It’s been a while since I’ve done one of these, and even longer since I’ve sang in public, but I was asked to be a last minute stand in for a friend from church and I’m glad I did it because it was so much fun!
We did Valerie,The Scientist and Can’t Help Falling In Love and I was super nervous to be first, but relaxed as it went on, and even felt confident enough to invite the audience to join in at the end of our last song.
Highlight of the evening was definitely my Psychiatry Consultant turning up to watch me sing! I’d mentioned it in passing during ward round that day, but never in my wildest dreams did I think he’d actually come, so kind! He sat right at the front and recorded all our performances to send to me afterwards – it really made my day.
I also convinced my team to do a bring and share lunch in honour of a rare day when all the doctors were on the ward and it was so so wholesome. Yay for making better Psych memories because it is well documented on this blog how much I suffered in F2, but now I find myself smiling and laughing a lot more at work and feeling much happier, so I thank God for that!
I didn’t have a great start to this rotation because I was told 10 days before I started that it was changing from a community to an hospital based post, but the upside was that I didn’t have to do on calls. I was also told that I could do outpatient clinics weekly if I wanted to, and I agreed to do one a week under supervision of a Consultant Psychiatrist.
3 days before these clinics were to start, I received an email informing me that I was now doing two clinics a week. No explanation or apology for the late notice; it was pretty much a ‘For Your Information’ thing. Ofcourse I was not having it, and refused to do the extra clinics because this wasn’t what I’d agreed to, it hadn’t been discussed with me, and it was unprofessional and just plain RUDE that this was being sprung on me like this.
I feel like this just sums up life as a junior doctor because you’re made to feel like a name on a spreadsheet being moved for service provision, without any consideration of the inconvenience or unfairness of it all. I have a life – being a doctor does not define it! It’s very unfair and I think I was absolutely justified in responding with emphasis on my disappointment in the poor communication and how badly it had all been handled. I am a doctor and deserve to be treated like a professional – the infantilisation and how junior doctors are treated in the NHS is really not okay.
So what was the resolution?
I decided to do the extra clinics because they’d already booked patients for them, and it would have been unfair on the patients to have their slots moved. If they hadn’t already booked these appointments, I would have definitely fought it more, but I chose to let it go.
Psychiatry 2 – 0 Tai
If they backtrack and say I have to do oncalls though, it is definitely NO and I’m ready to escalate to the BMA if necessary. Enough is enough!
I’ve mentioned many times that HSM is my go to watch when I feel down, and I used to watch it most days after work throughout my F2 year, especially after draining oncall shifts and long days on Gastro, and even more so during my Psych rotation. It got to a point that I’d get home from work and not say much to Boss, but I’d put High School Musical on and that’s how he knew I’d had a bad day.
Anyway I guess what I’m trying to say is that things might be feeling a lot for me to deal with recently, but not bad enough that I’ve had to watch my comfort film to feel better. So that’s definitely a reason to be cheerful! 🙂
(P.S. Starbucks Gal and Bangladeshi Bae came up to visit over the weekend, and it was so great hanging out with them again- so much love ❤)
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 😉
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!
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:
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!
It’s been way too long since I last posted- placement and OSCE prep took up most of my time, then I came home for the Easter break and catching up on sleep became my main priority.
Anyway, how did the rest of placement go?
My week with oncology was more emotionally draining than I thought it would be- lowest point was actually getting teary in a very long breast cancer clinic, because a lot of the women had just been recently diagnosed. So their worry for not only themselves, but how it would impact their spouses and children really got to me. It was such a mum reaction that reminded me so much of my own mother, that I called her straight after the clinic to tell her to please check her breasts regularly for changes. Breast cancer really ain’t no joke.
As part of oncology, I also got to spend time with palliative care teams, which again was pretty sad, but I learnt a lot from the team about the importance of sensitivity when it comes to DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) conversations, as well as how the goal of care is make sure patients are as comfortable as possible when it comes to end of life.
The remaining three weeks of placement were spent back in psychiatry with the mental health liaison team, and going back to suicide risk assessments was very tough. The most difficult patients I spoke to were the teenagers with eating disorders, who had been brought in to hospital for feeding because they had refused to eat. It really broke my heart to hear the stories of how their issues with food began; kids can be so so mean to each other, and what the patients had gone through with their peers was just awful.
I was also really surprised by how easily the patients had accessed pro-anorexia websites and Instagram pages, as some of them mentioned how they had been encouraged by strangers online to skip meals and stop eating. So scary! The patients I spoke to were eventually referred to specialist centres for their eating disorders, as they had continued to refuse food in the hospital, so there was nothing further that could be done for them. So sad 😦
The only slightly positive thing I took from my brief time in child and adolescent psychiatry was that I definitely want to work with children and young people in the future – to be able to make even the slightest difference in the lives of such patients would be quite something.
The rest of my time in psych pretty much blurred into one, to be honest. I saw schizophrenic patients, patients admitted after overdoses, and a lot of patients with depression. I know now that psychiatry definitely isn’t for me, because I really struggled with how draining it is, and I have so much respect for health care professionals involved with mental health, as their strength and resilience is inspiring.
On a lighter note, we had not one, not two, but THREE snow days due to the ‘Beast From The East,’ so placement was cancelled for those days, yay! Unfortunately, due to still recovering from my achilles rupture, I had to stay indoors to avoid slipping on the ice, but my housemates were super cute and built a snowman with me so that I wouldn’t feel too left out:
(Yes, they’re quite pathetic looking snowmen but I’d never made one before so humour me please).
“Suicide is not about wanting to die, it’s about not wanting to live.”
Psychiatry is tough. Very sad and very intense- on arrival on my first day at the hospital with Mental Health Liaison, I didn’t even get a chance to take my coat off before we were told that we had to go do a suicide risk assessment on a patient that had been referred to the team. Yikes.
We’ve only practised on actors, so to be told to do a proper assessment on an actual patient was quite the challenge. I’m not going to say it went okay, because confirming for yourself that yes, someone does want to kill themselves is never okay, but we were direct with our questions, and documented our findings in the notes, so we did it to best of our ability.
The remainder of our first week was pretty much more of the same- get there in the morning, given new patient to go see (usually referred to psych with low mood), assess their mental state, and present findings to the team. By lunch time we would be quite drained, so we were allowed to call it a day by about 2 in the afternoon, so that was good.
This week I saw a patient with schizophrenia for the first time, and what an experience it was. As we were talking to her, she seemed quite distracted and kept looking to the side, and it was only midway through the consultation that it dawned on me that it was the voices she was hearing that were distracting her. So it was really interesting to see how auditory hallucinations actually present in real life.
On a positive note, I’m walking without crutches now! Physiotherapy is tough but it’s going well, and it’s so great to be on two feet again, especially when my lasting memory placement at this hospital last term is the exhaustion from hobbling around the paediatric department… ahh, what a journey it’s been. Thanking God for progress, determined to be able to walk without a limp with time! (If you, or anyone you know, needs help, has been feeling very low, or just wants someone to talk to, call the Samaritans on 08457 90 90 90 (UK). Please don’t suffer in silence; there are options, you are not alone.)
My placement with Dr B came to an end today, sad times. My last day turned out to be the most stressful as I was over an hour late due to severe delays and signal failures. Typical.
Anyway my last ward round sure was interesting. A patient who definitely stood out for me was an alcoholic with an eating disorder, who I’ll call E. She’s had problems with food since she was a teenager and she started being picky about eating as a way of acting out. Years later, she got into an abusive relationship and her boyfriend called her fat constantly, which made her determined to lose weight. So from 8 stone she dropped to just under 6, and was admitted into the ward after she attemped suicide.
E was interesting because she knew she was underweight and so would binge eat, but then she’d feel guilty for eating so much and then make herself sick or go long periods of time without eating. So in a way she was both anorexic and bulimic.
I felt sorry for E because I could really empathise with her. When I was 14 someone close to me at the time told me I was “too skinny,” and I believed it, so I began overeating and considered taking protein shakes as a means of putting on weight. I eventually realised how silly I was being and snapped out of it, but meeting E made me realise that unfortunately, some people don’t.
As a result of this I believed everything E said to Dr B about wanting to get better and how she’d cooperate and start eating etc. It was when her mum joined us and told us not to believe E, as she had ‘the gift of the gab’ and controlled their family by dictating their meal and bath times, that I really discovered how manipulative E was, and I’d been well and truly sucked in, as E didn’t really think there was anything wrong with her. She was only saying what we wanted to hear.
Lesson learnt? Empathy is good as a doctor, but too much of it begins to cloud your judgment.
And that brought my time with Dr B to an end, as he let me go early because he had to go interview a potential consultant. I totally had to get a photo with him though, such a lovely man!
So with time to spare, I decided to have lunch in Green Park and go to Buckingham Palace to get a picture of the royal baby announcement. It was gone, unfortunately, but I took pictures anyway and pretended to be French. Fun times.
I am really bad at this blogging thing but I’m learning so please bear with me.
Anyway, yesterday was spent by yours truly shadowing Dr B in a hospital in London. Dr B is a medical director and has been a psychiatrist for over 20 years. He’s also one of the nicest people I’ve ever met, and really humble too, considering how much of a big deal he is! This was all made possible by my old Economics and favourite teacher, Mr B, who made it happen as Dr B is his dad. So cheers, sir!
I made it to the hospital just in time for the ward round, even though I’d overslept due to my numerous alarms not going off, grrrr. I was super duper proud of myself for planning my route on my own and getting there without getting lost. So to everyone who says I am incapable of being independent, HA.
The psychiatric ward was a whole new world compared to gastroenterology, where I had a placement in last year. First of all, there was way more security, i.e. coded doors and cameras, as patients have been known to “make a run for it” in the past. I was told not to go anywhere without a nurse or doctor, and I also had a nurse between me and the patients at all times. Intense stuff!
I met a lot of patients during ward round, but there were a few who stood out for me. One of them was a patient who I will refer to as A, who had paranoid schizophrenia. As a result of this, she did not take well to strangers and was very suspicious of me. In fact, she didn’t take her eyes off me when Dr B was questioning her, and refused to answer questions, demanded to be seen in private, then glared at me before storming out of the room. Scary times indeed. Dr B and the nurses assured me that she was like this with strangers all the time and it was definitely not me, but I was still a bit like WHOA. So that taught me that being a doctor will require patience, as shown by Dr B’s understanding nature with A.
Another patient who stood out for me was a man who I will call H. H was a 26 year old who was also schizophrenic. He lived with his parents, who were present while he was getting assessed by Dr B. H got admitted after he stopped taking his medication and attempted to take his own life by jumping off a building. H also believed his parents were conspiring against him and refused to acknowledge them. This made me very sad because I felt so sorry for both him and his poor parents. It wasn’t all doom and gloom though because H finally agreed to start taking his medication again and allowed his parents to escort him to his room.
The importance of communication was highlighted with another patient, who I will call M. M was Portuguese and his translator didn’t turn up in time for the ward round, so Dr B couldn’t talk to M to find out how he was feeling, and this was very frustrating for both of them as Dr B couldn’t do anything to help him. Very frustrating.
I learned that sometimes nothing further can be done to help a patient, as sometimes their problems stem from social rather than psychiatric factors. This was shown though T, another patient, who was getting discharged from the ward after attempting suicide, as he felt that was his only option after being disowned by his family in the Czech Republic because he had been in jail a couple of months ago.
So overall it was a great experience and I’m grateful to Dr B for the opportunity. Yesterday was my taster day and I have a week off from the placement because of the dragon show next week (yaaay). In two weeks, I get to shadow Dr B some more so I’m really looking forward to that.
I always thought paediatrics was the area of medicine I was most interested in, but now I think I’m beginning to consider child and adolescent psychiatry…
(Yes, they’re quite pathetic looking snowmen but I’d never made one before so humour me please).
Life As A Junior Doctor 