Tag Archives: better

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

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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.