This Is What’s Next

You all already know how this story ends.

The endings are rarely the interesting parts. Did you read the first six and a half Harry Potter books to find out that the good guys win in the end? (Uh: Spoilers.) You did not.

It started on a hotel balcony in Madeira. I had deactivated my NHS email account in the baggage check queue at Glasgow Airport, but the second last thing I’d done before flying away for a week to a warmer, sunnier annual leave than was offered by February in Scotland had been to submit my application to higher specialist training in Acute Medicine. And because I am paranoid, I had submitted the application under my personal email address. Under a cloudless Portuguese sky, my phone buzzed. I had been long listed and I would hear about an interview in due course.

Or it started in the medical receiving unit of a Glasgow hospital that no longer exists. At quarter to eleven on a Saturday night a few summers ago when I hadn’t sat down all day and had clearly not yet made it home to my rapidly cooling pizza and I realised that this, this, was what I wanted to do with the rest of my life.

Or it started in the medical receiving unit of a dozen other hospitals scattered hither and thither across the West of Scotland where through my years at medical school and in the Foundation Programme they had welcomed me in and given me work to do and shown me the nuts and bolts of how to be a doctor for real, and, where I had learned that, if you wanted, this was what you could do with the rest of your life.

And then it was spring and I was back under a Scottish sky, the April version of which is every little bit as steely-grey and rain-saturated as the February one. I had spent the previous two weekends printing out and putting together the required portfolio of evidence, a folder that might have served well as a blunt weapon if I’d run into a riot on my way to the East. I had spent evenings pacing my living room floor, trying to formulate an answer to the question, “Why do you want to do Acute Medicine?” Ideally, one that wouldn’t make me sound deranged. I had spent the previous evening as the SHO on call for oncology, replacing venflons and trying not to pull out all of my hair.

An early morning train to Edinburgh. A heavy wodge of paperwork. My good suit, and my lucky socks, and my very best terrified face, and a pressing concern that I shouldn’t vomit all over myself.

The most significant days of my life seem to begin thus.

It is five years since I graduated from medical school. I have just about persuaded myself that I really am a real doctor. I mostly don’t have the urge to giggle anymore when I introduce myself as one of the doctors, and most days these days I don’t actively expect to be stopped in a corridor by someone there to tell me that my finals results were all a terrible mistake. But as a brand shiny new junior doctor, I remember believing that the registrars were really the real doctors. They were proper adults and were very organised, and they knew everything. If it all went wrong and I needed to call someone (or maybe just scream really loud), the med reg would come. I still believe all that, and because I still believe all that I do not in any true sense believe that I am qualified to be one.

This is an awkward thing to not believe when you are on your way to a job interview.

But there is a little bit of point of no return to this kind of thing, and on I went through the door of the Radisson on the Royal Mile, my black suit and green-tinged face incongruous amongst the gaggle of short-and-T-shirted and frostbitten-looking Americans, and my imposter syndrome out in force.

An interview for a medical training post begins with an administrator who checks through all the documentation, and there is a lot of documentation. There is proof of identity and proof of registration with the General Medical Council, and, even though being on the GMC register in the first place depends upon your having one, your original medical degree. My original medical degree is A3 sized and entirely in Latin. And then there’s that blunt weapon of a portfolio, which contains proof of everything you have ever claimed to have done including things which are wholly unrelated to medicine. Two years ago in my interview for Core Medical Training, they asked what I was proudest of that was unrelated to being a doctor and I had to decide to talk about changing the world because I suspected no one would have believed me if I’d said, “being Ginger Rogers except with a thurible”.

My fellow interviewees and I took our places outside closed doors, waiting for the knocks that would signal the beginning of our half hour of torture.

“Why do you want to do Acute Medicine?” asked a consultant who I’d not met before.

I did sound deranged. But as the Cat said, we’re all mad here: we must be, or we wouldn’t have come here. I decided to go with it.

After ten minutes — and I think that at some point in those ten minutes I flapped my arms around and tried to design an ambulatory care service out loud — there came another knock. I gabbled out a run-on sentence about — oh, who am I kidding, like I have any memory of it. And ran.

The same corridor, another door. Andrew Lloyd Webber probably wrote a song about that. This time, I had a card to read about the clinical scenario that I would be presented with when I entered the room. An elderly man presenting with collapse, ?cause. This was more straightforward than any of the scenarios I had been trying to revise, which immediately sent me into a sort of flailing tailspin. My panic did not improve when I entered the room to be greeted by a man who used to be my boss and the information that he would be playing my 75 year old patient. I wish I could tell you what I said. I really do. I remember that I mustn’t have taken any time to organise my thoughts, because I vividly remember that I got a good third of the way through before I stopped and apologised and announced that I was going back to the beginning and starting again. I also vividly remember that the interviewer who wasn’t doing the roleplay looked thoroughly relieved after I had made this announcement.

Back in the corridor, waiting for the signal to enter the last room. Footsteps. A bang.

“Housekeeping!” a voice shouted.

We three candidates abruptly tried not to meet one another’s eyes, lest we giggle. That answered the question that had been niggling at the back of my mind ever since I’d arrived earlier that morning — been directed away from the business centre, been surprised when guest-looking people stepped out of the lift with me, noted empty trays and copies of the Times lying on the carpet outside rooms that were right next to the rooms we were all going in and out of. It seemed that we were indeed having our job interviews conducted in what were usually hotel bedrooms.

Not quite so weird as that one time I sat a postgraduate exam in a football stadium, but quite weird enough.

And then I ended with five minutes to conduct a “driving advice” conversation with a twentysomething professional HGV driver who had been newly diagnosed with diabetes, or so my card said. But when I made the mistake of asking an open question, he turned out not to yet know that he had diabetes at all. “This is a conversation that I’d normally take longer than five minutes to have but I’m on a timer here,” I tried frantically to project with my eyes to the consultant playing my HGV driver as I talked at speed.

Even this far on this side of knowing what the outcome was, my strongest memories are of all the spaces where I forgot to say things.

The end of the story is that I was disgorged back onto the Royal Mile, befuddled and blinking in the sun that had finally come out.

The beginning of the story is that in a little under three weeks, I’ll be a specialist registrar in Acute Medicine in the West of Scotland, spending the first year of my training in a district general hospital and my first six months trying to learn something about cardiology.

The end is where we start from.

Scenes from My Holidays

IMG_0524That my MRCP was followed almost immediately by ten days of annual leave was more down to circumstance than to choice. It turned out to be circumstance of the happiest kind. By the time I left work, two Friday evenings ago, two and a half hours late, I was nursing a splitting headache that I had just about convinced myself was a subdural haematoma (having whacked myself on the head with the car boot on Wednesday night, as you do) and by half past nine I was fast asleep (reasoning that by morning my subdural haematoma would either have got better or killed me, also as you do).

By lunchtime the next day, I felt like a human again. Apparently all I’d really needed was a solid twelve hours of unconsciousness with no alarm clock at the end of it.

I have been nowhere really in the last ten days. I’ve had my holiday here in Glasgow, rebalanced my equilibrium and remembered who I am outside of endless multiple choice questions, sorted out a few bits of my life, spent so much time cuddling the cats that they’ve begun to ask when they’re getting their house back, and altogether had rather a lovely time of it. Indeed, when I turned up on Saturday evening to the last night of the Giffnock Theatre Players’ production of Terence Rattigan’s Cause Célèbre (good play, excellently done) and happened across some friends in the bar, I was informed that I looked more relaxed than I have in months.

IMG_0544The excursion out to Giffnock was my second trip to the theatre of the week. The first had taken me all the way to the East, and, afterwards, left me meandering in a trance back to Waverley, dazed and gobsmacked and thankful that I’m not as a rule the mascara wearing type. I’d spent the early part of the weeks stalking the Twitter feed of Edinburgh Theatres for returns and found myself sitting in the third row of the stalls, spellbound and sobbing. I really cannot say enough good things about War Horse, but at the same time I really don’t want to say anything about it at all — I went in with only a very vague idea of the story, not knowing how it would end but knowing enough about it to have some idea of how I thought it might end, and, for two days, having avoided reviews the way normal people avoid syphilis. It is a remarkable thing, and do go, if you’re lucky enough to be able to get tickets, go and see it. Go, unprepared (for you will be anyway) and unwarned (if you can) and armed with tissues (lots of tissues).

A significant chunk of last week was spent on my sofa deep in CJ Sansom’s novel Dominion. Now, I have never read the Shardlake series that Sansom is best known for and I picked this up a couple of months ago in Waitrose, where I had gone ostensibly to buy milk, because I thought it looked intriguing. The prologue opens in the Cabinet Room on 9 May 1940. Neville Chamberlain has called together his Cabinet after the crushing defeat of the British military in Norway by the German forces. The subject up for discussion in Chamberlain’s proposed resignation from the office of Prime Minister. In our universe, that meeting ended with Winston Churchill taking up the office. In the universe weaved with devastating plausibility by Sansom, Churchill bows to Lord Halifax and from there we skip forward to 1952 and to a Britain that has been much changed by that one moment in history. I’m not quite finished with it yet. This is a great doorstop of a book with a lot of brilliantly done world-building, and it’s well worth the read.

I’ve also made a start on Aaron Sorkin’s new series The Newsroom. It’s not new, not at all, having premiered on US television in 2012, but it airs on Sky Atlantic in the UK and so for me it was watching the pilot with friends on New Year’s Day and then straight to the DVDs. I’ve taken the first season slowly, very slowly, so slowly that I’ve been impressed as hell at my own restraint. There are only ten episodes in Season 1, and Season 2 is not yet available on DVD. I rationed. I should admit right now that I come to this as a biased pair of eyes. I cut my political teeth on The West Wing and I consider it the single best piece of television there has ever been and possibly ever will be. I would watch paint dry if Aaron Sorkin wrote a script for it. This show is what Leo McGarry and Isaac Jaffee before him meant when they talked about surrounding yourself with smart people who disagree with you. I defy people not to catch their breath in the last fifteen minutes of the fourth episode, when… well, you’ll see, but for me that was a moment when what had already been great television suddenly upped its game to 110%.

IMG_0543It was only with the greatest effort that I resisted spending the whole week on the sofa. Annual leave in January in Scotland is what sofas and fires were invented for. In the end, I got myself out for my first runs and my first swim of the year. It still feels a lot like I’m dragging a millstone around by my legs, but that run there was a week ago and it has been getting steadily easier. I’d neglected these things — unnecessarily, I think, and at the expense of making me significantly grumpier — while I huffed and puffed over my exam. I’m back, and planning to stay back whether I have to take the exam again or not. I entered the ballot for the Great North Run at the beginning of the month, and in a week or so I’ll find out whether I’ve been successful. I’m planning for a half marathon in the autumn one way or another and I’m plotting further ahead, too, for the spring of next year and a long-cherished ambition.

There has been the cooking of real food and the building of new bookshelves and did I mention the cats? And, for a short blissful week, the doing of it all with no niggling guilt that I really ought to be studying.

Today, I went back to work. And despite my eleventh day off being considerably more fraught with both planned stress (job interview) and unplanned stress (the kind that requires a roadside breakdown service, although thankfully not en route to the job interview) than I might have liked, I’ve returned refreshed and raring to go and all the better for having been gone for a little while.