So it's 16th Sept soon to be 17th Sept 2015 and I have made it through now almost the first 2 months of Fy2! Initially it was odd, extremely odd, to sign "my name, F2" and answer the phone with "Hello, renal transplant SHO". That's right kidneys and transplants! Never quite saw that one coming.
Day one of being an F2 was quite a blur. A blur of acronyms, mainly. The whole ward round seemed to be spoken in code that only the medical and surgical consultant seemed to fully understand. Suffice to say it took about a week for me to learn to speak it, albeit perhaps a bit more simply!
So that month I spent most of my waking hours in the hospital. Our ward rounds started sharply at 0830 and my registrar made it very clear when I started that I must be in at 0800 to ensure that meeting did indeed start smoothly at 0830. Most days were very busy but I loved the buzz and learning new things everyday. My team were also very friendly and supportive and didn't make me feel silly for asking my continual host of questions!
After 5 weeks I was granted my week of annual leave in which I took my first postgraduate exam. Although I felt underprepared, it had been good opportunity to get back into my books which I surprisingly enjoyed. You forget in a way how much you've forgotten!
So I have now switched onto the chronic and acute renal team (we each take just a month's block on transplant) which is much calmer however I find myself back to square one, this time learning how to write dialysis scripts, and deal the other host of issues renal medicine can lead to.
All in all though, and slightly to my surprise, my love for medicine has definitely been rekindled and I find myself again feeling very uncertain where life might take me. Not in a nervous but more a factual way. Today came the news also that the British government have ruled an effectively 20% pay cut will affect juniors in England from next August... as if the bullet point pro-list for me staying in Scotland didn't need to be any longer!
At this moment in time I am also two nights away from my first medical SHO night shifts - my first now since the start of the year - in fact it was the night of the 1st January - so I hope I'll be able to stay up! I remember being delighted that I would have 8 months free of nights.. time continues to zoom by me!
Wednesday, 16 September 2015
Sunday, 19 July 2015
iminworkjeremy
Tomorrow will be day 8 of my first and only 12 day run. From August working more than 7 days in a row will be illegal, hurrah!
So far, it's going ?okay I think!
I'm alive anyway, just about.
Today was an atypical day. I was lucky, we had a weekend phlebotomist, which meant a lot of time saved rather than me taking 10 people's bloods after the ward round. My registrar was also extremely efficient but also thorough - everything you want in your senior!
We finished seeing everyone by 2pm. Later in the afternoon I had to update a family on their poorly family member. Usually this is the sort of conversation you dread on a weekend, as it often a patient whom you've only met once or twice. In the case however I knew this lady. I had seen her on admission albeit one month ago. I filled with dread however when I saw how sleepy and muddled she was today. Her deterioration was clear and I feared the worst. I met with the family - they recognised me as I had previously given them bad news! Not really a reason you want people to remember you. On the whole they took the news well, though her son, who last time had initially reacted angrily broke into tears. I could see he had slowly come to accept her fate. All the same, it was a difficult scene to watch and be a part of and I myself couldn't help but get a bit upset. You always feel for your patients, and especially so when they are so kind to others.
Half an hour later I found myself caught in another conversation. This time difficult for different reasons. The friend of a patient who was shall we say abnormally involved in her care pressed as to why she hadn't been consulted. It's difficult to say "because it's not your business" politely however much you sugar coat it! Our discussion - mainly her ranting - left me disheartened. Sometimes you try your best for your patient, and even then you can't please everyone.
Things calmed down, then in evening I started checking in on those patients we had been "keeping an eye on". One of them was very drowsy - she had been earlier and we had commenced intravenous antibiotics to help fight what we thought was a hospital acquired pneumonia. I didn't like that she still remained drowsy. Again, I updated her family, and they were very grateful. A friend of mine wisely said he felt 90% of complaints in hospital come from miscommunication or lack or, and he's not wrong.
The patient perked up a little, actually whilst the family were there, and I relaxed. When they left, I checked her again. Drowsy. I felt an unease. Did she really have a pneumonia or had we totally missed something? It was time for me to handover but again someone wise once said if you won't be able to get to sleep thinking about something, sort it out. I went back and examined again. I made a new plan, sent off extra bloods, arranged a further XR and asked to nurse to try a few things. I went back one last time and finally went to handover. Tomorrow I'll find out if any of my inklings were right.
Overall just another day as an F1 (soon to be a baby F2!) but another huge learning curve and a sizeable host of situations I hadn't been in before to learn during and from.
Some words that will remain with me from today... "I wouldn't want your job" (dying patient's family) and "you've been delightful" (complaining family member) and even from a (mildly confused) patient "I love you to bits".
Ah the highs and low of being a doctor.
Ps Hurry up and do some work Jeremy. PLEASE.
So far, it's going ?okay I think!
I'm alive anyway, just about.
Today was an atypical day. I was lucky, we had a weekend phlebotomist, which meant a lot of time saved rather than me taking 10 people's bloods after the ward round. My registrar was also extremely efficient but also thorough - everything you want in your senior!
We finished seeing everyone by 2pm. Later in the afternoon I had to update a family on their poorly family member. Usually this is the sort of conversation you dread on a weekend, as it often a patient whom you've only met once or twice. In the case however I knew this lady. I had seen her on admission albeit one month ago. I filled with dread however when I saw how sleepy and muddled she was today. Her deterioration was clear and I feared the worst. I met with the family - they recognised me as I had previously given them bad news! Not really a reason you want people to remember you. On the whole they took the news well, though her son, who last time had initially reacted angrily broke into tears. I could see he had slowly come to accept her fate. All the same, it was a difficult scene to watch and be a part of and I myself couldn't help but get a bit upset. You always feel for your patients, and especially so when they are so kind to others.
Half an hour later I found myself caught in another conversation. This time difficult for different reasons. The friend of a patient who was shall we say abnormally involved in her care pressed as to why she hadn't been consulted. It's difficult to say "because it's not your business" politely however much you sugar coat it! Our discussion - mainly her ranting - left me disheartened. Sometimes you try your best for your patient, and even then you can't please everyone.
Things calmed down, then in evening I started checking in on those patients we had been "keeping an eye on". One of them was very drowsy - she had been earlier and we had commenced intravenous antibiotics to help fight what we thought was a hospital acquired pneumonia. I didn't like that she still remained drowsy. Again, I updated her family, and they were very grateful. A friend of mine wisely said he felt 90% of complaints in hospital come from miscommunication or lack or, and he's not wrong.
The patient perked up a little, actually whilst the family were there, and I relaxed. When they left, I checked her again. Drowsy. I felt an unease. Did she really have a pneumonia or had we totally missed something? It was time for me to handover but again someone wise once said if you won't be able to get to sleep thinking about something, sort it out. I went back and examined again. I made a new plan, sent off extra bloods, arranged a further XR and asked to nurse to try a few things. I went back one last time and finally went to handover. Tomorrow I'll find out if any of my inklings were right.
Overall just another day as an F1 (soon to be a baby F2!) but another huge learning curve and a sizeable host of situations I hadn't been in before to learn during and from.
Some words that will remain with me from today... "I wouldn't want your job" (dying patient's family) and "you've been delightful" (complaining family member) and even from a (mildly confused) patient "I love you to bits".
Ah the highs and low of being a doctor.
Ps Hurry up and do some work Jeremy. PLEASE.
Friday, 1 May 2015
May Day!
I can't believe it's May!
It hasn't been the best of May Days. Though it started well! For the first time in many months I had a lie-in. My body is very good at just waking up when I don't want to so usually though I want one, it just isn't destined to happen. So not sure what happened today (maybe a bit too much indulgent Chinese last night!) but it was a nice surprise to feel well rested. The morning hours managed to slip away from me as usual without me noticing too much. I had every intention of going to the gym only instead I ended up looking up new places to live in. Our house contract comes to an end soon and we've decided to divvy up as 5 beds are hard to come by.
Then the afternoon disappeared (again I don't know how!) and before long it was time for my late shift at work. A poor colleague broke her ankle so we were one person short. I was therefore sent to cover wards I had never been to before.. always something that upsets me. I didn't know where anything was, or exactly what my job description was! Suffice to say it went fine until I had to handover to the night staff who gave me a tough time, I think simply because they were grumpy about being on nights! Such is life.
So a lot of unrest/change/work. But in 7 days I get to see my old housemates from London who I'm super excited to see. Then after that my family visit for when I turn the ripe old age of 26. Scary times.
It hasn't been the best of May Days. Though it started well! For the first time in many months I had a lie-in. My body is very good at just waking up when I don't want to so usually though I want one, it just isn't destined to happen. So not sure what happened today (maybe a bit too much indulgent Chinese last night!) but it was a nice surprise to feel well rested. The morning hours managed to slip away from me as usual without me noticing too much. I had every intention of going to the gym only instead I ended up looking up new places to live in. Our house contract comes to an end soon and we've decided to divvy up as 5 beds are hard to come by.
Then the afternoon disappeared (again I don't know how!) and before long it was time for my late shift at work. A poor colleague broke her ankle so we were one person short. I was therefore sent to cover wards I had never been to before.. always something that upsets me. I didn't know where anything was, or exactly what my job description was! Suffice to say it went fine until I had to handover to the night staff who gave me a tough time, I think simply because they were grumpy about being on nights! Such is life.
So a lot of unrest/change/work. But in 7 days I get to see my old housemates from London who I'm super excited to see. Then after that my family visit for when I turn the ripe old age of 26. Scary times.
Monday, 9 March 2015
Spring..(ing into the last 4 months of F1)
Or almost! It's not quite BST yet but it certainly feels warmer and having survived my first Scottish winter I look forward to very soon being able to change back my winter to summer tyres..!
I now have three weeks left of my current post in the countryside before I move back to Edinburgh for 16 months. I can't wait! It's not that I don't like the countryside but I definitely am missing the buzziness of city life and being in a big teaching hospital. As I said to a friend, deep inside I'm no country bumpkin! The good thing is I'm finally (as I think will keep happening every 4 months) settled into my job - I know how the computer system works, how each consultant likes their ward rounds, and where each ward is! Only to find myself about to leave the hospital!
Fortunately my next job is back at a hospital I previously worked in, and actually the specialty will be the same as my current one "general medicine" - additionally with 8 months of fledgling F1 experience under my thinly padded belt, I should in theory be a bit better equipped! :)
I also now have my next rota which means I can plan life for the next four months! Already I have plans to go away and have visitors... and possibly train for (my first) half marathon if I could just bring myself to commit to it ;) Watch this space!
Monday, 23 February 2015
The second new year of the year
My favourite time after Christmas is Chinese New Year. It's an excuse to get together with the nearest and dearest, eat lots, be merry and consolidate those new year resolutions.
This year we celebrated with our usual 10-dish (plus an extra one for luck) feast, listened to everyone's stories and upcoming plans and trips for the year. There is one person in particular who always teaches us all.
He (Uncle X) told us of how it was that he came receive his kidney transplant, a remarkable 27 years ago. He had long suffered chronic kidney disease and had been on dialysis. He followed his doctor's instructions to eat healthily, fluid restrict himself with the aim to control his blood pressure to aid the function of his kidneys. Eventually there came a time when he was told he needed a transplant. At the time, there were few oriental people in the UK and the medical team told him they had never yet had a donated kidney from anyone of his ethnic background. This they believed would have impacts on the immunological interactions his body would have with a transplanted kidney.
Without going into the minutiae, each person's organs have recognition molecules that tells the body they are your own. This is a defence mechanism, so that for example if a foreign body or a pathogen (e.g. virus / bacteria) enters, your immune system knows to activate and fight it off. In the event of a transplant, the body is artificially immunosuppressed with medications so it will not recognise the foreign, transplanted organ. Successful transplants escape "rejection" - the receiver must take immunosuppressant drugs lifelong however. To increase the likelihood of a successful transplant, it is imperative that the receiver's "recognition molecules" (called HLA proteins) are as similar to the donors as possible - and usually this means that people from a similar ethnic origin will be a more likely match. (This is similar to "crossmatching" before a blood transfusion.)
The doctors said that Uncle X would be put on the waiting list nonetheless if he consented, but that he must realise a transplant would carry risks, and in this case, the extra risks that they did not know how successful a transplant from a non-ethnically similar person would be. Uncle X considered his options and said that he did not mind being the guinea pig, if it meant that they could learn from their actions. What a valiant thing to do.
One day, the doctors phoned Uncle X. They said a kidney had come through. They said he was second in line - this meant they had called another patient who they felt would be a better match. They advised the other patient to come to hospital immediately. If it turned out the other patient was not such a good match after testing, then Uncle X would be tested. He was asked to come to the hospital immediately.
Uncle X went to the hospital, and met the other gentleman. On arrival, he was told the other gentleman had not been such a good match after all. He saw him curled up in a ball looking away from him, of course emotions were running high. Uncle X was tested. The team told him he seemed a good enough match and again asked him if he were really to undergo the necessary procedures for the transplant. Uncle X accepted. He spoke with the other patient. He did not tell him that he had been granted the kidney but told him his time would come; it wasn't today but it would be another time. The other patient asked if he could meet with Uncle X at a later date and they became acquaintances.
Uncle X had the kidney transplanted successfully, and miraculously 27 years later is here to tell the tale. Even today, kidney transplants are estimated to have a 10 - 15 year shelf life.
I once again was in awe of Uncle X, his wisdom and his kindness, both qualities of which I can only continue to aspire to. Hopefully the one year older, one year wiser saying is true...
Here's to a healthy & happy New Year!
This year we celebrated with our usual 10-dish (plus an extra one for luck) feast, listened to everyone's stories and upcoming plans and trips for the year. There is one person in particular who always teaches us all.
He (Uncle X) told us of how it was that he came receive his kidney transplant, a remarkable 27 years ago. He had long suffered chronic kidney disease and had been on dialysis. He followed his doctor's instructions to eat healthily, fluid restrict himself with the aim to control his blood pressure to aid the function of his kidneys. Eventually there came a time when he was told he needed a transplant. At the time, there were few oriental people in the UK and the medical team told him they had never yet had a donated kidney from anyone of his ethnic background. This they believed would have impacts on the immunological interactions his body would have with a transplanted kidney.
Without going into the minutiae, each person's organs have recognition molecules that tells the body they are your own. This is a defence mechanism, so that for example if a foreign body or a pathogen (e.g. virus / bacteria) enters, your immune system knows to activate and fight it off. In the event of a transplant, the body is artificially immunosuppressed with medications so it will not recognise the foreign, transplanted organ. Successful transplants escape "rejection" - the receiver must take immunosuppressant drugs lifelong however. To increase the likelihood of a successful transplant, it is imperative that the receiver's "recognition molecules" (called HLA proteins) are as similar to the donors as possible - and usually this means that people from a similar ethnic origin will be a more likely match. (This is similar to "crossmatching" before a blood transfusion.)
The doctors said that Uncle X would be put on the waiting list nonetheless if he consented, but that he must realise a transplant would carry risks, and in this case, the extra risks that they did not know how successful a transplant from a non-ethnically similar person would be. Uncle X considered his options and said that he did not mind being the guinea pig, if it meant that they could learn from their actions. What a valiant thing to do.
One day, the doctors phoned Uncle X. They said a kidney had come through. They said he was second in line - this meant they had called another patient who they felt would be a better match. They advised the other patient to come to hospital immediately. If it turned out the other patient was not such a good match after testing, then Uncle X would be tested. He was asked to come to the hospital immediately.
Uncle X went to the hospital, and met the other gentleman. On arrival, he was told the other gentleman had not been such a good match after all. He saw him curled up in a ball looking away from him, of course emotions were running high. Uncle X was tested. The team told him he seemed a good enough match and again asked him if he were really to undergo the necessary procedures for the transplant. Uncle X accepted. He spoke with the other patient. He did not tell him that he had been granted the kidney but told him his time would come; it wasn't today but it would be another time. The other patient asked if he could meet with Uncle X at a later date and they became acquaintances.
Uncle X had the kidney transplanted successfully, and miraculously 27 years later is here to tell the tale. Even today, kidney transplants are estimated to have a 10 - 15 year shelf life.
I once again was in awe of Uncle X, his wisdom and his kindness, both qualities of which I can only continue to aspire to. Hopefully the one year older, one year wiser saying is true...
Here's to a healthy & happy New Year!
Thursday, 1 January 2015
Two thousand and whaaat?
2015!
It's the first of the first and I find it really hard to believe all that happened in 2014. 365 days ago I didn't know I would be sitting at my desk in the Scottish countryside, about to begin a nightshift in 2.5 hours...
2014 was a year of great change for me. Probably the biggest year of change since leaving school. There were finals to prepare for - the final hurdle after six years of study, then came the applications for jobs which surprisingly to me made me question my priorities in life, then came the elective - the opportunity for me to travel and catch up with my family and friends up and down under! And lastly the big move from London to Edinburgh. This last bit makes me extremely happy... because whilst it was planned and whilst I thought I probably would enjoy it, it's turned out to have worked well for more reasons than I have fingers!
One of those reasons is that family time has become extra precious and over the last 5 months I have been to London briefly 3 times and my family have visited me twice. Over Christmas we ventured to Skye, Scotland's second largest isle. It was an idea that we had discussed when I first moved up but actually I have wanted to see Skye since I was 17! "Skye" just sounds a bit magical does it not?
We had a wonderful time, staying in a country cottage from Christmas eve. I was in charge of our food supplies for the week which I must admit took far more work than I anticipated but worked out well, and reminded me how much I enjoy being creative in the kitchen, something that work doesn't often allow me to indulge in.
Each day we would venture out in the sun/snow/frost/rain to visit another corner of Skye which was never short of stunning in all its many weathers! The evenings we spent playing games, watching Christmas television and movies (Frozen is now probably an annual must-see!) and preparing for where we might walk the next day.
When we had to go back to Edinburgh, I felt a huge reluctance to leave! To leave such a wonderful place and to have to take my family back to the airport and say au revoir, and of course to have to go back to work. But all good things must come to an end in some ways... otherwise they wouldn't be so good!
Here's to many good things and good times in 2 0 1 5 :)
It's the first of the first and I find it really hard to believe all that happened in 2014. 365 days ago I didn't know I would be sitting at my desk in the Scottish countryside, about to begin a nightshift in 2.5 hours...
2014 was a year of great change for me. Probably the biggest year of change since leaving school. There were finals to prepare for - the final hurdle after six years of study, then came the applications for jobs which surprisingly to me made me question my priorities in life, then came the elective - the opportunity for me to travel and catch up with my family and friends up and down under! And lastly the big move from London to Edinburgh. This last bit makes me extremely happy... because whilst it was planned and whilst I thought I probably would enjoy it, it's turned out to have worked well for more reasons than I have fingers!
One of those reasons is that family time has become extra precious and over the last 5 months I have been to London briefly 3 times and my family have visited me twice. Over Christmas we ventured to Skye, Scotland's second largest isle. It was an idea that we had discussed when I first moved up but actually I have wanted to see Skye since I was 17! "Skye" just sounds a bit magical does it not?
We had a wonderful time, staying in a country cottage from Christmas eve. I was in charge of our food supplies for the week which I must admit took far more work than I anticipated but worked out well, and reminded me how much I enjoy being creative in the kitchen, something that work doesn't often allow me to indulge in.
Each day we would venture out in the sun/snow/frost/rain to visit another corner of Skye which was never short of stunning in all its many weathers! The evenings we spent playing games, watching Christmas television and movies (Frozen is now probably an annual must-see!) and preparing for where we might walk the next day.
When we had to go back to Edinburgh, I felt a huge reluctance to leave! To leave such a wonderful place and to have to take my family back to the airport and say au revoir, and of course to have to go back to work. But all good things must come to an end in some ways... otherwise they wouldn't be so good!
Here's to many good things and good times in 2 0 1 5 :)
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