Where am I now?

To anyone out there still with this blog on their reading list..

Hi there! I fell off the blogging wagon a good few year back and its been a long old while since I posted... But heres a quick upshot of where my life has taken me:

1. I'm now a paediatric trainee with a few years experience under my belt.  Remarkably this means I stuck to the speciality I thought I would be interested in right back when I started medical school which is probably pretty unusual.  I do love paediatrics itself and the kids crack me up (although occasionally some of the parents send me nuts - a fairly typical paediatrics problem!) but the current state of the NHS, our new job contract and challenges of the "modernising medical careers" pathway certainly add a degree of stress to things.
2. Personal life is pretty good! I got my first house and got married last year plus got a couple of lovable but crazy cats!  
3. Husband is also a paediatric trainee which is an interesting and unusual dynamic - good side is we can empathise with each other about all things paediatrics and revise for exams together but bad side is because we are exactly the same grade we have to compete against each other for jobs in the area we want.  The upshot of this is that for our next job rotation husband has my dream St3 job whereas Ive been lumbered with a 1.5hr one way commute (as I said, joys of modernising medical careers type training plus an oversized + underorganised deanery).  Still the secret to a good marriage is not seeing each other right??
4. I'm considering sub specialising in neonates which is an area I never ever thought I'd be interested in until my last job which was tertiary neonates and I absolutely loved. 
5. Passed my last proper exam this year so have got my paediatric membership now - Halfadoc is all grown up!

Thats the brief upshot for now , hopefully I'll post more soon before busyness of life makes me fall of the blogging wagon again...

Halfadoc xxx

Unpublished elective posts: My first solo ward round!

Unpublished elective posts part one

Foreword
A few years ago I published posts from my medical school elective in Tanzania whilst I was out there (see 2011 around september time in archives).  I used to write them in the evenings on my PDA and then publish them as and when I was able to get access to a computer.  As my elective was in a very rural village this was quite sporadic - the hospital did have one computer but being the only computer for a hospital of 120+ patients it was frequently in use and even when you could get access to it (usually late in the evenings if you could find the key to the computers room) the internet could be outpaced by carrier pigeons and power cuts were very frequent meaning I often lost blog posts and emails halfway through trying to send.

The upshot of this is that there are several partial or fully written blog posts lurking on my computer that I never published.  Its difficult now to publish the partially written ones as the me that would complete them now already feels like a remarkably different person to the wide-eyed enthusiastic fourth year medical student who was getting frustrated by the level of care given at the hospital and the memories of that frustration have already begun to fade.   But, I will try and slowly publish these posts and stay as true to the thoughts I had at that time because my elective remains my most enlightening medical experience and so the most worth blogging about in my opinion.   I will say with each post whether it has been partially written in recent times so you can decide for yourselves how accurate to my experiences at that time the blogs are.  I won't delete bits of the blogs however much they make me cringe now!

My first solo ward round! (minor additions to first paragraph only)

5.10.11

Accidentally ended up finshing up a male ward round by myself today because the clinical officer had to go to opd and asked me to see the last few patients.   Pretty strange having two nursing students plus 1 qualified nurse following me and pushing the notes trolley; I am used to being the ward round follower or notes trolley pusher!  This entourage was definitely useful though in terms of taking a history when I do not speak swahili! This translation service wasn't completely useful however as clearly there are boundaries out here that we wouldn't feel were appropriate within a medical setting in England.  For example the nursing students refused to translate "When were your bowels last open" and giggled at the very suggestion.  Unfortunately this question wasn't really something I could charades-style act out...

In total it was only a few patients that I had to see on my own, but think I did manage them correctly and even noticed that a patient who appears to have had a stroke secondary to hypertension has not actually received his prescribed antihypertensives for the last 3 days, something which has not been noticed in the last 3 ward rounds! So feel pretty proud of myself really, maybe I will make a doctor yet!

Rest of day was pretty full of responsibility as well.  In maternity ward there was a patient in the labour room with poor progress of labour who was on an oxytocin drip which was supposed to be given at an increased speed every half an hour, however despite the fact that there was 3 midwives about plus an insane number of student nurses, every time I popped into the labour room from ward rounds the increase in speed would be massively overdue and still not done! So had to do it myself as well as go on two ward rounds - multitasking skills!

While I waited for the doctor to come and review this patient after the oxytocin had failed to increase the strength of her contractions, I watched the nursing students being taught how to perform a vaginal examination of a pregnant woman.  Craziest teaching of a pv exam that I have ever seen!About 20 students all round one patients bed whilst the teacher performed an examination this intimate examination on her! Poor patient! Talk about intimidating! Also some of the smaller girls standing at the back clearly couldn't see so I'm not sure how much they learnt from the experience. Very, very different to how this is taught in England!

The examination - there are two pregnant ladies within this corner - the one that is being examined and one nearer the camera that students are leaning over in order to see the examination

Halfadoc x

The unwritten rules of being a junior doctor/ 25+things you wished you knew before becoming a doctor

Well I thought it was about time that I did a junior doctor version of my post about things you wished you knew before starting medical school ( http://halfadoctor.blogspot.co.uk/2012/06/80-things-you-wish-you-knew-before-you.html ) so here goes:

1. (And this is the most important) Never say the "q" word. The q word is the dirtiest swear word of the medical world. In the rare event your day is "Quiet" DO NOT SAY IT!! If you do utter the word then be prepared to be blamed by all staff when seemingly every patient on the ward becomes deeply unwell.

2. When referring a patient you can prepare your referral as much as you like and still guarantee the senior you are discussing with will ask that one aspect you forgot to look up such as the all important serum-rhubarb level.

3. Crash bleeps like to go off when you are in the middle of a procedure or breaking bad news

4. Crash bleeps like to get cancelled as soon as you arrive at the correct location having run from the opposite end of the hospital.

5. As per above "crash call cardio" is an excellent way of getting your recommended exercise.

6. The patients you get called to see with low urine outputs/ poor oral intake will probably have drunk and/or peed substantially more than you have during your on call shift.

7. You will have to make some truely awful referrals/ investigation requests at the recommendation of senior doctors (surgeons I'm looking at you) and by the end of your fy1 year you could probably make a decent second hand car salesman after the amount of shit you have been peddling to other specialities all year.

8. For the above the words "my consultant would like" absolves you from blame for crap referrals.

9. You will get blamed and/or shouted at for the crap referrals anyway.

10. A great ward sister/ charge nurse who likes you will make your rotation survivable. Doubly so if said nurse is also an avid ward baker.

11. You will just be finding your feet in a speciality when you rotate to the next one. Return to go, do not pick up 200.

12. The most difficult to bleed patient will also be the one who needs daily/ twice daily bloods.

13. You won't have to do a female catheter until there's a patient that none of the nurses can catheterised and then suddenly you are expected to be the expert...

14. If you are a female doctor then in spite of your stethoscope neck adornment and totally different dress code you will get called nurse by patients 85% of the time.

15. To misquote pirates of the Caribbean: Your finish times are more like a guideline...

16. However late after your shift it is if you are on the ward you will still be considered fair game by other staff for more jobs.

17. As soon as you have qualified (if not as soon as you have started medical school) be prepared to be accosted by nurses/HCAs/cleaners/catering staff/ friends/ family/ the cousin of the great great granddaughter the lady who lives 3 houses away requested you look at and instantly treat their rash.

18. All rashes look the same to an FY1

19. The treatment for most rashes is emollients and/or steroids anyway.

20. You will develop a robust stomach that cannot be touched by indigestion. This is because you will strengthen it by consuming a lot of your lunches either whilst fast walking between wards or while typing a discharge summary with one hand and eating with the other.

21. If you start reviewing a patient whilst eating lunch however you may have gone too far.

22. Most of your friends will be doctors.

23. You will spend a lot of your social time discussing medicine with other doctors.

24. On the rare occasion you manage to venture away from the medical crowd for socialising please see point 17. You will still find yourself discussing medicine...

25. Scrubs are lifesavers when laundry day came and went about a month ago.

26.  You will find a pair of comfy shoes and wear them to pieces as the thought of breaking in new shoes on the wards is unthinkable.  (In my case I wore my shoes until there was decent sized holes in the soles.  I only threw them away when I stepped in a patients vomit...)

27.  You will develop a creepy habit of staring at people with bulging veins and thinking "phwoarrr how easy would it be to cannulate that!"

28. Your patients will rarely have such veins.


I will add more "rules" as I think of them

Dr Halfadoc x