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Wilkommen to my blog - my name is Karin Purshouse, and I'm a doctor in the UK. If you're looking for ramblings on life as a junior doctor, my attempts to dual-moonlight as a scientist and balancing all that madness with a life, you've come to the right place. I'm currently a doctor/research trainee in oncology after spending a year doing research in the USA. All original content is licensed under a Creative Commons Attribution 4.0 International License.

Sunday, 21 December 2014

Twas five nights before Christmas...

The last time I had a really vicious bout of the sniffles was this summer.  It's funny how well I remember it.  I was doing locum night shifts and had been burning the candle majorly in the run up, and personally and professionally I really wished I didn't need a steady supply of tissues and paracetamol on hand.  Now I feel much the same, having just had the most jet-set week of my life so far.

SWIMS 2014
So, with my herbal tea in hand, it's time for the Christmas edition of my scribbles.  Bless my blog, it's had a good year.  As has become my blog tradition, with Christmas upon us it is time to look back at the general mayhem and madness that was 2014 and 'learn' something from it.

This year:
January - SWIMS (That's 'Sensible Women in Medicine and Medicopolitics Society') held its inaugural conference in the Peak District, celebrating being normal ladies, basically.  January was the Month Of The North, and it was jolly wonderful.

February - I was up to my eyeballs in pipettes and petri dishes, trying to Do Science - and then remembering that being rubbish at something for a while is pretty damn healthy.
Tignes looking all lovely and white in Spring

March - I spent a lot of March revising for my MRCP part two exam.  I love this funny job I have called 'Doctoring' but it isn't half exhausting doing a full time job and then cracking out a nine hour exam between night shifts.  Lesson learned - this too shall pass.

April - I left the lab and went head first into night shifts as the Medical SHO; but actually through some of my own health strife I realised what life was like on the other side of the patient/doctor divide.  Puts things into perspective, that.

May - By this point I was well and truly medicine-d.  Breaking bad news and other such difficult conversations made me see, though, that this is totally the job for me.

June - ... on a similar theme, discussing end of life decisions - another one of those 'wait just a second there, I'm only in my twenties, how can I be ok discussing this' type moments.  And then realising it doesn't matter, because you're actually ok having this sort of chat and really it's a privilege to be the one doing it.

Wedding goofing around with my other bestie Matty
July - Apparently I didn't post anything in July, but I'll tell you for free that I was saying goodbye to a lot of excellent friends from the last two years as we finished our first official posts as doctors.  I'd argue these have been amongst the biggest in terms of friends, family and self, so it was a pretty big thing to say goodbye to.  Also - weddings.  So many weddings.  Marvellous!

August - I became a part-timer!  Oh it was wonderful.  Being a self-confessed work-a-holic, I became a work-and-life-a-holic.  This is when I got my cold, by the way.  I don't think Black Wednesday really had anything to do with it...

September - What a month.  Tears a-plenty, and that's from me, the ice queen.  Although I'd say what I learned from September that going and exploring pastures new doesn't mean what it did when you were 18.  Life really will still be there when you get back; it's more like 'adieu' than 'goodbye'.  That doesn't mean I didn't bawl like a baby when I gave my final wave to my friends, of course.

Claire and kickball in Baltimore
October - I moved to America!  What DIDN'T I learn, is probably a better question.  I learned that emigrating is the only way to really check if you're ready to be a grown up.  I learned that I am a lot more accepting of who I am than I thought.  I learned that making friends is still one of life's great joys.  I learned that I love my jobs, both of them, and that I am learning more about them all the time.   And I learned that alas, for me, there is nothing to equal the British ability to make a truly excellent cup of tea.

November - OpenCon.  'nuff said.

Oh to wander the streets of Oxford in December...
December - I can't lie - December has been flipping' hard work. I submitted another job application, various lab things went all 'science' on me (read: not working), my best friend went to Sierra Leone like the hero she is and amidst all of that... I got a job interview in the UK.  So back I flew, landing back in the USA two days ago.  Which was a lot more emotionally draining than one might think.  What did I learn from this?  Stop thinking, focus, and just go with it.  (But look after yourself.  As I've said many times on this blog before, no man is an island...)

New Haven's Christmas tree.  Subtle, huh?
So I really have no clue what 2015 will bring, apart from hopefully a renewed closeness with my stethoscope.  2014 had more twists and turns than I could ever have predicted.  Which goes to show, you really do never know what is around the corner.  Although I've had moments of doubt and fear, if 2014 has taught me anything, it's that you should never stop adventuring, whatever your definition of that is.  And with that - Merry Christmas, dear blog reader!

Monday, 8 December 2014

When your best friend goes to be an Ebola doctor

Unless you've been living on Mars, you will be aware of the Ebola epidemic currently sweeping West Africa.  My best friend, Claire, is leaving for Sierra Leone this week to work as a doctor with the Kings Sierra Leone Partnership (KSLP) at the Ebola Isolation Unit in Freetown.  Claire and I have been friends since our first week of medical school - we have lived together, travelled together, solved woes over endless cups of tea together, and grown as students and now doctors together.

Along with the rest of the world, I have been closely following the devastating events in West Africa. Towards the end of my time in the UK, I had a patient who was a returning traveller from the region, and I must admit that at the time, when Ebola was just appearing on the horizon, Ebola was well down my list of differential diagnoses in comparison to malaria, typhoid, yellow fever etc etc... I suspect if the same patient had come into hospital in the UK now, they'd be straight into an isolation unit.  It does make you wonder though how many of these common tropical diseases are now being untreated.  Having had malaria myself many years ago, it remains deeply troubling to me that so many people die from a disease that cost me about £1 ($1.50) to be cured of.  But now that Ebola has taken such a hold, how do you battle a war with so many fronts?

I have been struck by several aspects of the Ebola crisis.  Although comparisons between the AIDs crisis in the early 90's and Ebola are in some ways unhelpful (in terms of transmission, pathogenesis and disease course, they are totally different), they do highlight the gross inequalities in health provision, and how often it requires people in the Western world to be affected before they take action - as discussed by Kofi Annan.  Another is the role of the media - funny how the second it was reported that Ebola was marginally in control, it's no longer in the headlines. And finally, the mass hysteria about returning healthcare workers, quarantining and transmission risks.  This is despite the fact that, when asymptomatic, you are not contagious even if you have Ebola.

I'll admit, I wasn't super keen when Claire first told me her intention to go to work as an Ebola doctor.  Perhaps it was selfish of me, but having gone through the loss of close friends once, I just feared the worst - and that neither I, nor my friends, could go through that again.

But having read more about Ebola, the desperate need for staff and the immense progress in controlling the virus that has been aided by groups like MSF and the KSLP, I started to realise how ignorant I had been.  Of course there are risks, but when you consider how many foreign health workers are currently working in Ebola hospitals, and how few have actually contracted the virus, one must give credit to the healthcare staff there having developed very effective protection techniques.

Of course I am worried and anxious, and I will miss her hugely (it's amazing how Skype makes you feel like someone is not really that far away despite the fact I've been away for over two months!).  But rather than just sob to Kodaline, I shall instead say I am immensely proud of what she is doing; someone who has absolutely no idea how brilliant and brainy she is and will bring her zany love of life to everyone she meets in Sierra Leone.  Check out her blog for her progress (  As Christmas time approaches, I for one will be keeping Claire and all of her colleagues and, of course, patients in Sierra Leone firmly in my thoughts.
This beauty was taken on the roof on which we slept in northern Ghana (note our delightful sheen despite sleeping outside...) during our backpacking adventures around Ghana, Togo and Benin in 2008 having just finished our second year at medical school.  

Saturday, 29 November 2014

The First Thanksgiving

Thanksgiving baking...
I'll keep this short and sweet, but much like my Christmas lovin' last year, I like to take the opportunity of these significant holidays to say a little woop woop for all the good things going on in hopes that you will do the same.  Especially having just celebrated this, my first thanksgiving!  Of all the American things I have experienced so far, this may be my favourite.  I was welcomed first into the home of a friend in New Haven, and then later in the day New York to have Thanksgiving dinner with a lovely couple who had invited me along with a few other international students.  And today I put the world to rights with various Fulbright folks who continue to add shine and sparkle to my life with their refreshing and new outlook on things I normally only get to discuss with other medics and scientists.  I refer you to Hello Science, Meet Art to why that matters, to me at least.  Perhaps I will come out of this year the well-rounded young lady I claimed/hoped/strove to be when I started medical school?
Thanksgiving food...

Life mantra?
So I am thankful for the old friends I have, and their messages, Skype calls (often at hideous times [for them] of night with the time difference back in the UK), Whatsapps and emails.  I am equally thankful for all these new friends that have entered my world, both by welcoming me into their community or by letting me share this awesome emigration adventure with them.

They are also incredibly polite about the fact that I seem to be making it something of a ritual that I explain my research to each and every one of them on the back of a napkin.  Perhaps I should be testing at the end of the year...

Sunday, 16 November 2014

Concepts of Open-ness - OpenCon 2014

I left my scarf in the cafeteria at the US Senate on Capitol Hill.

Well, there’s a sentence I never thought I’d say. 

It was not the only surprising and overwhelming thing that happened at OpenCon2014, an open access conference for early career types like me. 

Appreciating that readers of my blog are a mixed audience (seriously, message me, because I would love to know who you are!), open access is all about making research openly available.  It is the strangest thing that research which is publicly funded is then submitted to a journal, whereupon it is peer reviewed for free by fellow scientists (for no reward, professional or otherwise), and somehow it gets spat out the other end with a price tag.  And a hefty one at that.  Of course there are some editing costs.  But when even Harvard University is struggling to pay for the rising cost of journal subscription, it’s a clue that something is wrong. You can read about Open Access on some of my other blog posts. 

Co-founder of PLoS, Patrick Brown
OpenCon2014 was an international meeting of 175 students and early career researchers from over 40 countries in Washington DC.  Over the weekend we heard some of the most compelling and diverse arguments in favour of Open Access, Open Data and Open Education from equally compelling and diverse speakers.  Highlights for me were Patrick Brown, Co-founder of PLoS (Public Library of Science, now probably the biggest completely open access journal) describing how he set up PLoS despite having no experience of publishing. Peter Murray-Rust described the potential of text and content-mining to actually maximize the potential of existing research.  And finally, one of the most affecting talks for me personally was by Erin McKiernan talking about what we can do as early career researchers (she is herself one).  We spent Monday on Capitol Hill meeting relevant political figures in the Senate. Wow. Directly lobbying HELP committee members. Awesome.  In the afternoon a group of us went to the National Institutes of Health (NIH – who fund most publicly-funded American research) to discuss ‘openness’.

I could go on about how amazing this weekend has been, how inspired I feel, how excited I am about the projects and plans we have for the coming year.

But I am also scared. For one thing, I realised the extent to which I know nothing about data management and access.  Yes, I am part of the ‘digital, internet generation’, and have no computer phobias.  But that does not mean I’m an expert.  My experience of software is pretty much limited to Word, Excel, Powerpoint and PDFs.  I have never worked on ‘code’.  Managing data is something I find incredibly challenging.  Organising my data so someone else can use it later on – well, where does one start?
In addition, I am not so much an early career researcher as an embryonic one.  I can still count the number of publications I have on my hands. And most of the time I am the middle-ish author.  How does one leverage preference over an open access journal when often these decisions are made when I’ve already moved on geographically, and when I’m authorship small-fry?  And when any publication at all is a requirement on a job application?
These are not meant to be excuses, and I have considered how I’m going to tackle all of these (a MOOC on data management, contacting my librarian at Yale and asking for help from OpenCon peeps re the former, and initiating early conversations and just being bold on the email front re the latter), but it just reflects some of the challenges facing baby researchers like me.  And if we’re the keen ones, for whom Open Access is a clear ‘Yes’, then I can understand how it seems too great a mountain to climb for less interested peers. 

I guess the key is to keep the fear in check and just power on with the support of my fellow open accessers, and continue to spread the word.  I really believe that open access and open data is the only way forward, and not only that, it’s better than the current status quo.   I want my research to be useful to anyone who wants to read and use it, and not just those who can afford to do so. 

But despite any fa├žade or game face, I am somewhat daunted.  So if anyone wants to help me on the journey, I’d be glad for the company.

(Also if anyone finds my scarf, it’s actually the only one I brought to the USA from home and it was one of my favourites.  My neck is henceforth very cold.  It is forest green with burnt orange flowers bought originally in Dublin.  If found, message me.  Kind regards, KRP.)

Thursday, 13 November 2014

Hello Science, meet Art.

There's a certain image that is conjured in one's mind when one thinks of a scientist, and perhaps a doctor.  When I was a child, if you'd told me I'd end up doing what I do now, I'd have laughed.  Psh. Sounds boring.

It's not, of course.  It completely rocks (except when your gel doesn't transfer to your membrane because you thought the bottle said 'methanol' when it actually said 'transfer buffer'.  Doh.).

However, I like to think of myself as a bit of a chameleon, not least because my own family is a bit of a pick-n-mix of skills and activities, and therefore the notion of just being interested in your own field is a little alien to me.  But how well do science and art really mix?  They are different worlds.  The first inhabited by bespectacled nerds, often in white coats with beige outfits underneath, hermitting away with a pencil tucked behind their ear, muttering mysteriously and scribbling away in what might as well be Klingon.  The second, perhaps also bespectacled but undoubtedly more trendy specimens, not an inch of beige in sight, pondering life and the meaning of it all.

(Those were stereotypes I just described there, by the way, in case you missed that.  I'm not trying to suggest these are accurate or fair.)

I'd like to think I inhabit the former whilst having all limbs healthily outstretched to the latter.  I went to the Museum of Modern Art in New York this weekend and embraced the opportunity to stretch my thoughts to, well, MY thoughts.  The feelings evoked by paintings I've only ever seen on my computer screen, as well as those I've never seen before.  I went to listen to the poet laureate, Charles Wright, who gave a reading at Yale.  Sadly I suspect copyright laws prevent reproductions here, but having reread some of his work at home I was struck for the second time (the first obviously being when I heard it in the flesh) how some of his words resonated with me.  And yesterday I went to hear a piano recital by Boris Berman, master of all things Prokofiev.

Even Rabbie Burns (Scottish poet) features in NYC!
Interestingly, I think the main value to me of keeping my head in the artistic world is that it keeps me human.  When I'm being a doctor, it gives me a way to explain or explore my feelings and emotions.  When I'm being a scientist, I think it reminds me that really science is art, shrouded in formulae, chemicals and protocols.  I don't think either of these should be underestimated.  As a doctor, I am so often required to have emotions and feelings on an 'as required' basis, as if feelings were controlled by a tap, and sometimes that's really hard.  There are patients whose final hours I remember so vividly that I still see them now; the look on a patient's face when they know their hour is here.  There's something reassuring about listening to a piece of music or seeing a painting that evokes those feelings again, but in a safer environment.  Perhaps the composer or artist had a similar experience?  It is almost a relief that someone has managed to convert that emotion into another art form, and you can find a way to deal with it.  Equally as a scientist, it is so easy to get bogged down in this, that or the other assay, and forget that it is flipping amazing what you are doing.  That sort of helps when your experiment doesn't work for the twentieth time.  Because when it works the twenty-first time, it's beautiful.

So I'm quite content to be a bunch of contradictions; I think without it, science or medicine would have no meaning or joy to me.  It does mean you'll have to tolerate my hippy music if you're working near me in the lab.  Soz.  

Saturday, 25 October 2014

Healthcare: a commodity, a luxury or both?

I expected my biggest culture shock between the USA and the UK to be healthcare.  I was determined to be open minded about American healthcare because it is all too easy when you grow up on a diet of free healthcare to think everything else is wrong.  On the face of it, the two systems couldn't be more different.  In the UK, the NHS means you can rock up to any hospital and get free treatment.  In the USA, if you want healthcare, you've got to pay for it; so basically able to afford insurance or somehow able to pay massive hospital bills.  That's putting it simply, of course.

A train view of the Big Apple
So what are hospitals and healthcare like in the US of A?  (Caveat: I am very much an observer here, having no clinical role.)  There are some more overt differences - the doctors wear white lab coats with their names embroidered, something we stopped doing in the UK when I started medical school 8 years ago.  I always carry my health insurance details on me.  Despite insurance, I would still have to pay a 'nominal' fee of between $25-75 (roughly £18-60) if I needed to see a doctor.  Teeth and eyes are extra. The hospital in my area is incredible.  There are trees inside one of the lobbies.  INSIDE.  At the clinical meetings (where doctors and researchers sit and listen to an expert giving a talk), you might have coffee and something to eat (and no pharma in sight). These meetings are always full, and always interesting.  I can only praise the close supervision and guidance I have been afforded by my research team (one of whom is a clinician, and one soon will be).  There is passion for good, compassionate patient care and research that will save lives.  There certainly is not a sense that everyone is rolling in money, and research funding is as squeezed here as it is everywhere.

Now, of course, the real problem does not lie inside the hospital.  A walk around town tells you all you need to know about who is, and who is not, benefiting from this phenomenal healthcare.  It is painful to witness the huge divide between those who can and cannot afford not just healthcare, but basic living.  To me, it feels like a bigger divide than home.  Uncomfortably big.

And yet, I do find myself thinking that the NHS can learn something from American healthcare.  Whilst it may seem like a waste of money to be giving food and drink to staff for free during a talk, it does make you feel like what you are attending is worthwhile, that you are valued and frankly means you can actually eat something whilst being productive.  Now, I'm not saying I'm expecting freebie food and drink in a publicly funded healthcare system.  I'm just pointing it out in a week when this story came out about a hospital in the UK that has banned staff from drinking tea or coffee at work, and UK junior doctor contract negotiations have stalled for a range of reasons which made my heart sink to the floor (take a read. It makes for fairly sobering reading).  When I worked in one department as a newly qualified doctor 18 months ago, we used to take it in turns between the doctors and nurses to buy a round of 'fancy coffee' (read: from the coffee shop rather than the machine) if the day was especially horrific.  I maintain it was the most efficient use of a tenner for team morale that I could wish for (and out of our own pockets, of course).  Sometimes these things are actually value-added rather than a silly luxury.

Finally, there is a real risk of losing people to a more appealing system.  One of my new buddies, who will shortly qualify as a doctor here in the USA, shares my squirms about divides created by American healthcare, but the lure of the research opportunities as well as the healthcare facilities is, for now, just too great.  One could argue that neither of these are selfish motivations - the opportunity to do your best research, and give your patients exactly the treatment you want.  Friends of mine who took a 'medical gap year' to gain experience in New Zealand are starting to wonder whether long term the work conditions tip the balance in favour of the antipodes.
Me and my bestie, fellow Dr from the UK, who came to visit :)

I would not trade any coffee or sandwich in the world for the free universal healthcare we have in the UK.  Perhaps it is hard to see my American colleagues in their shinier buildings with all the perks that come of healthcare being seen as a business rather than a commodity.  But it is so much harder to see those who will never get to walk those corridors because of the neighbourhood or situation into which they were born.  I think I am only just beginning to realise the power and voice I have as a doctor to advocate for issues such as these that I feel we cannot and should not turn our backs from.

That said, I can't help but feel that in the UK we could do with being reminded that neither the NHS nor those who work for it are a commodity, and sometimes it takes looking at healthcare through someone else's eyes to realise that often they are seen as such (and not in a good way).  

Monday, 13 October 2014

Learning American music, making a good cup of tea and Fall

Despite Eva Cassidy singing about 'Autumn Leaves', it is most definitely 'Fall' in New England; we were marvelling today at how we probably have all the same foliage in Europe but somehow it just looks so much more beautiful here… perhaps the lack of rain?!

Anyway, the culture shock (and I mean that in a positive way!) continues as I adapt my British/German ways to my new American environment.  This week's highlights:

- I started playing in an orchestra this week.  Easy, I thought - the international language of music.  WRONG.  I grew up with bars, crochets, quavers, semi-quavers.  Here they have measures, full beats, half beats, quarter beats.  My desk partner probably thought I was heading for the exit when I had no idea what was going on at the start of the rehearsal and initially didn't play a note.  Two and half hours of sight reading later, I hope I managed to redeem myself.

- Milk.  Again, a surprise complication. In the UK we have full fat, semi-skimmed (green top, for some reason the one most people drink) and skimmed (white water). Here, there is whole milk, half and half, skimmed, 4%, 2%....  And yes, it does matter which one goes in your tea.

- The pancakes are indeed as big as your face, but damn, they are good in the USA.  Don't get me wrong, I love a crepe, but how do they get buttermilk pancakes so fluffy?! This weekend I managed a double dose; I fear this may become a regular habit.

- Fall foliage really is amazing.  Here are a few snaps from East Rock running, and West Rock walking this weekend.  This meant we also braved the bus, which in a land with very subtle bus stop signs felt like something of an achievement.  It was so good to get some fresh air, and we were blessed with some glorious New England sunshine as you can see.  Although if post-grad medical exams are to be believed, I will be catching Lyme Disease at any moment.  I’ll keep you posted.

I am excited to have a VERY important visitor (my bestie!) this week.  I have done some baking specially (although this was also a mixed success – again there are certain ingredients e.g. flour I wrongly assumed would be the same! But hey, the first round still tasted good and simply means I will have to make more) and have cooked a batch of butternut squash soup. And I will be hopefully make some lab progress.  CRISPs(R), anyone?

Tuesday, 7 October 2014

How To Be a Brit in America

Greetings, dear reader, from this side of the pond!  I write to you from my new HQ in Connecticut, which I will be calling home for the next 9 months.  It's been a rather insane week since my violin and I upped sticks and landed here.  But my bags are well and truly unpacked, I have a bank account and a 'cell' number - frankly, my green card must be just around the corner (I jest, of course)...  Although it's very early days, I thought I would share my first reflections whilst they are fresh.  Perhaps they will prove useful to those considering a similar venture overseas, or will ring true to those who have made a similar move.  I'm sure I will laugh at these in months to come!

1) In the UK, I love black tea with milk.  You can buy tea in the USA.  Perhaps this is obvious.  The thing that is trickier is finding a kettle!  I have a whistling kettle in my flat that sits on the hob and makes me think of camping trips whenever I use it.  The thing other Brits and I have decided is distinctly absent is squash (to American readers - diluting juice?).  If anyone has a source in the USA, PM me!

2) Brits are (I believe!) famous for being very (overly?) polite.  Most Americans I have encountered are also incredibly polite - just about different things.  For example, I was profusely apologised to when the ATM I was asked to use to activate my bank account had a technical fault, and thus I had to move a WHOLE TEN FEET to a different ATM.  Conversely, it has made me realise how silly some of the things we apologise for in the UK are - e.g. the thing where if you are walking towards someone and will bump into them if one of you doesn't move, which brits feel the need to apologise for.  When really, no-one is at fault!

3) If going to the USA, always have a few spare dollar notes for tipping.  In the UK I was used to habitually tipping in restaurants (10%, usually), unless the service was truly awful.... and that's about it.  In the UK, I might round up a taxi fare if it was easier, or if the chat was good.  Some British people tip their hairdresser, or at a coffee shop if they have change, but again I wouldn't say it's expected.  Thus it is rather a culture shock to have to tip even the grumpiest taxi driver, and a rather heftier 15-20% in a restaurant.  It has been explained to me that tips are a notable part of peoples' pay, and as such, if I have under-tipped anytime this week, I can only deeply apologise.  I will improve!

4) I keep forgetting that tax is added to the price listed in shops.  This means I am never ready with the right cash - big sorry to anyone who has been kept waiting behind me in the queue this week.

5) Having a washing machine in your flat is a novelty in the USA (I have one in my flat.  Grateful ++.  I am way not organised enough to coordinate myself around taking it all to a launderette).

6) I'm sorry, but queuing really is a British art form.  This is based on not only this, but other world travels.  Queues happen here too, but sometimes people barge in, and then everyone gets really angry.  These two latter phenomena are simply not commonplace in the UK.  And even if someone did barge in, we would probably look at our feet, mumble or grumble a little (and quietly) and that's about it.

7) Open-ness and friendliness are definitely two of the best adjectives I can use to describe the Americans I have met so far here.  Despite me asking many moronic questions about how cell phone contracts work, how rental cheques are organised and how to send a letter to Europe, everyone has been incredibly helpful.

8) Getting some contacts together before I came here has been key to my early happiness.  I didn't know anyone in this part of the USA before I moved here, and just told everyone and anyone I met in the preceding months that I was moving here and was searching for friends!  It has been completely amazing how many people try and create contacts for you if you just ask, both before you arrive and once you're here; and I was amazed where such contacts ended up coming from.  My first few days have been completely 'made' by such contacts, and I have been blown away by their friendship and kindness; and ultimately many of these were also new to the area and keen to explore, so it's a double win - new friends, and someone to explore with!

9) Say yes to everything.  Thus far, I have met NGO workers at a cooperative BBQ I was invited to, painted in the middle of New York and drunk margaritas at the birthday party of someone I met that evening.  Random, and wonderful.

10) Sometimes it's bloody lonely.  It rained a flood on one of my first days here and I could barely leave the house.  I didn't really have anyone to call at that stage, and no-one wanted to go outside anyway.  I knew my family were busy.  I didn't want to simply call a friend in the UK within four days of arriving - I didn't think that was a good coping mechanism so early on.  But hey, that feeling passed.  And I ended up having a wicked evening with new friends.  I'm so lucky with what I'm doing, and I am trying to surround myself with reminders of that for future sad moments (which are inevitable, at home or away!).

I have, I guess, also been super lucky because as a Fulbrighter, I have access to the worldwide Fulbright community and more specifically the UK Fulbrighters based in nearby NYC who I met a few months ago.  What an awesome bunch of people!  I count myself as a very fortunate bean to be able to call them friends, and look forward to many more adventures over the coming months.  However this could definitely be YOU!  I didn't think I had a hope of getting a Fulbright, but it just shows you must TRY!  So give it a punt!

Overall, I think the main reflections from my fellow UK immigrants and I are a new appreciation of how it feels to be a 'foreigner' and how we are determined to bring the 'international hand of friendship' back to the UK.

In the mean time, I could not be more grateful for every email or message I have had from friends and family, wherever they are in the world, and to all the new friends I am making.  Perhaps a good reminder to all of us to send a greeting to someone we know somewhere in the world, or someone we haven't spoken to for a while, and say hello to that new person at our place of work.  It's never too late!

Saturday, 20 September 2014


So the time is nearly upon me to pack up my stethoscope and the NHS and leave the UK for American shores.  After over a year of emails, phone calls, panic and excitement, I can't believe in two weeks time I will be calling the USA home for nine months.

This blog so far has charted the ups and downs of my final months at medical school and the whirlwind first two years as a qualified doctor.  I have decided, as many do at this stage in their training, to tag out of training.  I am trading my stethoscope for a lab coat.

I am not alone: A third of UK doctors take a 'gap year' between their foundation years and specialty training.  I have to say, from personal experience I'd say that statistic is even higher.  Why?  A number of reasons really.  The last time I made a radical decision about my life was when I was applying to medical school as a teenager.  OK, so I took a year out to live in London and do a science degree, and had to apply for my first doctor job, but these were very much with the tide of my peers.  Finishing foundation (the UK name for these first two years) is the first time you actually have to decide a) what sort of a doctor are you going to be and b) where am I going to live for the next 5-10 years?!  It's quite odd hitting that sort of milestone in your mid twenties having made few major decisions in the interim aside from 'how am I going to make sure I actually have food in the house throughout my 12-day work stretch'?  Plus job applications come just after you've finished your first year of work and I certainly felt it was too soon for the big commitment of geography in particular.  And for some people they are still unsure about which specialty to commit to; if paeds is your hunch, it's a minimum 8 years of training - yikes if you're not 100% sure!  I love my job, but I'm also exhausted.  Sure, being a doctor is tiring, but so are all jobs - I think when you are a junior doctor, there is the added emotional, inexperienced stress factor which is all the more draining.
A few from recent countryside runs.

Plus, frankly, why not?  There's a big old world out there and in an age where so many people seem obsessed with nationalism and national pride, I am quite content to have my own pride about being a citizen of Planet Earth.  Life is short and I am keen to explore...

Little English town...
So I am meandering Stateside to Yale University for the year, and was lucky enough to get a Fulbright scholarship to help fund a brain tumour research project.  Being a Fulbrighter has already been an incredible experience and I haven't even gone yet - my fellow scholarship people and I had an induction session a few months ago and I just couldn't believe what an awesome bunch of people they were.  I think we shared disbelief that we had somehow got through the application process and felt unbelievably lucky.  As a medic, it was also hugely exciting and refreshing to meet these inspiring people from such a range of disciplines, given that my world is so often just about medicine.  I am excited about all these new friends and colleagues I am yet to meet, and all that I will learn about in a new area of science.

I'm saying my goodbyes, packing up my things and preparing for one hell of an adventure.  Recent events have reminded me once more that you just never know what wonderful things are around the corner, and that's a hell of a blessing.  America, be nice to me!

I shall miss you!

Wednesday, 3 September 2014

'Is there a doctor in the house?'

We juddered to a halt - I, along with the other tourists and commuters, struggled to stay on our feet.  A siren gave its intermittent noises indicating that the emergency stop button had been pressed.  I did a little harumphing and sighing, as did most of us.

But then I heard the words that chill you to your very bones the second they give you your medical degree.  

'Someone's unwell, we need some help'.

I was on my way to sort something out for my American travels - a strict appointment that I had been told in no uncertain terms I couldn't miss.  I was in jeans and a jumper with a casual canvas bag, earphones plugged in listening to my generic music device.  I could not have looked less like a doctor if I tried.  I waited a few seconds to see if anyone else was making any moves, peering to see if anyone else appeared to know what was going on.  Realising that no-one was doing so, I pottered over (I should add - there was no screaming or hysteria suggesting anything truly awful had happened.  I wouldn't want you to think I saunter in this fashion to all medical emergencies).

Again, reassess.  Man on floor.  Definitely awake, talking.  Also, it definitely appeared there there were no nurses or doctors or medical types around. Here we go...

'Um... can I help... I'm a doctor...'

Cue mass relief - 'make room, there's a doctor here'.  Weirdly, it was like a tension in the group of passengers who had crowded to help the gentleman was suddenly released, as if I had some kind of magic wand.  A quick ABC told me there was little I needed to do immediately.  I asked a few questions to rule out some of the worse things running through my mind and felt reassured.  I did by pure chance have my stethoscope in my bag but we were literally perched in the middle of the public transport network with everyone staring, so I decided to leave that.  Confidentiality and privacy had gone out of the window as it was.  We just needed to get moving to the station.  

Once we had made it to a station, I waited with the gentleman until relevant people came to get him to hospital.  Of course by this point I didn't care that I might be late for my appointment, but for what it's worth, I was perfectly on time.

There were a few interesting reflections from this.  One is how Londoners totally get an unfairly harsh reputation - everyone around this gentleman was trying to help.  When I asked if anyone had any water for him, about five people reached into their bags and someone even found a cup from somewhere. A few other people waited with me and were hugely apologetic when they had to head off.  

Another is, I guess, a more personal one about how crazily calm I felt despite having an entire crowd of strangers staring at me, hanging on my professional opinion.  It was like the ultimate OSCE.  I obviously don't know what happened to this gentleman, but I felt really comfortable with what I was doing and thinking.  That was... unexpected.  Does this mean in my two years as a qualified doctor, I actually have some experience to offer, and confidence in myself?

It is very strange to think that when I head to the USA in a few weeks, 'doctor' is a role I will be hanging up, along with my stethoscope, for nine months.  It's moments like this episode that make me realise that being a doctor is as much who I am as what I am.  And that is a very strange thing to accept.

Wednesday, 27 August 2014

Singing songs and other human things

On popping home recently, I bumped into a very old friend - someone I hadn't seen for years. I always find myself embarrassed by myself in these situations - there's something about saying 'Um... so I'm a doctor' that has the potential to feel like you've dropped a bomb.  Out of the resulting crater can spill out a whole bunch of emotions, as it did in this instance.  My friend had close family who were going through the complex map that is NHS-and-social-care and they were deeply frustrated.  Doctors crooking their heads and telling them what they thought was best, despite being a quarter of the age of the patient.  An a-amotional stream of medical types who had fifteen minutes maximum per day devoted to each of their patients (ward of 20 patients, 8 hour day - you do the maths).

There is always a question in clinical medicine (and I have previously written about the pros and cons of the so-called game face in medicine) - how much of 'you' do you reveal?  Particularly when you're a junior doctor, and, dare I say it, particularly when you're a female junior doctor?  When does 'being yourself' just become unprofessional?

I find myself increasingly leaning more on the human side of things than others might.  My friends roared with laughter when they heard that I sang an entire song from my childhood to a patient (and their family) because I thought it might make her smile at an otherwise rather difficult time.  I regularly tell tales and memories of my grandparents, and my (still living and going on mightily aged 93) grandmother is frankly famous from the number of patients I have told about her as an example of age just being a number and focusing more on what people can do rather than the date on their birth certificate.  If patients or relatives sigh at me and say 'you doctors just don't know what it's like' with complex discharge planning regarding their elderly relative who lives 300 miles away from them, I am willing to share their frustration with my own family's experience of exactly the same thing.  I talk German to my patients who are German.  I only introduce myself as 'Dr Purshouse' when the situation requires it (e.g. official-dom) - the rest of the time I'm 'Karin, one of the doctors'.

You're probably reading thinking I'm marking myself out for sainthood, but these are not beliefs and practices held by everyone.  Some people (and my colleagues) want doctors to maintain a more professional manner.  One of my colleague always introduces himself as 'Dr So-and-so' so there is no confusion later on about who he is, and to a degree also set the tone - he is a professional, giving his professional view.  Frankly it can be just confusing to patients, and a more formal approach can make it easier to understand who everyone is.  Some doctors prefer to keep their private lives to themselves, absolutely all of it, and part of that is also self-preservation and not getting too emotionally involved with their patients.

Trying to be a 'serious doctor'.
My take on this?  I am a doctor, and I ask for the same professional respect as I afford every human being (patients, colleagues, anyone), but if I wanted to be an emotionless robot, I would have picked a different job.  Obviously I judge every situation on its merits, and being super-casual is not what showing your human character is about.  Sometimes I think I should be a bit more formal at highlighting my role though: one of the questions on a confusion questionnaire screen is 'what is my job' - and if I had a nickel for every time someone said 'secretary'....

Hmm.  Perhaps I should try it for a while.  Keep the singing, but instead do a trial of 'Hello, I'm Dr Purshouse but please call me Karin' as a compromise?

Oh, it's tricky being a doctor and being human!