The sneaky approach of Black Wednesday...

Another year in the lab is about to come to an end, and what a whirlwind of a year it's been.  For a clinician scientist-in-training like me, it can often feel like you're treading water rather than actually swimming forwards.  But for the first time, as my last phase of general medical training (Core Medical Training) approaches, I feel I can see the light at the end of the tunnel.

Bungles here, Bungles there, Bungles everywhere!

Do you ever look at yourself in the mirror and wonder how on earth you ended up, well, HERE? Wherever 'here' is for you.  In my case, I'm 29 years old - TWENTY NINE!!  And I'm a doctor, and still quite a junior one, but not a very junior one.  And I'm also a scientist, and still quite a junior one, but I guess also not a very junior one.  Hmm!  And hopefully I'm also a lot of other things - being, as I hope, not entirely defined by my professional roles.  For one thing, I think I've nailed 'the doctor game' with my 3 and half-year-old niece (her idea, not mine!), and my colouring in skills are second to none.  The point is - I've progressed!

 A friend of mine quite wisely pointed out recently that while it can often feel that we are being pulled and pushed along a path we have not designed, ultimately we have made choices that lead us to where we are now.  It's just easy to forget them.  So when I read statistics such as an increase in unfilled junior doctor positions of 31% in one year, I know that's also no accident.  For the training programme I'm soon finishing, they have seen an increase in unfilled posts of nearly 10% in ONE YEAR.  Go one step further back in the career ladder, and only half of doctors completing the foundation programme (sort of like internship programmes) applied to higher training as GPs or specialists.

Dreaming spires, even when the summer sun is hiding

I'm part of a new generation of doctors, unfamiliar to the last, that is taking the scenic route through postgraduate medical training.  I too took a 'gap year' between foundation and specialty training - as did most of my friends at medical school.  Taking time out is not 'wasted time' - we return to training with new skills, new knowledge and new energy.  For me, research offers the opportunity to exercise a different part of my brain and I don't think it makes me a worse medical doctor (as discussed elsewhere in this blog).  For those who take time out to do short term clinical jobs in specialist areas, what they bring back to the table is hugely valuable.  In fact, I recently spoke to a friend who is now finding it difficult to be competitive in applying for a position outside her training programme because they have gone straight through without any time out.  I strongly feel that if the System closes its doors to these creative routes through medicine, those statistics of unfilled training jobs will only become more worrying.  

I am also part of a generation of doctors who has lived through this contract and NHS reorganisation fiasco.  And of course it's made me think about my priorities - because the system in which I work does not have time to worry about them on my behalf.  For me, having time to cycle, go for a run or play music are things that make a busy working life sustainable.  In the rotation I'm about to start, I got my rota a few weeks in advance, had a degree of choice over which rota I started on and I've already had some very precious annual leave approved.  They sound like little things, but they make me feel like a person with a life.  It's these little things that can make all the difference.  

Hopping from one job to the next...

So as Black Wednesday finds me, I'll be nervous to return full time to the clinical world and leave my cells for someone else to worry about.  My tips for new docs?  Gosh, I can't believe it's five years since it was my first day on the wards.  The top tips I'll be referring to myself are:

1) Ask a zillion questions over the first few days.

2) Learn how to do the basics! Prescribe things, request things - the actual LOGISTICS of doing these things are often the hardest!

3) Learn everyone's name - nurses, cleaners, HCAs, doctors - they are all friends you will need along the way.  

Wherever 'here' is for you this Black Wednesday, good luck - and remember everyone's had a 'first day' :) so be nice whichever side of it you're on!

Glorious Insignificance of the Medical SHO

There is a school of thought that you are either a soul of the mountains or a soul of the sea.

I still can't work out which category I fall into.  When I think of the mountains, I think of feeling lost amidst Milky Way-speckled nights in the Andes, or many, many hikes, soaked to the skin but somehow gloriously refreshed, up various British hills and mountains. But then, I think of times spent by the ocean - perhaps most pertinently the Pacific, once upon a time diving in, as well as more recently gazing upon and swimming in - where you also feel marvellously insignificant.  I like that plenty too.

After a week and a half back in the NHS as a junior doctor (for those who want to pin point it - a Core Medical Trainee, or Academic Clinical Fellow if we're being fancy) - I'm once again Dr Karin Purshouse.  I'm exhausted and full of some sort of viral plague but amazed at what my little brain has been able to retain despite ten months away from having three bleeping machines attached to me, people hollering 'DOCTOR! Doctor!' and not (at least significantly) eating/drinking/peeing for 14 hours.

And really, I can completely feel the difference a year away from it all has made.  I am about ten thousand times more relaxed, and feel calmer, nay, wiser, about the things I do and don't know about clinical medicine.  As predicted, I'm every bit the OCD check-a-holic I was pre-USA, but I'll just believe my lovely zany colleague who commented, 'well Karin, that's what makes you a medic'.  It's a little like getting into a time machine though - colleagues who were junior to you are now your equal in seniority terms; those who were middle grades like me are now registrars, registrars are now consultants (do I call them by their first names like I always did, or Dr So-and-so?!).  Simultaneously, nurses remember you, and you them.  The same nurses are the ones you trust to be your eyes and ears across the multiple wards under your lone responsibility at night time; the ones you will always come running for if they say you need to start running.  The same ones will hand you the patient's notes with one hand and a cup of tea with the other as you approach the end of your night shift, brain and vocal ability only just about still intact.

I am not the same, it turns out, as those who stayed when I left.  For one thing, I'm still smiling - my supervisor marvelled at how happy I looked a week in, despite various administrative disasters making my return a little more complicated.  I'm the crazy SHO who high-fives the nurses when we've kept three really sick patients alive together all night, or asks even the hospital canteen staff 'hi there, how are you' (this is VERY American, it turns out), or, shock horror, goes to a yoga class, dinner with new friends or a concert AFTER WORK.  Life seems extremely colourful once you decide to approach it America-style.

I still feel like a tourist in my own country, but that's ok - I'm finding plenty of new chums with whom to enjoy the ride, and equally finding moments of peace in the American books I am still working my way through, perching time by/in various waterways or nerding out at science seminars.  You can feel pretty insignificant in the NHS, but then, perhaps it's like when you feel insignificant in the mountains or the sea - it's about how you choose to approach and interpret that insignificance, and rather marvel at the greater structure you are part of.  Sure, it's a bit of a change going from the mind-boggling world of glioma gene editing to worrying about Mr Bloggs' bowel movements, but you know what? That's important too.  And the great thing about being a clinician scientist is that each side of that professional coin informs the other, and helps you keep your perspective on the coin as a whole.

I've stolen this from Freckle Volume 1, and I think it's pretty bloody wonderful.

West Coasting - where ocean and mountains meet!

'Society, as we have constituted it, will have no place for me, has none to offer, but Nature, whose sweet rains fall on unjust and just alike, will have clefts in the rocks where I may hide, and secret valleys in whose silence I may weep undisturbed. She will hang the night with stars so that I may walk abroad in the darkness without stumbling and send the wind over my footprints so that none may track me to my hurt - she will cleanse me in great waters, and with bitter herbs make me whole' - Oscar Wilde, De Profundis

Disclaimer: Mr Bloggs is obviously not a real patient name. 

Red, White and Blue Wednesday - not Black Wednesday!

Tomorrow I go back to school.  My American tax return is finally filed.  My American bank account is closed.  My American phone contract has expired.  I have packed up my remnant things (which essentially amount to a significantly-culled selection of clothes... photos... books... my violin... and my trusted collection of international fabrics) and am back where it all began to start again, again.  My stethoscope, now entering its 10th year of life, is in desperate need of replacement (perfectly functional, you understand, but a girl can dream of a Cardiology Littman upgrade...) but shall, as it always has, see me right as I re-enter the clinical world on Black Wednesday.

This junior doctor has been re-acclimatising to this drizzly, chilly but occasionally sun-kissed, sparkling land.  I feel a little like a tourist in my own country, but this period of 'tourism' and catch-ups with very special friends and family, as well as all-important solo reflections, have helped focus the mind for the next part of my little life journey.  I return to a beautiful city with a refreshed outlook on what's important and renewed resolve to listen to myself a little more.  Eek.  I am more than a little daunted about another fresh start - strangely way more scared than when I moved to the States!  I have enjoyed celebrating the joys of the lives of wonderful friends and family before and since my time in the USA; now it's time for me to get on with my own.

A most wonderful friend soon to start her own overseas adventure reminded me recently amidst a small anxious moment re 'returning home' - nothing, including stress, is permanent; it is just a state of mind and a reaction to a situation, and this will pass.  And with that; I will keep some important words in my mind - Gold Guide, and Out Of Programme Experience....  Perhaps this is why people shouldn't take gap years - once you pop, it's hard to stop!  

Citadel and a Ghanaian reunion

Mussenden, NI

Sunset at Helen's Bay, NI

Womad! Chai, Senegalese dancing and a serious dose of mud. 

10 months on - Wiltshire's still looking all green and great :)