#TipsforNewDocs – Essential Reading for New Junior Doctors

Some tools for the new junior doctor

Some tools for the new junior doctor

It’s that time of year again. New qualified doctors, degree certificate in hand (not literally!), are about to descend on Britain’s wards. I remember my first day quite clearly. A 12 and a half hour day in ICU. My first prescription was for 20mg of Omeprazole. I remember walking down, butterflies in my tummy and slightly nauseated from lack of sleep. My car broke down that morning, I had to get a lift from my ex-husband to work. I was 20 weeks pregnant and peeing all the time. I attended my first crash  and have yet to see another crash call like that one – all four Ts and four Hs were systematically explored, including opening the chest for pericardiocentesis on the ward. I remember walking up the hill on the way home thinking I survived, with the above exception my patients survived. Back home to bed, to come in again the next day. But that was it, THE FIRST DAY AS AN ACTUAL DOCTOR was over!

If this will be you in the coming weeks, I strongly recommend a trip to Twitter and reading the excellent #tipsfornewdocs hash tag. I didn’t read it back then, wish I had. These tips are informative, straight from the horse’s mouth and sometimes hilarious. If you’ve not signed up for Twitter, I strongly recommend it as a new junior doctor. You can learn up-to-the-minute news from medical bodies & departments, learn about new research, engage in educational learning, find support, laugh out loud and find yourself feeling very informed about your job and the NHS. There are so many good people and bodies to follow, too many to mention in fact, but JuniorDr magazine has a good list of top tweeters.

Due to having babies I’ve been an F1 for 3 years (now finally moving on to F2), so I’ve had the experience of what an F1 does for what feels like an eternity! If you are feeling nervous or excited about starting, here are a few of my tips.

1. Smile. Obviously, only when appropriate, but a friendly face is an essential piece of kit!

2. Value every staff member working on your ward, from nurse to matron to cleaner. Everyone is working for the same goal, no one is ‘better’ than another. We are all the same team!

3. Know your limits. Ask for help when you feel uncomfortable. Most serious errors I know completed by junior doctors were when they weren’t quite sure but did it anyway. Not advisable.

4. Take snacks and a drink. Ideally, you will have time for a break but if you don’t you can re-fuel quickly.

5. Understand that the hospital has many patients waiting to come in and waiting for beds. Your role is to help patient’s on their journey through hospital smoothly and safely. Take care of them during their stay, recognise when they might be getting sick, treat them within your limitations, help plan for discharge, discharge them safely home and inform their GP about their stay. This means that we F1s must do a lot of ‘F1 jobs’ like drug charts, TTAs, bloods etc. But these are really important and if approached with that in mind can be done with more ‘joy'(!!)

6. Get on top of your ePortfolio straight away!

7. Read #TipsforNewDocs

#tipsfornewdocs

#tipsfornewdocs

8. Refresh yourself of GMC Good Medical Practice guidance.

There’s loads more to say, but others have much more to contribute that just me. Most of all, good luck and enjoy your work. You’ve worked extremely hard to get there. Now the fun and true learning begins. See you on Twitter, I’m @morefluids.

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ALS, Breastpumps and Jam

It’s 7am and the babysitter has arrived. I’ve spent the past week reading up the ALS (Advanced Life Support Manual) in 5 minute breaks; in the garden, in the kitchen or while breastfeeding. I’ve not left my baby for this long, I’ve got a 1 hour drive to the course and the last exam finishes around 6.30pm. I’m worried. Baby needs to nurse else the day will have unknown consequences. But she’s having none of it and 20 minutes late I leave the house with my breasts full of milk. As I’m driving up and get stuck in traffic I’m now 40 minutes late. The last time I did a simulation course was after 9 months of maternity leave and I was terrible. I realise again, that I’ve not been on the ward in 6 months and I have baby brain. Husband has been on nights and I’ve been up 3 times breastfeeding baby. ‘This is sheer lunacy’ I think to myself. ‘Why am I doing this?’

Arriving late and last, the instructor announces ‘there’s a space at the front’. I walk to the front in front of everyone and sweating take my seat. I’m the only FY1 on the course and there are ICU consultants, anaesthetic registrars, other senior doctors and a few FY2s. Intimated. I am doomed to fail.

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The morning passes. We do our simulations of cardiac arrest scenarios. It’s about 27 degrees Celsius, hot and sweaty. I’ve let them know ahead of time I’m still breastfeeding and will need to pump at some points during the day. The timetable looks a bit tight. They’ve kindly found me an office and while everyone else pops off to lunch, I go in there and begin pumping. The fact there are 5 people in the office next to me and my pump is noisily whirring and sucking, unsurprisingly I have no let down of milk. Hard staring at pics of my little baby I eventually manage a measly 1oz of milk. ARRRGGHH!! Panic sets in as I know that I have 7 hours to go until I get home.

I return to the course with milk a plenty, sore jumbo boobs which spurt milk with every cycle of CPR. It’s quite distracting. Still, we’ve a nice bunch, supportive instructors and we continue our day. By the time it comes to my exam, I’m thinking it’s a tall order whether or not I will pass. My first scenario exam goes horribly wrong. I do that classic stressful situation thing of saying the opposite of what I mean. I can’t fix it. Midway through my exam I realise what I have done, explain and carry on. I know I’ve failed. My boobs are set to burst with all the stress!

I’m taken to another room where I do another exam. Nothing to lose this time. I think I’ve really extended myself now and will really be quite happy if I fail. Miraculously I pass. Praise be. In celebration, my boobs join in and spurt yet more milk. I now wait for the written paper. It’s 1 hour long. I have no time to express milk. I sit it and wait. Eventually after a long day, it’s announced that I have passed. I am too exhausted to be delighted and manage a relieved, wry smile. I need to get to the car and get home as I’ve not seen my kids in 12 hours.

My breasts direct me to the car and drive me home at top speed. I run in the door. ‘Where is she?’. Poor child reunited with mum is overwhelmed by the abundance of glorious milk. Husband shouts ‘did you pass?’. ‘Yes’, I yell as the joyful softness returns to my painful boobs. Now, I’ve got 2 kgs of strawberries in the fridge lovingly picked by my aunt and if I don’t make jam with them tonight they will go off. So I now begin the prep for jam making. Shattered!

Now, you will have to forgive my honesty. I talk frankly. Breastfeeding mums will empathise with what I am saying. Part of my frankness is to say. WHAT ON EARTH am I doing this for? The past few months have been pretty hellish. I’ve even Googled ‘alternative careers for doctors’ as this life is too much. There aren’t enough hours in the day to fit this in. On maternity leave, I’ve done two teaching courses, started two audits and quality improvement projects (and ALS). Why? Because I need to boost my CV for specialty applications later this year. Oh, and by the way, after three long years I can finally say I’ve been signed off for FY1 and will start FY2. This small piece of news is actually quite major! I’m delighted.

The main reason for the hell I’m afraid has largely been to my husband’s Emergency Medicine job. The hours and the rota are brutal for families. With no disrespect to single parents (my mum was one) I feel like a single parent most of the time. I do ALL the household chores, which with 4 kids is rather extensive and add in all the other ‘man’s jobs’. I’m not one for calling this man’s jobs but there are some I’m afraid. I haul the bins out, fill the car with power steering fluid, mow the lawns and basically seem to do everything in the house. He works long stretches at a time. Average 70-80 hours per week, most of them antisocial and weekends. He seems to have nights virtually every week. My son has no idea where or when he will see daddy. The few days off he gets between these 7-8 day stretches just don’t make up for his absence. By the time we get to a week’s break we are both so exhausted in takes 3 days to feel slightly normal again. When he works antisocial hours, it means I do every evening and the routine, I get up in the morning, there is no rest time. In the early days, I actually had days stretches where I got about 2 hours broken sleep. I would get to bed at 11pm, feed regularly throughout the night and when my son decides to get up at 4.30am, I’d be up for the day (until 10pm). This kind of lifestyle is unsustainable. I will say that my lovely husband does what he can when he is home, and does a lot. But I recognise that the nature of his job means he needs to stand and run around all day. I will ‘allow’ him the lie-in instead of me, when the chance arises. We are used to napping at odd occasions and he will tell me to nap when he can. This means we rarely have time together. Some days we may have only 15 minutes to discuss important things, re-mortgages, catching up with the kids and so on. It’s relentless. This kind of lifestyle impact is why emergency medicine is in ‘crisis’. This week the GMC reported that fact. My husband loves emergency medicine, but the toll on family life is too great. Around 50% of junior emergency medicine trainees leave the job at ST3. I am counting down the days until this job is over. In the past 2 and half years he’s done 16 months of emergency medicine in total, largely coinciding with the first few months of our youngest ones lives. I’m over it already.

Next week I return to work. I’m already encountering problems with the old breasts again. Despite being an NHS hospital there is nowhere that I can express my milk. This was the same situation 2 years ago, but I managed by visiting my son in nursery at lunch. I can’t do that this time and my baby is only 5 months old. With her CF she needs my breast milk for as long as possible and I want to give it to her. Bizarre that the NHS advises mums to breastfeed for as long as possible but have nowhere for their own staff to do so. I’m working on this with ‘health and safety’, but it’s one added stress I can do without before returning back. All I need is a quiet place where I can discreetly go off for about 15 minutes and pump, once or twice a day. I’ll give up my lunch break to do so, so as not to affect the team! Its been suggested that I tell my team members that I’m breastfeeding and ask my consultant if he knows of an office I can use. I will do this, but I find it rather personal info to share. I may as well announce to the team ‘I’m off for a poo now’. It’s my private bodily function and I’d rather not share it with my professional colleagues. Oops, just shared it with you though. Ha ha!

Must finish up now. But this week I also did a fundraiser for Cystic Fibrosis Trust and have raised around £1000! Absolutely delighted. Been moved and humbled by people’s generosity and caring. It was hard work (a cake bake and coffee morning) but so worth it. Again, I thank you all. We’re not quite at £1000, so if you fancy adding a few pennies to the pot I’d be most grateful. In return you can enjoy a slice of virtual cake and feel pleased that you are helping a good cause.

Here is our Just Giving page called the Marvellous M!

P.S. Everything I write represents my own views. I am very aware that colleagues, GMC, employers, husband’s colleagues and so on may read it. My blog is about the fact that doctors are human too. Our personal and professional lives are one! Hopefully our dedication to our profession, patients and our own families comes across.

Baking Cakes, Being Grateful, Community & Fundraising

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There are 25 eggs sitting on the side, three packs of butter, two punnets of strawberries and fresh cream in the fridge. Tomorrow I’m looking forward to hosting our wonderful community weekly coffee morning. It’s my last before I return to work next week. Every week the mums and kids in our neighbouring streets get together to chat, eat and support each other. I’ve been very privileged to live in this community, where I can walk down the road and say hello to many people. I can tell you the names of most of our neighbours. There’s one woman in particular who organises this, Hannah H, she deserves a nomination for a honours for community work if you ask me.

Anyhow, tomorrow I’ve asked if they wouldn’t mind me hosting a fundraiser for the CF Trust, as part of the Big Cake Bake.  As you may know my daughter was diagnosed with CF a few months ago, my blog tells our story. A researcher recently sent me this message.

“You and your family should be very positive about your daughter’s future.  She was identified by newborn screening, the multidisciplinary teams that care for individuals with CF do an amazing job and new therapies that tackle the root cause are now being tested in the clinic.”

For our Cake Bake and coffee morning I’ve started collecting virtual donations from family and friends who cannot be there. I’ve been totally blown away by the generosity of people, especially during these austere times. I feel proud to raise money for such a worthwhile cause and proud to have family and friends who support our activities. I am extremely grateful.

If you feel, please visit our Just Giving page and make a donation. Doesn’t matter how small or large, every little helps.

There are so many fundraisers that it’s hard to pick which ones to donate too. It’s likely to be one that touches your heart or one that you feel I hope that never happens to me.

Please bear with me while I mention two other fundraisers.

My cousin has very recently experienced a family tragedy and I was humbled by the generosity seen on his fundraising page for First Touch, exceeding his target by 181%. I’m sure if you read his story you will feel touched by his efforts.  I’ve been reflecting on this giving and expression of support during difficult times. Seeing family pull together for a cause is inspiring. My lovely sister-in-law and 13 year old niece ran Race for Life to raise money for their charity. Wonderful!

At times of need some people step out into the forefront to provide support, often people who you least expect. If you are one of those people, stand proud as you are wonderful! Thank you and enjoy a slice of virtual cake above.