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...

Junior medics have more 'crashes'.
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.

The rest of the article is on the BBC webpage, via the link above.

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.

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!

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!

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.

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??

The little things you miss

CDU/obs ward/critical care is absolutely amazing and I am loving it so much despite the severe sleep deprivation I seem to be having at the moment. What is it with locums who don't turn up to complete their shifts? Not on. At all.

However, whilst being totally rushed off my feet I have to say I noted why I missed working nights on MAAU which were a lot more relaxing than here, as nights here seem to be more and more chaotic by the second. It's the actually sitting down for a cup of coffee in the staff room when you want to (if there isn't a patient who needs you) and being able to read a trashy celebrity magazine stolen from the day room in peace. Here I'm lucky if I get to walk off for a cup of coffee without being nobbled to do something else. Not that I'm moaning, I feel a lot more useful here and more wanted. Not just as if I'm the useless SHO who you'll call if the staff nurse/senior staff nurse has a major issue and it can't wait until ward rounds. I feel like part of the team especially as I'm going to take my MFAEM (Member of the Faculty of Accident & Emergency Medicine) soon so people actually want me to work and get experience.

Now I know why I became a medic

After reading Shiny Happy Person's comment about her name being the link for Random Acts of Reality's blog, I attempted to change it. Only to find that when I accessed the template page I had the links up for both Shiny Happy Person and Random Acts of Reality on separate lines and in separate links. So now I am confused (and it does not take a lot really). So instead I have decided to leave it be for the moment and apologies to anyone who gets taken to the wrong webpage but I did try and attempt it later in the week when my brain may be functioning slightly more. Technology has never been a strong point of mine (well at least not computer technology). Anything other than medical equipment tends to fail on me, although I was known on the ward when I was a medical PRHO for having an amazing ability to make a 12 lead ECG machine go totally haywire. Luckily though over the years I have perfected my technique and now only have small problems with infusion pumps and only then because I forget that half the one's in the hospital actually have no battery life anymore and have to remain plugges into a mains electricity supply. Never mind, it's all a learning curve.

What do you all think of the new layout? Personally I prefer it, if only because I can read it more easily without having to grovel around in my bag/coat pocket to find my glasses! I am that blind, which is shocking really and I need to invest in contacts but the mere though of them makes me squearm. In other news I have moved jobs (again) back to critical care. For the next 6 months I am based on the clinical decisions unit and observation ward attached to the A&E department but am accountable to critical care (that is intensive care and high dependency, where I will also spend some time). There is more on the use of CDUs and obs wards here in an article from the BMJ. Personally I think they're just a "push the patient out of an A&E cubicle" solution and in the case of CDUs just an incentive to get patients out before they breach the 4 hour rule. I'm not complaining though, it means I'm going to spend a better 6 months than I did in admissions where I felt my sole purpose was just to stick drips in people, write up painkillers, look at ECG results and tag around with the consultant at ward round writing up his notes.

I'm sure it'll be hell for the first few weeks, although I'll know a lot of the nurses from the rotation I did in A&E earlier in my career so that should be fun as a lot of them are hilarious to be around. It means longer hours which my fiancé is not too impressed with as he's already doing enough hours (as a surgical registrar - mad soul) and thinks that I should become a GP. I hate that typical male sexist view that just because I am a 26 year old woman who has done her basic medical training I should now pack up and move into general practice because it's seen as a more female environment. I don't want to be a GP (no offence to GPs) because I like critical care and emergency medicine, I like the variety it brings along with the adrenaline which you don't get in primary care. You may get the variety but not the adrenaline and no where near the buzz from working in that environment. Plus, I won't just be seen as a female medic who will get married, settle down and have children and become a part-time salaried general practitioner. The whole issue of it annoys me.

There also appears to be a spark of interest in the media at present with self-harm. The Times covered two stories on the issue on Saturday in the health section and on the front page of Sunday's edition. Maybe it is because the government realises what a crisis the NHS is in when it comes to self-harm and many mental health issues in general. I found a large proportion of self-harm when I worked on admissions in the case of overdoses as the patients are admitted overnight and I expect to see a lot more of it now I'm back in critical care through overdoses and self-mutilation. It scares me to see the figures of self-harmers admitted to hospitals these days. I know that when I trained to be a doctor hardly any emphasis was put on self-harm in psychiatry lectures and rotations and a nurse I worked with once who had been an A&E nurse for 18 years said she couldn't remember the proportion of self-harming previously that is seen at present. I took a special interest in it during my mental health module, probably because of my history, and when I worked in A&E I always offered to treat the patients who were in the department because of self-harm or who were deemed to need psychiatric intervention by the triage nurse.

Many doctors take a dim view of self-harmers and I know a lot of my colleagues will be "tut-tutting" at the idea of giving them clean blades to use as it may encourage them to self-harm and therefore they will clog up the emergency departments even more (their views, not mine). It is true that there is a proportion of patients that will attend an A&E unit on frequent occasions having self-harmed but this is symptomatic of the nature of it, it is habitual and often increase in severity the longer it goes on. For the same reason this is why on admissions we had patients who had 6 or 7 piles of notes for previous admissions to the unit following overdoses. However, in the case of clean blades it could be said that prevention is better than cure and preventing infection is paramount, along with education into how to cut safely, thus avoiding major injuries.

Maybe you have to have been there to show the sympathy and empathy that these people need. It is a very vicious circle that I think needs a lot of specialist training to comprehend and unfortunately many NHS trusts don't have the resources (despite the National Institute for Clinical Excellence's guidelines stating all clinical staff should be given training if they come into contact with self-harmers). In the trust I work we are lucky that we have a deliberate self-harm team who assess people admitted following acts of self-harm but that is the end of their remit, they can discharge people, refer them to community mental health teams/psychiatrists, or have them admitted to an acute psychiatric unit, most of which is not what the self-harmer (in my opinion) needs. They need short-term intensive intervention when they are discharged, followed by long-term support. The former to prevent them from self-harming so badly again and not feeling as if they have been rejected and left and the latter to help them understand the condition and any triggers behind it.

Then again I have the experience, I self-harmed, and therefore think I am more aware of the needs and I know NHS trusts are overstretched already and are doing the best they can.

Over a month ago

That was the last time I posted, that's very bad isn't it? Well I guess not a lot has been happening, patients keep being admitted, transferred and discharged, some readmitted and some go to the lovely Rose Cottage (euphemism for the morgue). Meanwhile the doctors keep going around stressed, in a world of their own and contemplating their futures. The days of me reacquainting myself with A&E in a liaison capacity are well and truly over although there is the possibility that come the end of November there will be scope for me to go back on the odd day to meet with the consultants there for advice over the registrar exams. The trouble is the MAAU apparently needs me, I'm sure it should be wonderful to be wanted but at present I want to be somewhere else. The problem with being a medic though, or indeed any healthcare provider, is that you have to take everyone else's wants into account but nobody acknowledges your wants or needs.

I went back to see the locum GP, lovely lass, and as a joint decision I am not being referred to any form of psychological therapy (much to my fiancé's disgust) and am not taking sleepers anymore either, which is helpful because I can be enough of a zombie on a night shift, I need no encouragement. Did I just say lass a few lines ago? God, I really am turning northern, I'll be calling everyone love, pet and chuck soon. Definitely time to move back south me thinks.

So today, lovely readers, I thought I'd tell you about the NHS trust I work for. It is a teaching hospitals trust encompassing 6 medical hospitals and a dental hospital. It also has no stars according to the NHS star rating performance indicators. Now from the outside it is very difficult to see why this trust has no stars, after all it has a good nationwide image but working on the inside you begin to see why. Anyway, I'm not going to bitch about the star rating of it because it doesn't matter to my job really, the only thing it affects is patient services. The fewer stars = less funding from the Department of Health. According to the trust website it employs around 15,000 people and trets 125,000 inpatients, 65,000 day cases and 700,000 outpatients annually, making it one of the largest trusts in the UK. I'd probably agree with that. However, on another page it claims to be 'the largest NHS trust in the country'. You see what I mean, when there is conflicting opinions on the website, what hope is there for the patients and staff within the hospitals environment?

I think that concludes all I had to say today and I promise to be updating more frequently.

Thank god for locums

I went to my GP yesterday who actually was sick, so I saw another (very nice) medic who graduated the year before me and so understood the hell of being an SHO and understood that I wanted to be a registrar but wasn't sure if I was capable of passing the exams and that I was very stressed at work and didn't know how to cope. In fact I think I walked in and sounded fairly desperate because she took me fairly seriously. She agreed to give me 5 nights worth of sleepers, and I'm only allowed to take them at night (i.e. not to get rest during the day when on a night shift) and not continuous nights (standard procedure) and I have to go back and see her next week as she is a locum at the practice and will therefore be around for a few months. She said that I don't have to see occupational health at this moment in time but would like me to consider the idea of some form of psychological therapies to help me be prepared for any possible setbacks I may hit. All sound advice really.

Another locum who arrived yesterday was the locum registrar who is taking the position of the one who sauntered off to another trust and he seems exceptionally pleasant and wants to help all the SHOs/PRHOs along the way, which makes a change. Usually registrars just want to become senior registrars and consultants and don't give a damn about who they tread on along the way.

Found myself being a bit of a counsellor yesterday afternoon to a PRHO who I know has been having some problems. She's currently on her 6 month surgical rotation within MAAU and is therefore responsible for a hell of a lot of suturing and overseeing patient transfers to surgical wards. I knew a bit of her persoanl history, her mum was diagnosed with cancer during her finals and unfortunately it appears to be terminal so she is just waiting in essence which has been having an impact on her work. Yesterday she tried to suture up a fairly simple head wound and just could not do it, in fact she was having difficulty injecting the local into the area and ended up asking me to do it for her. I suggested that another surgical PRHO did it (they need the practice and I've never been a very good seamstress) and we went off to the staff room for a little chat. I told her that we all find things hard at times, and she admitted that she had never really grasped how to suture so together we spent about 1 hour injecting oranges and suturing up banana skins, I have to say I think we are both better off for the practice! I really feel an attachment with the girl, as I know I found my PRHO year tough due to one thing or another but am loathed to take her under my wing too much as present due to all the stuff I've got going on and also I know her mentor/consultant is an ogre and I don't want to be accused of being overly emotionally involved with her.

That's bureaucracy for you these days... you are willing to hold back from helping someone in need for fear of the reprimands, and it's not just colleagues, I know it happens in the ambulance service/A&E too.

Well I'm off to go and do one of my A&E liaison/crash course learning shifts now which should be slightly more thrilling than MAAU.

I think I'm semi-famous

Hello... it's me... that random person who should be writing this blog but has in fact been snowed under at work due to a registrar's decision to move NHS trusts. Great. Thanks. A lot.

Well I have to start studying for my advanced exams to let me become a registrar which means I am also getting to spend a couple of shifts a week in A&E doing 'liaison work' which in effect means I am an extra pair of hands that they don't have to worry about the pay or supervision of, it's nice to be wanted for a change. This registrar post means a lot to me and would be proof that I can actually achieve rather than just plod along and float through my medical career but it's going to involve a lot of hard work and time and I am so tired at present that I don't know if I can face it.

I was very naughty the other day and asked my fiancé (also a medic) to prescribe me some sleepers so I could get some rest, luckily for myself, my career and my reputation he refused but he bullied me into seeing my GP about everything (he thinks I have never really got over all my 'mental' stuff and am shoving it away, never to be dealt with) and so I have half a morning off work tomorrow to see him. Now I don't particularly get on with my GP, I don't know if it is the same for all health professionals but my GP seems to not be very keen on me as he always assumes I know what is wrong with me and what I need to be prescribed. I guess he thinks that in my eyes all he is is a signature on a prescription as I can't prescribe my own drugs, which isn't true. I see GPs as the 'gateway' to all NHS services and view my GP accordingly. Anyway, I know that depending on the result of the consultation there may be a visit to occupational health which means more explaining, but I know I am not coping well with the stress of everything at the minute and I want to stave off any impending doom than give into it.

Finally for the subject title of this post. I have since discovered that I have been mentioned on Mental Nurse's Blog which is a great privilege as I first read about their blog in The Observer a while back and have to say that they were some of the inspiration in creating my own blog. I feel deeply honoured.

Job opportunities

I seem to have neglected my blogging so on my day off I thought I'd write an update, although I sense I do not have a lot to write.

So finally I have a day off and then tomorrow I start back doing day shifts which tend to be terminally boring. Everything on a night shift seems to happen at double speed and because it is dark I can't see my awful surroundings that much (most of the time I can't actually see what I am doing either) yet on a day shift the hours seem to drag by.

I cannot complain though, at least I have a job when there are so many newly qualified doctors seeking jobs. It seems ludicrous to me that you apply for medical school and then train at university for 6 years and then not being guaranteed a job after your PRHO year. This year is usually spent in the same (or surrounding) NHS Trust as the one your university was located in, or used for the clinical placements and you are guaranteed a job for this year. When this year comes to an end you have to look for a post as an SHO in the speciality you want to work in. Unfortunately this is the difficult part as there are only so many allocated training posts in the UK. If you have been lucky in your PRHO year you will have already decided to train in a certain speciality and you will therefore remain in one NHS Trust doing rotations within that speciality, the most obvious one of these is psychiatry where you would gain knowledge in all aspects e.g. acute, elderly, mother & baby, crisis, liaison and outpatient and you will therefore always be able to find a post. However, for the rest of us mere medics the search goes on for a post and this happens every 6 months (in February and August). The problem is there are always popular posts (A&E for example) and these fill up quickly leaving the medics wanting to practise in A&E probably in oncology or something similar, basically where they didn't want to be.

Can you see why so there are so many medics who do not appear happy in their current positions and resent their colleagues who happen to work in the department they wanted to spend this 6 months in?

Rant over... I promise. Until next time.

Friday night is "why oh why did I choose this job?" night

I sat for most of last night wondering why I left the stressful yet fast-moving rotation of A&E behind to enter the equally stressful yet slower pace, and lower pay, of MAAU. To me it seems it is the same job, except we retain patients for longer than 4 hours and therefore tend to get them whinge at us more frequently, and we also have fewer doctors on duty at the same time. Usually we have a Registrar on-call (but never actually to hand), an SHO and a couple of PRHOs which sounds adequate to cover a 4 bay ward with 6 beds in each ward. We also have an excellent team of nurses and health care assistants who are more than happy to help an ailing, zombie-like doctor in their quest to cure a patient before the consultant does ward-rounds the next day but I always seem to spend my entire life running around like a headless chicken from one bay to another whilst having the PRHOs follow me round as if they were still med students. This is probably a little harsh as they were med students until a couple of months ago and are therefore well trained in the art of traipsing behind an ego-centric consultant and his/her medical team (i.e. registrars, SHOs & PRHOs) to look at all the 'interesting' cases/patients. What they have to realise now is that they are no longer required to follow the more senior doctor around and at 3am I would much prefer it if they left me in peace. Oh for the day when I can become a registrar and go on-call whilst refusing to answer my bleeper to anything less than a cardiac arrest!

So instead, dear reader, of giving you a breakdown of some of my patients last night (mainly drunks who needed sobering up, assault victims due to alcohol, a couple of overdoses and some nasty broken bones requiring surgery) I thought I'd give you an insight into my consultant here on MAAU and the guy who is my mentor.

My consultant seems as if he has been a doctor since Hippocrates wrote the oath in pen and ink yet has in fact probably only been qualified for less than 30 years and is a whizz on all things weird and wonderful after doing a short time in infectious diseases before deciding to embark on the general public's misfortunes in MAAU. He is a rather short, stout man who appears to think that women should be left to running a nurse's station rather than filling in ward-rounds. Nonetheless, he is a fairly decent bloke who is always willing to help you out if you encounter a problem (so long as it is between the hours of 9am and 5pm) and is wonderful to bitch about the PRHOs/med students to in the staff room. I am very lucky in this rotation to have such an approachable consultant, especially as it will be him who will be writing my reference for a registrar post in Febraury.

That's right fellow-bloggers, yours truly has decided to try and become an emergency medicine registrar after I do my (hopefully) final SHO rotation from February - August 2006. If not, well then I guess I could always try and become one of the few doctors who is still an SHO in their 30s but there's a long way to go until I hit the big three zero.

Day One of Bloglife

As this is a personal blog about my job and my life I should start by telling you about my day. Today actually started at about 2pm for me as that is when I woke up and it was September 2nd. I did a night shift last night on MAAU and although Thursday isn't usually a bad day this one had it's exceptions. A&E was bursting at the seams by approx. 10pm so all urgent, yet not life-threatening cases were diverted to another admissions unit, at a different hospital to the one I work in. We got all the patients who had been kicked out of A&E, often without treatment or the appropriate tests/examinations just so the patient didn't breach the 4 hour government guideline and of course our unit doesn't have guidelines or deadlines to keep to so as long as we have the bed space, the patients keep coming.

So of the best patients I had the pleasure of treating last night included a 57-year-old male who had suffered a suspected myocardial infarction and had been taken to A&E by ambulance. Once there he had received treatment including 'clot busting' meds and an ECG all of which had pointed to the above diagnosis and eased his symptoms. He was transferred to us by ambulance yet on arrival his ECG results and entire A&E notes had disappeared. Cue another ECG and long telephone calls to A&E to ascertain quantity and strength of drugs. Not a pleasant experience when A&E receptionists put you on hold because they cannot find a doctor to talk to you, despite the fact that they, or a nurse, could access the information perfectly easily and give you the required information. All of which would save a lot of time and energy because let's face it, who wants to bother to talk to an incompetent medic in a different hospital who has lost some medical notes when you already have far too many patients in your care and not enough time to grab a cup of coffee at 11pm when you've been working flat out for gods-knows how many hours? Not me, that's for starters. The patient is stable and has been transferred to Coronary Care where he'll be a lot better off.

Another wonderful character I had the pleasure of meeting last night was a 23-year-old female with multiple injuries to her face due to assault. She was in MAAU for observation after a head injury and had a suspected skull fracture which couldn't be diagnosed in A&E because the radiographer had gone home (never need a CT scan after 6pm on weekdays, or at all at weekends) and had been transferred to us in the meantime. Unfortunately she came with a couple of police officers who wanted to question her in relation to the assault and her response to everyone was to "fuck off, I don't need your help". The patient was also a drug addict and therefore had atrocious veinous access so trying to place a cannula in her arm in case we needed an emergency line was impossible. On the fourth attempt (this time in her foot) she kicked out in pain and told me to find a qualified person to put the line in (or similar words to that effect). Unfortunately I was the only SHO on duty last night and I had a Pre-Registration House Officer (PRHO) on duty with me. Basically a fresh-faced lad who only graduated and stepped into the big wide world of non-student medicine a month ago, or I had the Registrar (SpR) on-call. The SpR would have been my first port of call except I learnt the hard way in my first couple of years that a senior doctor does not like to be bleeped in the middle of the night for a cardiac arrest, let alone something as simple as a cannula). Out of kindness I let the PRHO try and to my annoyance he managed to find a perfectly suitable vein first time, just shows that a month as a PRHO where your sole job appears to be cannulas when you start pays off, he'll be a whizz when he leaves us in 5 months time. I'll have to ask him more often and save myself the sheer embarrassment.

Embarrassment... a word that is usually, ironically, reserved for PRHOs!

Introduction

Welcome all to this soon-to-be amazing blog, about me!
A few little facts about me for starters then.
I am a 26 year old female Senior House Officer (Junior Doctor) working on a Medical Admissions & Assessment Unit in a busy inner-city hospital in the North of England. I graduated in 2002 from King's College London, with a 2:1, and did my initial training in the same city. In 2003 I moved North and have acquired 5 posts in my time up here, including paediatrics, A&E, hepatics (liver), general surgery and currently MAAU.
That's my professional life. In my personal life I am engaged, and have been for nearly a year now, to my wonderful fiancé and have a kitten called Oscar. I also suffer from horrific mood swings and until the age of 23, when I graduated, I suffered from severe depression (often becoming delusional) and I self-harmed. I resisted being hospitalised as it wouldn't have done much for my job prospects and survived on daily doses of anti-depressants and therapy. I never had to go to A&E/hospital for my injuries as they were never that serious and I first met my fiancé in my 2nd year and we have been going out since then so he looked after me.
At the moment I plan to try and specialise in Emergency Medicine and try and go back into working in A&E, although I would also like to try a rotation in psychiatry to see if I could be a benefit to the ailing mental health services. However, nothing will happen until February 2006 now as I am locked into MAAU for 6 months so we'll just have to wait and see!
In the meantime, enjoy reading about the life of a mental medic and the NHS in general.