Excerpts from this really hilarious yet true book on the ups and (mostly) downs of housemanship. Buku ni ditulis oleh doktor yang buat housemanship zaman dulu (a few years ago) when working hours were crazy (before the 40 hours a week limit) and housemanship was just one year.
The synopsis on the back cover:
Trust Me, I'm a Junior Doctor charts a roller coaster journey from idealism to bewilderment as Max realises how little his job is about 'saving people' and how much it is about signing forms and trying to figure out all the important things that weren't covered at medical school - such as how to tell whether someone is dead or not. Max and his fellow newbies grapple with these and other complicated questions of life, love, mental health and how on earth to make time to do your laundry when working 25 hours a day...
Wednesday 13 August
"You need to come and see Mr Clarke. I'm really worried about him. He's getting worse."
Silence. I blink. The nurse on the other end of the telephone isn't giving me any slack. "Er... hmm. What do you want me to do?" I eventually whimper.
"I don't know, you're the doctor. But you'd better do something and quickly."
It's a little after midnight, and I've already been working since eight o'clock this morning. This is the sort of call I've been dreading. At this point I have an almost overwhelming desire to cry, but seeing this is my first on-call, I decide it's probably a good idea to reserve that one for a later date. I arrive on the ward. Only the lights on the nurses' station are on, and there are several nurses sitting around writing notes. "It's OK, the doctor's arrived," I hear one of them say. My spirits lift but I turn around only to realise that they mean me. Oh dear.
Mr Clarke has got terminal cancer and, I learn from the nurse, is really just waiting to die. He's in his late eighties. His eyes are sunken and his face haggard. He's in lots of pain, is having difficulty breathing and, to top it all off, the nurses think he might have had a heart attack.
"Hello Mr Clarke, it's the doctor, what's the problem?" I ask, not knowing what else to say. I pray that he'll make a miraculous recovery as I stand there, but instead his breathing appears to be getting worse.
He looks up at me and in a hoarse whisper croaks, "Help me, doctor. Please."
My mind goes blank. I have no idea how to help him.
It was for the Mr Clarkes of the world that I became a doctor. I naively thought that after doing a medical degree I'd be qualified to help people, ease their suffering. But as I stare at Mr Clarke all I can think of is why does he have to be dying during my shift? Couldn't he have waited?
In medical school we were taught how the body works and how it goes wrong, and then we learned the theory of how to fix it. What no one explained to us is that it's all very well knowing the minutiae of obscure diseases that affect only a handful of people, but that it will be of no use to you when you start work. What you really need to know is the routine stuff: how to put in a catheter, order an ECG, prescribe medication or fill out a blood form, precisely the thing that medical school doesn't teach you [thank God we do learn that in Manchester]. I had thought, erroneously, that these gaps in my knowledge would be filled in before I started work but no one has even told me what I'm supposed to be doing, where I am supposed to be, or, most importantly, how to turn my bleep off. I haven't even had a proper conversation with my consultant yet. You would imagine that you'd be eased into starting work as a doctor - some guidance as you performed procedures you had never done before, perhaps even a little course on common mistakes that kill patients. But oh no, that would be too simple. I don't even know how to use the computers yet, which means I can't order blood tests. As I stand on the ward, Mr Clarke and his problems are not my priority. All I'm worried about is not making a mistake; not getting in trouble. It wasn't supposed to be like this.
What should I do first? I open his notes and my eyes rest on the last entry: 'Contact on-call palliative care team on bleep 0440 if patient deteriorates.' I call the number and with a beam on my face hand over Mr Clarke's care to the doctor on the other end of the telephone. Pass the patient, brilliant. Crisis averted.
A few hours later, just as I finally get into bed in the on-call room, my pager goes off again. I pick up the phone by my side and it's the nurse letting me know that Mr Clarke has died and the palliative care team have just left the ward. "They've left you the death certificate to write," says the voice at the other end of the telephone.
"Oh, em, right. How do I do that?" I ask, trying to remember the lecture we had only a few days ago from the coroner.
"I don't know," comes the reply. "You're the doctor."
Wednesday 27 August
Ruby is in trouble. Not with Housewives' Favourite, in whose eyes she can do no wrong and who I suspect has earmarked her as his next sexual conquest, having - according to hospital gossip [doncha just love hospital gossip?] - already worked his way through all the female members of staff who are continent and with their full complement of teeth. No, she's in trouble with Mr Grant. Lewis was late for a ward round this morning, and while normally the consultants appear oblivious to our presence, let alone show any interest in us, halfway round the ward he turned to Ruby and, in his booming voice, bellowed, "Where's the darky?"
"The darky what?" asked Ruby, genuinely confused as to what he meant.
Supriya and I, who were waiting for Sad Sack to finish on the phone, stood motionless by the nurses' station, listening.
"The black one, you know, the other one that you were working with. Gone back up his tree, has he?" he continued, oblivious to the patients and Ruby's open mouth. Surgeons have a bit of a reputation for being reactionary and rude. Mr Grant, who has obviously graduated from the Ron Atkinson school of political correctness, however, is in a league of his own.
Ruby, never one to turn down the opportunity for a fight, didn't let this go. "What did you say?" she asked, squaring herself up to him.
"Don't make me repeat myself. The other one. There are two of you. Where's the other one?"
"Do you mean Lewis? Your house officer?" asked Ruby, rallying for a fight.
"Whatever his name is, why isn't he here?" replied Mr Grant.
At this point most people hoping, as Ruby is, for a career in surgery would have let things lie. "You can't call him a 'darky'. That's racist. It's disgraceful," she said, ignoring the squeals from the rest of her team for her to leave well alone.
"It would be wise for you to remember your position, my dear," snarled Mr Grant.
"I'm not your dear, and it's racist to call people 'darky'. How would you like it if people said 'where's that fat ugly spotty one?' when they wanted to know where you were.
Mr Grant turned on his heel and went to the next patient.
"And if you listen carefully," said Clive, Ruby's registrar, as they followed behind with the notes trolley, "you can hear the sound of Ruby's surgical career going down the drain."
But Ruby doesn't care. And that's why she's my friend.
Saturday 6 September
Ruby is thinking of applying to Social Services for a home help. We're floundering. There is no food in the cupboards. When we leave for work in the morning, the shops are not open yet, and by the time we get home, they are all shut. We are currently living on condiments, because that's all we've got in the fridge.
Mayonnaise can be very filling when eaten in suitable quantities. But we can't go on much longer like this. Surely we qualify for a UN food parcel drop sometime soon?
Saturday 13 September
Met my mum today for dinner. Didn't have a great deal to talk about. She spent a good proportion of the meal complaining about how much weight I'd lost, as if this was something I had done on purpose.
Thursday 18 September
Much of medicine is about trends: patterns are studied and analysed and the results are extrapolated in order to draw conclusions. As a result, it's easy for doctors to make judgements based on appearance. Certain people develop certain diseases. The prostitute with a cough, for example will have HIV, the eighty-year-old lady with one will have pneuomonia, while the immigrant will have TB. This of course is completely wrong, as we were all reminded today.
While on call last night Supriya accidentally stabbed herself with a needle after taking blood from a patient. He had come in with abdominal pains, accompanied by his girlfriend. Supriya had clerked him in and taken bloods. She was tired and somehow, as she withdrew the needle, it slipped and she plunged it into her finger. She left quickly and ran it under water. The nurses in A&E informed her that there was a protocol to follow and that she should return to the patient, explain what had happened and request that he take an HIV test to see if she had exposed herself to it. Supriya didn't panic - here was a sensible, middle-class man, a stockbroker, in a stable relationship, in a district general hospital. He didn't inject drugs, he wasn't a prostitute, he wasn't gay. What was the worry? He agreed to have the blood test done.
"Sorry, just a formality you understand," Supriya had explained and the man and his girlfriend kindly smiled back.
It was several hours later, while the girlfriend had left the department to get some coffee, that the man asked to speak to Supriya. "Look, I don't want to scare you, but..." Supriya broke into a sweat. "Well, the thng is," he hesitated. "You asked me those questions about have I injected drugs before and stuff like that..." Supriya grew paler. "Well, the thing is, I couldn't say anything in front of my girlfriend, but I have slept with prostitutes." Supriya nodded slowly. "And I haven't always used a condom. In fact, I've been really worried that I might have, you know, well, caught something."
Supriya closed her eyes. "Are you trying to tell me that you think you might have exposed yourself, and therefore me, to HIV?"
The man nodded.
Supriya spent the next ten minutes crying in the toilet. "I just never thought it. He looked so, well, normal. You'd never know that he was at risk of catching that sort of thing. If it had been someone who looked, well, dodgy, I'd have been extra careful while taking their blood," she sobbed as she retold the story after the ward round this morning... It was scary to see Supriya, previously a paragon of control, in such a state. It emphasised the seriousness of what had happened; the possible ramification not only for her health and further personal life, but her career.
I wouldn't have thought that Supriya, so focused and clinical, would have been the sort of person to cry so openly. You should never make judgements based on appearance.
Thursday 25 September
Mrs Mullen has a new hip. She had to wait a year for it, she told me last week, not that she's complaining. In fact when she was on the ward, Mrs Mullen never made a fuss about anything. She just got on with it. She even ate the food without complaint. "I think it's marvellous what they can do these days. I was finding it so hard to get to the shops, it hurt so much, and now I could run the marathon, I tell you."
While grown men have cried when I've taken their blood (I'm being serious here), this woman didn't even like to bother the nurses for her morphine. She even offered to make her bed every morning to save the nurses from having to do it. She's eighty-three for goodness' sake. I'm in my twenties and have fully functioning limbs and I don't make my bed unless my mum's visiting and certainly wouldn't stop nurses from doing it for me.
"I sometimes think that people these days don't know they're born," she said, after hearing the fuss that Mr Lindley in the next bed made when the nurse removed his stitches. "To be honest, I didn't like to take up the surgeon's time getting my hip done, but my niece persuaded me."
I don't think they make people like Mrs Mullen any more. My generation are a generation of complainers. We think the world owes us something. But if the world owes anyone anything, it owes people like Mrs Mullen. She left school at the age of fourteen despite having won a place at the local grammar school. Until she was twenty she supported her mother and four sisters, working in a factory. She worked in the same factory until she retired. She never had a day off sick in her life and never had a holiday. Not even to have her three children.
But Mrs Mullen is no doormat. She makes a fuss when there's something worth making a fuss about. She has been a trade unionist all her life, has fought for equal employment rights for women, and, she told me with a grin, hers was the first in the country to get them. She fought for pension rights and disability payments. "Couldn't take time off in those days to be sick, too much to do. I had to stand up for those girls. The conditions some of us had to work in was dreadful. Wouldn't be allowed now, I can tell you."
...
Being a junior doctor isn't easy. But as far as jobs go, you could do a lot worse. You could work in a factory for fifty years and never have time off. Perhaps if my generation had watched our mothers die of TB we'd be thankful when we got treated on the NHS and certainly wouldn't swear at nurses who are only trying to take our stitches out.
I couldn't believe my eyes today when I went to buy a sandwich from the hospital Friends shop this morning and who should be standing behind the counter but Mrs Mullen. "What are you doing here?" I asked, open-mouthed. "We discharged you last week. You're supposed to be at home, taking things easy."
"Oh I am," she replied. "It's only a few hours a week. I saw the advert for volunteers. It's my way of saying thank you for all that this hospital has done for me."
A box of Terry's All Gold would have done. But Mrs Mullen is the sort of person that gives back more than she takes. I ask for a cheese and tomato sandwich. She hands me egg instead, it's all they've got. I hate egg, but decide to eat it anyway and not complain.
Saturday 11 October
A weekend off but both Ruby and Flora are on call. I stalk around the silent house, looking for something to eat. I wander into Flora's room, heaped with junk, paper, piles of washing and long-forgotten textbooks strewn on the floor. I listen to the radio. I read the paper. I decide I must do something today, reclaim something from the dying embers of the week. But what? Just as I sit wondering if it is too pathetic to go to the cinema on my own, my phone rings. It's my sister.
Now, my sister Ellen is far more intelligent than I am. For this reason, she never became a doctor. Not for her a life of death, depression and sleep deprivation, oh no. She went into recruitment and spends her days finding people their ideal job. Matching employers with ideal employees. It's a normal, 9-to-5 job, sitting at a desk with her own telephone and lunch breaks. Lunch breaks! Imagine that. A whole break, just to eat lunch.
"What're you up to?" she asks with all the bounce and enthusiasm of someone who hasn't spent yesterday with a digit up various strangers' rectums.
"Nothing," I say.
"Cool!" she replies.
God, I hate happy people.
"Want to go out for lunch?" she asks.
"Let me just check my diary, oh no, sorry I can't, I'm dying of exhaustion tomorrow," I say.
She ignores this. "So is my big brother going to let his little sister take him out for Sunday lunch tomorrow then?" she asks. I smell a rat. My sister is only fifteen months younger than I am and only ever acknowledges that I'm older when she wants something.
"What do you want, Ellen?" I ask.
She acts wounded. "What, isn't your little sister allowed to care about her brother? Isn't she allowed to be worried that he isn't eating properly, now that he's a responsible doctor? Isn't she allowed to take him out for lunch in order to build up his strength?"
I'm too tired to bother to remind her that I know her all too well. "OK, I'll see you at The Five Bells at 1 p.m. tomorrow," I say.
I bet she's got a rash or something she wants me to look at.
Sunday 12 October
"Will you just have a look at this?" asks my sister as she shows me a rash on her stomach. I knew it. I look at my watch. It's only 1.10 p.m. She could have at least waited until dessert.
Alright, enough of the extracts. I think I might get RSI now from all the typing. Go read the rest of the book for yourself, definitely a good light read for both medics and non-medics alike!
The venue.
My Skechers are no longer presentable, so mesti tukar kasut.
The supporters.
The photographer.
And the judge.
