Training starts today!

Realising that doing a half marathon and one-mile swim all in the next four months around my rather antisocial work hours will be a little painful!

.....But this is what it's all about!

I may be on nights this week but training started today for my mega-outdoors-athon in May (Edinburgh half marathon) and June (Great North Swim).  A 7.35km run along the river on day one in the Oxford sunshine :)

I realised looking through my blog that I may have been somewhat cryptic but here's what it's all about.  There was an avalanche in Glencoe on the 19th January and close university friends of mine were amongst those involved.  They were friends not just by virtue of our time at medical school, but also an immense amount of time spent in the hills, bothys, the Irish sea, up to our knees in snow, curled up in a make-shift shelter of moss logs and many more wild places.  Their loss is still not something I can really believe is real, but they were full of so much joie de vivre and laughter that this seems a good way to start living life with them alongside us.

Begging emails of donations to follow!  

About Grief

Grief is something most people experience at some point in their lives.  For most of us, our first encounter with it is the loss of a pet or a grandparent.  For me, it was my grandad when I was 11.  I still remember being the one who picked up the phone that day to hear my dad at the other end of the line telling me the news.

Those who know me will know these last couple of weeks have been more challenging than I could ever imagine thanks to the recent deaths of, and serious injuries to, some of my closest friends ('Tier one', one might say).  The only comfort was that at least I had annual leave that week to be with my friends, to laugh and cry together, and to be able to do things like go on a hospital visit and attend funerals.  

But then, all falls silent.  

The rota waits for no-one, and I was back at work this week.  One email I received this week congratulated me on 'feeling ready to return to work'.  Hmmm.  Was I ready?  Well, my lovely friends wouldn't thank me for sitting on my bum sobbing away, and the good thing about being a doctor is that going to work at least seems to be a useful thing to do.  Work keeps you busy, but it is merely a shield.  The weekend comes.  You go to church.  The first hymn is Be Thou My Vision.  Cue - total meltdown.  

For my wonderful friends, Una Finnegan and Rachel Majumdar, and my other beautiful friend still in hospital. xxx

The events two weeks ago will stay with me forever, but so will my experience of grief itself.  It's like riding a wave, where the ups are tremendous and peppered with joyful memories from the past along with renewed zest for life, but the downs are low, low, and painful.  And embarrassing (who wants their colleagues and peers to see their faces blotched and tear stained?).  When you're riding the wave with other people on the same wave, that's fine.  Crying and laughing in quick succession becomes strangely natural.  The challenge is when those around you are not on the wave, because the event is not something that has affected them.  What does one say? What does one say during either the ups or the downs?  'Keep your chin up' (How very British).  'Work today was the worst thing ever' (hmmm.  Perhaps choose your audience when making such comments).  'I'd feel better by being there for you' (this is ok but not if you're making me feel worse in the process).  Maybe I'm being harsh....

But what has been AMAZING is the love and support from so, so, so many people.  Random messages and emails from people who knew them, who didn't know them, who had a suspicion that I knew them, and every message so kind.  I know it sounds silly but it was genuinely so helpful to know that people were supporting us.  Friends' families opened their doors and gave us somewhere to stay,  food, hugs, a cheesy film to watch and transport PRN.  It has been a tremendously warming experience amidst the sadness of it all.  I can only hope my friends' parents and families have felt this warmth also.  

So I may not know much about grief, but I'll tell you, it's unpredictable and unbearable.  But what joy to know how much you can love someone, and love those around you.  So I'm going to keep loving people, and should the time ever come that someone needs me like I need my friends right now, they are going to feel so loved they won't know what to do.

The Long Winter....

Did Christmas happen?  How on earth is it 2013?!

Christmas was a work-filled affair for me, so it genuinely doesn't feel like Christmas happened at all.  I was working 7pm-8am night shifts the whole of Christmas week, and I'm nearly at the end of a week of 7am-7pm shifts all of this New Years week.

My family were all abroad (parents with my 91 year old grandmother in Germany, sister with her in laws in South Africa).  On Christmas day, I spoke to my sister for about 90 seconds when I was at work preparing for handover.  I ate a slightly weird breakfast of chicken wrapped in bacon with a weird carrot mash and potatoes on my tod before sleeping my way through Christmas day.  When I woke in the evening to go to work, I had mushroom risotto.  That was my Christmas day.

But you know what?  We had a mince pie or two, donned our Christmas jumpers and ... carried on as usual.   Perhaps there are romantic visions that we serenade our patients with a carol or two, or give them all Christmas cake.  But the reality is, it is just like any other night shift without a moment's peace. There really is nothing, truly nothing, to smile about when you have to certify a death early on Christmas morning.  But this is what happens on a night shift, any night shift.  For every patient we saw during that week of nights, you felt awful that this was they were spending the season; after all, all I had to do was turn up to work!

And plus I have a substitute family of my fellow on-call buddies when my biological ones are in absentia.  You come to lean so heavily on your colleagues for a brief conversation, consolation, a giggle, advice....

I am absolutely exhausted now, but I am relieved that I did my best over Christmas and New Year to keep a smile on mine and as many other faces as possible.  The post-Christmas phase has been nothing short of manic, but hey, a smile's contagious right?

I have made two New Year's resolutions - both of which I am already actioning!
1) Have at least one regular hobby (in absence of being free any evening of the week each week - this is temporarily being filled by 'Reading' and 'Eating with friends'.  I'm just finishing Operation Mincemeat - incredible. Even post-nights, it kept me glued the whole 4-5 hours on the train to Newcastle between Christmas and NY.  I am also making the reading of a Sunday newspaper a weekly feature. )
2) Make more non-medic friends.  Evidenced by the fact I am going on holiday with a majority of non-medics at the end of Jan.  And I'm having lunch with a non-medic on Saturday.  You think this is extreme and constitutes unnecessary categorisation on the basis of employment?  Listen, I love my friends.  BUT.  You have no IDEA how dull my chat has become.  I need to broaden my horizons. 

Doctors cry (especially junior ones)

Ok, so I am really bored of crying at work.

Since I started working back in August, I have probably had a cry-per-month ratio higher than I have ever had in my life.  The thing is, I don't cry.  Normally.  So by way of learning to 'Man Up', here's my cry diary from the last few months.

Cry number 1 - Day 1 of work.  Ward that normally has quite a few doctors on it - find myself completely on my own for a chunk of the afternoon.  Feel overwhelmed by number of jobs to do and no idea how to do them, along with being asked questions I don't know the answers to.  New SHO arrives and makes the fatal mistake of asking me if I'm ok.  Cue tears.

Cry number 2 (and 3, 4, 5) - First set of nights.  At the end of a busy, horrible first ever medical night shift, I realise in front of the entire team that I made a small mistake - an error based on lack of knowledge of a particular routine.  A non-dangerous mistake that breaks me at the end of a long 13 hours.  Two nights later, and I'm similarly being dragged all over the hospital.  At 3am, I have a choice between the patient who is desaturating down to 50%, a blood pressure of 65 or chest pain.  That means the patient with the minor-sounding problem is unfortunately not a priority.  Said patient lets it known she is not very happy about this when I finally reach her at 7am.  For me, it's the final straw.  Didn't feel I'd been very supported in this  decision making process by the nursing staff, and once I've calmed down a bit, I have a chat about supporting each other during the night shift.  I think the patient realised I was upset and once I'd sat down going through her problems for half an hour, seemed to be more content with the situation and that I hadn't apologised for my tardiness without meaning it.  A few people subsequently asking 'if I'm OK' triggers Cry 4 and 5.

Cry number 6 - having had no deaths on my clinical team, we have three deaths in one week.  One patient who I'd seen over a weekend on call, and happened to see during an on call later the subsequent week, dies literally in front of me.  Then we had a couple of admissions that week of patients with dementia who had stopped eating and drinking.  Taking a history was impossible.  Persuading them to have bloods taken was tricky.  The underlying feeling of 'I can't actually make this situation any better' and 'What am I actually doing? What can I bring to this situation?' proves a little more than I can bear.  In fairness, I don't actually cry, but the only place I can find to hide to take a few deep breaths is the patients' bathroom.

Cry number 7 - there's a long pause before cry number 7.  Another weekend on call.  It's been a very busy Saturday and once the day registrar has left at 5pm, I'm on my own to sort everyone out til 9.30pm handover.  The bleep is out of control with non-urgent jobs.  Then at quarter to 9, someone is spiking a temperature.  I decide this is the most urgent job, and the others on my list will need to be handed over. I speedily do an assessment (my bleep obviously continuing to go off), take some bloods, take some cultures, get a new drip up.... and as I'm getting these things sorted in the office, I'm still being called - 'Doctor, can you just....'.  I don't know how I can say it differently - that unless the problem is more urgent than the one I'm dealing with right now, it will have to wait 5 minutes.  I head to handover, and I'm not angry, just tired and frustrated with myself for not being able to do 3 things at once.  The SHO reminds me that I can't expect to be able to do everything.  My night counterpart brings some water and tissues, and I get it together.  What a wimp.

Cry number 8 (8???? This is ridiculous) - new job, working late.  My senior and I assess a patient.  Once her blood tests are back, my senior decides she needs an urgent scan.  The person who would do the scan disagrees.  He does not communicate these feelings in a very sensitive way.  Some poor documentation on my part confuses the situation (which I apologise for) and overall I feel quite stupid and like my professionalism is being questioned a little unfairly.  It's the last of these which sets me off.  This has all happened over the phone, and I'm with my senior seeing another patient on another ward by this point, so a whole set of healthcare staff and patients alike are completely mystified by this sobbing doctor.  When I see said person later (scan finally done and entirely justified), I apologise for my part in any confusion.  I receive no apology.

You see?  I totally need to man up.

The thing that frustrates me more is, I am coming to believe now that actually, I am an alright doctor.  This is quite a big deal for self-depricating little me.  I had my end/start of rotation appraisals recently, and yesterday saw my feedback from the doctors, nurses, ward clerks, pharmacists from my previous rotation.  Their feedback was really nice! Of course, I am now sort of back to square one in a new job and the amount still to learn is overwhelming.  I am still just a junior doctor.  But I'm ok with that, because I know that, despite all of the above events, I learn from my mistakes and that I'm not terrible.

So really there is nothing to cry about.  I just need to learn to back myself, and cope better when things get a bit stressful.  And perhaps carry some Kleenex around in my on-call bag.  

Hello job, goodbye life

I finished my first rotation this week and it was with a degree of sadness and trepidation that I left the hospital and job I was only vaguely starting to feel on top of, in exchange for a new job in a much bigger hospital.

I now work in surgery, and my hours are, as one might say, 'plus plus antisocial'.  There is literally no regular evening hobby I can do any day of the week, because all my shifts either start, finish or occupy the evening time.  

Means of coping with this?

Go home and find your mama and give her a big hug.  Go for a stroll and contemplate life.  Generally escape the bubble that is 'work'.  

Buy yourself a truly excellent Christmas jumper.  And stop getting too bah humbug everytime they play 'Driving Home for Christmas' on the radio.  Because I will not be driving home for Christmas.  Even if I did, only the cat will be there because my family are (rightly) taking the opportunity to visit our extended family.  

Go to the pub and have a snuggly mulled wine with good friends.

I am determined not to be a whiner!  It's been quite an intense time, but my new musical and literary flavours of the month are helping plenty - I've just bought Lucy Rose (old favourite for complex reasons) and Alex Clare (@alexanderclare for all you twitter fans)'s albums, and can highly recommend both.  Book wise, a charity shop trawl proved fruitful.... 10pm finishes for me for the next 7 days, so I'm spending my early mornings with my nose in a (non-medical) book to keep my sanity and a smile on my face.  

The final leg of Two Weeks in the Life...

Day 10: Wednesday.

Really flagging now.  My two direct seniors are on call today again so I have them with me briefly then I'm on my own to prepare for the consultant ward round in the afternoon, and I have my medical student again to entertain.  I have compulsory teaching at lunchtime which is rather inconvenient but the ward round in the afternoon goes off reasonably without a hitch. I've been invited to a friend's for dinner and I don't get there til after 8 before meeting some other friends for a drink.  Struggling to suppress an insatiable urge to get 'out of my head' by now, and probably head home a bit later than I should have done.

Day 11: Thursday.  Final on call of the 2 week mega-work-a-thon, and I'm post take, so start at 8am.  It's reasonably painless but post-take days are always a bit more chaotic than I would like, with a combination of managing all your new patients and sorting out all of your existing ones.  One of our existing patients is quite unwell and it's quite handy that I'm on call in the evening as I can reassess him later on knowing all about him already.  I feel completely snowed under in the afternoon as my SHO is sorting out the few remaining new patients (most of whom are on other wards by now and therefore no longer our responsibility) and my Reg has other work to do.  A lot of our patients are to be discharged in the next couple of days and if I don't get on top of my discharge summaries today, I'm going to be in a right fix tomorrow.  I'm not really able to offer my medical student much by way of time as I have so much paperwork to do.  There's also an important end-of-life discussion that needs to be had with one of our patients' relatives; it's always upsetting to have to accept that your efforts are proving futile and ultimately someone may just be nearing the end of their life, but we have a very frank discussion and all agree a plan of action with my Reg.

Post 5-pm, I have a few jobs handed over, but nothing too overwhelming.  A lot of warfarin dosing and a few IV fluids to prescribe, and a couple of patients to review.

The person who's on nights is late - he's never late.  I carry on with a couple of small jobs I might have otherwise handed over when the night SHO appears at around 10pm - it turns out the night version of me has had a car accident in all the bad weather.  Fortunately he's alright, but obviously can't work, so the SHO tells me to hand over to him instead.  I drive home at the pace of snails as the weather really is awful and I'm feeling a bit shaken by the news of my friend, and when I get home I call him to make sure he's ok.  So by the time I have my sad dinner of microwave rice, it's gone midnight.

Day 12: Friday!  The last day!  I'm doing a quality improvement project with one of the other doctors so I arrive for 8am again to collect data from around the hospital before my day starts proper at 9am.  I get some unprecedented praise from the pharmacist for getting all of my 7 discharge scripts to her before lunchtime - you've got to take these small positive moments!  My SHO and I try to see everyone before this afternoon and pre-empt the jobs that might need doing, and by lunchtime I'm feeling quite on top of things.  A quick lunch, and I'm ready for the boss in the afternoon.  My SHO and Reg are both on call, again, today, so I'm on my own to direct the boss round everyone.  Even though we've discharged a lot of people, the remaining patients are all quite complicated and unwell, including my unwell patient from yesterday.  The boss seems reasonably content with how we've managed him.  Some relatives want a detailed update about one of our patients - I spoke to them at the weekend so know them already.  By this point it's after 5 and we still haven't seen half of the patients - it's important obviously to give a full update, but it's a challenge balancing this with the time owed to each of the other patients, and the general brain fatigue that has set in from being at work everyday for 12 days in a row.  The boss handles the situation like a pro, and everyone leaves happy.  It's after 6 by the time we've seen everyone, and it's left to me now to mop up the remaining jobs and prepare the weekend jobs list and put out the blood cards for the phlebotomists to take.

I finish, triumphant, around 7pm.  I'm going away to Devon this weekend with some of my junior doctor chums, and I am greeted by them with a flat cap and a beer.  Relief!  My twelve days are done, and addressing Life Beyond Work can now commence.

Weekend-a-geddon +2

Day 6: Saturday morning.  Slept terribly, got to bed late and awake at 6am. At work I am delighted to find I have a senior person to review patients who we've been asked to review over the weekend.  This is excellent news as it leaves me free to do the more menial jobs of chasing blood tests and receiving the rather endless stream of bleeps.  We're doing well (with just one crash call to run to) and by the time he goes home at 5pm, I've even eaten some food, had some fluids and feel vaguely on top of things.

Post 5pm, I'm on my own to mop up the remnant jobs and address any arising issues.  The problem is, there's only one of me, and I only have two hands.  The hospital has been so busy that a lot of the patients I've been asked to check bloods for over the weekend have been moved (many to the other side of the hospital), but their blood test cards haven't, so it's down to me to find out where they've gone and do the blood tests myself.  In addition to that, there's patients who are unwell, drips that need replacing and families who want updates.  My bleep is going off every five minutes and I've no sooner started a job than my bleep goes off again.  I have to risk-stratify my list of jobs and decide which ones I will have to hand over.  I get to 9.30pm and I am beaten.  A few tears are shed, not because someone has upset me, but just because I am tired and frustrated with myself.  My seniors always remind me that I need to just CHILL and accept that I can't do everything; although I know that, it's just frustrating that that's the case and ultimately, it's irrelevant to the patient or nurse at the end of that bleep you've just received that you've been on the go for 12 hours.  Just as we sit to hand over, an arrest call goes out and we all peg it to the relevant ward to start CPR. We're unsuccessful and it's a slightly sombre end to the day.

After all of that, I go back to my own ward to check a couple of things and leave hospital after 10.  Home after 11.  Quick pizza dinner, bed.  Same again tomorrow.

Day 7: Sunday morning.  Cream crackered and eat the remnants of last night's pizza for breakfast before heading into work.  Classy.

The ward registrar and I get tactical - I hate being disorganised and today I've consolidated the ten sheets of hand over patients into one 'ultimate list of lists'.  It's pretty frantic for the first five hours as we go round reviewing the patients we've been asked to review, chasing bloods, the odd cannula and trying valiantly to encourage people to put non-urgent jobs in a ward-based book rather than bleeping me all the time.  Another crash call takes us jogging into A and E - this patient survives.  When the ward registrar leaves at 5, I've got a fairly manageable to-do list.  I'm majorly flagging but there are still bloods to take and chase, and just at the end of the day, I'm asked to review someone who's breathing has changed.  It's quite a satisfying bit of teamwork as we get his bloods, ECG, chest x-ray and diagnosis within the space of about an hour.  The night junior doctor greets me with a cup of tea.  My hero.

An accidental snap, but accurately reflects the fatigue!

Day 8: Monday.  Everyone else is looking bright eyed and bushy tailed - the week is no shorter if you've done the weekend on call so I'd better keep up the pace!  Over the weekend my ward has essentially discharged half of its patients so it's all new faces - but luckily I know a lot of them because I've been involved in their management over the weekend.

My registrar and senior house officer are both on call today in the admissions unit so we're a team until midday and after that I'm on my own.  There are only a couple of patients left to see, a few discharges to sort out and the care for everybody else to coordinate.  Finish about 6pm and the boss turns up - luckily I have something useful to say about the day!  Time to head home, walk in the door about 7.30pm.  First time I've been in the door before 11.30pm since Thursday.  And then to the pub.

Day 9: Tuesday.  An unusual week this week as I'm at a meeting today for the whole day.  Although it's still a full day of work, it's refreshing to think about something else (although it is still basically medicine chat).  Issues discussed include women in medicine, something I feel increasingly passionate about.  It is different being a female doctor, because ultimately, I predominantly serve an age group of population for whom female doctors was a rarity.  Persuading them that I'm a doctor can be a challenge.

Get home no earlier than if I'd been at my normal day job and go to a friend's house for dinner.  Inevitably, medical chat predominates, although we reflect a lot on how we got to being here and how it's going to impact on the rest of our lives.  It's funny to think that we chose a career when we were just teenagers, and it's one which almost defines my whole identity now.  We talk about our respective 'Medical Finals breakdown moments' - the two weeks when I was doing my final exams at medical school were absolutely painful for my family to have to hear about over the phone.  It's weird how now that I'm doing it as a job, I don't feel they need to hear about the bad days.  They've done their time, and they don't need the worry of a wailing daughter down the phone!