Tag Archives: shock

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

When You Argue with a Fool

Have you ever had an argument that goes round and round in circles, never-ending with no point to be made? Where the person you are arguing with seems to be in a monologue? Where their comebacks are so off the mark that it feels like you are in a different time-zone? Where hitting your head hard against a concrete wall might be more productive?

I have and it used to annoy me so much that I’d get really upset and want to stamp my feet. And I used to try and reason with them and try to get them to see that the argument was entirely useless and was going nowhere. Now that I am older and wiser and my fuse less short, I deal with it in one of 2 ways. Either I say ‘look this argument is going nowhere and I don’t have the time for this’ or I just say ‘we will have to agree to disagree’.

I will confess something. I copied that 2nd response off somebody older who I admired when I was teenager. I remember the first time someone used it on me and back then, I couldn’t handle the maturity of it. Back then I thought everything was black or white. I thought every argument had to end with a winner and a loser. Now I know that there are many shades of grey in between (no, not 50 shades child!). Knowing that the world isn’t so binary makes arguments less upsetting for me.

I can now acknowledge what is fact for me is not necessarily fact for another because we are all shaped by different factors. We are shaped by our genes, our environment, our family, our friends, the media, our education, our beliefs, our religion, our culture and much more. Most important of the factors that shape how we view the world is our experiences. Hence, some of the things I would have argued successfully so passionately for 10 years ago, I am not so sure now are as I argued. Yes I enjoy a good debate but I am the sort that will not be dragged into an argument unless I have strong views on the subject and I have very solid reasons to back up my views. Fact is, I do not back away from an argument and I am often successful in getting my point accepted or at the very least acknowledged by my debating partner. But I choose what I will be sucked in by. And more importantly by who.

Which brings me neatly to the quote I have used as inspiration for this blog…‘don’t argue with fools, people passing by won’t be able to tell who is who’. It is my belief that arguing with someone who you know is arguing for all the wrong reasons is a complete waste of your life. This wrong reason might be that the arguer loves the sound of their voice and they are using you as a sounding board. Or they want to impose their beliefs on you because they do not think yours are important enough. Or they say things they don’t believe in order to shock or upset or entertain the passers-by. Or they want to score points. Or they are angry or upset or stressed about something or over someone and they want to take it out on a scapegoat. Or they are arguing for the sake of it, not because they believe in what they are trying to convince you is true.

These days, with my adult hat on if I spot the arguer with these wrong reasons and they ask an opinion so they can start a diatribe, I simply say: ‘oh good question but I am afraid I don’t know much about that. I’ll pass.’ Or ‘how about you tell me what you think’ or ‘I would be lying if I said I care about that matter’. Then I listen until my patience runs out and I find an excuse to not be in the same space anymore.

If it is a proper friend and they pick an argument over the littlest thing, I will usually get worried and ask if they are okay…really ok or if there is something they need to get off their chest? You know the saying ‘when you ask a woman what’s wrong and she says it’s nothing…’ Well fact is, when your sister/mother/husband/friend who you usually get on with great starts to conjure up arguments from the most innocuous conversation, then they are asking for help. Something is up and they want permission to spill. They want you to listen. So please, instead of entering into a slanging match, give them a hug and invite them to tell you what’s really bothering them. Chances are that they do not really think George Bush was a good president or Apartheid wasn’t all that bad.

The Original Aisha A Joda

So my name is Aisha A Joda and I am the 2nd in my family of the name. I was named after my grandmother Mammie who died 11 years and 2 months ago. She was taken too soon but at the same time, she lives on in her children, us the grandchildren and now her first great-grandchild. Of our generation, the only people that remember her clearly are my sister (the 1st grandchild), me (the 2nd), Michelle (a.k.a Aisha the 3rd), Jeff (a.k.a Ahmed the 1st of our generation), Ahmad a.k.a Baby A (the 2nd grandson Ahmad) and maybe to a degree Huwaida (a.k.a Aisha the 4th) who was only 3 when she died.

As I have 18 years of memories to share, I don’t know where to begin with Mammie’s story from my perspective. I will start from the last time I spent with her. She came to visit in London and unfortunately had a last minute conference or board meeting she had to attend so she had to leave us together for 4 or 5 days and nights. In all my life, I could not recall ever it being just me and her. For the first time, it was just the 2 of us…Aisha Joda, the first and second. I remember worrying about what to cook for her and what we would talk about and whether she would be difficult to please. I had nothing to worry about. She was as sweet as sugar and warmer than a loaf of fresh bread just taken out of the oven. All she asked from me was help to bring down a mattress so she could sit on the floor when she was watching TV and then taking it up stairs each night when we went to bed. And she wanted 2 hot water bottles because she could not get warm enough despite the fact it was only October and it was a fairly mild autumn. Being a teenager, I remember being uncharitable enough to think she was just being difficult asking for the hot water bottles but still, she was my mama’s mother and so I did as she requested every night and I even took them up into her bed as she seemed to struggle going up the stairs. Every night, she would say thank you and I would think ‘what for? I haven’t done much’. She would hop on the bus every day for some shopping and come back with some lunch because she didn’t want me to bother cooking as I was going to college (A2 year). We talked as we never had and she told me stories that made her laugh so had her shoulders would shake and she would clutch her bosom.

On the 3rd day, she came to me and said she would run out of her oral hypoglycaemics (medication for her type 2 diabetes) the next day and she didn’t want to go all the way into central London to see her private doctor for a prescription. Looking back, her unwillingness was probably because she was feeling unwell. Perhaps from her rheumatoid arthritis. Anyway, I took matters into my hands by going to my GP and telling them I was home alone with my grandmother and she needed a repeat prescription urgently. I didn’t even know but OAPs in England, even non-residents were entitled to free emergency drugs and this situation qualified her for it. Within minutes, we left the GP surgery clutching a prescription and headed straight for a pharmacy. I will never forget the look on her face as she thanked me for sorting it out for her. I protested that she didn’t have to thank me; she would have done the same for me. But she said ‘I thank you anyway. You saved my life’ and I could have sworn she had a tear in her eye. Crazy Mammie I thought although secretly I was pleased I could sort it out for her and that she was so happy over the little I did. Also secretly I was ashamed that I had grumbled in my heart for one second that she wanted hot water bottles when it was such an easy thing to do. The other 2 nights, I did her hot water bottles extra hot and took them 15 minutes earlier than bed time so that the bed was toasty warm when she made it up the stairs. I also put on the heaters for longer because I figured my mama would rather her mum was warm than save on the bill. One memory I will never forget is of her standing by the living room radiator that I had just switched off before bed and pressing the backs of her legs and hands on the warm metal to get a final warm blast before we headed upstairs.

She was to go back on the Thursday morning on a 5am flight and my mama came back the night before. I remember waking up despite loving my sleep those days and watching my mama and her mum get ready for the airport. She was wearing a black abaya that last morning I saw her and it had little crystals on the neck and sleeves with a matching scarf. I remember saying how beautiful she looked and teasing her about wanting to look good for our husband, my granddad (long story about the our husband thing). She laughed and said she wasn’t going to see him for another couple of weeks as she was going to Kaduna via Lagos and he was in Abuja for a work thing. I hugged her as she left and said safe journey. I watched them head out the door, never thinking that was the last time I would see her or hear her. My mama later said she had got Mammie special assistance so that she would be driven on those airport buggies because the walk was too long and she didn’t want Mammie to get too tired. That was the last sight she had of Mammie I am sure…Mammie on a buggy/transporter thingy, facing my mum as they drove her to fast track check in.

My love of Disney movies comes from Mammie. She had the whole collection of videos back in the day and whenever she went to the US to visit her 2nd daughter (my only aunty), she would come back with all the latest and we would go over to her every day for a video until we had watched them all then we would go back to our old favourites. She had watched them so many times that she knew every scene and every time one of her favourite scenes would come up, she would recite the lines and laugh with them. She also always had a large box of Thornton’s chocolates and would allow us to choose one every night after dinner. Of course being children, 1 was never enough so we usually stole an extra one sometime before dinner. We thought then we were clever and she wouldn’t know but I know now that she must have known but she never said. And somehow she always had another fresh box waiting when the current box was empty. Dinner in Yola was always in the formal dining room until I was 11 or 12 years old. Before that, the table was always set with proper china and silver cutlery with a fresh linen table cloth and matching napkins. My granddad sat in the centre chair by the window and she always sat opposite him. Then my sister and I would sit next to our husband and tease her for not being next to him as we were. Despite the air-conditioning and the closed door, there would inevitably be one fly in the dining room and Mammie hated flies with a passion. She would spend half of dinner flicking unsuccessfully as this sole fly that seemed to want to play. She was a very slow eater anyway and it was made much worse by her fly obsession so by the time we were done with dessert, she would be just be finishing her mains. She would take her dessert (which tended to be fruits) into the parlour (sitting room to you) and eat it as the children watched TV and she and the grownups had a good old natter.

I think she went through the menopause when I was about 4-5 years old. I remember saying to my mama and sister that she was always grumpy and I know I always wondered why she was always complaining of being hot despite it being about 20 degrees in her parlour with the A/C on. She would fan herself on and off all day and mutter about how hot it was. And sometimes she was short-tempered with the house servants and occasionally us. Oh and she had house-clothes that she would wear when she was indoors for comfort. It was obviously clean but in my young mind, I just thought it was a little unhygienic and eccentric since she had wardrobes full of beautiful clothes. Talking about her fashion sense, it was impeccable. Her hair was always neatly plaited and looking at her pictures of her in her 30s and 40s, she used to have all the latest fros and perms. She loved her shoes too and had 2 large shelves of shoes in her dressing room. My fit used to fit into her shoes and I would spend hours trying them on when she was in the kitchen supervising dinner or talking to adults. Sadly, I outgrew her size 3.5 feet when I was 11. Her makeup was always Clinique and her latest perfume Estee Lauder.

Being Fulani with our pulaku culture, public displays of affection in adults isn’t the done thing but being a little girl, I cared not one bit for that societal norm. we spent a lot of time in the holidays in my grandparents’ home and my mum would join us after work with or without my stepdad. I would happily hang with Mammie and play with my sister Charo and their dogs and tortoises and run from the geese. However, as soon as my mum arrived, that would all cease. I would run to her and hug her like I hadn’t seen her in a whole year and not 8 hours and cling to her for the next few hours until we went home. My grandmother would look on in amazement and several times she would ask me ‘aren’t you embarrassed’. Meaning wasn’t I embarrassed to show such a blatant preference for my mama over everyone else. Being precocious, I would look her straight in the eye (another thing children don’t do) and say ‘no!’ as if it should be obvious that I love my mama above anyone else. She would shake her head in amusement and give me a playful nudge as I sat as close to my mum as humanly possible.

Another memory that stands out is when my mum had travelled and we were staying with our grandparents. Mammie realised we were bored and decided to brave the heat and take us out for a drive. My sister was feeling helpful so she took the keys from her handbag to open the car and let the heat out before Mammie was ready. Of course Mammie had no idea and came out the entrance hall where her bag was and opened her bag for the keys. She didn’t find it and looked high and low for it, never thinking it would be in the car. My sister and I got bored of waiting by the car and came back to see what was keeping her. The memory of the sight still makes my sister and I roll about in laughter. It was a proper lol and lmao moment. We watched as she frantically rifled through her bag and started to shake onto the rug in frustration and we realised she was after the keys we had taken. Woops. We were beside ourselves with laughter at the frantic way she searched and at the same time, our hearts raced as we thought of how we would tell her that her search was fruitless because we had the keys. I don’t remember who told her but one of us did and she was relieved and exasperated all at once. We managed to control our laughter but for days after, every time we were alone we would mimic her search and fall about laughing. We still laugh at the comical image. You’d have to see it to understand just how funny the image was. LOL.

Mammie never forgot a birthday or anniversary. She was like a walking calendar and she not only remembered her children and grandchildren’s birthdays, she remember all her friends and their anniversaries and she had a card for every birthday and for the grandchildren she always had a present to go with it. To this day, a lot of my jewellery is from Mammie and I am still reluctant to buy anything precious because most of my precious stuff was Mammie related. I am having my Yola wedding celebrations in the coming month and the intention is to wear of Mammie’s many sets of jewellery as my way of including her in the day. Because she also loved to celebrate occasions and would have been dressed to the 9s and sprayed us all with her mint notes, squirrelled away in case an occasion necessitating money to be sprayed.

The call came on the 6th of October at around 7am. I was fast asleep as it was a Sunday, the day of lie-ins in my house. I suddenly snapped awake and looked around in confusion. I got up to go to the bathroom thinking maybe I was woken up because I needed the loo. I sat on the loo and nothing happened. As I went to get up, my mother’s mobile rang and I stood by her door to listen, curious why someone would call so early. All I heard was a stifled cry and then nothing. I felt my heart sink as I stood frozen by her door and I assumed my granddad had died. After about a minute, I pushed open her door and she looked at me with eyes brimming with tears and choked out a word ‘Mammie’. I remember holding her as we both wept and not knowing what to say or do. We must have been there for maybe 30 minutes, eyes dry and staring blindly into space. We were awoken by the phone ringing. The first of dozens of phone calls from her brothers and sisters, cousins, aunties, uncles and friends. Our doorbell was soon ringing too.

I won’t dwell too much on the aftermath of Mammie’s death but I will say I am so glad I got that last few days with her. My name is from Mammie. My looks are from Mammie. I eat slowly like Mammie. I love Disney Animation movies like Mammie. I am heat-intolerant like Mammie. I can find a bargain like Mammie. I love to laugh like Mammie. I think one of the biggest compliments that someone has paid me in the recent years was to say that I am like Mammie because I love family and I make the time to go see everyone when I get a chance to visit Nigeria (that is called Zumunci in the lingo). I hope that I can continue to carry on some of the greatness of the original Aisha Joda and I hope that if Mammie is able to hear or see me, that she is proud of the woman I have become as she was always proud of us all. In fact I know she would have been proud that I am who I am today. Aisha Joda, Mammie, my grandmother. You may be gone but you will never be forgotten!