Becoming a Doctor

“Becoming a doctor in a pandemic. That sounds…intense”.

I have heard this many times from strangers, family and friends. 

But can you complain to your seniors, to the nurses who have been through so much?

I missed my exotic medical elective and graduation ball. Boohoo. NHS staff and the general public have lost their colleagues, their loved ones, neighbours, people who they will miss for a lifetime. Children have missed vital education for their social, cognitive and intellectual development. Surely I am one of the lucky ones and have hardly missed out? 

Induction week

Lots of new faces and new systems. A tokenistic, virtual zoom workshop on resilience. Predictable. Classic. The subject never to be paid lip-service to again. Get used to it. That is the system. How things are done. The status quo. I am used to it, medical school was the same. No surprises there. Reactive approaches rather than proactive approaches to well-being. The trendy social media phrase ‘we move’ comes to mind. 

Yet, we hear burn-out stories from doctors in previous generations of moving and moving until the point of sheer paralysis. Is this our fate?

Can we avoid this foreboding ‘paralysis’?

Self-Care perhaps. In other words, the onus is on you, the individual to be the captain, steer your tiny boat forward on your journey. Through stormy weather and all that jazz. Though, the more mental tools you acquire the more you are likely to stay afloat. Move your body. Feel those endorphins. Rest your body, value that sleep. Nourish your mind and your body with nutrients, fresh food, good food. Nutrition is key. Let your mind unwind. Empty the pressure cooker that is your mind. Reflect and choose to hold on or to disregard those intrusive thoughts, worries and anguishes. Journal. Meditate. Converse with a loved one. Engage with a therapist or counsellor. Do what works for you. 

“Do not forget to do your reflections in your NHS e-portfolio.”  A tick-box indeed for your foundation hospital regulators to ensure safe and ethical practice amongst their employees. However, ultimately, you could use this time to ponder over personal challenges, self-limiting beliefs, mistakes made and how you wish to move forward. 

Personal challenges I have encountered

“I will be a renowned Psychaitrist”, I say to myself most days. It keeps me motivated, it feeds my fire internally and I believe in the art of manifestation. 

Instead of sipping pina coladas on a South American beach, I spent my medical school elective in a West London Male Psychiatric Intensive Care unit. Nile Ward. I am almost certain the experience was far more rewarding than little me galavanting around tropical islands, scuba diving and tasting alluring magical island food. In the unit, I learnt the power of shared humanity. The intricacies of the human mind. The vulnerabilities, the challenges and the tragedies faced by these young men in the face of their mental illness. I got to know them, hear of their childhoods their family life, their culture, their likes and dislike, their music taste, their stories. I even got to cook with them, a great pleasure of mine. Despite being in a secure mental health facility, with certain rigid safety protocols, the gap between these patients and myself felt minimal at times.

My first week of work on the Stroke ward. My first job. My first time I was relevant, part of the team, adding value and able to say the phrase ‘my patients.’ I look at the reception board displaying patient names, telling you what bay and which bed each patient resides in.

Week 1 clerking (taking a patient’s history and examining them) “Mr Robertson presented with left sided weakness and was admitted on ….”

Week 2 clerking “Mrs Patterson presented with confusion and was admitted on…”

Week 3 clerking “Mr Ali was found by his carers with slurred speech and right facial droop on…”

Week 4 clerking onwards “Bay C, Bed 3 …oh yeah the brain bleed, yes I have told the nurses to monitor the systolic blood pressure and to let me know if gets to over 140”.

Four weeks it took for me to get on the dehumanising train that is clinical hospital medicine. Goodness me. I was a hopeful, forward-thinking and innovation-driven medical student, an NHS Clinical Entrepreneur, a medic with a bloody Medical Humanities qualification. I had promised myself I would not become disillusioned by the NHS system, despite being warned by many of my predecessors. I promised that I would not become less human myself, or treat people than less than. That I will always remain compassionate me. Congratulations Dr Ally Jaffee, you have made it. You are living the dream after six years of training. Well done, you are now proficient in objectifying vulnerable people, your patients. This indeed is a personal challenge I have reflected on and am working through. 

Mistakes

Mistakes I have made so far that have made it into my written portfolio reflections: 

-Incorrectly following the labelling protocol for blood transfusion. 

-Failing to label the blood bottles, having already sent them to the lab. This meant having to re-bleed the already uncomfortable patient and apologise to the lab for wasting their time.

-Missing the radial artery 5+ times when attempting to do an arterial blood gas (ABG).

-Needing to take bloods from the cannula I somehow managed to successfully insert, to realise that I automatically flushed the tubing system with saline, meaning…yup no bloods. Solution= re-bleed the poor patient.

When you finally get the hang of something through practice, you run the risk of turning into a mindless, automatic zombie. My lesson is learnt: pause and double - check what I need to achieve from the task-at -hand, to be more mindful and to ensure I have dotted the Is and crossed the Ts . 

Back on that boat

Back to that boat metaphor from my earlier rambling. This boat that you are steering, that you are the so-called captain of, well the boat structurally is sadly pretty flimsy. This is secondary to diminishing resources, lack of attention and ultimately a broken system. However what you have to support you through this unpredictable, uncertain yet at times rewarding journey are none other than an unforgettable crew. Crew that make your days, your work, your existence less heavy. They are your support system. You have your seniors, who dependent on their disposition and outlook on ‘our generation, us millennials’ will inspire you and ups-kill you.

Or they can simply turn around and say: “Come on why are you so tired ?! We worked way more hours than this back in my training days.” That stung just a tad. You have the nurses that guide you and are genuinely the backbone of your clinical team. When you are on your own at weekends as the on-call duty doctor, they are seriously your lifeboats. They help you order your thoughts, to make a pragmatic clinical decision and they can also incite you with laughter and calm. If you are lucky to work in such a varied multi-disciplinary team like me on the stroke ward, you will also have your physios, occupational therapists, speech and language therapists to have a great gossip and chin- wag with. Finally, your fellow foundation doctors. Humans who hold your hand, laugh and cry with you as you do with them. They really make the long training and job worth it.

Find the ‘right’ crew for you and you’ll manage to stay somewhat afloat. 

Guest blog by Dr Ally Jaffee MBChB BSc.