Resisting the Twitterers

As much as I love Philip Schofield, I'm not sure I want my life reduced to one sentence soundbites, like one big continual Facebook update.

I like to think I'm more interesting than that... or is it more that I just talk too much and wouldn't be able to say all I want to say in one little sentence... I won't let you answer that one.

But given that I've had my Sony Ericcson phone for nearly 9 months, I think it's time to make beter use of it and its multiciplous features, so I've now linked my "mobile blog" (no, me neither) to this one, which essentially means I'm now going to upload photos direct from my phone.

They say a picture says a thousand words, so this is my way of showing you what I'm doing, rather than trying to say it.

Ta.

A day in the life of an (unwilling) surgical house officer

0555h
Alarm goes off. Snooze button depressed

0602h
Crawl out of bed and into shower. Realise have forgotten towel.

0610h
Realise need a shave. Cannot be bothered.

0615h
Select least creased-looking shirt.

0620h
"Breakfast" - at this hour, a glass of water, some tablets and half a piece of toast.

0640h
This being winter, gloves, hat and scarf on ready for the car.

0645h
iPod in, Morning playlist on.

0700h
Hello M61. Mentally remind self for the zillionth time not to follow sign saying "Bolton" in order to get to Bolton Hospital.

0710h
Park up.

0720h
Say "morning" to the night nurses (deliberately leaving out the 'good'")

0730h
Print off lists and test results and find out what bits are missing. Have a minor panic, but remember that I don't care so wander over to F6 to begin the Power-Clerking.

0755h
Still waiting for patients to arrive, but need to go as post-take. Weigh up which consultant getting angry first before remembering I supposedly here for patients, so pace off to F3.

0800h
Night house officer looks fed up. See the on-take list and realise why. Grab some radiology cards, spare history sheets and try to remember where I left all that boyish enthusiasm.

0820h
Breathe out. Have seen 15 patients in almost as many minutes and now struggle to avoid all distractions in order to note down all the jobs.

0830h
Arrive at radiology in order to attempt to get 10 ultrasounds done in 2 slots. Get bleeped 3 times by various wards asking why the jobs I just found out about haven't been done yet.

0900h
Ward round of current patients. Realise no-one has blood forms done and so attempt to dissuade registrar from ordering any more tests to avoid more work.

0930h
"Doctor, can you come and put a cannula in this patient?" Arrive to find patient is not mine.

1000-1230h
Work from bleep to bleep, incredibly inefficiently, but unavoidable unless I throw the bloody bleep out the window. Swear at nurses. Apologise to nurses. Re-explain things to patients. Take bloods.

1230h
Remind self this is lunchtime.

1400h
Realise canteen has now closed.

1401h
Get bleeped by registrar immediately after opening flapjack/Mars bar/crisps/generic fat-snack to do another ward round. Spend ward round apologising for not having done all jobs.

1445h
Arrive on F5 and cup of tea (strong, 1 sugar, drop of milk) and banter from ward clerk. Smile, laugh...then remember where I am and head off to make nonsensical referrals, check bloods and rewrite TTOs because the ones I wrote when I had time have got lost.

1530h
Get bleeped whilst sat by a phone. Immediately call back. Phone engaged. Call again. Rings, but no answer. Call other number for that ward. Get through to ward clerk. "No-one's bleeped you love!"

1535h
Get bleeped from same ward. Go through whole process again. This time get through to early shift nurse who wants me to write up fluid for a patient. Tell her I did it this morning. Nurse apologises.

1540h
Get bleeped from same ward by late shift nurse about the same fluid chart. Am less polite this time around.

1600h
Start checking bloods. realise loads haven't been done. Head off to redo them all.

1630h
Get bleeped by the SHo to ask if there's anything he can do now he's out of clinic. Say you're done and just updating the list.

1631h
Start updating the patient list. Get bleeped about an ill patient.

1700h
Get back from ill patient and redo list because forgot to save it before.

1715h
Get bleeped by the reg to handover patients.

1800h
Think about going home, but instead start printing off tomorrow's elective patient list and preparing the print-outs.

1830h
See every other house officer still at work and have group lament about how crap our jobs/lives/colleagues/sense of personal worth is/are.

1845h
Get in car and head home.

1930h
Sit and talk to housemate for one hour about how much we hate our jobs.

2100h
Refuse to give into tiredness and stay up watching some crap on telly.

2130h
Give in and get into bed.

2230h
Still awake thinking about tomorrow's jobs.

2300h
Watch some more crap TV.

0000h
Finally get off to sleep.

The Greatest Day

It's been a month since I last blogged... I've been getting slack.

My life is probably a lot better now than it has been. I guess I've learnt a bit better how to deal with things and I'm starting to have a life again.

The day-to-day stuff is pretty much the same, though the day passes quicker cos I work with some fantasticaly funny nurses who really make my day... I'm sometimes in near hysteria as we laugh so much, and that's really nice.
I wonder if there will come a time when I truly feel confident that I can do my job well... I suspect that it never totally happens which is why all doctors do neurotic things like call their wards at 11pm because they forgot to check an Xray or something. I did have a run of 8 cannulas inserted first time which I was pretty proud of. I still hate damned procedures though!
I got to work with a different SHO this week and it's been really brilliant, she's amazing because she is so relaxed but gets everything done and ensures we both go home on time having left nothing important to do the next day. I actually quite enjoyed this week of work, and that's a first, so I'm rather pleased.

I recently did some weekend nights which I was totally terrifed of, but ended up really enjoying. I only really feel like a doctor on nights, I feel like I can actually do something useful, and despite the fact it's quite hard, I prefer the challenges because they're more manageable... and probably I like the fact that I don't have to be concerned with the long-term problems of everyone.
I did some crazy stuff that I didn't really think people actually did, like maintain someone's airway for nearly 2 hours whilst we tried to find an intensive care bed. I also did my first chest compressions on a real person, which is a weird experience... especially when you look at the face of the person whose heart you are working for, and realise that you clerked them in a fortnight previously with what you thought was an uncomplicated urinary tract infection and here they are, in a somewhat more serious condition.
But then again, I clerked a woman with a rash that decided 3am on a Saturday was the optimum time to present to A&E cos it was "quite itchy".
And of course, the real bonus of working nights is getting to wear scrubs... and I don't even feel embarrassed saying that I look totally hot in my blues... I got asked out twice on my nights!

In other news...

- I bought the boxset of Heroes to get in on the act and it is literally amazing... I'm waiting for Season 2 now so I can catch up and start watching on BBC. I kept putting it off and ending up missing more and more so I'm chuffed to now understand why everyone was raving about it!

- Now that I'm living like a millionaire (well, it feels like that, finally having a wage), I surprised myself by making a clothes purchase without even looking at the price, cos I knew I would buy it anyway. For anyone that has seen me rummaging through the Primark bargain bin, this may come as shock news, but no fear, I don't think my frivolous spending habit is sustainable, so normal serice will be resumed soon I'm sure.

- I'm off to Spain on Wednesday for 6 days and I can't wait, I'm going to see my best friend Steve in Seville which will be ace. And then Ruth and I are going to large it up in Torremolinos, so it's gonna be an ace week off!

Well I'm still here. Which is no mean feat... the lack of blogs, and general tardiness in replying to everyone who's messaged, called or texted over the past month or so is a testament to what my life has become.

Can I say sorry for that now? I do keep trying to sit with Facebook and go through all my messages and reply to them. And I will call everyone back! (Especially you Gran... I haven't forgotten!)

So I'm 6 weeks in to my job. I don't cry every day now, which is nice. Indeed, I haven't in over a week, so things are obviously better. Well, maybe that's not true exactly, I think I'm just hardening up. I'm getting more bolshy though... my tolerance for rudeness, which already wasn't that great, has plummeted! I really can't stand people pissing about and treating others with no respect... I guess I'm fed up seeing people I care about upset because others around them are just being tossers.

I'm torn a bit really because there are definitely times in my job now where I find myself genuinely enjoying myself. Granted, these moments certainly consist of a very minor portion of my day, but they are there. I'm getting the cahnce to do the parts of medicine I like, which is namely talk to people.
As one of my favourite characters in "The Smoking Room", Annie, says, "I'm all about people".

And this reminds me of a passage in The Oxford Handbook of Medicine which talks very admirably of GPs, saying that they are specialists of their patients (rather than of a disease or particular organ system). And so this makes me think that perhaps I'd like to be, and would probably be a good, GP.

It's just the thought of more medicine in a hospital that puts me off!

Anyway, I'm getting a bit moany, so what good things are there? I've been working lately with Aga, who's brilliant and I really like her. And I've been eating lunch quite a lot at work now which is a definite improvement.

It's probably now time for me to start redeveloping a social life before I slip into hermit ways! If you want to help me with that, please get in touch!

And so it begins

Well, it's been 10 days since I started my new job as a junior doctor.

I now work in Care of The Elderly ward, and I imagine that my job is going to motivate me to write a lot about the NHS and what it's like to work as an "F1" doctor.

I've previously mentioned where I work, and so that might complicate matters... I've gotten in trouble with a big (ish) organisation before about my blog.

I guess the long and short of how I feel right now is that I don't think any medical school could adequately prepare you for starting work. I'm not saying anything new... people have said this for years!

I expected the feelings of inadequacy, borne of a lack of experience and familiarity, as well as the sometimes overwhelming sense of responsibility that is suddenly thrust upon you.
And I didn't think it would be easy to start with, and in that respect I've not been surprised.

I do, however, want to go on record as saying that it's really upset me how many of the promises I made to myself have already been broken. Before I started, I had a mental list of things I would never do, and ways that I wanted to act.
I guess I'm realising that the trade-off for having a world-class health service that offers near-equality of care for everyone, is that it's pretty difficult to achieve the optimum standards that you might desire for yourself or your family. I think I now understand why those with money choose private healthcare... its not the "health" part that's significantly different, its the "care" part.

Patients in the NHS almost without fail recieve adequate care. And yet, despite knowing that, it can be really hard to not spend 5 minutes with all your patients, just listening to them, because you just have other "more important" tasks to complete. And it's hard because you know that those 5 minutes could really brighten someone's day... and we're taught at medical/nursing school that happy patients heal quicker... which is why the emphasis on communication skills is there within training, because it's previously been an element lacking in UK healthcare.

I'm sure I've made a difference in a few people's days... but there are plenty of patients whom I've seen who I didn't "do my best" with... I had to settle for adequacy.

And so came my epiphany... as a nation, as a workforce, and as patients, we complain about the NHS because we don't really accept adequacy as acceptable. We want more. And why shouldn't we?

I suppose in the next two years I'll get plenty more opportunities to test out my theory!

"Is there a (14 day old) doctor on the plane...?"

It was about halfway through my final year of medical school, in about February 2008, when I first started getting the fear that my medical training would be be necessary in some strange situation... like an old lady falling off the bus or talking a would-be suicide victim off the Itchen Bridge.

I guess this was partly based in my experience of using my First Aid training the day after I flunked my St John's Ambulance assessment back at school. A man had an epileptic fit on the bus and so I had to "help" out. Well I did what I could and he didn't die so that equals sucess right?!

In actual fact, the fear that I would soon be a doctor meant I that had started to carry my mini-Oxford Handbook of Clinical Medicine around with me wherever I went... in my carry-on bag on planes, if I went home on the train for the weekend, that sort of thing.

And indeed, when Lucy and I flew to Tokyo about two weeks ago, and she spied this little book of knowledge in my bag and wondered why I'd brought it. "Because..." I replied, "... I know one day I'll need it."

Little did I suspect that day would come just 10 days later, on our return flight from Tokyo into Heathrow.




The long journey home...
Lucy and I had made our way to Narita Airport from a great hostel having experienced a 30-second earthquake the night before. We were kinda sad to be leaving Japan, as we'd had a great time. We did all the usual stuff at the airport and boarded the plane in good time. Before take-off, we got moved to emergency exit seats (which some long-legged saps had paid £75 for the privilege of!) as the economy section was more than half-empty. How lucky we felt, and almost excited at the prospect of being allowed to yell "Unfasten your seat belts and get out!" (seriously) should evacuation be necessary.
We took off and enjoyed our meals and movies from seats sprawled across the cabin, amused that we had far more space than those in Premium Economy in front of us.
Midway through my film, Juno, however, the audio stopped to signal a cabin-wide announcement:

"If there is anyone with medical training aboard, please could they make themselves known to the cabin crew, who will be making their way through the cabin"

My heart, at this point, was in my mouth, and my chin was at the floor, as Lucy turned around in her seat, and simply took my outstretched hand in comfort.

"What are you going to do?" she asked, mindful that about 4 hours previously I had said one reason not to have "Dr" on my credit cards was so that I could hide in such a situation.

The answer, however, came quickly, as two of the Japanese crew in their red jackets swished through the curtain.

"Hi." I gulped.

"Are you a doctor?" asked the stewardess, perhaps wondering if someone quite so scruffy could actually be a respectable physician.

"Um... well, technically yes I am... I graduated 2 weeks ago and have yet to start my first job. So, I can help as much as I can... but it might be good to see if there is anyone more senior about?" I said, probably far less eloquently than Ive written.

And off the stewardesses went, leaving me thinking that surely there's someone better than me aboard.

But apparently not, as they soon swooshed back, and there I was, ushered up to the Upper Class section of the plane, my head racing with gory thoughts of of throwing minature bottles of vodka across someone's chest before I pierce it with a coat hanger. Or having to deliver twins. And other such outlandish scenarios that would befit a disaster film.

And then, there was my patient. He wasn't a woman lying screaming with babies all ready to come out. Or an old guy clutching his chest. He was a young Japanese boy, sat in his mummy's arms. And I have to admit, I mentally (if not, indeed audibly) let out a sigh of relief. It wasn't SERIOUS serious. Phew.

Now I don't want to say too much online about the individual details of the case; confidentiality and all that. But essentially, I did what any medical student has done a lot of in their GP placements. There was enough, however, to get worried about, there were some high temperatures, lack of equipment, difficult history and of course the fact that everything had to be translated via a crew member. It's hard to appear empathetic when all you can say is, "two beers thanks ['ni biru, arigato', by the way]" in someone else's language.

And so, after I'd examined my patient and decided that whilst he was ill, there was nothing serious enough to divert the plane, I reassured the family and took a seat to write some notes, whilst chatting with the cabin crew, who all seemed to think I was some kind of hero just for smiling and prodding someone with a stethoscope.

I got invited to the bar, though realising I now had to keep a clear head for the flight should anything change, I didn't take up the opporunity, and actually just wanted to head back and finish my film whilst having a sleep. So I did just that, feeling pretty good about myself and what a good story this would make. And for the next few hours, I got waited on by the staff, who kept offering me things and making me feel pretty special. Hell, the manager came and gave me some bottles of wine to say thanks!

But that wasn't the end.

Later on, as meal #2 arrived, and seconds after I'd unwrapped my vegetarian quiche, a stewardess appeared. With a face that said, "I'm really sorry... but"... and sure enough those words came out of her lips too. And so off I trotted back up the plane, where there was now a new problem with my new Japanese friend... some tummy trouble.
I had a look and concluded it was probably constipation, and said to simply let me know if the pain got worse.

As I headed back to my seat, the senior crew member followed, carrying my dinner which they had kept heated for me. But one senior crew was apparently not enough... her Japanese counterpart also followed, carrying a plate with an Upper Class meal of steak and potatoes... I was being well and truly pampered. I sat and tucked in whilst my fellow economy passengers pretended to enjoy their quiches. But barely was I halfway through when I got called back up to the front of the plane.

The abdominal pain had got much worse. Now, the thing here is that, were I an F1 (junior doctor) in A&E with a kid presenting with increasing abdominal pain on a background of high temperature... well I'd want to at least consider the possibility of appendicitis.
And the trouble was, despite my suspicions that it was NOT appendicitis, that I couldn't seem to definitively rule it out - indeed, symptom wise, it was getting hard to ignore.
A quick glance at the Handbook did nothing to help me relax. And we had just under 3 hours left to fly. Everything was complicated by the fact that the family were due to fly onwards from London to another country. And I was the one having to weigh up being over-cautious with being safe. When I'd never actually worked as a doctor, let a lone a paediatrician, before in my life.

I took the Japanese senior crew member aside and just told the truth:

"Okay, if we were in a UK hospital, I would have referred this to someone senior by now... it's beyond my experience... I've done 8 weeks of paediatrics as a student and my career goal is in psychiatry. I've not even started work yet... and even when I do, I'm supposedly under supervision! I can't rule out the possibility that we might need an ambulance waiting for this little boy when we land. We probably don't... but right now we need to be ready because I can't, in all good faith, just say everything is fine."
"Essentially, I need this boy to go to the toilet, then feel better, for me to feel better. I'm going to keep checking him every 10 mins or so, and we'll be better able to decide in about half an hour. What kind of help do we have access to? Can you find out?"

Cue, some brief stuttering from my new air steward friend, but he quickly regained his professionalism and we sprung into action.

So did we have to land the plane in Kazakhstan?

Well... no. Indeed, never have I been happier to see a little boy emerge from a toilet having been sick, and "feeling better". Thank heaven.

I wrote up my plan and explained it with the family. The Japanese crew had rememebred there was a Japanese medical centre in London, actually fairly near Heathrow, and so we organised for the family to be fast-tracked through immigration to a taxi so hey could go straight there once we arrived in Heathrow. And I think we skipped ahead in the landing queue too (we landed 40 mins early).

We prepared the boy for landing... with sweets and also the help of my 24 year old teddy "Panda" (who goes everywhere with me), and I sat and chatted with the crew, whom I'd gotten to know pretty well during the flight.

Landing was uneventful, luckily, as I'd insisted to Lucy that should we crash, I would not be fufilling my duties as an emergency exit operator as I had worked enough for one flight!

Indeed, we reflected on the fact that I'd just done my first ever official duties as a real doctor, a mere 14 days after my GMC registration had come through (hell... it's so recent I've yet to be put on the updated list of registered medical practitioners yet!). And where I'd been worrying about starting on my ward in Bolton, I'd actually just done something far scarier. So Bring it on Bolton (actually, please don't)!

As I got off the plane, saying goodbye to the family, wiking at the crew, I went for it, boldly commenting that "I never actually got to sit at the Upper Class bar, this time, did I... and my name better be on a database somewhere now for when I next fly..."

Cue laughter, and lots of smiles... but I'm not lying when I say that if I don't get a letter from Richard Branson, I'll be mightily disappointed...



Signed,

Dr. Sebastian L Pillon
GMC Number: 7017305

Japan

For those of you who don't know...

I'm off to Japan tomorrow with Lucy for 10 days. We plan to go to Tokyo and Kyoto, and maybe elsewhere but we haven't decided yet.
I've always been attracted to the weird tradition/technology mix that I think Japan is... I find the psyche of it fascinating. And this is the kind of trip I won't be able to really do for a few years, so its kind of my last big adventure for a while.

We booked it a while ago as an adventure and whilst I'm excited about it, I don't mind admitting that I'm also pretty nervous.

I've never left Europe before... and in Europe I've always known that I could come home if I had had enough... but that's not an option when I'm 12 hours and a lot of money away!

I can't even put my finger on why I'm so scared... the sensible part of me knows that I'll be pleased to have gone and when I come back I will have stories to tell. I guess I'm a natural born worrier, and I don't really feel in control of this trip.
There's so many variables and I think I won't feel comfortable until I've made some decisions about where we're staying and things are booked... even though I know I can rough it and I do fine (Ask Olly about the hostel in Montenegro... it doesn't get a lot worse than that!)

Anyway, I guess I'm writing this blog as a plea really. I tend to get pretty homesick. And so now my dad has lent me his Japan-ready 3G phone, I feel a bit more connected to the UK! (I've put some numbers on it but can't easily move my whole phone book).
I'd really love to get txt messages, emails and facebook posts from my friends throughout the trip... just a few lines will really help pick me up if I feel a bit worried or homesick. I'd really appreciate it so much.
if you do txt... please sign off with your name in case I havent moved your number to the temporary phone.

And thank you to all those who have dealt with my worrying over this past week... namely:
- Celia and Grace for their Facebook msgs
- Olly and Carphone Warehouse for letting me take his breaks to reassure me
- Elly for the great advice on what to see
- Uncle Henry for being unwittingly very reassuring
- Lucy herself for being really understanding
and most of all...
- to Mum and Dad, who are always there with the right words and actions to help me, whenever and whatever I need. Thank you.
X

Right... to learn some useful phrases!

Sayonara!

Seb

Holiday in a Nutshell

- Lying on a pebbly beach and not having to deal with sand
- Greeting my brother at Dubrovnik bus station
- Looking out over Kotor Bay at sunset
- Drinking beer for €1.50
- Climbing up mountains
- Getting on buses when I'm not 100% certain that it goes where I want
- Bartering in Serbian
- Admiring tapestries of Tito
- Getting met at bus stations by hot Bosnians
- Drinking beer for 3KM (=€1.50 =£1)
- Eating čevapćići for every meal
- Watching TV at night on a balcony, talking about history
- Hanging out with cool people I've just met
- Getting the email addresses of cool people I've just met so I can then go visit them in Finland/Canada/Ireland
- Hysteria on night trains
- Going back to a cool hostel
- Eating a massive salad for 30kuna (£3)
- Drinking beer for 18kuna (£2)
- Doing a Welsh accent and making the whole dorm think I am crazy
- Arriving in Slovenia
- Seeing Tina at Vila Veselova (www.v-v.si)
- Wow-ing at the Škocjan Caves
- Swimming in Lake Bled
- Eating Burritos with cool New Yorkers we randomly bumped into in two different places
- Drinking coffee in a cafe at 11am
- Hanging out with my little brother and having those chats that make you feel really good.
- Strategically writing postcards so that no-one realises that I keep using the same phrases

6 days to go

Wow.

In 6 days, I'll begin my finals. I've been at Uni for almost 6 years now... and if all goes well I'll soon be Dr. Pillon. Isn't that weird? I'm not sure I like how it sounds to be honest: "Doctor Pillon".

And so, as is my way, I'm rather pensive. I have been for a few weeks now. My life is all abut to change... I'm getting a job! I've essentially been in school for the last 20 years of my life, and so the thought of that is a little scary. Not least cos my job is going to involve being responsible for people's lives... well at least some of the time.

Perhaps more is that fact that I'm going to be saying goodbye to a fair few friends as they move off to other cities to start their jobs. I'm pretty sure we'll still keep in touch, and hopefully meet up every now and then, but it's going to be sad all the same. There are people like Rachel, Andy, Katharine & Nick who I've gotten to know only this year, and they're ace! So I'm going to be going on holidays to Liverpool, Edinburgh, Leeds & Devon I think.

Then there's the student stuff... I'm really going to miss that 10% off thing. And being able to get up at 9am, watch America's Next Top Model and doss about.

Ah well, it's also a little bit exciting, I'm gonna be a doctor!

But I will still be silly, jump about, laugh all the time... just maybe I'll have to do it more in private now!

I'm Not Stupid!

I've just watched Shipwrecked on 4oD. And it's done my head in.

Why do they feel the need to KEEP ON re-capping what has literally just happened. I mean, if I wasn't actually watching the programme, then maybe I'd need to be constantly reminded that "the Tigers have made a secret deal with Mike... and Matt is unaware that if he chooses Tigers, he will be sent home". Though maybe it says a lot about a programme that they think it must be so boring and unwatchable that you won't be paying attention.
I actually started counting how many times the narrator rehashed this really-quite-simple-to-understand premise. He said it 7 times. In 48 minutes.

I actually burst out laughing when in the "tense moment" after the two new arrivals had chosen Tiger Island, the narrator says "and so now, the Tigers must choose who to accept".

So I'd like to make a plea... if you are so stupid that you are unable to follow a programme as intellectually challenging as Shipwrecked, please go ahead and maroon yourself somewhere.

(Phew, rant over)