know, how about Mersey as well? If you really just want to be a cardiologist.

God I am so pissed off with this steaming pile of horseshit. I love my job. I love being a doctor. I think I'm quite good at it now. I just don't know if I can put up with being treated like a child by the Government, condemned by the press and bullied by managers.

Fuck it. I'm going to play some Spider.

The weekend from hell

2007-02-01T12:24:00.000Z

I recently finished the worst weekend on call in living memory (my living memory in any case). Saturday was spent shoving various lines into a 76-year-old man's neck and groin and filling him with fluid, antibiotics and anti-fungal medication. He was an old patient of mine who had ulcerative colitis. He first came into hospital in October with a flare-up. Various things happened; he ended up having his colon removed and a very stormy time with a perforated ulcer, double pneumonia and Candida septicaemia. I saw him just before Christmas and he was much better - he just needed intensive physiotherapy to get him back on his feet, so my consultant sent him to the rehabilitation ward. When I was called to see him urgently on Saturday morning he was unconscious, with a very low blood pressure, acidosis and very low blood oxygen levels. He was severely dehydrated and in septic shock. He had not had his vital signs measured for two days (on meidcal wards nursing staff routinely do these every four hours, but this does not happen on the rehab wards). In short, he was about to die. I moved him to an acute ward and spent most of the day trying hard to keep him alive. He died just before my shift finished. I had to tell his family, who were devastated and could not understand why this had not been caught earlier. Neither could I.

Whilst I was still dealing with the above gentleman, a man came into A+E with complete heart block . He was seventy years old and had never been ill a day in his life. We couldn't get his heart to speed up despite drugs and external pacemaker pads (which basically shock his heart at intervals to stimulate a heartbeat). He stopped breathing several times before we got a pacing sheath into his jugular vein and got him to thex-ray room to insert a temporary pacemaker, which was unsuccessful because we couldn't get his heart to respond to the pacing impulse. He did however regain a normal heart rhythm spontaneously, but the ECG showed signs of a heart attack. Those same ECG changes can also indicate that the pacing wire has put a small hole in the right ventricle, a recognised complication of this procedure, which was performed by an experienced registrar. He was discussed with a cardiology consultant at another hospital, who recommended clot-busting treatment for a probable heart attack, despite the risk that it may not have been a heart attack at all but a hole in the right ventricle. This caused him to bleed profusely into the sac around his heart. A drain was inserted into this sac and he drained two litres of blood from his heart overnight but remained fairly stable. We gave him blood and clotting products to reverse the effect of the clot-busting treatment. Later the next morning, his heart stopped. We began to resuscitate him. I got a large syringe and began sucking blood out of the sac around his heart.

It was like a scene from a bad horror film. I had a bucket of blood next to me on the bed, into which I would throw full syringes after sucking blood out of the man's chest. Each time, someone would hand me a new one, and I would carry on. I was covered in it. After I removed about half a litre of blood, his pulse returned and we recorded a blood pressure. My registrar got onto the phone to London to arrange for him to be transferred for urgent cardiothoracic surgery. Ten minutes later, he lost his pulse again. We never got it back.

His family were waiting outside, and one of the nurses went out to tell them that he had died. We frantically tidied him up, mopping up the blood and hiding the bucket. We covered his body so that only his kind, sweet face remained exposed so his family could see him. His wife was so distraught she couldn't support her own weight. All the nursing staff and the entire arrest team were in tears. He had never been ill a day in his life.

After that, I dashed outside with one of the junior doctors for a much-needed cigarette. She was upset, but more than that, she was upset at herself for being upset. She told me what many people might think if they read this - 'This is our job, this is what we signed up for. We shouldn't be getting emotional or upset about things like this - does this mean I'm not cut out for it?'. I told her the truth, what I believe anyway - 'Nobody should be cut out for this. If you get used to things like this, then it's time to change profession'.

765 days and counting...

2006-12-16T14:03:00.000Z

http://www.nationalnightmare.com/

According to the fantastic 'Bush Countdown Clock', we only have to endure another 765 days, 9 hours and 54 minutes of the hideous Bush administration. But let's not misunderestimate how much havoc monkey man can wreak in the meantime...

Daniel Craig

2006-11-15T19:29:00.000Z

Oh yes.

The English language

2006-10-30T06:30:00.000Z

First of all may I say that I am currently in the middle of a week of nights, and my patience is running thin what with the complete buggeration of my body clock coupled with seeing too many irritating pissed people who feel the need to present themselves to A&E because (surprise surprise) they feel sick.

I thought I should add that disclaimer before I launch into my tirade...because people who mutilate their own language really PISS me off.

I have lost count of the number of signs I have seen with misplaced apostrophes - 'Video's for rent', 'Fish and Chip's' (no really), and, by far the best I have ever come across - 'We fix roof's, fences' and fascia's'. Does nobody learn how to use punctuation any more? That isn't even an excuse - does nobody READ??!!

Using the wrong 'there' or 'their' is another one that makes me spit, as is complete disregard for the correct use of 'too' 'to' or even 'two'.

'Could of' instead of 'could have' is another one, though slightly more forgiveable than the above examples.

It isn't just 'uneducated' people who make these stupid errors either. Doctors, nurses, graduates, accountants - I have seen those mistakes made by people who really should know better.

It's embarassing that people who do not speak English as their first language know the rules of English grammar better than we do. It just serves to reinforce the (broadly true) view that English speakers are lazy and arrogant about languages - we cannot be bothered to learn any other languages, and we really can't be arsed to learn our own language either.

Bollocks.

Get on with it!

2006-09-05T21:46:00.000+01:00

Things are slowly getting back to 'normal'. I wake up every morning, remember that my mother is dead, then get up and have a shower and get on with the day. I am having fewer moments where the enormous weight and total unreality of the situation hit me and knock the wind out of me, but they still happen. One of the worst things is that I keep thinking things like 'oh, I must tell her that' or 'she'll think this is hilarious'. Once I even got my phone out to call her whilst I was walking to the train station.

One of the things that bothers me is feeling like a walking cliche. The simple fact that grief is so universal, which I suppose I should find comforting, just pisses me off really. Every thought I have about my mother seems like it has been thought before (and written about with far more eloquence than I could ever muster).

I sometimes can't believe the sky can be so blue, that the trees and fields on my train journey can be so beautiful, that the night sky can be so clear and above all that life itself can still go on, when she isn't here. Where is she now? But that is just another cliched grief question which can wait for another day.

The following poem says a lot about how I feel right now, although again I feel that the words and sentiments are somewhat tired and over-used (its reading by John Hannah in Four Weddings and a Funeral serves to add to that well-worn quality). It just feels right to reproduce it here, knowing that WH Auden was once feeling exactly as I do.

Stop all the clocks, cut off the telephone
Prevent the dog from barking with a juicy bone
Silence the pianos and with muffled drum
Bring out the coffin, let the mourners come.

Let aeroplanes circle moaning overhead
Scribbling on the sky the message He Is Dead.
Put crêpe bows round the white necks of the public doves,
Let the traffic policemen wear black cotton gloves.

He was my North, my South, my East and West
My working week and my Sunday rest
My noon, my midnight, my talk, my song
I thought that love would last for ever: I was wrong.

The stars are not wanted now: put out every one
Pack up the moon and dismantle the sun
Pour away the ocean and sweep up the wood
For nothing now can ever come to any good.

What do you want me to do with your mum's brain?

2006-07-25T09:13:00.000+01:00

That must be the most bizarre question I’ve ever been asked.

My mother, who was 58, died suddenly this week. The post mortem showed that it was probably a sudden cardiac death related to heart disease we didn’t know she had. As I come from a small town, and am ‘medical’, I know most of the people who work at the local hospital, including the pathologist who performed the post-mortem examination of my poor mother’s body, and who asked me the above question. She had a chronic neurological condition, and he wanted to know if I wanted to donate her brain to medical science, or at least send samples of it off for specialist analysis. Being ‘medical’, I thought about it. Being a daughter, I said no.

I actually went to see the pathologist to discuss the results of the post-mortem. I never would have thought that I would be able to wall off my feelings in the face of something so awful, but it just happened. I sat there in his office, next to a sheet of histological slides taken from my own mother’s heart and lungs, and talked as if it was one of my patients who had died. I enquired as to whether my mother’s kidneys had any evidence of scarring from the frequent urinary tract infections she suffered from. I nodded impassively when he hesitantly told me that her liver was a bit fatty (she liked her wine). I listened attentively while he told me that her skull was intact, that there were no external injuries apart from a cut on her little toe, which I blandly confirmed had occurred some days before her death.

I feel like a robot. It feels like something is stuck inside me.

I went to her flat with my dad (she was divorced from my father but they were still friends). I looked at her notepads, her doodles, her work notes. I looked in her diary – ‘lunch with X’, ‘cleaner away’, ‘book taxi’. I moved around the space where she had lived, the room where she had died, and I tidied. I cleaned.

Then I found my mother’s laundry bag. I took out two t-shirts which she must have worn recently. I held them to my face and I smelt my mother’s perfume, I smelt her. And dear God I cried. I rocked. I held my mother’s clothes to my chest and some of what was stuck inside me came out, but not all of it. I clammed up again soon afterwards and got on with tidying the flat.

I’m hoping that nothing comes unstuck until after the funeral. I can’t go to pieces in front of a load of people, even if that’s what’s expected. I need to stand up in front of everyone and tell them that I loved her, that she was a wonderful, beautiful person, that she was my mother and nobody else’s and that she did a damn good job of bringing me up.

I hope to God the dam doesn’t burst before I’ve done that for her.

Summer Service Provision

2006-06-12T19:13:00.000+01:00

Medicine is much quieter in the summer. Fewer old grannies with infective exacerbations of their emphysema, fewer pneumonias, just fewer patients on the list generally. All of which means that those people who are unfortunate enough to be admitted to hospital when the weather is lovely are more likely to get good service.

Obviously, if it's less busy, waiting lists for scans etc will be shorter, but I also mean they will get better service from the junior doctors who care for them. We have time to go back and check that Mr Smith with neutropenic sepsis has enough fluids. We notice that he has been on 1st line treatment for over 48hrs but is still spiking temperatures and actually have time to ring the microbiologist and get advice about changing his antibiotics. We have time to repeat his blood cultures ourselves (because the ward is understaffed and there is no way in hell the nurses are going to get around to it).

We also have time to chase the results of scans and tell the patients these results as soon as we know them, rather than checking the computer quickly to see if they're back and thinking, oh well the result won't change management in the next couple of days, let's just wait, no time to go down to radiology, hunt down the radiologist who did the scan and badger them to report it for you.

We have time to sit down and think about more complex patients and how we should treat them, rather than just throwing more frusemide/Augmentin/Oramorph at them and hoping they'll go away.

More complicated patients are more likely to be kept in for full investigation of their anaemia/deranged liver function tests/odd chest xray shadow, rather than it being a case of 'we've fixed the pneumonia, everything else can be investigated as an outpatient', whereupon the patient is duly shipped out to await a load of other investigations and their poor beleaguered GP receives a scrap of paper two weeks later saying 'GP to chase results'.

On the flip side of this, fewer people stay in hospital unnecessarily in the summer, because a)waiting lists for scans/other investigations are shorter and b) we have time to tie up all the irritating loose ends that are normally put at the end of the (endless) job list and forgotten about. People can come in, have their investigations, get fixed and be discharged.

I started my general medical SHO job in the winter, and had come to believe that people just never got sorted out properly because there wasn't the time - you had to focus on what brought them in, never mind any other problems they might have, medical or otherwise, and ship them out ASAP before your team's next 'take', when another busload would be dumped on you. Doing the ward round, I always had a mental image of all the other patients who still needed to be seen, the ever-lengthening job list and the hideous spectre of our next 'take'.

Now I realise that this isn't the case. We do have time to be thorough. We are capable of providing a good service to everyone. Just for three months of the year.

If only it were always summer. If only we had more doctors.

The Slim Fast Plan

2006-06-10T00:53:00.000+01:00

Ah, the slimfast plan. So beautifully simple. A 'delicious, nutritious' milkshake for breakfast, one for lunch, and a 'proper dinner'. Or, a milkshake for breakfast, be hypoglycaemic by 11am whilst sitting in clinic and start alarming patients with your disinhibition, try and fill your stomach up with black coffee and be climbing the walls by 12pm and find that you are unable to take blood pressures because your hands are shaking too much, dash off at 1pm to have another poxy milkshake and nearly collapse from hypoglycaemia in the middle of the Consultant's afternoon round, get home at six feeling dead chuffed for making it through the day without scoffing chocolates on the ward like you normally do and looking forward to a 'proper', (but healthy and only 600 calories) dinner, then get invited out to dinner and bugger everything up by eating a whole mozzarella garlic bread, a huge bowl of spaghetti and a slice of lemon tart. And half a bottle of wine and a liqueur coffee. Sod it.