Intensive Care: Love, Romance and Caring

Post Christmas, Pre-New Year – well, I feel like I am in a bit of a time warp – unsure whether I should be reminiscing on the year just gone or looking forward hopefully to the year ahead. There is no doubt that I have a lot to be thankful for. I mean last year (well, technically still this year) I managed to survive medical school finals and my first 5 months as a junior doctor. Along the way though I have had my heart broken a little bit – but perhaps the year ahead will offer something more positive in that regard. It may seem like an odd thing to bring up – romance, love and caring, in a blog that is supposed to be about my trials and tribulations through medicine as a doctor – but you know what – it is incredibly apt and suited to this time of year. I say this for a number of reasons; Firstly, I feel very lucky that I have a loving family around me because not everyone does. In fact there is a Christmas tree in the foyer of the hospital where people can write and leave tags sending loving wishes to those loved ones that they have lost. I make sure that I read a new one every day when I walk in and walk out of hospital. It reminds me that people will be grieving this time of year for family members and friends lost to illness and disease. It is not always, in that sense, a time for celebration but rather sober reflection and quiet thanks to the people that we have been fortunate enough to have in our lives. The second reason I bring up romance, love and caring is that I have had to fill out four death certificates in the Christmas week just gone – two of which died Christmas Day. It breaks my heart to see those families desperately hanging onto the life of the loved one in intensive care whose very organs – heart, kidneys and brain have all but failed – and only kepy alive by the very machines that surround their struggling body. You can see the hope in their eyes and the fear of losing someone whom they clearly love so dearly. These people will have once been young, fallen in love and enjoyed the excitement of love and having a family. That for them is over and as sure as death is a part of life, they will – and did die. There is very little I can do to ease the grieving of the four families that week gone – in fact there is nothing I can do. It is a pain I have yet to personally experience and to be honest I fear for it when the time does come. The third reason I bring up romance, love and caring is that I had someone whom I cared very much about this week tell me they wanted to not pursue things any further with me. As someone whom I was excited to see a future with, and have it ripped away, I guess makes me ache a little more for it. Will it come in 2014? Well I can only hope and see what the next 12 months bring. In the meantime I will try as best I can to support those who come to intensive care to see their loved ones in such grave states and to remember that we all deserve compassion and love – not just at Christmas but all year round.

Merry Christmas to you all and I wish you a 2014 full of good health, happiness and love.

Dr Nick

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The Star Wars of Medicine: Intensive Care Unit

So last week I finished up surgery. Walking away from the battle-ground of surgical wards and operating theatres was a fairly liberating experience. Bloodied and bruised from my 4 month encounter with perforated appendices, angry surgeons and post-operative infections and sepsis, I was relieved and exhilarated all at once. I had, after all, folks, just survived what was my most dreaded junior doctor rotation. With that box ticked, I look to the future. What next?

Intensive Care.

What a contrast. Walking onto the intensive care unit transported me into the future of medicine. Each patient was neatly packaged into one of the 8 bed intensive care unit’s bays, with several large machines all connected to them and an authoritative nurse sitting at the end of each bed marking down the numbers on an over-whelming large piece of recording paper – heart rate, blood pressure, urine output and so on. This really was meticulous medicine.

It’s a good time to say, that a bit like Ronsil “does exactly what it says on the time”, these patients are also all very very sick – and hence requiring Intensive Care. Here, The majority heavy sedated, intubated (i.e. a tube is put down their throat to pass oxygen rich air in) and ventilated (i.e. mechanical breathing done for them, rather than you or I’s automatic breathing we do without thinking). They all without fail have tubes going into veins and arteries in their necks, forearms and groins with baffling names like “central line”, “art line” and “vascath”.

The Unit too is constantly met with the chorus of machines…..“bleep…bleep….bleep”. And of course the all too often cardiac arrest buzzer. They after all, very sick here.

And you know what it all looks terrifying to the untrained eye. I consider myself, by the way, currently in that category – untrained. The only positive I can see at the moment is that I know what all these lines, tubes and machines are for (although have no much idea at the moment of how they quiet work or how to put them in – though that will come with time) and that everything that is said and done is for the patient.

I am only a week in but already I understand that medicine on intensive care is about optimising the human physiology to the nth degree. It is fine-tuning for survival – life and death. I find this fascinating and am sure that the next 4 months will be eye-opening, technically demanding, dramatic and emotionally draining. What an experience I am in for….

Speak to you next week.

Dr Nick

 

The Hierarchy of Hospitals

It’s wonderful that when I meet people outside of medicine. For they actually think I know what I’m talking about, show interest in me with a genuine curiosity about life as a doctor, and well, make me feel like a human being. If only it was that way for those within the inner circle of medicine! For you see, within this inner circle exists a very clear hierarchy – and I, ladies and gentleman, am very much nestled someone near the bottom.

And on that note I would like to tell you one of the first gems of knowledge my junior doctors and I had imparted on us at the start of our surgical experience:

“Remember – shit rolls downhill…”

“Ah!” such fond memories and butterflies in the stomach…..

I joke for I actually had a pretty good time on surgery – I got to slice and dice, diagnose and treat a wide variety of conditions from children with acute appendicitis, to adults with cholecystitis, diverticulitis and acute pancreatitis. Surprisingly more information stuck in my brain than I realised during my 4 month surgical rotation as a junior doctor it seems. However, boy oh boy, is there a hierarchy!

Let me explain how this works. For each hospital team there are various layers. At the top is the consultant that runs that team. They are the top dog, the king pin, all seeing all knowing oracle that can do no wrong. They are feared, respected and revered all in one. Below them are the Registrars. Now this come in various grades – from the senior Registrars that are knocking on the door of becoming a Consultant to the more junior registrars that have more time to go. These are your middle-grade doctors who, as a junior are usually your point of call – they run the day to day show while the Consultant does more big-shot stuff. Don’t ask me what this big shot stuff is though (I’ll tell you in 10-15 years time if I ever make it that far along my career!). Now below them sits the senior house officers – “SHOs” as they are known. They act like the big brother or big sister for the bottom rung of the team – the House Officers i.e. Me. Why do I say it like that? Well simply because most of the day to day ward jobs and looking after moderately sick people are done by the House Officers -and the SHOs. So, when we, as house officers don’t know what to do – we go running to the cool head of the SHO. Much like a little brother or sister would do. Just to note too that is indeed how that trickles further up to i.e. when the SHO doesn’t know they go to the registrar – and when they don’t know the registrars run to the Consultant – usually in a hail of facts and figures about the patient and how they are on the brink of death unless the Consultant puts down their golf club or BMW magazine and comes straight away! Oh course I jest…it’s usually an Aston Martin mag….

So that’s it:

 Consultant -Senior Registrar –Registrar -Senior House Officer -House Officer/pond scum.

Oh and then there are of course the medical students too. But from my experience as a medical student, they may as well be a weak fart that people tend to shuffle away from. (note: as this is the case for medical students I do try my very hardest to be nice, helpful and teach them…but the fact is that being less than a year qualified myself, the emotional scars of my medical student experiences are still too raw to be around them!!)

Now as I said at the start of this – shit does truly roll downhill. Whenever something goes wrong it is usually the house officer’s fault. Amusingly this is the case even if we WERE on annual leave back in Essex (yes, me)! How we, as junior doctors, learn to deal with this is varied. Some of my junior doctor friends fight it until they are blue in the face, proclaiming their innocence until they are an exhausted heap on the floor of some operating floor after all the ranting and raving, moaning – and of course, wishing they were in a vet. I on the other hand do tend to just smile. I mean, come on, what’s the big deal – it’s done now – they’re just looking to offload the blame – so fine, no skin off my nose. In that way, it blows over in 5 minutes and we are all playmates again. Simple. Plus, I’ve wasted no energy in moaning (which, after-all, is not good for the soul!).

Does medicine need to have a hierarcy? Well, you know what, it probably does, yes. In a job where seniority and experience counts for a lot, we need to know whereabouts the person we are talking to sits on the ladder of importance. Without knowing that we could spend way too much time talking to someone far too junior – and in the blink of an eye and wasted time, the patient in question dies.

As I type this, I have finally finished my time on surgery. I hope you’ve enjoyed my thoughts on my time there. Next on the agenda is 4 months in Intensive Care. This will be another world full of technology, detailed human physiology and most likely a lot of cardiac arrests. Let the games begin..

Dr Nick

Reflection: 12 months of change

So today marks the beginning of the Festive Christmas Season. December 1st. The decorations go up in a flurry of mal-coordinated enthusiasm with every colour clash out there hard earned and appreciated for all its glory. So too, goes up the tree which is unceremoniously shrouded in tinsel and ball-balls. All of course to the melodic backdrop of Slade and lest we forget, the first lady of Christmas songs – Maria Carey – the ONLY time of year her song is allowed on repeat. It is quite simply synonymous with Christmas.

Let me try and describe to you the scene from where I sit typing this. I have a mince pie steaming by my side with a glass of mulled wine, a beautiful 6ft Christmas tree with an explosion of coloured tinsel, decorations and lights. But that’s not all, the walls are draped with art covered tinsel and ornaments of polar bears, beaten up and aged Santa Clauses, and reindeer covering every corner of shelf space. Of course, Maria Carey is also playing.

I am bloody lucky. I know that. As I sip the mulled wine and take in the Christmas magic that has unfolded in front of my eyes I smile. I am a junior doctor who has just survived his first 4 months of a surgical rotation and am about to move to Intensive Care for 4 months. I enjoy my job and I am excited to go to work tomorrow. I am eager, switched on and driven at this very moment in time. I have a wonderful house with great people, great friends and a bullet-proof family supporting me. I’ll say it again – bloody lucky. My pressures in medicine are ones that I place on myself. I want to be successful as a doctor. What defines success? For me it boils down to delivering safe and effective care to our patients – AND being happy and healthy myself. The two must go hand in hand if there is longevity in this work.

My mind drifts back to 12 months ago. A 30 year old, dirt poor student living in student accommodation in a box room with what felt like the weight of the world on my shoulders. Questions circulated my head like vultures on prey – “will I pass medical school finals?”, “will I get accepted into a London hospital or have to move away from family and friends?”, “Will I be able to cut it as a doctor?”, “Will I even enjoy it?”. They plagued me – especially in the thick of night. Life as a medical student was very hard. You are without clear purpose in the hospital setting, merely tagging along to clean whatever snipped of knowledge you could get – while at the same time avoiding looking like an idiot in front of a doctor. It is hard. I sympathise with all medical students and try to be as nice to them as possible when I meet them on the wards (unless they are rude that is – in which case they get nothing from me but a cold shoulder!).

How so much has changed in the last 12 months. Life as a doctor compared to a medical student is so so very different. I am excited for the future. A year ago I was terrified of the future. It is amazing how time heals, moulds and shapes our hopes, expectations and worries.

Now I started this reflection by saying that I know I have it good currently. I think it is important I know that for another reason other than to put a smile on my face. Not everyone will have a nice Christmas. People will be homeless, scared, lonely, abused and grieving. For them Christmas will be an anchor on these painful emotions that will drop every time around this time of year. I can’t solve all the problems – none of us can. However, as Mother Theresa said [paraphrased] – “start with the person nearest to you, and don’t worry about numbers.” If I can do that, it may help someone. If we all do it, it can help a lot. Be kind to people this Christmas period – it costs nothing but is invaluable.

Right, it’s time for a Christmas movie. Of course, it has to be LOVE ACTUALLY…

Dr Nick