Things that I didn't know about medicine before I started

• How many people in hospital are there, not because they are in actual need of the services hospitals provide, but because the provision for them in society is so inadequate. This mostly includes elderly people with nowhere to go that will care for them. These patients are often turfed to hospital from the bad nursing homes.
• How bad some nursing homes can be. Also, just as much, how good some nursing homes can be.
• How hard nurses work, for so little respect and appreciation. And how good nursing care is as important, maybe more so, than good doctors.
• How many patients are not listened to by their doctors. It seems so basic to me. I think it was William Osler who said "Listen to your patients. They are giving you the diagnosis".
• How little explanation patients get from their doctors and other health professionals. I remember one clinic with a vascular surgeon, with a middle aged man who came in because of claudication (where you get pain in the legs when you exercise, becuase the blood flow isn't sufficient.) He said, at a very fast pace. "Yeah, you've got quite significant claudication. Probably atherosclerosis. I'll send you for a doppler. When we get the results you might need an angioplasty for that." Patient: "Sorry, what?" Doctor: "Angioplasty." Slower and clearer as if he didn't hear. Patient, seeing the doctor was pissed off : "How do you spell it? I'll look it up." The patient looked at me. I looked at the doctor, becuase I didn't want to piss him off. He shrugged and went to do paperwork at his desk before the next patient. I took the opportunity to tell the patient quickly about what the words meant. I would hate to become santimonious, but really, I hope I never forget that not everyone has been to medical school, and that it doesn't make people stupid to not know what all the terms I have spent six years trying to cram into my head.
• Just how much your lifestyle and money and education affect your health, not advanced medicine. I don't mean in this country - around the world.
• How little resources and time are given to palliative care in this country. It's shockingly underfunded. So many doctors I speak to don't even see the importance of the whole speciality. Doing Oncology a few months ago, I spent time in the hospice next to the hospital. Funded charitably. Staffed by volunteers.
• How rare it is for even the best doctors to do more than delay death a short time. In many ways it's a losing battle.
• The only lifelike character on Scrubs is Dr Kelso.
• How much influence big pharma has on research, attitudes, and prescribing habits, how sneaky and underhanded the propaganda can be, and how this is accepted by most.
• How brave most people are in the face of losing their health.

There are some days I will miss London

Feeling bogged down in the library with the work I'm doing for finals - book upon book - I walked down the road to the Wellcome Trust for their exhibition on death and dying. Also, I am in the middle of my Oncology rotation, and have spent time in the hospice next to the hospital in the last few weeks, having been taught and told a lot about death recently. Entering the plush building, I am greeted by an introduction to the exhibition explaining how our ancestors were much more in touch with their feelings about death than today's society is - they describe it as one of the last taboos. The exhibition is pictures of people in hospices in Germany, big, beautifully taken black and white pictures - shortly before and shortly after they died. A small note next to the two pictures explains a little about their life, and about how they were and what they said about their coming death. Very moving, most were calm, resigned. The exhibition didn't shy away from describing the fear and desperation of some of the people - these were the ones I found most moving, the words of my favourite poet, Dylan Thomas, running unbidden through my mind. Rage, rage .... Two expensive black folders, with thick cream paper, lie at the exit for people to write in. I loved to read what they said. Many saying how moving it was. Many saying how grateful they were that someone had the courage to present it. A 9 year old girl writing that she was very interested and grateful for someone telling her a little about "what it was going to be like". A doctor writing that he tries to give people "a good death". A man writing that he was going to go home and make love to his beautiful wife.

I walked out, feeling pretty washed out but with a small feeling that I had the beginning of quite a new thought - that death can be a pretty life-affirming thought, and fear of death is perhaps fear of life, and not making of it what you want.

The tall glass buildings of Euston Road shine down on me as I leave. The traffic noise assails me. I walk back to the libary to continue my reading.

I've been lucky enough to get the job that I wanted as an F1 (a junior doctor, the first job a doctor does after graduating). Many of my friends have not, particularly the ones that wanted to work in London. But I am one of the lucky ones. So that's really great, the new system has worked for me.

I have, however, just recieved the papers from the hospital I will (if I pass my finals!) be working at. They are going to charge me £485 a month for staying in the hospital accomodation, which would mean more like £550 with council tax and bills. Not in central London, not in London at all, not a big house, not in a nice area of town, not even a nice building. No, just a room. One room! For this price, in the city I will be working in, you could rent a house for this price. Considering I will be moving to the same hospital as the boy, we can get a mortgage for a three bedroomed house - for about £600-£700 a month between us. How can they possibly justify these prices? I always saw myself living in hospital accomodation, even if you did have to pay for it. But there's no chance that this makes any sort of financial sense at all. I don't understand how they think that this is reasonable.

Another reason that this has got everyone pissy is that last year (or the year before that in some places) junior doctors didn't have to pay for accomodation at all. This amounts to getting on for a 20% pay cut. I don't think I am special because I am going to be a doctor. I don't think I am any more deserving than another profession. But without any consultation to cut effective pay by 20% - I don't believe that this is fair.

One of my favourite blogs, http://nhsblogdoc.blogspot.com/ , has just done a great piece on this - even showing a picture of a typical hospital accomodation. One I stayed in in December I had to clean the cockroaches out of my room, and the bathroom. The one I have at the moment has boards over some doors warning me about asbestos. I'm off to propertyfinder.com.

These hands ...

... have stitched up cuts

... have, as Turk says, been so far inside someone's abdomen I couldn't even see them

... have held bowls for patients to be sick in

... have palpated countless chests and abdomens

... have stuck needles into countless arms to take blood

... have been inside people's mouths, noses, ears, vaginas and bottoms

... have been covered in blood, vomit, sweat, poo, urine and amniotic fluid

... have catheterized three bladders

... have delivered two babies

... have held patient's hands

... are, along with my eyes, my most prized posession

End of A & E

I'm done with Emergency Medicine for the time being. Not for long, as I have enjoyed it so much I don't think I'm going to be able to stay away! I'm starting Oncology next week after a full week off for Easter - I haven't been given so much Easter for a long time!

I had a preview of Oncology recently though. One man - comes in, as his family had insisted on it. Quite non specific about what's wrong, over the last few months he's been breathless, pale, and very sweaty at night. His white cell count was 102. You'd wonder what was going on if the white count was over 10 - 102 is stupidly, ridiculously high. He turned out to have leukaemia. Another man - the day after - came in after collapsing. He had been breathless, and was coughing uncontrollably. I listened carefully to his chest and froze my face to not let my concern show. (I have a terrible weakness of being very expressive, loads of people have told me that.) His right lung sounded so sick - no pleasant whoosh of air. Just ominously quiet sucking, cracking sounds. He turned out to have a really large tumour in his lung. This really got to me, these two patients in succession that I had seen the worry in their faces, and their family's, increase as their time in A&E dragged on. I was crying silently in the toilets by the end of Wednesday.

So winding down from A&E I am far far away from the city, staying with my parents and the boy, surrounded by farms, where I am woken by chickens and lambs, where the buses go every 3 hours and stop at 6pm. Where the church and village hall are the social centres and people buy vegetables and animals from each other. Where the silence is so deep it feels noisy after living in the big smoke. When we weren't living abroad in the Middle East (we followed Dad's job) I spent much of my childhood around here, and took it for granted. Now I savour every second I'm here. Where people aren't rushing, where it's dark and so silent at night, where everyone knows each other, and likes that they know each other. It's so delicious, I can almost taste it.

Blues and Twos

I've been out with the paramedics this weekend. When I was younger, when I wasn't being a juvenile deliquent, I wanted to be a paramedic. This weekend made me realise how much I would have enjoyed it. Saw some great cases, including a little 8 year old boy who'd fallen from a tree and had a huge nail, foot-long piece of wood attached, through his foot. The paramedics were so great to him. So friendly and jolly, and defused the rather stressed situation in an instant. After a few puffs of Entenox he was giggling away and complaining about his ruined trainers. Bless him!

A & E

"Outside a new day is dawning. Outside surburbia's crawling everywhere."
-Kim Wilde
Doing A&E at the moment. In an area of the city where even the name of the place is a buzzword for middle-class. But I love every second. It's an almost palpable pleasure to be somewhere so organised that patients honestly don't have to wait more than an hour, even for very minor stuff, and for anything serious it's immediately. If they need a specialist to see them, they get seen. If they need to have a scan, they get scanned. It's delicious! The NHS really can work!
I lov every second of A&E. It's brutal and ugly and beautiful and visceral and it's so interesting compared to other specialities. I think I'm going to at least try to go into it as a speciality. You meet fascinating people - from the self-confessed landowner who had cut his hand on his chainsaw and joked that he should be greeted with a bottle of Moet every time he comes as his taxes alone pay for the place. Tee hee! What a prat! To the alcoholic man, fitting from withdrawal, trembling involuntarily under every touch of my hand. To the woman from Myanmar, who didn't actually know the difference between an A&E and a GP. To the childs arm so broken from a trampoline tumble that he had a new right angle in his forearm. To the endless numbers of elderly people with so many things wrong that I take up pages and pages writing it all down. To the motorbiker, who had been hit by a car, who ended up getting 8 stitches from me in his elbow and knee. Love it.