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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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

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!

One Year As A Doctor

I started life in GP land as an FY2 doctor last week, and it’s been a welcome break from how hectic hospital life has been over the last couple of months. I’m now fully registered on the GMC register, meaning that I can now discharge patients on my own, as well as write out paper prescriptions, so it’s only up from here tbh.

Still can’t believe I’ve been working as a doctor for a year now, and what a year it has been! From moving up north on my own, to dealing with the COVID pandemic and the exhausting changes it brought to our rotas, it has really been quite the start to my medical career.

As always, the glory goes to God for seeing me through it all; a year on and it still feels surreal to introduce myself as an actual doctor. It sometimes feels like a dream to be doing what I’ve wanted to do since I was 5 years old, and I feel so so blessed everyday.

I definitely feel like my confidence in my abilities has sky rocketed too. I had a lot of imposter syndrome when I first started, but I can say with confidence that though I may not be the “smartest” doctor, I am a good and safe one; being a good doctor is about more than being able to reel off facts about disease pathology. So for new doctors, don’t stress out if there are things you don’t understand, no one can know everything.

So, some reflections after my first year:

Current job – General Practise

Useful Things I Wish I’d Known Earlier: 

1. Some nurses can do skills like venepuncture, cannulas and ABGs, so that’s another reason to make sure you’re nice to them, because they will help you when you struggle.
2. Before you call to make a referral or seek speciality advise (ESPECIALLY from Micro), make sure you have all the bits of information about the patient ready, or you will get absolutely wrecked by disgruntled seniors. Trust me, speaking from experience #peak
3. TRUST GUIDELINES. Not just for antibiotics, but step-by-step guides on managing electrolyte disturbances, diabetic patients, ACS protocols and so much more can be found on the Trust intranet pages, so it’s always helpful to look there first before calling busy medical registrars…

What am I good at? – Speaking to patients and putting them at ease. Shout out to the years of experience working at my local theatre because it really helped build my people skills, as well as my confidence with speaking on the phone. I can now also say that I don’t struggle with cannulas as much as I used to, yay! The struggle was so so real but finally got there in the end! I had to swallow a lot of pride, and kept asking colleagues to watch me do cannulas to give me improvement tips, and they really helped. So I must stress that asking for help is not a sign of weakness.

What makes me nervous? – Signing off on chest x-rays on my own; always the creeping fear that I’ve missed a small pneumothorax…

The last time I cried at work was? – My last day on the Respiratory ward; the Discharge Coodinator got me chocolates as a leaving present and told me I was her favourite junior. It was the loveliest surprise after what had been a pretty busy day, and a great end to my time on that ward.

A memorable non-med related thing I have done: I went to the beach on my own during one of my days off and it was so great. Got some fish and chips and read for hours by the beach and it was brill. Will definitely do more solo days out in the future!