Tag Archives: hands

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

Appreciating the Small Things in Life

I don’t know if I mentioned that I got married last year in April. I must have somewhere. We have made it through the first year baptism and we have grown as a couple so much. Of course it hasn’t been smooth sailing but I would not have expected that being that we are both passionate about what we care about, both rather opinionated and both not the types to shy away from an argument. My post is not to pretend it is all paradise, a fairy tale. Perfection. It is in fact about the opposite. About how it doesn’t have to be perfect but you can be perfectly happy especially if you stop sweating the small stuff and instead start appreciating the little things that make the relationship great.

My husband from time to time gets a little insecure (particularly after a few days of me getting increasingly irate when he is not doing his boring chores) and asks if there is anything I think is good about him. I always react with a bit of disappointment because I know what I am like and when anyone does even the littlest thing that makes me smile or happy or proud, I am the first to say it, usually using the word ‘amazing’. So this here post is to tell you about the little things the husband says and does that makes me go all  mushy inside and makes me forgive him when he does the big things that make me want to cry in anger or in frustration.

I will start with a little thing he does which always sets my day up nicely. He makes me a cup of tea or if I am lucky a sandwich for work. I will admit now I am not usually a morning person so finding that he has made time for me in the morning and so saved me some time makes me go all warm first thing in the morning. It just used to be tea in my travel mug to drink on the way to work or on weekends in a nice mug by my bedside. Today, he presented me with the flask pictured above. Not only has he made me tea, he has gone out and bought a little flask to keep it warm knowing how slowly I drink tea and how it goes cold before I get to the last drop. And the flask is in a colour I love and the writing on it is paying me a compliment. What better way to start the day I ask you? I look outside right now and it is a grey rainy Monday morning but my heart and soul are smiling like the sun is up and shining Yola-style.

The other day, he went out and came home in the early hours to find me in bed. I was curled up on my side, tensed up waiting to see if his hands were cold from being outside. Imagine the relief when he placed his warm hands on the small of my back. Better yet, his hands were covered in oil and he gave me the loveliest backrub I could have asked for. I drifted back to sleep and it was the best night’s sleep I had for over a month. That’s #2 of the small things he does. He gives me impromptu massages, backrubs, foot rub, head massage when I need them the most. When I come home after a 14-hour day at work and collapse in a heap and I am so tired I cannot muster up the energy to take off my shoes or eat dinner. In the same vein, he will also fetch my dinner and a drink and make me eat it all then when I start to doze off with my plate still in my hands, he takes it all away and even carries me up to bed. How could I help but love him?

He pays me compliments all the time. I am quite a low maintenance girl if I say so myself and I have a healthy appreciation of myself. I don’t have any great hang ups and my self-image is good. I do not need compliments but I do appreciate them. Who doesn’t? Like the compliment on the pictured flask, 4 years and counting since we met and I know he thinks I am hot. Let me be honest, I do not see myself as hot. I know some people think I am pretty, my mama and sister certainly say I am beautiful and so do my closest friends but I sort of take it for granted that they see the beauty within as well as without. I know I am not ugly and even strangers have paid the odd compliment to me. Omosede Ighile even called me beautiful many years ago when no one outside my family had ever and I won’t ever forget that compliment because those days, I was a little less self-confident and it meant a great deal. Anyway, I digress. Sorry. Some days I look in the mirror and think ‘niiiiiiice’. Some pictures I think ‘wow wee’ maybe he is right I am hot but mostly I don’t remember to look at myself because honestly I do not care how I look most of the time. He does though and what I think is too skinny to be womanly, he loves. He looks at me like I would expect a guy to look at Shakira, Jennifer Lopez or Halle Berry. He gives me a smile that I know means he thinks I am sexy and you know what, it feels damn good. Because I know with many men, after that initial honeymoon phase, they stop seeing your beauty and it all becomes boring routine. Not for my hubby. He sees my beauty even when I am at my scruffiest, usually post night shifts wreck and he tells me verbally and with his eyes. Aren’t I a lucky girl?

Linked to his complements is that he is proud of me. Not only does he think I am hot, he also thinks my brains are hot. I mean, I can’t pretend not to know I have been blessed academically. It’s all on paper from the time I was like 2. So yeah, I know I am no slouch in the intellectual department. However, being a doctor and surrounded by lots of doctors who are not just intelligent but many are in the genius sphere (unlike me), I do not feel as special as I did say back in primary school when I was the school’s big brain. But when I am around my husband or when I hear him talk about me to his friends, I go back to that happy place where my mama was bursting with pride at her baby’s academic achievements. When my sister used to tell everyone who would listen how much of a Brainiac her little sister was. He is so convinced of my intellectual prowess that he would rather listen to me prattle on about religion, nature, culture, psychology and even art than consult Professor Google or people in those fields. What is best is that despite not being medical in any way, shape or form, he swears I am the best paediatrician ever. Even after I was facing my first ever exam failure (post-grad paediatric specialisation exam, 1B). I laugh but really, I am delighted that someone has so much belief in me that even when I doubt myself, he is there to shake me back into believing and therefore being great again.

Following on from there, he likes to hold hands. Small thing #5. He is so proud to be my husband. He was proudly proclaiming that even before I agreed to be his wife. My sister and I used to try to curb his enthusiasm and point out he wasn’t even my fiancé at the time but he was irrepressible. It was ‘my wife’ this and ‘my wife’ that within the first year of our courtship. Silly man! I got used to it eventually but it took a while. Now he will get upset if I fail to hold his hand or kiss him long enough in public. I know he takes it seriously so I try but I am a shy Fulani girl. Public displays of affection (PDAs) do not come naturally. Particularly when it goes beyond a quick kiss. I still get embarrassed. Not because I am not proud of him but because I have been brought up a certain way and PDAs are a no-no in Yola. The attention it draws is just a little embarrassing for this Fulani girl. But I am working on it.

Last small thing in this post because I will be late for work otherwise. He will dance with me whenever I give the slightest sign that I am in the mood for it. As soon as I start singing a song or I start nodding my head to music, he will duet with me and he will want me to get up and do a dance. Unfortunately for him, I don’t have the energy he does after work (it is physically and mentally draining being a doctor if you are not one). So I will usually bow out after one dance but he will happily dance for me whilst I cheer him on. His energy and enthusiasm, whilst in need to curbing most of the time is an amazing quality and I might not say this to him often, it is what stops it being boring round ours and we are always up to something or the other. Keeps it all fresh and turbulent and exciting. Much better than boring which I have a very low threshold for. Might explain why I am a paediatrician. It’s a lot of things but so very rarely boring.

So there you are dear husband and dear readers. I have told you all today about some of the reasons why I love my husband so much and why despite all the big faults, I love him to bits. Tell me what little things you love about your husband/partner/lover/wife/girlfriend/fiancée too. I would love to hear it!

p.s this paragon of ‘small’ virtues is called George. My Georgey boo 😀

Corazon Por Corazon

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

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

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

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

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

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

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