Tag Archives: kill

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

She is Someone

A little girl is born. Hopefully, she is received into the world with love and happiness. Unfortunately, there are still many places where having a baby girl is not a joyous occasion. Where femicide is still a problem – where baby girls are killed soon after being born because the culture sees it as shameful to be a parent to girls and not boys. Where new born baby girls are still dumped in their thousands, left defenseless because they are unwanted by those who bring them into this world. where baby girls are sent to a far flung rural hamlet and not registered in the birth registers. Where girls are sent out at a very young age to hawk small wares and be taken advantage of by paedophiles whilst their brothers are sent to school to be educated.

Sadly, the world is very unequal when it comes to gender. Even in the most ‘advanced’ of societies, women are under-appreciated. It boggles my mind that for the same job, same hours and same skills set, many women in the USA and Europe still get paid less than their male counterparts. Today, professional women who live in a partnership (marriage or otherwise) in the West still do majority of housework and childcare. Many a man will complain about doing what few chores he is asked to do for the woman (and his children) he claims to love. Many a man will feel they are entitled to be selfish and only worry about what is theirs alone whilst their woman cater for them and their children. To many, it doesn’t even occur to them to consider how their woman feels. How hard they make the life of their woman by not contributing a fair amount to making their home as nice as it is. To many, they don’t routinely say please or thank you for all the little things their woman thinks to do for them.

Double standards are still very evident in everyday life today. A man who has serial one night stands is a young man sowing his wild oats. All sorts of excuses about them needing to get it out of their system, yadda yadda yadda. A young woman does the same, she is seen as loose. A teenage girl gets pregnant and everyone judges her and her parents but very few will point the same finger at the teenage boy who made her pregnant. He doesn’t have to stop hanging out with his friends, he gets to carry on going to school whilst she has to drop out of school in shame and lose most of her friends. The baby is seen as her responsibility and she gets judged if she stumbles and becomes overwhelmed by one of the hardest jobs in the world.

A mother I think arguable has the most essential job in the world. The world’s population is obviously dependent on women bearing children. The mother does the lion share of teaching children about life, how to treat each other, and the difference between wrong and right. She teaches them about hygiene and how to dress. She is often the disciplinarian. She gets to play bad cop and yet in most cases, the children know that mother loves them. Mother’s hug is the best. Mother’s kisses cure all hurts. Mum is the one you run too when your heart is broken. Mum’s food is the one you crave when you are ill. And we all know, mother knows best. She wants what is best for us. She always has a welcoming smile, an ear ready to listen and a shoulder to lean on in our moments of doubt. She is our best friend. This is why my mind is boggled by the fact that women are so undervalued in this world. How can any man think less of a person because they are female when they were shaped by the love of a woman?

Now I know some mothers are not the best of mothers. Not all mothers are amazing. Not all of them get it right. However, the vast majority have their hearts in the right place and do the best they can for their children. Most of them, despite their faults, try to be all that I have described above for their children and I think regardless of their failures, we should remember how much of their lives they give up so that they provide for us. So that they are there for us. And our gratitude should translate into respect for our mothers which extend to all the mothers out there.

Religion interpreted by men also discriminates against women. I will talk about my religion Islam because I know what it means to be a Muslim girl and woman. There is a lot of obsessing about how women dress in many Muslim communities. Men conveniently forget the Islam asks men to cast down their gaze when in the company of the opposite sex. So I ask you, if they are busy not staring at women, why do they notice every little thing about how we decide to dress? Also, apparently some Muslim men believe that a woman should ask the permission of her husband to leave the house yet the husband is free to go and do as he pleases without letting his wife know what his plans are. What amazes me even more is that in some Muslim circles, the said husband goes out and pulls another woman to bring home as a second wife and that is all acceptable whereas if a wife wants to go to the market or college/university, the husband is allowed to be mad she went without his permission. Is what way is that fair?

So all I am saying is that I think men need to rethink how they treat the women in their lives. So we are biologically different and in the old days, perhaps physical strength was directly linked to survival but in this day and age, things are different. Physical strength is only an advantage in a few circles. Women have as many skills as men do and are as valuable in modern society as the men. Most importantly, women do the world’s hardest yet most rewarding job for free. They are our mothers. They deserve our respect. If you are an employer, pay everyone fairly for the job they do. If you employ a woman to do the same job as a man, pay her the same. If you are married or cohabiting with a woman you love and she works as many hours as you do, do some cooking and cleaning too and don’t make her ask you a million times first. If you haven’t seen your mother for a while, call her up today and take her out for a nice dinner or if you lucky to have lots of money in the bank, buy her a cruise or send her off on a surprise holiday or spa break. Show her how much you appreciate all the love and time she has invested in you. Call up your sister and tell her you love her. You know it’s the fair thing to do. Just do it!

The Greatest Heist

When people talk about the Palestinian-Israeli conflict, I want to shut my ears and not have to listen about who started what and whose fault it was. Initially (I’m talking about the most recent spate of killing this summer), the UK media was all pro-Israel and blaming it all on Hamas and Islamist militants. Of course this is the currently flavour of the new millennium so I don’t expect any different. However, I do wonder why we have got to the point that legitimises Israel enough that we question who started what.

I know history isn’t my strong point…indeed I dropped the subject as soon as I was allowed to in school because the lessons were so boring for me, I felt like I was having a mini-stroke each time I had to endure one. But these days with the internet and good writers, I am loving my history. So let’s look at the facts about Palestine and those who came in to steal their land.

Palestinians (comprised of mostly Muslim and Christian Arabs and a minority of Jews) were living peacefully in the South-western corner of the Middle East. In the years around 1948, Europeans of Jewish descent (mostly Russian, German, Polish and Romanian) mobilised and en-masse emigrated to the ‘Promised land’. They were led by a group of political extremists who called themselves Zionists who wanted their own State. Unfortunately, it was already occupied by the Palestinians. These Palestinians were home and had no intention of letting someone else move into their land and displace them. So they didn’t quietly give up their land. They fought to protect their homes. The emigrants decided that if the occupants would not create a space for them, they would force them to. So they killed nearly 1 million Palestinians and they moved in. In 1948, after a lot of bloodshed, the Zionists lay claim to over 50% of the land occupied by the Palestinians.

The UN did a lot of hand-wringing and said the occupation was illegal but their voices were quiet because politically and economically, the Zionists were powerful and for the UN big players (the US and UK especially), the Zionist money trumped the human rights of the people of Palestine. So the UN threw up its hands and turned away without any real admonition to these land-grabbing killers. Over the next 60+ years, the Zionists grabbed more and more land for their new territory (Israel), all the while killing thousands of innocent Palestinians and generally making life for the majority of Palestinians intolerable.

Today, Israel with its approximately 7.5 million population occupies a territory of just under 22,000 square km compared to Palestine’s 3.5 million population who occupy less than 6,000 square km. From all accounts, the Jews only owned 7% of the land to begin with. So they owned less than 2000 square km and that has somehow grown to 11 times its size (now occupying 78% of the area). Israel has built walls effectively imprisoning those within them and controls movement of the Palestinians. It controls the movement of food and other commodities needed in daily lives. Palestine which existed hundreds or even thousands of years (as there are historical texts that talk about Palestine from around 600AD) is not a UN-recognised country but Israel which was created within a lifespan and who illegally grabbed land has a seat on the UN council.

Am I missing something here? Put yourself in the shoes of the Palestinians. Whoever you may be and wherever you may belong. I try to imagine what I would do. This is how I imagine this. My husband and I have a house (not imagination). It has a few bedrooms and a few bathrooms, a kitchen and a living room, a garden and a garage. It belongs to us. It is newly built so it never belonged to anyone else. We have papers of ownership. The records all show the deed are in our name. My husband and I live in it. We are chilling at home one weekend when someone knocks on my door. It is a family of 4 from neighbouring Coventry. They are from out of town and they have no place to spend the night but they have a tent. Can they camp out in our back garden until they are rested? We let them have our garden. One day, we come home from work and they have moved into our garage. Sorry, they say, it was raining so hard that we just needed to get some more concrete shelter. Okay I say, being kind-hearted. Days roll into weeks and I say to my husband it would be nice to have access to the garage again but we decide to just let them be because they are not causing undue inconvenience. One day, both my husband and I work late and come to find the family has moved into the house and occupied 2 out of 3 bedrooms. There are only 2 of you, they reason, and you really don’t need more than the master bedroom and your bathroom. My husband and I are not happy. It is our property after all and we paid for it. We contact the police who says it is your home but our hands are tied if they say you invited them in. As we try to think of a solution, we come home one day to find our things have been moved into the garage and the locks to the doors to the house have been changed so the only room we have access to is the garage. We knock on the door angrily and are told through the letterbox to leave or else.

What would you do? Of course, we would try to get the Police to evict them and restore our property to us. We might involve the local media and social media in an effort to get some support. However, if everyone sat on their hands and were not interested in our story would we just leave it at that? The truth is we would try anything to get them out. We would break down the door and throw their things out and move our things back in. We would drag them kicking and screaming out onto the street outside if we were strong enough to do so. Or we would mobilise our neighbours and friends to get them out.

This is what Palestinians have done as far as I can see. They fought not to leave their land. They were forced out. Many tried to appeal to the world for help to restore what was legally their land. Then a small fraction of the population got angry enough to pick up arms and resort to violence. Hamas and other political groups were born and as they gain more support, their weaponry gets more sophisticated. However, the moneyed Zionists have far superior weapons and superior defences so again, it is the whole population of Palestine that suffers. But Hamas and their ilk do not stop to consider that and neither does Israel. The innocents of Palestine (mostly unarmed young men, children and women) continue to die as they are caught in the crossfires.

Now picture that Palestine is located in Europe. Imagine that England was Promised to a group of people in their Holy text a couple of millennia ago. And these people decided to mobilise in 2015 to collectively travel to England. Then imagine that they initially claim asylum and stay with people of same ancestry. And over months, they move into neighbouring lands until the neighbours protest and resist. The invaders then mount violent assault on the people occupying England, pushing all those people North and across in Wales and Scotland. Imagine them killing more than 10% of the people currently living in England and then declaring England is no longer to be called England…that they have renamed it ‘Promised Land’ and the English are no longer citizens of a known legitimate state. Imagine…

What a dire situation those people live in! What kind of a world sits back and watches the conflict deepen and life become more and more inhumane for millions? What kind of world rewards criminality with legitimacy? I feel desperately sorry for those who are living under this tyrannical rule and feel they have no choice but to put up with because it is their home. Obviously I know that the issue of humans and their attachment to land is complex and people have always valued land more than most things including significantly their lives. And there is the small issue of the walls around Palestine so many cannot merely leave and move onto greener pastures. What a hot mess!