Tag Archives: doctor

Physician Heal Thyself

Yet another doctor has committed suicide recently. The 3rd in the past year in the UK that I know about. There are probably more. It is so sad. On the face of it, many people might think what do doctors have to be so depressed about? The public still imagine that being a doctor comes with a good job, good income and the respect of the population in general. Those of us in the profession and our loved ones know better. For most doctors, the work is relentless. The NHS is no longer fit for purpose. There are too many patients with less resources to care for them. There is more and more paperwork borne out of the NHS having too many ‘managers’ who analyse medical errors and harm and feel that creating another form to fill in will prevent future incidents. They fail to realise that what is needed is more funding to employ enough staff for the numbers of patients we treat. They fail to realise that they need to invest in their staff and make them feel appreciated and valued for their hard work and for doing more than they are contracted to do. They need to examine the levels of sickness and absenteeism and realise that burnout is real and so is depression. Above all, they need to realise that without preventative measures, doctors will continue to work themselves until they simply can’t.

Although the UK rates highly in a lot of economic and living standards indices, being a rich developed 1st world nation, it doesn’t do so well with mental illness. The positive news is that the UK had made it into the top 20 of the world’s happiest countries in 2017 (it was previously 23rd and is now 19th) for the first time since 2012 when the world happiness report started being published annually.

In March 2017, the Mental Health Foundation commissioned a survey to look into prevalence of mental health in the UK and to identify the factors about individual that make them vulnerable to suffering from a mental illness. It found that 7 out of 10 women, those aged 18-34 and those living alone had a mental illness. Only 1 in 10 of the whole population are happy most of the time. Women are 3 times as likely as men to suffer a mental illness. Stress is a growing problem. Majority of people suffer from either a generalised anxiety disorder, depression or phobia. Self-harm and suicide are not classed as mental disorders but are a response to mental distress usually cause by mental illness that has not been recognised and treated.

With these statistics in mind, it is easy to see why young female doctors are at risk of mental illness. Couple that with the fact that medicine attracts people with a type A personality who are high achievers and do not like to admit they have a ‘weakness’ or that they need help. I have already described working conditions in today’s NHS. No wonder so many young female doctors are struggling and every year, we lose a few to suicide. What I find particularly difficult with this is that when colleagues pay tribute to those who have died, there is always a huge sense of shock. Unfortunately, these women hide their illness so well that often even their closest confidants have no idea how much despair they are in. Their friends often describe them as ‘superwoman’, someone who ‘has it all’, always helping others, taking on incredible amounts and managing to ‘juggle it all’ somehow. They give so much to others that they forget to give their selves.

Caring. Freedom. Generosity. Honesty. Health. Income. Good governance. These are the things that increase happiness and promote mental well-being according to the Mental Health Organisation. I would sum it up as friendship. I think human beings are social creatures (yes, even the introverts) and need to have at least one good nurturing relationship. This is intrinsically linked to self-worth. Many people who have attempted suicide and lived to tell their story say that depression and anxiety eroded their self-worth to such an extent that they felt useless and that the world would be better without them in it. Depression interferes with rational ordered thinking. When it is severe, it is like being in a deep dark hole, full of doubts and lacking in any hope. Far from being selfish, I believe people who contemplate suicide are (in their warped thinking) being selfless and believe in that moment that they are un-burdening those around them.

So is there anything we can do to turn the tide? Most experts agree that by the time a person has planned to commit suicide, it is probably too late to do anything. The depression has taken over and has them fully in its grasp. Where we can make a difference is at a much earlier stage. We need to prevent people with low mood going on to develop depression. We need to be that friend who validates their self-worth. The one who lets them know in words and action that their presence is very much appreciated in your life. We need to talk about mental health more so that someone at the early stages of depression feels able to confide in someone and seek help. If mental illness is so prevalent, why do we not talk about it more? Why are we ashamed to say, ‘I am depressed, I need time off work to get treatment/rest to get better’? Would any of us feel ashamed to call in sick at work if we developed appendicitis, had to have surgery and needed a few days to recover? Just because mental illness is invisible doesn’t make it less valid. I think this ultimately is what will turn the tide. Talking about it, admitting we have a problem and asking for help early, taking time out now to prevent getting to the point where all hope is lost and we feel like we have no other option other than suicide.

If you are reading this post and can identify with the desperation that mental illness can induce, please reach out to somebody. Ask for help and support. If you are in the UK, there are some very good resources. Your GP should be your first port of call. If you are feeling suicidal, call the Samaritans on the free phone 116 123. Mind has help pages online that can be accessed at https://www.mind.org.uk/information-support/types-of-mental-health-problems/suicidal-feelings/helping-yourself-now/#.WX8lFojyvIU as does Turn2Me at https://turn2me.org/?gclid=EAIaIQobChMIvKCtr8Sz1QIVT5PtCh2D7QnCEAAYAiAAEgKyyPD_BwE. The Mental Health Foundation has some great guides for promoting mental wellbeing which can be accessed on https://www.mentalhealth.org.uk/your-mental-health . The app Headspace comes very well recommended for dealing with stress, anxiety and depression.

If you are a medic, there is a wonderful Facebook group called Tea & Empathy for peer support for all those working in healthcare. It was founded after we lost another one of our young doctor colleagues a couple of years ago and is a brilliant space full of supportive caring people. The Wales Deanery has published a booklet specifically aimed at helping medics cope with the stress of the job. You can access it here: https://www.walesdeanery.org/sites/default/files/bakers_dozen_toolkit.pdf.

Finally, I want to say to you all: You matter. You are loved. You are not alone. Be kind to yourself x

 

The Cycle of Life Part 3

I could write and write about the many lives I knew that were cut short in their prime but I will complete the cycle with this last blog about one of my oldest friends. His name was Nabil. We probably met as babies but the first meeting I remember was when I was 15 years old. We had moved to London the summer before and were getting settled in still. My mama came home one day and announced we had been invited to have dinner the Ibrahim’s on Saturday. Who were they? I asked. She explained that they were old family friends. The parents were my grandparents’ friends and although their children were younger than my mother and siblings, they knew them well as children. I am told one of the kids had even stayed periodically with my grandparents in Lagos when they were going to school there. She told me that the oldest daughter had 2 sons, one my age and I was going to meet them.

Although we both lived in North London, it was quite a trek as there was no direct tube route and we had to go on 2 (or was it 3?) buses. By the time we got there, my nose, fingers and toes were frozen and all I wanted to do was curl up into a ball and sleep by a fire. I needn’t have worried. As soon as we stepped into their house, I felt my frozen cells begin to stir. It was always tropical in that house. Mum and Baba (the grandparents) like it very warm so there was never any danger of being cold once you got in there. I was introduced to the many adults, face after smiling face. It was like a mini-Northern Nigeria. All the warmth, the noise, everyone speaking Hausa. The boys were called down, Nabil and his little brother. They were instructed to take me upstairs until it was time for dinner. Although Nabil was friendly, he was definitely the quiet one. His little brother made up for it. He was very chatty, still pre-adolescent and full of excitement about life. Back then, he was quite small too. Very cute!

Nabil played us some music and told me about how they had only been in London for a year so were new to town too. He explained who was who in the family and we made general chitchat with his little brother telling us his fantastical half made up tales. We were in the same year of school and I was older by 2 months. By the time we got called down to dinner, we were friends. Over the delicious dinner cooked by Mum (his grandmother) and his mum, we talked some more. We exchanged numbers when I left. We stayed good friends over the years. We went to visit every so often and they made the trip across North London a few times too. We text occasionally in between visits. The next year, we talked about finishing year 11 and applying for colleges. I told him I was doing all the sciences and Maths because I would be applying to do Medicine. He said he wasn’t sure yet what he wanted to be so he was still thinking about which subjects to choose. We talked about where to go and I must have been convincing because I suggested for him to join me in Barnet College and he promised to consider it. He wrote down his address on a teddy bear notepad I had so I could sent him information when I had a confirmed place.

Common sense prevailed and he went to a college more local whilst I went to Barnet College. We went to see movies together and we even ate out at this stage, being all grown up at the ripe old age of 17 and 18 years. Every time we went out, he would insist on paying for everything and I would argue him down so we went halves. His little brother had grown into pre-adolescence by then and would irritate Nabil endlessly. His patience was great and he would repeatedly ask him to butt out of our conversations. I didn’t mind. I had a sister too and as the younger sister, I knew what it was like to be the little one. When we applied through UCAS for universities, he finally had a plan. He was going to study Maths. I was shocked. I mean, I was a straight A student and I got my A in Mathematics, an A* even in AS. I was no slouch when it came to it but to do a whole degree in Maths? I was agog! Why would anyone in their right minds do such a thing? He took my teasing in his stride. He said he didn’t have a profession in mind like I did and he knew he could use his generic Maths degree to do a wide range of things. I accepted this but I still thought him mad. He gave me that calm smile of his. ‘You’ll see’, he said.

As is the norm, we saw each other less when we went off to different universities. I went to Birmingham and he stayed in London. We probably saw each other once a year but when we did, it was like no time had passed at all. Ours was a very easy friendship. He would tell me about his ‘crazy’ Maths course. He seemed happy. I would tell him about Medicine and how much of it there was. How I realised more and more that what I knew was only a small fraction of how much I needed to know. He was openly impressed by how well I coped with it. His support and belief in my abilities were unwavering. Just like his friendship. I knew he was there somewhere should I ever need a friend. We text and Facebooked more than we spoke face to face. I can count the number of times we spoke on the phone in all the years.

Over the years, I would tease him gently about his girlfriend, or lack of. As the Fulani girl, I should have been more embarrassed to talk about such things but he was so shy about it. It became part of our friendships. I would needle him about ‘her’ and he would counter by asking me about my many boyfriends. I wasn’t shy about it. I had very little in the way of boyfriends but I told him of every encounter and how I preferred not having a boyfriend. He never admitted to any love interests but his brother was a more open book and I know there was somebody special at some point. He graduated and started an online sales platform. Next thing, he was talking about going back to Nigeria for his NYSC (mandatory youth service). He settled in Lagos. I happened to go the Lagos route once in his time there so I got to see him. He looked way too skinny and I was worried. As a newly-qualified doctor, I saw ill-health everywhere and was concerned he wasn’t sharing. He reassured me that he was fine. I didn’t need to doctor him. I believed him because youth corpers do tend to look the worse for wear during their year’s tenure.

The last time I saw Nabil was in Life Camp, Abuja in 2011. He happened to be visiting Abuja whilst I was there on a 10-day holiday. He was staying with a friend who brought him over. Again, I thought he was too skinny and he laughed it off. ‘Maybe I was always meant to be skinny like you’, he said. We chatted for an hour and he had to go. As we hugged goodbye, I felt how bony he had become. Life in Lagos was a hard one for a young man trying to start a business. My parting words were ‘You need to eat more. You should look after yourself better.’ His reply was a laugh and a ‘Yes doc!’ I stood at the door and waved until the car was out of sight. Not for a second did I imagine I was saying goodbye for the last time. The fuel subsidy crisis in Nigeria was the last thing we ever chatted online about. He became very involved in the demonstrations. I worried about his safety and he sent photos of himself and his friends at Lagos marches, looking happy and less skinny. He had found a cause to believe in. I was proud he was making a stand for a cause.

News that he was ill came out of the blue. I was in Yola, having taken a year out from working in the NHS to see the world. My mama got a call from one of his relatives saying that he was in hospital with a bleeding illness, cause still unknown. It was pretty serious and they were considering transferring him abroad as the healthcare available in Lagos was deemed inadequate. When my mother related the facts, I wanted to know more. What sort of bleeding? Was it related to a fever? Was Lassa fever the suspected cause? When my spoke to them again later, she was given more details. He had woken up that morning and told the friend he was living with that he wasn’t feeling too well. I think there was mention of a headache. He had been well the night before going to bed. His friend had gone with him to hospital and he either vomited or peed blood. The exact sequence is hazy but the gist of the story was that he had become sick rather quickly and what started out as an isolated bleed was now bleeding from multiple sources. He had been given a transfusion, we were told. He was conscious but seemed to be deteriorating.

When my mama related all of that news, I immediately thought the worst. When I burst into tears, she was alarmed. ‘He is alive,’ she said to me. ‘Don’t write him off.’ I tried to explain what I was thinking. I didn’t want to be a pessimist but unexplained severe generalised bleeding had a poor prognosis even with the best medical care. And he was not getting that. Not yet anyway. I had 2 professional experiences to draw on, both rather negative. My first experience of a patient with uncontrollable bleeding was in Malaysia on my medical elective in the 4th year of medical school. He was brought in by his heavily pregnant wife and a male relative to the A&E where I was working. He was very quickly diagnosed with Dengue Haemorrhagic fever. However, before any real treatment could be commenced, he went into cardiac arrest. With the medical students and his wife watching, the doctors performed CPR. It was horrific. He began to bleed from every orifice imaginable. His ears, nostrils, mouth. The blood was coming up the tube he had inserted into his lungs to ventilate him. The only part visible with no blood streaming out of it were his closed eyes. It was over as quickly as it began. It was obvious to everyone that he was far too ill to be saved. His wife was led away with the news.

The second experience was indirect. I was working in FMC Yola (Federal Medical Centre) and although Yola was ‘free’ from Lassa fever at the time, there were new cases being reported further south of the country. In fact, about 6 months before I had started working at FMC, there had been a patient with Lassa fever there and 2 of the doctors had contracted it from him. Unfortunately, 1 had died and the second had got to the Lassa Centre down south in time to be treated. He was one of the registrars on the paediatric team I was working with. So although he was okay, it seemed that mortality was quite high and only those who were diagnosed early and treated before they started actively started to haemorrhage (to bleed) were salvageable. Nabil’s story didn’t quite fit the bill because he had not complained of a fever and indeed had no fever in hospital. But it was my best guess with the facts I had and I feared the worst.

I pulled myself together eventually and prayed and waited with my mama. Next time we got an update, it was to say he was worse still, I suspect barely conscious at this stage. He was still bleeding despite all efforts and his parents were with him (they don’t live in Lagos). An air ambulance had been organised and he would be transferred abroad as soon as possible. We even heard he was being placed in the ambulance and I thought maybe there is some hope after all. That hope was short-lived. We got a call a few hours later to say that although his parents were in a flight to London, his air ambulance had never taken off. There were complications and unfortunately, he had not made it. I was so upset! All I could think is how his parents had no idea he had died and how they would have to make the return trip with that news weighing on them. To be honest, I have not asked them what happened exactly but it could only have been a terrible day.

I think the initial reaction of tears had taken the edge of my grief. I had started my grieving process before he was gone. I sat around in disbelief as my mama asked if I would be okay. As we made arrangements to go and visit his family, I could not stop thinking about how final death was. That was it for him, in this life anyway. I have no brothers so I whilst growing up, I found a handful of boys/young men to be my shining examples of decency in the male sex, my torch bearers when I felt dark about men in general. Nabil was one of them. Here was a gentle, calm, positive young man who believed in doing what was right, what was decent. He was respectful of God, his parents and our culture. He was a great friend and it was clear from the few times that I spent with him in the company of his family and friends that he was an all-round good guy. Losing Nabil was losing a little of the light in the darkness that sometimes surround men for me. Nabil was a good guy. Now he is no more. It took just over 2 days for a healthy young man in his mid-20s to sicken and die. Muslims would say it was time to go. I accept that but did it have to be such a horrible death? What did he ever do to deserve such an end? Why him?

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

Your Body is Your Temple

I don’t mean that in the gym-bunny, mirror-worshipping way mind you! I mean it in a biology-is-amazing way. I genuinely am proud to be a geek when it comes to biology and how amazing it is to study. I knew I wanted to be a doctor before I understood what a career meant but I think it must be because I looked around as a tiny tot and thought, wow! Everything God has made is simply amazing. The trees, the animals, the sky, the insects…I will attempt to give you an insight about the little things (or not so little depending on your perspective) that make me so awe-inspired.

First, the atoms making all matter up. When I look at the structure of an atom and how it greatly resembles a planet, I am immediately amazed. How can something so simple and so tiny be so organised? The bit I love best are the electrons whizzing around like little moons outside of the nucleus of an atom. The fact that there is a space (albeit miniscule in human terms) between nucleus and electrons yet there is an almost unbreakably strong force holding those structures together. And the fact that when you think every small particle has millions of atoms all linked together but all quite independently holding their ground with their electrons orbiting and repelling each other, creating a little force field of protection for their little territory. Then multiply that by millions and you make a little baby whose atoms are organised in equally amazing cells.

Cells are just a feat of engineering. Google the structure of a cell and maybe look at an animation of what a cell is doing all the time. As you sit here reading this, your cells are busily functioning. Making energy from glucose, enzymes and oxygen in the mitochondria and funnelling that energy in the form of molecules called ATP where they are needed for your cell to do more stuff. As the cells work, they are making waste products and heat that they are getting rid of either into fluid around them to go ultimately into blood to be excreted mainly via the skin, lungs or kidneys. The nucleus in each tiny cell is using up some of that energy to copy your DNA either to make little proteins out in the cell fluid (cytoplasm) or copy the cell’s DNA depending on what type of cell it is.

These proteins are what run your body. Your enzymes and hormones. The building blocks to build more cells to replace those that are dying (happening all the time) or  to repair damaged worn out cells (like nerve cells you can’t make more off). The enzymes help you break down your food, absorb it into cells and then process it, making ATP for more energy. They also help you to convert hormones and other chemicals from one form or another to be used in other intricate processes. Some very important security proteins are those that control how your cells are copying their DNA and therefore multiplying – they often have names like p53. In simple terms, they spot if your cells have copied DNA wrong and the new cells are abnormal (those are the cells that either die or could potentially become uncontrollable and may become a cancer). They then stop that cell being made and destroy it. It is only when something goes wrong with these proteins that you fall victim of cancer or more accurately a tumour with the potential to become cancerous. The hormones tell your organs and glands how to function, whether to make more proteins, work harder or relax a little. Other bits like your white cells also help you fight infections by either producing poisons that kill harmful organisms or simply by wrapping themselves around the bugs and effectively imprisoning them.

I will mention cancer briefly because I find it fascinating and scary and impertinent in equal portions. Like I said, cancer is basically a mistake made at some point when making cells. Some of these defective cells will just die because they do not work well enough to process energy needed for them to survive. Some though become super-cells and not only can they make energy, they evade your bodies normal security proteins and start to multiply at a crazy high pace (fascinating!). These cells then take up space they should not normally take up and even more impressively, they somehow hijack your blood vessels by producing proteins that encourage growth of blood vessels around them so they make themselves a nice super-supply of blood, getting extra blood with all that extra glucose and oxygen to fuel their drive to multiply further (making you anaemic and breathless because you are short of oxygen). The ball of supercells (tumour) then grows and grows, taking up space and pushing your organs out of the way, making them function not as well (giving you some of the symptoms of cancer like constipation when they press on something like bowel) or blocking tubes (like the trachea in the lungs so you become breathless eventually or your bile ducts so you become jaundiced and cannot get your digestive enzymes to your tummy to allow you to digest and absorb food so you lose weight). This is the impertinence of cancer. Eventually, it replaces your normal organs and that’s when the real big problems present. That scares me because you have millions of cells all multiplying constantly and mistakes are bound to happen. It takes just one mistake that goes uncorrected and you potentially have a cancer in the making. Goodness gracious me!

Back to awesomeness though. The next thing that never fails to impress me is reproduction. You can’t escape it. People say love makes the world go round. Some say it is sex. Really, it is reproduction. From simple cell reproduction as above allowing a little baby to grow and for a body to keep functioning to actual mating and reproduction. It really is not all about sex. Even ‘simple’ beings like bacteria reproduce by exchanging DNA in a very unsexy way. Have you ever seen snails/molluscs ‘mate’ for example on nature programmes? It is so weird and amazing all at the same time. That is what binds us all living beings together. We are all programmed to reproduce to ensure our all-important DNA is preserved. So sex my friends is beyond physical lust. You are pre-programmed to want to procreate.

Babies in general are simply fabulous (take it from this paediatrician who is daily seduced by their endless charms at work). However, baby girls are a cut above the non-girls (sorry boys). When a little girl is being made, by 20 weeks of pregnancy, she already has ovaries which have made all the eggs they are ever going to make. In fact, she normally has more than she needs in her lifetime (more than one a month for all of her fertile years) and about 80% will degenerate leaving 20% of her (best) eggs ready for when she one day is ready to become a mother. A baby boy in comparison does not produce any sperm so has no capacity to reproduce. At the earliest in a healthy normal boy, sperm do not come into being until the boy is at least 9 years old. So yes, I know I am probably coming across as very feminist but hot diggity! Girls are awesome!!!

I will stop at that incredible piece of biology because I will get too excited if I carry on. When I stop and think about biology, I have all the evidence I need for God’s existence (or whatever you like to refer to that life force that controls us all whether we are willing or not). There is clearly intelligent design at play. Biology did not just happen and continue to happen. It is a true miracle and I thank God that I am human so that I can appreciate all of nature’s amazing-ness.

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

Listen to Granddad

My grandad by everyone’s standards is a legend. He has seen and done so much in his lifetime and he continues to do so today at the age of 85. Look him up. Ahmed Joda is his name. I won’t bother to write about his many achievements because so many have done so over his many years of service. I want to write about the man beneath it all. My grandad who I call Baba. We all do, his children and grandchildren alike. Because before I realised what other people thought of him, through my young eyes, all I saw was an ‘old’ man who was my mama’s dear father. My only grandfather. The patriarch of the family who was also the main father figure in my life.

The first thing we all know about Baba is that he is a stickler for punctuality. Now this might not sound significant to you but coming from Nigeria, it so is. Have you ever heard of the concept ‘African time’? Did you know ‘Nigerian time’ constitutes even worse ‘lateness’? So a Nigerian who is always on time is as rare as hen’s teeth. His most precious possession is his watch. He looks at it every few minutes even when he has absolutely nothing to do. It’s like a nervous tick. And God forbid he forgets his watch at home, he will drive us all mad asking for the time every 5 minutes.

When Baba asks you to meet at 5pm, at 5:01pm he will be on the phone asking where you are if you are not there. If you make plans to go somewhere with him, be sure to get there on time because I kid you not, if you are more than a couple of minutes late, he will go without you. Whoever you are and wherever you were meant to go with him. I think I wrote a blog about how he invited his friend from Abuja to come to Yola (9 hour road trip) to join us all on a trip to Gembu (6 hour road trip). We waited for 20 minutes and despite the fact that it was 6am and we would get there by lunchtime, he declined to wait and left without them. Lord knows what they went through to find Gembu because Nigerian roads outside of Abuja and Lagos are poorly signposted especially places like Gembu and they didn’t turn up until the next morning! We in the immediate family are no strangers to his bark of ‘come on!’ which when I was little used to make me cry because it sounded so scary. Over time, I have learnt not to react so emotionally to it but still, when that bark comes because we are more than a minute late to leave for some engagement, my heart skips a beat.

I once asked Baba why being punctual was so important even when no one else (Nigerian) cared and why we had to be the first ones at every event. He explained and although I cannot remember exactly how he phrased it, the message is reflected in the following quote:

‘Know the true value of time; snatch, seize, and enjoy every moment of it. No idleness, no delay, no procrastination; never put off till tomorrow what you can do today.’

Lord Chesterfield

He certainly lives by that rule and as I have said before, he has achieved more than most people would in 3 or 4 lifetimes. Perhaps he is still going so strong at 85 because he is mindful of seizing every moment he has been blessed with. I certainly want to emulate that when I grow up.

So many things I love about Baba but one of them is easily how much he has empowered us all to speak our minds. He has never been of the school that children should be seen and not heard. From a very early age, he would ask our opinions on topics most adults would never broach with children and he would give your answer his undivided attention and take it on board. Many years later, he would repeat your words to you especially if you had learnt from experience that things were not black and white and he would invite you to explain why the change in opinion. This means that in the Joda household, we are all prolific debaters and will put across our arguments without fair of censure as long as we were being honest. Active debate is encourage actively and even the youngest gets heard as long as they want to contribute. I think what keeps Baba so young at heart and full of zest is that he surrounds himself with the young and he sees life through our eyes. That way, his ideas are always in date and he can converse about whatever you choose to discuss.

Somehow, Baba never asked me what I wanted to be when I grew up until I was 13 years old. I brought the topic up because when I was choosing my optional subjects for SS1, my mother expressed surprise that I didn’t want to do Economics. My response was one of surprise too because although I was good with figures and mathematics, I was always more into my science than finance. Turns out Baba thought I would make a great economist. Next time we sat around the dining table, I asked him why he thought I would make a great economist. I can’t remember his reasons but I promptly told him I was going to be a doctor and that there was no way economics would even feature in any options I would take for a career path. He expressed his disappointment that that was the path I had chosen but of course it was up to me. I was going to be the first doctor in the Joda lineage and thought he would appreciate my individuality.

It wasn’t until I was qualified and he sought my opinion on some of his medications that I felt he was proud of the career path I have chosen. So was I right not to listen to Baba? I thought so until the recent NHS upheaval which might mean me changing career tracks this late in the game. He is almost always right my grandad after all. Maybe what he foresaw was that being an economist would be a better quality of life for the grand-daughter who was feisty and named after his beloved wife. Perhaps he knew that my hard work and talents would not shine the brightest as a doctor. Perhaps he even predicted that I would end up working in the NHS whose main shortcoming is its poor economics. Who knows? As of now, I think I chose the right profession. I knew I wanted to be a doctor before I even know what a doctor really does. I love the job itself now, more than I ever thought I would. However, the politics of the NHS now means I am questioning whether my love for the job justifies my continuing on in the career when it means me risking my health, my social wellbeing and happiness and giving up so many of my dreams. Watch this space!

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.”

Should anyone accept blatant injustice and a distinct lack of appreciation?

Question I often get asked: would you push your children down the route to become a doctor?

Answer before graduating medical school: yes if they expressed interest in medicine, I would encourage it.

Answer now: Not unless medicine was the only thing they want to do (like me) but I would encourage them to look at other career pathways and think about the quality of life they might be signing up for. I would tell my child (and indeed any other child that asks) that there are plenty of ways of helping people, not just medicine. I would say that unless they have spoken to many doctors, read blogs/articles written by a wide variety of doctors and done a good period of shadowing of a full time NHS junior doctor, maybe consider something like law or better yet engineering if they want a profession or even become a journalist, photographer or best of all a human rights activist. Other healthcare roles are available and evolving with incentives and support to train in those pathways. A physician’s assistant is better off than the physician, not just in terms if salary but expectations and quality of life. Nurse Practitioners (specialist or advanced) certainly have a better work life balance and earn more for their hours.

Maybe in the 20th century, doctors’ pay and the respect they got compensated for the gruelling backbreaking hours of hard work and sweat and not getting to see daylight for days on end. But not now. Not in the NHS in England

Government threatens the NHS in England
Government threatens the NHS in England

anyway. I dread to think what the state of affairs will be in 2022 when a baby being born today would be making that career decision 😐

P.s my answer in short: no save yourself, do something else

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.