Category Archives: healthcare

Champion the Truth

If you don’t live in the UK, you may have missed the junior doctor contract row that has been brewing for a few years but has escalated over the last couple of months. If you live in the UK and rely on major media outlets to keep you informed, you may think the dispute is about junior doctors asking for more money. I would suggest you turn to social media for more accurate information from doctors, other NHS staff and more importantly their families. Long and short of it is that the dispute is about our Government deciding we junior doctors need to work longer hours whilst our pay is cut and refusing to do the simple arithmetic that would show that if you want more junior doctors working around the clock, you need to recruit more of them because we are already working long hours and we absolutely will not do me as it would put our lives and the lives of patients that we hold so importantly at risk. I mean, how is it fair that the Government has voted to pay its MPs more and they can still claim vast amounts on expenses yet the very same Government says we have no money in the coffers to pay for more junior doctors? Isn’t that ridiculous???

I digress, please read up on Facebook, twitter and blogs writing on the issue. Plenty of truth out there is you care. The baseline is that at least half of the junior doctors who have voiced their opinions have stated either that they have made up their minds to quit the NHS or are at the very least, looking into alternate careers or going abroad. The simple truth is we as a group of junior doctors think the bottom line is that the Tories have vested interest to tear down the NHS and privatise our healthcare and hence line their pockets. There is also strong evidence out there that the current fool we call our Health Secretary has been a champion of NHS privatisation for many years and probably owns share in private health insurance conglomerates like Virgin Health.

This blog is actually about the one good thing that has come from this attack on junior doctors. We now have an online Facebook forum called Junior Doctors Forum which is by invitation only. It has 63,000 members and counting. Not all of them are junior doctors. We have consultants, medical students, nurses, midwives, paramedics and other allied healthcare professionals plus a few lawyers, journalists and even politicians about the forum. What I want to do is big up the passion of those on the forum and champion them sticking to their guns and being honest about how they feel and what this is doing to us as a group. Never has there been so much unity within the profession. Medicine is a very hierarchical and competitive profession and although we all start as one, we generally sub-divide as we become more senior and choose specialisation programmes. Our world then shrinks even further so all we know is related to the one field eventually. Our only contact with the outside specialities is if they are part of the multi-disciplinary team that we need to make sure each patient’s care is optimal with the inclusion of all relevant expertise.

So it is all good news though? No. Unfortunately when you get 63,000 opinionated voices with the top 1% in terms of IQ and ability to rationalise, debate and analyse, you get varying opinions. I am all for freedom of speech and embracing our differences. However, as with all other aspects of life, some are excessively worried about how other people interpret our opinions. An article was published based around a discussion we had on the forum and people are getting all uppity about all coming across professional and un-emotional. Why? If this was about professionalism only, we would all continue our stony silence whilst we get attacked as we give our all for the greater good. This time, we have stood up and shouted NO because not only have they attacked us (we have thick skin because of the nature of being medics who take enormous responsibilities day in, day out) but they are threatening the very fabric of the health of our nation. Their proposals are not only ensuring that many of us want to leave because we choose life and living than putting ourselves in danger from physical and mental exhaustion, they are also meaning that we are now less willing to carry on doing extra unpaid hours for no thanks.

The NHS has been running on the goodwill of its junior doctors for a very long time and things have been in a steady decline for the past decade yet this is the first year that doctors have threatened to strike. We love the NHS and have been carrying its weight to the detriment of our mental, physical and psychosocial health for far too long. This is the straw that will break the camel’s veritable back. It is because we are passionate that we are fighting the proposed changes which may start with junior doctors but we all know will extend to the rest of the hardworking staff the NHS is lucky to have as its employees. How then can anyone ask that we lie about how angry and betrayed we feel? How upset we are that we are being made to reconsider our futures? Whether we can afford to have children and continue to be there for our patients? How the lies of Hunt et al are demoralising us? How we don’t feel it is worth it anymore to carry on in the NHS when all we get for breaking our backs for a pittance (£11/hr 6 years after graduating for me compared to a plumber who can earn up to £50/hr) is abuse and an Etonian ignoramus vilifying us for caring.

Well, I am here to say that no. I will not be unemotional. If I didn’t care for the NHS, I would have quit after my first foundation year when I became a fully licenced medical practitioner. If all I care for was the money, I would be abroad today with a private clinic, dictating my hours and pay. If I didn’t care, I would not be attending protests and spending what little I have left over after my living expenses and medicolegal expenses on supportive merchandise. I care and I am not afraid to show it.

Hunt is only the face of the Tory campaign to break the NHS and leave privatisation as its only viable option. The Tory Government is libellous, dishonest, spineless and un-democratic. If the general public continues to buy the bullshit the Government is peddling, it will be the British public who will pay the price in the next few years. So unless you are all dying with something that will kill you with certainty in the next couple of years, wake up and realise facts. Fact is the NHS as we know it will be no more unless the whole of the British public fights this. Just google how much it’d cost you to pay for your health insurance in the US and imagine the UK going the same. Doctors are in hot demand the world over. We can and will be forced to leave the UK and the NHS is this horror continues and we will be fine. I assure you. So the fact that I am getting emotional is not because I am a greedy lazy overpaid privileged posh kid as Hunt and co would have you believe. It is because I care and I am not afraid to show it. Fact!

Open Letter to David Cameron – Our Silent PM

This was written by the father of a UK doctor. He lives in Sweden but is speaking out to save our NHS. If you share his sentiments. Reblog or share my link. Please.

Sir,
Your silence in the matter of the NHS and Junior doctors is conspicuous and indicates your silent approval of the Health Secretary and his policies.

This is not a matter only between Mr. Jeremy Hunt, the NHS, and junior doctors. In fact, this concerns everyone, from a child yet to be born to the elderly person counting the last breath and every one in between. Therefore your intervention is of vital importance to the national interest.

It is also very painful to see how ruthlessly and insensitively you treat the elite youth of your society. The youth who have chosen to indulge in the service of people of your nation, day and night, ignoring their own comfort and social life. They are the foundation of health and wellbeing of your nation of which, I am sure, you are proud of.

I have seen the plight of junior doctors. They are working day and night, have no control over their week-ends or holidays, when on call they have to be available for up to 48 hours. They cannot think of taking leave irrespective of personal urgency. In spite of all this they are single-mindedly devoted to their duties and responsibilities and have never asked for a pay rise. They are just short of being slave driven. To add ridicule and insult to their calibre, Mr. Jeremy Hunt wants to reduce their pay and increase their working hours (while informing the public he is doing the opposite). All the while he has been projecting them as greedy and an unwilling work-force. You are watching all this silently.

The fact is that junior doctors are tired, fatigued, exhausted, demoralised and yet they stand erect and defend the health system of your nation.

I will spare myself the energy and assume that you know more than I can ever explain. You will be well versed on the internal workings of your own government, therefore, I will draw your attention to a few things which might have escaped your attention. I do not think that this has escaped the attention of Jeremy Hunt because it appears his is a well calculated mission.

First, all signs suggest that you want to privatize the NHS. If that is so, you should come out boldly and declare to the public that you want to do so. Firing the gun from the shoulders of the junior doctors and blaming them is not graceful nor is it worthy of a strong Government. The public who have placed you in the high office have the right to know your plans rather than manipulations. If your Government succeeds, cutting the pay of junior doctors and increasing their working hours, junior doctors will survive in one way or another. However, the entire population of your country will suffer. I do not think that they will forget nor forgive. Therefore, before you dismantle the NHS, it is imperative that you rethink your plans because the health and wellbeing of your country depends on it, and for this, you are directly answerable – even in the future.

Second, the Health Secretary has succeeded in downgrading and vilifying the medical profession as much as possible. Once again, you are a silent witness to this. He has taken away all the motivation and incentive from bright and elite students of your schools and colleges to choose the medical profession. If he is allowed to succeed further, you might find medical colleges left wanting for students. That would create an enormous shortage of qualified and quality doctors in the long run and an ever increasing burden on the health service.

Thirdly, if you and Mr. Jeremy Hunt succeed in privatising the NHS – I can see how this could be the interest of Mr. Jeremy Hunt. Your previous health secretary Mr. Lansley, has recently take a role in a company who is promoting privatisation of The NHS.

If The NHS is short of funds (and we know it is, through systematic underfunding by the government), it is not the fault of junior doctors. On the contrary they have to work even harder without adequate machines, equipment and staff. It is a simple case of mismanagement of finances and mismanagement of administration. Instead of pointing the gun toward the junior doctors – who are the weakest link in the chain of NHS hierarchy – aim your guns at cleaning and pruning the financial management of NHS. Look deeply into it as to why The NHS is in this position.

There are 53000 junior doctors. They are working for at least double that number. Each doctor is giving you output for at least two doctors. Instead of motivating them, patting them on the back, and incentivising them, you want to pull the carpet from under their feet so that all of them tumble down. More worryingly, you are willing to do this on the whims of a few people who may not think beyond their own interests at the cost of the health of your entire nation.

Your junior doctors are dedicated, hardworking and responsible. They are the future specialists, researchers and innovators. They are the backbone of the health system of your country. Give them the respect they deserve. Give them the motivation and sense of worth. Applaud them for having chosen the medical profession.

I have seen them working with dedication and without complaining in spite of all the hardships they face as my son is one of 53000 junior doctors.

This letter is the voice of 106000 parents who are proud of their children and their devotion to the service of people.

Best regards,
Anil Bhatnagar

The Expiry Date

This morning I read drkategranger’s blog regarding her expiry date (she is a doctor with terminal cancer who talks about death so candidly, it inspires. I would absolutely recommend!!!). The blog and some of the responses to it got me to thinking about death. I have already written about dying and the fact that I fear it not so much. As a Muslim, I tend to see death as just one of those certainties of life so I treat it quite matter-of-factly. This blog is will be further musings about my experiences of death. I will start with a quote from Hadith (Islamic teachings) which summarises how I generally see life and death:

Al-Hasan Al-Basrî said:
‘The life of this world is made up of three days: yesterday has gone with all that was done; tomorrow, you may never reach; but today is for you so do what you should do today.’ Al-Bayhaqî, Al-Zuhd Al-Kabîr p197

I am generally an optimist or more accurately an optimistic realist so I try not to be morbid and I am generally not one to dwell on death. However, I have had times in my life where the thought of dying has crossed my mind. Last winter was a pretty bad time for me. I was working in the hospital that inspired me to become a paediatrician (which still inspires me) but I was in a job with a particularly toxic individual who succeeded in poisoning the atmosphere. I became depressed after 6 weeks of this. So much so that I hated waking up every morning I was scheduled to work. It got to a point that I would lie in bed, sleepless and think ‘would it be that bad if I didn’t wake up in the morning?’ As soon as the thought came to my mind, I would feel guilty and terrible. Guilty because I knew that my life really wasn’t that bad and that there was so much for me to be grateful for. Terrible because I knew my death, although insignificant in the grand scheme of things, would be horrible for my nearest and dearest. My mama especially. I got through those 4 months because my husband was there and would not let me sink into the depths of depression that kept pulling at me. Thank you George!

I am now back to my normal sunny self despite some current work horrors. As a newly-qualified doctor back in 2009, I dealt with death day in, day out especially on my first job on gastroenterology at a busy inner-city hospital. After the initial shock, I got used to it. Not that I didn’t care or it didn’t bother me but I dealt ok with it. There are 2 patient deaths from those days that have stayed with me. Both died of alcoholic liver disease. Both men in their 40s.

The first patient died slowly from hepatorenal syndrome (HRS). Basically with chronic liver failure, if your kidneys too fail, you will die soon because that means 2 of your 4 vital organs are dead or dying, unless you get brand new organs (i.e. transplants). As things currently stand, you cannot be put on the transplant list for a new liver if you are still abusing alcohol because the new liver will get damaged just the same and it is considered a waste of an organ that is in high demand but short in supply. So with my first patient, who I will call Patient A, when his kidney function tests declined rapidly and nothing we could do medically fixed it, we diagnosed HRS and my registrars and consultants had a meeting with his wife to inform her of the diagnosis and what that meant for the patient. He too was told in due time but because of his liver failure, he was confused and did not fully grasp the fact that his condition was terminal.

He deteriorated slowly over a few weeks but in the meantime, he would ask me daily when he could go home and travel to India to be blessed in the Ganges River. I would mutter something non-committal and beat a hasty retreat out of his side room. Initially, it was clear that his wife knew his death was near. But even she began to belief he would miraculously recover from his liver and kidney failure. Every week, she would say something that made us worry we hadn’t prepared her for the inevitable. Every week we would remind her gently that although she couldn’t see it, he was in actual fact deteriorating judging from his biochemistry lab results and worsening oliguria (he was weeing less and less).

In the week of his death, he suddenly looked well again. If I wasn’t the doctor patiently doing bloods on alternate days and chasing those results and noting the relentless rise in his urea and creatinine, I too would have started to believe in miracles. His wife upon seeing the light return to his eyes and his demeanour brighten plunged headlong into denial and joined him in planning their trip to India to the Holy Ganges River. Less than 24 hours before his eventual expiry date, it was devastating for me to watch her grief as the light in his eyes faded rapidly and he shrunk back into himself. Within 12 hours of his final illness beginning, his strength was gone and his mind with it. His utterings became incomprehensible and he became completely disorientated. The look on her face said it all when we came in to see him on our ward round that morning. We returned the look and she ran out of the room to sob in the corner. He was anuric by then (had stopped weeing completely) with a creatinine of over 400 (in other words, his kidneys had packed up). His liver function tests painted an equally damning picture. We completed his end of life paperwork that morning and when we left work that evening, he was hanging on by the tips of his fingers. We came in the next morning to the news that he had died before the end of the day before. The side room he had occupied for many weeks stood empty, awaiting its deep clean before the next customer.

Patient B was a young alcoholic who had developed liver cirrhosis in the months before I started the job. He had just turned 40 and I don’t think had any idea how serious the consequences of regular alcohol binges could be. Reality hit when another patient who was his ‘neighbour’ on our ward developed HRS and died rather quickly. All of our words of warning had somehow not sunk but with this other patient’s death, his mortality was clear to him. He called me over urgently that afternoon and said ‘Doc, I am ready to change’. I was pleased and felt a sense of accomplishment when I referred him to the rehabilitation programme. His wife found me the next day before they were discharged home to thank me for getting through to him. I was honest to say it wasn’t anything I did.

Unfortunately, he came in a few weeks later unwell with an infection which caused his liver function to deteriorate badly. I was encouraged to hear that he had no touched a drop of alcohol since his last admission. He developed litres of fluid in his tummy and I had to put in a tube into the side of his tummy to drain out all that fluid. He was in a lot of discomfort and fearful for his life and he asked me ‘Doc, am I going to die?’ I hesitated over the words I used but in the end I made no promises. Just that I would do everything I could to help him get through this. At first, it looked like the drain and intravenous antibiotics were effectively doing the job and the next day, the fear was gone from his eyes. I was encouraged by his blood results and left having ordered some more routine bloods for the next morning. Coincidentally, at I was securing his abdominal drain, I carelessly dropped the needle I was using to suture and when I went to retrieve it, gave myself a needle-stick injury. I had to get a co-doctor to inform him and take blood samples off him to check that he didn’t have any blood borne infections I could catch. He apologised every day after the event like it was his fault I had stuck myself with a contaminated needle. He asked me about those results daily – he seemed genuinely to care for my welfare. This went on for over 2 weeks as he slowly improved.

I was doing the ward round alone one morning when I was called urgently to his side. He was in a great deal of pain and was writhing in his bed with his abdomen larger than before we drained him. He was pale and clammy and his eyes looked like a man staring down the barrel of a gun. I could barely make sense of his words and as I changed his prescriptions, called the blood bank for blood products and prepared to get a new drain inserted. I could see the life begin to ebb out of his eyes. In a panic, I called my registrars and told them I needed them on the ward ASAP because patient B had taken a turn for worse and nothing I was doing was making a difference. The registrar told me to leave the drain for the meantime and focus on reassuring the patient. After I asked the nurses to call his wife in, I went to him and I held his cold hand. I looked into those eyes and I knew in that instant that he was not long for this world. I remember saying a mental prayer that he could hang on for his wife to be by his side.

‘Doc!’ he cried. I squeezed his hand and responded ‘Yes B?’

‘I am dying aren’t I?’ he asked. I looked down and swallowed the lump in my throat. ‘I am here for you B and I will do everything I can to help you. Your Mrs is on her way in.’

‘Stay with me,’ he entreated fearfully. I nodded and again I had to look away because the fear in his eyes was too powerful for me to take in. The rest of it was a blur. His wife made it in before he died but not in time for him to know she was there. He was delirious by the time she got to the ward and as he was slipping away before our very eyes, there was little time to have ‘that conversation’ with his wife. The consultant whisked her away and broke the news to her. She could see that treatment was futile by then and knew that he was on maximal available medical treatment. We had no more to offer. She signed the DNAR (do not attempt resuscitation) forms and we set about making him less agitated. When we finally called it a day, he was less distressed, still mumbling incoherently and his eyes had started to take on that distant look I now associate with death. I came in the next morning to a request to come to the morgue to complete his death certificate and Crem forms so that his wife could lay him to rest. I got a call 3 days after his death to say his blood tests for blood borne infections had come back negative so I was in the clear. I cried in the staff toilets. He would have been relieved not to have put me at risk I think.

What did patients A and B teach me about death and dying? Firstly that when it is your time to go, it is your time to go. Life unfortunately doesn’t usually give you a clearly labelled package with an expiry date on it. Secondly, although death is scary for the person dying, it is actually worse for the person who loves them who has to watch them lose their battle to live and battle their fear of the unknown. Who has to go home and face life without them and rebuild their lives around the hole left by the dead loved one. Who for a very long time will think about their dear departed every morning when they wake up and every night before they fall asleep. Lastly, every human is unique. Despite having the same disease and modifying your risk factors, your body will do its own thing. We doctors can try to influence outcome but whether we succeed or not is not within our power to control. That is beyond science and medicine. That is life. That is God. That is reality. May we all depart this world in the easiest swiftest way possible. Amen

What does a Junior Doctor Do Exactly?

A letter written to Jeremy Hunt by a consultant currently working in England.
An excellent illustration of how indispensible ‘junior’ doctors are to the NHS and the public as a whole. I couldn’t have put it better myself so I haven’t tried to 😀

…………………………..

Dear Mr Hunt,

My name is Philip, and I am a consultant physician. Not so long ago, I was a junior doctor and like many others I am outraged and angry about what you propose to do with ‪#‎juniordoctors‬ and their ‪#‎juniorcontracts‬.

I thought that maybe, given you have not worked in healthcare, you might not understand what it is that doctors do (much like if I was made, say, head of Network Rail) so I thought maybe I can help you by shining a light on what I used to a few years ago as a medical registrar.

The medical registrar is the most senior medical doctor in the hospital out of hours. In explaining to my friends what we do, I tell them everyone who doesn’t need an operation right away, or doesn’t have a baby falling out of them, above the age of 16, is our business (and often we have to look after those too). We were the ubiquitous shirehorses that carried the hospitals medical workload day and night. And here’s a typical night shift I did at a general hospital. (all details changed and adapted from real cases to protect patient confidentiality).

I arrive at 8:50 PM for a 9:00 PM handover. It’s been a busy day and the emergency department is full. The outgoing medical registrar tells me there are no beds in the hospital. There are 10 patients waiting in A&E for the medical team, and a lot of patients need reviewing on the wards. He’s already admitted 36 patients during the day, and the consultant is still there seeing some of them with the daytime doctors. I wave hello at her as I head into the fray. I know the consultant and she’s not seen her kids since her on call week started. She waves back wearily.

My first patient for review was a young man with abdominal pain. My first thought as I walked into his cubicle, he looks sick. This is a skill you develop after years of training, when you look at someone and know that they are minutes from death. He’s grey, clammy and shocked. I immediately set about treating his shock and assessing why this has happened. Does he have a bad infection? Is he bleeding? Does he have a blood clot on his lungs? A quick bedside test confirms he’s bleeding badly, likely internally, and my surgical colleague (another junior doctor) and I urgently arrange for an operation. He hurriedly talks to his parents and completes a inacapacitated patient consent form as his condition deteriorates. I leave him in theatres with the anesthetists and surgeons as I have other patients to see.

The next patient was an elderly woman who has fallen. Although she has no hip fracture, she’s unable to walk and needs admission for painkillers and rehabilitation. I reassure her as best I can and stop many of her medicines potentially making her fall. There are no beds for her on the assessment unit or the elderly care ward, so the A&E sister arranges for a pressure support mattress and bed for her in the department overnight. She was lonely and depressed, and I spend some time talking to her about her worries and fears but after a while I needed to move on. She squeezes my hand and smiles, thanks me and settles for the night.

Next is a resus patient with an asthma attack. He is drunk and abusive verbally, though he’s too breathless to be too abusive. A blood test show his attack is life threatening and he he fights off attempts to treat him by myself and the A&E team, pulling off his nebuliser mask and oxygen. As I read out the blood test result to the intensive care registrar (another junior doctor) the man goes blue in the face, gasps and stops breathing. I drop the phone, run over and take over his breathing with a manual ventilator. He has had a respiratory arrest. Alarms blare, help comes running, we inject him with various medicines to help relax his airways and the intensive care doctor slips a tube into his windpipe to help him breathe. The consultant physician, still there, helps with what she could, running blood tests and helping to scribe in the notes. After a nervous period, he stabilises and we take him to intensive care.

It’s now midnight.

In the meantime I have reviewed five more patients, seen by the twilight team, and also my night SHO has discussed some patients with me. The consultant finally got home around 11PM. I’m now on the wards, a liver patient with severe cirrhosis is unrousable. I read through the notes. He has cirrhosis and is not suitable for a transplant. The team has tried everything. I sit and talk with his family, telling them I’m very sorry but there’s nothing more to be done. They cry, one of them screams at me that I’ve killed him, but I accept this as part of my job. With more assurance they’re calmer and I reassure them he’ll be kept comfortable.

My bleep goes off as I write in the notes. Is that the medical reg? The hospital is now totally full, can you please choose some patients to send to our sister hospital down the road? I groan, although I understand the necessity patients understandably hate it. I pick four stable patients and liaise with the registrar down the road.

2AM. I send my SHO off for a quick break as I review some more patients. A confused elderly man who might have a urine infection, a young man with severe headache, a diabetic patient with a very high blood sugar, a lady withdrawing from alcohol and hallucinating. The A&E sister makes me a coffee, lots of milk, lots of sugar.

3AM. I’m with a man in resus again, he is vomiting bright red blood in large volumes. He is jaundiced and looks unwell, very unwell. As the A&E team arranges for a massive transfusion to be set up, I ring the intensive care doctors and the gastroenterology consultant. He listens and says “I’ll be coming in”. I then slip a line into his neck under local anaesthetic, a practiced skill that’s hard at 3AM when you’re tired, but fortunately successful. We pour blood, clotting products, medications and antibiotics into him to halt the bleeding. The gastro consultant arrives at 3:40 and he’s taken to theatres where he performs a life saving procedure. The patient goes to ITU.

4AM. A brief moment to sit down for a quick break. I have reviewed three more of the SHO’s patients. This is the first time we’ve had a chance to sit down together, a quick chat and a cup of tea was interrupted by a cardiac arrest bleep. We run to the cardiac ward. A 54 year old gentleman admitted with chest pain by the day team has had a sudden cardiac arrest. The excellent CCU nurses are doing CPR and attaching a monitor. I ask them to stop as it’s attached, the rhythm is ventricular fibrillation.

“Back on the chest please, charge defib to 150, charging. OK, off the chest, stand clear, top middle bottom myself, oxygen away, SHOCKING.” The patient jolts. “Back on the chest please.” I heard myself say.

Two minutes later he has a pulse. We repeat an ECG, he’s had a full heart attack. I call the cardiologist at the heart attack centre 10 miles away. He’s accepted and an ambulance crew transfers him for an emergency angioplasty. I send my SHO back to A&E as I write a transfer note.

5AM. The resus doors burst open. Another patient, an elderly woman with breathlessness. The A&E F2 listens to the chest, pulmonary oedema. She’s given the emergency treatment but it’s not working. I decide to start her on positive pressure oxygen. Strapped to her face was a tight mask blowing oxygen to inflate her lungs, buying time for the medicines to work. The plan works and pints of dilute urine fills her catheter bag, her breathing improves and she says thank you through the mask. Despite the fatigue I smile and give the F2 a fist bump for a job well done.

7AM. Four more reviews. a patient with kidney failure due to medications, a depressed young man who took an overdose, an elderly nursing home resident with pneumonia, and an elderly man with a broken hip whom I assess with the orthopaedic surgeon. I start to round up the patients for the ward round. 18 patients overnight, five transfers out, one death. A relatively quiet night. I check with the clinical site manager and SHO that we’ve not missed anyone and click save on the list. No one is waiting to be seen, a good feeling.

8AM. The consultant from last night arrives, she looks tired but asks us how we’re doing. OK we said. We start in A&E as most of our patients are still there, the site manager is worried as some of the patients from last night are coming up to 12 hours in A&E. We review each patient’s story and tests, and talk to them about their condition. We visit ITU for the two new transfers there.

11AM. The ward round of the night patients are done, and I have completed a death certificate for a patient overnight. I climb into my car and listen to the breakfast show as I drive home, an hour away. I’ll be in bed by 1PM , and back for the night shift after 6 hours sleep. A relative luxury from a relatively quiet night.

This would be a relatively quiet night for a junior doctor and I am sure many registrars would laugh at how easy I’ve had it! But the people doing this work are junior doctors, who show dedication, commitment and goodwill beyond belief. They do lifesaving work up and down the country, working hard without complaining and sacrificing time with their families.

Please, I beseech you, treat them fairly and with the compassion they treat others daily. The new contract is not fair, and the extended hours it’ll cause is not safe. ‪#‎notfairnotsafe‬

I hope this little story will give you some insight into the vital work junior doctors and the NHS do. If you like, please come and spend a night at our hospital, I’ll come in with you and show you around. Please talk to my junior colleagues and listen to them, you may be surprised what you’ll learn.

Best wishes,

Dr Philip Lee

Save Our NHS!

Sharing this from a doctor’s facebook wall with permission because she says it better than I could express through the mounting frustration and despair I feel.

“I would like to tell you what the NHS means to me. It means that as a doctor. I get to think about what my patients need, and what is best for them. I get to think about that, above all else. Because my patients are someone’s daughter, someone’s wife, someone’s mother, someone’s mentor, someone’s shoulder to cry on, someone’s friend. I get to value their life over all else.

I love that. I love that when I’m driving down a busy street at rush hour, and an ambulance with blue lights and sirens wailing, presents itself to this mass of people on the road – people with jobs to get to, meetings to attend, events to arrive at, exams to sit – not one of them stops in the middle of the road and refuses to let the ambulance pass.
Not one of them thinks their schedule is more important than the stranger in the back of the ambulance, fighting for their life. They, the general public, the person on the street, the people of Britain, value a stranger’s life above everything else at that moment. I love that. I love the humanity.

Jeremy Hunt says, he wants us to provide a 24 hour NHS. I think thats fantastic. I am pretty sure I have already worked every hour of every conceivable day to make up the 24/7 ideal. I work bank holidays and public holidays and religious holidays. I work often right up until I need to leave to catch a train to a graduation or a wedding. Sometimes I have an Emergnecy and I work past that. And I send my apologies and I lose my tickets. Because the person I am working on matters. Because I value their life over all else at that moment in time.

I think a 24/7 service is wonderful. It’s the dream. It’s like dubai at night. Or New York always. The service that never sleeps. I mean. I never sleep. Not on call. But, yes, sure, things can be delayed. It takes longer for one doctor to see 80 patients at night, than it does for a team of 4 to see them during the day. It takes longer for one lab technician to process 80 blood samples vs a team of 5 during the day. It takes longer for one radiographer to image 80 patients overnight than a team of 3 during the day.

The hospital is not just made up of doctors. We cannot work without our colleagues. Nurses, phlebotomists, pharmacists, radiographers, porters, health care assistants, scrub nurses, physicians assistants, and anaesthetics techs.
We all work together as a team. At all hours of the day and night. Because we value the life of the person we are seeing.
We would love a 24/7 service. But you cannot achieve it by taking the same doctor, spreading him or her thinner to cover the gaps they are already covering regularly – and then tell them that’s what they ought to have been doing all along so let’s slash your meagre pay by 1/3 for good measure.

To achieve the sort of dreamlike 24/7 service Mr hunt is selling and we all want to buy. The answer is simple. Create more training posts. Hire more doctors. Twice the current amount. Hire more nurses. I’m tired just watching them scramble night after night, running between rooms taking care of double their normal case load. Hire more ancillary workers. If you really wanted a fully functioning service, where 3am on a Sunday looks the same as 10am on a Tuesday, that’s the solution.
Don’t fillet and tenderise your already overstretched team to plug the gaps. And don’t turn the public against them because they have said that it’s not right.

What happens to our value as human beings? As care givers? As people who place others first? Where is the logic, in destroying one of the greatest legacies of modern history? In order to reappropriate the money as bonuses for management consultants who “told us what was wrong”.

I never finished my story about what the NHS means to me. When I’m done with my job. And that isn’t dictated by the clock but by when my patients are all stable. When I’m done I go home to my mother, who is terminally ill. Sometimes she is very unwell. And at those times I return to the hospital. This time not as a doctor, but as patient and family. I cannot begin to explain the relief in knowing that our arrival isn’t heralded by piles of paperwork to determine how much money we have to pay for treatment. They wouldn’t find much. I’m always overdrawn. I once laughed when I lost my wallet, because there wasn’t any point in cancelling my bank cards. They would find nothing in the account. I am 34 years old and a “junior” doctor that has been working for 10 years. But I have nothing worth stealing. That’s because I usually just get paid enough to cover my rent and bills. And when I need to do exams or get a wedding gift or live without relying on a credit card I would pick up extra shifts, working even more weekends and holidays than I normally would, which was already a lot.

Then, like a lot of my colleagues. I volunteer. I volunteer my services to local communities. I voluntarily sit on charitable boards where I help develop plans to help the most vulnerable in society. I travel to refugee camps to help those that unlike me, cannot make ends meet, have been forced out of their homes through no fault of their own, and now have no one to care for them. Very few people value them at all, these proud, resilient, insightful people in camps and on journeys – let alone above all else.

So I am grateful for the NHS. Because as a terminal cancer patient. My mum and I show up at our A&e a lot. And often at the most inconvenient times. 3am. 7pm. Weeknight. Weekday. The tumor doesn’t care. But you know who does? NHS staff. They care. They value her life over all else when she walks through the door – even if she may not have very much life left to live. They always smile. They always listen. They are always patient and kind. They are cheerful most of the time, even as their pagers bleep mercilessly through every conversation they have, alerting them to another patient in need of being valued.

They trundle away regardless of the time, tucking my mum into bed, helping her to the bathroom, taking her blood despite the fact that her veins disappeared under the influence of chemotherapy long ago. Patiently searching for those life giving green threads in her hands and arms. Listening to her chest. Poring over her substantial medical history to make sure they understand everything. Discussing the minutiae that may unveil what the cancer is doing this time and how they can best hold it at bay. There are no shortcuts even at 3am. They value their patients and the families above all else. And I love them for that.

That’s what the NHS means to me. Service that comes full circle.

I treated someone’s mum like they were the only person in the world that mattered right then. And later on that night, some other kindly fatigued uniformed intelligent gentle soul did the same for my mum. And sometime during those 24 hours someone was late to pick their kids up from school or collect their dry cleaning – because an ambulance with the most valuable person to someone else, closed off the road they were on as it whizzed past.
That. is Healthcare delivered as a right, not a privilege. That is humanity. So the only question, Mr. Hunt. (And anyone else who backs the sham of making an understaffed workforce doing the best it can to work twice as long for two thirds of the pay, and ensuring that women who have families and researchers who seek to cure terminal conditions like my mother’s can’t do their job, which is what they value – ) the only question is – What do you value above all else? Money? The bottom line? The shareholders? Your mates who run companies that want private contracts? A shot at being PM?

None of that will matter to you when you are ill, Mr. Hunt. I promise you. At that moment in time. You will value your health above all else.

More than that, you will want a team of dedicated well trained NHS employees to value you above all else.
Value.your.health.service.”

Being a Paediatrician

I knew I wanted to be a doctor when I was about 4 years old. I can’t explain now how I came to that conclusion or why I was so sure. I just knew and now I am a doctor. In my 2nd or 3rd year of medical school, as part of career guidance we were given a link to a website where we could input our data and get a psychometric analysis done on us. I had to answer a series of questions about how I felt about certain things, my beliefs, my principles, how I solved problems. Eventually, I answered the numerous questions and it took a minute or 2 to load. Then it gave me the list of medical specialities ranked according to the ones I am most suited. Pathology and neurophysiology came last as I would have expected but I was taken aback by the top 3 choices. It said: Paediatrics, Palliative Care and Neonatology. I poo-pooed the test and dismissed it. When I went into medical school, one thing I was certain of was that I loved children and I never wanted to see them sick and suffering. Therefore I sort of ruled out paediatrics very early on. Back then I thought I might end up being in Obs & Gynae (obstetrics and gynaecology) because it was a good mix of medicine and surgery and I thought the variety and acuteness would suit me. I also thought I could be a GP because it retained the versatility of all of medicine without having to make a choice.

During my Obs & Gynae posting as a medical student, I found that although it was interesting the speciality did not set my pulse a-racing. There was no eureka moment. The specialists were nice but I didn’t feel any kinship with them. My paediatrics was my last medical school posting and the moment I stepped into the Children’s Hospital (BCH), I felt an excitement. Even though most of it went over my head and there seemed to be a lot of calculations and there was the issue of small people who were not well, I felt right at home. Over the 6 week placement, I grew to love BCH. I loved the patients, the child-friendly wards with their play areas, the kindness of the nurses and most especially, here were doctors I wanted to be like. Who I enjoyed spending my time with. Who seemed to derive pleasure from their work even as they were rushed off their feet with the number of patients. By the end of that placement, the career puzzle for me was solved. I was going to be a paediatrician. And to my surprise, the patients I loved spending time the most with were the little premature babies born with complex problems needing surgery to survive.

As an FY1 (first year after graduation from medical school), I met a patient in her 30s who had inoperable incurable ovarian cancer. We bonded as I tried hard to get some blood out of her for some tests her consultant had ordered. When the ordeal was over, I thanked her for being patient and she called me back to say she thought I had a way about me that would be perfect for palliative care. She said she didn’t know if I already had my career mapped out but that I should think about going down the Palliative care route. I thanked her for her kind words and left in a reflective mood. Despite my psychometric prediction, I had never given it much thought. I considered it over the next few days and concluded that although I was a listener and when it came to my patients very patient (unlike in my personal life then), I wasn’t sure I could handle all the emotions that are linked with patients who are dying. So I filed the idea away under ‘unlikely’ and didn’t give it any more thought until just recently.

Earlier this year, I stumbled across an online course on paediatric palliative care and signed up to it. As I worked through the course modules, I realised that I was into all the issues that were being raised and although a lot of it was challenging, it was exactly the kind of challenge I relished. A lot of it was to do with talking about options and choices. About spirituality and counselling. About co-ordinating care. About letting the dying patient and their relatives dictate the terms about how these last days/weeks/months should be handled. I realised that palliative care is not just about the advanced care pathway which outlines what to do when death is imminent but also about actively keeping the patient well enough to reach certain goals. It is about enabling the patient to die in a way that is most acceptable to them. It is about being there for the patient and their family so that when things become scary or unexpected, there is a comforting presence to guide them through the darkest hours/days. So I have come full circle and now I know that I would like to sub-specialise in paediatric palliative care. I wish I knew where my Obs & Gynae patient was so I could share the news. I wonder if she is still alive today.

I love being a paediatrician by the way. If I don’t end up sub-specialising, I would happily be a general paediatrician. There is a different vibe on a paediatric ward or in a paediatric hospital like BCH. There is a friendliness that is missing in adult medicine. People seem to go out of their way more to be helpful in the paediatric world. Nurses do not seem to be as difficult or as disconnected as they can be in adult medicine. The paint on the walls is brighter happier colours. There are toys, music and games everywhere you go. The best bit about my job is the children. It is such a privilege to work with kids. They are amazing little packages, mostly untainted by the negativities that come with growing up. They come out with the best statements and questions that make you stop and think or laugh until your belly hurts. Their bravery is comparable to none and watching them as they struggle with illness and develop ways of coping is inspiring.

Of course paediatrics is a complex speciality by its very nature. Our patients are often too young to tell us how they feel and exactly what their symptoms are so we have to be more observant than our adult counterparts and we have to go on what other’s (parents/carers) impressions are more than the patient’s own words. Many do not understand why they feel poorly. They just know that they are not happy and they want it to be fixed. Parents are often not at their best when they meet us because they are anxious and stressed about their sick child and are frustrated because they have no solution to put them out of their misery. So yes, it is often the most difficult part of the job having to face irate upset parents who want to find someone to blame for their helplessness. Who want to take out their frustrations on someone else and make demands because it makes them feel they are doing something…anything. Sometimes, these parents do cross the line of anxious and stressed parents to parents who are abusive (mostly verbally but occasionally physically). Unfortunately, it comes with the job but we deal with it in our own way. Usually by being patient and reasoning with but where necessary we call on services to support and protect us. Luckily, these horrible encounters are not an everyday occurrence.

I have so many examples of the beautiful little people I have come across in my job but I will tell you about a recent one. I was on-call over a weekend and covering the haematology ward (haematology deals with diseases involving the blood cells). A 2½ year old boy with severe haemophilia B came in with bruising which meant he needed an injection of factor IX (the bit of blood he doesn’t make enough of which is essential to prevent you bleeding without much force). It was my job to treat him so with his parents and a fellow doctor assisting, we held him still and I injected the medicine into his vein. He cried as I did it and when it was done (it only took a minute), his parents prompted him to say thank you. Through his tears, he turned to me and said ‘thank you’. Then as I tidied up, they got their things together to leave and he waved and said to me ‘bye lady’. With no resentment. Despite the fact that I had just poked him with a needle for reasons he was too young to understand. I thought wow! Only a child would be as forgiving as that. The momentary feeling of guilt for making the gorgeous little boy cry passed with that exchange and off I went, to do more things to other children which might make them cry in the short term but looking at the bigger picture, everything I do is in their best interests so when I go home and I go to sleep, I feel happy and satisfied. And thankful for another day where I have done all I could to make another child’s life that bit better.

Judge Me Not

Yo teach, I’m fed up with this shit!

Judge me not by the color of my skin,

This olive complexion given by genes.

Hate me not for my accent,

Trying to hide it for your pleasure.

 

My grades reflect MY knowledge!

Don’t give me that

“Cause you were taught in a white school” shit.

What you know?

Ma stayed up with me studying,

You gave up,

Saying I’ll never make it.

 

Now I’m laughing. 

Six years later and I’m graduating,

Heading off to college,

While your rich and privileged dropped out. 

Y’all could’ve believed in me,

But you refused.

So later fool, I’m out.

Off to better places and higher goals.

 

The poem above is entitled JUDGE ME NOT BY THE COLOR OF MY SKIN by NANASEVEN432 (accessed on http://www.powerpoetry.org/poems/judge-me-not-color-my-skin). It says so much about what it is to have skin that is not white in a majority white country. Britain is much more inclusive than America judging by what is said in the media. Yet, the first thing I am judged by generally is the colour of my skin.

I moved to London aged 14 and I can tell you far from rejoicing when my mama told me we were moving to England, I was very sad for many months. I did not want to be the new girl at my new school and I certainly did not want to leave my friends. I was afraid of what it would be like to be the foreigner. I was not excited about the prospect of cold winters or being away from the extended family. Little did I realise that as soon as I stepped off the plane, I would lose my identity and join the nameless mass of ‘black people’. That I would be held responsible for every bad thing any black person has ever done or will do in the future. That I would be judged even before I open my mouth and speak.

When I went for career’s advice in secondary school, I told the lady that I was going to be a doctor. I believe I was the first person from my school in Tottenham to become a doctor (I might be wrong but my teachers say so) so you can imagine this careers advisor’s expression. She took a minute to compose herself and said you need to consider other options like physiotherapy or nursing (these are probably more attainable for the black population). I was like I am pretty sure that is what I want to be. Another white tutor at College met with me to give me advice on UCAS applications and cautioned me against applying for just medicine (UCAS allows you to apply for 4 medical schools only which usually means prospective medical students apply for physiotherapy or medical science or pharmacy in the last 2 UCAS slots as backup). Well, I told him, I will take my chances. I don’t want to be a physio or anything else. I saw the lack of belief in his face but I smiled anyway, thanked him for his advice and left.

I went to Dubai with my sister 7 years ago and during that trip, we went on a dune surfing excursion. We were placed in a 4×4 with a couple of Russians who were rather un-exposed. When we got out to stand on top of the highest dune and admire the breath-taking sight, one of the young Russians stood beside us and said ‘You are exotic’. My sister was bemused by it and I was just a bit ‘ehn?’ Exotic meaning what? Strange like an exotic bird or fish that is rarely seen? Non-European like exotic fruits from Africa, Asia and South America? Non-white? Personally I was put off. It didn’t end there. There was a whole group of Chinese tourists in the other 4x4s in our convoy. When we got to the campsite and were sitting around, eating and watching the belly dancer do her thing, a Chinese young woman timidly came up to my sister whilst I was off fetching a drink and asked if she could take a photo of her. My sister said yes. I watched with surprise from where I was and as I walked back, a group of Chinese people descended to my sister’s side and posed for pictures with her. Like some sort of statue. I stood sternly to the side, daring any of them to want to include me in their craziness. I think the expression on my face spoke volumes because no one bothered me.

This was repeated a couple of years ago in India whilst I was travelling with a bunch of people. We were in Delhi at one of the largest grand old mosques up on a hill where you could see much of the city. I was hanging out with an 18 year old Aussie as pretty as a flower, let’s call her Audrey. She looked like the much talked about English rose and the Indians visiting the site thought she looked like Princess Diana. As we sat in the shade, tired from the walking and the heat, a father approached us with his daughter. He motioned to Audrey and mimed taking a photo. She shrugged in acquiescence and the girl sat next to Audrey whilst her father took a photo. This emboldened another father nearby who without a word, strode over to Audrey and dumped his baby in her lap then walked away to take a photo. A queue quickly formed and poor Audrey was trapped in a photo-taking frenzy. I watched from the side lines as she went from not minding being used to being embarrassed and feeling harassed. She went redder and redder and eventually extricated herself from her fans. Later I asked how she felt and she said ‘trapped’.

Over the years, I have got bored by the question of ‘where are you from?’ From fellow black people, I realise that the question is normally a way of finding common ground but in general, I feel it is a way of reminding me that I am a foreigner here. Unfortunately for those who don’t like us foreigners, I was born a British citizen (by virtue of my mum being a Londoner by birth) so this is my home too. I am entitled to be here. I have paid my way and will continue to do so. My work is essential to the population. Some people go on to say ‘you speak good English’. My reply now is always ‘of course I do. It is my first language’. In a way that is true. I learnt to speak Hausa, Fulani and English simultaneously as a little tot and actually my English vocabulary is the strongest of all 3 because I was educated in English. Indeed I would like to point out that if you were to test the British population on their grammar and comprehension, you would find that across the ethnic groups, indigenous Brits tend to score the lowest. Sad but true. So don’t patronise a black person with ‘you speak good English’. Many of us have lived here most of our lives if we were not born here. Many of us are as British as British comes.

I would call myself a Nigerian Brit. Nigeria first always because my blood is Nigerian. I was born in Nigeria, my parents are both Nigerian, my first steps were taken in Nigeria, my foundation was in Nigeria. Nigeria made me who I was so that when I came to Britain I could contribute to my school and my community. But I am British too. I learnt my profession in Britain. I have worked all my working life in Britain. My closest friends now are mostly here in Britain. I love Birmingham. I met my husband here. I married him here. I have bought my first home here in Britain and I hope to have my children here. I have aspirations for Britain. I want it to be better. I want it to grow. I want Britain to embrace all its children, regardless of the colour of their skin because I honestly believe that the colour of my skin tells you nothing about who I am. What my dreams are. What my beliefs are. What makes me special. Above all, I believe that what makes Britain great is the diversity of its population. This is what makes our country part of the UNITED Kingdom.

On Death and Dying

My best friend confessed early in our friendship her fear of death and I remember being curious about why she was scared. Now looking back, maybe the question should have been why I did not feel the same? I mean of course death is not a welcome or happy thought but I don’t dwell on death and I certainly don’t actively fear it. I am very much of the school that there are 2 certainties in life: we are all born and we will all die. And since death is inevitable, I don’t think about it much.

Death is the final release.  Whatever one believes in, I think most of us believe that once you are dead, you don’t feel pain anymore. I know some people believe in reincarnation, some like me believe in the Hereafter and some think that whilst your body dies, your spirit never does and it still retains the memory of pain/anger/hurt/happiness. Although I believe in the Hereafter being Muslim, I do think that when I die, my soul leaves my physical shell and returns to its source (God). Then at some point, our lives are all assessed and we are rewarded (or not) for all our good deeds.

I wonder sometimes about what it feels like when your soul detaches from your body. I wonder if it is like a physical break, painful but transient or if it is more like an emotional separation where the after effects are long felt. I then wonder what the soul feels if it feels anything at all once it is separate from the vessel that conducts and interprets pain. Beyond that, I think death is more fearful if you are not the one dying. I mean, I would imagine that if I was in a terrible car accident, I would either die instantly with no time to think or become scared of what was happening. Or I would be in pain or feel myself getting weaker and weaker and it would be so unbearable that death would be a welcome reprieve. Same as if I had a chronic illness which was not curable but I was steadily deteriorating then dying would probably be a mercy for me.

When I think about dying properly, I realise that although I am not afraid of the dying itself, I am scared of some of the ways that I could potentially die. I am afraid after all. Being a medic, I have seen many people die so I have spent time thinking about the way I would not like to die. I guess one of the scary things about dying is that most of us do not have any idea when we are going to die. It is different for those who are diagnosed with ‘predictable’ illness but even there, giving patients a prognosis (i.e. a number of days/weeks/months/years they are expected to survive) is not an exact science.

In the past 6 months, I have come across patients who were not expected to survive being born and the first few days of life yet despite all odds, they are still with us many months later. I have also come across patients who were predicted more time only to deteriorate much quicker than anyone has experienced, giving no time for their loved ones to be prepared. The only people whose time of death can be predicted with any accuracy are those who are already brainstem dead but on life-support and when the machines are switched off, we can be fairly sure they will die within a certain time period. Even so, we have all heard of the ‘miracle’ stories where patients defy the odds and remain alive far beyond the expected time of death.

My ideal death would be the one most people wish for. I would like to die in my own bed, in my sleep. I would like for it to be when I am old but young enough that I am still completely independent. I would like for it to be after a family reunion where my nearest and dearest are all sitting around a table and reminiscing about the good old days. I would like for it to be after my mother has gone to her grave because I can’t think of anything worse for a mother than to bury her own child. I would like for my children (if I have them) to be old enough that losing their mother does not scar them too badly.

If I am unfortunate enough to have a catastrophic trauma and needed life support, I have told my closest family that I would prefer not to be kept alive for many days. I would like to be given a chance to recover (if there is one) but when it gets to the time where my chances of waking or recovering are much less that 50% then I would prefer for the machines to be switched off. I would like to be an organ donor although in my donor card, I have not ticked the skin donor thing because I am a bit squeamish when it comes to being buried with bits of my skin harvested. I don’t yet have a will but I have told my husband of my wishes verbally if I don’t get around to writing a will before the day comes.

I would like to be buried according to Islamic rites. I think the simplicity of an Islamic burial suits me perfectly. Washed and wrapped in a cotton shroud and buried within a day. If I am in my bed, the closest Muslim graveyard would be perfect but if I happen to be abroad in a strange land then I would like to be taken back to Kaduna, the town of my birth because that symmetry also appeals to me. Also my great grandmother and grandmother are both buried there so it would feel right to lie next to them.

When my grandmother died, there were a lot of tears and prayers and silence but there was remembrance every evening after the crowds dispersed and I found that uplifting. I think the sitting around the dining table and talking about Mammie’s life helped lift the gloom that surrounded us all. The fact that we could all remember and share our memories of Mammie reminded us all that although she was gone, a part of her was alive in us all. And that she had had a good life and her quick death was merciful. Those evenings also reminded us that life is transient. It is unpredictable and death can pick any of us at any time. In remembering our dead, we embraced life and were thankful for all we had been gifted with. I really hope those I leave behind can do that instead of it being all sad and tearful. May we all die a pain-free dignified death and may those we live behind be able to accept it is our time to go and may they have the strength to celebrate a life well-lived (hopefully).

Corazon Por Corazon

I speak very little Spanish but being a salsa fan, I have heard enough Spanish lyrics to know the Corazon means heart and the Spanish-speaking world is always ‘Corazon this’ and ‘Corazon that’. The title is a nod to the video I just watched on Facebook which has inspired this piece. It was posted by Andre Gayle who has stuck English subtitles on a Spanish video entitled Corazon por Corazon (heart by heart…changing the world). Basically, the video is about the loss of our humanity, the very essence that is supposed to make us superior to other animals and plants. It highlights what cruelty and sadness there is in the world and how a lot of us are desensitised to the sight of another human in need. So much so that when we witness suffering, many a times our response now is to take out our smartphones and take a video instead of offering our help.

It made me cry, especially the scenes of animals and children being abused. It made me ask ‘why’ again. I am the half full glass type of a girl but occasionally, I become despondent when I watch the news and it is full of pictures of little children being bombed by Israel or another old pensioner being abused by a carer. It makes me question what I am doing spending so much of my time doing NHS/eportfolio paperwork when there is suffering out there and I have the medical training to perhaps make a difference to so many, in Nigeria for example. It makes me question whether having children is a good idea because what legacy are we leaving behind for them to inherit?

The environment is a huge worry for me. I drive a Nissan Leaf in an attempt to be greener and I recycle and try to minimise waste. I know my efforts mean something but are probably insignificant in the grand scheme of things but at least having made the effort, I go to bed with a clearer conscience. For every person who drives a ‘green’ car or cycles or walks, there’ll be 10 people who drive cars with ridiculous amount of emissions, who waste more than half the food they buy and who never do any recycling. As the ozone layer thickens and the greenhouse effect is compounded, global warming intensifies. Formerly temperate climates develop extremes of weather. Flooding, draughts, tsunamis, tornadoes, forest fires and earthquakes occur with greater frequency than ever before. Large populations of the world who are dependent entirely on subsistent farming are living in famine conditions year after year. Ironically, in Europe and the US more and more of the population are buying excess food and every week are binning it as they buy too much and let it all go to waste. Too much of land is taken up by refuse which no one knows how to get rid of properly. Mountains of waste piling up as we become more and more wasteful. Turns out that even our recycling is not all recycled. Because our Governments have not invested enough into recycling plants so only a fraction of the potential recyclables are being  recycled.

Kindness is becoming short in supply too. As the video highlights, it is now commonplace to watch a person being beaten, robbed or even stabbed and no one wants to step in because it is all about protecting the self. Every year, there is someone on the regional news who has been stabbed or mugged in a bus or at a bus stop or somewhere similarly public where everyone has just stood by and watched. Yet some of these people have the audacity to whip out their phones and video the event and then post it on YouTube. I always wonder how these onlookers would feel if the victim was not a stranger but their mother, father, brother, sister, daughter, son or best friend?

As for the violent offenders, many of them are children who are old enough to know between right or wrong but even at that early age, they seem hardened and lacking in the most basic of human kindness. I know this lack of kindness and empathy is multifactorial but I am convinced one of the main reasons is poor parenting that comes with the modern time. As a paediatrician, I am in a privileged position to be able to closely observe the intimate relationship between parents and their children. There are many things we see that cause us to raise our eyebrows and a few that send us running to Social Services. But what I find most disappointing is when a young child aged 3 or 4 does or says something cruel and the parents, instead of taking the opportunity to point out what is right or wrong and explain why, turn their faces away and throw away the chance to shape their child into a decent person. A couple of weeks ago, I was on-call and went to see a 10 year old boy who was in pain with my registrar (senior to me) and an ST1 (junior to me). The registrar examined him and decided we needed to investigate by taking a blood sample. The boy’s reaction was to shout ‘You are not f*****g touching me. I will bash your f******g head if you come near me’. What did his father do? He bowed his head and my registrar shot the top of the dad’s head a look. As more swearing came forth, I stepped closer to the boy and said firmly ‘I’m sorry you are scared of having a needle but you are not allowed to speak to us like that. We are here to help you.’ That stopped him in his tracks and he resorted to sobbing. His red-faced dad followed us out of the cubicle to apologise and all I could think was ‘don’t apologise to us, teach him to have a bit more respect.’

Speaking about respect, I think that has run off with the kindness. As doctors, we are at the receiving end of a lot of disrespect but we put up with it because we understand when people come in contact with us, it tends to be the most stressful, frustrating, unhappiest time in their life. I think a little respect goes a long way. It is in the small things like saying sorry when you barge into somebody, holding open a heavy door for the person a few paces behind, picking up an item someone (especially frail, old or pregnant) has dropped right in front of you or even smiling at a stranger who makes eye contact. It is about saying please and thank you to anyone helping you out even if it is their job to do it. It is about acknowledging your work colleague who does a little extra work so you don’t have to do it or staying longer at work to finish a task so they don’t have to hand it over to you. It is about realising your loved one is sad and giving them a hug. It is about saying the occasional thank you to your spouse for all the little considerations they give you daily that make your life better without you even realising they’re doing it.

I will say that I am lucky to be surrounded by lovely people who I am proud to call my family and friends. I know I did not get to choose my family but I certainly chose the family I keep close and the friends I surround myself with. These people are generous. They are donating to charity and taking part in fundraising for charities. They are courteous to strangers and helpful where they can be. They smile easily and are generous with their hugs, kind words and cups of tea. They recycle. They reclaim furniture. They treat their pets with love and tenderness. They are there when you get bad news. They hold your hand and sit beside you when there are no words that can ease the pain and hurt. They pray for you to succeed and celebrate whole-heartedly when you do succeed. They turn up when you need them the most. They laugh with you and not generally at you (but sometimes they laugh at you too if they know you can take it). They care about their neighbours and it is not always about them. They are diamonds…beautiful bling with surprising strength. They inspire me every day to be a better person and whenever I reflect on the people in my life, I feel blessed.

Brummie Beautiful

Before I became a Brummie, I lived in London. My oldest friends in the UK mostly live in London and most thought I would be back to London first chance I got after uni. I had other ideas. When I applied to study at the University of Birmingham, my top reason was not how well the University did in the overall league tables (it is one of the top ones) or the style of teaching at their Medical School (systems-based learning with early clinical contact which suited me perfectly) or even the extra-curricular opportunities available (our uni loves sports and music). I just knew that the Midlands was the place my heart felt the strongest pull towards.

I first visited the Midlands a year after moving to the UK when we went to Nottingham to visit an old classmate of my mama who happens to be a GP whose son was at the Medical School in Birmingham. I loved the idea of the Midlands, ironically it brought to mind Tolkien’s Lord of the Rings which is based around Birmingham and the West Midlands but I didn’t know that then. There was something about the calmer pace of life that I was immediately drawn to and the open spaces and clean air in Nottingham. My London stresses simply fell away and yet it felt like there was enough to do for me here. The best way I can describe how I felt is that my pulse matched the pulse of the Midlands.

Knowing how I felt about the Midlands and having spoken to the medical student son of the GP friend of my mama’s, I knew that my 2 certain UCAS application spots for medical school would be Nottingham and Birmingham. I ended up applying for a spot in Imperial College and Kings College (both to match my Queens College pedigree). I persuaded my mother to accompany me to the Open Day at the University of Birmingham and my top choice became Birmingham. I loved it all. From New Street Station which to be honest wasn’t all that (although we are awaiting our new state-of-the-art concourse and generally more beautiful station which is being worked on as I write). To the pace of the life – there was enough bustle for me not to be bored bearing in mind my Lagos and London background. To the mix of people – black, brown, white and many shades in between of all shapes and sizes and how happy majority of people seemed to be as they rushed around shopping and working. And finally the beautiful grounds of the University of Birmingham which impressed me from the moment I stepped out of University station and cast my eyes on the Iron Man on the little roundabout leading to the main University Campus.

The longer I have lived in Birmingham, the more in love I have fallen with it. People are scornful of the ‘accent’. Err, the accent y’all think is Brummie is actually Black Country and majority of people in Birmingham City do not sound anything like that! And I don’t even mind the black country brogue despite the fact that when those people speak to me, I have to focus really hard and find myself staring at their lips as if I can lip-read. The other common misconception is that it is all warehouses and dirty ugly buildings which I am sure are a stereotype from the war days. Well, you should see Birmingham now. We have lovely centuries-old cathedral and buildings, many right in the centre of town. We have a beautiful open market on weekdays behind the Bullring and the Rag Markets which are closed also behind the Bullring. I cannot not mention the Bullring because it is now a major family attraction for all its shopping and food court. Also the Mailbox which is glamorous sister of the Bullring with its more expensive designer shops and trendier restaurants, bars and clubs. There is the Arcadian with all of its entertainment by night and dining facilities by day. Our China/Oriental town is thriving right next to the Arcadian with Chinese supermarkets and many restaurants to choose from.

The Jewellery Quarter is simply the place to be if you are looking for a great deal on diamonds and precious metals. If you take your time browsing, you will find jewellery shops with beautiful antique one-off pieces like the pearl bracelet I wore on my wedding day. There are also jewellers there who will for a fee design unique pieces for you or use an old stone to design a new piece or re-structure an old necklace or bracelet to suit you. I lived in the JQ so you could say I am partial but it is a lovely place to live with lots of flats perfect for single young professionals or newly cohabiting partners who are yet to start having a family. The cemetery is a peaceful place to hang out…it is a proper old-school one with large tombstones and in many spots, whole families laid to rest together over the years. For the year I lived there, I would walk through the cemetery every morning and evening and say a prayer for those whose bodies were laid there and I would wonder about their stories and smile at the fresh flowers placed at gravesides.

The biggest thing for me though is the people of Birmingham. Of course we have our EDL-racists, our illiterate chavs, our stinky tramps and our gangs which are not the best but which large city doesn’t have them? As the second largest city in the UK, we have our fair share of the not-so-desirables but you have to look deeper than that. We are a melting pot of all the races of the world. The ‘minorities’ here are not minorities. We have large communities of Indians, Pakistanis, Chinese, Jamaican, Nigerian, Ethiopian, Polish and Iranians. You name it, we have got them in fair numbers in Brum. With all these groups comes the variety of music and food on our streets. We have festivals to cater for all the different groups. We celebrate Eid and Diwali with as much gusto as Christmas. We have plays celebrating all the different cultures. The highlight for me, we have children that are more mixed than in any place I have lived. We have the unlikeliest of mixes…black and Chinese, black and Indian, Pakistani and English, Spanish and Turkish, even Nigerian and Polish. As a paediatrician, it is a privilege for me to get an insight into these families and appreciate the diversity of my home. Simply put, they say home is where the heart is. For me, Birmingham is where my heart is.