Number of fingers in a rectum: 1
Number of catheters in a penis: 2
Number of needles stuck in veins: more than I can count

So with my favourite stethoscope, my favourite pen, and a bucketload of fear, I have tramped the wards for the first time as a real true doctor. I was unlucky with the rota and have started off on nights on "medical take" - I have to help look after the problems that aren't for the surgeons, like babies, broken bones and appendicitis. It means suicidal people, heart attacks, and chest infections - translated into para od, MI, and LRTI. I have been prescribing medications for real. I have been writing in notes and signing my name doctor, and answering my bleep and saying I'm a doctor. It's like I've been looking down on someone else doing all this, it feels surreal and very strange! That could be the sleep deprivation, or as it's referred to, "the jet lag". I feel I have learned more about real medicine than medical school ever taught me. Two things: firstly, the days of spending as much time as I felt like with patients are over. I hate to have to feel like I am limited in time when I'm talking to people. Secondly, the nurses know more than me about everything.

We have a few hours of teaching every week.The first week was death. We had the coroner talk to us about death certificates, the head of palliative care talk to us about the Liverpool Care Pathway (the principles of looking after people who are dying) and finally the chaplain. He's quite young, and hilarious, and completely adorable. Not in a horrid happy-clappy way. In a genuine way. "The chapel is on the seventh floor," he says. "It's non-clinical. It's dark, There are pillars to hide behind. And I promise, if I see any of you sitting there in a huddled lump, I won't come up to you and say "hello my daughter, what can I do for you?" I may arrange a flower or two, just so you know I'm there." Isn't that wonderful?
I have the day off tomorrow. I'm doing nights for the rest of the week. Hopefully it will go as well as this week has gone.

Signing

A General Surgery clinic, years ago right at the beginning of my clinical training. I had been assigned the Professor of Surgery at the large teaching hospital that I had been placed. He was a formidible man - an obviously talented surgeon - the go-to guy that everyone relied on to rescue the sickest patients from their bleeds and cancers and perforations. I respected him so so much for his dedication and exacting standards, even if it meant feeling very very stupid for a lot of the time! I still am glad it was my first rotation, as he drummed into me what high standards I should keep for myself.

However, he was in medicine for the excitement of his surgery and his research. He didn't really like patients, and was interested in them only as a potential cut. So when a deaf man came into the clinic, I grimaced inside. I knew exactly how this was going to turn out.

"God, deaf! You take a history, I don't have time for this."

I dutifully go. Begin by calling out his name in the waiting room - mentally slap myself. Go up to him and touch his arm to get his attention, then say hello. He smiles and comes with me to the room. I say hello again, trying to be as friendly as I can. I ask "do you lip read?" whilst pointing at my lips. He understands, but shakes his head, and gestures with his hands that he just signs. I get out my notebook and we do the whole history by paper.

I find the surgeon again and present the history of the man's problems. He listens, comes in, and speaks loudly to the man - "Where is your pain?" The man makes the gesture that I am sure he has made every day of his life - hand to ear, shaking his head. As Prof asks each question, I show the man where I wrote the question in my notebook. Prof carries on examining the man. Explains what he thinks may be wrong in the same load slow voice, finishing with "So go for an ultrasound now, I'll see you again." The man looks at me, a little confused by now as to why this man keeps on talking to him. Prof leaves. I look at the man, trying not to mirror his amusement and rolling of eyes. I get out my notebook again.

So, this is why I am doing sign language classes! I have had very very little success with remembering anything at all so far, but I have read it takes years. Also, to actually do any good and to be able to take a history, I would need to get really quite fluent. Maybe one day.

I got a crush on Obama

http://www.youtube.com/watch?v=phBBnxXJdoM

This is like a joke to me! Is this really going to make anyone think any better of McCain? Is anone that stupid?

A shadow

I am shadowing the doctor I will be taking over from in 2 weeks. She's from Eastern Europe and says she is shocked every day at the dirt of the hospital.

Best quotes: My new consultant - "What's the most important thing for this patient? Placement. Ever read "The House of God"?"

The F2: "The most important thing you will learn is what to do with the dying."

Wondering what to do with a patient with strange symptoms - F1 - "Get House on the phone." Registrar - "Oh, he'll just say it's lupus." F1: "It could always be lupus."

Also, I found out I am on call on my first day, next Wednesday, which means that I will be clerking patients in from A&E, and carrying the cardiac arrest bleep. Dear God! I am nowhere near old enough for this! I just don't know how to prepare for it.

Too posh to push

I was so interested to read the G2 today about how many obstetricians would actually opt for a caesarean. This follows a report last week about how midwives are trying to decrease epidurals even more, by trying to make people pay for them.

I was lucky enough to deliver babies during my Obs and Gynae rotation. I saw a lot of births, natural and caesarean. I would go for a caesarean in a heartbeat.

From the other side of the clipboard

I've been reading an old edition of the Student BMJ about how it can be a really positive experience to be an inpatient for a while. It made me remember how a matter of a burst appendix when I was applying to medical school was something that actually taught me a lot.

Firstly, how it's absolutely astonishing how little I felt I saw any medical person. I met the surgeon once, after the operation, for about 30 seconds. That's it! His juniors came round occasionally, not even once a day, and never asked me how I was. I felt rather abandoned! And when my cannula tissued, my hand was growing steadily bigger for a day filling with antibiotics and looked white and horribly unhealthy, and it took about 24 hours for anyone to come. I would have taken it out myself if I was an inpatient now, but then I was still scared of doctors. I hope that when I start I will try to remember that patients are scared of their disease, scared of their pain, scared of my needles, scared of my drugs, maybe even scared of me and my colleagues!

Nice little earner

The NHS has a surplus of more than £1.6 billion this year yet hospitals in the UK stand to make £3.5m in total from charging their first year junior doctors. The charge is equivalent to a 20 per cent pay cut, it has been calculated by the
BMA.

- Daily Telegraph, 8th July 2008

I sit in my newly furbished living room as I type. The house still smells of its new paint and new carpets. (Light cream - I wonder how long they will stay that way!) and I am thrilled to be here. It's 5 minutes from the hospital and it's half the price I paid for half the space in London. I love it. But if you'd told me until 3 months ago that I would not be living at the hospital I would be working at, I would be very suprised. But I've gone to the private sector.

I would have been expected to pay £485 a month for one small room in a block if I had gone for the hospital accomodation- that's more than I paid for my room in Marylebone! People in my position last year didn't have to pay a thing.

I don't think junior doctors are special. I don't think they deserve a free ride. But with people already being put off applying to medical school because it is too expensive, salaries for the first year should not be cut into to such an extent for such ridiculous charges.

And still, just across the Severn:

The Welsh Assembly Government has announced that free accommodation will continue in Wales, yet hospitals in the rest of the country will begin charging first year doctors for their rooms when they start next month.

- Daily Telegraph, 8th July 2008