My holidays

Well I might not have been far (Crieff, Kinross, north shields) but we have seen a heat wave. The pictures below show the sights of my two weeks off.

Interviews

So, having completed my CT applications only 2 weeks Ago, today I find that my England/Wales/NI application has reached interview stage. All applicants are guaranteed one interview. So in January I have to head to Torquay!

This is not as easy as it seems. Interviews are on Monday's, and the easiest seems to be to fly to Bristol, then hire car to Torquay. But it all depends what time they give me.

30th birthday present!

It's here and I now have wonderful proper coffee!

Clinic week

This job has a very odd Rota. Lots of weeks with 7x13hr shifts or 5x12hrs and then to counterbalance it all, clinic weeks which are 3 clinics plus teaching session totalling 2x8hr days.

This is one such week, and thus gives some free time to catch up on MSc reading, write case reports and audit reports from last block, and even do some Christmas shopping, cleaning and catch up on sleep.

However this does mean that the end of December and into January is a busy month of 12hr shifts. Still that's a week away and we have Christmas first.

Impending birthday

Last night was a friend's 30th Birthday. This isn't the first, second, third or even fourth of my friends to reach this milestone but with my own 30th less than 7 weeks away, I felt this one more than the others.

Discussion flowed as the meal progressed and we came onto the issue of Bucket list and things to do before reaching 30.

I have thus started making my Bucket list but I'm not sure I have the right idea......

1. laundry
2. buy christmas presents for family & friends
3. finish my deep cleaning of the kitchen...

More interesting alternatives welcome, though I'm not sure I have any free Saturday's between now and then in which to achieve them!

Mobile blogging

This is my test to see how the mobile blogger app works!

Back to it, even if 'it' is a grindstone.

Today was back to work after my 2 eeks off, and after 6 weeks away from my base ward. Some patients remained the same, and the seniors haven;t changed. We now have a new FY1, who is a touch scatty especially regarding chasing blood results though.

Today was odd as I started the day in clinic, which is at a different site. This was then followed by our department meeting, so I didn't get to the ward til 2pm, then saw 5 patients on a ward round, made a couple of referrals, checked some bloods and got a new bleep battery. Thus a nice re-introduction to ward life.

Clinic was interesting. It was the general Geri's clinic, which focussed today on people not eating, weight loss investigations and the stubborn-ness of the old. People who find cooking boring, don;t want microwave or packaged meals, refuse family help but look at you and say - 'you need to stop me losing weight before i fade away' adding a cursory 'Doctor' at the end.

Thankfully the Consultant was taking this patient, and I just had to watch and start writing the pile of referrals - the poatient also has poor mobility (catabolism of muscle to provide energy?), a swollen leg with prominent veins and painful shoulder arthritis - thus referrals to dietician, physio, OT, orthopaedics, DVT clinic, Radiology (shoulder Xray) all needed writing.

Then tonight I got home via Tesco, and found that I need to get a grip on my online MSc work as I let it slip when on receiving and holiday. Thus 4hrs so far of paper analysis and reading about good papers and statistics. I will miss this week's online discussion group and paper critical analysis, so I ahev submitted my online review. i also need to start worjking on the statistics MCQ and this week's case of the week - also at internalmeded.org

I also need to make a start on more cleaning of my flat. I have made step one - buying cleaning materials!

Holidays are restful?

Well the past two weeks were leave, which has involved driving almost 2000 miles, traveling a further 500 as a passenger, visiting Newcastle, Edinburgh, Perth, Motherwell, East Kilbride, Belfast, Aviemore, Manchester and Kinross.

Manchester was the most geeky part of the whole trip, to see a recording, for radio 4, of Infinite Monkey cage, hosted as ever by Prof Brian Cox and Robin Ince. This live in Manchester episode goes out on 21st November in the afternoon. It was odd being involved in the media production system though - multiple applauses at the end for them to run under the edits as the show as recorded went on for over an hour, and needs to be 28 mins by time of broadcast.

The rest of the holiday was altogether more restful, but even so, I;d still liek another week off before going back into work.

Nights... my thoughts

So we are hear again - the 'staying up late the night before'; the 'lying in as long as you can'; the 'fill the day with stuff that relaxes your brain'; the 'eat healthy food with carbs for long release energy'; the 'go to tesco and hoard sugary stuff'; and finally the 'large strong coffee as I head to work' - nights!

I like nights - it;'s when you as a junior get to make most of your critical decisions. You have less hassle of ward rounds etc (until morning). It's you, the patient and your clinical skills. It's very much dealing with what happens, very little planning and very adrenaline fuelled seat of your pants stuff.

In the simple world, when I am first on I deal with GP calls and A&E referrals of new patients, I clerk them and present them to ward round. The range of investigations I can get overnight is more limited than during the day, as are the senior opinion options. This is the relatively easy side, the part that relies on working through each patient, deciding what is wrong and commencing treatment. It's just like days, but with a bit more stress of not knowing how many you will need to see, and there only being 1.5 doctors, no FY1's and such like.

Being second on means ward cover. This is more daunting. 11 wards doesn't sound many it;s about 400 patients, including HDU, CCU, Renal, Haematology and such like. These are the complicated patients on huge list of drugs and for whom 'getting them to morning' may be the best your management plan can achieve. The specialist nurses on these wards frequently know far more about these patients than I do, and even more about their conditions. Their guidance whilst reassuring can also put you off the scent though.

We also have to act as a referral centre for regional services in some specialties where doctors at other hospitals will call and ask to refer a patient to us. We then call the consultant on call for that specialty and relay the info that the other doctor gave us. The consultant then gives us a list of more info they want and a game of phone call tag goes on with us as the centre!

All in all, where's that coffee!

Careers

I am pondering the latest volumes of careers advice to hit my inbox from NHS Education Scotland. I can imagine some of you shouting "You've got a career, remember the 5 years at Medical School....." before wandering away muttering. As ever with the NHS, it's not as simple as all that!

The idea is that after Foundation Training, you pick a specialty or group of specialties to train in. Some have Common Core Training (eg Surgery, medicine); some is more specialised from the start (Radiology, Obs/Gyn, Paeds). Anaesthetics is unusual in having 2 ways in - Pure Anaesthetics, or Acute Core Anaesthetics - this second option involves a common core of 3 years alongside Emergency Medicine and Acute Medicine (so some A&E experience) before popping out into year 3 of Anaesthetics training (cunningly meaning that one has two 'year 3's' for added confusion.

One also needs to have a strong CV to support the application, in terms of audit, commitment to specialty, other learning etc. So more work, more exams and more stress. Just when you thought it was all over....

Update

So after various thing have happened at work, I now feel compelled to blog again. I think I blog when I have some free time, feel strongly about stuff and most likely when unsure of the future, some or all of which are coming into play together at the moment.

Basically, I have been pondering work and such like and lloking at some fine blog posts by other medical / para-medical professionals online and pondering about stuff. Also this week I have had 5 week nights in the flat in one week for the first time since some time back in March....maybe even February.

In that time I have changed hospital, twice, changed specialty, completed the FY1 e-portfolio of CPD learning, and decided to take the plunge and apply for an MSc in Internal medicine (online distance learning) so I may get a student card again, but hopefully no student loan.

It's fair to say that I have found surgery challenging. The consultants seem more remote a lot of the time, and senior support on the wards is often spartan - but often contactable by Pager.....the ward rounds happen whenever, but daily and are usually as brief as can be, even in HDU. So I think part of me misses the support of Medicine and the ease of contacting a senior. Also working for only one or at most 2 consultants made life easier and 2-3 days between ward rounds did allow some time for completing tasks rather than the 24hr time periods.

Sorry for the delay

And the blog returns, a mere 6 months after the last post. a safe interval has now elapsed for any tales of work i tell not to be easily related to specific patients or staff or indeed wards.

With almost 7 months of general medicine behind me, it is a little daunting to consider that when I come to make my career choices in a year's time, this will be all the acute medicine I will have done. as I spend 3 out the next 4 blocks in surgical or related specialties.

The job

Well the wee hiatus of the past 4 weeks has been largely so that any stories I post cannot be linked in a time-wise manner to any specific patients etc, and also because adapting to the job of an Fy1 takes some time.

Firstly, time:

You start at 9 and finish at 5 most days, or as most of us do, 8.40-6ish (6ish meaning between 5.30 and 7). It' snot just that we are relatively inefficient as we are new to the job, but also because the boring mundane jobs tend to get left til last, like printing blood forms for the following morning, printing out radiology reports to stick in notes etc.

Secondly, food:

Being able to survive without food during working hours is a skill worth mastering. You may be lucky if you took lunch with you, and get to eat it over your PC whilst on hold to switchboard, accessing results etc on the PC and signing off filing. This however doesn't help digestion, and you may not want to read this report or this report about the cleanliness of NHS keyboards if you do eat lunch this way.

Thirdly, support:

If you are lucky then your ward SHO won;t have too many patients to see on other wards; clinics to attend to, or be on nights / receiving. under these circumstances they will help you with some of your tasks. if not, the prioritisation of what needs to be done now, today, or even this week is essential. achieving the list of jobs requiring doing between successive wardrounds is a skill, especially if there are only 2 days between ward rounds.

Fourthly, referring:

A skill not taught in medical school. How to present you patient in 3 paragraphs and explain to another specialist why you want them to come and see your patient and what you want them to do when they do so. This is often followed by a phone call from them wanting 200 bits of info - 50 of which you don't have and half of those are such that you cannot bluff them. this may necessitate ordering more blood tests, radiology etc, prior to the specialist coming to see your patient. This is especially difficult if the specialist is based at a different hospital as you need to obtain a phone number for the person, and then maybe a fax number to send the letter, and they always page you back when you are not near the notes for the patient concerned.

Finally, ward cover:

After 5pm, and at weekends, you may suddenly go from looking after one ward to looking after 7 or 8. Each nurse assumes you have an encyclopaedic knowledge of their patient, and as such may not use names when referring to 'my wee man in room 3'. You may also start to hate your colleagues who have left 'the venflon no one has managed to do all day' or 'they need some fluids writing up but they have a special regime which isn't written down'. But you are fully aware that you may have done the same on nights when you just wanted to get away...

But in your first month all these can be forgiven on the day you pop into the medical business centre and find in your pigeon hole, a small self sealed perforated envelope with your name on it. Upon opening you see that the NHS has decided to reward this work, which is much like an onward progression of your final year med student shadowing role with a sum of money.

Growing pains?

At lunchtime today we had some small pondering about when was grown up - 21, 22, 23, 24 or is it not age related?? This discussion included the 4 pillars of grown-up-ness - car, live in life partner (we are very PC), mortgage, proper job.

The main reason for the discussion was that most of us are now approaching having 3 of the above, some lucky ones having all 4. but we don;t necessarily feel properly grown up. Maybe this all changes next week when we get paid and we have responsibilities....or maybe its a gradual process or morphing from students to adults.

Thoughts?

The Hospital

Running on Monday night on C4 at9pm.

It's factual, accurate and sadly likely to end up reflecting a chunk of my life from now on....

See here on 4OD (until end of August)

http://www.channel4.com/programmes/the-hospital/4od

It's also annoying enough to make you want to shout at the TV.

Bridging a gap

DSC02525, originally uploaded by djw1981.

On Thursday I was across in Fife seeing a friend for a meal, and on my way to kill time I stopped off at North Queensferry, and took this picture of the Forth bridge.

A Saturday off

Today is an interesting day. The first Saturday in ages when my diary was empty all day. i had a few 'could do' things but nothing I 'had' to do. I then checked back to find this was my first free Saturday since the end of revision, and going back before that, thus my first free Saturday since October 2009. So almost nine months.

And what have I done with this bonus thus far? Well.........I fell asleep reading the Saturday paper, woke up, listened to the 'Now Show' live instead of on podcast; went for a wander round Glasgow and the Merchant city festival, had a nice coffee and am contemplating what to have for tea at a sensible time.

Normal service is resumed next Saturday with doing sound for an event, the following week is the Fringe, the one after I'm at camp, then working my first weekend and at the fringe again to round off August!

Time to move on

The first part of moving on has happened i guess.

Graduation has happened, GMC numbers and certificate have been received, induction dates and details have been receved, and I am slowly turning my flat into something more like ahome after 18 months of being an extension of a library.

After getting a safestore unit in june, i have moved all my notes from my first degree and years 1-3 of medicine togetehr with old receipts, camping stuff and even my christmas decorations into the safestore box. This has left me room to get all my books onto my bookshelves and leave my desk and table free to eat from!!

I even bought my first CD racks, after ten years of owning CDs (I thought I'd see if they stuck around before investing in a storage solution) and was so happy with it I even bought one for my DVD's. this tidy up and organisation hopefully makes my flat look less like a students work area and more like a relaxing living room. i can;t help thinking though that when I sort out my new fridge freezer and some new kitchen flooring the flat will look a bit more homely and less studenty.

Still one step at a time.

Holidays and delays

I thought I had posted this last week but it seems i clicked 'save as draft'
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Just back from holiday in Gibraltar. Though the journey back seemed almost as long as the holiday. going out we were beset by a 4hour delay at Edinburgh airport due to Spanish and French air traffic controllers strikes. they don't actually walk out, just reduce the number of planes they control so they cause inconvenience but still get paid (please note BA cabin crew etc). This meant a whole 3hrs sleep at Gatwick before getting up for the early morning flight on to Gibraltar which was a mere 45 minutes late (same reason as above).

Gibraltar was nice and surprisingly for a small peninsula half filled with a huge rock there was quite a bit to do, including a chunk of sitting in the sun on a beach or by a pool reading a book. We even spent some time on top of the rock watching planes coming into land and the connected road closures - the main road runs across the runway at the airport. Whilst up the rock, one of the resident apes also stole my brother-in-law's ice cream, much to his displeasure.

The day we arrived had been misty and muggy but the Sunday through Friday were clear bright hot days. there must be something to do with travel for the Saturday we were coming home dawned overcast and windy. We got to the airport early (Dad aims for 15 minutes before check in opens) and checked in before heading through to the small departure lounge, which rapidly filled up with passengers for three flights back to the UK - easyjet, monarch and BA. all were showing a 40 minute delay. Just at the time the first plane was due down, we got an announcement saying that due to the wind and poor visibility, the easyjet and BA flights were diverting to Malaga airport.

15 minutes later they announced that BA would be attempting another landing in 30 minutes but that Easyjet had cancelled their flight and we should all queue up for a new flight. a rapid sprint back to the check in area saw us join the long queue to rearrange flights. We managed to get seats on the 2230 from Malaga (it was about 1300 at this point0, but with self arranged transport to malaga airport. the airport staff advised that the express bus did not run on Sundays so our choice was a taxi at 150Euro. This we did and arrived after visiting a Spanish cashpoint and being forced to decide if my debit card was 'Current account', 'savings account' or 'credit account'. Turned out that it only gave me money if I clicked 'credit account', so I assume that is what I have.

Malaga airport is soul-less devoid of character, devoid of shops and aimed solely at budget airlines and the charter market. As was becoming a common pattern, the 2230 flight left at 0030 next day allowing me some time to book a room at the Gatwick Hilton - their last remaining room. The minor issue being that I wanted it for 3 - myself and my sister & brother-in-law. The room was allegedly a 'compact family room' with a double bed and 2 bunk beds, but Hilton said it could only sleep 2 adults and adults could not use the bunk beds. Aye right. After checking in around 3am, we found that the lower bunk suited me fine.

Next morning we headed over to the terminal to check in for the Easyjet 1500 flight to Edinburgh. Which suddenly flicked on the online departure screen to 'contact airline' whilst still being open for check in at the airport. a quick sprint to the airline desk confirmed that it was in fact cancelled. The next Edinburgh seats were Wednesday, but they had Glasgow seats at 2100 but no guarantee that the plane would run. As we pondered the cost of rail tickets or car hire, I called BA and managed to get us 3 seats on the 2100 BA to Edinburgh (where the car was). After another 8 hours in Gatwick, we took off almost on time and made it safely back to Edinburgh.

Time to dust down my travel insurance claim forms now and write the story with supporting evidence for them.

Budget

I just ran the BBC Budget calculator and it gave me a slightly surprising result; the only problem is that this takes no account of the effect of the VAT rise. I think my VAT bill will rise by more than £87 thus I will pay more, c'est la vie.

The indications are that you will be £85.75 better off.

Breakdown of difference

	2010/11 £	2011/12 £	Difference £
Income tax	5975.00	5775.00	£200.00
National insurance	3012.35	3126.60	£-114.25