Like Arnie, I’m BACK. Three years a Doc.

Right, four months is a long time not to write to you all – especially since the one before that was only a flash in the pan about my life as on my paediatric rotation (where, admittedly most of the time was being handed babies all fresh from their caesarean sections 10 seconds earlier, and helping them breathe).
So, with that said I am here to make amends, to take a deep, refresh breath and start again with my blog. After-all, for some of you, you have read about me from the days before I became qualified…So let’s look at the numbers:
THREE years – that’s how long I’ve been qualified now
THIRTY THREE years – that’s how old I am now
EIGHT specialties – that’s how many I have rotated through (surgery, ITU, medicine, paediatrics, A&E, GP….)
ONE year – into my specialty training to become a qualified GP
TOO MANY – that’s the number of deaths I’ve born witness too as a doctor and the number of mistakes I have made as I learn
NOT ENOUGH – births – seeing a life stumble into the world will never get boring
So as I sit here on my sofa, what else has happened in my life. Well, I suppose the biggest change is that I have started watching ITV’s Good Morning Britain and not BBC Breakfast News….
Only kidding. Sorry, the jokes aren’t any better I’m afraid.
The big changes are that I am now happily engaged to a wonderful fiancé, I am now a do-er upper of our new flat, and I am fast becoming familiar with the trials and tribulations of wedding planning, colour schemes and catering companies. The biggest trick of course is knowing when to nod supportingly or when to frown in agreement at her dislikes – though sometimes I still get it wrong.
So there we have it, after three years as a doctor I am now a 33 year old engaged, house-trained (partially) GP in training. A great feeling I have to say.
BUT….and there’s always a but – I want to share with you more of my medical adventures, trials and tribulations on the wards, and my ongoing personal game to see if I can make it as a media medic. So keep reading, spread the word if you can about my blog and follow me on Twitter (@Dr_NickKnight).
I’ll aim to blog every Sunday.
Until next week, stay healthy and happy and keep your chin up.
Nick
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The Baby Drier

“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.

photo (10)

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.

Nick

Recovery: Don’t let it be in your blind spot

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. 

Nick 

The Junior Doctor Contract: Beware the Iron Fist in a Velvet Glove

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.

Loo roll

Dr Nick Knight

@Dr_NickKnight

Medicine for Little People

“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).

Waiting for the baby to arrive on the neonatal table in theatres....

Waiting for the baby to arrive on the neonatal table in theatres….

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.

Lift to freedom at the end of my first long day on the Special Care Baby Unit.

Lift to freedom at the end of my first long day on the Special Care Baby Unit.

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….

The Hospital At Night

It’s 0445am on Saturday 11th July and I am having a rare lull in my night shift. …

You know, the hospital at night is a unique, thought-provoking experience. It’s the time when all the hustle and bustle of the full complement of the daytime staff, relatives and heavy footfall across the WELCOME sign of the hospital disappears in the wake of silence and shadows. Instead you are left with a handful of nurses, doctors and cleaning staff echoeing their footsteps around the hospital corridors and wards. In a place which, during the day, you are side-stepping prams, patients, wheelchairs and stretchers, you can, at night you can stand uninvaded in the ground you hold.

That is one of the many reasons that I love night-shifts.

Now don’t get me wrong. This doesnt make me some daytime recluse, shying awaying from human contact – and daylight for that matter. I love it for it leaves my mind largely unitterupted to drift outside the box and ask – and try to answer – the questions that occupy my mind. Questions, that during the daytime, are drowned out by the emotional, physical and audible noise of hospital life.

For that reason, for me, at least there is a zen like state about night-shifts. You are one of a handful of doctors and healthcare members covering some 300 or more hosptial beds. You will – and do – get called to anything and everything. On a typical night I can expect to get called to a cardiac arrest (when someones heart stops), to possible new strokes, patients who fall out of bed, drug charts that need re-writing, family’s who need to be called to say their loved one is dying and they need to come in, and to write pain relief medication. All of these things indeed have happened since I started my shift at 9pm on Friday night.

As I go through a night shift, I find a very precious time. It’s a time to think about medicine, my career choices, – my life choices even. There is no magic to this – it is quite simply the silence of the night shift lets me do that. And to be honest, in a world that is as noisey as ours – with mobile phones and emails keeping us constantly connected – I welcome the opportunity for some peace and quiet. Of course, yes, the down side is that when it all goes wrong, and patients get really sick, and you are exhausted at 4am trying desperately to get a needle into their vein, the zen is gone, and the stress levels rise. You take the rough with the smooth.

I am sure I will be told I’m a little dramatic (well, my mum always says I have been one for theatrics even since I was a talking table in the school play) but I see the night shift as an adevnture! It is also a challenge for yourself. I like to see how well I can cope with the lack of sleep, with my body’s desperate desire to make me shut down into a low-power setting, and with the knowledge that I am part of only a small medical team and there is very little support outside of this. It teaches a certain degree of autonomy as a doctor and it pushes you to make decisions in the dead of night that during the daytime you could very easily defer to someone else. That ‘push’ makes us better doctors – and I would hope that means better patient care.

[15 minute pause in writing this]

As I have just learned too – the night shift is a rare opportunity to practice the things you don’t often get to do in the daytime; Like, as I have just done, to put a cannula into the vein of a screaming 4 year old boy. Now putting a cannula (they’re the tube that go into the veins to give medicine and fluids) in a adult can be tricky enough but when you are faced with an arms flairing, lungs open and vocal cords roaring, 4 year old grissler – it is an alltogether more challenging task. Still, after using two nurses and one mother to help me (and I must confess, on the second attempt), we managed to get the cannula in. In a vocal range that could rival Maria Carey, all it took to appease this little one was a sticker with a smiling panda on it. To be 4 again.

The sun is rising and the London is waking up once more. You may not all have a night shift to find your zen peace and quite but do try and find some part of your day or week that allows you the time to properly digest your thoughts rather than let them fester and give your brain indigestion.

Right, time for a coffee and a stroll of the wards….

Nick

The Human Spirit.

It’s Monday. I should be sleeping since my week of night shifts starts this evening. Thanks, however, to the 18 inch electrician’s drill bit that is currently working its way through the downstairs flat exterior walls, and the road works outside – sleep is not an option.  The entire building is vibrating! But you know, I look at it with a peaceful mind.

Why?

Quite simply because when you hear of the tragic horrors of events in Tunisia last week (and similar unspeakable atrocities that go on around the world – heard and unheard of), you cannot but realise how precious life is. How precious our families are. How precious our friends are.

Yes we live in an era of instability, concern and unrest but we also live in a world where people are willing to look after others, to put themselves in harm’s way in order to protect to their very last breath those they love – and for complete strangers. We too live in a world where men and women display courage and resolve by trying to stop pain, suffering and distress – people who have no responsibility to even try – such as the builders who were throwing rubble down on the individual who committed those murders as he escaped through the streets.

The human spirit is indelible, strong and etched in all of us. We may walk around in a society where individuals fear to speak to strangers, where heads are held down and eye contact eschewed.  But when individuals are in real need, I still believe in us, I still believe in the human spirit, and that intangible innate call to protect and help.

I would never dream draw parallels to those events in Tunisia but what I can say is that at the end of every day in hospital, I leave with an albeit tired smile on my face, forcing myself to discharge the negativity that can understandable creep into my mind, and instead recall those small, unrecognised, moments where the human spirit shows itself.

Never give up on the human spirit. Please. We need it now more than ever.

Nick