But yesterday...

Yesterday, he walked to the radiology department.  Yes, he stopped to catch his breath, but he got there, and back.  Yesterday he was talking to his family.  He enjoyed his dinner.  He made his fire.  He had plans to go out with friends.

Today, he's wheeled into the department.  He can hardly catch his breath.  He can't talk.  He can't move his arm or leg.  He lifts his eyes to grab my attention.  He understands.  He moves the other hand, grasps onto the bed side rails.  He's impatient, he's uncomfortable and he's distressed.

In just over 24 hours, his life has changed forever.  That's what a stroke can do.  Take a proud elderly man, and force him into giving up his independence.  Stop him taking his medications which help his heart failure, make him breathless.

I read somewhere once, the question, 'would you prefer to have a form of cancer, or a stroke, a motor neurone disease?'.  The answer slightly surprised me, the reply was cancer, and today I see entirely why.  That man didn't want to live like this.  He told his family that.  He wanted to die at home.  His wishes will no longer be upheld.  But I certainly hope his passing is comfortable and dignified.

Blog neglect

Life has changed.  And in trying to fathom it out I've had to neglect my blog.

In the last two months, I've turned into not only a fully qualified doctor, but also a patient.  I am pregnant again.  And whilst that is reason for celebration, there's a great deal of trepidation.

I've had many miscarriages in the past.  It's something I don't dwell on, but it's something that in the early weeks of pregnancy is always in the back of the mind.  It's a human thing.

We weren't trying for a baby, it is a lovely surprise, however that has led to complications.  I didn't know my dates, I knew when my last period couldn't have been after, but not when before that date.  I booked a '12' week scan.  Going along, they dated me at 9 1/2 weeks.  That was at least 3 weeks back.  Not too problematic, until you realise that I therefore had a positive pregnancy urine test at 2 days post-conception.  It's just not possible.

The sonographer didn't understand.
The consultant's 'team' member didn't understand.
Noone understands.

The implications in my mind are that a baby which is dated incorrectly could be left to go post-dates too far, putting it and myself in grave danger.  That a baby who is not dated correctly is therefore already small, and it was my daughter being small that saved both our lives - got us into the system of seeing consultants and being carefully monitored.

So now I am a walking pharmacy, ad-cal d3, aspirin, folic acid and for good measure ferrous sulphate.  Except I'm not a good patient.  Ad-cal d3 and folic acid make me feel sick, really really sick.  So i've not really managed to get them down my throat.  I'm constipated enough to not want to take the ferrous sulphate.  And I just don't want to be on tablets, so haven't started the aspirin yet.

I suspect the roots of this are deeply held, and that no health care professional, doctor or midwife, will even ask any question relevant to find out this.

You see, I am now terrified of pregnancy.  Almost phobic.  The thought of getting 'fat' makes me nauseous.  The thought of getting pre-eclampsia again terrifies me.  But equally the thought of not getting it, and having a 'normal' sized baby also terrifies me.  My daughter was 'perfect', how can a big 'normal' baby be any better than that?  I don't know how to care for a new born.  I know how to care for an incubator baby, and a 3 week old, but not a new born.

I don't want to have choices about giving birth.  I'm still affected by my c-section.  I still feel the need to explain why, and how ill I was; how there was no choice in the matter.  I don't need to feel the guilt that my body can look after one baby, but not my first born.

'Can he have some night sedatives, please doctor?'

Many of our patients request night sedation, hospitals are noisy places, the lights are left on, and it's difficult to sleep when the patient next to you is snoring like a trooper.  But this request wasn't from the patient.  It was from the nursing staff.

You see, the patient was old.  He was wondering.  He didn't want his bed.  He wanted to sit in the chair between two other patients.  He'd woken another patient, and demanded that 'she' get out of bed.  That man wasn't confused, he wanted to stay in bed and sleep.

The nursing staff stated he was aggressive.

I walked to the ward, late at night, dreading a demanding patient.

I found a lovely gentleman, quite happy, easily led back to his bed space.  Did he want a cup of tea, 'oh yes', said he.  Into the kitchen, a quick cup of tea made, cooled down with plenty of milk.  Gratefully recieved, he started to drink.

Off I toddled through the hospital.  BEEP BEEP, my bleep rang out.

'Doctor, you must sedate him, he's keeping the other patients awake, Mr Smith is now sitting at our nursing station refusing to get into bed as he's keeping him up.'

I explain that I can't sedate one patient for another's comfort, that I can't sedation would increase this patients risk of falls, of head injury, of broken hips, and that it's just not ethically correct.  It's not good enough.  I suggest moving him into the nursing station area, where won't bother the patients in the bay, where the nurses can keep a close eye on him and reduce the risk of him falling.  'He is aggressive and won't let us move him', i'm told.

Back to the ward I march.  This is a care of the elderly ward, they should be able to cope with this.  The patient is perfectly amiable, he walks with me, he sits on a chair in the front area.  I collect his chair, a foot stool, a blanket.  I tuck him up.

Off I wonder, down to the next patient.  I hear no more about this man overnight.  Sometimes it's the simplest answers which work the best.

Young hospital visitors

Childrens art work adorns her bedside table.  Photos of grandchildren beam down on her.  She's stuck within herself, but mention the pictures and her eyes light up.  It's a way to talk to her, to get her to open up.

We often have young visitors to the hospital, they liven up the area, and bring some of our patients 'to life'.  I love seeing them, although probably because at heart I wish to be a paediatrician.

One thing I feel we all have a duty to, is to look after these wee visitors.  A pen and piece of paper to a bored looking 6 year old.  A glass of water to a hot and tired toddler.  A kind word to a pre-teen.  A smile.  These are our patients of the future, and it's their experiences of the hospital as a visitor, that will as much as anything affect their access to services later in life.

Nothing spelt this out more to me than a recent visiting time.  A warm, quiet afternoon, no reason to suspect what came next.  Sat at the nursing station, the emergency buzzer sounded.  Two nurses run past to the location.  Unusually, this was a real call.  The wheels swung into motion.  The crash trolley wheeled to the patients bedside.  An emergency call out to the 'crash team'.  Screens protect the scene, a security officer stands.  Staff hurrying, scurrying, running.  Fetching equipment, information.  More staff arriving.

Stood at the nursing station gathering information, I noticed the little girl opposite, suddenly I see the scene through her eyes.  Scared.  Not understanding what was happening, but realising something big was.  Her relatives not reassuring, not knowing the little girl had noticed, not understanding what they were seeing.

I realised that what I was doing for the patient may or may not have the effect I wanted, but what I could do was have a massive impact on what that little girl took away with her.  I slowed my step.  I relaxed my shoulders, the expression on my face.  I smiled.  Things which made seconds in difference to me and the patient, but had the ability to have a much greater impact on the little girl and other relatives on the ward.

A short while later, the team drift away.  Two members of staff walk past, one with tears slowly running down her face.  A shake of the head.  Again the atmosphere changes.  I continue on with jobs, walking the corridor multiple times.

'Thank you' says her mum.  'Here's your pen, thank you'.

Sims

We're on ward round, and I look across to my colleague.  She's playing with her phone.  I then realise she's not texting or reading a text, but is playing a game.  'Oh', she says, 'I'm just sending my Sims to work, I forgot to do it before'.  A senior is talking to a patient, a sober moment, when his phone rings, 'I just need to get this' he says and slips out of the curtained area.

Moments which seem to happen day in and day out.

Mobile phones and technology are intruding on our everyday life, but how far should this be allowed to happen during working hours?  Should we be able to answer phones and messages?  Should we be allowed to play simple games, Sims, farm style games?  Should we be allowed to check emails, surf the internet, 'Facebook', or any one of the things which technology now allows us to do?

I feel I need my phone.  Sure, Little Miss's nursery have my bleep number, they can contact me through that.  But what if they forget which hospital I'm at?  What my bleep number is?  They are also more likely to start by contacting my phone.  For them, what if I'm not at work that day?  They're not to know that any day I have off I take Little Miss out of nursery and we have fun.  So I feel it's an easy line to my daughter.  To allow nursery to contact me, and for me not to worry about her whilst I'm at work.  It's my security

Anyone else who phones gets a very few tearse words, stating that I'm at work, and it's inappropriate for me to talk!  If it's that urgent they'll call back, leave a message or send a text.

As I've mentioned, I've recently discovered that I can use the internet on my phone.  It's a revelation!  But anything I need during working hours can be found using the work computers and internet.  And, maybe that's the crux of my problem with my colleague playing Sims at work.  Maybe I just don't understand it.  Maybe it just doesn't hold the same influence over how I start my day, how I need to spend my time.  And for that, I'm proud.

Oops

Standing at the ward desk, I wondered why my bleep kept making sounds.  Noone had bleeped me that day....ahh but the emergency bleep did go off in handover this morning...hang on, wait a second....I check my bleep.  Drat, I'm on call.  Rubbish, I'll have to phone my husband and tell him he can't go to badminton tonight as I need him to look after Little Miss whilst I work.

'medical alert, medical alert, A&E resus, ETA 5 minutes'.  Are you being serious?  I've now also got to inform the team that a) I'm on call, and b) I need to be on route to resus for an emergency.


The usual hubbub occurs when the patient comes in, secure the airway, check the vitals, gain access, take bloods.  Nothing unusual about this patient.  I get stuck in, I'm given the blood and start spliting the sample between bottles.  I plunge the needle into the blood cultures bottle and pull it out gently.  Ouch, that scratched me....oh dear lord, I think...I peel back my gloves...I've got a needle stick injury.  I pull my gloves off, run the tap with my hand under it and try to squeeze blood out of the most miniscule cut.  I grab the attention of someone else, I hiss 'I've got a needlestick, can you finish the bloods for me please'.  5 minutes later I don a fresh set of gloves, and help back with the patient.

Once it's all settled, a lovely colleague contacts occupational health.  They tell him what bloods to take from the patient, he counsels the patient and gains consent for his blood to be tested for blood bourne viruses.  He agrees.

Occupational health are nice enough.  Until they need to take blood.  'Make a fist with your hand'.  Umm no, sorry I can't do that.  The only other time someone asked me to do that, the act of taking blood hurt so much I promised myself I'd never make a fist again.  The reasoning is simple.  A nice relaxed muscle is easy to part fibres and hurts less than a contracted muscle.  She takes the blood eventually.  One week later my arm is still bruised, a good 5cm area.  My veins are clear and obvious and easy to take blood from.  It shouldn't have been that hard.

'Ahh, you had your Hep B more than 2 years ago, you'll need another one of those'.  No problem, I go through the consent form.  I'm breastfeeding, I tell them.  I'm told I can't have it, but it shouldn't matter.  Later that day I think about it.  I check the BNF (book of medications).  Why if a newborn can have a half dose of the hepatitis B vaccine, can't I have it?  It's not like half of the vaccine is going to come out through my milk.  Back I go to occupational health the next day.  I explain my reasoning, and that I want the Hep B. 'No problem, I just didn't think you'd want it' comes the reply.  That one sentence, which destroys everything that we are taught at university.  Medicine is no longer a paternalistic society, so why is occupational health?!

My African Experiences: After Birth

In the UK an ideal birth usually ends with baby being placed onto mum's chest.  This seems to be the stuff of dreams.  In my African experiences, this was miles away to what happened.

Often with luck, rather than judgement, the baby would be delivered in the delivery room.  A room in which a mop and bucket was kept, but both, as well as the water within the bucket had seen it's best days; and the water never noticably changed, but at least smelling of bleach.  A room which never looked clean.  A room which had sharps bins overflowing with used needles.

Baby would initially be placed onto mum's chest, but more for convience than anything else.  In this country which never had enough staff, the mother was purely used to hold baby whilst the cord was clamped, with pieces of wool tied around it, and cut with previously used scissors.  The baby would then be taken away from the mother.  If well, breathing and crying it would be rubbed with a Kanga, then weighed, and wrapped up tightly in a fresh Kanga.  It would then be placed on the side until mum was ready to leave the delivery room.  Whereby it would be carried to the post-natal room and placed next to mum.

If baby was not in a good condition it was frequently left to us, foreign students, to help revive the baby.  In practices more closely related to eras gone by, we would swing the baby by the legs, rub its back, rub its sternum (breast bone), anything to stimulate a cry.  If all of this failed, we would 'suction' the baby.  This had to be a last resort though.  Why?  Because the hospital did not have suction catheters, they had IV tubing cut down to size.  These 'catheter's were not single use either.  Not only had the been used for running medication through them, they then had been used on other babies, prior to being placed in bleach to disinfect them.  There was no removal of the disinfectant before popping the tube down babies nose and into it's lungs.  It was an unhygienic practice, but one of which we had no choice.

I was horrified by some of what I experienced.  Us, foreign students would hold the babies, rather than leave them on the side, side by side with the babies who never made it, who were also wrapped up but this time with their faces obscured.  We'd do our best to maintain safe, hygienic practices; to learn from the students who had gone before us, from those of us who had greater experiences in our own countries.  Whatever we could do, had little impact, but may be, just may be we made a difference to one mother or one baby somewhere.

My African Experience: Prematurity

This post follows on from Pre-Eclampsia: My African Experience.

The hospital I spent time observing in had a SCBU unit, although how functioning that unit was, was difficult to tell at times.  It seemed to accept any baby who had survived birth.  Although from my time there, I never once saw a baby be seen by a paediatrician post-natally.

The unit itself had three incubators.  Only one of which the temperature settings worked on.  It also had 5 plastic cots, which were covered with a mosquito net.  Although each of these nets had holes in, and on requesting a new net for the cot, the 'new' nets also had holes in.  Each incubator held up to three babies (depending on size and requirements).  The babies seemed to give given very little care.  A 26 weeker was given steroids, as there was no ability to give them to mum whilst baby was in utero.  It had a nappy for a new born, which came up to its nipples.  It seemed so fragile, but due to the local knowledge, technical ability and resources, nothing more was done for it, that wasn't being done for the other babies.  This consisted of ensuring all babies were cup fed every 2 hours, day and night.

'Feeding time' was a different experience in this hospital.  All the mothers with babies in SCBU slept in a dormitory just off the labour ward.  Every 2 hours a bell would be rung.  All of the mothers would then queue up in SCBU.  They'd wash their breasts, take a cup and hand express into it.  They'd then take their child and cup feed it.  Even to the smallest and weakest baby.  They had no NG tubes.  This was the best they could do.  Some of the older babies, could cope with this, but for the younger gestations it was too much.

The midwives/neonatal nurses (who knows what job title they actually held), seemed to do very little, save for 'babysitting' these babies.  In fact the only thing I distinctly remember them doing was sharing their lunch, in the same room these babies were living in.

The 26 weeker, who may have had a chance with maternal steroids, NG tube feeding and other techniques and medications that the western world holds, died after a mere 3 days, lying in a working incubator with two other babies.

My African Experiences: Pre-Eclampsia

During my pregnancy with Little Miss, I spent 7 weeks in Africa.  As part of my medical studies.  Gaining an appreciation of medicine in a different setting, in an impoverished country.  And that is one thing I certainly did.

The area I spent time in has a birth rate of 32 per 1000, with a population of 1 million.  So around 32000 births a year.  The hospital I spent time in seemed to be the main focus of where women attended.  However, in times of need the mothers could be sent to another facility in the area.

There were never enough beds, the women shared a bed.  In a unit of approximately 20 beds, or 40 women, there were only a small handful of midwives.  The women were unable to go to the delivery room until they were fully dilated, then they walked, with all their belongings, to the delivery room.  Many never made it and delivered on the floor.  If all three beds in the delivery room were in use, then you had to deliver on the floor.  An hour after having baby, still born or alive, you had to leave the delivery room.  The only exception I saw, was one mother who was having a blood transfusion after having a still born.  She was allowed to complete her blood transfusion in the delivery room.

What was more shocking than this, was the lack of modern medical and midwifery care that was available.  The stark differences between care of a pre-eclamptic woman in the UK in comparison to the region I was in.  In the UK I was monitored twice weekly, Little Miss and I were hooked up to monitoring, and my blood pressure would be taken. I had scans every other week, checking for growth and blood flow to the placenta.  I was given anti-hypertensives and two steroid injections to help Little Miss's lungs to develop.  Once they were concerned they took me into hospital and monitored my blood pressure hourly, and finally every 10 minutes, before getting me into a HDU room for medications to stabilise my condition and for an emergency c-section to deliver Little Miss.  Little Miss was put into an incubator and was able to have an NG tube to bed fed with formula milk.

Had I been in the unit I visited, it would have been a different story.  I would have chosen how often I wanted antenatal care.  I would have chosen, and paid for each scan I wanted.  My blood pressure may never have been picked up on.  If I was lucky enough to have visited the hospital/antenatal care and found to be pre-eclamptic I would have been put in a bed, and they would have waited.  No monitoring, just waiting to see what would happen next.  They had magnesium sulphate, a life saving drug.  But it was in the 'emergency use' box, and pre-eclampsia was common place enough that it wouldn't have been seen as out of the ordinary.

I never once saw antenatal steroids given.  But I did see them given to the babies in SCBU.  I never once saw a c-section for pre-ecampsia.  I did see eclamptic fits.  They gave paracetamol.  The mother, and child would invariably die.  If Little Miss and I had been there when things went wrong, that would have been our fate too.

Born Too Soon: Global Action Report on Preterm Birth

FACT: Preterm birth is on the rise
FACT: 15 million babies are born before 40 weeks gestation every year
FACT: 1.1 million of these babies will die
FACT: >75% of these deaths, are avoidable without intensive care facilities
FACT: Poorer families are at greater risk, world wide.

The new report 'Born Too Soon: Global Action Report on Preterm Birth' looks to address this.  Not Even a Bag of Sugar and Mummy Pink Wellies both address the report much better than I could, but in 2010 I spent 7 weeks in an African country, working on my medical elective within a hospital.  I spent time in the 'maternity' areas, and the paediatrics department.  Within this series I will draw on these experiences.

It really stands out in the report that it's not talking about ground breaking new developments, but introducing a level of care across the world, which is currently available to some mums and babies and not others.  The use of tocolytics (to slow labour), of corticosteroids (to strengthen babies lungs), and of good antenatal care.

The report looks further into the problem than just this though.  It is looking at the role of poverty, of gender equity and the improvement of maternal health.

It also states that, as I will discuss in a later post, sometimes it is the medical and nursing professionals failing to undertake the simple basic care, which fails the infant.

Sibling planning

I love Little Miss with all my heart.  She is my whole world (sorry husband dear!).  But I don't think my family is complete.  I have space in my heart for another little one.  

Little Miss is such a happy, sociable little girl, who loves other children.  She would make a fantastic big sister.  When she's been in the little baby room at nursery, I've often caught her stroking a upset babies hair or hand, trying to calm them.  Or hovering over a sleeping baby, keeping watch, and warding off other children.  She's happy to share, as long as it's not her shoes, bag or coat.  Those are Little Misses only!

My feeling originally was not to have a little one during my first year of work.  To get this over and done with, as one of the more stressful years (pre-registration, although i'm sure no more stressful than any other), and to settle into the work.  Then this stretched to, not having a new little one before I get my full training post.  Not wanting to go to interviews pregnant.  And now, not wanting to turn up to my first day of that job pregnant.  

My fears of many years ago, of pushing back when to have children are happening again.  

There's the added complication of the pre-eclampsia I had with Little Miss.  The risks of this recurring increase with time between pregnancies, and increase with older age of mummy.  So not wanting to be pregnant for social reasons could be putting my life in danger.  Which isn't somewhere I want to be either.

I need to put my head to this and think.  The most difficult thing, is that we all know it's not possible to plan exactly when a baby will arrive.  There's hope that 'doing the deed' will lead to a pregnancy and that pregnancy will come to fruition at the right time, but no dead cert.

Easter egg hunts

Little Miss, Little Miss, here's one.....come over here Little Miss, quick, quick, quick.

Ahh the annual Easter egg hunt.  A week or two late, as it was the first time we'd properly caught up with the family.  Little Miss's aunty loves the annual Easter egg hunt, despite being rubbish at it.  She needs so many hints and clues about where the bounty is 'cold...cold...hotter...hotter...bingo!'.

This year there were 18 of us, all hunting for the eggs.  I'd managed to get last minute at the supermarkets, when our usual creme eggs had already been sold out.  So Sunday had us wrapping mini-eggs in cling film, before granny and great-aunty set them out on the field.

I'd warned Little Miss's aunty that I'd had Little Miss in training during the previous year...and it worked.  Aunty found none of the general parcels, and had heavily laiden clues to find the three chocolate bunny rabbits (bought especially for Aunty, so she'd get something), whereas Little Miss and I found 7 packets.  Not bad for going the speed of a 22 month old!

For next year Little Miss needs to go it alone in finding the parcels, so that we can get even more together!  Better get her back in training.

Job Roulette

I opened my email, my heart sank.  Right area, wrong jobs.  Massive disappointment.  Heartbreak.  The only job I've ever wanted, and I'll have to wait a bit longer.

She opened her email, her heart sang.  Right jobs, commutable...rubbish the car is hire purchase with limited miles...her first thoughts, 'how will I afford it'.

Our jobs for the next year have all hinged on a few things, the first a 'portfolio' of various bits and pieces.  Evidence of learning, of partaking in the job, of partaking in medical education.  These portfolios were ranked, points given for each part, for how good the consultant thought you were.  Frustratingly these were very subjective.  The best doctor may or may not get the best score, likewise for the least impressive doctor.

You'd like to think that your GP or hospital doctor, irrespective of their experience, worked in that part of medicine because they wanted to, because they were passionate; but in the world of junior doctors this isn't true.  Jobs are grouped into threes, four months in each.  Each 'rotation' has something you may want to do, and something you may not.  Hopefully there's more that you are interested in, than you're not interested in.  Each rotation has space for three doctors.

Ranking of jobs is done by what you do or don't want to do.  Psychiatry...no thanks.  General practice...yes please.

Ranked doctors and ranked jobs are then put into a computer, I can only imagine, and the top three ranked doctor gets their top ranked jobs.  The rest may or may not depending on how the doctors with better scores, ranked the rotations.

It appears that my portfolio just wasn't good enough.  My only saving grace was Little Miss.  She afforded me a 'get out of jail free pass'.  I didn't get a single job that I'd ranked, I got another, but one that is within my local area, because of 'special circumstances'.

Those special circumsances are ironic.  They've given me a job where I'll work 1 weekend in 2 for four months.  Where my shifts will be a constantly changing pattern.  Where Little Miss won't have a clue whether mummy will be at home at bedtime, or breakfast time, or any other time.  Those special circumstances will turn Little Miss's world upside down.  That is the true heartbreak.

I'm trying to think of the positives.  1/3 of the year will be quiet, there's the potential for audits, to boost my future applications.  1/3 of the year will be brilliant for my confidence.  All of the year will be with patient contact, there's no microbiology or public health for me!

New Baby Presents

I've been lulling over what to buy several new babies who are on the horizon, to other mummies.  It's brought me back to presents that we were given when Little Miss was born.

Now Little Miss was *just* 4lb when she was born, and surprised most people by being 6 weeks early.  Prematurity isn't something that most of the people we know, have much experience in (save for my medic mummy friends, who all seemed to have problematic pregnancies!).

I remember being so disappointed that many people bought Little Miss newborn, and 0-3 sized clothing.  She didn't fit in most of these clothing until 6 months old.  In fact some of the clothing she was kindly given she didn't fit into until she was a year old!  (However, they were lovely once they did fit Little Miss, and she wore summer clothing all through the winter with tights, vests and cardigans!).

There were some notable gifts which where given with the utmost thought

• My first primary school teacher bought Little Miss a Hungry Caterpillar cup, bowl, plate, spoon, fork and knife set.  At the time it seemed bizarre, for such a tiny baby.  Now it seems the most sensible present, and is very much loved.  It has been used at various weddings for Little Miss to eat from, as it's such a nice set.

• A very good friend from University made us a hamper.  He sent gifts for Little Miss, clothes which fitted her a year later; sweets, chocolates, fruit tea and treats for me (and daddy).  The thought which went into this was greatly appreciated.
• My sister cooked homemade shortbread, perfect for a SCBU mummy on the go.  A taste of home.
• My Nana's church crocheted Little Miss a blanket.  I love handmade bits, and this is used frequently.
• My MIL bought Little Miss a fleece blanket from Primark.  It cost very little, but was so soft.  And everytime it becomes too old, and not soft enough, I run out and buy another!
• My mother knitted, like her life depended on it, and soon enough Little Miss had a whole wardrobe which fit her, and was in lovely colours.

I've been trying to add to this list of great presents and have come up with

• A childs china cup.  We had these as children, they'd be good as Christening presents too.  Ones with Peter Rabbit, or Thomas the Tank Engine on.
• A homemade 'taggie'.  A small square blanket with ribbon 'tags' on it.
• Home knitting, there are lovely patterns for knitting hats and blankets amongst other items.
• Soft leather shoes like these ones

How about you?  What was your favoured items you were given?  What would you like to have been given?

Health and Safety

In the short time I've worked at the NHS I've nearly slipped over twice.  Both accidents.  Both incidents treated in completely different ways by my colleagues.

As a doctor, I don't have a clue where wards keep their cleaning equipment.  Maybe I should, but I don't.  Or who to contact if there are spills on the floor.

As a employee to the NHS, it is just as much my job to ensure that there are no health and safety problems for the patients, their visitors and my colleagues.

The first time I slipped, I was attending to a very sick patient.  His catheter bag had left urine on the floor.  I saved myself on the end of his bed, pulling my wrist.  I didn't have time for sorting me out, it was the middle of the night shift.  I duely let the staff know there was a hazard on that size of the bed, and asked someone to grab something to make it less slippy.  I think some sheets arrived, to give more 'grip' to the floor and soak some up.

The second time I slipped, I was was also attending to a sick patient.  But this time it wasn't an emergency.  Again I saved myself by grabbing the end of his bed, again I pulled my wrist (the same one), and also my shoulder this time.  I immediately found a nurse to ask where I could organise getting it mopped up appropriately.  She refused to stop her drug round, or give me information on who to contact, or where I could find equipment.  She would sort it 'later'.  I found some paper towels, and gloves and mopped it up.  There was no concern for my health.

Many of our patients are elderly, infirm; their visitors too.  I honestly believe that it's our duty to protect them.  For me, a slip meant slightly pulled ligaments.  For the elderly this could mean a fractured hip.  It is up to all of us within the NHS, as well as the visiting public, to ensure that health and safety hazards are sorted in a timely manner.  In this fashion, I will continue donning my gloves and grabbing paper towels, where others seem reluctant to help.  I will continue picking up the small bits of litter which clutter our corridors and stairs.  And, I will continue to look out for the health of everyone, who may use our hospitals, whatever their reasons.

A new trick on an old phone

I recently rediscovered that my phone had the internet on it.  I'd known this all along, but some 4 years ago when I got this phone I remember the internet being expensive.  I was a student.  I couldn't afford this technology, this luxury.

This past two years I've had free internet service on my contract.  It was only a very short time ago that I thought about this, that talking about how appalling my mothers phone is for 'surfing the net', and then I realised....my phone could do this.

With very little battery I checked if there was a local Dunelm Mill, and found instructions as to how to get there on google.  I 'facebooked' about my little discovery, and checked later for updates.

I then tried to find 'apps' which may work on my phone.  I was horrified that in this day and age of computers, phones and apps, that I'd have to pay at least £1 and up to £5 for a simple game, or other app.

So for now, my phone will remain a phone, a messaging tool, a camera.  And I will be continuing to search for my next phone.

Goodbye to the old, hello to the new

Prior to being a medic I worked in the Temping world.  I loved going into a company, working for a couple of days, then moving onto the next.  I thrived on learning the ropes quickly, on taking on responsibility quickly whilst taking the place of someone away from their job through sickness or holiday.

As a junior doctor these skills are back in use.  I work in 4 monthly rotations.  Each four months there are new colleagues, new nursing staff, a new patient load, a new system covered.  The basics of medicine are the same, the basics of the job are the same (get the patient back out of the door in at least as good, if not better condition than they were previously), but the nitty gritty changes.

The hospital I work in is ward based.  I used to work on Ward B.  The nurses were brilliant.  Some real characters.  I learnt from them.  We worked as a true team.  They were my back up, without a doubt.  They had a real knack for bringing the important to your attention.

My new ward, A, just seems different.  Well it is, the set up isn't the same.  The nursing staff don't seem confident, whether that's in our abilities or in theirs I've not worked out yet.  They ask for simple information multiple times.  They don't check in the notes to find answers prior to asking us.

My background of Temping means that I love new starts.  My love of my old ward means I'm not sure about this change.  I love being in a larger team, but this doesn't completely offset the fact that nursing staff run the wards, and can sometimes be the medical teams biggest resource.  Either way I'm sure I'll find reasons to start loving my new ward, nurses and job....I'm sure we always do.

'Arry

Little Miss has a new word.  She learnt it on her holidays.  'Arry'.

Harry was a little boy two months older than herself.  She loved him.

Little Miss's understanding of the world is lovely to see.  Harry was found by the toddler pool during the day.  She'd run to the pool to find him.  They'd sail their bath toys across the cold paddling pool, she'd dabble her hands in...he'd wade in.  They'd argue over a pink dolphin, or a blue duck.  But they were happy as Larry together.

After dinner one night we walked back to the hotel bar via the pool areas.  Once down at the level of the toddler pool she ran as fast as her legs could carry her, shouting 'Arry, 'Arry, 'Arry'.  In Little Miss's world the only place Harry could be found was by the pool.  It didn't matter that she'd also spent time with him at the entertainment.  Harry should be at the pool!  He wasn't.  She was distraught.

Harry left hours before us, but in the middle of the night.  Little Miss searched for him.  She wasn't distractable. Over the past two weeks it seems she still hasn't forgotten him.  We got into the car on Friday, and she suddenly became all excited that we were going to see 'Arry, 'Arry, 'Arry'.  I had to let her down gently that we were going to see Granny instead!

Vocabulary

'Can you say purple'
'pu-ple'
'Can you say apple'
'ap-ple'
'Can you say orange'
'-nge'

And so goes a telephone conversation in our house at the minute.  Little Miss has started to learn words, and her aunty loves it!  This conversation is repeated time and time again.

Little Miss has traditionally refused to show any new skill without perfecting it, without our knowledge, first.  She didn't crawl until she went the whole way across the room.  She first walked 8 steps in a row, dipped down to the floor and then walked away again.  So, starting with one or two words surprised me a little.  I'd just assumed she'd be one of those 'strange' children who started talking in full sentences.

Instead, in one walk home from nursery she had three new words: purple, white and yellow.  The colours of the flowers we were admiring.

Now all she needs is to learn some words which may help in everyday life:
This weekend we weren't at home.  Little Miss started attacking the kitchen cupboards, looking for something. Did she want an apple, no.  Did she want an orange, no.  Did she want a banana, no.  Well what on earth did she want?  Finally it hit.  She wanted a drink.  She's said 'dink' before, but as per usual a hard won word had disappeared.  She downed a full glass of milk in one...and then was happy.  Serves me right for having her cups in a low position so that she could easily bring us a cup, to show she's thirsty, and that option not being available as a communication tool when she needed it else where.

Survival - #dosomethingyummy

#dosomethingyummy has been running this month to gain awareness for CLICSargent.  I first became aware of CLIC in the late 1980s, raising money through a drama group I used to attend.  It's a very deserving children's cancer charity, who have done a huge amount of good work over the years.  March 10-18th is the week that they're attempting to raise money.  This follows the prompt of 'Tell us your story of survival.  What did you overcome?'

Rising at 4am, I pad down the corridor.  It may be summer, but my room is freezing.  The nursing staff raise an eye.  I should be in bed they say.  I should be resting, asleep.  My breasts ache, heavy with milk.  How can you rest when you're the only mummy on the ward without her baby?  How can you rest when you know you need to express, to increase your milk supply, for the little one who is still so dependent on you, despite the umbilical cord being cut.

Little Miss was born during my medical studies.  Ironically enough during my paediatrics block.  She was strong at 34+2 but my body rejected her placenta.  I was seriously ill with pre-eclampsia.  The only treatment for me, was for Little Miss to come into this world.

My first night of not being pregnant was in a different hospital to Little Miss.  I begged a transferal to the same hospital as her.  I was transferred the next day, released from HDU.  Midnight I arrived.  Midnight I got my second cuddles.  Midnight my parents and parents-in-law met their first granddaughter.

My mind whirled, what next?  Destination post-natal depression?  Into action my brain sprang.  I couldn't sit and drink tea all day at home without Little Miss beside me.  I'd sob into it, and tea is too precious.  I couldn't get the bus to Little Miss, that would take hours, my milk would never survive.  That was it, I'd go back to uni.  I continue my studies (fortunately a week of lectures then shift work).  My brain was addled, but it was the best that I could reason.

It worked.  I successfully breastfed Little Miss, and continue to do so.  I have a fantastic relationship with my daughter; and a medical degree, completed less than a year after Little Misses dramatic entry into the world.

I survived.  Little Miss survived.  Daddy survived.

A long week

How many days did your week have?  Mine had 12.  Yup that's right.  I worked 12 days in a row.  4 of those I wasn't home in time to put Little Miss to bed.  8 of those I was.  One of which I returned to work to complete a task I'd managed to miss.

By today (day 12) I was exhausted.  I was worn down by the hours put in and by my seniors 'attempts' at support.  My usual happy-go-lucky self disappeared.  I cried. 

My relationship with work is a complex one.  Ever since I can remember I've wanted to be a doctor.  I'd also never considered not having a family.  I'm a doctor because I want to 'help', because I care for people, but also because we have bills to pay, just like the next person.  I work because I want my daughter to have the best.  But part of the best is being at home with her. 

Tonight I finished work at 8pm.  3 hours late.  I was lucky that Little Miss managed to stay up late.  I was lucky that her daddy was there to pick her up from nursery, when that should have been my job.  Part of crying was that I just wanted to get home to see Little Miss, and there was too many jobs to do, that couldn't be put off until Monday, to know that I would never get home on time.  Every day this week Little Miss has stood at the door and cried as I've left for work.  She's never done that before.

I am lucky that the nurses on the ward I work on, are fantastic.  They are the ones who supported me today.  They are the ones who asked if I was ok, as they saw 'me' disappear; as they saw me crumple they gave me hugs, they brought me the most appreciated glass of juice possible.

Today it is the nurses who need thanking.  Always supporting the doctors, always there for the patients, always underappreciated.

A start

My life seems dichotomous at times.  I'm a health care professional and a mummy.  A junior doctor trying to find her way in a new career, and trying to balance this with my family's, particularly my daughters needs. 

Not aiming to chronicle life, I aim to consider writing about what I struggle with at times.  Work, work-life balance and bringing up a little one; as well as the potential for little ones at any point in the future.

If you like the idea, read on.  If you have an idea for a post, let me know.