Twelve months can go by in the blink of an eye or a painful minute by minute slow-mo. We have all experienced those years that cement our lives, define who we are, or are simply packed with some of the best – or some of the worst memories we have stored. I am 2 days away from finishing my junior year as a doctor in London. Looking back and re-reading some of my old blogs from July and August 2013 makes me realise how so much has changed, and how much has remained unmoved. With a year as a doctor now over, I wanted to reflect with you….
MY LOVE OF MEDICINE
We all start out as eager pups when it comes to medicine, drunk on the knowledge and drama of episodes of House and ER, keen to become the best, most knowledgeable doctor that we can be. When I first started out, I quietly wanted to achieve this, for with knowledge comes confidence, and with confidence comes a lower level of stress! My greatest fear about medicine was being confronted with a situation or emergency crisis that I simply did not know how to handle. Many sleepless nights were had, particularly just before an on-call (where the chances of isolated emergency crises may arise with more probability), with visions of patients dying because I simply didn’t have the knowledge. Thankfully this never materialised and maybe it is one of those never events – because deep down you can always do SOMETHING to make the situation better. I still love medicine as a subject. I love the human body, human physiology and the science behind how we work. Perhaps though, I am more cognisant that there is so much more to learn. This frustrates me as there is just not enough time – I want to know more about how we, as a complex biological system, work every day, but I am always just too exhausted or simply still at work. I think that my love of medicine has evolved slightly as well. The more I see of medicine, healthcare, and the people and patients within hospital, the more I realise my passion rests in their wellbeing. This is a global measure of a person and focuses on aspects like good nutrition, stress, physical activity, sleep and so on – not rather the complexities of a patient’s glomerulonephritis and their anti-GBM antibody profile. There is a lot of work to be done in the area of health and wellbeing and its one I find myself increasingly drawn to it.
Being a doctor is hard. I must confess that I nearly quit medicine every year while at medical school. My poor family have been up and down with the decisions I have made or threatened to make (such as quitting medical school). The job demands you to disregard other aspects of your life and despite the glory and drama shown on televisions, the reality is very different. The pressure can be immense, the work load punishing, and the thanks for the sacrifice, well, obsolete. I hate the attitude of ‘well it was hard for me so it should be hard for you’ since while I agree on the right of passage to earn your spurs, we should always be striving to make the system better, work less demanding and more efficient and harness a team ethos. For a team ethos to work you need a team. Over the year I worked with brilliant teams in intensive care and anaesthetics and not so great teams elsewhere. This is not necessarily because the individuals were not team orientated but because they just were not there. The best example that I can give of this is in the general medical job that I am just finishing up, I am the only ward doctor 90% of the time – all decisions rest largely on my shoulders – and while it has made me stronger, it has emotionally exhausted me – and I feeling that at present. If I was being honest, the job as a doctor is not what I thought it would be and it has indeed left me with questions about the future and where I should be directing my career – is it in medicine or outside of it? If I am honest it is leaning to the latter. This saddens me somewhat but then excites me at the possibility of venturing out into the health and wellbeing sector on my own and using all of my energy, enthusiasm and passion to make a different. You should always follow your passions. Plus, I do like the idea of being my own boss!
I won’t lie – it hasn’t been great. I am yet to meet anyone and it is something that increasingly bothers me. I was optimistic at the start of my junior doctor year coming into medicine, being in London, and getting out there to meet ‘the one’ – but it just hasn’t happened that way. When I look back at the year and ask myself “why?” I do have a number of reasons that include being too exhausted to even want to go out on a date, not being able to get back from work much before 8pm to even get to meet a date by 9pm, having the weekends to sleep and just enjoy some peace and quiet and things I know I will enjoy – rather than trek out to meet someone I may not like. Haha, yes I know, I know, writing this I do sound a little sorry for myself and well, I guess I am a little. Still, nobody likes a moaner so I will persist and hope that someone is around the corner and all these feelings will change. Rather amusingly I have been on a few dates where the girls have said “it won’t work as doctors live for their jobs”…it was hard to deny. Now that’s sad! Let’s not mention the girl I nearly had to get prophylactic cover for after we went on a date and then I found out the next day I was potentially exposed to a dangerous airborne pathogen in intensive care…!
Thanks to my amazing family, I am stubborn, hard working, and driven. This means that I don’t like to leave a job unfinished. Now while this is great in many spheres of life and I thank my lucky stars every day for having such a wonderful family – the downside is that I do stay late at work and I do the extra bit of work, or finish up the last discharge summary or missed set of bloods. This means personally I loose out on my time at home or resting. Over the year this has worn me down. And it is my own fault and people often say “oh, just leave – it’ll get done eventually” – that isn’t my ethos. My family have also made me kind – and because of that I will stay and talk to patients, don’t stone-wall their relatives and try to make time for the things that people may often say “that’s not a doctor’s job”. Well I would argue that sometimes we all just need to muck in and help out and sometimes that means doing the things you may not be meant to – in healthcare nothing should be above your station. I would also like to think that I have a lot of patience, rarely loose my temper and make people feel uncomfortable. Much to my disappointment, I have lost my temper at other people (staff not patients), raised my voice and made people feel uncomfortable. These instances (the most recent being last Thursday) have usually been at the end of a day in which there was chaos on the wards, no support and I was feeling the pressure. I must say I always cleared the air and apologised and we have continued working together (as are the highs and lows of any relationship or team). Worryingly for me this is a quality that medicine and working as a doctor has drawn out of me – I was not like this before. I don’t like it and it does concern me that this has surfaced after only a year in the job. This is not the sort of person I wish to become and so if need be would walk away from medicine to preserve this.
I smile at the thought of this section because it is very much like a yo-yo. Some weeks I’m up, some weeks I’m down – and it is, in all honesty very difficult to decide which one predominates. Currently it is down as I have had a very tough few weeks on the wards and this may be reflected in the tone of this blog (don’t worry, I am sure I’ll bounce back to hyperactive Nick shortlty!). The frustrations, stress and pressure of being a doctor in combination with my personality traits of wanting to do well, hating to make mistakes, and always wanting to be better and more effective at what I do, act as a pestle and mortar slowly grinding away my mood. You see, medicine doesn’t allow you to progress at the rate YOU want – it is a slow insidious process that happens at ITS pace rather than the one you set. I am inherently a positive, aspiring, a massive dreamer and a happy person – all the qualities my family instilled in me (I know I keep harping back to them but they made me who I am and I am so grateful for that!) – And medicine does not seem to have promoted these but instead demote them. This to me is utterly unacceptable. Maybe this will change as I progress into my Senior house officer (SHO) year. If it doesn’t, I will take further action – he says dramatically…!
After a year of medicine, there isn’t a cannula I can’t get in, a blood sample I can’t get or an arterial blood gas that can’t be acquired…I am a true blood-hound! The same goes for putting in urinary catheters (though big prostates always prove a little trickier), nasogastric tubes and, although a little harder, even the odd central line! Perhaps I have a procedure fetish? – I love that aspect of medicine – and it is perhaps why anaesthetics and intensive care was such an enjoyable rotation for me. The other aspect that has improved, that I noticed compared to starting as a doctor, is the ability to assess an unwell patient. Over the year I have written numerous blogs about how I assessed sick patients either on-call, on the ward, in A&E or even intensive care, from those with severe sepsis to those who were having a cardiac-arrest. The confidence in me to assess someone unwell has moved on leaps and bounds – a very comforting process. Of course there is still an awful long way to go and lots of learn about managing the acutely unwell patient but when asked to review a ‘sick patient’, it no longer fills me with the fear and dread that I had with my first few months as a doctor.
Now despite everything I have said, I am a calmer doctor than I was a year ago. When my bleep rings off I don’t flinch with fear, as mentioned above, when I asked to review a sick patient, I don’t panic, and when all hell is unfolding at the rate of knots on the ward, I am less panicked. There are three reasons that I can put this down to; firstly as I have gained my experiences, my knowledge bank has improved and so I am more comfortable with managing the situations (as, most likely I have experienced similar ‘nightmare’ days – and survived them); secondly I have realised that you cannot control everything, that some chaos does just happen and that you have to learn to let go and not hold onto control so strongly as it can be counter-productive and ineffective; thirdly, and this goes particularly for my last rotation job, I have to be ‘seen’ to be in control – for the nurses, healthcare assistants, patients and relatives will most likely turn to me as the doctor for the answers and re-assertion of control. Thus if I am running around panicked, this will just fuel the fire. I should also add, mind you, that we have some amazingly experienced nurses and health care professionals in the NHS who would equally and more capable of managing these situations – it is just a sad fact that there is still this perceived (and misplaced, in my opinion) hierarchy in the NHS – with doctors higher up.
MY PHYSICAL HEALTH
As I am typing this blog on a sunny summer Sunday morning, I am in agony, just about able to lift my arms up off the table. You see I have started back at the gym yesterday (I bought new trainers to motivate myself!) after 10 months of very little deliberate gym or fitness work. Life as a junior doctor is very poorly compatible with exercising three or four times a week – well for me at least. I mean by the time I have got up at 5.30am, worked all day, got home at 8pm, eaten, I am already thinking about bed in an effort to salvage the 6 hours of sleep I may be able to muster! That said, I bet that I must cover a good 5km running up and down on the hospital wards – and that, plus all the countless missed lunches, would account for my 5kg weight loss this year. That is going to change, I will no longer, I have decided, stand by and let this happen. Hence – new gym membership. New attitude.
SUMMARY OF A YEAR
My year as a junior doctor has been challenging, exciting at times, and difficult. It has brought with it untold emotional and psychological questions for me about what I want from life and whether medicine can deliver it. Physically I don’t think that I am better off but I do have no doubt that I am mentally more robust having experienced first hand people go through loss, suffering, stress, pain and anguish – but I have also seen joy, relief, healing and happiness. I have seen good nature and bad nature but over-all I feel comforted by the knowledge that kindness is out there in a world that the media often makes us feel is just out for itself. I feel that I have come some way as a doctor, cut my teeth in my junior year and survived it. I have only however just tickled the surface. I don’t feel like I have made any inroads at all to having a family of my own and this is something that must change in the forthcoming year – which I guess starts with meeting the right person – or at least getting myself out there. If you are reading this and thinking, that this blog was more about me as ‘Nick’ rather than me as ‘Dr Nick’, well that true and it is for good reason; you see medicine is just my job – not who I am – I still have dreams and aspirations of my own to be healthy, fit, happy, settled and secure, and life as a doctor effects the ability to achieve those. We will see what the next year brings but I am determined to make it a 12 months to remember – and I do hope you will continue to read and enjoy my blogs into the forthcoming year.
Best wishes to you all.