Tag Archives: commitment

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

Silence is the Residue of Fear

…Says Clint Smith (find him on YouTube) on the topic of ‘the dangers of silence’. I am sure we all have had things that we have been afraid of and that we have sometimes let those fears get the better of us. I know I have but as I have got older, I have learnt to deal with it better. The way I see it: either we let fear rule us and it limits our lives or we rule our fears and find ways of neutralising them and despite them make progress in life.

I used to be scared of heights, snakes and spiders. Many children are frightened by these things too. I guess one reason is that these things are potentially dangerous so we are physiologically and psychologically programmed to have a healthy fear of them. Secondly, children listen to their parents and siblings and as these phobias are the commonest in the world, we tend to feel that if mum/dad/older sister/brother is scared of them, there must be a good reason so we copy them.

I know personally that my fear of heights came from the fact that whenever I have gone higher than 4 metres off the ground, I feel this irresistible pull to jump off the edge and that scares me. Over the years, I know that the urge to jump is weaker than my desire to live so I am not so scared anymore but honestly, there is still a seed of fear in there somewhere when I am in a glass elevator over 10 floors high.

With snakes, it is simple. My mama is scared stiff of snakes. She will not wear anything with the image of a snake on it. She doesn’t want to see snakeskin shoes or bags. She can’t stand jewellery in the form of snakes. She doesn’t even like harmless cartoon snakes like the ones in Jungle Boy and Aladdin. So I was scared of them. Despite that, I loved the 2 cartoon snakes I have mentioned and I am happy to look through a glass wall in a zoo at the prettily coloured snakes and watch a documentary on them. Plus I would not turn down a ring or earrings shaped like a snake. However, I draw a line at having to handle one (God forbid someone tries to drape it over me) and I would never buy anything made up of snakeskin.

Icky spiders – I just don’t like the rough fuzzy texture of their skinny fragile legs. And they are a little stupid aren’t they? Because when you try to lead them out or catch them gently and release them outside, they run at you, try to climb all over you or cling to you and then in your irrational fear, you squash them. Oh dear!

A fear that was harder for me to deal with was my fear of commitment. My parents were divorced before I was born and I didn’t know very much about the reasons why until more recently. What I knew back then was that he must have been bad because my mama is an angel and he hurt her. Also through my mama’s feminist work and from attending feminist conferences with my mama, I heard a lot about the bad things that men do to women. Naturally I thought it was crazy that any woman would subject herself to a committed relationship with a man.

I didn’t have a proper boyfriend until I was 18 and that didn’t last long because he, rightly, wanted a girl who would keep in touch regularly (it was a little long distance, he lived about 2 hours away from London) and I resisted his requests because it felt like too much commitment to me at that stage. My next relationship was nearly 3 years later and this time, he was keen on being more intimate and yet was happy to be non-committal. I guess at 21 years, I had matured a little bit more and wanted some commitment. My fear then became that he wanted to use me and that I would fall in love with him then I would have my heart broken. So I broke it off.

I met George, my husband, when I was nearly 25 years old and he is the first to tell anyone who would listen that he knew he wanted to marry me within 48 hours of meeting me. Well, I embroider slightly. He insists he knew in the first hour of us meeting that he wanted to marry me but I think he is being rather dramatic. He did tell me on our 2nd date, 5 days after we met, that he liked me and he thought I was potentially the one he wanted to spend the rest of his life with. Wow! Honestly I wanted to run away as far as my little legs could carry me. Instead, I sat in the reception of our favourite Chinese restaurant and tried to shush him because I didn’t want anyone to hear. I also told him that he was lucky I was leaving for a year abroad in the next week because if I hadn’t been, the fear his words had struck in my heart would have sent me into self-destruct mode and I would have sabotaged that relationship too.

The time and distance made me realise that here was a man who made me laugh, who loved me for me and whose heart is good. Here was a guy with whom the chemistry was just right. Here was a man who I could be myself with. So I meditated about it for many months whilst I was away. I talked to my mama, my sister and my friends. I prayed for guidance and I realised that although I was scared, petrified even, of committing to George, I was more afraid that I would throw away the chance to be happy. So I took a leap of faith and 3 years later, I am married to him.

So are you fearless now? I hear you ask. No, not quite! I have many small fears. I have one big irrational fear and I have one proper grown up fear. The grown up fear is my fear of failure. I have been lucky never to have failed at anything I set out to do until I failed my specialist paediatric (the dreaded 1b) exam last year in June. That failure threw me for six. I knew I had to retake the exam because I cannot progress beyond ST2 year (level 1 of specialist paediatric training). But I hated every minute of it. The fear crippled me. I couldn’t sleep, eat or work properly for many months in the lead up to the repeat. My ability to deal with the normal stresses of my relationship and work was at its lowest level ever. I even got to the point that I was thinking of giving up on the career I love because I was so scared I would fail again.

I got over that fear by thinking up a plan B. There are so many things I could be. I might want to be a paediatrician first and foremost but actually the underlying love is of children. So what else could I be that would allow me to work with children? As soon as I gave myself the permission to imagine, the list of alternatives was extensive. Top was human rights activist, academic teaching medical students, author of children’s books and even babysitter. The last one was particularly tempting especially because I know from my doctor colleagues that a babysitter taking care of 2 young children full time can earn as much as I do without any of the stress of being a doctor. Food for thought.

The last fear I will confess to is my irrational fear of mice/rats. I love Tom & Jerry – and as a child, I would always root for Jerry the mouse over Tom the cat. However, in reality, I hate those rodents. It comes from the time we cornered a mouse in our kitchen and tried to capture it. it poked its head into the drain hole of the kitchen sink and then squeezed through that tiny aperture. That was the freakiest thing to me! How can a round mouse do that? Bleurgh!!! So now I am petrified of them. A decade ago, I was in an uncle’s house in Nigeria and went into the guest bedroom to grab something. As I turned round to leave, I spotted a tiny mouse flash past the doorway and it must have been behind the chest of drawers beside the door. I jumped onto the centre of the bed and tried to work out a route of escape. My 2 year old cousin came to find me and joined me on the bed. We tried to shout for my sister and friend to come and save us but we were too far or too quiet to be heard. My sister finally came to find us about 30 minutes after we disappeared. She still laughs about it because when she came, I could barely speak in my fear as I tried to warn her that the mouse was there. She had to coax me off the bed after proving to me that the mouse was not laying in wait. That is one I still grapple with and I am not sure I will ever outgrow my fear of mice but luckily, I rarely have the misfortune of tangling with one.