Great Expectations...?

First of all, just a little thank you to you, whoever you are, who is reading this. I've had a few really lovely messages of late, and it remains a surprise that anyone reads my scribbles, let alone writes to me about them.

Onwards - I had an exam this week but to be honest, I've stopped telling people how I think exams have gone because they are now so fed up of me thinking I've failed when I end up passing.  But for what it's worth, I definitely feel like I left my brain at home on Tuesday, and am already putting another £400 aside for the resit in January. Harumph.

For it is a source of constant amusement to me that everyone thinks 'Ah ha!' - you're a doctor now. You're sorted! Thirteen years at school, another six at uni, boom - you're done, with a job for life. When I told my parents I was doing more exams, they were thinking this was another standard Karin keen-bean moment. Uh oh, no no.  I am not a special case, this is the reality of becoming anything at all other than an SHO (and soz, but I'm not keen to be the go-to cannula woman forever).

Spend most of my time feeling like this...

 But it's basically blimmin scary to think of what expectations there are for the future.  I can look forward to a lot more exams well into my thirties, and revalidation every five years after that. That's assuming I get a job, given that we're approaching a real bottle neck of medical graduates and higher training/consultant posts.  This is before I even THINK about the fact I have ovaries. And it's not just my ovaries; I'm soon to become an auntie and I want to do that properly too.

It's essentially very easy to feel like you're failing by someone else's standards - those who think you're some career-hungry monkey who's just trying to get ahead at the expense of your personal life; those who think you're not all that committed to your career after all; those who judge your frenetic activity and think that's what you want for the rest of your life, when really you're just plugging in the hours now in hope it all chills out later on; those who tell you how to live your junior doctor life - 'make sure you do at least 3 audits and a few posters' - uhhhh when?  Some junior doctors seem to be able to relax about this (mainly boys, I note. Man, I envy you). I'm... working on it.

So I am henceforth focusing on the KP Standard of 'I'm making up my own plan'. I'm hoping to go to America for a year next year to do some research and have already had the full range of complete enthusiasm to wincing in pain at this 'career suicide'.  Well, whatever.  Medicine isn't the one-way-route to lifetime riches that it's perceived to be, it's still a job I love and I'm taking the scenic route to whatever it is that life is going to look like for me longterm, and I know I'm incredibly lucky to be doing a job where I can say that.

The scenic route always makes you feel a bit more travel-sick along the way, and you may burst a tyre or two, but journey's end is always more beautiful. I'll think of that as I head for my resit in January...

How much game face is too much?

If there were an Oxford dictionary definition, it would read something like; 'noun - used to describe the ability to hide one's true feelings and thoughts behind a face that suggests you are neither affected nor concerned by what is happening.'

Doctors are GREAT at game face. I do sometimes wonder whether, personally and professionally, we've got the balance a bit skewed.

Professionally, some would argue 'Game Face' is crucial. On my oncology job, it would have been curtains if I'd fallen apart with every tough conversation or breaking bad news encounter. Yes, these discussions may have been difficult for me to bear personally, but you've still got to get through your shift so that they and the other patients don't suffer.  Further more, it would almost be selfish to imagine that any news you deliver to a patient or their families is more upsetting to you than it is to them.  Your job is to be empathetic but 'the rock'.  I'm now working on the intensive care unit and the emergency admissions unit, and you can imagine the range of traumatic situations one encounters on a daily basis.

For me, all of this has evolved somewhat since losing my friends. Being in ITU has been especially challenging because my friend was in ITU after the avalanche.  I know exactly what it feels like for those families who come in to an environment with all the beeping machines and almost space-like sterility. Someone comes and tinkers with a machine and then walks off again - what were they doing? What does it mean?

This is Una in a nutshell! From her wall at her flat in Edinburgh.

But almost from the start, I have felt that wearing too much of the mask means you lose why you became a doctor in the first place.  People know when you're not being real. No-one is emotionless - and so I have let the controls go a little and have a bit of banter in the more light hearted moments, and, to an extent, wear a little of my heart on my sleeve in the sadder ones.

My game face has also changed personally. I think Una and Rachel always saw their own worth, in a very humble way, and channelled it to bring joy to others; I feel this strength from them at a time where I have found myself really missing them.  Sometimes we should just be honest and not be embarrassed by ourselves.

To value yourself helps you to see the strength and character of others, and I think game face can get in the way of that.  But I also think it gets in the way of seeing what is true, good and right about people.  And whether it's in your personal life or at work, whatever work you do, how can you respect and value someone truly unless you're real with them, and they're real with you?

It's been a tough few months, and maximal game face is the only thing that's saved me in bleak moments.  The other thing is being around 'good people' and you know how I know they're good? Because there's no game face, and we're all honest. Boom. It's tough to define what a 'good person' or a 'good doctor' is, but I'd suggest that's somewhere to start.  So come on everyone, retract that game face a little and you may just be surprised....

Changeover day!

I am totally shattered, but like all junior doctors up and down the country, it's the first Wednesday of August which can mean only one thing - changeover day!

This time last year, I was a bright eyed, newly qualified doc who got really freaked out when someone called out 'Doctor!' and I realised that it was me they were looking at to solve the problem they had.  One year on, I still get a bit freaked out about the fact I'm a doctor, but I hope a little more calm and finesse has entered my game.

But if you get a slightly baggy-eyed Karin coming towards you in hospital, it's probably because I'm not that bright-eyed version of Karin I was twelve months ago. I was on call three times last week, as well as working the other two days. I was at work all weekend. I worked a normal if horrifically busy Monday before doing another 12 and a bit hours on call today. Then.... I moved house, along with all my other doctor buddies. I've been living out of a rucksack for 3 weeks in between house rents, and today moved out proper into my new digs. But that was nothing compared to my friends who finished their shifts and are moving locations completely overnight - the house I was moving out of had two of us moving out and two people moving in, three of us doing so at 11 at night. Most of us have to be at our new jobs between 7-8am tomorrow morning.

But this isn't meant to be a whine.  It was just quite surreal to work for so long, get home late, eat dinner and then say - 'Right - let's move house!'.

I've scribbled in a couple of places about tips for junior doctors, advice on the first day etc.... My top three tips:
1) Eat lunch. And drink water. This is not optional. You can check bloods while eating if necessary.

2) Ask for help. There are no stupid questions for at least 2 months, and actually not even after that. I ask lots of stupid questions, but I'd rather look stupid and know for next time.

3) Make friends, have some laughs and generally get a team going with your fellow doctors, nurses, pharmacists, ward clerks etc. It's the joy of the job and it will make everyone's job easier and more fun.

For me, it was emotional to the last working on the cancer ward. I got my first personalised card; I nearly cried when I was given it!  It is so true that while you don't do the job to get any thanks, and certainly not on a cancer ward where the courage of everyone around you (patients, family, staff) is just overwhelming, it is just so special to think that you might have actually done your job well and had such a personal connection with a person and their family.

Everything I'm about to say is a cliche, but really, the last few months of working on that ward, in combination with losing my friends in January, have made me feel more full of love for life than I could have imagined.  So my actual biggest tip for new doctors? Try and focus on how bloody lucky we are to do a job that has the scope to make some kind of difference to someone's life. 

Not that sort of doctor!

So apart from people often requiring a lot of persuasion to believe that I am, in fact, alas, a doctor, sometimes (often?!) people knowing you're a doctor can definitely be a bad thing...

I am trying to carve some kind of cross-clinical-research type career, and today spent some time on my academic day discussing my project from my research job next year with the guys from the lab. In a lab, a clinical doctor is apparently a bit of a novelty, but I found myself saying 'well, yes, I'm a doctor.... but not that sort of doctor!' - meaning I may have MBBS after my name, but definitely not PhD!

Because in the pure science world, I am even MORE of a baby in terms of knowing what I'm doing than in the medical world.

Lots of words were said that I didn't understand. I tried to keep up in the lab meeting with the different techniques and arrays being used.  In my defence I later went briefly up to the clinical ward where I work day to day and was trying to describe one of the microarrays to one of my medical doctor colleagues, who sighed as he left the office saying 'well, you just go home and enjoy your microwaves, or whatever it is you're doing'....

I know I'm studying translational medicine and all, but it really is like learning another language. It is actually quite a tough balancing act expressing your genuine interest for what is being discussed whilst only having a bit of a clue what it all means, and also accepting that the person talking to you is probably thinking 'what a wally'!

Hence - an evening of reading awaits!!

Fatigue, fess-ups and... fun.

I'm in the middle of an unexpected 12 day work-a-athon pre-Great North Swim, and although I can't complain, the last seven days have definitely been ones where I think - gosh! My job is full on! In the last 7 days:

Number of significant breaking-bad-news encounters - 2

Number of prescribing errors - 1 

Number of times crying - 1 (see above. Everything was fine. Realisation one is fallible is just quite distressing)

Number of antibiotics prescribed - lots

Number of steroids prescribed - as above plus lots more

Number of other specialties who have been grumpy with me - 2 (once justifiably, the other probably not)

Number of ePortfolios that are definitely ready for end of year sign off - 0

Number of hours of sleep - definitely not enough. And progressively less as the week went on. Not on purpose, you understand.  Self-perpetuating cycle of not-being-able-to-switch-off-ness.

Number of hours in the library on my academic day - 10

Number of evenings requiring bolstering by friends - every. single. one.

What a strange existence it is to be a junior doctor... On realising this, I did what any lucky daughter would do and called my MUM.  

Now, my mother is very wise. Nonetheless, I think it takes a particularly wise mother to know what to say when one's daughter comes across as slightly unhinged. Because I do sometimes feel quite messed up about this job and my life and how much I love it and yet how bonkers it all is.  I haven't really worked out how me and my life and my friends and my job all sort of stick together.  The last of these sort of has to be the most important right now. 

And of course, my my mum is right. The first year of a new job is always a bit crazy. Probably the first two or three years, even.  All one can do is muddle through, eat food, sleep and keep yourself sane. 

And have fun along the way, bien sur!

I'm female and I'm a doctor - so what?

The above is exactly what I thought when I started medical school.  I was made aware of the Medical Women's Federation (MWF) and a lot of the issues relating to female doctors seemed quite distant to me; maternity leave... child care... Naively, I thought this was all that mattered when it came to the fact that I happen to be a girl, and frankly, was so far from my thoughts that I thought no more about the fact that I had ovaries and wore make up from time to time.

Then I read a BMJ article saying that there was a 28.6% pay gap between male and female doctors - what?! There is more to this than pure numbers, but the disparities don't stop there.  There are specialties with a particular lack of oestrogen, perhaps surgery being the most well known, but I was also alarmed to read that amongst medical academics (which I would love to count myself among one day) nearly a quarter struggle to return to work, whereas in comparison most men go to a new or promoted position after a career break.

What on earth is going on - did I miss something or are we still stuck in the last century?

I thought about my own (limited) experience as a doctor, and the advice handed down to me about where my career should go.  And it all became clear.

Discrimination feels like it should be really obvious, and that it can't possibly happen because it is so taboo these days.  And yes, sometimes it is subtle.  But often it is so obvious, I feel embarrassed that I haven't said something.  I've had comments about how I look from male senior doctors who have subsequently turned it into a team joke, and banter from another colleague when patients think I'm a member of secretarial staff (no offence intended to the secretarial staff - I just think said patients might find it a bit weird if they then witness me putting up drips, doing ward rounds with patient examinations and prescribing medicines...).  Most career advice I have been given has come with the heavy caveat about the fact I'm unlikely to pursue XYZ career because I'm a girl and off I'll run to have babies.  At the time, these little digs seem so unimportant - it is easy to laugh it off - and you don't want to seem weak and whiny by kicking up a fuss about something that's 'just a joke'.  Because sometimes it is.  And I'm sure any of the chaps I have worked with would be absolutely mortified to think they had caused offence because I'm a girl, or frankly just think it's silly banter.

But do these little chips and inferences eat away, gradually, at women? I don't know if I want to laugh these sorts of jokes off forever.  Heaven forbid I actually do have children one day and then I dread getting a whole other round of 'oh, typical, off you go, leaving us with another gap in the rota...'  And I think if you are told something enough times, you end up feeling like you either have to join the club and become almost masculine about the whole thing, or walk away completely.  That's how women stay away from the board room of many a hospital - it's just not worth the argument.

I'd like to think we can meet somewhere in the middle.  First of all, I refuse to fit the leadership stereotype of stampeding to the front, telling everyone I'm the boss and that anyone who dares to disagree with me is a fool.  I'm going to do it my way, and be an inclusive leader wherever I work.  Maybe that is a 'girlie' way of doing things, but hey - I'm a girl!

And I certainly don't want there to be an end to the fun and jokes on the ward.  But I don't desperately want my legacy to be 'that tall blonde doctor' (which was the latest 'joke' I got to enjoy at my own expense).  No, it's not a compliment. Just maybe check now and again that your jokes aren't stepping over the line, and I'll make it my job to tell you that the line has been crossed.

Maybe I'll feel differently if I'm ever lucky enough to have babies, but for now, that would be enough.

Recent training...

Oxford morning running...

More Oxford morning running...

Bradford-on-Avon --> Winsley running

Oxford Town-Gown 10k running...

With only two weeks to go til our team triathlon starts, we would be ever grateful for your support!

Today a bunch of us ran the Oxford town/gown 10k; a little warmer than we would have liked, and inevitably I brought up the rear, but nonetheless with two weeks between me and a half marathon I was pleased to make it round in less than an hour (just!)

I will post more blog-appropriate things soon, but in the mean time, if you've got some pennies going spare, consider giving them to www.justgiving.com/organisedfun.

Thanks!

K xxx