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I’m a Junior Doctor and the NHS Makes me Happy!

Nursing Notes

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I'm a Junior Doctor and the NHS Makes me Happy!

Other than being a serial Facebook and twitter spammer with a former unhealthy dependence on emoticons, I am a Medical Registrar – Gastro is my thing. I am a ST8 (that’s right… 8!!) – so I am pretty much as senior as it gets as a “junior” Doctor.

It was my second career choice, I admit. Till this day, my career of choice would be to be a Ghostbuster… However, after my dear sister, Ipshita Roy (Chotdi) told me that was not possible and I was, undoubtedly, an idiot, I swiftly reassessed my options. I concluded then that I would be a doctor like my dad.

I was six at the time. I have held on to that dream with ease ever since. I can tell you now, one thing that never once featured in my choice was the want of money – when I was six, I barely knew what a chocolate coin was, forget real money!

I have just worked a 12 hour shift on a Saturday and I will do another one tomorrow – on a Sunday. I am totally spent, but, not at all unhappy about it. The satisfaction I get from working as I hard as I do will be easy to relate to by anyone who has ever worked hard – who is surely all of us.

During my shift today, I was reminded of something that made me smile and then compelled me to write this nonsense despite being happily exhausted…

I LOVE MY JOB

I love what I do, I love why I do it, I love who I work with and I love working in the NHS – the single best team I have ever had the honour of being part of.

There was simply nothing special about today – it was like every other 12 hour shift that I have worked on for the last 10 (nearly 11) years, and that’s the beauty of it. What happened today was not a show – it was entirely earnest and run-of-the-mill whilst being inadvertently phenomenal.

If you can bare to read the rest of this drivel, I will tell you just a few things that happened today to explain why…

THE HANDOVER

Ok, so this will be a weak start for any doctor reading this because the morning handover is as common-as-muck in a hospital. They happen around the country in every hospital, every single morning, every single evening, in every specialty, every single day of the week – of which there are 7…

So, what struck me? I was sat in a room with two other registrars (we are basically the boss’s deputy – the general secretary to the President as it were – we make sure the show goes on), the Consultant herself (Yes, Consultants do work weekends – every weekend) and about 12 other junior doctors. A second consultant had already started a ward round on another ward – I eventually gave her a lift back to the station at 21:00…

(Yes, Consultants DO WORK WEEKENDS…)

There was a doctor allocated to each department / ward of the hospital… Their job is to ensure that all sick inpatients are reviewed, their bloods are checked, their salts and sugars are kept stable, their scans (including CT heads, MRI spines, CT abdomens, etc) were done TODAY…

May I remind you, this was happening on a Saturday – it happens everyday… It will happen tomorrow too…

Did anyone look reluctant? Of course not. They were all there to their job – the job that they had worked hard for since the age of at least twelve. I’m not saying there was the sound of clinking halos resonating through the room. As with any work place, there was the comedy cocktail of “morning people” (who are these people?!) and the resolute “non-morning people” (these are my people). There was the spectrum of grumpy to excess jolly, which simply is not welcome at that time of the morning…

But, no, not one person was reluctant. All ready to do their duty. All correctly unaware of what an awesome service they were part of.

I was impressed by the system and impressed by every one of my colleagues who were there to make the system work and to keep their patients safe with a total disregard for the calendar…

THE DIABETES NURSE

I saw a young fella yesterday evening – around 19:00 – So out-of-hours. Basically he got sick while out with friends and he was found to have diabetes. His sugars were through the roof.

He came to us. I saw him. Checked he was safe. Gave him his first shot of insulin. And then sent him home.

Many doctors & nurses will now be shouting – “WHAT?!! YOU SENT HIM HOME?!!”

The first diagnosis of diabetes can sometimes be a dangerous time – so sending them home is not always a good idea.

But, the only reason I could do that safely was that I was able to bring him back today.

And I did. I brought him back to an ambulatory care clinic which happens every day of the week, again, of which there are 7…

He came to us at 10:00. I saw him in the clinic and called the diabetes nurse.

Diabetes nurse on a saturday?! Wasn’t she in a spa?

No she wasn’t. She was at work.

I bleeped her and she was the most delightful lady on the other side of the phone. She actually thanked me for bleeping her and using the diabetes services – “It’s what we are here for”. And yes it was.

This lad was young. A sporty type. Being told he has diabetes and that he will need to inject himself every day for the rest of his life…

That’s some heavy news! He was doing a good impression of a brave face, but we knew he was terrified. I would be.

So the nurse, realising that he was just about keeping it together, said to him – “i just need to step outside to make a very quick phone call”. She returned with the biggest of smiles and the most comforting of manners and took him through it all again until he got his head round it. He then did his first injection by himself and felt pretty chuffed…

What she didn’t tell him was that she went outside to call her own daughter to tell her that she would stay on at work beyond her shift, would not be able to drive her daughter to her netball match and watch her daughter captain the team. She wanted to make sure this new patient of her’s was ok. Her daughter, of course, understood. More than that, I bet she was proud of her mum too…

Of course, rightly, the rugby-lad knew nothing of her sacrifice and never will – and why should he? We are not doing any favours, we are just doing our job.

But, I knew. And I was grateful and I was most definitely impressed.

This young lad got told he had diabetes, saw a senior doctor and a highly trained experienced specialist nurse and became independent with injected his own insulin – all within 15 hours on a Saturday…

There is only one thing that would be different if it was a weekday – it would be a weekday… THAT IS IT!! He would have got exactly the same world-class treatment and training any day of the week…

That is simply awesome!

THE 1930’s JAZZ

A bit later I got called to review a lady with abdominal pain. While I was sat at the desk going through the notes, there was a poor elderly lady extremely agitated. She had dementia – a cruel disease. She was terrified simply from being in an unfamiliar environment. She was thrashing about trying desperately to find simply anything that was familiar to combat her fear.

I then watched as the healthcare assistant (HCA) went to see if she was ok. Through no fault of her own, the patient was very rude to this young HCA. The HCA, however, was simply wonderful.

She just pulled the curtains around partially so that the ward would not seem so threatening. She spoke with the gentlest of voices. She made sure that the patient could still look out the window. But, the terrified lady was still seeking rescue.

One of the cruel features of dementia is regression and familiarity is key to feeling safe – that’s why patients are sometimes calmer when with their families.

The young HCA recognised this and then did something, which I thought was just lovely…

She went away and came back with a CD… She then put started to play jazz from the 1930’s… Almost immediately a memory seemed to spark in the terrified elderly lady… She stopped shouting and thrashing about and instead simply smiled quietly… Finally the exhaustion of her terror was allowed to catch up with her and the lady finally slept… Perhaps for the first time in days… The HCA then just watched her for a few moments to make sure she stayed settled… She then sorted out her bedding and made sure she was warm and decent…

It was a simple thing, but could anything be more important to that patient than to have some peace? I think not.

And the beauty of it was that this was not a moment of innovation from a maverick. This was a rehearsed plan on the dementia ward. This was a routine thing for the staff. They do this all the time. I later learnt from my excellent colleague, Fiona Windsor (who incidentally is one of the most inclusive and best leaders I have ever seen), that the elderly care wards have a “Reminiscence Cupboard” – full of various artefacts collected simply to provide familiarity in situations just like this one…

The thought that the NHS invests in keeping their patients safe is just beautiful… It is not just about blood tests and X-rays – It is about the patient and what they need…

Imagine if we were allowed to do more?

Wonderful…

THE MAN WHO HAD A STROKE AND ATE A SANDWICH 9 HOURS LATER

I got called to review patient on the stroke ward. While I was on the ward a nurse asked me a quick question about another patient…

He had a stroke at 3:00 am this morning… His wife called the ambulance – they were there in 8 minutes and he was in the hospital within 20 minutes of the stroke… He then had a CT scan of his brain before it was 4:00 am…

The CT head was reported by an on-call Radiology Consultant… Yes, consultant… and the patient was seen by a Specialist Stroke Consultant (oh look, yet another consultant!) & a specialist stroke nurse… All by 4:20 am…

When they saw him, the patient could not speak and the right side of his body did not work. He too was terrified because although he could not speak, he could understand every single thing that was happening…

The consultant then reviewed the scan and decided to thrombolyse him (give medicine to break the blood clot which was causing the stroke)…

Ten minutes later, at 4:30 am, the gentleman was able to speak… He was able to say, “thank you” to the consultant and shake his hand – with his RIGHT hand…

When I popped in just to see how he was doing, he was eating a cheese sandwich, I tried to chat to him, but he said, “I’m very sorry, I really must have a wee…”

He then WALKED to the loo…

Stroke? What day of the week? Doesn’t matter – we’re there anyway…

THE ONE QUESTION THAT WAS NOT ASKED BY ANYONE IN THE NHS TODAY

“What can you afford?”

Point made.

THE NHS WILL BE FINE… IT WILL BE…

What I remembered today is that the NHS is incredible and not finite.

At the moment it feels like we are losing the fight to save the NHS and that we are getting slaughtered in the media… And yes we are. The media misrepresentations have been simply disgusting.

And yes, we may well lose a series of battles, but we will not lose the war…

I will tell you why…

Our opposition are armed only with weak motivations.

We are fighting against those motivated by greed of power and political gain – there is no sincerity in that…

We are driven by a pride in what we love. We want to preserve and improve on a belief we hold so fiercely.

The nurses, HCAs, physiotherapists, dietitians, OTs, pharmacists, paramedics, domestics, porters, cleaners, PA’s, support staff, all allied health professionals and doctors are not driven by greed or political gain…

We are driven simply by a love of our duty and a sincere want to do our job to the best of our ability…

Greed & dishonesty cannot compete with that…

At the moment it feels like it is only the junior doctors and student nurses who are fighting to save the NHS…

But, that is not because we are the only ones who love and value the NHS.

It is because, through clever and strategic media spin, we are the only ones who have had the chance to know the truth yet…

However, the greedy, by definition, will always make the same mistake – they will want too much…

At some stage, the powerful few will take it too far and will visibly damage the NHS.

At that stage, it may seem like we have lost the NHS and that we have lost.

However, what in fact will happen is that the greedy will damage the NHS so much that the patients and relatives that we are fighting to protect will sadly start to be affected directly.

Then we will all know as one that our beloved NHS is in danger.

The country WILL get together and say as one, “Get your mits off our NHS!!!”.

This country will not allow it and we will never stop fighting at any stage to prevent it from ever getting to that.

The NHS is too loved and appreciated by each one of us to let it just fade…

I am proud to be close friends with heroes like Ben White & Shabnam Parkar who I had long respected before all this… Of course, my big sis Sushmita Roy who has stepped well out of her comfort zone to fight for a cause she loves…

This battle has given me the opportunity to be in awe of new talented heroes like Hannah Brotherstone who got me into this whole thing, Amar Mashru – video maker extraordinaire and Reena Aggarwal – who has made it beautifully clear that we are not fools and Johann Malawana is no puppeteer – the BMA has NOT mislead us, it represents us clearly – very different!

We have in our ranks Roshana Mehdian, Anna Warrington, Sundeep Grewal, Salwa Malik, Yezen Sheena and Taha Nasser who are no mugs in the media.

We have fresh faces like, Lolly Sarah, Ed Preston, Nadia Masood and Kishan Patel. We have people like Palak Trivedi who simply cannot help being heroes…

We have those who tirelessly work in the background like Seán Mâtheiken, Amrita Jesurasa, Alex Gates, John Sykes, Taryn Youngstein, Bridget Catterall, Mohsin Khan among so many more…

We have actual friends of Justin Beiber and chart toppers Katie Rogerson, Harriet Nerva & Joe Blunden…

And let’s not forget Danielle Jade Giza, the student nurse who is spear heading the fight to oppose the cuts to NHS bursaries…

And that is just those in the NHS… just wait till the rest get involved!!

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Adam Kay’s Letter to the Secretary of State for Health

Matt B

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Adam Kay's Letter to the Secretary of State for Health

Adam Kay, a former Doctor, publishes an open letter to the Secretary of State for Health calling for him to walk a mile in the shoes of a junior doctor.

In his new book, ‘This is Going to Hurt: Secret Diaries of a Junior Doctor,’ the former obstetrics and gynaecology doctor writes candidly about his experiences as a junior doctor and the effect working in medicine has on both his personal and professional life.

In the open letter to The Secretary of State for Health, he said;

“Roger Fisher was a professor of law at Harvard University, who suggested back in 1981 that they should implant the American nuclear codes in the heart of a volunteer. If the President wanted to press the big red button and kill hundreds of thousands of innocent people, then first he’d have to take a butcher’s knife and dig it out of the volunteer’s chest himself; so that he realizes what death actually means first-hand, and understands the implications of his actions. Because the President would never press the button if he had to do that.

“Similarly, you and your successor and their successors for ever more should have to work some shifts alongside junior doctors. Not the thing you already do, where a chief executive shows you round a brand-new ward that’s gleaming like a space station. No: palliate a cancer patient; watch a trauma victim have their leg amputated; deliver a dead baby. Because I defy any human being, even you, to know what the job really entails and question a single doctor’s motivation. If you knew, you would be applauding them, you’d be proud of them, you’d be humbled by them, and you’d be eternally grateful for everything they do.

“The way you treat junior doctors demonstrably doesn’t work. I strongly suggest you seek a second opinion.

If you’re interested in reading more, you can buy a copy of his book on Amazon or book tickets for his ongoing tour.

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The Junior Doctors Survival Guide written by Nurses

Matt B

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The Junior Doctors Survival Guide written by Nurses

Well done. Congratulations. You’ve survived medical school and made it ‘on to the shop floor’, this is where the real test begins.

Your first few weeks as a Junior Doctor are going to be difficult and jam-packed; a new hospital, new colleagues, new patients, and a new hospital system to figure out.

Here are ten tips that will stand you in good stead for your first day, week, month, year and beyond. This is your Junior Doctors Survival Guide as written by Nurses;

  • Respect the nurses. You can come to us for advice and guidance – we will have you back – but please don’t take us for granted. We have an abundance of knowledge about our patients, the hospital and how to make stuff happen.
  • Each member of the team is important. Doctors, nurses, porters, physiotherapists, domestics, estates, plumbers – the hospital simply couldn’t function without them.
  • Don’t be a smart arse. We know and understand you have worked hard through medical school and congratulations on becoming a Doctor, but now it’s time to get to work.
  • Have a sense of humor. Make sure your able to have a laugh and a joke but be careful not to cross the line.
  • Master cannulation. I don’t just mean know how to put a cannula in – develop the skill and master it – it will stand you in good stead for the future.
  • Eat and drink. The list of jobs is, and always will be, almost endless. Make sure you take your breaks; eat, drink and chat to your fellow colleagues.
  • Show emotion. I’m not going to lie to you, it’s going to be hard – medical school hasn’t prepared you for the first few months of life as a Doctor. If you’re having an especially tough day talk to someone about it. Don’t beat yourself up for having a little cry – it happens to the best of us.
  • Don’t just look at the numbers. We spend 12 hours a day with our patient, we will come to you when “something just isn’t right”, we don’t know what, we can’t put our finger on it. But, we know our patients.
  • Your first death is hard. Expected or not, nothing can prepare you for the death of your first patient. We have all been through this. See- show emotion and How to Deal with the Death of a patient
  • Tidy up after yourself. Nothing and I mean nothing, annoys the ward staff more than a Doctor who thinks the staff are there to clean up after them. Tidy away your sharps, notes and coffee cup.
  • Ask for help. Your seniors are there to support you – it’s literally their job. Don’t be afraid to escalate patients or situations to them and never put yourself in a situation where you have no backup.
  • Admit when you simply don’t know. Making up an answer to a question can have serious consequences. If you don’t know. Say, but find out.
  • Try to go home on time. Look through your list – find out what can wait until tomorrow. Your downtime and social life are important too (check out our list of NHS Discounts for downtime ideas). You work to live not live to work.
  • The hospital at night is scary. There are fewer doctors, nurses and seniors around to support you. Call for help early and escalate appropriately.

Remember, you are part of our team. Our job is to work together in the interests of patient care. We will try to look after you, make you tea when you’re sad and, rest assured, we will tell you when you’re being an idiot.

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