medical school

Welcome to Glasgow – Ten Years On

It had been a good conversation. We had had a good rapport. We talked about what he liked about where he worked, about the book we were both reading and our mutual love of Sebastian Faulks, and about my microbiology research and what I thought I wanted to do when I grew up.

At the end, we shook hands and said how nice it had been to meet each other and then it was time for me to venture back into the dark cold evening in a strange city.

“Have a safe trip home,” he said. “Are you driving back to Geordieland tonight?”

I paused in the act of gathering up my things. “I’m on the train and I had a sodding disaster of a journey to get here, so heaven knows what it’s going to be like getting back,” I said.

A couple of hours earlier, I had been disgorged from the Edinburgh to Glasgow train onto the platform at Queen Street. My journey to Scotland had been delayed by a tree on the line outside of Kings Cross, leading to an hour of pacing back and forth beneath the departure boards at Newcastle Central Station. On a train, finally, I made a flurry of phone calls, making frantic promises that I was still planning to be there that afternoon. Just north of the border, an announcement was made over the PA that due to unforeseen technical difficulties, which I would later discover was a felled power cable in the Central Belt, the train, which had been scheduled to take me direct to Glasgow Central, would terminate in Edinburgh. Edinburgh Waverley is a labyrinthine behemoth of a train station and I’d only been in it a couple of times, and always for a leisurely stroll to the Playhouse. As we pulled in, I was first off and barrelled past the crowds of people swarming around the station on the mid-January afternoon, squeaked apologies and little old ladies flying every which way. I made it onto a train to Glasgow with less than thirty seconds to spare.

I blurted this story out. The filter between my brain and my mouth was plainly lying scattered in pieces somewhere along the tracks of the East Coast main line.

“Oh,” said the man who had been interviewing me for a place at medical school. “Well, good luck.”

That was ten years ago this week.

I am still occasionally asked why I chose a medical school in Scotland. There were 25 medical schools in England during the application cycle in 2006-2007, after all. My usual answer is that I was running out of places to apply to, which people take as either a joke or as a sign that they’ve committed a social faux pas on a par with starting up a dinner conversation about how much they liked the Twilight series.

I applied to medical school for the first time in 2002, when I was in sixth form. In the UK, the maximum number of medical school applications that could be made in one cycle at that time was four. I applied for the second time in 2005, at the beginning of the final year of my BSc. My third application was going to be in the autumn of 2006, when I was in possession of an honours degree, my old room in my parents’ house, and a customer service job in the public transport industry that I hated. It doesn’t take Alan Turing to realise that by the time I whittled down medical schools to places I hadn’t already been rejected by, places who accepted graduates, places whose graduate admission criteria didn’t include A-level requirements that I didn’t meet, and places that didn’t require me to live in either Keele or Hull, the list was getting quite short. “What about Scotland?” asked someone, and the rest is basically history.

That first day, I saw the medical school, the fence surrounding the ancient university buildings, Queen Street station (twice), and a bit of Sauchiehall Street out of a steamed up bus window. And when I say that I saw them, I didn’t arrive until half past three in the afternoon and it was January 11th, so I didn’t really see them. And then I got on a train back to Newcastle.

I already had another interview booked. It was for a four, not five, year degree; a graduate entry programme with all but the first year of tuition fees and a good chunk of living expenses funded by the NHS. I had two good friends already at the university. It was not in a city that consistently feels like the rainiest place on Earth. On paper, it was perfect.

I returned to England and spent the next two days going quietly crazy. On the third day, I called my mum on my lunch break at work. “I know this isn’t logical,” I said. “I know that it’s an extra year and it’s more debt and I don’t think I care. I’ll go to Warwick for my interview, of course, but if Glasgow offer me a place then I’m moving to Glasgow.”

Now, it is the case that if a person wants you at their university even after you conclude the interview by reciting a monologue on the black hole of twenty-first century rail travel, the laws of good karma and good British politeness do dictate that you probably ought not to turn them down. It wasn’t that, though. Anyway, they hadn’t offered me a place yet. In retrospect, it was a bold thing, and not in a sensible way, to start making plans for what I’d do if I was made not one but two offers. It would have been bold for anyone, but for a person who before this had been rejected by nine medical schools across what was by then three application cycles and who had concluded that interview in that way, it bordered on foolish.

It was, however, exactly what ended up happening, and eight months later, just like I’d said, I packed all my worldly possessions into a Transit van and moved here and I’ve never left.

It has been a decade since I first fell off a train into the arms of this place that I knew nothing about.

Bold. Foolish. Rash.

Maybe.

In that decade I’ve not had a single regret.

I can’t explain any better now than I could have then what it was that happened that day — something that tugged hard on my instincts, that paired me to this glorious city and told me that we were for each other. How do you explain what home is? I don’t, but I knew it when I saw it.

… And Then My Head Exploded

My plan was to spend today sorting out the last bits of my job application to Core Medical Training, which closes on this coming Thursday evening.

If you imagine the state of my chewed fingernails and pulled out hair as they were during FPAS, two years ago, but on steroids.

The understanding of your average non-medical person of the whole business of medical jobs/postgraduate training is limited, and that’s because it’s a little bit insane. To illustrate, the conversation I had this afternoon with my stepfather: “Is it right that you don’t know where in Scotland you’re going to be working?” “Yes, and it might not even be Scotland.” “What? They could send you back to England?” “Er. Yes. Except for the part where I’m not actually guaranteed to be employed.” “So, but, if they do employ you, that’s permanent, like, is it?” “No, it’s for two years.” “And then you have to apply again?!” It’s not the first time I’ve introduced the concept to him. I keep on introducing it every time he asks why I’m not in the market to buy a flat. It’s difficult enough to wrap your head around when you’re one of the people on the inside of the system. And, in the background, my mother: “I DO KEEP TELLING HIM!”

My application form is more or less done.

The bits I had left to sort out were little things, like finding out my membership number for what used to be Disclosure Scotland, fixing a silly typo in my spiel about specialty commitment, and finding the bits of paper and digital files to prove that I’ve done the presentations and got the degrees and attended the conferences that I’ve said I have. At interview in January, I will be expected to prove all those things. If I can’t prove them in January, I can’t claim them on an application form in December.

That was pretty much where the wheels fell off the wagon.

I’m going to offer you a free piece of advice.

A little bit for medical students. Mainly for FY1s who, having acquired a salary, are starting to think about upgrading their computers from the ones that they kept running with bits of string and the power of prayer through the last days of medical finals.

This is my advice.

Make backups.

Keep everything.

No.

EVERYTHING.

If you have a piece of paper that shows that you’ve been on a training course, put it in a folder somewhere safe. If you have an email from someone complimenting you on a piece of work you did, download it and save it before they take away your university email account. If you gave a presentation as part of a Special Study Module, get a download of the electronic feedback from your supervisor before you graduate. If you went to a conference, don’t lose the certificate that says you went to the conference. Scan hard copies. Any digital copies of any posters or presentations or publications or teaching feedback or anything, dump them all in a file called “Job Application Evidence” and then make a backup and then a backup of your backup and then make sure your backups work.

If your hard drive is full and your flat is beginning to look like the flats of those people who are on the television show Hoarders, except with paperwork instead of ketchup bottles, you might be just about on the right lines.

And if all of that sounds a little bit excessively paranoid, let me tell you about the situation I found myself in tonight, when, before I managed to find anything useful, I found:

  • The transcript from my undergraduate degree
  • Three out of date Disclosure Scotland forms
  • Scanned copies of my last flatmate’s BSc and MSc certificates
  • The tenancy agreement for a flat that I have not lived in since April 2012
  • An invitation to Flo and Beanie’s wedding (which happened more than a year ago)
  • A budget for my last flatmate’s wedding (which also happened more than a year ago and also why?)

I mean, if you’re going to cull, these are the things you’d cull. The conference certificate? Is not the thing you’d cull.

In terms of what I’ve got for this job application, I get credit for the BSc, and then I actually don’t have a lot else except enthusiasm.

This makes the small amount I do have really important.

In the summer of fourth year, I gave a poster presentation of a case series that I’d seen when I was doing an SSC in Haematology at a national medical students conference in Bournemouth. It’s the only thing on this application that I’m getting a substantial(ish) number of points for. I’ve got a very little audit and I’ve got evidence of having taught medical students when I was an FY1 and I’ve got one publication in which I claim the smallest number of available points for publications and proceed to stretch, quote unquote, the broadest definition of medicine to quite frankly ridiculous extremes. That’s it. The poster that I presented at a national conference is my Thing.

I lost the conference certificate when I moved house. Last week when I emailed the conference organisers in a mad flap, they said that they could issue me with a new certificate if I could provide them with a copy of the poster.

In the spring, I got a new laptop.

I backed all my files up onto my iPod, wiped the hard drive of the old one, and gave it away to my mum. Today, I opened my iPod up and discovered that what I had actually backed up were a series of empty folders. Cue panic. The folders did not get any emptier when I opened them for the second time or the third time or the fourth time. In a flash of inspiration, I remembered that there was a time in medical school when I had software on my computer that automatically backed everything up to a virtual server called Sugar Sync (hat tip to Bean Blogger for recommending it to me, back in the day). I found the website. I remembered my username and password. I could not for the life of me see my files — and what I could see was that I had used 2.7GB of available space, so clearly they were somewhere.

At that point, I called the person who has become my partner in crime for MRCP and CMT and Also Good Things and I flailed down the phone. (“I have so little proof of anything, I’m wondering if I ever went to medical school.”) She sensibly pointed out that if I was using 2.7GB of space on a virtual server, I was using it for something. I gave her my username and password, and she too failed to see any of my files. We pondered whether I should try to download the software for it, to see if that helped, and I did. There was a folder called MBChB, which looked promising, so I synced it back to my current laptop. After it looked as if it was done syncing, I went on the hunt.

I did not find the poster.

I found a copy of the original version of the abstract that I had submitted. I also got a message from the friend I had gone to the conference with, saying, in response to a panicked text I had sent her, that she was fairly sure the poster that I’d displayed, the A0 version, was in her loft. I had no idea how I would get an A0 poster to conference organisers in England, but I was making progress.

The first email I sent to them explained the situation and said that I was attaching the abstract submission.

The second email, which I sent about fifteen seconds later, actually had the abstract submission. It also had a link to the blog post that I had written the day after the conference, should they have been in any doubt that I actually went to Bournemouth. It also apologised. Profusely.

Then, I took another look at the computer and realised that it had started syncing more files.

The third email had a digital copy of the poster attached.

There is no adrenaline left in my adrenal glands. I’m never doing this again. And first thing tomorrow morning (after, I’m guessing, the president of the UK Medical Students Association is done mocking me), I’m buying an external hard drive.

As The Romans Did

Last year, in the middle of the Preparation for Practice rotation I had in what would become my hospital, I had a couple of weeks with a consultant who likes to teach on ward rounds.

I like consultants who teach on ward rounds. I had just switched over from vascular surgery, mind, and I’d therefore become unused to having my presence acknowledged on ward rounds, let alone taught anything on them. And I do genuinely like that specific consultant, even if most of our interaction these days is based on him kindly doing medical reviews of my surgical patients and then me calling to ask if he would mind terribly translating his handwriting as I’ve been squinting at it for a half hour and cannot make head nor tail.

On a particular day, I was taken into a room and pointed at a pleasant gentleman in the corner and asked for a spot diagnosis.

Er…

I had an answer in my head, but the problem with spot diagnoses is that getting it wrong means inadvertently insulting someone’s appearance. Honestly, ask anyone who thought they had a perfectly normal neck until four medical students panicked and told them that they had a goitre. My dithering went on for a beat longer.

“BRING BACK COMPULSORY LATIN!” he bellowed.

I studied Latin for four years. This threw me completely and I dithered a bit more.

“If you have too much of something…” came the prompt from my SHO.

I gave up and took a punt on my original answer. “Oh, OK,” I said. “He has polycythaemia rubra vera?”

Yes. Indeed.

“So,” I said to the SHO as we went back out to the notes trolley. “Hypothetically, how badly do you think he would take it if I told him that ‘polycythaemia’ is Greek?”

 

And Go!

It’s difficult to believe that a year has passed since medical finals, but tomorrow is the first day of those same medical finals for the almost-doctors in Glasgow. I know a lot of you, whether because you used to be in my year before I didn’t intercalate or because you were my medical students this year when I was new and terrified or because you are friends in some other way.

My love and my hugs and my prayers and my tightly crossed fingers are right there with you.

Now, take a deep breath and go be magnificent.

keep calm and don't stress

Advice for the FPASing

It is that time of year again, when final year medical students all over the country realise that they have to start applying for one of these job things. I know this partly because my Facebook feed exploded on Monday morning with fifth years who just registered for FPAS and partly because suddenly half my blog hits are coming from people who got here by searching for FPAS information.

I’m writing this not because I consider myself to be any sort of expert. I’m writing it because I figure that if Google is going to send you here, you may as well get something useful out of it.

  • You are entitled to find this a little bit scary. The other thing that happened on Monday morning was that FY1s collectively developed a superiority complex about the whole thing, and — well, it’s easy for us to say that we’re rising above FPAS now, but for two weeks last year I was absolutely incapable of clicking on anything that said “register” or “submit” or “agree” unless I was holding my flatmate’s hand.
  • In my application cycle, the Foundation Programme as a whole was oversubscribed by 81 applicants. I do not know and nor does anyone else how far oversubscribed it is likely to be this year, but I would expect it to be by more than last year.
  • Your application is scored out of 100.
  • Between 34 and 43 points are available for educational achievement at medical school. These are the points that correlate to your academic decile, which you should have been told by your medical school. The formulae for calculating academic deciles are not standardised.
  • Of the 7 points that are available for additional academic achievement, 5 of them are for an additional degree. You will only be awarded points for one additional degree, so, if you came to medical school with a BSc and an MSc and a PhD, choose whichever gives you the most points.
  • Of the 7 points that are available for additional academic achievement, 2 of them are for publications, presentations, and prizes. The important things to note here are that publications must be in a peer-reviewed journal and must have a PubMed ID; that presentations must be at a national or international level and do not count if they are for the BMA or for a student organisation; and that prizes must be at a national or international level and must be first prize. The things to note that I am most often asked about are: 1) UKMSA presentations do not count, 2) Student BMJ articles do not count.
  • Your application will not include any white space questions. Your other 50 points come from the Situational Judgement Test, which you will sit on either December 7th or January 7th. Your medical school chooses the date. You are the guinea pig year for the SJT, which is why none of us can offer you a great deal of useful advice about it. There is an official practice test on the UKFPO website.
  • There is no blanket minimum score for getting into your first choice Foundation School. It depends on which your first choice is and on how many other applicants select it as their first choice.
  • The competition ratio for South Thames for 2012 entry was 91%. A lot of you have been asking that. It was the least competitive Foundation School in London last year and that was the lowest competition ratio since 2008, and the stats I have only go back to 2008. I wouldn’t bet on it staying like that this year.
  • The competition ratios for the four years before that are in this table. FPAS has changed geographical boundaries over the last few years, which is reflected in the Foundation Schools that are listed as not applicable in some years. The vaguely nonsensical order is reflective of nothing except that this is the order I was working from last year.
  • Good luck!

Graduation Day

On Tuesday evening, I found myself in a pub with two people who had, in the past, received degrees from my undergraduate institution. We are different ages and in wildly divergent disciplines and not there at the same time, and our paths did not cross until we all landed up at the same church in Glasgow, but we had each, at some time in our lives, attended a graduation ceremony in Durham Cathedral. And all of us remembered clearly that at those graduation ceremonies, the only thing we had been required to do was to walk onto a stage, shake the Chancellor’s hand, and walk off the stage. Our hoods had been donned before the ceremony. Our degree parchments were sent later, by post. I had, briefly, panicked and thought that I was meant to curtsey to Bill Bryson, but this turned out to be a nightmare reserved for those whose degrees were affiliated to the Royal Academy of Dance.

My first inkling that my Glasgow graduation might be a little different came last year, when I was informed that a song would be somehow involved. My second inkling came on Tuesday afternoon, when someone from the Registry hoisted himself to the top of a table, performed feats of origami with the hood borrowed from the neck of a dentistry graduand, and announced that this was how we were to carry ours, in our left hand, as our name was called and we ascended to the stage. He went on to say that I would pass the hood across to someone at the top of the ramp, turn to face the Principal, let him bash me on the head with his cap while the person who now has the hood throws it around my neck, shake his hand, walk to someone at the top of the next ramp, take my degree parchment, shake his hand, and walk back to my seat. I had begun the day by tripping over my own two feet, throwing a full mug of coffee all over the spare bedroom, landing on the floor, and bringing down two cardboard boxes on top of myself and an indignant kitten. By the time the man from the Registry got to his first comma, the whole enterprise had begun to sound like a feat of memory and coordination worse than Corpus Christi.

And on Corpus Christi, my feats of memory and coordination are performed backwards.

“You didn’t tell me there would be choreography!” I squeaked later, rather unfairly, at a friend who was awarded her medical degree in 1999.

It is perhaps not entirely surprising that I only got as far as shaking the Principal’s hand before I forgot what to do next. My instinct, when I forget what to do next, is to reverence and then make something up, but this wasn’t that kind of occasion (we invoked the Trinity, mind, twice and in Latin, so you can see how there might be some confusion), and, besides, you can’t reverence Anton Muscatelli.

I have very little recollection of how I got off the stage, except that the traffic at the top of the first ramp failed to grind to a complete halt and so I assume that I must have done. I remember that at some point I was intercepted by the man with the parchments, who, from the look on his face, realised that I’d forgotten about that part and would have marched right past him without actually receiving my degree.

Yet, we all somehow got through it. We all made it back into our seats, we all made the Declaration (the only part of the ceremony performed fully in English, someone in 1868 presumably having had the sense to realise that people committing themselves to the profession that they have just joined ought perhaps to understand what it is that they’re saying), we were all blessed, we all processed out of the Hall and through the cloisters, and, improbably quickly, I tracked down my family in the disorganised chaos. My family, incidentally, who had by this time spent several minutes trying to phone me on my mobile phone, which they had put into their bag for me for safekeeping. And, for at least a short period, so I am assured, I was generally considered to be the best daughter/granddaughter/niece/cousin in the entire history of time and space.

They had all been waiting for this for almost as long as I have.

And although I make fun and although I do occasionally wonder why my life tries to resemble a slapstick comedy and although the Scottish weather provided us with a torrential downpour as if determined to end things just exactly as we had begun them, I had a wonderful day. I laughed a lot and cried a lot and beamed at the stranger who congratulated me as I ran down University Avenue in my gown. I was happy to be with the family who trekked up from Newcastle for this and with the friends from all the different bits of my world who came out to celebrate afterwards. It was a fitting end to five fabulous years and I cannot wait to see what’s waiting in the next five.

Dr Beth

I do solemnly and sincerely declare that as a graduate of the Faculty of Medicine in the University of Glasgow, I will exercise my professional knowledge and skills to the best of my ability, for the good, safety, and welfare of all persons committing themselves or committed to my care, regardless of their individual status or standing. I will not knowingly or intentionally do anything or administer anything to their hurt or prejudice for any consideration, or from any motive whatever. I will keep silence as to anything I have seen or heard in the practice of my profession, which it would be improper to divulge. I will assist patients to make informed decisions and I will respect these decisions. I will endeavour to earn and keep the trust of my patients and colleagues, by acting honestly and fairly, and by continued effort to improve and share my knowledge and skills.

(Photo credit to the Glasgow Herald.)

Knocking Out A Twelve Foot Mountain Troll

A wise woman once wrote, “There are some things you can’t share without ending up liking each other, and knocking out a twelve-foot mountain troll is one of them.”

I arrived in Glasgow at 8am on September 9th, 2007, with a backpack and a map showing me how to get to my new flat from Central Station. My parents and all my worldly possessions were in a van somewhere in England, as they had taken a wrong turn and spent a certain amount of time trying to get to Scotland by following signs to The South. I had only been here twice, and one of those times was for my medical school interview eight months before. I had spent the last six years trying to get into medical school, but, now that I was in, I had no idea what I’d really let myself in for. I knew no one.

This is a long journey. It is a hard journey. It is a journey that nobody makes alone.

I’m taking a lot of memories away from my time as a medical student and they will all be to do with the people I met along the way. The ones who I worked with and and cried with and laughed with and celebrated with. The ones who graduated last year. The ones I’ll graduate with. The ones who have taken time out and will graduate next year. The ones we lost.

The people I did the MILE with, when we locked ourselves in the library for 24 hours. The woman I first met when we were both sixteen and on a week-long course for prospective medical students in Nottingham, and then didn’t see again until we sat down next to each other in Freshers Week. The group who I suffered with through fourth year ophthalmology with The Consultant In A Kilt.  The two people who it is a miracle that I ever did meet, considering that I was sent to look for them by a priest who was able to describe them only as ‘but they’re medical students‘, as if medics identify each other by some sort of homing signal. The people who helped me move out of my flat when it fell down. The groups with whom I took my first fumbling steps into the world of PBL. The people whose cars I’ve spent hours getting lost in, because I always did seem to get sent to places in the middle of nowhere. The people I first learned how to ceilidh with. The people I lived through Stornoway with — if only because, if there hadn’t been witnesses, there would be parts of that month that I would think couldn’t possibly have happened in real life. The person who I met in Jim’s Bar on my first day at Glasgow and who went on to be my flatmate for four years, who is a part of so many of the memories I have. (I would get sentimental, but I wrote her part of the yearbook and I’ve been sentimental enough there to last us a good long while.)

And all of the many many others.

This is where we became the people we are. I may not have been close friends with everyone — there are too many of us for that. But we all knew each other. And we’ve all done this epic thing and we’ve done it together. Today, looking back at it, I can think of no group of people I’d rather have done it with. There are some things you can’t share without ending up liking each other, and knocking out a twelve-foot mountain troll is one of them.

How Not To Deal With Heart Block

I write about my triumphs, and so it’s only fair that I also tell you about my disasters.

The nice people at the GMC and the sadist who dreamt up NHS ePortfolio would call it reflective practice, although I expect I’ll swear more in this than I might if I were writing it for my educational supervisor.

As part of Preparation for Practice, I spent a day this week at one of the acute care training facilities where they have plastic people who can talk. The basic idea is that a room is set up to emulate a hospital ward or a medical receiving unit, complete with everything that would usually be found in such a room, a phone that goes through to two people behind a one-way screen, and a SimMan who can sweat and shout and, as we discovered to our collective horror, vomit. Acting as the FY1, assisted by a nursing student who would be acting as a staff nurse, we were each to run an acute care scenario. We could call for help in the same way that we would in real life. We had all recently been on an ILS course and so we were promised that at no point during the day would we be expected to deal with a cardiac arrest. The place is also full of cameras and microphones, so that the six or seven people who aren’t involved in a given scenario can watch from the next room.

The other times I’ve done this sort of thing have been in exam situations. The main difference between an exam and real life (and, therefore, between an exam and a simulation) is that, generally, in OSCEs, it isn’t in real time. For example, in my last final, I had a patient who was having an asthma attack. “I need venous access,” I’d say to the examiner, and she would instantly tell me that I had venous access. “I’d like to get a blood gas,” I’d say, and, after a short delay, someone would hand me a set of results. In an OSCE, acute care scenarios are usually set up in a way that allows for a protocol to be rattled through — and has to be set up that way, really, on account of time constraints. I hadn’t had to worry about getting venous access or doing the blood gas, and I hadn’t had to give so much as a passing  thought to the simple but suddenly incredibly time-consuming tasks like getting a Kardex or finding someone who knows where the ALS drug box lives. And, oh, how relieved am I that this, the first time I’ve really needed to think about those things, was in the safety of a simulation and not actually during my first medical on-call.

It was really shit.

It was a really valuable learning experience, but it was, you know, really shit.

I arrive in A&E to see a woman who had collapsed while out shopping with her husband. I am met by a senior nurse who informs me that the department is very busy and that my patient has been got onto a trolley and started on an oxygen mask but has otherwise been left. I have a staff nurse who starts getting her obs, and someone has kindly got for me a list of her usual medications. I start talking to her, and determine fairly quickly that I’m not going to get much of a history. For one thing, she thinks we’re in Asda. However, she is talking and so she has a patent airway. The nurse has got a monitor turned on and I can see that her oxygen saturations are down in her boots, so I turn the oxygen mask up to 15 litres — cursing as I do so the people who think that everyone over the age of 45 is a CO2 retainer until proven otherwise.  I ask the nurse if she has the other obs yet. And I think that’s where it all fell apart. I remember everything that happened next, but not exactly which order it happened in. I know that I was interrupted by a senior nurse who wanted me to clear the bay because other patients were waiting. I know that I got another FY1 in to get IV access. I know that the nurse told me the other obs and that I misheard them or heard what I was expecting to hear, and I ended up thinking that she was hypotensive with a tachycardia rather than hypotensive with a really profound bradycardia.

I know that I was being watched by my colleagues, who had the obs on a second screen and had realised that they weren’t what I thought they were and were by this time trying to get me to look up at the monitor through sheer force of will.

The patient, through all of this, was steadily becoming less and less responsive. I panicked and disappeared into my own head, which is not the way to be an effective team leader. If I had said, out loud, while I was assessing circulation, that the patient was tachycardic, the nursing student would, I hope, have realised that I’d made some sort of mistake somewhere and at least repeated the heart rate. If I had said, out loud, “oh, my God, the world is ending, help,” which was the thing I was chanting to myself at that point, she might have suggested that I call someone else or the FY1 who was cannulating might have realised that I was actually floundering so badly I could have been an extra in The Little Mermaid. I needed, ultimately, to make a phone call to my FY2 and said, “I have someone down here who is really sick. I don’t know why and I don’t know what to do.” And I did, in the end. And then I called the cardiology reg. And then I put out a periarrest call. My educational supervisor, when I told her about this, said that in real life I’d have asked for help more quickly than I did, and I think that that is probably true. It didn’t matter that I couldn’t remember how to treat heart block. It mattered that I freaked out and, instead of falling back on ABCDE, I fell back on the time-honoured response of metaphorically curling up into the foetal position and squeaking helplessly.

I could have dealt better with any of the other scenarios than I did with that one. There are areas of knowledge that I’m confident in, and, unless it’s the kind of cardiac arrhythmia that I can fix with CPR, cardiac arrhythmias is not one of them. Although, after a half hour with the Oxford Handbook of Clinical Medicine and a chat with a couple of people, I now know how to treat heart block. Of course, there were things besides my wobbly knowledge base that made it difficult, like being asked to clear a patient out of a bed while the patient was busy becoming unconscious, but that is the kind of thing that I need to get used to dealing with. (“I was trying to be polite,” I said, protestingly, to the tutor who had been acting as the interrupting nurse. “Don’t,” she said.) But although I might have acquitted myself better if I’d had to assess a septic patient, I wouldn’t have learned nearly as much as I did from dealing very badly with something that I didn’t know much about. I think this might have been what I meant when I wrote on Sunday about maybe needing, now, to be thrown to the wolves.

But like I said, only if I can have my FY2s bleep number tattooed somewhere before I get thrown to them.

It was a hideous experience. It was admittedly a great deal less so than it would have been if this were a real patient, but, nevertheless, it was shit. And sometimes there is nothing to do about that but to acknowledge that it was really shit, to have friends who understand that it was really shit and are able to offer their own stories in commiseration, and to find value in the parts that were valuable and to take from it the lessons that can be taken. And, when you’ve done all that, to move on.

What’s Next?

And so we approach the end of the hospital-based part of Preparation for Practice. In a few days, I’ll have what I intend to be my very last last day of school. My fifth, since you asked. It will be the end of my two-and-a-half decades in full-time education, and I can’t decide whether that’s terrifying or exciting or just about damn time.

I’m not really a doctor yet — that doesn’t happen until either June 26th or July 31st, depending on if you count from graduation or from when GMC registration kicks in and someone gives me actual responsibility. I’m still very much the medical student and I’ve been clinging to that title like a child to their comfort blanket. Yesterday, our wonderful hospital pharmacist asked me to make a clinical decision regarding a complex discharge that I’d spent most of the afternoon trying to sort out, and I promptly looked like the proverbial rabbit caught in the headlights and deflected to my FY1. And then I realised that, sooner rather than later, now, there won’t be an FY1 there for me to deflect to, and I sat on the train home last night and quietly freaked out about that.

I’ve spent the last five weeks learning a few new skills and then relearning the ones I had, once upon a time, before I lost them under my revision notes. I’ve readjusted to having a commute and spending the whole day on my feet, squinted at consultant hieroglyphics and tried to turn them into disharge summaries, chased bloods, dusted off my tourniquet, had countless fights with three different computer systems, and reflected that I was never warned when I applied for a job in this hospital that I’d need a sat-nav not to get to work but to find my way around work. And mostly I’ve been glad that I’ve had a grace period to figure these things out without having to be the FY1 at the same time. I’ve had reason to be especially glad of that, as I work in a hospital that takes medical students from almost all of the Scottish medical schools and so I’ve been meeting fifth years who are scrambling to finish their last core rotation and have still to get through the ungodly horror of finals.

Overall, it’s been a useful few weeks. If I’ve accomplished nothing else, I’ll show up for work on July 31st and I’ll know where to find the canteen and the toilets and the handover room, what the emergency buzzer sounds like, and how to use the phones. These are the important things. They are also the things that nobody ever seems to bother to actually tell you at inductions.

I think I’m ready to be done.

Oh, I don’t feel ready to do the job, which is a different thing altogether and isn’t something that can, at this point, be fixed with more Prep for Practice. I don’t think I’m ever going to feel ready to do the job. It is a scary scary prospect. I think maybe the only way to get ready now is to jump in with both feet (and my senior’s bleep number written in permanent ink on the back of my hand, probably) and let the chips fall where they may.