Dissident

On a week of nights. Have been here since 9pm last night. About 2 hours left to go before I can walk home, eat and sleep. I'll try and stay awake and do something useful for an hour or two before I pass out.

Have been enjoying myself recently - the Reading festival rocked. Pearl Jam were a whole new experience for me and The Automatic were very very good. BodyCount kicked ass (helped along by the 'flapjack' consumed during Belle and Sebastian). At the end of this current week of nights I'm off on a holiday to Europe before returning to the wards. Am currently spending money at almost exactly the rate I am earning it which is ideal (I am still too young and carefree to have a mortgage to worry about).

Better go. What's that coming over the hill....is it a consultant?

How to pass PACES

This is my advice on how to pass PACES. It worked for me and suited my revision style.

Books

You must buy/borrow/steal the following three books (~£100 in total):

• Aid to the MRCP PACES: Volumes 1 AND 2 by R.E.J. Ryder
• Cases for PACES by Stephen Hoole

Courses:

If you have lots of money and are desperate to pass, do this course:

Pastest 4 day course (£1500!)

If you need help with Neuro or Fundoscopy, do this course as well:

Neuro/Ophth one-day course (£325)

(when I did it it was over 2 days, not sure why they have tried to squeeze it into one day)

If you have limited funds, do this course instead of the two above:

Ealing weekend course (£750)

As you will see on the 'net, there are lots of courses out there aiming to teach and take away your cash. Most are good from what I've heard. It feels like all they have to do is advertise a course and people are willing to bend over for them whilst they empty your bank account. Saying that, I did all three of the above courses and passed.

If you were trained in the UK and speak reasonable English you shouldn't need a separate Ethics/History taking course. But if you have money to burn do one as they are the 2 stations which are failed more than any other!

The MRCP PACES exam itself will cost about £900 if you include diploma fees/travel/hotels.

All of the above must be supplemented by seeing patients on the wards, honing your examination technique on friends/stuffed animals and learning those 3 textbooks. Passing PACES is then down to luck on the day.

If you have any questions / need advice for MRCP PACES I will answer them if I can via the comments section.

Vegas MRCP

Passed! WICKED!

It makes all the sacrifices worthwhile:

Weekends spent revising rather than seeing friends/family/my girl-friend
Missing the wedding of one of my best mates
Having to cut my hair and look respectable
Not having a break since March
Missing Metallica on a rare trip to the UK
Missing the Goo Goo Dolls in London (although more news to follow on that hopefully)
Missing the Foo Fighters
Missing out on a trip to Switzerland to present a research poster I helped out with
Spending the best part of 4 grand on revision
Not joining a gym because I genuinely thought that I would be losing valuable revision time by making myself healthier
Making my junior house officers work slightly harder than I would ideally have liked to so I could get enough practice examining patients
Missing the Rolf Harris exhibition which finishes this week in London

Thank you to everyone who helped and everyone that wished me good luck. It all made a difference, as the exam is probably 50% knowledge and 50% confidence. I owe you all.

Will it ever stop?

I'm referring to my out-of-work work-related commitments. The late nights cramming for the exam have seamlessly blended into late nights preparing for case presentations. I have 3 different presentations to do in the space of 8 days. And I am on call for 25 hours over the weekend so need to get things done in the next few evenings.

I hope that after all of this I will be able to relax. It all depends on the result of the aforementioned exam. Will find out next week one way or the other. Just typing this is making me nervous. I REALLY want to pass.

On a lighter note, saw the Chili Peppers in London over the weekend with one of the guitarists from a band I used to play in (before we both graduated and got spread out all over the world). The support were awful but the Chilis rocked. They have so many songs to choose from now but everything they played kicked ass. Nice to see Flea and Frusciante working the crowd with their magic too.

Next piece of fun for me is a weekend in Jersey in a couple of weeks, then a weekend in Europe. August finishes off with the Reading festival. Work hard, play hard, retire early I guess. Problem is I'm rapidly tiring of working hard. Batteries need recharging ASAP.

Another day another dollar

14 hour shift today. Taking things at my own pace, sorting patients out properly but not trying to see more than I'm comfortable with. Spent some quality time with some relatives of two of the really ill patients on the unit, explaining that their relative was very ill and likely to get worse. I think they appreciated what I had to say and the way in which I said it. That in turn led me to appreciate my role as a doctor a little bit more. It can be a rewarding job as well as a challenging one.

I have somehow ended up with three presentations to do in the next three weeks. So much for a relaxing break after the exam! Am also working for 2 of the next three weekends. Not all bad, as the weekend in the middle I get to see the Chili's in London. Already making holiday plans for August/September.
First, I would like to sort my career out. The clock is definitely ticking. Or perhaps it is a time-bomb I hear, which is about to explode and shatter the structure of the NHS. Fingers crossed...

Forget about it

England out, again.
Quarter-final, again.
Penalty shoot-out, again.
Knocked out by Scolari, again.
The English FA appoint a crap manager, again.

It is Sunday and I am on-call. Again.

So what now?

Exam finished. Survived. It was tough, but could have been worse. I'd give myself a 50-50 chance of passing. Will find out in 5 weeks.

Back at my place, watching the footy with a bottle of Lucozade and a microwave meal. Don't have the energy to get caned tonight. There is a beer festival for me to look forward to this weekend which will fill that hole nicely.

I seem to have a lot of nervous energy inside at the moment. If it wasn't dark and I lived somewhere where the kids don't carry guns to school I would consider going out for a run. Instead I'll probably have a shower and read my latest book about gambling. It's a good way of keeping the potential addiction at bay (I hope).

Have had a couple of conversations tonight which got me thinking about the career issue again. I can defer this until I get the exam result. Then it may (hopefully) be time to make some decisions. I've got some cool stuff lined up in the next few weeks and my future career plans can wait a little bit longer to be dealt with. I'm back at work tomorrow with a 13 hour shift and if that doesn't break me I might actually enjoy myself now that the shackles of revision have been removed from around my neck.

Stumbling across the finish line

I am struggling to revise. I have always had a short attention span (30-40 minutes maximum) but now I can barely sit still with a book for more than 20 minutes before I have to get up and make myself a drink or something. My brain feels full.
No more blogging until Monday night. I will let you know how it goes. To add to the fun, The Royal College of Jesters won't give me the result for about 5 weeks, even though they will know on Monday afternoon what the outcome is.

One week

Thanks for the good-luck messages. I intend to work solidly all week to prepare for the exam. I have 2 major motivations:
1) I do not want to sit this bloody exam again.
2) I can't wait for Tuesday when I can sit back with a cold beer and watch.... oh no, I forgot - I am back at work the day after my exam doing a 13 hour shift. Never mind. There's always the 2010 World Cup to look forward to.

Whether I pass the exam or not is now down to luck. All I can do is my best and nothing more. Whatever happens, it's been an experience that hasn't killed me so by definition I am now stronger.

Positive mental attitude

I have my exam date. 2 weeks from now. Not ideal, as it could have been 5 weeks from now. And they are sending me to the middle of nowhere as predicted (£50 for a train, £60 for a hotel, etc).
Still, it will be nice to get the exam out of the way early before everyone else. I will be able to enjoy most of the World Cup and be able to watch Henman get his ass kicked at Wimbledon for the last time before he retires. Besides, if I had more time to revise I suspect I would probably end up shaving my head and going a bit mental.

Will be out of the blogging loop for the next week but look forward to resuming next Sunday when I will know everything and will feel really confident about the exam.

The Royal College of Jesters

Revision gets harder as you get older. My exam is this month. Of course, they haven't given us the date or the venue yet. It could be in just under 2 weeks or it could be in 5 weeks. That makes a hell of a lot of difference when you are trying to plan a revision schedule. They might tell us this week, or maybe next week. As for the venue - they could send me anywhere from Wales to Cornwall and I won't know until they decide to end the suspense and inform me. That will make booking the trains/hotel/etc just a little bit more stressful, which I'm sure will add to their fun. You would think that if you spent 700 quid on an exam (plus over 2000 quid on revision courses for it) they might be kind enough to organise the damn thing properly.

Bastards.

Zzzzzz...I wish

I should be fast asleep but for one reason or another I have not been able to sleep tonight. I could be revising but that seems like a brick wall at the moment. I will be at work in 4 hours. Don't really have anything interesting to say right now. Oh yeh, my patient from last week died. It's always the nice guys.

Helpless

One of my patients is bleeding from his gut, probably from a tumour which will kill him in the next 7 days. Yesterday I tried to get an investigation done (an endoscopy) which may have enabled us to find out where and what the problem is and perhaps do something there and then (for example laser treatment) to stop the bleeding.

I asked the Consultant Gastroenterologist to consider doing this test as a matter of urgency as it may save his life.

The reply was "If he is going to die of cancer anyway in a week we don't really want to do the test; if there are complications it will put our mortality figures up and it isn't worth the risk. First I would like you to do some more tests to find out if he does have cancer so we can think again."

So he is sitting on the ward now, continuing to bleed from his gut. I have continued to give him blood transfusions to try and keep up, but by the morning (if he is alive) he will have had nearly 10 pints into him over the last couple of days.

And by the way, the other test that they asked me to get done was an ultrasound scan. My senior spoke to the consultant in charge of that test, and he was told that although he had free slots yesterday afternoon to do the scan, because it was not urgent it could wait until tomorrow afternoon.

My patient is dying in front of my eyes. I do not have the skills to do these tests myself and the people that do are dragging their feet. I am not happy with this situation. If this man dies it will be because the NHS has failed him. He will probably die anyway, but an extra day/week/month with his loved ones would be worth its weight in gold. I will be upset when he dies and I will continue to be despondant about the organisation I work in.

Doctors are stupid

I have just finished a week of nights. I am OK, now trying to reverse my sleep cycle and not waste the whole weekend in bed. I am also less concerned about my Texidor's Twinge thanks to the comments received!

One night this week I was taking a break in the doctors' mess when I saw a tired, demoralised mid-30's surgeon come in. He collapsed on the sofa with the 2 pieces of toast he had just fashioned into a sandwich, and scoffed them down really quickly. At that point, his pager bleeped, he answered it and left to return to the wards/theatre/A+E/whatever.

A thought struck me - that was probably his dinner, and possibly his only break of the entire 13 hour shift. Most doctors are the same. They run around doing jobs for patients/nurses/other doctors, and neglect themselves. They don't empty their bladders until the end of the day, they don't eat anything more substantial than the chocolates at the nurses' desk, and they definitely do not take a 40 minute break every 4 hours as they are meant to.

Why? Because doctors are machines? No. Because they have huge humps on their backs where they can store water like camels? No. Because they are so fat they only need one meal a day? No. Because they genuinely want to eat chocolates and crisps and give themselves heart disease as well as shortening their lifespan by messing around with their sleep cycles? I doubt it.

It is because doctors are brainwashed into thinking that they are martyrs. Patients should always come first. Nurses and senior doctors are more important than us. If you have to miss your dinner and your breaks to get more work done, so be it. The NHS does not give a shit about you, Dr. Junior. If you want a reference, you will see as many patients as you can. Of course, if you are so tired and hungry that you make a mistake and someone complains, we will suspend you and ruin your career. It is not our fault. We will replace you with an overseas doctor and screw their career over as well.

Doctors seem to feel that if they don't eat and don't have breaks then that makes them 'better' and more dedicated. Medicine is held up to be a vocation, so you have to devote your life to it and if your spouse/parents/friends suffer as a result so be it. Medicine is your life and you will give yourself completely to it.

No. I will take breaks and I will eat good food. If my pager goes off and I am on a break, I will tell the nurse I am busy and will be up in due course. I will let the patients stack up in the department waiting for hours to be seen if it means I get a decent rest and time to myself. It is not my fault that people have to wait up to 24 hours to be seen properly in hospital (after the initial meet and greet by the A+E doctors). It is a lack of funding for more doctors and more nurses. So I will not sacrifice my mental and physical health to see as many patients as I can. I will see them at my own pace and make sure each one gets my full attention and gets sorted out properly. If an emergency comes up along the way I will drop my dinner and run to it, but those occurences are actually few and far between. I will always put my own health at the top of my priorities.

Medicine is not a vocation. It is a job. A job that can be done well or done badly. A job that should involve regular meals and breaks. A job that does bring pride and satisfaction when a patient says "thank you", and allows you to make amazing differences to patients and their loved ones. But it is just a job.

Texidor's twinge

I have discovered something during my revision which may actually be of use in a wider sense.

The "precordial catch syndrome" is a common yet under-recognized cause of benign chest pain in adolescents. The syndrome has a remarkably consistent, characteristic presentation and is therefore easily diagnosed. Nonetheless, it frequently leads to elaborate testing and/or referral to a paediatric cardiologist and can be a source of considerable anxiety.

The syndrome was first termed "precordial catch" by Miller and Texidor in 1955. They characterized the condition as presenting with sudden onset, with sharp, stabbing, well-localized precordial pain, and reported its occurrence in 10 patients, 1 of whom was Miller himself. Later authors coined the phrase "Texidor’s twinge".

I think I may have this. If so, I'm sure that at least one of you has too. Otherwise I'm just going mad.

Characteristics of precordial catch syndrome:

- Sudden onset

- Occurs most frequently at rest

- Very well localized

- Sharp, stabbing, needlelike pain

- Exacerbated by deep breathing

- Each episode lasts for 30 seconds to 3 minutes

- Sudden, complete resolution

- No associated symptoms

- No abnormal physical findings

Let me know if I'm not alone....

* Please note that this posting does not constitute medical advice.  If you are feeling unwell when you read this it would be unwise to seek such advice in a blog.  Call an ambulance and get sorted out properly. *   

The B Team

Hi. Sorry for the gap - have started cramming for the next (and final, if I pass) post-grad exam in June. There is a hell of a lot of work to get through and I will need luck on my side too.

The incompetent fool I was working with on my last ward is still there, and no doubt still useless and dangerous. Sod it. Not my problem now. I have moved to another department.
Ironically I did not complain about the aforementioned person, but when one of the senior doctors later decided to ask her to do some work, she (the useless one) complained to the consultant, which resulted in the senior doctor being reprimanded for being too harsh! And the icing on the cake was that the senior doctor mentioned my name in their defence stating that I had also had issues with the fool. The rumour was that the consultant wanted to see me but I rotated to my next job before any of that bollocks could be organised in time. It's a shame that senior doctor didn't help me out when I raised the issue in the first place. They only mentioned my name to deflect attention from themselves.

The next few weeks will be rushing by as I frantically try to learn as much medicine as I can. If I fail the exam I can resit it a further two times before turning my attentions to something completely different. If I pass, I'll stay in hospital medicine but will be looking at career options which don't involve selling my soul to Hewitt and her minions.

Situations

One of the doctors I have to work with is incompetent. She is lazy, work-shy and not fit to look after patients on her own without close supervision.

I have been gently warned by my seniors, in no uncertain terms, that if I bring this up with the consultant, not only will nothing change but I will also then be regarded as a trouble-maker and someone who is "not a team player". I have tried speaking politely to the doctor in question but have made no progress. I will be switching to another ward in a couple of weeks, and do not have to work with this doctor again after today, but nevertheless I am concerned (and so are the nurses) that her laziness is affecting patient care. She only sees the patients who are well and leaves the ill or complicated ones to other people. This results in her colleagues (i.e. me) getting stressed and annoyed, and more importantly means that the ill patients suffer. Unfortunately I was only born with two arms, two legs and one brain so I cannot do everything on my own all of the time.

In an ideal word, a senior would take her aside, have a strong word, and then re-assess her performance after a week. If there was no improvement, she would be relieved of her duties and one of the many unemployed junior doctors in this country would fill her place and do a very good job. The reality - my immediate senior is not doing anything, if I bypass him and go to the consultant it will negatively affect my career, the doctor in question will continue to be crap, the patients will continue to suffer, and the unemployed doctor will remain unemployed. I am not choosing the correct course of action ethically but the NHS is screwing me over enough and I am not prepared to give them another stick to beat me with. I am going to enjoy my week off next week, come back and do a few days and then switch to the next ward, leaving this incompetent idiot to swan around and get all her boxes ticked in order that she can progress up her career ladder.

One day she will be taken to court.

I have a good friend who spoke out loudly in a vaguely similar situation and the NHS spat him out like a bad olive - he is now unemployed and unable to find work because the previous employer will not issue a reference. He is arguably a more ethical person than I am, but I would not swap positions. Does that make me selfish? What about the patients who may suffer at the hands of my incompetent colleague? Is my inaction putting them at risk? Are they more important than me? In my opinion, my family, loved ones and friends come first, then me, THEN everyone else. Fuck this incompetent doctor and fuck the system that allows her to continue to work. It is not my fault and I will not stick my head up above the crowd to have it chopped off. Any number of doctors or nurses could complain, but it seems to have come to the point where it is either me or no-one. I would value the opinions of the panel.

SHO Ward Round

Obs stable, afebrile. Poor sleep pattern due to excessive ETOH but otherwise no new complaints.

Patient comfortable, ready for bed. Things are looking up. In the last 4 weeks, he has managed 2 holidays in Europe and has acquired a 60Gb iPod. Not to mention doing a week of nights without harming himself in any significant way. Managed to see Jack Johnson live, and has yet another holiday lined up next month. He is well on track with his new aim to spend money as fast as necessary to ensure he is enjoying life outside of work. The whole business of saving money seems so futile right now.

On the downside, he will be back at work in a few hours and has a presentation to do in a couple of days time. He has another exam to do in a few months and a back-log of "admin" crap to sort out (tax returns, bank bills, etc).

On examination : Tired, needs a haircut. Otherwise unremarkable.

Impression: I think at the moment the ups outweigh the downs, and that is all you can really ask for. A slight overall improvement in the patient's condition compared to 2 months ago, but the prognosis remains uncertain. At this stage we have opted for improvement in quality of life rather than seeking potential curative therapies. Patient in agreement.

Plan: Continue

I can't cook garlic bread so how can I save lives?

I should be in bed. I have 2 more nights left to work. I am tired.

I got home at 10am this morning and put some garlic bread in the oven. I was so tired I thought I'd lie on my bed whilst I waited 15 minutes for my breakfast/dinner to cook.

The next thing I was aware of was waking up at 1.30pm in a room full of smoke and the fire alarm screaming in my ears. And now I can't sleep because it has been a really nice sunny Spring day. So I will be very tired when I start my 13.5 hour shift in 4 hours time.

Maybe if Patricia Hewitt knew what actually went on in her hospitals she would give a toss. I challenge either her or one of the multitude of drones she employs to come and shadow me for one night at work.

Still, at least I have taken the next week off as annual leave (would be nice if I was provided with some time off after 7 nights in a row, but never mind. I am delighted to use up my limited annual leave to recover). I am going to leave the country for a few days and party like a MF with the Lost Doctor.

Oh yeh, hope you all had a nice Valentine's Day. I was working nights and the love of my life was on call in a different hospital from 9am to 9.30pm.
Happy Valentine's Day Mrs Hewitt.

Hospital@Night

I am working a week of nights. The first 2 have been fine from my mental health point of view, but there have been a number of worrying occurences. The NHS 'Hospital@Night' Plan needs some serious work...

At the end of the night, the Consultant in charge comes in at 8am and does a ward round seeing all of the patients admitted (about 50). Today we were going round as usual, and one of the patients we saw had been sitting there for 15 hours. His blood tests and ECG confirmed that he had suffered a heart attack. This could have been picked up 10 hours earlier and he could have had some treatment. As it was, his heart continued to infarct (die) whilst he slept peacefully and the nurses checked his blood pressure and the doctors ignored him because no-one had thought to mention him to them.

Another patient had been sitting there all night with chest pain, having been admitted the previous day. The consultant had requested some tests and a further review. Again no-one told us (the night doctors) so by the time I saw him (when it was his 'turn') it was obvious he needed to be moved straight to the coronary care unit for urgent treatment.

The icing on the cake was when we arrived at the bed of an elderly lady. She hadn't been seen by any doctors since her arrival in hospital several hours previously, because it wasn't her 'turn' yet. We were sifting through the referral letter from her GP, and checking her observations on the chart. It was then that we realised she was dead. And she had been dead for up to 2 hours. Here eyes were open but her heart had stopped beating some time ago. Her observations (temperature, blood pressure, heart rate, etc) had been recorded at 6am. It was now 8.30am, and the Consultant astutely observed that her last recorded observations were at 8.15am so she must have died within the last few minutes. We made an immediate decision not to attempt to resuscitate the lady as it would have been futile. And then I looked at the observation chart again and realised that the observations at 8.15am consisted only of a temperature and nothing else. So someone had come to the lady to check her observations routinely, recorded the temperature and then was unable to record a pulse or a blood pressure. This was because she was dead. And was anyone told? No. She was left there, sitting with her eyes open looking 'comfortable at rest' whilst the breakfast trolley trundled around dishing out tea and toast.

Throughout the whole night, we had been under pressure as usual due to a lack of staff and a lack of beds. As soon as patients came up from A+E (ED), we were trying to ship them out to any available beds in the hospital. It got to the stage where the nurse manager in charge asked me to only see female patients for the whole shift as we only had 4 female beds and no male beds available. I almost told him to f*ck off. Furthermore, patients are put on a waiting list to be seen based solely on their time of arrival. It has nothing to do with why they are in hospital or whether they are about to die or not. So we are forced to see Uncle Jim with his sore big toe whilst Granny Edna's heart dies piece by piece in the next bed, just because we don't know about it. No-one tells us who is ill and who needs to be seen first. It is pot luck. It is all about the hospital meeting government targets on waiting times so they can get more money to pay the managers. And this Hospital@Night plan is one such target.

My advice is this - if either you or someone you care about is admitted to an NHS hospital as an emergency, worry. It is a crap system and it is getting worse. And despite a team of nurses and doctors working as hard as they can to help people, lives are being lost. What a shame the NHS is so stretched. It could be wonderful. It is going to get much, much worse. The Hospital@Night is a bad place to be.

The weekend is over....

I've been partying hard all weekend.
The time : 9am to 9.30pm Saturday and Sunday
The place : the hospital
The cost : 2 days of my life
The outcome : I am tired

Good night

You can buy happiness

A great philosopher once said that the only way to keep sane whilst working in the NHS is to have regular extravagant holidays. I am therefore going to book 3 this week, spread over February and March.

My happiness is apparently inversely proportional to my bank balance. It used to feel good saving money and putting it away so I could buy a house in the future. But why? I can easily take out a loan when the time arises so in the meantime I am going to spend spend spend. My new iPod is finally on the way as well. If anyone has suggestions for things for me to waste money on, let me know. It's party time.....

Let the music play

Hurrah! I have access to my music again. For the last few months I have struggled in vain to download the latest upgrade version of iTunes via the internet. Not only do the updates not install on my laptop, but they crash so I haven't been able to listen to the 6000 songs I have "acquired" over the last 2 years. And since my iPod battery died, I have been reluctant to give any more of my money to Apple just now.

Today my brother, who works in a normal job, was given his Christmas bonus - a shiny 60Gb iPod. Aside from the usual thoughts ("sigh, I wish I was in a job where the Christmas bonus was not working a week of nights"), I ripped the installation CD out of his hands and installed iTunes straight away. Wicked. Now I can listen to all my tunes in peace, starting with "Never, never gonna give you up" by Barry White. He remains the daddy.

Apple - I apologise for infringing your copyright agreements yet again, but if you would produce software that worked and hardware that was designed to last for more than 18 months then I wouldn't have to.

Time for me to be slept out

Apologies for the gap in posts - have spent more time reading other bloggers' words of wisdom recently.

Cracking on with the new job in cardiology. Going well so far - the consultant is very good and VERY demanding but so far we are keeping the ship afloat. I have moved up the food chain and now have a junior (house officer) working under me which is great - nice to be able to offload some of the bullshit paperwork/phone calls and get on with clinical work and making people feel better (like the good old days, apparently).

Yesterday I nearly got in to an argument with the "Bed Manager" - i.e. the person who is responsible for moving patients around the hospital so that we end up with cardiology patients on surgical wards and people with brain tumours on cardiology wards and so on. What a shitty stressful job that must be. The person in question in my hospital is notorious for making nurses cry by threatening them with disciplinary action if they don't expedite the "sleeping out" of patients from one ward (i.e. the ward that they are admitted to because it is the best place for them to be treated) to another less suitable ward, simply to make room for more people to come in. An example; a patient comes in with alcoholic liver disease, and is admitted under the care of the liver specialists. Sounds good - it is. They are treated on the liver ward, nursed by nurses trained in dealing with liver problems, and treated by doctors who know a lot about liver problems. But as soon as the patient is at the point where they are more likely to survive than not, the "Bed Manager" (not the doctors) decides that the patient is safe to "sleep out" to any other ward in the hospital i.e. orthopaedic/geriatrics/surgical wherever there is a spare bed. So when that patient becomes ill (as patients tend to do), the nurses who are experts at dealing with fractures/strokes/colostomies have a hard time managing the specialist liver disease and the patient does not receive optimal treatment. The icing on the cake in my hospital is that the patient is now being looked after by a completely new set of doctors who have a lack of specialist knowledge of the disease in question. Suboptimal all round. Of course the patient is not told any of this, and they naturally assume that they are receiving the best treatment possible in the NHS.

On a more positive note, I passed the exam last month - not as jubilant as I would be as two close friends didn't quite make it this time. They'll pass next time, but it would have been nice to party together. It's difficult balancing a demanding job with demanding revision.
Next exam is already looming, but I think I will be taking a break from all that crap for a while and just enjoying some novels and films. Got tickets for Jack Johnson next month which I'm really looking forward to. Reading a very good book called "The Pig that wants to be eaten". Check it out if you get a chance.

Happy New Year! I'll be the one at work...

Friday night, just back from work. Managed a banana for lunch today. I could have taken a 'proper' lunch break (i.e. a luxurious 20 minute spell eating a sandwich in the doctors' mess hoping my pager didn't go off), but I opted to work through as that was the only way I would finish on the reasonable side of 6pm.

Have got back into a normal sleep pattern after a joyous week of nights, and managed to spend 3 nights at home over Xmas before coming back to work on the (Public Holiday) Tuesday for a truly wonderful 12 hour shift.

I recently switched to Cardiology, which means I am helping to look after patients' hearts now rather than their brains. Other than being very busy all day, the new job is going quite smoothly. I would consider it as a future career if it wasn't for the fact I would have to do a PhD in the subject (literally) and continue working weeks of nights into my late 30s. Not a chance.

Looking forward to 2006 immensely. My New Year's resolution is to go to the hospital at 9am on New Year's Day and work a 13 hour shift with a 20 minute lunch break in between. I hope I can stick to it, really I do.

I am tired

Night 6 of 7. For each of the last 6 days, my life has been:

11am - get home from work, eat a bowl of cereal, collapse exhausted on my bed and sleep.

4-5pm - wake up (my body has realised it is not normal to sleep during the day), put the radio on, try to go back to sleep

7.30pm - get out of bed feeling exhausted, have cereal/eggs/sausages (I can't spend time cooking as I need to grab as many minutes in bed as possible). Quick shower, walk to work and start at 9pm.

9pm - get to work already feeling exhausted, start seeing patients immediately

8am - officially the end of my shift, but that is when the Consultant comes in to see all of the patients we have been looking after (between 30 and 50 of them). The ward round finishes between 10am and 11am. I am not paid for these extra hours and I am not allowed to tell anyone that I work them because then the hospital would be breaking the law. If I complain, my consultant will give me a bad reference and obliterate my career.

11am - get home, start the whole bloody cycle again.

I do not have scheduled breaks whilst I am at work. I may be able to get 15 minutes to have a drink of water and even a piece of toast, but that is it. You are made to feel like a slacker if you are not working yourself into the ground for the duration of your shift.

It is 4.20am and I have eaten 2 slices of toast. Better get back to my wonderful job.

Anti-climax

Exams finished! Went OK, all things considered. I had set aside 2 days at the start of the week for last-minute revision, but ended up spending them in bed with a really bad cold. Haven't really slept all week, but managed to stay alert for the actual exams.

I should be feeling really good now that I'm back in my room having spent 3 nights in London, with no more revision to do until results come out in 5 weeks. But I have this horrible sinking feeling of despair, largely due to the fact that I am starting a week of nights. It's 6.30pm and in 2 hours I will be leaving for work, to return at about 11am in the morning to go to sleep. The shift will be busy, with a half hour break at some point if I am lucky. Otherwise it will be flat out at all times. This will be repeated for 7 nights in a row, and then I will have the weekend off before I go back to "regular" hours on the Monday at 8am. It is depressing no matter how you try and dress it up. I guess there are worse things to be doing, but I am going to be counting the minutes until this time next week when I can finally relax and try to feel good about life again.

The next 2 hours are going to fly by, and the following 14 hours will probably be agonisingly slow. I will be tired for the duration of my shift, and will have to double-check everything I do to ensure that no mistakes are made.

I have just ordered a pizza and am going to put some music on to cheer myself up a little before I donate yet another week of my life to this career.

"The final stretch"

The weather this weekend has been nice. Sunny, fresh, and no rain. Lots of people out and about, sightseeing, Xmas shopping, having fun. What a shame I've been stuck inside revising for the exams.

Still, there's always next weekend to enjoy. Oh I forgot, I'll be doing a week of nights.

The GP careers talk I went to last week added to the confusion. I now have approximately no idea as to what I will be doing this time next year. I could be in South America, soaking it up in a hot-tub with Uncle Rico, or I could be on a week of nights.

I have decided to spend more money in the next few months. There is no point of working and earning money if it is not spent at least as quickly as it is earned. At least that way it feels like you are working for a reason, rather than simply saving it in a bank so you can give it all away later when you take out a mortgage. I don't think a few thousand quid here or there will matter when I'm three hundred thousand pounds in debt living in my one-bedroom flat in zone 13 and commuting to work. I will begin by buying another iPod.

This might be the path to job satisfaction....

Homophobic sexist racist scum

It turns out that Michael Barton and Joey Taylor, the men who murdered black student Anthony Walker, are members of the BNP. What a surprise. Anthony, 18, was killed with an ice axe in Liverpool earlier this year. Because of the colour of his skin. [article]

Following the freezing of the accounts of the BNP by British high street banks HSBC and Barclays, because of its racist views and its clear links with nazi groups the National Front and Combat 18, the BNP have resorted to using the internet-based banking service Paypal. Anxious to raise money for what it sees as a last-ditch fight in the May 2006 local council elections, they are using Paypal for donations and as a way to easily shift money from place to place to pay for the thousands of racist/homophobic/sexist leaflets and posters necessary for any campaign at local level.

Please e-mail ppelce@paypal.com and ask them to stop Paypal's support of a clearly fascist organization. Paypal is now owned by eBay, a company that has responded to complaints in the past.

Rapid Review of life in the NHS

Monday. No lunch, finished late, lack of senior support.

Got home - too tired to open my eyes let alone revise. Must stay awake in an effort to pass the exam next week.

Spoke to a close friend (a doctor) - he had a bad day at work, finished late, spent his day doing menial tasks.

I have another doctor friend who has taken this week off as annual leave as that is the only way he could get enough time to revise for the exam. He may well pass, but at the expense of a holiday this year.

Spoke to another doctor - she finished work 2 hours late tonight (at 11pm instead of 9pm) and is now on her way to a friend's house to drink a bottle of wine.

So I decided not to speak to any more doctors tonight. I tried calling a couple of non-medical friends in an effort to cheer myself up. One answered from the pub and the other one is in bed.

Tomorrow evening I am going to a meeting outlining the career pathway into General Practice. They couldn't have come at a better time. Hospital life is not for me. Something would have to change drastically - the job is not going to get better so the alternative is for me to get even more cynical and learn to accept this lifestyle. No way.

A good day at the office

I had a really good day today. Got in a bit late, no-one noticed, and it was really quiet so I managed to get some revision done. Sent my only patient home, so for a while I had no patients to look after! We had 2 free lunches, some teaching, and my on-call shift was really easy. Then one of the registrars (senior doctor) picked me up from the hospital in her car, and we all went out for a nice meal with a few drinks. The registrars paid for us (the junior doctors), to say thank you for our work over the last 4 months. Not a big deal you might think, but it was completely out of the blue and has left me with a warm feeling inside (half a bottle of red may have something to do with it too).

I'm itching to get this exam out of the way now so I can throw myself back into medicine again and see what happens. Things may well go downhill again in the future, but I now realise how important it is to appreciate the good days and not take them for granted.

I'm looking forward to going into work tomorrow. This is the first time I have felt like this for nearly 4 months. My glass is definitely half-full right now.

Back on track?

Back from Wales. Didn't get to do any sightseeing (apart from a pub, that probably doesn't count), but spent some time with an old friend and got some solid revision done. The guy leading the course (Dr S Sharma) knows pretty much all there is to know about medicine, and it was inspiring in some ways to listen to him teach. It has provided a little burst of enthusisam that should (I hope) carry me through to the exam. I'm already dreading the next week of nights but looking beyond that to a nice peaceful Xmas. As long as the weather improves. It's too cold to do anything. Apparently Friday is going to be even worse...

Back at work in a few hours, on call until 9pm. But I don't mind, as it's my last one until December 9th!

Inertia

Revision is slow. I am getting some done, but it's a struggle. My legs literally start shaking after about 15 minutes and I have to get up and do something else. The way I get my focus back is by thinking about how much I want to get these exams over with, so I can move on from being a "junior" doctor. I am considering doing a Keano and leaving by mutual consent, but not until I have a better alternative lined up. He has the choice of joining Celtic or becoming Ireland's manager. I have the choice of going into Neurology or General Practice, or walking out on the squad because I can't stand the training facilities.

A plan

Busy day today, no time for 'lunch' unfortunately. Was also told I need to present an interesting case in 3 days at the weekly meeting. I know nothing about the disease in question so it looks like revision will have to be put on hold (or rather kept on hold) until the weekend. Not ideal as there are only 3 weeks to go. Hence my plan:

1) Do the presentation (settle for a mediocre result as I'm too busy to perfect it)
2) Crack on with revision
3) Finish the exam, have a big night, then start my next week of nights the following day
4) Plan a holiday. I need something to look forward to, even if it only a 2 week break

Whilst all this is going on, I do not want to be dwelling on the state of the NHS or the future of my career. What I end up doing in 6-9 months is in some ways irrelevant - I want to pass these exams whether I leave the NHS or not, so that is what I will devote my energies towards. My life could be much, much worse than it is right now. At least I am the one handing out the treatment.

Despair

I have reached the brick wall.

I would like to have a job that I enjoy and that pays me well enough to enjoy my life as I want to.

My current job pays me well enough but I do not particularly enjoy it. My pay will rise gradually over the next 10 years but I envisage that I will remain unhappy and continue to feel the same sinking feeling every day as I approach 9am.

So I need to find a job I enjoy more, possibly sacrificing some of my salary to do so. Within medicine, the jobs with the most regular hours (GP, Dermatology, etc) are ones I am not particularly interested in. The jobs with the best pay (surgery) do interest me but I am not prepared to sacrifice my life to become good at them.

So do I leave medicine? I will lose the good salary and the job security. I will hopefully also lose the stress and misery that working in the NHS can bring. Or will I? Will I end up doing an office job somewhere which is just as stressful and be earning less doing it?

There is no easy answer. My final plan may be to continue to get my exams, and once I have those under my belt quit medicine and see what happens. I think a short break will be in order. But what will that actually achieve? Will it just be a waste of time that makes it harder to progress in a career?

When I say I have reached the brick wall, what I mean is that I have reached the point when I honestly feel that thinking about the issue more will not help in any way. The fundamental problem is that I want to be successful and happy in my career and my life outside work, and medicine is not providing that. I may have to accept that I will not be fortunate enough to achieve job satisfaction, and spend my time trying to make the rest of my life as good as it can be.

On the other hand, if you think about the fact you only have one life to live then why would you want to waste over half of it doing something you don't enjoy? Sometimes I feel like jacking all of this in, just in case I get hit by a bus in 10 years - at least I could say I had fun while I was alive. What if you spend your twenties and thirties working towards something and then it all ends? Would you look back and say "well, at least I tried" or would you think "shit, I wish I had spent the last ten years with friends/travelling/partying/gambling(substitute your own vice)".

Now I'm not suggesting it is sensible to live every day as if you are going to be dead next month (that would lead to chaos), but doing a job like mine you see plenty of "fit and well" young men and women coming in and dying within days/weeks/months. It makes you think about your own life and whether or not you are making the most of it.

I am now going to listen to some Portishead, and try and do some more revision for my exam which may not actually be of any use to me in the future but it might be so I will try and pass it and if I pass it it means I can get out the NHS quicker.

I am going to get caned on Friday night.

The third way

On the train home tonight, I overheard a debate between a young Tory and a Lib Dem voter. They were talking about the pros and cons of the death penalty (you can guess which side each were on).

If someone is convicted beyond any doubt of murder/child porn/rape/treason/terrorism (with witnesses, DNA and a signed confession), then rather than a) pay for them to spend their life in jail with pool tables and Sky TV or b) give them the easy way out and execute them, I would like to propose an alternative. We take all such offenders, line them up side-by-side, and make them walk across minefields to clear them. The ones who don't get blown up can then be taken to another minefield to continue their work. Related work could include donation of kidneys to young children who need them, or using convicts as "monkey-sparing" agents in laboratory research.

So now that we have come up with the idea, who should receive this novel sentence? Murder and child porn is probably a straightforward example. But if you want to include terrorists then I guess Mr Mandela would never have made President. And as for treason, I'm sure most of the Chinese would be getting very nervous.

So I guess prison isn't such a bad answer after all. Even for Tories.

I start work in just over 6 hours so best get some Zzzz.....

A day in the life

Got to work at 8.40am. Worked through to 5.40pm without a break. Didn't have time for lunch. Ate 2 satsumas on the ward whilst walking around reading medical charts.

Got home at 6.15pm. Ate. Fell asleep fully clothed on my bed at about 7pm. Woke up at 11.30pm. I am going to stay up for a couple of hours now and do something with my life.

The countdown continues

Coming to the end of night 5 of 7. It's been pretty quiet. Attempted to sleep for an hour on some plastic sheets I laid out on the floor, but it didn't work. Next time I do nights (December), I'm going to aim to sleep all day and stay fresh during the nights, with/without the use of sleeping pills as needed.

When I was working in Australia a mate came up with a good way to try and stay positive during a week of nights - instead of just counting the nights as 1 to 7, count up from night 1 to 4 and then back down to 1. It seems trivial but it really does help to see the (day)light at the end of the tunnel.

And the week goes on....

Night 2 of 7. Shifts are 9pm to 8am. Been good so far - relatively quiet, have seen a couple of interesting patients and got to assist with some brain surgery. Not every nightshift worker gets to say that!

Still trying to find the trick to nights - I've tried: sleeping for a few hours as soon as I get home / trying to stay awake then sleeping before my shift starts / getting caned the day before I start nights / getting caned the day I finish nights / a mixture of all of these. There is no reliable method for easily slipping in and out of the system.

It's a proven fact that messing around with circadian rhythms shortens lifespan (article). So hopefully I only have a year or two of this left.....

If you were given a million pounds, you'd be very happy. If you were told it was the only money you were ever going to get, you'd probably be a bit more careful in spending it. I want to treat time like that. I only have a million units of it to spend. Being at work at this time on a Sunday morning is a waste of that time, no matter how easy the shift is or how interesting the patients are.

The debate goes on (in my head)

It is 4.30am on a Saturday morning. I am at work. Wicked.

Pro's of being a doctor:

• Fulfilling when you make someone feel better
• Great job security
• Good salary
• Excellent job to travel with
• Mentally stimulating (some of the time at least)

And some of the con's:

• Constant background stress level
• Crap hours
• Being stuck in an inefficient stretched-to-the-limit machine (a.k.a. "NHS")
• Gradually becoming more cynical by the week
• Trying to balance work and (diminishing) life

A good friend reminded me last week that the grass is always greener on the other side. The latest solution is to break life down into a series of short-term goals, and not get too bogged down thinking about the future. It is working to some extent.

But none of this makes up for working a week of nights. F*ck that.

Perspective

A villager from the Kashmiri region was being asked about the recent earthquakes. He said "We were all pretty down about what happened here but then we heard that a load of clay models got burnt over in England and it made us all realise that things could be a lot worse".

Still waiting to hear from Bono and Geldof regarding the earthquakes. Surely there must be some publicity in it somewhere for them?

Thanks to someone special

Last night rocked. What happened was amazing. Funny how things turn out sometimes.

"In the depths of winter, I have finally learned there was within me, an invincible summer..."

Albert Camus

Can't sleep won't sleep

Finished work. Walked home. Ate. It is now 10:17pm. I have a choice:

1. Do something interesting (pick up the guitar, go out, watch a DVD)

2. Stay up late revising for my exam

3. Go to sleep so I don't feel like crap when I wake up at 7.30am to do it all over again.

At times like this, I ask myself what the Colonel himself would have done.

Option 1) would be nice as I would feel like I still have a life.

Option 2) would probably be the more sensible option but then I would feel even more knackered tomorrow (and besides, I can't absorb much information in this state).

Option 3) would feel like I'm just giving up my twenties to a life of work, revision and sleep.

Is it worth giving up a decade of your life to make the next more enjoyable? Discuss.

Prayer to Benassi

Bored.

Tired.

Hungry.

I need some.....satisfaction