You’re Day Has Arrived

I’m writing this to remind myself in a year when I’m a grown up doctor just how it felt to be going on my first set of nights as a doctor.

This was a scary moment, finally getting the doctor lanyard and leaving the medical student ones behind. Graduation was a good day, this made it real!

The past fortnight has been a steep learning curve. There’s been the induction stuff (although I was surprised how seamlessly that went and how not terribly mundane it was!) the meeting new friends (I’ve got a tea and therapy buddy – win!) and the assimilating new knowledge to contend with. And that’s been without managing a social life in the background….

I slept 12 hours straight through on Wednesday. Things were suddenly brighter as I woke but I think this is going to be my life from now on, this is what I signed up for. The years of medical school are behind me and the big bad world has been welcoming thus far…. but there’s that imminent sense of ‘I’m gonna mess up fear’ that is trying to get the better of me just now and it’ll be fine once I step up to the plate but much like the athletes about to compete in Rio I am apprehensive about how my first shift with a signature and a pre-registration licence to boot will g (the clinic nurses I’ll be working with have already nicknamed me 007 and half) .

It’s taking some adjustment to go from being the big fish in a small pond to a small fish in a big pond, that transition made during a lifetime. Nursery to Primary school, primary to secondary, secondary to uni, uni to uni (if you’re an eternal student like me) and now uni to first job. It’s been almost overwhelming the camaraderie that I’ve been shown, that we the new FY’s have been shown. Most of it I’m sure has a ‘you’ll not be smiling in a couple of weeks’ undertone but any questions have been answered no matter how silly, no one can do enough to make sure the newest junior member of the team is okay but now it’s the business end of a weekend of nights where my decision making will be required and relied upon. Realistically there are a million pot holes that could show themselves but they won’t and good basic management with a slug of seemingly pointless questions will serve the patients well but it still doesn’t allay that fear completely.

There is so much advice out there, for years I watched the #tipsfornewdocs hashtag splutter into life and begin it’s annual soapbox of helpful hints and tips (most of which I’d learn off by heart)  wondering if I’ll ever require it’s helpful input but wading through what is useful for me as an individual has been a welcome distraction as my day has arrived.

There’s so many demands on life that you cannot please everyone…. I spent my first weekend of induction away with friends where I laughed, talked all manner of non-medical things and ate too much food, I’ve nipped home before these nightshifts to see my parents and have breakfast with the bf as it’s possible we’d not see one another for another two weeks and I’ve slept. But it felt a little bizarre to pitch up for day one as a doctor and then sod off for some pre-nights furlough. My life in medical school was a hectic heady mix of classes, placements committee meeting and projects on the side and now I have a job a bigger responsibility but one thing instead of 19050796948854 things. But I wouldn’t change it.

credit:http://theberry.com/2015/01/19/daily-motivation-25-photos-725/

 

 

 

Losing Control

Medical training is controlled, it’s measured and dosed to students as per the curriculum. In first year you learn to talk to patients and examine specific parts of the body. You continue this in second year but think about what is going wrong. Third year adds more to think about, how will you manage this patient. It’s all done in a controlled environment, safety and support are vital and no-one is hurt if you go wrong.

The real world isn’t like that. Control goes out the door the second you hit the wards as a fourth year student. Yes you’re supported and yes you can defer whenever you need to but there are consequences.

My first day of general medicine I was clerking patients in, me – a clumsy and mildly terrified fourth year garnering a patients story, noting my findings and presenting the patient. If I get the wrong end of the stick I’m doing a disservice to a patient. They’re stable and it’s highly unlikely I’ll do them harm but I could delay their care because of my learning.

I’m a big girl now

It’s the final semester of uni, the culmination of five years of practice and learning. It’s the time to stand on the plate, stethoscope, name badge on a lanyard on and play ball.

the red lanyards of doom…

I’m reminded of five year old Me who used to play hospital with my teddies… Cutting them up and seeing them back together (so much for #notasurgeon) that little girl who was full of excitement and determination.

  

dad at his masters graduation

Since I’ve been knee high to a grasshopper medicine is all I have ever hoped to do… I get a thrill from helping people. I like to make them feel better, to have their story taken seriously and do something to relieve pain. Medicine isn’t quite what five yea role me thought it’d be but it’s still amazing. 

I’m often asked why, particularly recently with the political upheaval, why when it’s so much effort? Because… Because seeing the relief on the face of someone who’s getting treatment, owning their condition or finally feeling better is amazing. It can be overwhelming when someone says thank you and all you want to say is thanks to them. Thanks for sharing your story and letting me help. One shift I had this week saw me cried on by someone at the end of their tether with a painful and debilitating chronic condition, an older gentlemen who was confused serenade me and swear at me and a difficult catheter specimens sample nearly cover me in wee. But you know what? I didn’t mind! I eased pain and soothed worry and I’m only a student!

   
It’s incredible to think of the difference 5 years makes. The young graduate who started medical school is a far reach from the medical student I am now. I’ve learned more knowledge, tested my endurance, built my emotional resilience,  practices my professionalism, worked on team work and begun a lifetime of mastering the art of medicine. I was reminded of this the other day when I did my ILS course (a resus council required course!) and in ten minutes I was able to help manage my own ‘patient’, diagnosis and great their ailment… Something I would not have done five years ago! That’s pretty darn incredible! 

The Ideal Illness?

How common is it to encounter patient families who want to take the pain for their loved one?

#TELHack A Newbie Perspective

It’s been a good while since I broke out of my comfort zone (my brother recently questioned whether I had a comfort zone. Yes actually, I do).

Without detracting from the reason I’m attending my first hackathon I want to reflect on just how much time fourth year medicine has taken up. My life for the past year has been a treadmill of constant placements, changing weekly, fortnightly or monthly depending on the specialism. It’s been hard to try and ‘square the circle’ of a work life balance without paying in missed birthdays and missing out clinically. It’s a stifling situation to creativity and innovation, with the focus (rightly so) being on exams and reaching the clinical competency required of a medical school final exam.

This brings me nicely onto my next point: Hacks. Defined as ‘an event, typically lasting several days, in which a large number of people meet to engage in collaborative computer programming’

I was due to go to one a few weeks ago but my medical finals put paid to that.  I can’t remember how I had heard about this Specific hack but with exams past, a time limit on my university commitments (ending in June 2016) I’m on the hunt for a fresh project. Probably not the wisest decision  but there we go.

Each week at the moment seems to be a hectic blur of hecticness and this week appeared to be one of the worst for hectic activities but Friday rolled round and I set off with excited trepidation. I am at that stage of the academic semester (or lack of one!) where everyone is cranky or just wants a break and as the adage goes a change is as good as a rest. Since resting is not on the agenda until at least next weekend… A change it was.

Purposely I’d decided to fly down earlier in the day… Meaning I could go see two lovely ladies… @hannahpopsy and @rosedewy for what turned out to be quite a cathartic moan and groan  about the awfulness of final year. Freshly relieved of my woes I headed off ready to hack.

I have a feeling this blog might end up too long so I’ll be back with more soon.

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Top 10 tips to Getting Through Finals

I’m almost there, finals exam start on Tuesday… I’ve been referring to them as the #endofschoolquiz because, well because. Medical School Finals are terrifying, they’re big and they’re intense. There’s no easy way round it… it’s part of the long process and journey that one goes through at medical school. After an arduous year of trundling round what felt like every department in multiple hospitals you sit ‘Finals’ (Technically in Dundee they aren’t the final finals as we sit an OSCE in May time but these are the last written exams we sit!). Questions on ANY topic can come in any order and there are also practical OSCE stations to sit. In total you sit 6 hours of written exams (approximately 400 marks worth of Questions) and 2 hours of practical OSCE exams and this is what decides your fate, whether you are ready and able to progress to final stages of medical school and preparation for WORKING AS A DOCTOR. It’s meant to be overwhelming right? It’s meant to be tough because in less than a year you’ll be looking after human beings who are sick.

Cardiology Pharmacy

**THESE NOTES HAVE BEEN MADE BY ME WITH A PRIMARILY MEDICAL SCHOOL FINALS FLAVOUR**

These notes were compiled from the local formulary the BNF (requires registration – very much advised) and appropriate SIGN and NICE guidelines

Image from Flickr here

4th Year According to West Wing Gifs

This is a bit of a soap-box ranty fest but I have feels and they need out! What better way than with Josh, CJ, President Bartlett, Toby and Donna!

General Surgery Made me feel a bit….

On Death and Dying

ON DEATH AND DYING

It’s taken a while to be able to write this post, a bit of reflection (man alive I hate the connotations of that word) and the passage of time to wonder how to construct this.

Amidst the frustration of speciality fatigue (the drain from being in a new department, with a new group of people every week!) It was time to hit the ED. The week generally goes along the lines of an ED ward round filled with overdoses, suicide attempts and alcohol-related head injuries followed by ad-hoc teaching.

Of course an ED is the place you’ll encounter death, any are of medicine carries the risk of seeing a life end… however when it’s sudden, unexpected and undignified it’s nothing short of horrific.

In my ageing block I saw how lovely death can be, indeed my own gran passed away in peace and quiet with mum at her side. Death can be something someone can own, they can choose and say ‘please, leave me be’. Hearing of someone in hospice who had their dog in bed when they died them filled my heart with joy and happiness, a life well lived and a death eased and comforted. Isn’t that what we all strive for?

As a future medical professional it’s all very easy to say ‘oh I wouldn’t have that, I wouldn’t want X, Y, Z treatment’ but what about those who can’t know, who’s lives are lived and lost in our hands? It’s part of or job, if not the most important part of our job to prepare, help and facilitate a good death no matter what happens. Even when that death is a grim, clinically isolated experience.

There are many firsts in medical school, a first time using the stethoscope, a first time taking blood, a first time cannulating a real patient…. and for some a first doing CPR. No one really prepares you for any of these firsts, especially the sad ones, the ones that are terminal manoeuvres and end of the line, backed into a corner procedures. By it’s very nature CPR isn’t a planned thing, it’s a ‘the patient is already dead but lets keep them ‘alive’ long enough to work out what’s gone wrong’ thing.

It’s difficult enough to process something like that in an environment you’re familiar with, a ward team you know well, a team you’re used to, but as a student, dealing with it is tough. You don’t choose who you’re on placement with, and you may not even know them with the ebb and flow of BMSC-er’s (those who took a year out to do their BMSC), so you’re in an unfamiliar department, with unfamiliar people, dealing with an unfamiliar (and now dead) patient. It’s all horrible and isolating. But it’s transient too, medical school comes to an end and you’ll be with people you know for a longer period of time, you’ll be doing things that aren’t a first and you’ll know that feeling you had the first time.

My first time felt nauseating and tense, doing something you’ve trained for in simulation, something you’ve had drilled into your subconscious on a real patient is strange. The body doesn’t click like Little Annie, it crunches and rubs with fractured ribs, it sags and takes time to recoil, it  doesn’t tell if you’re fast enough, or too slow. It simply is, it’s a moment and a cataclysm of emotions surging against the muscle memory of concentration.

The aftermath, the deep sigh of relief as the moment passes, as the emotions abate into the tremulous post-adrenaline state as the patient is dispatched, with protocol and routine, to the viewing room, to regain whatever shred of dignity remains in the ripped taters of their clothing. Is this a good death? It’s not for anyone but themselves to say but there is one thing that’s true, it’s a million miles away from the serenity and peace I saw in hospice.

But how do you move on? How do you process the witness of a life passing on? Is there a class ‘on death and dying’ that covers how you should feel after such an experience? I doubt there can be anything that prepares you for the nasty firsts properly. It’s something that needs debriefed and support to work through, the silence it can bring is unhealthy and caustic…. It starts with sharing, and talking, something we as a profession majorly suck at. We like to boast of our successes and strengths, but weaknesses remain hidden. But we will all have these moments, either as an undergraduate or post graduate, and they happen daily. The realisation of not being alone is a relief, and the permission to be upset is cathartic. It will get easier to cope with, but won’t ever get easier to go through. Nor should it, as we are one of the few professions who gate-keep life.