Sympathy for medical students

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?

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....

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

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

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

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'

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 :)