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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.

Tuesday, 15 April 2014

Being a doctor being a patient.

 A mix of emotions from top left clockwise - how I feel now,
how I felt a lot of my night shifts, how I felt when occasionally
panicking, what I spent the first half an hour after
my shift feeling like i.e. ahhhhh!
Apart from slightly losing my marbles circa 6am, and perhaps again at 9.15am, I have survived the first two weeks of my new job as the medical SHO which have thus far consisted of night shifts and nothing else.  Finishing yesterday morning was another great wave of half-relief-half-nausea, relieved somewhat by having a cuppa with some of my old lab chums.  Remember how I said clinical medicine seemed the comfortable norm?  Hmmm... rose tinted glasses, much!  Although I must say I kind of enjoyed it (Kind of, in the sense that it is tough to say your enjoyment is complete when you are at work over an entire sunny weekend, sleeping during the day and up all night). 
The last fortnight has been completely insane.  Apart from a bunch of night shifts, I've also done a day-and-a-half of exams, written an assessed essay, work on a conference agenda, done prescribing-related teaching for all the house officers and then an afternoon of simulation teaching.  I managed to catch up with some of my favourite university people in between these various studious things, before you think I'm a total social loser.  

But actually the weirdest thing of the last fortnight is that I had a flavour of being a patient.  

I've had a couple of health worries on my mind and the first of these I found out about via a poorly timed (by me) phone call to my GP surgery.  It was really quite unfortunate and perhaps my fault that I ended up finding out over the phone that I needed to have some more tests done.  I wondered whether it was more worrying because being a doctor means knowing a bit too much about the worst case scenario.  I guess I was also a bit distressed because I'd like to think I am quite particular about the when/where/who/why of any news I am dishing out to patients, and realised that because the news breaker probably didn't realise they were 'breaking news' I wasn't given that sort of consideration.  I then found out I had a second medical issue that needed investigation, and within a fortnight I found myself with two hospital referrals and a whole bunch of worry.  

Any social recluse-ing I've been guilty of recently has been a genuine apathy symptom of compartmentalising stress.  I'm quite an open person, and it's strange having things that you don't feel able to share with friends and family.  I felt quite irrational as I knew that it was all cautionary really, but also perhaps felt that by vocalising my worries, it made it all more real.  Even sitting in the waiting room is a bizarre and lonely experience.  It's a bit like being in a massive herd of cattle, waiting to be picked out and painted.  Once you're in the room, it turns out the 'so what do you do for a job' question is pretty much numero uno, so there was no hiding my professional identity.  It's pretty weird going to see a doctor in the place that you also work.  I accepted that I might know them - in the event I was quite glad I didn't as it made it easier to slot into the patient role, although I must say everyone I encountered was excellent without exception.  

Anyway, as expected everything was absolutely fine and dandy with nothing further needed, and I could worry about my night shifts in peace.  But there's nothing like experiencing what it's like on the other side before being on call for a whole weekend to remind you that every patient is a human being with worries, fears and a life.  

Excepting the odd panic moments, it was these thoughts that kept a smile broadly stuck to my face the whole weekend, hopefully staying cheerful and providing a chuckle or two as I dashed across seven floors of a hospital.  

Friday, 4 April 2014

'Hi, it's the medical SHO on nights...?'

I feel a strange combination of hungover, awake-and-wired and fretful panic.

It is this joyous phenomenon I love to hate - the 'I've just finished nights' effect.

I've now been awake since 7pm yesterday evening (it's now 4pm), having done a twelve-hour night shift in between.  I've tried to nap, but every time I close my eyes I have a nauseating wave of 'oh... wait... did I do that right'?  Here's a night in the life of a medical SHO.

9.30-10.30pm-ish - Arrive at work and enjoy a splatter of bleeps, phone-calls and face-to-face meetings with people I've never met wanting to hand stuff over.  I cover a myriad of random medical specialties on nights - geriatrics, gastroenterology, cardiology and a smattering of new admissions (they're in many ways the most fun - because they have a tendency to be moved in the middle of the night, leading to another fun game - 'hunt the patient').  Some people give me things to check (blood tests, x-rays etc), others tell me about patients they want me to review during the night, and some do the triple whammy of giving me a bleep too.  By the time handover is done, I've got three bleeps to receive calls on, and a couple of pages of things to do.  I try to remember who has given me what and which patient belongs to which teams - after all, in twelve hours, I have to hand them all back.
I am not a person... I am a bleeping machine...

10.30-00.30 - the worst time, I find.  This is usually when any immediately sick patients tend to be discovered, as well as drips ceasing to function (thus needing to be replaced) and it's usually when you'd be keen to cast an eye over the sick patients you were asked to review.  If only you could be in three places at once!

00.30 - 04.00 - this is when the night shows itself i.e. if it's going to be a complete disaster or not.  By 2am, usually all the immediately unwell people are dealt with, and you have made a plan that will last for the next few hours.  Hopefully.  You return to the list and it might be the first chance you've had to check those blood tests or scans you've been asked to chase.  Every finger is crossed that they are normal, or abnormal in a way that is manageable overnight e.g. prescribe some fluids or a medication that will stabilise things.  What is less ideal is when they are abnormal in a way that requires intervention overnight - that is ultimately what I am there for, but sticking needles into people to do repeat blood tests at 3am is not a speedy way to make friends.  Another surprise entity is when you are hunting down tests results that never seem to appear - cue some detective work to sniff them out!

04.00-06.00 - if you're in luck, this is your chance to grab a quick sandwich and drink of water.  I've found that carrying a bottle of water around with you is absolutely essential, and certainly an error I made in my earlier night shifts - it helps to keep your head clear, and a loo-break is also reassuring from the point of view of knowing your kidneys are still working.  One of my night shifts I even had time to go and help the take (i.e. new patients coming into hospital) and clerk someone in.  The key for this time is to get everything done by 06.00 i.e. any bloods you need to do for the day teams, any patients you wanted to review.  Because what happens at 06.00?  Nursing rounds.  And that's when the next round of unwell patients/failing drips etc tend to be discovered, ready to keep you busy until handover.

06.00 - 09.00 - it's hard to keep perspective about the fact that your shift is nearly over.  In fact, that's not as frustrating as being so UNBELIEVABLY close to normal working hours that if you actually want to speak to a specialty or get something done urgently, it doesn't require an inordinate amount of persuasion.  Everything is starting to get a bit hazy as fatigue starts to set in.  I sit down quietly for a rest for a cumulative time of about 5-10 minutes in the average night shift.  Keeping your list attached to your person and up-dated is the only way you're going to make sure nothing gets missed and all the jobs get done.

09.00-10.00 - hurrah!  Handover time! Or... time to play 'hunt the doctor team'.  Everything you received (bleeps, patients, etc) must be handed back; the question is, who is who?  You walk up to a team of doctors, looking quizzically around their little circle - 'which team is this?' you enquire timidly.  Everyone looks slightly aghast, as if it is both obvious and scandalous that you didn't know that this was Dr so-and-so's team.  You are relieved when you recognise a few faces and can at least get some direction.  Sometimes it is easier just to bleep the people directly or just go to the ward to hand people over.  It's actually quite scary handing patients back - ultimately, in the cold dark of night you have to make the best decision you can with the information you have at the time. You didn't hear that Mrs Smith always has that funny turn at 2am and that it's perfectly normal.  You weren't aware of exactly what number of crackles on the lungs are normal for Mr Bloggs, because until that night shift, you've never listened to his chest before.  You weren't there for that discussion about Mrs Jones about just how aggressive to be with the intravenous fluids.  Obviously you look for trends in patient notes, but you have to have a bit of confidence in your thought processes, obviously with a healthy dollop of humility.

Starting a new job on night shifts was never going to be easy, but it is definitely one of those times where I think - 'next time I'm NOT on nights and go to greet the night doctor, I'm going to make an extra effort to be nice, sympathetic and helpful'.  I do have a propensity to be a worry wart about these things, but all doctors, myself included, have made mistakes.  It's really not a 'what if', and rather a 'when'.  I hope I did a good job, and I forgave myself for calling the registrar for advice on the basis that doing your first night shifts in a year after four months away from clinical medicine was probably not the time to attempt heroics.  Equally, I hope I start to build a little confidence, as I really think that's half the battle.

Exams next week, and then more nights next weekend.  Bring. It. On.