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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, 27 December 2015

#ImInWorkJeremy Junior Doctor Christmas Special

Working late but looking great! 
I think it would be hard to find someone more excited and happier this festive season. What a year 2015 has been!  I can hardly believe this time last year I was calling America 'home'.  A Masters thesis was written... Gary the brain cancer cell was born... Many, many adventures were had - so many adventures! And halfway through the year I returned to my little island, and spent a great deal of time feeling like a resident alien on home soil.  But this extra-terrestrial feels a lot like she's come home, whatever that means, even with a bunch of Christmas night shifts.

Sometimes I just can't believe how lucky I am to be a doctor.  No matter how much I might miss the relative freedom of research (in terms of planning your own time - not necessarily fewer hours!), the last few weeks in particular have been an absolute joy.  And that's despite a solid dollop of challenging professional situations - flying solo as ward doctor for a week and a half, a number of difficult deaths, countless complicated medical situations to tease apart, diagnose and manage, many 'I don't think your relative is going to make it' discussions, several complex family set-ups to navigate, new procedures to learn, and some really sick people during my Christmas night shifts.  Of course I've not been alone, working with other junior doctors (could you ever meet a more committed, fun, all-round awesome bunch of people?) and nurses, and of course the awesome consultants for whom I've been working - no matter how miserable the situations we've had on the ward, we've found a way to laugh ourselves silly everyday and I'm learning an enormous amount. Surely the wonderfulness of working in a hospital is exemplified at Christmas time - no-one is grumbling when they're leaving late on Christmas eve, and no-one is whining when they arrive for their 13 hour shift on Christmas morning.  What a special place to work!

Christmas, honest!
A key part of this is clearly balancing your life outside of work too, and on that score I *think* I'm finally getting the balance right.  From art galleries to string quartets, climbing walls to more than a few mulled wines, I am so lucky to have friends old and new with whom to share these adventures.  I started the year a scientist in America, and I finish it a doctor in the UK - and the life that has embellished that transition has been a rollercoaster of a ride.

I am celebrating Christmas and New Years with a stethoscope around my neck, working my way through the holiday season with many other junior doctors, consultants, nurses, physiotherapists, occupational therapists, radiographers and many other hospital workers.  In the nicest possible way, I hope I don't see you - instead, I hope you're sharing some good vibes with the people you love.  Merry Christmas and a Happy Hogmanay! 

Friday, 18 December 2015

Til Death Do Us Part

I see bodies at the very edge of life.  

I see bodies when the hearts within them are barely able to send the blood they pump to the tips of fingers and toes.  I see bodies whose lungs are squashed, scrunched and crispy from a lifetime of whatever air and debris has reached and settled within their alveolar spaces.  I see bodies riddled with cancers that are known, and I’m the one who’s broken the news, and those that will never be known about because the owner of the body is happier not knowing.  I see bodies full of infection, which in older people often means an associated delirium which renders the recipient a different, distressed version of their known self.  I see bodies of patients who cannot get out of bed without people or equipment to help and look into their eyes as they beg me to let them go home.   I see bodies that have long since lost the memory of who they are, who I am and what this world is that they inhabit.   And, finally, I see bodies where life has gone completely and their last medical rite is for me to confirm that this is so. 

Of course, these are not bodies.  These are people, wonderful human beings, with all the laughs, frustrations, tears, joy, sadness and adventures that life has thrown at them.  Most of my patients are around 90 years old.  If I have a patient in their 70s, that’s young.  I often remind my parents of this; retiring in your 60s, you still have at least 50% of your life to do again.  I may have romantic notions of adventuring and then growing old in a house by the sea, reading, painting, playing my violin, writing, playing games and drinking tea, all surrounded by family and friends until one day I simply fall asleep, never to wake up.  But you don’t know what your old age is going to look like.  To look after older people is to consider your own life and death, because you are experiencing that of others on a daily basis.  

So when I read that I’m supposed to be having an epiphany about giving ‘individual’ end of life care, I can only assure the rest of the world that this is no epiphany at all to any junior doctor.  Who could love a job like mine, where so much of it requires looking death in the face, were it not for the care of the individual?  If I am lucky I will be able to do discuss a patient's diagnosis with them and plan their final weeks, days or hours as they would wish.  But I, and they, am not always so fortunate.  I recently was called to see a patient who was clearly going to die within minutes of my arrival - as the on-call doctor, we were meeting for the first time.  That did indeed require a 'snap decision' that meant I could give this patient the dignified death they deserved.  It meant I could look the relatives in the eye and say truthfully that their loved one had died in peace and without pain.  It meant that this patient had two of us holding their hands when death parted our worlds.  I know the conversations I had with the family during and after that time will never be forgotten - strangers before, I am now and forever part of that life.  

People often think I’m a bit weird for wanting to be an Oncologist because of the close professional proximity I will have to death.  This belies the fact I already look death in the face in some capacity on at least a weekly, if not daily, basis.  Each conversation and experience is different because each patient is different - that’s what being a doctor requires in life as well as in death.  Perhaps I should be relieved that there is a bit of government guidance that tells me to do what my colleagues and I are already doing?  Instead I feel a little bit of my heart sink; a disappointment that patients from my past might think that I didn't see them as individuals because only now am I being explicitly told to do so. 

Don't tell me I don't know what death looks like.  I see bodies at the very edge of life and see the individual underneath.  I'm not sure my fellow junior doctors and I were ever in any doubt about the importance of that.

Tuesday, 1 December 2015

The Second Thanksgiving

Saluting an amazing life :)
‘I’m not afraid.  I’ve lived a wonderful, happy life.  I’ve made a few mistakes along the way, done some things I’m not proud of.  But I can’t complain and I wouldn’t change a thing.  All I want is for my family to be ok, to be happy.  When it’s my time, I’m ready’.  

Thankful, much? One of my patients recently had us in pieces every ward round, reminding us how a life should be lived and appreciated.

Homemade pie, y'all?
I read back my post from this time last year (The First Thanksgiving) - gosh blimey, how time has flown! And I'm bloody exhausted (hence the brevity of this, but aware that my little blog is being woefully neglected) - 12 days in a row, including a 7 day stint halfway through where I did over 80 hours in the hospital, and I look forward to a rather disgusting slog of days and nights (we're already discussing Christmas jumpers and head-gear...) before I hit the relative finish line of Christmas.  And then I'm back for New Years!  Party's at the hospital, chaps and chapesses!

I wrote a lengthier scribble but decided for once in my life to be concise, mainly because every bit of my thanksgiving chatter was about the same thing - people.  Friends old and new, family, my patients, the patients' relatives who expressed their support to junior doctors this week, my non-junior doctor colleagues who did the same, the man laughing at me singing in my car en route to work, the hospital coffee shop chap who gifts me free coffee - oh so many human moments big and small - they've all made me want to give life the massive air punch it deserves on a daily basis. And we haven't even talked about OpenCon2015 yet!

High five, people.  You make me glow! And for that I am thankful :)