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.

Advertisements

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.

Image

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).

Image

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.

We weren’t expecting you, but you are here now. Cystic Fibrosis – The Diagnosis

In medical school, the cystic fibrosis lecture was memorable. The lecturer, I do wish I could remember his name because I want to thank you for the hope he instilled, was passionate. He conveyed his excitement about the new drugs in development for CF, raved about the possibilities of gene therapy and said ‘there will be a cure one day’. It was like a performance, an uplifting speech, much of which went over my head as he talked about delta F 508, CFTR and so on. Interesting, I thought, but that will never apply to me as we don’t have the CF gene in our family. For sure we don’t; I’d have bet £1 million that we didn’t. Especially as I’m half Ghanaian. No way. That’s the thing, you imagine that these things always happen to other people. That’s what my doctor husband thought too when he sat through the same lecture one year earlier.

Our daughter’s life had a brief 3 week period of no known CF. We received cards and gifts, fell in love with her and celebrated her welcome into our life. She will be my last baby and she took quite a journey to get here. We were thrilled to meet her.

Here she is!

Here she is!

It’s always on the power of hindsight you look back and see hints of things to come. The newborn heel prick was memorable as she was reluctant to give her blood. The midwife came another day to try again. I nearly said ‘don’t bother’ as those things won’t apply to her. The test took longer than usual to come back. Odd I thought, I think they are repeating it. Still, I thought nothing of it. Some three weeks later while feeding in the middle of the night I thought, ‘it’s still not back I better just give a call’.

Didn’t need to because at 9am one Tuesday morning a worried sounding health visitor called to say we needed to go to the children’s hospital at 2pm that day. She sounded like she didn’t want me to ask her any questions. Panic ensued and I Googled the name of the person we were to see. Palpitations set in as I saw that she was the CF specialist nurse. My husband tried to reassure me saying it was probably nothing and that the blood tests were going to be repeated.

Now, I often tell patients to use the Internet with caution as there is a lot of misinformation out there. Googling positive CF newborn screening I found such misinformation. Confident that this was a big mistake and that the test would be repeated we went down, I nearly told my husband not to come. As a doctor, I had no idea that the heelprick test could be diagnostic. Merely a screening tool for other tests I believed. There she was a lovely healthy baby with nothing wrong with her.

As we arrived at the hospital I knew something wasn’t right. We were ushered into a room quickly, taken out of the waiting room. I felt this to be a bad news room. When the specialist nurse and consultant walked in carrying and large folder with our baby’s name on I thought, this isn’t good. This isn’t good at all. Why was the consultant there, what did he want?

They began by asking how the pregnancy went and how she was doing. “Fine, OK, she was just breech that’s all,” I said. From then on he explained how the test had shown the 99.5th percentile for the enzyme produced in CF patients. The blood sample had already been sent all over to labs here and there. Long story short, two genes were found. “That means that she has a positive diagnosis of cystic fibrosis,” he said.

Stunned.

Terrified.

Devastated.

Shocked.

I looked down at my baby. It was like I had been told she was dying. That’s what it felt like, looking back on it now. I was shaking so badly I thought I would drop her. My dear 3 week old baby, what life does she has ahead of her I thought. Tears ran down my face as I looked at hers, so innocent and so new. How was this tiny baby going to live her life like this I grieved. “Is there any chance that its a mistake?” I asked. I knew it wasn’t but just had to be sure. I was simply unprepared, not that you could be, for the diagnosis. I would pull myself together for a few minutes then burst into tears again. My two year old tore road the waiting room as if nothing had happened. We asked questions, we absorbed answers, though probably only a fraction of what was said. It seemed completely surreal. This couldn’t possibly be my child. My husband looked pale, in shock and spoke quietly. He felt the need to be strong, matter-of-fact, optimistic to support my postpartum collapse.

I felt that her future had been re-written. I felt that she was facing an unknown world. I wondered if we were up for the job for looking after her. I remembered patients I had cared for on a respiratory ward and I remembered the battles these patients had faced, the antibiotics, their life in hospital, their lines, their life. I remembered the lady I helped prepare the papers for her lung transplant. All of this flashed before me. In a moment, I imagined quitting my job, my child being ill, my family and a trillion other worries all at once. Our family’s future was also re-written. It was too much to take in.

This is where the consultant said, “you must not change any of your hopes and dreams for her or for you all.” “You must live a normal life.” Lots more was said about her going to university, school and travelling the world. I realised by the end of the two hours we spent there that we did need to carry on as normal. She needed us to be strong for her, to be her rocks of support, her advocates and love her unconditionally.

Coming to terms with the diagnosis and quest for information I found it hard as words like, life threatening, fatal, lung transplant and so on stood out. I chose not to read information that told me her life expectancy is 41. I know now that those diagnosed through screening can do very well because we catch it early.  We are now around 3 months into prophylactic antibiotics, Creon, daily physiotherapy and the amazing multi-disciplinary care team support we have for her. This is where I truly understand and appreciate how each individual contributes synergistically to brilliant care. I shall not go into details as every patient has their own care plan and experience of this journey. What I will say is that now, more than ever, I know we must be grateful for the NHS and the service it provides.

Reactions from family and friends were unpredictable. That was very hard. All I can say is call people, communicate even if you don’t know what to say. We experienced a sad sense of abandonment which will stay with us forever. If you don’t know what to say, say just that “I don’t know what to say”. Cards and gifts stopped and her birth stopped being celebrated. Some even said “I bought a present for her but I feel that I shouldn’t send it now”. Please do. It has taught me that no matter what every child’s life must be celebrated and welcomed. Each child has taken a difficult journey to get here. That said, support has been great. It’s brought many family members closer together. Our family unit of six seems stronger than ever. I’m extremely grateful for my rekindled relationship with my youngest brother, who has been outstanding. Thank you to him and to you all.

If you would like to know more about what cystic fibrosis is please look at the CF Trust website. If you have a few spare pennies or pounds (not that many of us do these days) please consider a donation to the charity. In America? Try the Cystic Fibrosis Foundation.

I am hoping that in her lifetime we shall find a cure. I believe her future, though uncertain, looks bright. But there’s much to be done.

My daughter and I

My daughter and I

Coping Mosaic

Getting through the day as a busy mum?! I used the following coping strategies: mugs of yummy tea, moments of beauty in the garden, baked goods including this Malteser Tray Bake and, admiring the beauty of my children and never taking them for granted.

My 14 week old daughter's chubby feet as she is asleep.

My 14 week old daughter’s chubby feet as she is asleep.

Nature's beauty. Flowers in my garden.

Nature’s beauty. Flowers in my garden.

Delicious tray bake, heck I'll even eat for breakfast. Don't tell my kids.

Delicious tray bake, heck I’ll even eat for breakfast. Don’t tell my kids.

Mum's mug of tea. Cannot live without it.

Mum’s mug of tea. Cannot live without it.

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 – White Doves and Screw Top Jars

During our training for the labour and delivery department we were never told about the white doves. I happened to read about the doves one night from a staff training book. I encountered my first dove one evening as I arrived for my shift.

The staff were unusually sombre, one nurse had been crying, it had been a long difficult day. A new nurse arrived to take over the shift. The nurses’ station was oddly quiet. I then saw the white dove on a patient’s door. This was her first child and she had come in at 28 weeks with signs of preterm labour. Every effort they had made to stop the delivery failed. I am not sure exactly what happened but in the final stages of labour the baby’s heart rate had dropped and she was born with no signs of life.

I was asked to pack up the baby’s wristband, footprints, birth card and other personal items. The mum had asked for them to be destroyed, but the nurses had stored them for her, in case she would change her mind. She never did, it was too painful.

I understand that the doves represent death, and letting the baby ‘go free’ to rest in peace. There was peace in the room, but a kind of empty, void in which nothing can fill. The mum looked grey, she did not speak, and she did not move as we moved her to the postpartum room where she would sleep hearing the cries of other living babies that night. Her husband spoke cheerily to me as I wheeled her over, he was asking questions like “where do you come from?” and so on like nothing had happened.

I was angry with him, I didn’t want to answer but this was his way of dealing with it. A kind of denial. He walked with a bounce and I couldn’t understand why. I wanted to respect her loss, her sense of solitude, emptiness and despair, filling the void with idle chitter-chatter seemed wrong.

I saw him leave 15 minutes later to go home. He couldn’t get out fast enough, I imagine that he needed to leave and mourn in privacy. I felt for the woman alone in that room with no-one there. I wanted to go in and be with her, but I’m not trained or placed to do so. I still wonder what she felt those first moments of being completely alone. That night I cried on the way home. I thought of that baby and the short life it had led.

Barely a week later I arrived for another shift. A woman 18 weeks pregnant had had a missed miscarriage. I didn’t know about her loss and she had no white dove on her door. I walked into the room and again noticed the silence and sadness that filled the air. I chose not to be with her as she had a D&C. It seemed bizarre that she had no white dove on her door, her baby had also died and she too was feeling the same loss.

A couple hours later I was given a screw-top jar to take to the lab. It was marked ‘products of conception’. I knew what I was carrying. I carried it in the elevator as others came in laughing and joking about other worlds. I looked inside the blood filled container and saw the foetal sac and looked away. I was carrying this to pathology. I’m not very religious but I said a prayer as I carried this ‘child’ to its final destination. To these parents this baby was their beloved child no matter how many weeks old it was. I carried the jar with the same love and respect I would have carried my child. Still they wouldn’t know that, but at least they know that someone cared.

** These are based on events, but genders, details and so on have been changed to protect identities. When appropriate, consent was obtained.