#foundationdoctor

[disenchantedmedic]

It's been a while!

Hey guys, It's been a while! Ive just sat and read through every post on this blog and it made me so sad. Not only to remember how low I was back then, but to remember what an absolute shit deal we have as doctors. And it's just getting worse. Doctors are taking their own lives, and I think every single one of us can empathise with someone getting to a place where that seems like the only way out. I read one of my earlier blog entries where I talk about 'thinking how I can break my leg as painlessly as possible in order to get a few weeks off work' - I remember driving into work and wondering what speed I could crash my car, not to die, but to hurt myself enough to get some time off. I remember being envious of sick, unwell patients, because they were laid watching Jeremy Kyle while I was sweating with a million and one jobs to complete. It really was that desperate. When would that escalate to more? I am SO happy where I am right now (I'll come on to that in a bit) , and so to think about those thought processes right now is horrendous. Horrendous that I would consider hurting myself to get out of a situation. A situation I felt trapped in. What's scarier is that every time I've discussed this with another medic, they admit to feeling the same way, on many occasions. It's the feeling of 'there's no way out of this'. We're made to feel trapped. We're all the 'smart kids of the class' who always succeeded. We all worked our arses off, sacrificed huge chunks of our youth to getting the best grades, doing the extracurricular stuff that's needed to get into Med school. But it was ok, you work hard, you get what you want, is what we are told. Then we spent all of those exhausting years at medical school, doing 9am - 6pm lectures, Monday - Friday, when our friends on other courses just had a few hours here and there. But it's ok, we want to be doctors, we need to work hard. Then we moved on to clinical placements and spent our weeks devoted to the hospital, taking every opportunity to learn, going in on weekends, at night, as soon enough we would be there, working, in our dream job... Then before you know it, bam! We are doctors, and it's definitely not all it's cracked up to be... All that time, all that dedication, we need to push through. Right?? I'm unhappy but it would be a huge waste to just quit and do something else. Right? ..... Wrong. Life is complicated. I've done some really cool, really bizarre things over the last year or so, that I will talk about in following blogs, and these things have really made me realise this. It is so so complicated. And we aren't prepared for this. At school and throughout our education, having a good stable job is put up there as one of the most important things to achieve. Having a big house, a nice car, a family with a dog and 2.5 kids (or whatever the saying is!) will bring us all the happiness we need. It's "that simple"! And we were always pretty confident that our efforts of getting to where we now are, these high flying successful doctors, would secure this for us. I mean we're doctors! People sound so impressed when you tell them this, we must be so rich and have amazing holidays and lovely big houses... We must be so happy right?! If you are anything like me, you will have gotten to a point, maybe mid F1, where you really started to realise that money and material objects do not bring happiness. This job, this job stability, definitely does not bring happiness. I remember being offered £1000 to work a weekend that the hospital was really short staffed for, and I remember thinking no amount of money could get me to stay in that hospital for a second longer than I had to. When you have no time, time becomes priceless. I didn't want more money, I wanted more time. A weekend, out of the hospital, to do things that you enjoy, with the people you love, really has no price. For me, no amount of money could get me to do an extra on call weekend. And I think many of you are the same. So, if we aren't doing this for the money, what are we doing it for? This was the question I really started to ask myself... I always wanted to make a difference, I enjoyed the challenge being a doctor presented; I like applying the physiology and pathology I've learnt to real life scenarios, and seeing people get well is the most rewarding situation. The moment a family thanks you, sincerely, for helping their relative, well, you really can't describe that to anyone who hasn't experienced it, and as rare as 'thanks' are, they really do make you remember why you are doing what you are doing. I started to note good and bad days, simply using a tally chart. And I would recommend this to everyone struggling with their career choice right now. Just to see the reality of the situation. It's easy to let a bad situation cloud your judgement and forget about all the good points... Well, for me the tally chart made up my mind, of 100 days at work, I had 88 bad and 12 good. Could I really justify what I was going through for a 12% chance my day wouldn't be horrendous? No chance! Something had to change. So I took a step out of training, and that's where my last posts left off. I made sure I finished F2. I know it's not easy for everyone, but It's worth getting to the end of, as it gives you the freedom, and safety net, of knowing you can go back to training whenever you want, should you want. I'm now approaching "F5" as I like to call it, and I can honestly say it was the best decision of my life. I've blabbed on a while now, I'm currently in San Diego about to go out for margaritas and chill by the beach (for real!) but I'll write another blog post tomorrow about everything I've been up to and why it's working amazingly for me!

[differentshadesofamber]

The Struggle of Self-Care as a Junior Doctor

I’ve lived with anxiety and depression for most of my life. People often comment that they never would have guessed but the truth is, it’s all I’ve ever known so it’s (shockingly) a part of the personality that they’ve come to know. Below is an account of what it’s like to live with anxiety and depression as a medic with training wheels on.

I got handed over about an unwell patient with DKA. I was told to check if they were on fixed or variable rate insulin.  The patient also needed a new cannula oh and by the way “you may get bleeped about a few cannulas that I’ve not had time to do ...but if you leave them long enough they tend to sort themselves out”. Fine. I get to the ward and ask the nursing staff about the insulin. I’m met with blank stares. “She’s not on anything. She was on the DKA protocol but now she’s not on anything except her regular insulin”. Grand. I attempt to get the cannula in. No luck. The patient is one of those people that keeps mentioning how difficult they are to cannulate. I try a few times. Nothing. My bleep goes off. It’s the microbiologist on-call. He wants to discuss a patient that I was not handed over was to be discussed. I scribble down the discussion and shove the paper in my pocket. I’ll need to make sense of that later. Back to the cannula. I’m not getting anywhere. Plan: give insulin, measure glucose and ketones, if raised bleep me so that I can assess and start variable rate insulin if needed. I bleep my registrar about the cannula. I get a frank “the take is busy”. Ok cool. The patient doesn’t need it urgently. 

The shift goes on and I swear to God I have never done so many cannulas. Cannulas that were supposed to be done by the team. Cannulas that the on-call didn’t have time to do. Cannulas that I, the night ward cover, had to do. At one point I got bleeped 4x in a row while trying to cannulate a patient who was beginning to become unwell and needed an IV diuretic for her pulmonary oedema. The bleep keeps going and I keep failing to cannulate. The bleeping starts to get to me. I give up. Plan: give oral furosemide, I’ll attempt to cannulate later. I come out of the bay only to find out that the registrar was the one bleeping me from *five feet away*. I.e within earshot of that annoying bleep! He then proceeded to tell me that I had made a mistake. The patient was on fixed rate insulin and now the ketones were raised she needed variable rate insulin. I was still flustered from the failed cannula. I don’t even have the motivation to explain myself. I just say ok. Plan: “you need to do an ABG in exactly one hour it must be one hour”. Fine - it’s on the top of my to do list. Off I go to another ward to do yet another cannula. I get bleeped, the patient who was beginning to become unwell is now even more unwell. I re-assess, I attempt to cannulate, still no joy. The patient had multiple co-morbidities including CKD. The notes said not a candidate for dialysis unless anuric (she wasn’t) or hyperkalaemic .... I needed to get IV access. I try again. No joy. I ask the night sister to have a try. The registrar bleeps, “everything ok?”. This patient is becoming unwell, she’s not for dialysis, becoming more breathless, sats dropped suddenly. I’ve given oral furosemide, still trying to get IV access. The patient’s potassium that morning normal so I didn’t think it was likely that it would suddenly become raised. The registrar comes and assesses her. I get told off again. “The information must be correct. Not for dialysis at this time”.

Failure.Useless.

The registrar discusses the patient with renal on-call. Plan: patient not for dialysis (insert eye roll here), likely pulmonary oedema, give IV furosemide, repeat potassium. Now at this point my mood was crashing. I’ve lived with anxiety and depression for such a long time. I know once the negative thoughts start, the old habits kick in and a snowball effect takes hold.

Few more minutes till I need to do that ABG. I grab my dinner and manage to get a spoonful of rice in before the bleep goes off again. It’s the night sister, she’s had a call that I’m not answering my bleep. Clearly, I am answering. It’s possible that when I got bleeped 4x in a row while trying to cannulate an unwell patient it got lost in the messages. “Well there are four cannulas...”. I get another spoonful of rice in and I’m back on the wards. Two cannulas done. ABG time. I get to the ward and the nurse reports that the treatment was delayed. Fine. The registrar calls - why hasn’t the ABG been done? 20 minutes later, ABG time part 2. I try. I fail. I try a few more times. The patient asks for me to stop.

Failure.Pathetic.Can’t do anything

I ask my reg for help. again.

Pathetic

Back to the ward to finish the cannulas. There’s a lull. I get a few hours sleep. Then there’s a MET call. I take the bloods. I try the ABG. I fail. Again. I try again. Nothing

Failure.Pathetic.Useless

I tell the reg I failed. Again. Back to the wards. Another patient is unwell. There are two vancomycin levels that need to be done.

I get bleeped about a patient who starts to desaturate. Severe COPD with worsening wheeze, not tolerating NIV, for full escalation of treatment. I get IV access, I get the ABG (finally!). Plan: back to back salbutamol nebs, IV hydrocortisone. Reassess with ABG result. Bleep if no improvement. After three nebs, the patient’s sats are better ... but not for long. The nursing staff changes over and the flappiest, can’t-deal-with-stress-iest nurse comes on. “this patient is really unwell, can we get a reg”. Yes but I need to repeat the ABG. “we need to call the reg”. Yes but can I get the ABG result first? The patietn needs and CXR and then I’ll call the reg. Plan: start NIV, titrate settings based on ABG reuslt. “I’m calling the reg. How do you call the reg? This patient’s NEWS is 15 we need the reg”. The nurse proceeds to get out the arrest trolley. My anxiety kicks in.

Move faster!So Slow!Why is this hard for you!

The nurse fast bleeps the reg. My hands are shaking, I feel like I’m talking a mile a minute. I tell him my assessment and plan. He agrees. He dictates his assessment. He leaves. The patient’s blood gas comes back. She’s improving. My night shift ends. My brain is scattered and I can feel the depression creeping in.

I always remind my colleagues that we all have bad days. Today was a bad day. I remember the days that I used to say that it was another bad day in a bad life. It’s hard not to still think that sometimes. I crash at a friends house. I need to get home. I can feel those thoughts creeping in

I feel like I want to die. No that’s not true.

The next evening, I crash in my own bed for 20 minutes. Then it’s time for choir. They ask me to sing a solo. I don’t want to. I know I’m spent. The church numbers are dwindling, who else is going to sing it? I fudge my way through it.

Failure.

Another member will sing it with me.

Is this burnout?

I get home and do all the self-care. Candles, music, yoga, comfy clothes, colourful fruits and veggie juice. I always feel with my stomach so instead of stress eating I feed myself nutritious food. Like a support from inside. I rub essential oils. I tell myself I’ll feel better in the morning.

I wake up the next day. I do not feel better. I do my yoga and eat breakfast. My first step outside, my hips ache from the night shift. I walk to slowly. I miss my train.

Can’t do anything right

I get to my meeting and I’m suprisingly social. Then I get a call, “why didn’t you come to work today”. Panic. Anxiety is back into play. Did I forget something? Did I make a patient drive for hours and forget about them? Did the nurse need something signing? Was there a problem?

Useless.Unorganised.Doing too much

I can’t concentrate. I’m so exhausated after the anxiety, I crash mentally and physically. My facial muscles start to twitch. I start to sing. I need to get home. I have work tomorrow. I have my driving lesson. The test is in a week. PANIC. Can’t afford to mess that up too.

I can’t sleep.

Is this burnout?