“The paediatrician is here now” the theatre nurse announces. I smile sheepishly knowing full well what lay ahead…
And there I am, standing next to the neonatal resus table, under the glare of the harsh surgical theatre lights, as yet another life is brought into the world by caesarean section. As the obstetric doctor proudly raises the baby, dripping in its own urine (and often faeces if it’s gotten a little stressed) I gear up for my part. Sorry, that should be ‘he’ or ‘she’….calling the baby ‘it’ isn’t really the warmest welcome to the world is it now. But then again, I suppose what happens next isn’t a particularly warm welcome either…
You see for I, GP trainee Nick, on my paediatric rotation – am the BABY DRIER.
Yes, for once this messy bundle of life comes out into the world, and after a quick hello with mum and dad, they are whisked off to me. Now while it is true that I am there in theatres to provide neonatal resus care to any babies that have a high risk of coming out unresponsive, blue or floppy (all bad things) thankfully that has only happened on a handful (of what is many now) deliveries that I have attended – day and night.
So here they are, dunked onto my resus table like an awoken hibernating creature. They normally look irritated, cold, wet and generally like they don’t feel like breathing (Don’t be followed by TV – babies look a mess when they come out). And here is where I, the baby drier, come into my own. You see best medical wisdom states that in order for a baby to breathe and generally adjust to life outside of mum, the best thing to do…is rub them with a towel. Lots.
And that is what I do. I rub the baby with three different sets of towels (for when one gets damp, I swap it out for another one – warmed under the heated lights of the resus table). 95% of the time, that works and the baby goes nice and pink, lets off a roaring cry and I can finally breathe.
The other 5% of the time are heart in your mouth moments that have an unbelievable way of focusing your mind to that baby and only that baby VERY quickly. For today however, let us all be thankful for the days where paediatric doctors (or GPs training on a paediatric rotation!) just have to be…the baby drier.
Mind you as I hand the baby to mum and dad, they look at me like I’ve performed a miracle. I don’t have the heard to say it’s just like drying the dishes when you’re in a rush…
I wish you all a great end to the week.
Familiarity is quite simply knowledge of something. That can of course be for better or for worse. I mean, I am familiar with how I feel with my 6am alarm but that doesn’t mean I like it. On the other hand, I am familiar with that wonderful feeling that I have when I take my first sip of morning tea to start the day. The thing is, in order to be familiar with something, you have to experience it repeatedly. What I want to talk about is that sensation of unfamiliarity and how we need to stick with it so that it does become familiar.
Now being a doctor definitely has its downsides. One of those big downsides for me is unfamiliarity. I, along with all the other doctors that go through their medical school placements and then their speciality training rotations will encounter this. For me, it is made all the worse because I am always, unequivocally lacking in my confidence as I start a new training post. So there I am, every 4 months – starting a new unfamiliar training post with no confidence. It is such a pain in the arse and very much a ground hog day experience until I fully quality as a general practitioner – and then, onto Sports and Exercise Medicine!
So let me give you an example; at the end of July, I would walk onto the gastroenterology every ward – a familiar ward, my medical stomping ground, knowing ever little corner of it, the staff, where I can hide my coffee without my being told off my the ward sister (aka the boss). I was comfortable. I was confident and that translated into how I felt about the medicine I practiced. Fast forward into August and I can’t even find my way to the paediatric ward. I don’t know the staff. I don’t know the expectations of me in paediatrics. In fact, I can’t remember the last time I spoke to a child. I don’t even try and hide my coffee because I’ve spilt half of it down my trousers. So, when I do finally arrive for my first day I am not only late but appear to be incontinent. In short, I was in unfamiliar territory.
As type this I have just finished a week working my 9th week in paediatrics. I can now navigate a babygrow effortlessly having conquered this, the rubix cube of the garment world, I have resuscitated babies and I have dealt with unwell children as part of the paediatric team. I no long wear my coffee on my trousers but in a mug – with its own hiding space. In essence, I am now familiar – and happier for it.
So why am I am talking about familiarity? Well, it’s something that affects us all. It’s also something that grows and evolves with time – and as it does, so often does our confidence, knowledge and application. And that is why we need it! We need unfamiliarity to stretch and unceremoniously push us out of our comfort zone. That, afterall is where we grow. Stay in familiar territory for too long and we stagnate. Nobody wants to stagnate!
My worry however is the period before we feel this confidence and the risk that many of us let our heads drop, let our motivation wain and we quit. I have definitely been there with my career in medicine – constantly taken out of my comfort zone, constantly questioning my ability, and constantly considering leaving medicine. But you know what, every time, and I mean EVERY time, I get through that period of unfamiliarity – and in its wake is familiarity, more confidence and more application. Now of course, yes, like I said in the beginning, it’s not always ‘nice’ familiarity. But you know what, even then I learn how to deal with it – and soon It is no longer a surprise and is an opportunity to adapt and evolve. Afterall if you cant change the situation, change the way you well about it.
I hope that if you are reading this, you to decide to stick with it, to get past that period of unfamiliarity and know that you will get into that familiar zone with progression, knoweldge and application at your fingertips.
And don’t forget – after a while, dip your toe into more unfamiliarity. It’s how we all grow….
This week I wanted to talk about recovery. Now recovery is a word that is used in all sorts of contexts isn’t it – from recovery after exercise to a tough day at work to a horrible psychological event or even a break up. I even recover from a tense episode of X-factor from time to time…
The fact remains however that recovery is incredibly to us. It is about preparing the body and mind for the next iteration, the next stage of being or action. And it is bloody important for without it we can significantly disadvantage ourself.
Of course it’s not just important because we all enjoy some time off from that event, job, task (or person!) – but because in order to perform well – whether that be physically or mentally – we need to have that period of time to heal, reflect, digest and learn from the event.
And I bet you know what I mean it I say that we fail to do that – when we fail to allow recovery to take place – we may find we begin to struggle to perform as well as during the previous event. As an added factor, stress levels can too build as performance drops, so compounding the effects of what was already inadequate recovery.
For me, I’m going the end of two weeks off from a long stretch of busy paediatric accident and emergency shifts followed by a set of night shifts in paediatrics. I was both physically and mentally exhausted. Due to the workload I doubt that my recovery between shifts was probably enough to fully ‘recover’. And so I crawled to the start of my two weeks off. My period of recovery.
And for the first 3 days I slept. Then ate. Then sleep. I was in desperate need of recovery!
I was, in essence, trying to refuel the body and rest the body and the mind. Perhaps it’s because I’m a scientist by background before I became a doctor but to me this was an incredibly important process – not least to have some time away from baby vomit and screaming children – but to allow me to process all that I had done, seen and learned in that stretch of paediatric shifts. To put it in another context, just like when going to the gym and lifting weights, it is the during recovery days afterwards (not the days you lift weights) that the muscle recovers, repairs and grows.
So there we go; Recovery has been a huge focus for me during the past two weeks (and of course yes, I didn’t need that long and indeed I had a little holiday within that and got tasked with plenty of DIY jobs!). Now though I am ready to return to the frenzy of paediatrics, get my hands dirty, learn, experience and keeping moving forward with, for now, a refreshed body and mind. How do I know this? Well because I miss it, I’ve had enough lying around and now I want to start growing as a doctor again.
So I guess my message to you is this – yes, recovery in our busy modern lives can often get left in our blind spot of life – but please try and make sure you ask yourself from time to time – am I giving myself enough recovery? And if the answer is no, then find a way to weave some more into your days. Every little counts.
Have a great week.
I have just sat here for the last 45 minutes thinking about what to write about the junior doctor contract debate. My tea next to me has now run cold, the apple nicely oxidised and I’ve clearly neglected to pay attention to the programme on television as “Beth has a big decision to make….” though I’m not sure who Beth is nor the decision she’s making.
I am a calm man and it takes a lot to make me shift from that baseline. I would also like to think that I am a reasonably educated man, despite occasionally having the mentality to rival my current paediatric patients. The new junior doctor contract is circling us, the junior doctors, like a hungry vulture smelling fresh meat for the taking. All the while however, we, the men and women who have worked so tirelessly to earn the privilege to become doctors stand in formation, ready and willing to slip our hands out of our velvet gloves of calm and professionalism and show that yes, while gentle, we too possess an iron first.
I have my opinion of the contract. I also have my opinion on the precarious and risky nature of industrial action and its repercussions both within our ranks and on our relationship with the public and our patients (Mind you, I count myself lucky that most of my patients are under the age of 10 years – I doubt I’ll get much stick from them). With that said, the American novelist and social critic, James Baldwin sums up the position we, as doctors, are in when he once said, “not everything that is faced can be changed but nothing can be changed until it is faced”. Therefore, we have no choice but to face up and be counted.
While my emotions on this matter are quite simply a melting-pot, my support will be quietly unwavering – not through standing at a picket fence but my unceremoniously slipping off my velvet glove ready to show my iron fist. But until then, I will digress into a mere breath of immaturity and say thank you, Junior Doctor Contract, your timing is perfect – I just run out of toilet paper…
….it seems you will have your uses.
Dr Nick Knight
“Ah, the paediatrician is here” The midwife in the labour ward operating theatre states.
I go to look around for them, while having the sinking realisation that the ‘paediatrician’ – is me.
I smile, opting for the non-verbal response….as it feels less like lying.
So imagine that you have somebody in front of you who is sick. I mean really sick. Having laboured through medical school and clambered the slippery ladder of my first two years as a qualified doctor I should be able to handle this. It’s the simple principles of airway, breathing and circulation (your ABCs…).You see once you have stabilised these you can breathe a little, buy yourself some time, and work out the precise nature of what has made this person very sick.
Only problem is, the somebody in front of me who is sick is 3.5kg in weight, has a head circumference of 32 centimetres and is about as long as my forearm. Paediatric and neonatal (less than 4 weeks of age) medicine has just clubbed me around the face with a wet nappy and then pointed and laughed. I stand over the neonatal resuscitation table in the theatre having been handed a crying, slimy thing that has just produced from mum on the table – with a little help from the Obstetricians scalpel. I dry him off vigorously to stimulate a cry (a sound you always want to hear after a caesarean section as it means baby’s lungs are working) and look at this little fella. He is pink, crying, his chest is rising and falling (i.e. he’s breathing) and has a good heart rate when I listen with my stethoscope (all of which pretty much fills his chest).
For the first time in what feels like 5 minutes…I exhale.
Still this 3.5kg bundle that I am looking after over in the emergency theatre, rather unaccustomedly dressed in my pink theatre paediatric scrubs, needs antibiotics and close monitoring, as mum was a little unwell and there’s a chance of infection transference to him. That means I need to out a cannula in his vein.
DO YOU KNOW HOW SMALL A BABY’S VEIN IS!!!
My first attempt was a shambles. I technically, was over-powered by a baby. The second attempt was marred by my audience of the new dad watching me as I repeatedly poked his new-born child with a needle. The third attempt, by some miracle only known to higher powers, went it. I took some blood from the cannula to check for infection. Again, another new process I soon learned means squeezing the arm of a baby so blood vacuums out of the vein painfully slowly. This again looks horrible to the uninitiated eyes of the new dad…
The above is only a snapshot of the almost vertical learning curve that my new rotation in paediatrics and neonatal medicine has taught me. In the past 2 weeks (having been finally allowed back to work after the ‘hole in the lung’ incident…still ongoing), I have mastered the impossible rubik’s cube that is the baby grow, how to pick up a baby without terrifying its parents – or the baby, how to communicate with children from 2 years to 17 years (something that requires knowing what’s cool…not what you think is cool), and putting on my reassuring face when I really have no idea what is going on. Thankfully I am incredibly well supported by my senior team, who are great.
Paediatric and Neonatal medicine is not just a down-sized version of adult medicine – it is another world. No, make that another galaxy. Their physiology doesn’t behave the same as adults, the history taking and examination is a tailor-made, painstaking balancing act that would rival Indiana Jones when he swapped those bags of sand for the treasures, and the fear of missing a critical condition is something that focuses the mind to a degree that I haven’t experienced previously.
With all that said, I love it. Partly because it is such a privilege to look after lives that are not years, not months, not weeks or even days but HOURS old – and partly because I get to unleash my inner child as I try to engage with these children. An added bonus is I get to wear stickers with smiley faces on my I.D badge…
Right time to watch CBBC. You know, after-all, it’s important to know what the kids watch….
It was precisely 20 days ago that I was at work. It was a Monday morning and I had just finished a busy weekend admitting medical patients from A&E. The Sunday was slightly trickier than usual – I felt like I’d slept in a funny position and my right ribs ached. Still, nothing like a steady stream of patients to focus the mind, and so on I cracked for the 12 hour shift. That night when I got home, however I could hardly breathe. Bent over double on the bed, panting like an expectant mother, I looked to my girlfriend with a glance that said “What the hell is all this about!” I am after all a fit, young(-ish) 32 year old with no medical issues. After failing to convince me to go back to A&E at 1am that morning – my argument being that I’d just spent 12 hours there and I am under no circumstances going back tonight – some knock-me out painkillers, shot of whisky and the classic of all medical inventions – the hot-water bottle (thanks, Mum), I fell asleep….albeit with a breathing rate of 30 per minute.
The next morning things were no better. Being the stubborn mule I am, I still refused to go to A&E – after-all we were short of team-members on the ward. Sadly however, once my registrar saw me hunched over like Golem from Lord of the Rings, puffing away at 30 breaths a minute, I was sent packing down to A&E. I had failed.
Now there are not many perks to being a doctor. With that said, that Monday three weeks ago, I was exposed to one of the greatest cornerstones of the NHS – comradery. You see as soon as I wondered down into A&E, had a quick word with the A&E registrar on the shop-floor saying that I needed an X-Ray to exclude a collapsed lung (that, since I am tall and skinny – well I prefer athletic! – a spontaneous pneumothorax was the most likely cause of my breathlessness), I was whisked into an A&E cubicle. Over the next few hours I had seen 2 A&E consultants, 2 A&E registrars, had a chest X-ray and CT scan, been squeezed into a respiratory clinic that afternoon to be seen by a Respiratory Consultant, and had the on-call medical team drop in to see if there was anything they could do. I was utterly humbled by the togetherness and sense that within the NHS, we look after each other. Now I say all the above not to anger people – and I appreciate some may dislike the fact that I had what is, yes, preferential treatment – but these people whom saw and treated me where my colleagues (for I had spent 4 months working in A&E) and my friends. Throughout the entire process, I spent my time wondering how I could repay them, to show my gratitude for their timeliness in treatment and kindness.
Now not one to be a debby-downer on the situation, let me tell you my two highlights of that day spent in A&E, CT scans and outpatient clinics. The first was the utterly bemused look on one patients face who saw me donned with a cannula in my arm, hospital gown on, being wheeled down the corridor – for I had been the doctor who had treated him only the night before! The second musing was the locum puzzled nurse (who didn’t know I was a doctor) who came in to see me in the A&E cubicle to insert a cannula, only to find me with my own stethoscope listening to my own chest, before defiantly stating that I will insert my own cannula thanks – though as it turns out that isn’t so easy, so I had him do it in the end. Being a patient was a huge eye-opener – you are devoid of control – something that as a doctor, I have a lot of. It brought a definite new respect for what it is like to be a patient. Plus, cannulas bloody hurt!
Anyway, we digress. It turned out that I didn’t have a collapsed lung. In fact it turned out that I had a 2.7cm hole in my right lung – described as a cavitating lesion. Now it is fair to say that this came as a surprise to the A&E team – and to me. What can cause a cavitating lesion like this? Well, many things including infections like tuberculosis or a fungus. And yes, cancer can as well. This latter diagnosis kept me up for a few hours on that first night I got home befor, at around 4am, I decided that I should stop being an idiot – a 32 year old man who has never smoked, has no risk factors and no other symptoms of malignancy – does not have cancer. And so I put it from my mind from then on.
[Initial Chest X-Ray which we expected to show a collapsed lung)
Of course we still didn’t know what it was. The reward for not knowing was an investigation called a bronchoscopy. This is a way to look into the lung and take some tissue to look under a microscope. Now the best way to describe it is this: picture sitting upright in a chair, a little drunk, and then having someone funnelling a slowly leaking hose-pipe down your windpipe and your lungs….all while telling you to “just relax and breathe” in a tone that would be a hit in any yoga retreat. Let me tell you, it is NOT possible to relax…and as for the breathing…well, you feel as though you are drowning. Thank God for midazolam. It was fair to say this sedating drug did its job – I didn’t even recall the first conversation with the respiratory consultant after the procedure.
[Post bronchoscopy – Oh course, I have no recollection of this picture. Bad hair day..!]
Of course from that day that I went down to A&E to get that ‘quick’ x-ray, I have not been back at work. Why? Well, if I did have tuberculosis, I would be a huge infection risk – particularly as I am now moving into paediatrics – and those little people have far weaker immune systems than you or I. As such, while the hospital doctors that are treating me wait to see what bugs grow in the Petri-dish to see if it is tuberculosis or something else, I have to be at home.
Three weeks at home may sound like a luxury. It was hell. I felt a fraud, lacking in purpose, lost even. You see I felt well in myself after a week of antibiotics and guilty that I wasn’t at work. It made me realise how much I value my job as a doctor, how it is part of my identity and that I love that. I am after all, proud of being a doctor and working with such brilliant healthcare teams. Although, it is true that I became a very good house-husband over that time, the itch to return to work never left me. And finally after three weeks of waiting and waiting, I have finally been given the all clear to return.
After all that has happened, two questions do still remain: what IS that hole in my lung? And how can I possibly thank all the people that cared so much for me while I was converted from the doctor to the patient.
Only time will tell…