Patients Who Inspire Doctors

As a doctor we meet patients who inspire us, move us and motivate us to continue in this challenging career. Recently, I was called to ED resus to see an out-of-hospital cardiac arrest, their heart was beating, but they were in a very bad way. I intubated them and took them to the Cath Lab. It was very bleak indeed. A young person, younger than me infact. You can imagine everyone’s sheer joy to see them up and talking three days later. No words to express how amazing that was. Early community CPR and use of a community defribrillator was absolutely critical. That persons co-workers saved their life. They were my ‘star patient’ this week, this year. Infact, this ever.

What’s a star patient? I recently wrote about them for The Guardian entitled The patient who showed me how to be a better doctor and person.

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Survey of Junior Doctor Parents Show More Than 50% Considering Leaving NHS England

jdcchildMore than 1000 junior doctor parents have spoken up voicing grave concerns about the new contract, set to be imposed this August. In an online survey conducted in April 2016, 99.4% consider the contract will have a detrimental effect on their family life and less than 5% of respondents plan to continue their career as it currently is. 93% consider the proposed contract will have a detrimental effect on their relationship with spouse or partner. More than 25% are considering leaving the profession altogether, with a further 26% considering a move to another country.

“There are around 54,000 junior doctors. A junior doctor is anyone graduated from medical school up to consultant or GP level. Most are of child rearing ages and many have children. When doctor recruitment is already in crisis and only 5% of junior doctor parents plan to continue as is, imposition of this contract could throw the entire doctor workforce into disarray,” states survey creator, Dr Sethina Watson, junior doctor and mother of four. “This contract threatens both lives of medic children and, with a potentially reduced workforce, the lives of patients too.”

The survey asked a range of questions on current level of training, current and potential childcare and whether or not they envisaged continuing their current career should the contract be imposed. The survey identifies extreme difficulties in finding childcare, 93% state that finding childcare with the new contract will be more difficult. The governments equality analysis of the Junior Doctor contract openly states that it disadvantages women but that this ‘indirect adverse effect on women is a proportionate means of achieving a legitimate aim’. The equality analysis suggests that some women may find it easier to arrange informal, unpaid childcare in the evenings and weekends. The survey results showed that nearly 60% of respondents do not have access to such childcare. Of those who do, 86% believe it will be unreliable for ensuring attendance at work. There may be a surge in doctors requesting part-time working, which can still entail up to 55 hours per week.

Of particular concern are the doctor and doctor couples that comprise nearly 40% of those who responded. “I cannot imagine how it would be tolerable if the frequency of our weekend working were to increase; I could easily imagine this causing marital and family breakdown,” said one married male doctor.

Jeremy Hunt’s rush to impose the contract threatens to create a potential time bomb that could explode as early as August as thousands of junior doctor parents struggle to find childcare or quit their jobs. The legacy could harm generations of children and lead to a loss of thousands of years of medical training from the workforce.

Survey Results Summary:

  • 1060 Respondents
  • 84% aged 30-44
  • 82% female
  • 84% married/civil partnership
  • 38% have doctor partner/spouse
  • 38% full time employment, 41% less-than-full-time
  • 39% caring for one, 39% caring for two
  • 59% use nursery and 58% spouse for additional childcare
  • 34% ST 5+
  • Of those choosing to stay in medicine 58% will stay in speciality
  • 40% spend between 20-39% of net household income on childcare
  • 58% do not have access to unpaid informal childcare, those who do 86% say not robust or reliable enough for work
  • If contract comes in 48% plan to use partner for childcare, 48% don’t know what they will do (you could have more than one answer for combination arrangements)
  • 75% expect to pay for this additional childcare
  • 93% said that finding more childcare would be more difficult
  • 4.6% will continue their career as it currently is
  • Those considering other options 87% cite impact on children, 79% impact on spouse, 53% cannot afford further childcare, 77% emotional strain and stress as key factors
  • 74% state the proposed contract will definitely have a detrimental impact on their relationship with spouse/partner (19% state probably)
  • 93% state it will definitely have a detrimental effect on family life and 6% say it probably will

Complete survey findings are available JDCchildcaresurvey2016.

Survey conducted by Dr Sethina Watson, Anaesthetics Trainee, mother of four and former founder of MomMD.com. Follow me on Twitter @morefluids.

For a short link to this survey use http://wp.me/p3pm8R-bk

Featured in The Guardian – Junior doctors: ‘over half could quit NHS England over Hunt’s contract’ and Hospitals braced for walkout as Hunt says doctors’ strike must be defeated.

For more information on the survey and permission to use findings, please contact me below

Being a Junior Doctor & Parenting a Child with Cystic Fibrosis

Last week junior doctors staged another strike in opposition to the proposed enforcement of Hunt’s Junior Contract. A contract which most doctors believe will endanger patient lives and destroy the NHS. On the eve on the third strike, while my daughter recovered from anaesthetic I wrote the following piece.

“My husband and I are both junior doctors. Unfortunately, we cannot join the picket line this time.

We aren’t there because we are in hospital with this little one.

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Smiling despite low oxygen saturation and high fever.

Our three year old daughter has cystic fibrosis. She’s not been well recently and she’s in for a general anaesthetic, bronchoscopy, fixed intravenous line and two-week course of heavy duty antibiotics. The NHS is so vital for her care and future. We have no doubt that she will be well cared for the next two strike days.
The junior doctor fight is for every patient and every person working in the NHS. Doctors looking after her (and everyone else) should be well rested, motivated and valued. She starts nursery soon, we’d like to see her and our other children at weekends. We already work many weekends away from them. CF shows us that life is precious; it is too short.

Doctors involved in her care over the next two weeks will be many; junior doctors, respiratory consultants, anaesthetists, radiologists and microbiologists. But also ward nurses, recovery nurses, operating department practicioners, specialist nurses, student nurses, ward clerks, pharmacists, pharmacy technicians, porters, health care assistants, domestics, dieticians, psychologists, physiotherapists, radiographers, play specialists and more. Behind the scenes are lab technicians, estates workers, IT staff, medical secretaries, central sterile services team, theatre managers, ward managers, volunteers, security staff and a huge long list of others.

We all work together for our patients. We make something pretty amazing. To think that adding just junior doctors to the ward at the weekend is all that is needed ignores the rest of that amazing team.

When times are tough, we remember this phrase, ‘Dum Spiro Spero’. It means while I breathe I hope. Perhaps one day there will be be a cure for CF. We try to remain hopeful about the junior doctor ‘fight’ too.

Junior doctors are standing up for the future of the NHS. Let’s all stand together. Good luck, we’ve got our badges and banners on the ward ready for tomorrow. She says a big thank you for everyone looking after her.

Mr Hunt, I request that you engage with us and take our concerns seriously.”

Since then, she has been recuperating in hospital and faces further treatments prior to discharge home. The contract in short, may mean many doctors simply cannot afford to work in the NHS, whether financially or emotionally. Minty’s story was featured in The Independent and on Doctors of the NHS.

As always, fundraising for the CF Trust is a goal. Minty’s Godfather and family friend aim to cycle from London to Paris to raise money. Find out more about Magical Minty Cycling Team on Facebook or donate here.

To understand more about the Junior Doctor contract this recent Facebook post is an excellent summary. 

No Spoonfuls of Sugar Here

Having a positive attitude to taking her cystic fibrosis medicines helps my 23 month old take her morning medicines with ease. Recently she’s decided she wants to do them herself. Took a long time for her to get to this stage. Many of these, especially flucloxacillin, taste not so great. Next steps will be her own Creon and much more. Normalising this with positive language. No vile, yucky stuff here. We love CF meds to keep her healthy!

First Hospital Admission

Sudden turn of events. Life has now been refocused on what’s important. Minty has been fighting off a nasty cold for weeks. She became quite unwell yesterday afternoon, worse this morning. I took her to the children’s hospital today, by the sound of her breathing I knew this wasn’t like her usual infections. So tomorrow she goes in for a general anaesthetic, bronchoscopy and long line (central or picc) for 2 weeks IV antibiotics. It’s the day we’ve been trying to avoid. She’s at home now running around like mad after prednisolone and salbutamol. You’d never know she was unwell!

Going to be staying in with her. We are allowed out for home visits etc. Lovely Minty, always smiling.

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The Longest Journey. Anaesthetics Here I Come!

For me children and career are entwined in a complicated relationship of progression and pause. Had I never had children I would never have become a doctor.

My journey to becoming a doctor began 16 years ago when I was pregnant with my first child. I encountered the medical profession in ways I never had before, saw amazing doctors who were brilliant role models. The decision to become a doctor was an epiphany, a complete realisation that this was the job I should have done all along. Deciding to do this at a time when I was about to become a mother seemed ridiculous and absurd. My career aspiration was set within a few minutes of my epidural ‘kicking in’. I went from the worst pain in my life to no pain whatsoever. That was it, from that moment I had to do that job. I was 28. The anaesthetist was a magician in my eyes. How he knew what drugs to use, where to place them and to what effect. This was something I simply needed to do. 

From that point my journey to become a doctor has taken what seems forever. The journey has been complicated, hard but extremely rewarding. I spent the next 6 years holding my dream. 

Just six more years.

ImageI was working in my other career but most of all raising my two girls 5000 miles away from where I wanted to go to medical school. I volunteered in a hospital developing x rays, watching births, making coffees and many other things to see if the job would be worth the sacrifice it would entail.

I waited and waited until I could apply to medical school. I wrote to the BMA. I should have kept the email they sent. They told me that very rarely did people over 30 get into medicine, and indeed their brains did not have the ability to absorb information and learn quickly enough! I applied and was rejected. I waited again and applied again, this time receiving two fat envelopes inviting me to interview at Bristol and Kings the day after I was told my husband had lymphoma. I explained to the Universities and withdrew my applications. I applied the following year and was invited to interview at Bristol. 


Just one more year.


This time I flew 5000 miles and arrived to be asked first in interview ‘you didn’t just fly all the way from America to do this interview did you?’ ‘Umm, yes.’ was my answer. I was 33.

I was unable to do the five year course as I did not have science. No bother, I was delighted to do the six year course.

Just one more year.

My first day in medical school was awful. Starting on the 6 year course I was given a physics exam which I could not do. I thought they had made a huge mistake giving me a place for I would never be able to pass this course. I passed. Balancing medical school with family was hard, but not impossible. As I mentioned the two are entwined. Exams always coincided with school holidays, so when others revised I was making craft projects and cooking dinner. My marriage did not survive and in the third year I made the decision to carry on my degree despite great personal and financial hardship. I felt like I was racing against the clock, trying to finish my course before I got too old. During my time in medical school I always knew it was anaesthetics for me. SSCs, placements and electives confirmed it and I worked hard to demonstrate my commitment to specialty.

Unexpectedly I remarried 2 months before finals and became pregnant with my 3rd child. The job I had finally waited for was due to start when I was 20 weeks pregnant. I was advised not to start. But I’d gotten the anaesthetics and ICU F1 job I wanted and couldn’t wait to start. 

I was extremely ill during the pregnancy and developed pre-eclampsia. I decided to go part time doing F1 over two years,which again wasn’t part of my planned career journey. Yet, more time to wait to start my anaesthetic job. I met with a careers adviser for support in my first 3 weeks of F1. She told me that ‘I didn’t stand a hope in hell’ of getting an anaesthetics job and in fact told me I should give up medicine altogether! I politely said that I hadn’t sacrificed so much to get to this point and give up. She also said that my CV would not be as competitive as my ‘younger counterparts’. 

Just one more year.

My husband and I were keen on more children. Having had my third aged 40, having another one seemed a challenge. Another clock was ticking. But aged 42, I finally had my last and fourth child. This added another year to F1 training.

Just one more year.

F1 seemed to last forever. It was extremely difficult. But I kept my enthusiasm alive by hoping one day I may get an anaesthetics job. I worked hard on audits, presentations, publications, courses and as much as I could to demonstrate my commitment to specialty. In my early 40s, I attended my interview. I knew it would be tough as needing to stay in this area means tough competition. But I know that not having the luxury of time I had to worked hard to get the job. 

Waiting one month for my interview results was hard. I was gutted to see that I did not get an anaesthetics training place in Severn. There were 21 jobs and I scored 24th. I was upset to see my lowest marks were awarded for commitment and reflective practice; the two things I had worked most hard on over the five years. 

But I am delighted to say that I applied for a place through clearing and I am now doing ACCS Anaesthetics in Wales from August. I shall be commuting to South Wales from Bristol. I am very excited to finally be training in the job I have waited years to do, I shall be, ahem, 40-something. I am also really excited about joining Wales Deanery. There may be twists and turns, hurdles and roadblocks but eventually I am getting there; making sure I enjoy the journey along the way.

If I see you I will beep my horn across Severn Bridge.

Araminta

During my pregnancy we went round and round in circles looking for names. My husband and I simply could not agree. We started looking for names that ‘were a bit different’. My husband told me how he once met a girl called Minty. I loved it initially but thought who could actually call their child Minty!! Bonkers. But we looked up the origin of the name and found Araminta. We added that to our list, should it be a girl.

When she was born we spent all day going over and over, could we actually use this name. Will people think we are silly. In the postpartum room I read up on the amazing Araminta Tubman and it was decided there and then. Who was Araminta Tubman? She was born in 1820 and was one of the strongest, toughest women of her era. Born into slavery she escaped and led more than 300 slaves to freedom via an underground railroad. She was a suffragette, a humanitarian and spy. As a child she was beaten by her ‘owners’ suffering a severe head wound which plagued her for life, causing seizures, narcoleptic attacks and severe headaches. Harriet Tubman, widely known and well-respected while she was alive, became an American icon in the years after she died. A survey at the end of the 20th century named her as one of the most famous civilians in American history before the Civil War. She inspired generations of African Americans struggling for equality and civil rights. ‘Minty’ Tubman told others when she died she ‘will go to prepare a place for you’.

Naming our daughter after such an amazing woman seemed apt and an honour. Same day we found out her Ghanaian great grandparents were called Minta. We gave her the name of a strong, independent woman who fought her life through great adversity and hardship. Little did we know that 3 weeks later we would be told our darling Minty had a life-shortening condition of cystic fibrosis.

ImageMinty is now one and what a strong little darling she is. She’s proving to be feisty, energetic, humorous and assertive. Everyday she kicks the ass out of CF. She will be an inspiration to us I am sure. Rancid tasting medications, physio and infection is part of her daily life. We are used to it now. Last year we were in a dark place and now we are totally and utterly dedicated to supporting her and hoping for a cure. Who knows what her future holds? I hope it is a bright one.

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So where are we now? Next week she has her yearly check up, including her first bloods and chest x-ray. I am hoping that all is well and the continuous coughs and colds she’s had most of the year have caused no lung damage. (P.S. please add yourself to the organ donation register as someone and their family would love your lungs should tragedy befall).

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We’ve amassed a huge array of blowing toys for physiotherapy – many of which come from my lovely brother and his wife (a community paediatric consultant who has to deliver such diagnosis to other families). These are great as they help create positive end expiratory pressure which splints the lungs open nicely. Great gifts for any child with CF. (Avoid bath toy gifts with holes in that collect water and culture hazardous moulds). CF physio can be fun!! Siblings can join in too.

I’ve met and talked to some other amazing parents who’s children have CF. We’ve cried together and shared our stories. We give each other hope and support.

2013 was pretty bad in places, so I wanted to start 2014 with a bang. So I have assembled a team of amazing people who are going to jump 10,000 feet out of a plane with me to raise money for the CF Trust. Scared to death of it. Freefalling at 120mph might put hairs on my chest, or rather blow them off. I am humbled and extremely grateful for the folk who are joining me in this challenge. Why raise money for the trust? CF is a life shortening condition that kills thousands worldwide and is carried unknowingly in the genes of millions. There are around 10,000 people living with CF in the UK, only half will celebrate their 40th birthday. In the UK five babies each week are born with it and two people lose their lives to the condition. We MUST raise money to find a ‘cure’, help people and their families live better lives with the condition.

Please visit our team fundraising page and consider sponsoring us, however little you can give, many will appreciate it.

We are JUMPING FOR HOPE!!

P.S. Next week I find out if my anaesthetics training application was successful. Nervous.

Checklists and Breastpads – That Doctor Business…

The deciding factor on becoming a doctor was about 15 minutes after an epidural during the birth of my first daughter. I was in awe of the anaesthetist, I could not believe that I went from the worst pain of my life to no pain at all. This man with his tray of marvels and skilled hands was a magician in my eyes. That was it. I MUST do that job. Though then it was the job of a physician not necessarily that of an anaesthetist.

Fast forward 14 years and I’ve been privileged to do two anaesthetic and intensive care FY1 jobs. Love it; love being in the anaesthetic room, love talking to patients before an anaesthetic, spending time with patients and loved ones in ICU. It’s a perfect blend of patient care, pharmacology, physiology, practical skills and technology.

The world of medicine and motherhood collided most embarrassingly one day when helping an anaesthetist in theatre. The surgery was over and the final checklist of sutures, swabs and so on was being applied. I do love a good checklist – so important in patient safety and improving the delivery of care. The theatre was in full swing. I glanced to the floor near the surgeon and noticed a small white circular pad on the floor. I was about to call out – you’ve missed that swab on the floor when I noticed to my horror that it was MY BREASTPAD. It had made it’s way quite happily out of my bra, over the top of my surgical scrubs and onto the floor. I cannot imagine how I would of explained my answer when someone picked it up and said “What’s this? This hasn’t been accounted for.” The anaesthetist must have observed this and felt unable to say anything as we chatted about propofol and ASA grades. Mortified I swept in and stuffed it into my pocket. Needless to say, if you happen to notice me take a quick peek down my front or gently pat my breasts discreetly (not in front of patients, of course) you know that I am checking for errant breast pads.

I'm sure this doesn't appear on a surgical checklist

I’m sure this doesn’t appear on a surgical checklist

Oddly, the journey has come full circle and I am now hoping for a career in anaesthetics. Unfortunately for me, it’s competitive, very competitive in this area. Add into that the need to stay local I have to drag myself to the top of a very large heap of applicants. We shall see. I’ve yet to apply. I shall apply this year, if all goes well. I say if all goes well as my daughter’s diagnosis with cystic fibrosis adds some serious perspective to life. She and my other children will always come first. Her consultant told me not to hold anyone’s dreams hers or my own. “You just carry on,” he said. “Life must be as normal as possible”.

Not that a life in medicine is normal. It’s unpredictable, challenging, hard work and ultimately rewarding. There are ups and downs, good times and bad times. Balancing motherhood and medicine has been an on-going battle – not sure I like that word but can’t think of another at this time. My status as older mum of four quite often baffles my senior colleagues. I can’t pretend it’s not awkward as an FY1 on-call with the consultant with whom my daughter is best friends with. Not often awkward for me, but sometimes for others. One consultant openly told me he was freaked that my kids were older than his. Another remarked when I said I wasn’t keen on paediatrics, “don’t you have a maternal bone in your body? Don’t like kids then”. “Yes”, I replied “I’ve got two (at that time) of my own”. Awkward silence ensued. Even the other day I was asked what I wanted to be ‘when I grow up’ by another colleague. I’m 43 in less than two weeks but I agree with you, I’m yet to grow up!

Now, back to what I need to do for my intended career. My checklist includes, audits, presentations, projects, publications, commitment to specialty and much more. Even on maternity leave I’m at courses, completing audit cycles and sorting the next detail to demonstrate my suitability for this career. Now, I’m not stupid, I know I’ve got a challenge ahead of me. I have my back-up plans. So let’s see. I’ve already been told by a retired anaesthetist that I haven’t a hope in hell, I should give up before I’ve even started, my CV will be in no way competitive compared to my younger colleagues. Do you know you’ll be 50 odd before you are a consultant? All in the space of 5 minutes of meeting me and knowing nothing about me. But we mature medics have heard this all before. We wouldn’t be standing in front of you if we’d not thought about this. But as I keep saying I am enjoying my journey rather than focussing on the destination.

Now back to those lists – shopping, ARCP, to-do. I do love a good list.

From There to Here

Medical school graduation and my girls!

Medical school graduation and my girls!

My previous entries are from 10 years ago. Just a brief re-cap to bring you up-to-date. Moved 5000 miles from California to England. Changed lifestyles, divorced, re-married and graduated medical school 3 years ago (see pic with number three in my tummy). Now a mum of four children and married to another doctor. It has been quite a journey – never focused on the destination just took each day at a time. Sometimes it felt as if I would never graduate medical school, much as it feels that I will never finish foundation year 1 as a doctor. But I did graduate, even managed honours, and am now set to finally finish FY1 this year having taken three years with two babies during it.  The journey still continues and I am enjoying (when I can) the ride. The destination? Who knows! Ride along with me.

Journey into Medicine – Roses

She was quietly in pain. Silent as she moved her body to the bed, grimacing with tears in her eyes. I helped her up. I looked at her unsure what to say. She reminded me of my mother. With silvery grey hair, she has bought a black knitted hat and blanket from home. We took a series of 6 or 7 hip x-rays. She moved her body the way the tech asked. She was so eager to please. She could barely hold back her tears.

I wheeled her to wait for the hospital porter. Finally, she could no longer hold it in. “Not everyone can do this job”, she said, “I want to thank you for what you did in there. Thank you”. I hadn’t really done anything. The tears began flowing. She had been in and out of the hospital with cancer for the past 18 months. She looked at me, looking for my understanding and said “I do not want to live any longer, I do not want to live with this pain. I just want to be able to say when enough is enough”. I saw her pain and wanted to help her. We talked for a while, I patted her shoulder. She seemed relieved; she just wanted to talk to someone. She just wanted to tell someone she couldn’t stand it anymore. I felt privileged that she told me, she shared her most intimate desire. She was not suicidal or hysterical, she was rational and clear.

I asked her how long she had been in the hospital for,  ‘just three days this time’ she said. She wanted to go home. Her daughter lived one and half hours drive away and would not be here this weekend. We talked about the house she has lived in for 40 years, her garden, and her love of where she lived. I took her up to her room and she was grateful. Climbing back to her bed, she looked happier, no longer alone in her moment of darkness. I do not know what happened to her. I think of her in her garden, enjoying the warm sun, the sweet scent of Jasmine, and pruning her white roses. This is where I hope she is now, and for the rest of her days.