The one where Romeo was done: the Junior Doctor Years

 

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When I started my first few days as doctor the BMA asked to write about it in a blog for them.

Now on the very last day as my time as junior doctor it only feel natural to reflect on how I was feeling then and how I’m feeling now.

I went to a brilliant medical school but I didn’t feel ready to be a doctor. As a wise friend reassured me, there was no one at that point who was more qualified at that point in their career than me and my other colleagues fresh out of medical school. Even with all the reassurance it felt like a big plunge. 

First day on the job, F1 Aslam in General Surgery. A speedy ward round and then we were on our own. Yes we had seniors around and luckily they were lovely so we could ask them if we needed help but I do remember looking at the other F1’s and thinking “right, so it’s us guys”. 

 

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We made it through our first job. Where we stumbled we helped each other up. A sympathetic ear in the corridor. A text, “I’ve left you a coffee on ward 31”. A reminder to handover and just go home. The struggle was too real but we were in it together. We understood each other.

Then at that magical period when we had all learnt all of the important codes, where the good coffee was and who to go to  if you needed help, we were split up and it and it was a start from the bottom again.

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New job. New people. Unknown Salma.

F1 Aslam Acute Medicine. The weight loss ensued. I literally dropped a dress size and looked dreadful. 

“Don’t eat by the computer, have a proper break” I’m told by one of the consultants.

This job is a lesson in how to look after yourself because I was failing at that on an astronomical level.

Teary on the way home from work. It’s just never enough. I learn by the end that it is is never enough. All you can do if your best and that is good enough. There will always more patients to see and more jobs to do. Self preservation is paramount.

Final job of F1. Reunited with one of my friend and we become team gastro. 

Gastro makes me hangry at time and we stay late a lot. On those really bad days, we get give sympathy chips from the ward hostess and inhale them.

The weight loss is rectified much to my families relief. Punjabi family- no one liked slim Salma. 

We panic less. We’re almost at the end. I’m with my friend. If we have tough days we have each other and cake. Cake is our friend.

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End of the year. Breather for a hot minute and then we’re a back to it.

Something different for me. F2 Aslam Hospice.

This job is an honour to do. The best nursing I have ever seen, the most dedicated staff and I learn some important life lessons.

I start horse riding lessons, there is nothing to wait for and no ones guaranteed anything. I try to be as brave in my own life as the patients around me and go after what I want. I try to appreciate more the everyday. One of my patients sits out in a chair with the help of the physio before I go on leave. It makes my week.

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The first job I have been sad to leave but onto Radiology.

The supernumerary life is sweet and I get to learn. Ironically work usually get in the way of learning. Here I am a sponge. I am jealous of the Radiologists eyes and brain. Apparently we can see the same thing but really they’re the only ones seeing the images. I play envious spectator, go the MDT meetings and get to help with interventions. I go to ITU and see ultrasound at the bedside. I get time to use the ultrasound probe. People know my name. They encourage me. I’m in a happy radiology bubble and decide to apply so that one day I can sit in the lower GI MDT and feel really smart too.

I get into Radiology and it’s a win for hard work and being brave.

Last job F2 Aslam the GP.

I left my heart in Radiology. It’s a different world and I realise early on that it’s not for me. Long days with no other juniors around me.

Never ending tea and tasks.

Done.

One months funployment until Radiology starts.

Do I feel ready for that? Well just like Salma at the end of medical school, no, but I’m as ready as I’ll ever be.

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Until the next post xxx

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The things we pay for

 

Sometimes I have a lot of words to say but on this occasion I think the picture and caption don’t need my words.

 

 

“Social media is not free you pay with your attention.”

 

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Until the next post,

Salma xxx

 

 

Confessions Of A Junior Doctor

 

 

There are a few things that us Brits care greatly about. The great British Bake Off (and the colour of Mary’s jacket). A good cup of tea. The weather. Oh, and the NHS.

(Another) election also means potentially more shake up for the already struggle institution that we all know and love so when it came to watching the first episode of the new TV programme from Channel 4, I feel we all sat up a little straighter.

If the reaction from twitter and my non medic friends is anything to go by, the new documentary following junior doctors in Northampton General Hospital touched a nerve with everyone. For the medics it was a case of “yep, I remember that” and for the non medics it was an unfiltered eye opener.

People relate to people and for all the talk about the much contested junior doctor contract this programme wasn’t about that. It was about the people on the front line doing that thing that they loved and living with the very real consequences of a system under pressure. Like their patients helpless at times in the face of disease, these junior doctors were also visibly helpless to the pressures of the NHS. The 9-5 working day which many doctors know in reality is an ideal more than an often subscribed to reality was demonstrated by the doctors having to stay late at work.The statement of “a large part of it runs on the goodwill of the staff..without that there would be no NHS” rang particularly true.

If there is one thing keeping the NHS together it is the people. As a junior doctor myself I have had some of the hardest days of my life at work. I’ve cried. I’ve run around like a headless chicken. I’ve stayed late. Yet with all of the difficult conditions why do we all stay?

It’s a question I’ve asked to junior doctor friend before. Their confessions weren’t caught on camera but rather in my car, or the canteen, or on the way to the pathology lab because the pod system stopped working. The response comes in many forms but ultimately the answer is something like “because I care”. And that I find universally in the NHS.

For all its flaws and imperfections, it’s filled with some of the best people. People I feel lucky to have worked with. The other day I found a consultants doing a ward round at 7pm on a Friday evening. For those of you who don’t know this is quite unusual. They weren’t being paid for this. They just wanted to make sure their patients were ok. When I went to help I was told it was all in hand and there was “a system” in place (that perhaps I would have ruined!). This is one example of someone going above and beyond their “job”. Everyday I see this. I don’t even have to look hard. I meet a million unsung heroes everyday on the NHS.

If you haven’t already gathered I’m a fan of this programme. For someone who doesn’t own a TV and doesn’t watch any TV programmes regularly, I shall be tuning in again.

The long and short of it the NHS is breaking but people still care. I don’t have a solution but I do know where you can go to educate yourself about the real state of the NHS every Wednesday at 9pm on channel 4. Oh and vote wisely.

Until the next post,

Salma

Wanderlust or procrastination?

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I’m the kind of person who is naturally very reflective. To you it’s a walk to the shop and a rude person who doesn’t serve you quickly enough. To my it’s life teaching my about patience and a little reminder of what not to do.

I though I would share some thought that I’ve been having recently to the aim that it might stimulate some debate and may make you think a little.

“I love to travel”. “Wanderlust”. “I’ve got the travel bug”. If i had a pound, scrap that penny, for every time I’ve heard that recently.

Apparently, we’ve all been bitten by the same thing. We must have all eaten the same rotten fruit. Work pressures, failing relationships, debt, or maybe just the wish to see something new and learn about the world. It looks like we ALL suddenly want to travel. Everywhere. And all the time.

Now don’t get me wrong. The thing I said about wanting to see the world and everything, I buy that. I also want to see what people my age are doing half way around the world and learn from them. I want to go to the far reaches of the world just as much as the next gal.

But to my over reflective self, I also see something else going on. Procastination. “I don’t know what to do so I’ll travel”. That’s not to say that that isn’t a good use of someones time, because I really think it is, the world has many lessons to teach us all. But the bigger issue I have is how will this help you figure out that thing that you want to do? Or that decision you want to make. I’m all for taking some time out to think about things, but what I don’t agree with is wasting time.

Because time is precious. It’s why I can’t have something in my life I don’t think is good for me. I can’t do fake friends. I physically can’t tolerate it. My body shuts down. My mouth won’t open. I have nothing to say (and if you know me you know I don’t shut up and as my friend you have to tolerate me). Time is a GIFT. It will never come back. That thing you’re deciding on might not be possible in a few years. That career. That family you want. That move round the world. That visit to a family member. Whatever it is.

As one of my faviourite TED talks said “I’m not discounting 20 something exploration, but what I am discounting is 20 something exploration that’s not suppose to mean anything”.

If you read my last blog post, you already know that I’m quite an extreme person. I don’t like that TED talk I LOVE it. I come back to it time and time again. Life gets messy and that reminder can get lost. I need to remind myself first of all.

So I’m gonna just leave this post and that talk here. Think of it as life giving you a little reminder. Or you could just think of it as that Salma girl with one of her (maybe annoying) blog posts again. Whatever.

Either way, it’s here.

Have a great day.

Salma xxx

Daring greatly: moving to the dark side

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I’m an extreme kind of person. I don’t know how to like something a bit or do a bit of something. If I’m in I’m in.

Recently I threw myself into something at full speed. My medical speciality application. I went full steam ahead chasing my dream as if nothing could stop me. I couldn’t guarantee that I would get in but I dared to try.

And I honestly think that that is half of the mental battle. In the process of applying for this job I was told so many times “oh that’s really competitive”. And the speciality I was applying for IS competitive. It’s not untrue, but the undertone of that comment was often quite negative. Discouraging even. Once I decided that this was the only thing I wanted to do, I blocked this out. If I didn’t I really think that I would have been paralysed. Too scared to even try.

Later I would choose to reply to this comment with “yes, but I’m also a competitive applicant. I make up that competitive pool too”. And it’s true. For everything that is “competitive” firstly, YOU are also part of that. Secondly, someone HAS to get the job so why wouldn’t it be you?! I put that to the side.

That wasn’t my priority because that wasn’t my decision. All I could really impact was me and how I performed on the day and the things that I could do to try my best to get my dream job. To waste mental energy on anything else is unnecessary baggage and when you’re trying to climb you gotta drop that baggage or you’ll never get anywhere.

I guess the point that I’m trying to make is nothing ventured nothing gained. To give yourself a chance you have to try and to try is to be brave.

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On the day of my interview, when my portfolio had finally come together, I cried! Not because anything awful happened but because I had even gotten this far. I was proud of myself and whatever the outcome almost didn’t matter because I had tried my best. At the end of the day that is really all that counts. Yes I would have been disappointed to not get the job I wanted but the biggest tragedy is to not try.

I’m talking about chasing a dream job here but the same rule applies to anything in life that is a bit scary to go for. That thing you want to do but you convince yourself you’re not quite good enough yet. You just have to be a bit brave and got for it. Brene Brown (if you don’t know who this is, google her, she’s amazing) introduced me to this quote below by Roosevelt. To me it’s about trying. Being brave. Daring. It’s not easy but the rewards are so sweet. When you don’t try, you don’t enter the arena and you fail yourself already. I almost did that to myself, but a mustard seed of faith and a pinch of bravery and a why the hell not me attitude, helped me get past that.

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.”

 

I’ll be starting training in Clinical Radiology in a few months and if I didn’t dare greatly, I would be either starting nothing or starting a job I never really wanted to do. There is nothing special about me that isn’t in anyone else. I just gave myself a chance by trying and if I didn’t get in first time round, I would have given myself a chance again.

I hope this post spurs you on to think of an area in your life where you could dare greatly.

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Cheers to chasing the dream

 

Until the next post,

Salma xxx

perception Vs reality: death, the failure to cure

 

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Christmas at the Hospice

A wise person once told me there are only two things in life that are guaranteed. Life and death.

Out of the two, I think we have a problem with talking about one of them.

I love life as much as the next person but I think my views on death are quite different. I think there are major issues with the way we look at death. Both the general public and as doctors.

As a doctor I often get the feeling that death is seen as failure (and sometimes it is when we get avoidable things wrong). But most of the time it really isn’t. People age. Organs tire. Treatments don’t always work. It’s at this point that we have to take a step back and think about what we’re really trying to accomplish.

Our aim changes. There’s a branch of medicine that deals perfectly with this change: palliative medicine. It’s may not be everyones job to treat dying patients, but it’s everyones job and business to recognise when someone reaches this point and to do something about it.

I’ve been working in a hospice for 4 months (really not as depressing as you might be thinking) and no I didn’t spend 4 months trying to save someones life. What I did do was try to help a little. Sometimes that meant treating an infection and other times it was treating agitation at the end of life.

I’ve moved back to the hospital now and it really doesn’t take very long to come across patients who are at the end of life. Yes we can all recognise it but I really think we have big issues in being black and white about it and saying it.

I’m not saying it doesn’t get said. But I think there is often a delay in relaying what we can all see happening and communicating that to the patient and their families.

I think it’s a cultural thing. You go to medical school and you become a doctor to “save lives”. Then you’re faced with a patient with a condition you can’t cure. They may not be imminently dying but you know they will at some point. Your mantra of “save lives” suddenly becomes a bit redundant. I’ve seen a mix of reactions to this from avoidance to a feelings of hopelessness. The end result of this is things don’t always happened as quickly as they should.

If you’re patient is having a heart attack you don’t delay telling them and starting treatment if it’s appropriate. The same attitude should be applied to the dying patient.

It’s can be a difficult discussion but it’s just as important as telling someone about a heart attack. It isn’t always a failure or anyones fault. People die.

I was also one of those doctors who went around with the attitude of “I save lives” (or at least I was trying to). My effort for my patients hasn’t changed but my perspective on what I do has. I now like to think of what I do as “I try to help”. Whether my patients can be “cured” or not, I’m always trying to help them. It makes dealing with the “we’ve reached the end of what we can do to cure this illness” conversation easier and also stops death from being the enemy.

Because if I’ve learnt one thing from my 4 months at the hospice it’s this. We might not always be able to cure disease or avoid death but that doesn’t meant there still isn’t a hell of a lot we can do to give someone the time and dignity to live the time they have left in the way that they want to.

Until the next post,

Salma

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

GP land: over the hills and far away

 

In case you missed it and want to have a read, here is a blog post I wrote for a GP magazine on the language we use in healthcare and the importance it might have.

Happy reading!

Salma

xxx

 

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I was a medical student and I was in a clinic with one of my favourite doctors. He had a two-eared stethoscope (the only one I have ever seen to this day), would often hand me the drug chart during bed side teaching and ask me for a differential diagnosis and he called me Faiza for a year because I once sat in Faiza’s chair. He was so nice I didn’t mind that after six months he’s still called me Faiza.

One day in clinic we were trying to contact a GP surgery to get more information for the patient who was in front of us, a confused breathless man. We called several times but the line was engaged and then no one would pick up. No luck that afternoon.

‘No response from GP land’.

 This was the first time I had heard the term and since then it’s not been an uncommon term for me to hear around the hospital.

When I first heard it, it reminded me of something akin to the telletubbies: ‘Over the hills and far away the GPs come out to play?’

Language and choice of words interest me. GP land is banded about all the time. In general conversation, in on call rooms, in multi-disciplinary team discussions, but do the words we have have an impact on how we view certain specialities?

GP land is far away from us ‘the hospital’. GP land is unrelated and like the telletubies say, over the hills and far far away. Once the patient is there they are very much someone else’s responsibility, the GP’s, there to pick up the pieces after a hospital admission at the mercy of a discharge letter for information.

The patient, who every physician will agree is at the centre of their efforts, has interactions with so many different specialities but the ‘us’ and ‘them’ attitude between doctors in every speciality still surprises me. It doesn’t help. Being a junior doctor you quickly move around specialities and you straddle the line between us and them. One day you’re ‘with the surgeons’ and the next you can be in ‘GP land’. Same patient, same you, but a different hat and different outcome even though ultimately we all want the same thing; the best outcome for the patient.

One of the hardest hats to wear is that of a GP’s in GP land. The hats there don’t have the fancy gadgets of the hospital.

In an ideal world patients would move seamlessly between primary and secondary care but as long as ‘GP land’ and the ‘big bad hospital’ attitude exists we as clinicians don’t help things. Yes there are bigger reasons behind the sometimes not so seamless primary to secondary care exchange, but sometimes something as simple as the language we use can shift attitudes a little and change thinking from ‘us’ and ‘them’ to ‘we’.