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Posts by Beth Routledge

All About The Glamour

If you ever find yourself thinking about going into medicine for the cars (with lights and sirens) and the booze (rx: diazepam and Pabrinex) and the women (competent women in scrubs are attractive in real life, too), remind yourself of this:

It will happen from time to time that you are eating lunch and doing paperwork, when one of the nursing staff will appear, and, via eyebrow semaphore and a series of deeply apologetic hand gestures and the fact that with the other hand they are carrying a distinctive shape covered in an array of paper towels, communicate something that, eventually, leads to you saying,

“Oh, God, do you want me to look at it?”

For The Souls Of Our Departed

For empty spaces at dinner tables. For graduations and weddings and birthdays not attended. For family not met. For hugs that will never be given and calls that will never be answered.

For all the saints who’ve known your love.

For those who died trying to make the world a better place, and for those who died trying to make a better place for themselves in the world.

For those who have died in the broken heart of this city.

For those who have died on the battlefield.

For those who have died as a result of racism, or homophobia, or sectarianism, or gender inequality.

For those who have died at the hand of their own demons.

For the people whose hands I’ve held as they died. For the people who I couldn’t bring back to life.

For the times I send someone into a room to say goodbye to their person, and the ones I can’t get there in time.

For the person for whom the wail of a siren broke from Great Western Road into the middle of Psalm 23, a brief invasion of chaos to remind us that the tragedy goes on, always, and that our humanity is in grieving it, yes, but in fighting it too.

For the names and the names and the names of the people we have remembered by name. For the safekeeping of those names throughout the year. For the people who they were loved by, and are loved by.

For the people who I love and see no longer.

For those who die alone.

For those who will die tonight.

For those who die with no one else to pray for them.

For all who here sought and here found him, whose journey is ended and peril is past.

For everyone who we have ever loved who is now safe with God.

For the tears we cry tonight, and for the promise of the Resurrection too.

Alleluia, Alleluia.

A Meditation On The Never-Ending Shift

I am a newly minted SHO, on my first weekend of FY2 nights.

It is a couple of minutes after one o’clock in the morning.

I have been at work for nearly five hours already and things are mostly under control. I’ve checked in with the seven wards that are my responsibility, chased a few bloods and a CT scan, admitted someone who had been transferred from another hospital in the late evening, seen a couple of sick people, answered a phone call from my registrar who is on call from home and wanted to check in with me before she went to her bed.

The staff on this ward have made me a cup of tea and encouraged me to help myself to the box of Quality Street on the desk as I write them up some paracetamol and routine fluids.

My tea-and-chocolate-and-fluid-prescribing is interrupted by my bleep, shrill in the night shift quiet.

A patient on another ward has spiked a temperature. It isn’t unexpected, but can I please go up and do the appropriate things? I go, dropping off my fluid chart at the nurses’ station on the way.

Upstairs, the patient I have been called about is reasonably well with their temperature. I examine them and explain what I’m going to do. It is a hospital where we have regular patients, and for this person it is not their first time at this particular rodeo. They are ruefully accepting. I look through their notes and obs, take bloods and blood cultures, and prescribe antibiotics and a bag of fast saline. I make a plan with the nursing staff that I’ll review them again later in the night, after the antibiotics have gone through; but they’ll bleep me before that if they are worried.

The radio that I carry on these shifts squawks at me. The shift coordinator wonders if I can put in a venflon — the patient is due medication, and our clinical support worker is busy and anyway in a building on the other side of the hospital campus. Yes, of course I can. The procedure is straightforward and done quickly. I check my jobs list, and rewrite a prescription chart and update some fluid prescriptions while I’m there.

I cut through the ward next door on my way back downstairs. I am intercepted by a member of the nursing staff. A person has died. We speak about whether the death was expected — yes — and the patient was comfortable — yes — and the family were there — no, but they are on their way back. I go into the room and spend a few minutes with the person, and perform the last offices of my profession. Afterwards, I locate their medical notes and document my findings. Rest in peace, I write.

I arrive back at my now stone cold cup of tea. I have been away for an hour.

It is still a couple of minutes past one o’clock in the morning.

Keep watch, dear Lord, over those who worked and watched and wept this night.

Running Into The Fire: In Praise of Medical Aid Workers

My thoughts over the last week have been very much with Pauline Cafferkey: the nurse who flew to Sierra Leone at the height of the Ebola epidemic, contracted and initially recovered from Ebola this year, and is now back in the Royal Free Hospital in critical condition.

Since the outbreak of the epidemic last year, hundreds of NHS staff have assisted in the crisis — mostly nurses and doctors who responded through the various voluntary agencies and through the voluntary government registers.

But did you know that this hasn’t been a one off?

The situation in West Africa over the last eighteen months is something that has generally been in the public consciousness. It could hardly not be, although, not for nothing, but as a geographical hemisphere it took a Western woman contracting the virus for us to really start paying attention — Teresa Romero, a nurse who came into contact with it while working with returned travellers in Spain. The efflux of healthcare workers to Sierra Leone, Liberia, and Guinea and then their return has also been something that has been known and talked about; again, it could hardly not be.

I suspect though that people are generally less aware of the thousands of healthcare and healthcare support staff who go to work around the world in areas of acute crisis and longer term humanitarian needs.

A few years ago, I had the privilege of meeting Christopher Bulstrode, a trauma and orthopaedic surgeon in Oxford who is just one such person. He wouldn’t remember me: he was the highlight of a medical student conference that I was at in Bournemouth. At the time he was not long back from Haiti, where he had been part of the immediate response to the earthquake in 2010. They are a few years old now, but his diaries from Haiti are well worth reading.

A lot of the work is coordinated through NGOs: Medecins sans Frontieres, Medecins du Monde, MERLIN, Voluntary Service Overseas, and many others. The staff include doctors and nurses, but also pharmacists, logistics coordinators, mental health staff, lab technicians. It isn’t only on home turf that a multidisciplinary team is needed. 2500 staff go into the field every year from just MSF in the UK alone.

There are also staff in the UK who are registered with the international emergency medical and trauma registers (UK-IEMR and IETR). They were set up twenty years ago so that doctors could go to Sarajevo in the Balkans War, and have existed ever since. They were part of the response that enabled medical staff to be despatched to the Philippines in the aftermath of the tsunami and to Haiti, as well as during the Ebola epidemic.

I am in awe of all these people; of their skills and their selflessness and their courage.

And in that isolation tent in London, of a nurse from Glasgow too.

My thoughts and prayers remain with Pauline Cafferkey, and with all medical aid workers stationed throughout the world and the ones who have now returned home. They are people who willingly go into the middle of situations that most of us would rather turn tail and flee from, with their only real motivation to help people who need help. I am in awe of them and I am humbled by what they do.

Not Safe, Not Fair

For the last few weeks I have been giving daily thanks for the combination of fate, circumstance, and medical school admissions committee that led to me moving to and falling in love with Glasgow eight years ago.

Because I live in Scotland, I have not been forced into seriously thinking about taking industrial action as the only viable way to save my profession. Because I live in Scotland, I do not wake up every morning feeling sick at the prospect of not being able to pay my rent come next August. Because I live in Scotland, I have dodged the bullet of the imposition of the new junior doctor contract by the Health Secretary in Westminster.

In England, my colleagues have had an exhausting couple of months. They have been devalued and demoralised. They have been accused of lacking professionalism and vocation. They have been threatened and lied to and bullied and abused. They have fought back against their bullies. And they have done it while routinely working more than twelve hours a day and working twelve days in a row, and at a time of year when most of them have been rotated into new jobs in unfamiliar hospitals in areas that will not have been entirely of their choosing.

Last night in London there was a peaceful protest by thousands of junior doctors marching on Whitehall. It was the biggest march by junior doctors in history.

They were protesting the imposition of a contract that will result in the following:

  • A pay cut to all doctors below consultant grade of anywhere between 10 and 40%.
  • An end to the safeguards in place to prevent Trusts from forcing their doctors to work what are considered unsafe hours.
  • An increase (from 60 hours to 90 hours) in the hours worked that are considered “social”, so that in effect working at 9pm on a Saturday would be the same as working at 2pm on a Tuesday.
  • A financial penalty to people who have children (thus increasing gender pay disparity), to people who change specialities, to people who choose to take time out of programme to do research, to teach, or to further their own medical education, to people who change specialties.

In July, the British Medical Association left talks about the proposed contract after it was made clear to them that they were not allowed to negotiate unless they accepted certain preconditions of it including that pay cut of an unspecified amount. We are now nearly three months away from that and still NHS Employers in England have refused to withdraw their preconditions for negotiation, have been unable or unwilling to put a number on what people can expect their salary to be in August, and today cancelled with five hours notice a series of meetings that were being held for junior doctors to ask questions about this contract after it became clear to them that junior doctors were going to protest and were going to ask questions — questions, one can only assume, that will be awkward and embarrassing to these agents of our anti-NHS government.

I am now into my fourth year of postgraduate working and my third year of postgraduate training. I spent last year employed not in a training programme. I spent a year being a doctor in the job for which I was contracted and then in my evenings and weekends running around various hospitals in the west of Scotland being a locum to plug rota gaps, keep up my acute medical experience, and make up for the fact that I would not have been able to pay my bills on my basic salary. I got a lot of experience last year. I took that year because of a commitment to both my specialty and my region, a commitment for which under the proposed new contract I would have been penalised.

I am still considered a junior doctor and still will be for at least another eight years,  providing I don’t extend my training to do anything like teaching, researching, or having children, all things which under the new contract are considered mere frivolities of no value.

My current rota has had me working one in two weekends since I started this job in August, which is legal because I’m not on the rota to do more than twelve days in a row. I finish a run of night shifts at 9.30am and am expected back at work at 9am the following day, which is legal because I’m getting the mandatory eleven hours of rest between shifts. I have been working a 59 hour week on average, although often running straight into another week without any days off, which is legal because I get a few weeks now where I’m not on call at all and so over the course of sixteen weeks it will (presumably, although I haven’t actually done the maths) average out to 48 hours. My colleagues and I come in early and stay late and, no, despite the hilarious conversation I had with the rota monitoring department last week, never go to lunch, on the days when that actually happens, without taking our pagers, and wouldn’t want to. Any reading or exam studying or teaching preparation has to be done in my own time. I am paid a £32,000 basic salary for this (before tax, pension contributions, National Insurance, or student loan repayment) and then an additional 50% banding supplement (on which I pay National Insurance, tax, and student loan repayments, but not pension contributions) for the extra 10 hours per week (the basic salary is for a 38 hour week) and the fact that a percentage of my hours are worked at night and at weekends (these are “antisocial”, partly because they are antisocial and partly because work intensity is higher at those times).

All this under the current contract. My rota is within legal limits and probably not even the worst I’ve ever had and I am renumerated well for my work. I am not looking to work less. I am not looking for a pay rise. I tell you this all to illustrate why my colleagues in England are fighting so hard against a contract that will make it worse, for less pay, and with no repercussions for any of the safeguards being violated anyway.

It is insulting and demoralising, yes, but it is also not safe. It is not safe for doctors, but it will not be safe for the patients either.

To read some of the papers and even to read some of the documents from NHS Employers themselves, you’d be forgiven for thinking that people who aren’t consultants are just playing at it. No. I remember primary school, and playing was never this exhausting and never with this much riding on it. No, no junior doctor is playing at it, and the majority of us aren’t fresh-faced dew-eyed just-finished-medical-school 23 year olds with not a care in the world either. The few who are don’t stay that way for long. You don’t, not after you’ve run an overnight surgical take by yourself in an inner city hospital or been part of a team that was unable to resuscitate someone or been the person to give another person the worst news they will ever have. This is a difficult and demanding job, and we do it proudly and we do it well and we do not stand quietly by while our work is devalued and our patients’ care is compromised by making them be cared for by doctors who are being forced to work unsafely.

I know — oh, believe me, I know — that we have not yet returned to the bad old days of hundred hour weeks and thirty-six hour shifts, but remember, if that’s going to be your argument, just remember that doctors campaigned to get that changed. It was done then, and it can be done again. I have never known the medical world be so united — senior colleagues, the BMA, the Royal Colleges, all of them standing up and agreeing with us that this contract will be bad for doctors and bad for patients, and if enough of us keep talking then eventually someone will have to listen.

Yes, junior doctors in Scotland and in Wales too have got a lot to be relieved about right now, but from our safe havens we have a responsibility to stand up for our colleagues in England and we will do so.


On the first day of my new job, I learned that I was going to need to move house.

This was nothing to do with my job or my commute — I’m only moving about three hundred yards down the road, although it turns out that doesn’t make a difference to how much work the actual moving is. Still, it’s not the evening you plan, is it, for when you get home from your first day?

This led to a months of phone calls that sounded like, “This property does require you to be in full time employment. Are you in full time employment?” “Yes. Yes, I am.” “Excellent. Now, we can offer viewings from 9.30am until 4.15pm, Monday to Friday.” And then the ones who let me view things in the early evening, racing there from work, and were very keen on the single quiet teetotal doctor looking for a long-term let until I mentioned that I’d be wanting to bring a couple of jungle tigers* with me.

Nevertheless, I have acquired a new flat and the last few weeks have been a flurry of form-signing and organising and box-packing and address-changing.

I own more books than I thought I did.

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Normal service will resume soon.

“I have two small well-behaved house cats who have lived in a a rented flat for three years and for whom my landlord is happy to provide a reference.” You’d have thought I was saying I planned to raise show ponies in a one bedroom flat in Shawlands.

The Sun Is Coming Up

You find me on a late summer evening, slumped at my dining table, in sock feet and an old race shirt and ancient leggings. My hair has long since given up on its plait. I have no idea what timezone I’m in. The only decision I am competent to make tonight is what kind of food I would like the delivery people to fetch me. I’ve either just flown halfway round the world, or else I spent my weekend going from dayshift to nightshift and back again by Tuesday morning.

Internet, let me let you into one of my dirtier secrets:

I really like working nights.

This is born out of my romantic notions about them, notions of which three years of, you know, doing it, have entirely failed to disabuse me.

Look, I know it’s a bit weird. If you say it out loud to people, they tilt their heads and say, “but nights are awful”, like I’m trying to be a brave little soldier, which couldn’t be less true, or like I’m a bit mad, which… well, I also have romantic notions about marathons, New York, the nature of democracy, empty cathedrals, London, and the NHS, so you go on and decide for yourself how mad I am.

Oh, they have their unpleasant bits. This past weekend there was a night when I went from actually sitting still for a bit to running up five flights of stairs and I promptly lost both my lunch and my dignity down the sluice. I have on one occasion been so tired that my four o’clock in the morning brain forgot how to use a tampon. And the sheer dragging-myself-through-treacle effort of transitioning back from nights to days, which really is awful.

But that would be like saying that New York is awful because of the jet lag on the way back, or that because of David Cameron we should all give up on the nature of democracy and move to North Korea.

In one of the last episodes of The West Wing, on a night that has lasted whole lifetimes and has seen friends and co-workers through unimaginable highs and unthinkable lows, when newly President-elect Santos makes his victory speech, he says this: “You know, if you haven’t left this room in a while, the sun is coming up!” And everyone applauds. And that’s how I feel when I see a nightshift sunrise; every time. At the end of a night when a great deal of work has been accomplished, for better or for worse, and I’ve spent it wide awake and being allowed to do my acute medic thing for twelve hours and wandering the dark corridors of a world that is very peculiarly mine, I think of that, and I think too of the dawn prayer: “we thank you for bringing us out of the shadow of night into the light of morning.”

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Early on Monday morning, I crossed the ambulance bay in the crisp early light of half past six in September in Scotland. I was as content in that sunrise, heading back to AMU for my microwaved porridge, as I was huddled over a mug of coffee the morning I watched the sun come up over the Serengeti.

This was originally going to be a nightshift survival guide for junior doctors, but it got away from me a bit in the writing of it. At some point perhaps I’ll do that properly, and, look, yes, I’m very lucky, it’s not heroic to like working nights if you can sleep anywhere and at any time and have a stomach that can mostly tolerate whatever and whenever you feed it. But the most important piece of advice I can give is to stop listening too much to people who tell you that they’re something to be endured and start trying to enjoy them a bit.

Open, Inclusive, Welcoming (and Proud)

It always gives me great joy to march at Glasgow Pride in the company of my Episcopalian brothers and sisters.

Photo: Gordon Smith

Photo: Gordon Smith

Today, I was marching with Changing Attitude Scotland, which is the network within the Scottish Episcopal Church that works for the equal rights of LGBT people within the Church and beyond. I was out there today with people from the Diocese of Glasgow and Galloway, many of whom were from my home church of St Mary’s Cathedral; but I was also out there with people who had come from across the Province to join us.

Pride is about marching for gay rights, which are equal rights. Pride is about celebrating everything that has been accomplished, and about remembering the work that has still to be done.

A number of us out there today were involved in the equal marriage movement in Scotland. A number of us have now turned our attention to the movement for marriage equality within the Church. Our work is not done.

I think it’s really important for religious groups to be seen at Pride. I’m always pleased to see groups from the Reform Jews, and to have a chance to catch up with the Metropolitan Community Church and Affirmation Scotland. I think it’s important for this face of the church to be public and out there. The group that I march with has grown in size and enthusiasm, year after year after year. There were more than thirty of us at Glasgow Pride today, a far cry from the four wet and bedraggled Piskies who gathered on the Royal Mile in 2008. This year was the first year that our efforts at Pride have been partially funded by the Diocese of Glasgow and Galloway, and that’s a big thing. We are no longer a fringe movement or a special interest group. We are in the Church and of the Church, and the Church is starting to recognise that. That’s a really big thing.

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You think the world has changed, but as I walked through George Square today there were still flashbulbs turning to the priest walking next to me and people nudging their friends as they read out the words on the banner that I was carrying:

“Look! Look! The Scottish Episcopal Church Welcomes You!”

The world has changed. It’s changed because we keep changing it. And every time we do something like this, we change it a little bit more.

As long as our religious institutions are not equal. As long as our youth are rejected by their families. As long as a teenager can be killed merely for being on a Pride march. Our work is not done.

Today was a great Pride. Thanks to Glasgow Pride and to the Scottish Episcopalians who came out to support us.

Small Voice: Tanzania, Healthcare, and the NHS

I was honoured when the brilliant team from GRF invited me to contribute to their Small Voice podcast which is recorded right here in Glasgow.

It was a joy to visit their studio and to be interviewed by the lovely Anne for the Thousand Words segment. Here I am on the August edition of Small Voice, talking about my time in Tanzania, my experiences of healthcare, and my love letter to the NHS.

Small Voice: August 2015

I’m on at 24:43.

For All Doctors: New and Old, Starting and Starting Over and Starting Again

Go placidly amid the noise and haste, and remember what peace there may be in silence.
As far as possible without surrender be on good terms with all persons.
Speak your truth quietly and clearly; and listen to others, even the dull and ignorant; they too have their story.
Avoid loud and aggressive persons, they are vexations to the spirit.
If you compare yourself with others, you may become vain and bitter;
for always there will be greater and lesser persons than yourself.

Enjoy your achievements as well as your plans.
Keep interested in your career, however humble; it is a real possession in the changing fortunes of time.
Exercise caution in your business affairs; for the world is full of trickery.
But let this not blind you to what virtue there is; many persons strive for high ideals;
and everywhere life is full of heroism.

Be yourself.
Especially, do not feign affection.
Neither be critical about love; for in the face of all aridity and disenchantment it is as perennial as the grass.

Take kindly the counsel of the years, gracefully surrendering the things of youth.
Nurture strength of spirit to shield you in sudden misfortune. But do not distress yourself with imaginings.
Many fears are born of fatigue and loneliness. Beyond a wholesome discipline, be gentle with yourself.

You are a child of the universe, no less than the trees and the stars;
you have a right to be here.
And whether or not it is clear to you, no doubt the universe is unfolding as it should.

Therefore be at peace with God, whatever you conceive Him to be,
and whatever your labors and aspirations, in the noisy confusion of life keep peace with your soul.
With all its sham, drudgery and broken dreams, it is still a beautiful world. Be careful. Strive to be happy.

Max Ehrmann, Desiderata