But I can't honestly say that I feel alive.
MMC and MTAS still stink, the fiance is back from Iraq and is looking forward to working in Birmingham without any consideration for the fact that if I get a job I won't be anywhere near Birmingham, I am trying to calm myself down over the one interview I have and am trying to resist the urge to run away and quit this profession. Oh, and I'm trying to stop bursting into tears on ward rounds or when in ICU or Theatre, I wish I was back in A&E but then I don't, then I sometimes wish I wasn't anywhere.
So if you were wondering where the posts had gone it's because frankly I can't see the point in posting, I can't see the good or positive side to medicine anymore and I don't want to bore people with my pathetic whinging, but thanks for the concern about my lack of posts, that means a lot to me, it really does.
Thursday, May 03, 2007
Thursday, March 01, 2007
Auf Wiedersen, A Bientot!
Although, unlike in the great film Cabaret, the end of this post will most certainly not end with
Is it a fact that MMC/MTAS is not beautiful.
I have been shortlisted for one interview. In ACCS (Emergency Medicine) and have been rejected from CMT and ACCS (Acute Medicine), which I am not that unhappy about. The interview is for London. The fiance has only been shortlisted for one interview in West Midlands deanery (as he is a military applicant all his applications were handled by West Midlands deanery). Trouble is, I got rejected from West Midlands deanery.
The fiance is highly likely to be working at the Royal Centre for Defence Medicine, and this is what he wants to do, which is in Birmingham. I am going to be working in London (if I get a place). I know this is going to wreck our relationship.
I know I have been lucky. I have an interview, I have an interview for the deanery/UoA I wanted. But still I don't feel happy. And now I feel selfish because of this.
Where are your problems now? Forgotten? I told you so. We have no troubles here! Here life is beautiful... The girls are beautiful...Even the orchestra is beautiful!
Is it a fact that MMC/MTAS is not beautiful.
I have been shortlisted for one interview. In ACCS (Emergency Medicine) and have been rejected from CMT and ACCS (Acute Medicine), which I am not that unhappy about. The interview is for London. The fiance has only been shortlisted for one interview in West Midlands deanery (as he is a military applicant all his applications were handled by West Midlands deanery). Trouble is, I got rejected from West Midlands deanery.
The fiance is highly likely to be working at the Royal Centre for Defence Medicine, and this is what he wants to do, which is in Birmingham. I am going to be working in London (if I get a place). I know this is going to wreck our relationship.
I know I have been lucky. I have an interview, I have an interview for the deanery/UoA I wanted. But still I don't feel happy. And now I feel selfish because of this.
Saturday, February 24, 2007
Rule number one of blogging
Never post when slightly drunk.
I have to admit that my last post (on the shambles that is MMC/MTAS) was posted when I was drowning my sorrows over finding out the deadline had been extended with a bottle of nice chilled white wine. This may account for the slightly melodramatic, 14-year-old, style of writing.
However, despite being slightly inebriated when writing it, my thoughts on the matter are still the same. Although in the cold, sober, light of day I am probably slightly less likely to swear and sulk about it so much. But the general point still stands. I doubt I will be shortlisted and I will be out of a job with no other skills/experience to do anything else and I will, obviously, not be a very happy bunny.
In my personal life I have discovered that the fiancé is back from Iraq in a bit (week on Monday) for a week's leave. I can't believe how he is coping with all the MMC/MTAS stress and having to operate as a medic in a war zone. Kind of puts things into perspective a little.
I have to admit that my last post (on the shambles that is MMC/MTAS) was posted when I was drowning my sorrows over finding out the deadline had been extended with a bottle of nice chilled white wine. This may account for the slightly melodramatic, 14-year-old, style of writing.
However, despite being slightly inebriated when writing it, my thoughts on the matter are still the same. Although in the cold, sober, light of day I am probably slightly less likely to swear and sulk about it so much. But the general point still stands. I doubt I will be shortlisted and I will be out of a job with no other skills/experience to do anything else and I will, obviously, not be a very happy bunny.
In my personal life I have discovered that the fiancé is back from Iraq in a bit (week on Monday) for a week's leave. I can't believe how he is coping with all the MMC/MTAS stress and having to operate as a medic in a war zone. Kind of puts things into perspective a little.
Friday, February 23, 2007
My true thoughts on MMC
Oh how I hate MMC, how I hate MTAS, how I hate being a doctor right now and how I hate being me.
I probably have 6 months left of being a doctor, after all, who on earth is going to shortlist me? And even if they do I now have to wait even longer to find out because of the fecking eejits. Of these 6 months I have spending half of this time in anaesthetics, a worthy cause but not the speciality I love. That is Emergency Medicine (of which I know anaesthetics is a part but hey...) and I only get to spend 3 months there.
I admit, I haven't tried hard enough as a medic. I never strived to sit memberships exams for the various colleges out there, I was always perfectly happy being a Senior SHO, or even just an SHO. I didn't become a doctor for the letters after my name and the experience of being a college member. I became a medic to do what I am doing now, helping people, making people better, easing their pain and suffering and enhancing my diagnostic skills.
Unfortunately this counts for jack-shit with MMC. Letters after the name is what they're looking for. Career minded medics is what they want. People dedicated to the furtherance of the NHS, not their patients.
Well fuck that, they got me and I may not be any of those things but I know that when I am on good form I am a damn good and empathetic doctor and that is what I care about, not being what MMC wants me to be.
So I may be unemployed in August and yes, I'll act all non-chalent and pretend I don't care. But between you, me and the gatepost... it's going to hit me fucking hard and I don't know how I'll cope. After all the stress of university didn't agree with me very well so fuck knows how I'll take being unemployed and not having the qualifications or life skills to do anything else.
But no one will care anyway because the government will have filled it's quota of junior doctors with the people they wanted and no one will give a toss about those left out to rot with the rubbish.
I probably have 6 months left of being a doctor, after all, who on earth is going to shortlist me? And even if they do I now have to wait even longer to find out because of the fecking eejits. Of these 6 months I have spending half of this time in anaesthetics, a worthy cause but not the speciality I love. That is Emergency Medicine (of which I know anaesthetics is a part but hey...) and I only get to spend 3 months there.
I admit, I haven't tried hard enough as a medic. I never strived to sit memberships exams for the various colleges out there, I was always perfectly happy being a Senior SHO, or even just an SHO. I didn't become a doctor for the letters after my name and the experience of being a college member. I became a medic to do what I am doing now, helping people, making people better, easing their pain and suffering and enhancing my diagnostic skills.
Unfortunately this counts for jack-shit with MMC. Letters after the name is what they're looking for. Career minded medics is what they want. People dedicated to the furtherance of the NHS, not their patients.
Well fuck that, they got me and I may not be any of those things but I know that when I am on good form I am a damn good and empathetic doctor and that is what I care about, not being what MMC wants me to be.
So I may be unemployed in August and yes, I'll act all non-chalent and pretend I don't care. But between you, me and the gatepost... it's going to hit me fucking hard and I don't know how I'll cope. After all the stress of university didn't agree with me very well so fuck knows how I'll take being unemployed and not having the qualifications or life skills to do anything else.
But no one will care anyway because the government will have filled it's quota of junior doctors with the people they wanted and no one will give a toss about those left out to rot with the rubbish.
Tuesday, February 20, 2007
Seconded
I have been seconded to anaesthetics for 3 months. Whilst this is somewhat bad (as it means I have to leave the beloved A&E department and all the hilarity that involves) it is also good as I am now working a daily shift pattern that will see me working either early (8am - 5pm), late (3pm - midnight) or a night shift (11pm - 9am the following morning). This is of course good news as it means shorter days. However, being a anaesthetics SHO means I have to go back to doing on-call work, which is bad.
On the whole, so far anaesthetics looks good and I'm managing to incorporate some ICU work into the secondment too. Apparently the trust thought I needed to "spread my wings" and although I have completed a lot of the other necessary rotations related to A&E (paediatrics, general surgery, critical care etc) I have never been attached to an anaesthetics firm so it is all a learning curve. Let's just hope it's a good learning curve.
On the whole, so far anaesthetics looks good and I'm managing to incorporate some ICU work into the secondment too. Apparently the trust thought I needed to "spread my wings" and although I have completed a lot of the other necessary rotations related to A&E (paediatrics, general surgery, critical care etc) I have never been attached to an anaesthetics firm so it is all a learning curve. Let's just hope it's a good learning curve.
Saturday, February 03, 2007
Friday evening
It was a weird and wonderful shift last night and quite harrowing at times. I arrived just before I started to a waiting room full of patients, which is never a good sign as it invariably means there are a lot of frustrated people as they have been waiting a fair while and last night was no exception.
The first patient I saw was a 12 year old girl with a suspected fractured wrist which she had sustained from falling off a kerb whilst wearing those wheelie shoes. Her father who was accompanying her was rude and aggressive and kept telling me that they had been waiting for nearly 3 hours before they were seen whilst people who had arrived after them had been seen first. I tried to explain that the department was very busy and that his daughter would have been assigned to a triage category reflecting her injury and that patients are seen not in order of time of arrival but in order of clinical need and seriousness of illness and/or injury. The father then blew up in my face and accused me of not caring about his daughter’s wellbeing and suggesting that her injury was trivial. I bit my tongue and said that the girl needed to have an x-ray to see whether her wrist was fractured or not and gave him the x-ray form and told him to make his way there. It turns out that she probably has a scaphoid fracture, but these being notorious to not show up in initial x-rays and not wanting to send her home merely with a tubigrip, when she was exhibiting all the signs of a bone injury not a muscular injury, I have referred her to be reassessed by the fracture clinic next week where they will re-examine her wrist and take another x-ray, by which time if it is a scaphoid fracture the break will show up and I gt her wrist put in a cast as a precaution. I also gave the father and daughter some social advice on the use of ‘Heelys’, in relation to this incident.
The next patient was a more harrowing case. A 24 year old male who arrived on foot with his girlfriend after having a severe headache at the back of his head for a few hours which came on suddenly and was worse than any other headache he had ever suffered before. Now that sentence rings alarm bells at any doctor for a diagnosis of subarachnoid haemorrhage and sure enough he was exhibiting other symptoms; he was nauseated, had vomited, had photophobia (dislike of bright lights), neck stiffness and was becoming sleepy. I sent him off to have a CT scan to confirm the diagnosis, which it did – subarachnoid haemorrhage as a result of a burst berry aneurysum, and on his return put him in resus just in case he lapsed into unconsciousness and made a referral to the neurosurgeon (at a different hospital). The ambulance arrived to transfer him to the neurosurgery department and I discovered a few hours later when I rang to see how he was getting on that he died on transfer to the hospital, probably from the aneurysum rebleeding. Now I know that I couldn’t have predicted this and I did my best but I hate it when things like that happen. Subarachnoid haemorrhages are one of the things about emergency medicine I hate. They are very rare, thank goodness, but tend to affect young normally fit and healthy people and unfortunately there isn’t really any way of knowing who will survive and who won’t.
After that there were the usual Friday evening cases of alcohol related injuries, people having got into fights, the odd depressed patient attending A&E because they felt they couldn’t cope over the weekend and their CPN had gone off duty at 5pm so could they access the duty psychiatrist/crisis team and a few domestic violence cases, one serious and three non-life threatening, all with police attendance.
Then my last patient of the evening was totally bizarre. I would like to say that I thought I had seen most things in emergency medicine and the nurse who assessed this patient had told her “not to worry because we’ve all seen everything before”. Thing is, I had heard of patients like this, I have had colleagues deal with them but I had never treated one. She was referred to me by a male colleague as she was insistent on a female medic, and after discovering her problem I could understand why. She told me that she had been feeling upset and lonely and so had decided to have ‘a play’. Unfortunately she decided that as she was lacking in a vibrator or dildo that she would use a carrot. Trouble was she had got a little bit too excited and the carrot had snapped and whilst she had been able to retrieve half or it the other half was left inside. Normally I would have had a little snigger to myself over this (and don’t berate me for it because I’d like to know anyone who wouldn’t) but she sounded so embarrassed and upset and thought that I’d judge her (she was 58 and clearly thought that I would think that 58 year old women shouldn’t have sexual urges) that I couldn’t even find it that funny at the time, however typing it now I am smiling. Anyway, once I’d treated her and when she asked me my advice (which was to possibly expend some money in Ann Summers) and I’d given her a script for some generic antibiotics (carrots are not the cleanest items) she left, thanking me profusely. In fact as I left my shift she was still sitting outside the department waiting for me to thank me again and she tried to give me £10 as a way of a thank you present but I obviously had to refuse. She also praised the way I’d handled the situation and said the department was brilliant because no one had laughed at her or been cruel about her. I just smiled and walked off, feeling awful because I know the gossip that was going round the staff room in relation to her (that I didn’t partake in) and felt quite appalled that I could laugh about it with colleagues when the patient thought I had acted so professionally.
Another night shift tonight, except it’s a full 12 hour one, let’s hope Saturday night isn’t quite as eventful as Friday evening.
The first patient I saw was a 12 year old girl with a suspected fractured wrist which she had sustained from falling off a kerb whilst wearing those wheelie shoes. Her father who was accompanying her was rude and aggressive and kept telling me that they had been waiting for nearly 3 hours before they were seen whilst people who had arrived after them had been seen first. I tried to explain that the department was very busy and that his daughter would have been assigned to a triage category reflecting her injury and that patients are seen not in order of time of arrival but in order of clinical need and seriousness of illness and/or injury. The father then blew up in my face and accused me of not caring about his daughter’s wellbeing and suggesting that her injury was trivial. I bit my tongue and said that the girl needed to have an x-ray to see whether her wrist was fractured or not and gave him the x-ray form and told him to make his way there. It turns out that she probably has a scaphoid fracture, but these being notorious to not show up in initial x-rays and not wanting to send her home merely with a tubigrip, when she was exhibiting all the signs of a bone injury not a muscular injury, I have referred her to be reassessed by the fracture clinic next week where they will re-examine her wrist and take another x-ray, by which time if it is a scaphoid fracture the break will show up and I gt her wrist put in a cast as a precaution. I also gave the father and daughter some social advice on the use of ‘Heelys’, in relation to this incident.
The next patient was a more harrowing case. A 24 year old male who arrived on foot with his girlfriend after having a severe headache at the back of his head for a few hours which came on suddenly and was worse than any other headache he had ever suffered before. Now that sentence rings alarm bells at any doctor for a diagnosis of subarachnoid haemorrhage and sure enough he was exhibiting other symptoms; he was nauseated, had vomited, had photophobia (dislike of bright lights), neck stiffness and was becoming sleepy. I sent him off to have a CT scan to confirm the diagnosis, which it did – subarachnoid haemorrhage as a result of a burst berry aneurysum, and on his return put him in resus just in case he lapsed into unconsciousness and made a referral to the neurosurgeon (at a different hospital). The ambulance arrived to transfer him to the neurosurgery department and I discovered a few hours later when I rang to see how he was getting on that he died on transfer to the hospital, probably from the aneurysum rebleeding. Now I know that I couldn’t have predicted this and I did my best but I hate it when things like that happen. Subarachnoid haemorrhages are one of the things about emergency medicine I hate. They are very rare, thank goodness, but tend to affect young normally fit and healthy people and unfortunately there isn’t really any way of knowing who will survive and who won’t.
After that there were the usual Friday evening cases of alcohol related injuries, people having got into fights, the odd depressed patient attending A&E because they felt they couldn’t cope over the weekend and their CPN had gone off duty at 5pm so could they access the duty psychiatrist/crisis team and a few domestic violence cases, one serious and three non-life threatening, all with police attendance.
Then my last patient of the evening was totally bizarre. I would like to say that I thought I had seen most things in emergency medicine and the nurse who assessed this patient had told her “not to worry because we’ve all seen everything before”. Thing is, I had heard of patients like this, I have had colleagues deal with them but I had never treated one. She was referred to me by a male colleague as she was insistent on a female medic, and after discovering her problem I could understand why. She told me that she had been feeling upset and lonely and so had decided to have ‘a play’. Unfortunately she decided that as she was lacking in a vibrator or dildo that she would use a carrot. Trouble was she had got a little bit too excited and the carrot had snapped and whilst she had been able to retrieve half or it the other half was left inside. Normally I would have had a little snigger to myself over this (and don’t berate me for it because I’d like to know anyone who wouldn’t) but she sounded so embarrassed and upset and thought that I’d judge her (she was 58 and clearly thought that I would think that 58 year old women shouldn’t have sexual urges) that I couldn’t even find it that funny at the time, however typing it now I am smiling. Anyway, once I’d treated her and when she asked me my advice (which was to possibly expend some money in Ann Summers) and I’d given her a script for some generic antibiotics (carrots are not the cleanest items) she left, thanking me profusely. In fact as I left my shift she was still sitting outside the department waiting for me to thank me again and she tried to give me £10 as a way of a thank you present but I obviously had to refuse. She also praised the way I’d handled the situation and said the department was brilliant because no one had laughed at her or been cruel about her. I just smiled and walked off, feeling awful because I know the gossip that was going round the staff room in relation to her (that I didn’t partake in) and felt quite appalled that I could laugh about it with colleagues when the patient thought I had acted so professionally.
Another night shift tonight, except it’s a full 12 hour one, let’s hope Saturday night isn’t quite as eventful as Friday evening.
Friday, February 02, 2007
Stressed
So I am trying to complete my MMC application before I go to work but the bastard computer is not letting me access MTAS and my hard drive seems to be in melt down. *screams quietly to herself*
I start work at 5pm and am only on shift until 11pm (short shift woohoo). Am praying for a quiet evening so I can calm down slightly and try and take my mind off MMC.
Doubt it will happen though, after all it is a Friday evening and I doubt I'll manage to get away at 11 on the dot. Still at least it's only a half shift.
I've discovered recently that thanks to MTAS and MMC you have to be thankful for the small mercies in life.
I start work at 5pm and am only on shift until 11pm (short shift woohoo). Am praying for a quiet evening so I can calm down slightly and try and take my mind off MMC.
Doubt it will happen though, after all it is a Friday evening and I doubt I'll manage to get away at 11 on the dot. Still at least it's only a half shift.
I've discovered recently that thanks to MTAS and MMC you have to be thankful for the small mercies in life.
Thursday, February 01, 2007
I Hate MMC
AAAAAAAAAAARRRRRRRRRRRGGGGGGGGHHHHHH!!!
That just about vents my anger over MMC. I am offically useless and am going to be unemployed.
Why? Because I am not experienced/qualified enough for ST3 training in Emergency Medicine as I don't hold Part A of MCEM or equivalent. So am stuck with ST2 places in ACCS - Emergency Medicine and ACCS - Acute Medicine and 2 CTM specialities.
I'm just a useless doctor and because I haven't pushed enough to further my career I'm now screwed. Plus I'm opting for the 2 speciality/2 UoA option.
Just hope the fiance has more luck with his application as he can only choose 2 specialities and his application is being processed by one UoA - West Midlands deanery - on behalf of the Defence deanery.
This is such a cock up.
That just about vents my anger over MMC. I am offically useless and am going to be unemployed.
Why? Because I am not experienced/qualified enough for ST3 training in Emergency Medicine as I don't hold Part A of MCEM or equivalent. So am stuck with ST2 places in ACCS - Emergency Medicine and ACCS - Acute Medicine and 2 CTM specialities.
I'm just a useless doctor and because I haven't pushed enough to further my career I'm now screwed. Plus I'm opting for the 2 speciality/2 UoA option.
Just hope the fiance has more luck with his application as he can only choose 2 specialities and his application is being processed by one UoA - West Midlands deanery - on behalf of the Defence deanery.
This is such a cock up.
Wednesday, January 31, 2007
London... home sweet home
I have got a few days off now (including today) and I decided to treat myself. So today saw me tootling off on a train into London, which reminded me of the joys of being back in the South (reaching London within 60 minutes - joy) and then reminded me of the pain of being back in the South (old trains, annoying timetables, overcrowding - not so fun).
Anyway, I am a Londoner at heart. I was born in the City, grew up there, went to school there, went to uni there and did my house officer years there. Then I moved 'oop North' and came back down again because the fiance's job moved him to the South East (though not London, unfortunately). I feel as if I have an affinity wih the place and I had a really nice day.
In the morning I saw the parents, who haven't seen me for a while and we had a nice coffee and chat. Apart from a few awkward questions like "when are you going to get married?" and "when are you going to become a registrar?" and "why did you become a medic when you could be earning so much more in the financial services and with much less hassle?" it was a success. They don't seem too keen on the emergency medicine life of things but then again I think they've been watching too many shows like Panorama and Tonight with Trevor MacDonald with the lead story being 'A&E staff suffering more abuse and violence from patients', oh and knowing my mother, probably reading the Daily (Hate) Mail as well.
This afternoon I saw an old friend from uni. We were in the same year at med school together except he dropped out after the 4th year, graduated with an MSc in Medical Sciences and is now working as a medical journalist earning about 3 times what I do whilst I stuck the course. Sometimes life isn't fair. We met for lunch and then we did a bit of shopping, well I did some shopping and dragged him with me.
Some things I noticed on my excursion were the reason I love London so much:
The Tube
The ability to get on a bus when you want to
Krispy Kreme doughnuts available pretty much everywhere, rather than having to hunt for them
Oyster cards, thus proving the world can go paperless
Busy shopping streets like Oxford Street with the ability to nip down a side street and feel like you stepped into a parallel universe because it's so quiet
Shops, that are big, and actually stock stuff
Free museums, that you might actually want to go into
Decent buskers on Tube stations.
However, there is one thing I resent about London (well, Oxford Street in particular). I do not want to be accosted whilst I am shopping by a guy with a megaphone asking me what I have done to redeem my sins in the name of Jesus Christ and then stopping to ask me what job I did and telling me that I should let nature run it's course and people are meant to die when God wants them to. Meaning that the job I attempt to do everyday is pointless.
Now I know medicine has a low success rate ultimately (everyone is going to die) but I like to think that we (medics) try and stop people dying prematurely, or from curable conditions or in pain and discomfort. Or as a colleague I had who worked in cardiology once told me "my job is delaying the inevitable because in the end heart failure ultimately gets every one of us". She has a point.
Tomorrow sees me cleaning the house, what fun!
Anyway, I am a Londoner at heart. I was born in the City, grew up there, went to school there, went to uni there and did my house officer years there. Then I moved 'oop North' and came back down again because the fiance's job moved him to the South East (though not London, unfortunately). I feel as if I have an affinity wih the place and I had a really nice day.
In the morning I saw the parents, who haven't seen me for a while and we had a nice coffee and chat. Apart from a few awkward questions like "when are you going to get married?" and "when are you going to become a registrar?" and "why did you become a medic when you could be earning so much more in the financial services and with much less hassle?" it was a success. They don't seem too keen on the emergency medicine life of things but then again I think they've been watching too many shows like Panorama and Tonight with Trevor MacDonald with the lead story being 'A&E staff suffering more abuse and violence from patients', oh and knowing my mother, probably reading the Daily (Hate) Mail as well.
This afternoon I saw an old friend from uni. We were in the same year at med school together except he dropped out after the 4th year, graduated with an MSc in Medical Sciences and is now working as a medical journalist earning about 3 times what I do whilst I stuck the course. Sometimes life isn't fair. We met for lunch and then we did a bit of shopping, well I did some shopping and dragged him with me.
Some things I noticed on my excursion were the reason I love London so much:
The Tube
The ability to get on a bus when you want to
Krispy Kreme doughnuts available pretty much everywhere, rather than having to hunt for them
Oyster cards, thus proving the world can go paperless
Busy shopping streets like Oxford Street with the ability to nip down a side street and feel like you stepped into a parallel universe because it's so quiet
Shops, that are big, and actually stock stuff
Free museums, that you might actually want to go into
Decent buskers on Tube stations.
However, there is one thing I resent about London (well, Oxford Street in particular). I do not want to be accosted whilst I am shopping by a guy with a megaphone asking me what I have done to redeem my sins in the name of Jesus Christ and then stopping to ask me what job I did and telling me that I should let nature run it's course and people are meant to die when God wants them to. Meaning that the job I attempt to do everyday is pointless.
Now I know medicine has a low success rate ultimately (everyone is going to die) but I like to think that we (medics) try and stop people dying prematurely, or from curable conditions or in pain and discomfort. Or as a colleague I had who worked in cardiology once told me "my job is delaying the inevitable because in the end heart failure ultimately gets every one of us". She has a point.
Tomorrow sees me cleaning the house, what fun!
Tuesday, January 30, 2007
Meme
Stolen from Patient Anonymous:
The medical specialty for you is.... Internal Medicine
The medical specialty for you is.... Internal Medicine
Internal medicine is better than any of the specialties. When a patient comes in for a check-up, you can send them home with a clean bill of health. And when a patient comes in with high blood pressure, you can prescribe one of a wide variety of drugs, including beta-blockers, diuretics, and ACE inhibitors. And when a patient comes in with some other problem, you will be able to refer them to one of a long list of your colleagues.
To find out what specialty best fits your unique personality, go to:
Sunday, January 28, 2007
Burns Victim
General rule in life that should always be followed. When cooking on a gas hob, never leave the ring lit without a saucepan/frying pan on it as someone may reach over it and burn themselves thus ensuring a trip to A&E to get burn dressed and nylon jumper removed from burn.
Even more obvious rule, never do this if you are a junior doctor and the A&E department you will end up in is the one you work in and the staff treating you will be your colleagues.
Needless to say I have been the butt of many jokes these last few days, especially when people suggest that doctors are 'intelligent' or 'sensible'. The chorus of "oh no, look at MJ, she burnt her arm by leaning over a lit gas ring and she's a doctor" rings from all corners of the department.
I think me and my slightly poorly arm will retreat away from the world of humiliation and sarcasm and try and get some sympathy now, and give up on cooking, after all that's why instant microwave meals were invented.
Even more obvious rule, never do this if you are a junior doctor and the A&E department you will end up in is the one you work in and the staff treating you will be your colleagues.
Needless to say I have been the butt of many jokes these last few days, especially when people suggest that doctors are 'intelligent' or 'sensible'. The chorus of "oh no, look at MJ, she burnt her arm by leaning over a lit gas ring and she's a doctor" rings from all corners of the department.
I think me and my slightly poorly arm will retreat away from the world of humiliation and sarcasm and try and get some sympathy now, and give up on cooking, after all that's why instant microwave meals were invented.
Tuesday, January 23, 2007
Flattered...
Firstly, thanks to all the people who posted comments in relation to my last post and my new additions to my blogroll. It is very flattering to think that there are medical students and medics out there who enjoy my writing and can relate to it. It makes me think that this blog is worthwhile and it is not just me who is going through this crap of Mucking-Up Medical Careers (oh, sorry that meant to read Modernising Medical Careers - what a silly mistake).
I don't really have a lot to say. There have been a lot of minor incidents in the department, a few major ones and a few I'd rather forget. There have been a lot of people screaming at me, a fair few vomiting over me and a few discharging themselves only to be brought back in by an ambulance crew 10 minutes later because they were found collapsed at the hospital entrance.
The most exciting thing to be happening in my work life at the moment is that we have acquired two groups of 4th year medical students in the department doing their Student Selected Choices (SSCs). They are like chalk and cheese. One group wants to work extremely hard and they offer to do anything (including tasks that they aren't allowed to do) and the other group saunter in late and spend most of their time sitting at the workstation drinking coffee and trying to chat up nurses and ambulance staff. I even caught one girl trying to chat up a severely ill patient yesterday!
It must be incredibly boring being a student on your SSC in A&E. When I look at other specialities that I have worked in and look at the students doing placements in things like paeds and hepatics and then compare them with the students in A&E then the A&E lot aren't allowed to do anything. In fact the student nurses complete more hands on experience than the med students will. They are there to observe how an A&E department works, and I think to learn that emergency medicine is not like ER or Casualty, but although that by their 4th year they will have learnt plenty of clinical skills that they could put into practice (or supposedly will have learnt the skills) due to health & safety and the fact that an A&E department really isn't the place to continuously mess up (not that all students do, in fact some of the students are amazing) they cannot practice most of their newly acquired skills.
They are left to deal with the paperwork (which is good as no one else round here does their paperwork), take histories, take blood samples, cannulate patients, help interpret ECGs & X-rays, run up to the lab and try and bully the bioscientists into getting the sample results faster, administering activated charcoal, acting as mental health liaison by sitting with patients on DSH/suicide watch when the mental health nurse cannot be bothered to tear themselves away from their tea break and if they have a nice mentor, possibly even attempt an ABG or steri-stripping (although they are not allowed to suture).
So I warn you potential med students and med students alike. If you consider completing a placement in A&E during your time at med school, then reconsider because it is by far one of the most boring and non-productive placements, in my opinion, that you will complete. And I am passionate about emergency medicine.
I don't really have a lot to say. There have been a lot of minor incidents in the department, a few major ones and a few I'd rather forget. There have been a lot of people screaming at me, a fair few vomiting over me and a few discharging themselves only to be brought back in by an ambulance crew 10 minutes later because they were found collapsed at the hospital entrance.
The most exciting thing to be happening in my work life at the moment is that we have acquired two groups of 4th year medical students in the department doing their Student Selected Choices (SSCs). They are like chalk and cheese. One group wants to work extremely hard and they offer to do anything (including tasks that they aren't allowed to do) and the other group saunter in late and spend most of their time sitting at the workstation drinking coffee and trying to chat up nurses and ambulance staff. I even caught one girl trying to chat up a severely ill patient yesterday!
It must be incredibly boring being a student on your SSC in A&E. When I look at other specialities that I have worked in and look at the students doing placements in things like paeds and hepatics and then compare them with the students in A&E then the A&E lot aren't allowed to do anything. In fact the student nurses complete more hands on experience than the med students will. They are there to observe how an A&E department works, and I think to learn that emergency medicine is not like ER or Casualty, but although that by their 4th year they will have learnt plenty of clinical skills that they could put into practice (or supposedly will have learnt the skills) due to health & safety and the fact that an A&E department really isn't the place to continuously mess up (not that all students do, in fact some of the students are amazing) they cannot practice most of their newly acquired skills.
They are left to deal with the paperwork (which is good as no one else round here does their paperwork), take histories, take blood samples, cannulate patients, help interpret ECGs & X-rays, run up to the lab and try and bully the bioscientists into getting the sample results faster, administering activated charcoal, acting as mental health liaison by sitting with patients on DSH/suicide watch when the mental health nurse cannot be bothered to tear themselves away from their tea break and if they have a nice mentor, possibly even attempt an ABG or steri-stripping (although they are not allowed to suture).
So I warn you potential med students and med students alike. If you consider completing a placement in A&E during your time at med school, then reconsider because it is by far one of the most boring and non-productive placements, in my opinion, that you will complete. And I am passionate about emergency medicine.
Sunday, January 07, 2007
New additions
You may have noticed that I have made some new additions to my blog roll. All of their blogs are absolutely fantastic.
For a look at the stresses and strains of being a medical student in today's world may I suggest that you check out Angry Medic who is currently at Cambridge University (and by the sounds of things wishing they weren't) and Of Short White Coats who is studying at a London Medical School, and urges you not to guess which one as she won't tell you.
I have been reading Diagnosis? NFI's blog for quite a while but never got up to sticking a link up to it. They are an ECP working in East Anglia who blog very eloquently on how the ambulance service (like all other areas of the NHS) is in turmoil.
FtM Doctor and Dr. Grumble show the viewpoints of hospital doctors currently working in the NHS. FtM Doctor is currently in Obs & Gynae, and a transsexual although his blog is about much more than just this, and Dr. Grumble in Cardiology. Both are excellent reads.
Just thought I'd share my finds!
For a look at the stresses and strains of being a medical student in today's world may I suggest that you check out Angry Medic who is currently at Cambridge University (and by the sounds of things wishing they weren't) and Of Short White Coats who is studying at a London Medical School, and urges you not to guess which one as she won't tell you.
I have been reading Diagnosis? NFI's blog for quite a while but never got up to sticking a link up to it. They are an ECP working in East Anglia who blog very eloquently on how the ambulance service (like all other areas of the NHS) is in turmoil.
FtM Doctor and Dr. Grumble show the viewpoints of hospital doctors currently working in the NHS. FtM Doctor is currently in Obs & Gynae, and a transsexual although his blog is about much more than just this, and Dr. Grumble in Cardiology. Both are excellent reads.
Just thought I'd share my finds!
Saturday, January 06, 2007
Urgent plea
This is a plea from the deepest darkest depths of the Home Counties and all the areas within the M25...
Could all you yummy-mummy's (and you know who you are - you shop in Waitrose, buy your kids ready prepared packed lunches because making lunch isn't in the nanny's job description, drive Chelsea tractors and send your kids to independent prep schools) stop bringing your kids into A&E departments just because you cannot get to see a GP.
Your child is highly unlikely to have meningitis just because he has a headache and a temperature... how do I know this? Well their runny nose, hacking cough and croaking voice all scream "viral infection" at me as soon as they walk in the door, and if that isn't enough, I know because one of your snotty nosed brats has passed said hacking cough onto yours truly.
Your child is also unlikely to have irritable bowel syndrome just because they have stomach ache and diarrhoea (and I don't care if you've suffered from it for years)... how do I know this? Because I happened to walk past the waiting room whilst you were feeding them packet loads of crisps and bars of chocolate. They are more likely to have overeaten, or possibly have anxiety due to the pressure placed on them to pass school selection tests at 11, and how do I know this? Because when you weren't feeding them junk food you had them working from revision books for their SATs and reciting pieces of information for the private school exam.
Plus an A&E department will not give you the advice of a consultant paediatrician just because you turn up at triage with a child, you will get an SHO, if you are lucky an SHO who is specialising in paediatrics.
And do not be surprised when you get a cold emotional response to your pleas from doctors and nurses when you have just exclaimed loudly in the middle of the department that if you do not get to see said consultant then you will resort to BUPA or PPP or whichever medical insurer you use.
Plus I do not care if your husband works for an important company or you have friends in high places or you could get media coverage of the hospital being medically irresponsible.
I am trying to do my job and I am not a paediatrician, nor am I a consultant. I am an SHO who is working very hard to earn a living and to get her career to progress. I have my own worries about my fiance being in Iraq and I could do without your abuse whilst I am trying to complete my job.
Is that understood?
Could all you yummy-mummy's (and you know who you are - you shop in Waitrose, buy your kids ready prepared packed lunches because making lunch isn't in the nanny's job description, drive Chelsea tractors and send your kids to independent prep schools) stop bringing your kids into A&E departments just because you cannot get to see a GP.
Your child is highly unlikely to have meningitis just because he has a headache and a temperature... how do I know this? Well their runny nose, hacking cough and croaking voice all scream "viral infection" at me as soon as they walk in the door, and if that isn't enough, I know because one of your snotty nosed brats has passed said hacking cough onto yours truly.
Your child is also unlikely to have irritable bowel syndrome just because they have stomach ache and diarrhoea (and I don't care if you've suffered from it for years)... how do I know this? Because I happened to walk past the waiting room whilst you were feeding them packet loads of crisps and bars of chocolate. They are more likely to have overeaten, or possibly have anxiety due to the pressure placed on them to pass school selection tests at 11, and how do I know this? Because when you weren't feeding them junk food you had them working from revision books for their SATs and reciting pieces of information for the private school exam.
Plus an A&E department will not give you the advice of a consultant paediatrician just because you turn up at triage with a child, you will get an SHO, if you are lucky an SHO who is specialising in paediatrics.
And do not be surprised when you get a cold emotional response to your pleas from doctors and nurses when you have just exclaimed loudly in the middle of the department that if you do not get to see said consultant then you will resort to BUPA or PPP or whichever medical insurer you use.
Plus I do not care if your husband works for an important company or you have friends in high places or you could get media coverage of the hospital being medically irresponsible.
I am trying to do my job and I am not a paediatrician, nor am I a consultant. I am an SHO who is working very hard to earn a living and to get her career to progress. I have my own worries about my fiance being in Iraq and I could do without your abuse whilst I am trying to complete my job.
Is that understood?
Friday, January 05, 2007
Happy New Year
Although it is a little late.
I seem to have neglected blogging for far too long and yet I am not quite sure why. Maybe the current post I have is more demanding than the last, that is of course a very plausible reason as there are fewer staff in this department than in the last department I worked in. Or maybe I just haven't had anything interesting to say.
To be honest, I don't think anyone really reads this blog anymore. I am not as critically acclaimed or as witty as Dr. Crippen (NHS Blog Doctor) or any of the other medical related blogs out there. But I will endeavour to keep blogging, if only for my own sense of achievement.
The fiance is now in Iraq, doing his duty as an army medic whilst I am left here in the A&E department I am currently working in. I am becoming disillusioned with emergency medicine in my current post. This time last year I was working in a big city, now I am working in a town, not that it should make any difference. I quite enjoyed doing the menial A&E jobs such as simple suturing, removing splinters and other such tasks, but now I am apparently 'above' these jobs as I am a doctor, not a nurse practitioner. Granted some nurse practitioners do a splendid job, just not the work of one I saw yesterday.
Lee is a 20 year old lad who had got quite drunk on Tuesday night and had decided to jump off a wall whilst holding his bottle of beer. Now, as any normal person could have predicted, Lee didn't land smoothly and landed on the bottle of beer which lacerated his leg and arm. Luckily he was wearing jeans so the glass didn't go into his leg, or so he thought, but he did have some nasty cuts so he went to A&E. When he got there he was assessed by a nurse practitioner who cleaned the wounds and sutured them up and sent home with the instructions to get the sutures removed in 10 to 14 days. Lee presented at A&E again yesterday where I saw him. The sutures in his leg were extremely red and swollen, clearly infected, although they were undoubtedly very, very neat, much neater than I suture. I questioned him to see what treatment he had received and was shocked to hear that his wounds hadn't been X-rayed to see if any glss was in the wounds. I sent him down to X-ray and lo and behold he had 3 small shards of glass in the wound. I took out the old stitches and under local anaesthetic explored the wound to find the glass, which I did, I then sent him back to X-ray to ensure I had removed all the glass and resutured his wound, with the aid of steri-strips as the skin wasn't holding after being previously sutured.
This took extra time, but should have been done in the first place. One of the first rules of A&E medicine that I learnt was that if a penetrating or lacerating injury had been made with broken glass then the wound had to be X-rayed to ensure there was no glass left under the skin. Clearly this pearl of wisdom hasn't been passed onto our dear nurse practitioners.
I seem to have neglected blogging for far too long and yet I am not quite sure why. Maybe the current post I have is more demanding than the last, that is of course a very plausible reason as there are fewer staff in this department than in the last department I worked in. Or maybe I just haven't had anything interesting to say.
To be honest, I don't think anyone really reads this blog anymore. I am not as critically acclaimed or as witty as Dr. Crippen (NHS Blog Doctor) or any of the other medical related blogs out there. But I will endeavour to keep blogging, if only for my own sense of achievement.
The fiance is now in Iraq, doing his duty as an army medic whilst I am left here in the A&E department I am currently working in. I am becoming disillusioned with emergency medicine in my current post. This time last year I was working in a big city, now I am working in a town, not that it should make any difference. I quite enjoyed doing the menial A&E jobs such as simple suturing, removing splinters and other such tasks, but now I am apparently 'above' these jobs as I am a doctor, not a nurse practitioner. Granted some nurse practitioners do a splendid job, just not the work of one I saw yesterday.
Lee is a 20 year old lad who had got quite drunk on Tuesday night and had decided to jump off a wall whilst holding his bottle of beer. Now, as any normal person could have predicted, Lee didn't land smoothly and landed on the bottle of beer which lacerated his leg and arm. Luckily he was wearing jeans so the glass didn't go into his leg, or so he thought, but he did have some nasty cuts so he went to A&E. When he got there he was assessed by a nurse practitioner who cleaned the wounds and sutured them up and sent home with the instructions to get the sutures removed in 10 to 14 days. Lee presented at A&E again yesterday where I saw him. The sutures in his leg were extremely red and swollen, clearly infected, although they were undoubtedly very, very neat, much neater than I suture. I questioned him to see what treatment he had received and was shocked to hear that his wounds hadn't been X-rayed to see if any glss was in the wounds. I sent him down to X-ray and lo and behold he had 3 small shards of glass in the wound. I took out the old stitches and under local anaesthetic explored the wound to find the glass, which I did, I then sent him back to X-ray to ensure I had removed all the glass and resutured his wound, with the aid of steri-strips as the skin wasn't holding after being previously sutured.
This took extra time, but should have been done in the first place. One of the first rules of A&E medicine that I learnt was that if a penetrating or lacerating injury had been made with broken glass then the wound had to be X-rayed to ensure there was no glass left under the skin. Clearly this pearl of wisdom hasn't been passed onto our dear nurse practitioners.
Friday, October 06, 2006
No surprises here then
Saw this story originally in the London Lite paper on my way home from work last night, and subsequently on the BBC News homepage. It goes like this...
What gets me, is they actually call this news! Every medic up and down the country knew this and I'm sure it came as no surprise to the families of medics. The European Working Time Directive was meant to be a great rule that would see junior doctors work no more than 56 hours a week and one night shift in 10. Basically it was never going to be possible. Junior doctors are relied on heavily to do on-call work, lots of shifts and the evil over-nighters. They were never going to be tucked up in bed at 10pm with a cup of cocoa even with an EU order over them. Hospitals have found ways round the maximum 56 hour week and junior doctors are still working anti-social, overworked shift patterns. It comes with the territory as a medic.
In other news, I found a job in an Accident & Emergency department in this Southern neck of the woods. It feels bizarre to be back around the area that I trained in, but good because the department is amazing! Fiance is off to the battlefield come the New Year and I'm panicking slightly about that, but I've seen him go off before and return in one piece, so I'm sure this time will be no different.
Junior medics have more 'crashes'.The rest of the article is on the BBC webpage, via the link above.
Junior doctors are being put at increased risk of road traffic accidents because of exhaustion.
A survey of 1,619 junior doctors by the Royal College of Physicians found that one in six had a road traffic accident when commuting in 2004-05.
Returning from a night shift was found to be most risky, although half of accidents happened on the way to work.
The College warned that working patterns were to blame with doctors doing too many night shifts in a row.
The annual survey of specialist medical registrars found that 264 of the doctors questioned had a road traffic accident - 134 when driving to work and 130 when returning from work.
Although more of the doctors who crashed on their way home had been working a day shift rather than a night shift, the overall risk of crashing was far higher for those who had worked through the night.
Doctors only work about one night in 10, but 56 of the doctors who reported an accident on the way home were returning from a night shift and 74 from a day shift.
The introduction of the European Working Time Directive in 2004 means that doctors no longer work more than an average of 56 hours in a week.
But the RCP said despite attempts to reduce working hours, poorly designed rotas left almost half of doctors working seven 13-hour shifts in a row, resulting in a 91-hour week.
It recommends hospitals switch to a nine-hour shift pattern rather than 13 hours, with fewer shifts in succession.
What gets me, is they actually call this news! Every medic up and down the country knew this and I'm sure it came as no surprise to the families of medics. The European Working Time Directive was meant to be a great rule that would see junior doctors work no more than 56 hours a week and one night shift in 10. Basically it was never going to be possible. Junior doctors are relied on heavily to do on-call work, lots of shifts and the evil over-nighters. They were never going to be tucked up in bed at 10pm with a cup of cocoa even with an EU order over them. Hospitals have found ways round the maximum 56 hour week and junior doctors are still working anti-social, overworked shift patterns. It comes with the territory as a medic.
In other news, I found a job in an Accident & Emergency department in this Southern neck of the woods. It feels bizarre to be back around the area that I trained in, but good because the department is amazing! Fiance is off to the battlefield come the New Year and I'm panicking slightly about that, but I've seen him go off before and return in one piece, so I'm sure this time will be no different.
Thursday, June 08, 2006
Sigh...
I have just got back from work, and am wondering how I am meant to sleep when it looks so gorgeous out there. The department was rammed last night, and so hot, even I was nearly melting in a set of scrubs (how elegant they are).
I felt very sorry for the poor old dear who had been brought in my ambulance and her daughter had wrapped her up in a big fleecy dressing gown to "keep out the cold", the paramedics had then put a blanket over her (they always seem to put a blanket on you, do they not realise that the NHS can provide sheets) and then the nurse who had signed her ambulance sheet and put her in a bed hadn't taken either her dressing gown or her blanket off. Said nurse then decided to run through a set of observations (vital signs; things like temperature, blood pressure, pulse etc.) and hurriedly ran across to me to exclaim "I'm a bit worried about the patient in bed 3 as her temps running a bit high". I wouldn't have minded this if she had been extremely pyrexial but her temp was 38.4C, a little high but could possibly be down to the fact that she was wearing enough clothes to go on an Arctic expedition in a hospital that had a more sub-tropical theme to it. My advice? Take the blanket and dressing gown off, put her in a gown and cover her with a sheet, if that doesn't make her feel better in about 5 minutes go and get a fan. The nurse's comment "gosh, I would never have thought of that" in a very sarcastic tone. Well don't ask my advice if you know, I mean I have got other things to deal with.
The patient I was actually dealing with was a 19 year old first year university student (studying something obscure) who was convinced she had failed her first year exams, convinced her parents were going to stop funding her if she got below a first or 2:1 this year adn had swallowed a large amount of painkillers, antidepressants (her own she claimed, but then then also claimed she didn't have a history of depression) and anti-histimines. She was found in her room by her boyfriend who bought her into A&E and then proceeded to berate her at triage and dump her. Good timing. I tried to pick the pieces of all of this up with a girl who won't talk to me, and even if she would she was crying so much she was nearly hyperventilating. She's promptly throws the activated charcoal across the room at my colleague (who has been working for about 15 hours at this point due to a staff shortage) and he doesn't take kindly to having things thrown at him and goes over to "have a word with her". She then decides to run away, hide in the toilets and is found crying in the corner of a cubicle having smashed a mirror and is slicing her arms with the remnants.
We (the nurse who found her and I) got her back into a cubicle, calmed her down, got her to drink the charcoal and ran the necessary blood tests and ECG. They all came back normal/slightly abnormal. She was a bit tachycardic but then she was in an anxious state so the rapid heart wasn't so much of a problem. However, we did still want to keep her in until later today either on CDU or a general medical ward. Trouble was CDU was full and none of the general medical wards would admit her unless she had a medical problem that needed treatment/observation. Time to call in the psychs as she obviously was about to be discharged and I didn't want to send her home without an assessment. Along trot the Crisis Resolution Team (we no longer have a duty psych, we have nurse led 'teams') who carry out the necessary paperwork (i.e. tick boxes 1-18, fill in questions 19 & 20 etc.) and declare that my patient (who is acutely distressed, has run out of the department and been found actively self-harming) is at no risk to herself and is not likely to self-harm again! I couldn't believe it. Anyway, we pushed the boundaries and she's being kept until midday on CDU.
Another fun filled night and now I am off to bed. Goodnight!
I felt very sorry for the poor old dear who had been brought in my ambulance and her daughter had wrapped her up in a big fleecy dressing gown to "keep out the cold", the paramedics had then put a blanket over her (they always seem to put a blanket on you, do they not realise that the NHS can provide sheets) and then the nurse who had signed her ambulance sheet and put her in a bed hadn't taken either her dressing gown or her blanket off. Said nurse then decided to run through a set of observations (vital signs; things like temperature, blood pressure, pulse etc.) and hurriedly ran across to me to exclaim "I'm a bit worried about the patient in bed 3 as her temps running a bit high". I wouldn't have minded this if she had been extremely pyrexial but her temp was 38.4C, a little high but could possibly be down to the fact that she was wearing enough clothes to go on an Arctic expedition in a hospital that had a more sub-tropical theme to it. My advice? Take the blanket and dressing gown off, put her in a gown and cover her with a sheet, if that doesn't make her feel better in about 5 minutes go and get a fan. The nurse's comment "gosh, I would never have thought of that" in a very sarcastic tone. Well don't ask my advice if you know, I mean I have got other things to deal with.
The patient I was actually dealing with was a 19 year old first year university student (studying something obscure) who was convinced she had failed her first year exams, convinced her parents were going to stop funding her if she got below a first or 2:1 this year adn had swallowed a large amount of painkillers, antidepressants (her own she claimed, but then then also claimed she didn't have a history of depression) and anti-histimines. She was found in her room by her boyfriend who bought her into A&E and then proceeded to berate her at triage and dump her. Good timing. I tried to pick the pieces of all of this up with a girl who won't talk to me, and even if she would she was crying so much she was nearly hyperventilating. She's promptly throws the activated charcoal across the room at my colleague (who has been working for about 15 hours at this point due to a staff shortage) and he doesn't take kindly to having things thrown at him and goes over to "have a word with her". She then decides to run away, hide in the toilets and is found crying in the corner of a cubicle having smashed a mirror and is slicing her arms with the remnants.
We (the nurse who found her and I) got her back into a cubicle, calmed her down, got her to drink the charcoal and ran the necessary blood tests and ECG. They all came back normal/slightly abnormal. She was a bit tachycardic but then she was in an anxious state so the rapid heart wasn't so much of a problem. However, we did still want to keep her in until later today either on CDU or a general medical ward. Trouble was CDU was full and none of the general medical wards would admit her unless she had a medical problem that needed treatment/observation. Time to call in the psychs as she obviously was about to be discharged and I didn't want to send her home without an assessment. Along trot the Crisis Resolution Team (we no longer have a duty psych, we have nurse led 'teams') who carry out the necessary paperwork (i.e. tick boxes 1-18, fill in questions 19 & 20 etc.) and declare that my patient (who is acutely distressed, has run out of the department and been found actively self-harming) is at no risk to herself and is not likely to self-harm again! I couldn't believe it. Anyway, we pushed the boundaries and she's being kept until midday on CDU.
Another fun filled night and now I am off to bed. Goodnight!
Tuesday, June 06, 2006
Summer Nights
I am on a week of nights this week which I don't actually mind. I hate nights in winter when you arrived at work in the dark and leave work in the dark and because you're working in some goddamn awful NHS hospital (and I note proper 'old style' NHS hospitals, not a new fancy PFI one which looks more like a shopping centre) which has very few windows and ghastly flu-tubes meaning that you never get to see any daylight. No, working in the summer is quite pleasant as the hospital has cooled down somewhat (why do NHS managers seem to think that simply because 'it is a hospital' do we need the heating on when it's 23C outside) and you see some daylight.
Most of the work is the same... alcohol related, poisonings, collapse from unknown cause, etc etc etc. However, you do get to see some different types of patients, such as those with heat stroke or surprisingly there tends to be an increase in the number of poisonings by illicit drugs, so I was relieved to find this article from the 'New Scientist' which clarifies my thinking. Obviously, you see more alcoholism related injuries/illnesses which occur from people sitting outside in the sun for lunch, having a few drinks and then deciding that they can drive home/return to their manual job/construct a garden shed. Also, more dehydration and self-neglect as elderly people (in my observations) don't go out when it is hot, and therefore do not stock up on food etc and it is startling how many say "well my daughter-in-law was meant to go to the supermarket yesterday for me but she rang and said she didn't because it was a nice day so she was going out for a drink with her friends from work". Members of the public, sunny weather does not mean you can neglect your duties, whether this is collecting food from the supermarket for mother-in-law, leaving your kids in the car for "just 5 minutes" whilst you chat to a friend (with no window open and in direct sunlight), doing the same with your dog or neglecting to apply suntan lotion to your child who is about to spend all day outside on a school trip and will come back with very nasty burns (although I sense the teacher should have had some input there, but now I remember that teachers are not allowed to touch children anymore so the child suffers severe burns, dehydration, heat stroke and ends up in A&E... bureaucracy gone mad!).
On another note, I will soon be unemployed in August and have just been informed by my darling fiance that he is moving South with his job (surgical registrar). Currently we both work in the North, me in a city and him in the country, but we are to move. He is an army medic and therefore has to work where there are MDHUs and so we have been told where we are going. I have just had a quick look on the NHS Jobs website and there are a couple of job opportunities that look promising, both Registrar posts in Emergency Medicine. They are both under the scheme where you train 'on the job' for 5 years after being qualified for 3 years and having been considered to have had enough training in a junior role to undertake a more senior role and senior training. I guess I'll have to start applying!
Most of the work is the same... alcohol related, poisonings, collapse from unknown cause, etc etc etc. However, you do get to see some different types of patients, such as those with heat stroke or surprisingly there tends to be an increase in the number of poisonings by illicit drugs, so I was relieved to find this article from the 'New Scientist' which clarifies my thinking. Obviously, you see more alcoholism related injuries/illnesses which occur from people sitting outside in the sun for lunch, having a few drinks and then deciding that they can drive home/return to their manual job/construct a garden shed. Also, more dehydration and self-neglect as elderly people (in my observations) don't go out when it is hot, and therefore do not stock up on food etc and it is startling how many say "well my daughter-in-law was meant to go to the supermarket yesterday for me but she rang and said she didn't because it was a nice day so she was going out for a drink with her friends from work". Members of the public, sunny weather does not mean you can neglect your duties, whether this is collecting food from the supermarket for mother-in-law, leaving your kids in the car for "just 5 minutes" whilst you chat to a friend (with no window open and in direct sunlight), doing the same with your dog or neglecting to apply suntan lotion to your child who is about to spend all day outside on a school trip and will come back with very nasty burns (although I sense the teacher should have had some input there, but now I remember that teachers are not allowed to touch children anymore so the child suffers severe burns, dehydration, heat stroke and ends up in A&E... bureaucracy gone mad!).
On another note, I will soon be unemployed in August and have just been informed by my darling fiance that he is moving South with his job (surgical registrar). Currently we both work in the North, me in a city and him in the country, but we are to move. He is an army medic and therefore has to work where there are MDHUs and so we have been told where we are going. I have just had a quick look on the NHS Jobs website and there are a couple of job opportunities that look promising, both Registrar posts in Emergency Medicine. They are both under the scheme where you train 'on the job' for 5 years after being qualified for 3 years and having been considered to have had enough training in a junior role to undertake a more senior role and senior training. I guess I'll have to start applying!
Thursday, June 01, 2006
Public Health Announcement
I have a few words of advice for those of you wishing to conduct 'Do It Yourself' projects over the weekend. This comes from my observations over the Bank Holiday weekend of injuries people have caused to themselves.
1) When a set of instructions says that the project requires 2 people, it says this for a reason. This is probably because a wardrobe is a heavy item and one person cannot support it. I don't want to see more people with crush injuries and suffocation from a wardrobe falling on them.
2) Do not walk around the house holding a battery powered drill at a 45 degree angle to the ground (i.e. straight out in front of you) and still have it switched on. The likelihood is that you may bump into someone when you turn the corner and the drill bit will penetrate their lower neck (not pretty).
3) Never think it is a good idea to hold screws/nails/pins inbetween your teeth until they are needed as they can go through your tongue and cause a lot of bleeding. Plus the Max Facs doctors will not like you for it.
4) Place the ladder on a hard, stable surface and not near steps. Ladders have a habit of moving backwards slightly when weight is put on them and if you placed your ladder at the top of a set of stairs, hey presto, you just fell down the entire flight and broke numerous bones in your body.
I think that's it for now. In all fairness, just show some common sense.
1) When a set of instructions says that the project requires 2 people, it says this for a reason. This is probably because a wardrobe is a heavy item and one person cannot support it. I don't want to see more people with crush injuries and suffocation from a wardrobe falling on them.
2) Do not walk around the house holding a battery powered drill at a 45 degree angle to the ground (i.e. straight out in front of you) and still have it switched on. The likelihood is that you may bump into someone when you turn the corner and the drill bit will penetrate their lower neck (not pretty).
3) Never think it is a good idea to hold screws/nails/pins inbetween your teeth until they are needed as they can go through your tongue and cause a lot of bleeding. Plus the Max Facs doctors will not like you for it.
4) Place the ladder on a hard, stable surface and not near steps. Ladders have a habit of moving backwards slightly when weight is put on them and if you placed your ladder at the top of a set of stairs, hey presto, you just fell down the entire flight and broke numerous bones in your body.
I think that's it for now. In all fairness, just show some common sense.
Friday, May 26, 2006
It's just been one of those days
Managed to get a short shift today, only 10 hours instead of the usual 12. However, with the sort of day it has been I am glad I didn't have to work the last 2 hours.
It has been one of those days where nothing has gone right. Patients have been shipped in the Clinical Decisions Unit from A&E not because they need further tests which can be arranged by us, or because they need to be observed for a few hours, but simply because A&E has been packed to the rafters and no one has been seen by a doctor until about 3 hours after they booked in. This of course goes against the government's wonderful guidelines that patients should be seen, treated and discharged/admitted within 4 hours of arriving at A&E.
What this ultimately means is that patients who have presented with minor injuries have been told by the triage nurse to make a GP's appointment (for conditions lasting 2+ days), go to a Walk In centre or go to the Minor Injuries Unit. This has weaned out a lot of malingerers but some creep through the net. Usually the ones who claim to be in pain, or insist on having an X-Ray, or have problems that nurse practitioners won't deal with (and don't get me started on the rant there, see Dr. Crippen's blog for some good rants).
I've had some very funny conversations with patients today, including one that went like this. Bearing in mind that the patient had already sat in a cubicle in A&E for 1 1/2 hours whilst nobody treated her. She then got moved to us as she was elderly, dehydrated, had previously collapsed and no one could work out what was wrong with her and no one was prepared to risk discharging her.
Me: Hello, I'm MJ, I'm one of the doctor's here. What seems to be the problem? This being done whilst flicking through her A&E notes.
Patient: I don't know. I felt funny this morning and collapsed. My neighbour found me. I feel much better now, can I go home?
Me: Not yet, we really need to find out what's wrong with you. Are you in any pain? Noticing that in her notes she has been taking dihydrocodeine (a strong painkiller) regularly for 8 months.
Patient: No, no pain.
Me: So why are you taking dihydrocodeine?
Patient: For the pain.
Is there any wonder I want a brick wall to bang my head against at times??
It has been one of those days where nothing has gone right. Patients have been shipped in the Clinical Decisions Unit from A&E not because they need further tests which can be arranged by us, or because they need to be observed for a few hours, but simply because A&E has been packed to the rafters and no one has been seen by a doctor until about 3 hours after they booked in. This of course goes against the government's wonderful guidelines that patients should be seen, treated and discharged/admitted within 4 hours of arriving at A&E.
What this ultimately means is that patients who have presented with minor injuries have been told by the triage nurse to make a GP's appointment (for conditions lasting 2+ days), go to a Walk In centre or go to the Minor Injuries Unit. This has weaned out a lot of malingerers but some creep through the net. Usually the ones who claim to be in pain, or insist on having an X-Ray, or have problems that nurse practitioners won't deal with (and don't get me started on the rant there, see Dr. Crippen's blog for some good rants).
I've had some very funny conversations with patients today, including one that went like this. Bearing in mind that the patient had already sat in a cubicle in A&E for 1 1/2 hours whilst nobody treated her. She then got moved to us as she was elderly, dehydrated, had previously collapsed and no one could work out what was wrong with her and no one was prepared to risk discharging her.
Me: Hello, I'm MJ, I'm one of the doctor's here. What seems to be the problem? This being done whilst flicking through her A&E notes.
Patient: I don't know. I felt funny this morning and collapsed. My neighbour found me. I feel much better now, can I go home?
Me: Not yet, we really need to find out what's wrong with you. Are you in any pain? Noticing that in her notes she has been taking dihydrocodeine (a strong painkiller) regularly for 8 months.
Patient: No, no pain.
Me: So why are you taking dihydrocodeine?
Patient: For the pain.
Is there any wonder I want a brick wall to bang my head against at times??
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