A junior doctor rants..

A junior doctor rants..

There are lots of unhappy junior doctors right now, Jeremy Hunt wishes to change our contract and have more of us working on weekends and pay us less for weekends than we currently are paid. This will apparently make hospitals safer. This is not true. 

For me to work as normal I need cleaners, laundry staff, sterile supplies staff, nurses, phlebotomists, pharmacy and all their staff, a full radiology department, haematology labs, biochemistry labs, microbiology labs, porters, ward nurses, staff in the canteen, theatre nurses, endoscopy staff and nurses and secretarial support. 

What’s the bloody point of 2 surgical registrars getting paid half the money when we don’t have a team? Who does Jeremy speak to that suggests this is wise? Nobody with any sense I suspect. Come and spend a weekend with me and have your eyes opened to the NHS…

My 13 hour shift starts with a stabbing in A&E; a Bighospital weekend special involving a heroin user, a sword, a litre of blood loss and a patient who soon wishes to discharge against my medical advice. I have to speak to the police at length and spend an hour sorting this unfortunate man out, he absconds from the department to “sort things out himself”. We await the results of that with baited breath..

Up to the ward to review the 4 admissions that my day shift colleague was too busy to see. The ancient cheap computer I use to review their X-Rays takes 3 painfully slow minutes to log me in to and automatically locks me out after 60 seconds of inactivity. Over the course of the night I log in 26 times, you do the maths. 

A patient in HDU has the DT’s and has pulled out his IV lines, his catheter and is now trying to leave. He has punched a nurse and has had enough diazepam to sedate a hippo but the litre of vodka a day he is withdrawing to keeps him going. 

A few ward reviews and a ward round in the high dependency unit to trouble shoot any issues and the night flies by. 

At 3am it calms down, I drink a can of juice and check Facebook and see what normal people do on a weekend night. I need to book on a course for some more training I think I need; it costs £595 which I am not reimbursed for. I can’t pay for it until after pay day but I keep checking there are still places available. 

This year alone out of my own money I have spent over £5000 on exams, courses, conferences and travel and accommodation and textbooks. It’s only because my husband is the main breadwinner that I am able to do this without it impacting on our family. Many of my colleagues struggle to pay for these things. 

Back to A&E to see a man who is critically ill. He needs to go to theatre tonight or he will die. I get a CT to confirm the diagnosis and we get him on the table within an hour. The operation goes well but I doubt he will survive, he is taken to ICU post-op. 

By now it is 6am and I am exhausted. I have had one coffee and one can of coke. I have nowhere to go on nights to rest so I lie with my head on the desk for five minutes before dealing with the problems that have occurred whilst I was in theatre. 

I have an admission to review, a very advanced cancer patient is ill and distressed as her colon is hugely dilated and she is in pseudo obstruction. It’s so blown up it’s compressing her chest and she can’t breathe. She looks 9 months pregnant with twins but is otherwise tiny and cachetic. 

She has kidney failure, has vomited some blood and hasn’t eaten or drank for 3 days. Gently I pop a tube into her rectum and let litres of gas escape from her and then fluid stool. Her abdomen decompresses and she can breathe. 

I secure the tube and gently sit her back up. Then she hugs me and leans her tiny thin bald head against my shoulder and thanks me for doing that. “I feel so much better for that. Thank you”. Then she sobs and says “I’m so scared of dying. I can’t leave my husband he isn’t coping with this”. 

Jeremy Hunt can try and take a third of my salary from me, he can try and take my contract from me, he can try and damage my family life and home life, ruin the morale of me and my colleagues but he can’t take the love I have for my job and for the NHS, for the patients I care for and their families. 

He can’t take away the hands I hold and the people I help. He can’t take away the colleagues that I work and laugh with and share the amazing privilege of doing this job with. 

Who has he helped? Whose life or even death has been better because of what he could do? I love the NHS and I love my job and I won’t let him destroy that. 

Our contract is not fit for purpose and the NHS is similarly ailing but the solution is not to destroy “junior” doctors contracts. 

Last weekend I was the most senior doctor in the hospital for surgery from 5pm to 8am. I operated on and managed all of them without a consultant. Hunt is trying to devalue “junior” doctors and imply that the treatment is in some way substandard.

Please support us like we have supported you and don’t let Jeremy destroy the NHS for our children. 

#juniordoctors

First day of surgery as a Mother

Dear Friend,

You are not alone today and neither is your child. You have left her safe and she will be fine. 

The first time is the worst, subsequent returns to work will not be as scary as the first one.

Most people won’t remember how long you’ve been gone, so don’t remind them that you took your full year plus 7 weeks annual leave from last year and another 3 weeks from this year. Whether it’s been 26 or 62 weeks since you last held a knife, you’ll be feeling nervous.

Your childcare arrangements have to be surgery proof. If you start at 8am and frequently work until 7pm don’t use a nursery that shuts at 6pm unless your other half is the one doing the pick ups.

Work like you did before. I don’t care that you have been up with a teething baby and are tired. Nobody asked you to be a surgeon and a mother, you’ve made your bed so now you have to lie in it. 

Christmas does not mean any more to you than anyone else. Just because you have children doesn’t mean you can leave early on Christmas Eve either; take a day of annual leave if it’s so important. Ditto the on call arrangements over Christmas; you will have to work Christmas sometimes, kids under 5 have no clue when it really is Christmas Day so consider moving it to the 26th; I’ve done this to great success. 

I would not recommend returning to work whilst breast feeding if you are able to.  I did it once and came back when I was down to just the pre bed time feed and frequently found myself stuck late at the operating table with milk leaking out of me and soaking through the gown. Not good for anyone and it made me feel like a bad mummy. 

You don’t need to use the children as your reason to say no to things. You can say no without giving a reason. I watched a friend walk out of a meeting that ran late, which had been arranged to finish at 12.30 to fit in with her part time hours. She stood up and excused herself and walked out of the room saying she had another meeting, I knew she was going to school to collect her son. Never explain and never complain, as Kate Moss says. 

Ignore all articles about guilt, about stressed out working women, about bad mothers, good mothers, stay at home ones; basically avoid the Daily Mail. Also ignore those images of a woman in an ill fitting food stained suit balancing a briefcase and a baby and talking into the phone. Who are these women? 

You used to be really good at this. It is still there, you are still that woman. Welcome back! Xx

All the errors and mistakes 

All the errors and mistakes 

How many mistakes have I made? How many people have I harmed? Hopefully not as many as I have helped, at the end of one’s career the thank you cards should outnumber the complaints. 

I have undoubtedly caused harm, I can think of some of them now and those are just the ones I remember. What about all the people I’ve harmed and not known about? 

The woman who I sent for a CT scan in error, entering the patient details from the preceding patient. The operations that I did that would have been done better by someone more experienced. The pelvic abscess from a bad lap washout.  The massive incisional hernia that resulted from an abdomen I made a shambles of closing…shit there’s loads of them. 

There are probably plenty I don’t know about, the wound infections, hernias, anastomotic leaks even deaths. (Jeremy Hunt take note, junior doctor bodge ups that would not have happened if a consultant did them, maybe. I hope you do read this you lanky shit) 

The question that interests me now is how the hell do you start letting trainees do the operating and decision making and not freak out? I cannot imagine it, walking out of theatre and leaving a trainee to do the anastomosis! 

I need to become a good trainer;  having been obsessed with being a good trainee I now need to figure out how to teach people. Knowing how to do something doesn’t mean that you can teach it. I have had the benefit of some amazing trainers and emulating them is undoubtedly the way forward. 

I’m sure I will manage to train someone and trust them and feel happy to leave them to do the operation, but will I be happy to deal with the complication?  I remember seeing a consultant blame his trainee for a bilateral hernia that recurred on one side “that’s the one my registrar did” he told the patient. The patient looked at him like he was a twat, as did I. 

Letting someone do it in your name means taking the blame when it goes wrong. How do you cope with that? I can barely cope when something goes wrong that I have done never mind taking the rap for my trainee. It looks like I am going to be a terrible boss, who senior trainees will hate because I don’t let them do anything. 

Where are we meant to learn this? The GMC that licence my practice insist that the care of my patients my first concern, which of course it is. Nowhere in the Duties of a Doctor am I obliged  to teach or train: but I am really and if I don’t I won’t get a registrar and I can’t easily do the operation without skilled assistance. 

How do I face a patient with a complication that I didn’t directly cause but was done in my name?  Apologising is obviously in order and I do this without hesitation or reservation and so far haven’t been sued for admitting that a mistake has been made. People are very understanding, famously the family of a massive error have never sued as the surgeon was so open from the outset; I take my lead from him and haemorrhage regret and apologies for every ileus and leak that I come across. Sorry doesn’t mean you’re guilty or negligent. 

How do I face my registrar and be kind and pleasant when they have fucked something up? I have caused my fair share of problems and  I have been on the receiving end of some spectacular bollockings but overall mostly lovely bosses who have soothed my troubled conscience. I will try and be good and fair and take the pain. I’ve plenty of practice of doing this sort of thing as a parent, but I love my children more than my future trainees. 

There are so many things to worry about above and beyond the actual operating and none of it is in any book or written down anywhere.