My Last Shift As A Gastro FY2 Doctor

What a whirlwind the last couple of weeks have been! I am officially in my last week as a FY2 doctor – tomorrow is my last post-take on call shift and then I will be DONE; we thank God!

Last Tuesday was my last shift on the ward, and I’ve spent the last couple of days visiting my dear aunty Funzie for a much needed retreat – it was so much fun and I’ve come back feeling refreshed and ready to change over jobs next week… but more on my post FY2 plans later.

In the month it’s been since I last updated this blog, I started and completed my on call night shifts, and my goodness, the hectic day shifts on the ward were definitely a breeze compared to how overwhelming the nights were. 1 doctor (me), covering 10 medical wards… it was A LOT.

I’m not going to go into detail about how they went because it took me a while to recover from how awful some of the shifts were, so here’s a haiku to sum up my nights:

Never ending bleeps,

Yay for helpful registrars,

Site team are the WORST.

Yupp. And in the words of Forrest Gump, “That’s all I have to say about that.”

Moving swiftly on, how was my last day on the Gastro ward? I started the day hoping for a calm, relaxed shift; I was only meant to be working till 3pm because of allocated self development time, so surely the ward would be fine till then, right?

Yeah… WRONG.

My last day on the Gastro ward involved a patient self discharging, then being brought back to the ward by the Police because they had tried to take their life. This same patient also snuck alcohol on the ward, which they downed with some Paracetamol and Anadin, ofcourse. They then required holding powers (a.k.a sectioning) by me because they became aggressive and tried to leave the ward; all this whilst continuously threatening to take their life. Yupp. And this was just one patient.

Also on the ward that day was a patient who had an upper GI bleed that required an urgent endoscopy, as well as other acutely unwell patients with ascites and liver cirrhosis. Basically, it was all kicking off and with the Registrar dealing with urgent referrals around the hospital, I had to manage most of this by myself, whilst also being shadowed by the new FY1 doctor, so I even had an audience watching me trying to juggle everything!

I guess I can laugh now at the irony of me having to section a patient whilst on a GASTRO rotation – I really thought I was done with Psych after the draining four months of it I had but NOPE, I had to bring back a lot of my knowledge of holding powers to be able to correctly section the patient. I was the only one on the ward who knew how to do it, so I guess that was God trying to tell me that though my experience of Psych was quite distressing at times, I really learnt a lot from it, because I was able to apply a lot of my patient management skills from there to the suicidal patient on the ward.

My last day wasn’t all doom and gloom though – I got to do my first ascitic tap! It’s funny because I’ve done quite a few ascitic drains now but never a tap, so glad I was able to do it before leaving Gastro.

Despite how busy it’s been, I’ve really enjoyed my time on Gastroenterology. I find it so so interesting and I’ve learnt so much over the last four months. I would really consider it as a speciality if I didn’t have to go through being a Medical Registrar as part of training for it. Yeah Med Reg life, especially in a district general hospital, is most definitely not for me… *shudders*

Here’s to more regular updates now that my foundation training is coming to an end and I have a new job… but more on that in my next post 😉

Life as a Gastro FY2 Doctor

Today makes it exactly 8 years since I started this blog, time flies! And what a journey it’s been…

In other news, I’ve been in isolation with Boss for the last week because of being alerted through the Track and Trace app that we’d both had a COVID contact, so we were told to stay at home for a total of six days, and it was GREAT. I definitely needed the time off work to catch up on rest and just have some time to not do anything tbh, because I realised that I’ve not really had much of a ‘lockdown’ / ‘stay at home’ experience due to working since the pandemic started, so it was nice to have a bit of that because I’d definitely felt a bit left out.

Luckily we both had no symptoms and were feeling pretty well in ourselves, so isolation for me involved a lot of sleeping, eating lots of food, watching films, reading, and even some karaoke (Boss was less keen for the latter but I had a lot of fun.)

Anyway, I’m preparing for my first set of night shifts in hospital since I rotated to Gastro back in April, so thought it was finally time to catch up on what my first two months as a Gastro FY2 doctor have been like.

One word: HECTIC.

I’m definitely seeing the stark contrast between working in a big teaching hospital (where my FY1 jobs were), and a smaller district hospital (where I’m currently based), because I definitely had things easier last year and really took it for granted…

How are things different? I think staffing levels were the biggest shock to me, because I was used to working on wards with at least 3-4 other junior doctors, and I’d have 5 to 6 patients to do jobs for, with daily Registrar and Consultant ward rounds, and senior availability at all times. So being on Gastro in a smaller hospital has been quite the change because there are definitely not as many junior doctors in this hospital, meaning that normal patient load for me can be up to 10 to 15 patients during a day shift.

I also didn’t realise how much of a luxury daily Consultant ward rounds are, because with only three Gastro Consultants to cover clinics, endoscopies, and take referrals, it isn’t possible to have a Consultant on the ward every day, meaning that patient reviews fall to the most senior junior doctor on the ward to lead, and that is usually me… definitely a step up in responsibility!

On call shifts are even more intense because it’s usually only one or two doctors covering all the medicine wards in the hospital (yupp, not just Gastro), and involve looking after up to 300 patients spread across the 10 medical wards… yeah. Sometimes after my busy on call shifts I struggle to sleep because I can still hear the sound of my bleep going off in my head, SO annoying.

It’s not been all bad though – I’ve become so much quicker and more efficient at doing jobs and reviewing unwell patients, so my confidence there has definitely increased. I’ve done a lot more ascitic drains now, and even a couple of lumbar punctures too!

And you know what? Despite the busy shifts and how hectic things have been, this is STILL better than my time on Psych. So it could definitely be a lot worse. #neverforget

I leave you with yet another scrubs selfie – here I am on my first day of Gastro:

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Please Don’t Touch My Hair

During ward round yesterday, I had to resort to this to stop staff (yes, STAFF) from touching my hair without permission:

I can’t believe that this still needs to be said in 2021, but don’t touch black women’s hair without permission. It is rude, an invasion of privacy, and just WEIRD. I am not a pet – it’s very dehumanising and uncomfortable because you wouldn’t touch a white person’s hair in the same way.

I am TIRED.

Junior Doctor Anecdotes: The Mezzo-Soprano Who Needed a Cannula

HELLO! It’s been a little while since I last updated this blog – it’s been a busy couple of weeks getting used to working in hospital again, but loving life on Gastro so far! It’s definitely been better than Psych because it’s great to be part of a team again, so it’s been nice to have more support and seniors to call when I feel out of my depth with patients. I’ve also spent the last couple of weeks finalising my plans for life after F2, which has all been very EXCITING, but more to come on that soon…

Anyway, since I started on Gastro, I’ve completed my AMU oncall block, which involved long 12 hour shifts. As the ‘post take’ doctor, it was my job to see new admissions with the Consultant, and then do the jobs for them. It also involved keeping track of the patients being clerked by the ‘clerking doctor,’ as I’d get bleeped to see them with the Consultant when they were done.

As you can imagine, I was kept very busy during these shifts because the patients who needed post taking were from all over the hospital, so definitely a lot of walking, meaning that I got to know my way around the hospital pretty quickly! It really taught me how different staffing levels can be in smaller hospitals, because my F1 jobs were in a big teaching hospital that had a massive Acute Medicine department, so AMU shifts there always had a lot more doctors around to do the jobs and clerking.

A patient that stood out during my AMU long days was an elderly woman, who I was called to cannulate. Various nurses had attempted but were unsuccessful with getting the cannula in, and she really needed one for a CT scan, so I said I would give it a go. Anyone who has followed this blog for a while will know that I reallllllyyyy struggled with cannulas last year, and after 8 months of GP and Psych, rotations where I didn’t have to do any cannulas, I was seriously out of practise. So why did I volunteer to try, you ask? Well I decided to back myself and give it a try if she was willing – practise makes perfect, right?

Yeah… so my first try was no good… as was the second #peak

The lovely lady told me to give it another go, even though I was ready to give up at this point. As I was setting up the equipment, I was chatting away to try and put her more at ease, as one of the reasons that my cannula attempts had been unsuccessful was that she kept flinching/tensing when I inserted the needle, so I thought that if I got her to relax a bit, it might just work.

As we were talking, she joked that we might be more successful if I sang to the veins “to get them out of hiding,” which immediately reminded me of that time I sang with a nervous patient to get a blood sample from her. So I was suddenly struck with some inspiration.

I asked her what her favourite song was, and she replied that she was “old school” and more into musicals, so OFCOURSE I had to ask her what her favourite musical was, and it was Les Miserables, one of my favourites as well! I suggested that it might help if she sang her favourite song from it in her head to distract herself from the needle, but she became visibly emotional at this.

She told me that she had been a mezzo-soprano and had sang in choirs for most of her life, but then she got diagnosed with Parkinson’s Disease, and her voice was the first thing to go. She added that she still loves singing, but it makes her sad because she doesn’t sound as good as she used to be, so doesn’t like singing to herself as much. Then she asked if I would sing with her.

So that was how the both of us ended up singing I Dreamed A Dream from Les Miserables together in the middle of the ward, and this ex mezzo soprano showed me that she still had quite a voice on her.

And guess what? I got the cannula in on the third attempt.

NO MORE PSYCHIATRY

Dear readers, I am officially done with my Psychiatry rotation and I AM FREEEEEEEEEE. AT LAST.

This has definitely been my most emotionally and physically draining job so far – I am well and truly exhausted. Psychiatry has been such a challenge for me, so I’m glad to be at the end; it’s been a very long four months!

So as always, a recap of the highs and lows of the job:

What was I good at? – Getting my documentation done during clinical reviews so that I didn’t have to type up notes afterwards. One of the pros of being a fast typer!

What made me nervous? – “New admission” are still two of my least favourite words, especially when oncall. I really had no idea what to expect when seeing patients sometimes because people present with psychiatric conditions in different ways, so every new patient encounter was always lowkey nerve-wracking because of this.

Useful thing I’ve learnt? – How to prescribe medication for rapid tranquilisation, which are drugs given intramuscularly for urgent patient sedation. The doses for these meds are now ingrained in my brain forever.

The last time I cried at work was? – My last day. And the day before that. And the day before that. And the day before that… yeah, I cried quite a lot towards the end of Psychiatry because I was starting to feel very overwhelmed by the demands of the job. Having to deal with being short staffed with high patient turn over, as well as being the most senior junior doctor on site most days and managing unwell patients was A LOT.

My happiest work moment so far was? – Again, my last day. The ward manager and nursing team gathered in the office to present me with leaving gifts as a thank you for my work on the ward. They told me that they’d noticed how hard I’d worked and how difficult it’d been for me, so they thought I’d “smashed it” overall. This meant so so much to me and I was such a speechless, teary mess. But happy tears this time!

Another happy work moment from my last day was being given this by the patient I’d had to be hidden from:

What a journey it’s been with this patient, so a very fitting end to it all.

A memorable non-med related thing I have done: I finally watched Greta Gerwig’s Little Women and it was amaaaaaaazing. I LOVE the book, and I was supposed to watch it in the cinema last year… but then lockdown happened. I’ve put off watching it for months because of how gutted I was at not being able to see it on the big screen, so finally watching it was really quite something for me.

Anyway, here I am on my last day on the Psych ward:

#freeasabird

Junior Doctor Anecdotes: That Time I Had To Hide From A Patient

Every now and then, I take a break from updating this blog when I feel like there is too much going on for me to write about. I usually describe this as “when my head gets too loud,” which means I need to take some time out to silence the noise. So that’s what I’ve been doing over the last couple of weeks, because if I’m to be honest I’ve been struggling a bit.

Psychiatry is hard. And very very emotionally draining. The events of the last week haven’t made things better to be honest – I am tired. It is very tiring to be a black person in the UK right now, in the light of the Meghan and Harry revelations. It is tiring to be a woman right now following the tragic Sarah Everard news. I’m just tired of it all.

Psychotherapy has been helping a lot. One of the positives of being on Psychiatry is that we (junior doctors) have mandatory psychotherapy sessions every two weeks, which involve us talking in groups about our struggles, difficult patient cases we’ve been involved with, and sharing coping strategies. The sessions are facilitated by a trained therapist, and they have been so helpful with dealing with stress and quieting a lot of the noise in my head lately. Which brings me on to the topic of this blog post – yes, I really did have to hide from a patient.

Why, you ask? Allow me to explain.

On the ward right now, there is a patient with severe health anxiety. This patient is convinced that they have every possible condition you can imagine, and constantly insists on being examined/having blood tests done/having scans requested. There have been no indications for these investigations, but still, this patient is determined to keep repeating them, threatening to kill themselves if we don’t agree to their demands. And this is why they have been admitted to the ward.

The nurses are usually able to calm this patient down and distract them when they get agitated and distressed, but all these efforts come undone when they see a doctor. And this is where I come in. I am the most senior doctor on the ward the majority of the time, especially after the patients have been reviewed by the Consultants in the morning, (yupp, #psychlife), so when this patient sees me, they immediately become more anxious, insisting that I do blood tests and examine them.

This patient is intense and unrelenting – they scream and shout and accuse me of not caring and being a terrible doctor, because I firmly remind them that there aren’t any indications for the investigations they are requesting to have done. It got so bad that I actually cried because of some of the awful things they were saying to me. I know it’s not the patient’s fault – health anxiety is a really debilitating mental illness, but I am still only human so sometimes the words get to me.

The nurses picked up on this, and deduced that my presence was most definitely a trigger of this patient’s anxieties, so they suggested that I make myself scarce on the ward when the patient is around. This has led to me having to hide from the patient in a side room on my own when I have to do jobs on the ward. Yupp, this is really truly my life right now, but I guess I can see the funny side to it. And to be fair, it’s working – the patient is a lot more calm and rational in the absence of doctors so a win/win situation, right?

Join me next time (hopefully sooner rather than later), as I continue with recounting the ups and down of life as a junior doctor. To all my dedicated readers, your comments and messages are very much noted and appreciated.

That Time I Got Hit By A Van

It happened nearly a month ago, which is why I haven’t posted on here in while. So without further ado, a much needed explanation:

I was walking home after a hectic day,

Long story short – I saw the driver turning, he didn’t see me crossing,

So what else can I say?

I was knocked to the ground, but I didn’t hit my head,

Just had some leg bruising and ankle swelling instead.

No broken bones, what a great relief

I got off pretty much unscathed, a feat that beggars belief.

I’m doing okay though, getting on with life in the best way I can

I don’t tear up as much now when I remember that dang, I really got hit by a van.

Yupp, I continue to be accident prone, it seems. Sigh. But I’m feeling less bruised now, and grateful to God that it wasn’t anything more serious because my gosh, I’ve been thinking a lot about how bad it could have been and really freaking myself out. Massive shout out to Boss for keeping me calm and patiently listening to me catastrophizing, it’s been A LOT.

I’ve been doing a lot of reflecting over the last couple of weeks, which I guess is normal after a traumatic event, so I leave you with this nugget of wisdom – life is short and can be over before you know it, so make sure you let the important people in your life know how much they mean to you. In fact, let them become tired of hearing it so much; you don’t know what could be round the corner. In my case, it was a van…

Also, three words: HIGH. VIS. JACKET.

Some Good News

With how hectic the last week has been I forgot to mention that I got my first dose of the Pfizer COVID vaccine!

It felt like every other injection I’ve had in the past- sore arm afterwards for about a day or so, but one week on and no other side effects so far; feeling good!

I got the vaccine because with new COVID variants and going back to working in hospitals soon, I’ll be very much exposed to and be at increased risk of infection. The vaccine offers protection and reduced severity of COVID symptoms, so I think the benefits outweigh the risks.

Here’s praying the roll out of vaccines bring us closer to some normality…

2 Months As A Psychiatry FY2 Doctor

It’s been nearly eight weeks since I rotated from GP land to Psychiatry, and in those eight weeks I have had normal day shifts, as well as eight very eye opening on call shifts. Some might even call them harrowing/low key traumatising to be honest, so here are 8 lessons I have learnt so far:

1. My least favourite words to hear when I’m on call are “new admission”.

2. I am much better at interpreting ECGs then actually doing them.

3. You must be able to prescribe rapid tranquilisation when needed- know your doses well. Rapid tranquilisation meds are given intramuscularly to quickly calm aggressive/violent patients, so they’re usually given ASAP in emergencies.

4. Following on from the point above, don’t let nurses pressure/intimidate you into prescribing anything you don’t feel comfortable prescribing. Yes, a lot of them are more experienced than you in Psychiatry, but remember that it is YOUR name that will be on the prescription, so if anything goes wrong, you’ll be the one in trouble, not the nurse. So always speak to your Consultant and DOCUMENT THIS before prescribing unfamiliar medication.

5. Racist hallucinations are a thing??? A patient I assessed last week told me the dead voices she was hearing and seeing were white, and because of this, they didn’t like me talking to her. I felt like I was in the Sixth Sense, your gal was SHOOK.

6. Suicidal patients can be very creative when it comes to ways to hurt themselves. Horrifyingly so. I’ve struggled with sleeping sometimes because images of some of these graphic foiled attempts, and the subsequent restraining required by staff, keep playing in my mind when I close my eyes.

7. Some patients will relapse shortly after you’ve discharged them as okay to go home, but you shouldn’t blame yourself for this. Sadly some patients will appear better and be deemed low risk, but because healthcare professionals aren’t mind readers, it is difficult to know if they’re just saying what we want to hear.

8. I am very sure that acute psychiatry is most definitely not for me. Nope. Only two more months to go…

A Much Needed Break From Psychiatry

Two weeks into my Psych rotation and I am feeling DRAINED.

When I’ve explained how it’s draining to people, I’ve been able to summarise it like this:

My time in Respiratory during the first wave of COVID on that awful COVID rota was physically draining because of the long shifts. GP was more mentally draining- I had shorter days but was using my brain a lot more because of how much more independently I was working/reviewing patients on my own.

So far, my time as a Psychiatry SHO has been emotionally draining. I work in an acute psych unit, where we have a lot of acutely unwell patients with psychotic symptoms, so I’ve felt more on edge.

We were told in our induction to constantly be on our guard- we carry alarms all the time, are never to have our backs to patients, should always sit closer to the doors, and should always review patients with a chaperone. So it can get pretty intense!

I have an oncall shift once a week, which involves me being the only doctor around to cover the acute site, as well as the elderly psych and eating disorder units. As my oncall shifts vary between 16 and 24 hours in length, I live too far away to go home, so I stay in the doctors’ rest rooms provided for us:

Sooo nice! It really does feel like a hotel, haha.

Anyway, I’m off this weekend and Boss and I have recently gotten into making and decorating gingerbread men, so much fun!