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.

What’s Next?

You may remember that not too long ago — it feels like forever ago —  I was being admonished by my emails to prepare properly for a job interview and spending evenings being grilled on clinical scenarios by long-suffering friends.

It is with something beyond joy and no small measure of disbelief that I tell you that this afternoon I was offered a job as an ST3 in Acute Medicine in the west of Scotland. I am a bit terrified, and a bit gobsmacked, and a bit weepy, but I am mostly just really bloody happy.

And That Was Wednesday

I woke up this morning, got dressed, got on the bus to work, and sat down in what I am almost positive was urine.

That was 8.15am.

Thankfully, I work in a job where no one is going to think it’s all that inappropriate if I go about my day dressed in blue pyjamas. So en route I went into the theatre changing rooms and borrowed a pair of scrubs.

And then got in the lift to go up to my ward and stepped in the puddle of vomit that was on the floor of the lift.

I found a packet of the big alcohol wipes and wiped off my shoe.

And finally started my ward round and made a theatrical gesture and sent a patient’s full glass of Irn Bru flying.

There are days when you just have to call it good and try again tomorrow.

giphy

Sitting in ill-advised places. I’m blaming it on the Bossa Nova.

Take AIM

Just before Christmas, I spent a weekend down in Bristol at Take AIM, a conference aimed at junior trainees who have an interest in acute medicine.

The second year of core medical training is notable for a sharp uptick in the number of times per week a person is asked if they’ve had any thoughts as to the specialty training they might consider. I tell them that I’m applying to ST3 in Acute Medicine, and they’re startled — either by my questionable life choices or my level of decisiveness, I’m never quite sure.

“Oh, and — really?” asked my most recent clinical supervisor. “Do you think I could get you to change your mind?”

I should be clear, my choice of medical speciality is hardly the first time I’ve had a questioning eyebrow raised at my life choices. My life choices have, after all, led to me sitting on the M74 on my day off looking for exit signs to Lesmahagow with my only provisions being a boot full of wedding paraphernalia, and being in the back of a Jeep reversing backwards around the corner of the shelf of the Ngorogoro Crater while the part of my brain not occupied with screaming asked if this was really how it was all going to end, and nearly getting arrested in the middle of Tianenmen Square. And those things all turned out brilliantly. So.

The raised eyebrows can be flattering, in their way, if their purpose is to persuade me out of my specialty and into theirs, which is sometimes.

But — unspeakably frustrating in another way.

At this point in CT2, some people haven’t made up their minds, which is fine: that’s why staff grade posts and taking time off from training are good things to do. I have, though. I had my time off from training, remember, and I needed an Archimedean epiphany fuelled by sleep deprivation and adrenaline, but I’m done. I’m sure. I’m not a foundation trainee who ought to be prudently murmuring about keeping her options open. I’m in, and with my eyes wide open. If my mind wasn’t changed by perpetual backshifts in a hospital that was literally closing down around me and where we occasionally had to see patients in the cupboard for lack of bed space, it is unlikely to be changed by the prospect of thirty years as an oncologist.

I know when I was ten that I thought that a doctor was a doctor and it was all basically the same thing, but it’s not like that’s actually true.

Yes, isn’t it nice that we don’t have to all be the same thing?, I want sometimes to say.

I’ll be honest, mind: I understand in my brain why my particular thing isn’t for everyone. In my heart, I don’t really understand why anyone would ever do anything else.

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Heart and Brain: TheAwkwardYeti.com

The frustration of being a core medical trainee is that it feels — and is — a terribly peripatetic existence. I don’t yet have my tribe, or whatever the collective noun for my specialty colleagues would be. An insanity of acute physicians, perhaps. I still don’t have that, five years in. My experience is that nor do most CMTs. You sort of have to go looking for it, and therefore my weekend in Bristol was precisely what I needed.

Take AIM was the initiative of registrars training in acute medicine and has the stated intent of promoting what is a still relatively new and rapidly expanding speciality to juniors. It gets funding from Health Education England and support from the Society of Acute Medicine, and it has consultant input, but it’s still principally led and run by senior trainees — which, as someone who isn’t yet but hopes soon to be in specialty training, is a helpful thing for me, to hear from people who are in a position to tell me what the next five years of my life are likely to look like and who are willing to do it in a warts and all kind of a way. My first real contact with them was in October 2015, when I joined in an hour-long discussion on a Sunday evening on Twitter and came away from it feeling that thing you feel when you have found your people and they get you.

Bristol was like that, too, but better.

It had a bit of careers advice in it, and a bit of debunking of the more commonly held myths of acute medicine. Personally, I’m considering getting the sentence No, I’m Not Just Going To Be The Med Reg Forever tattooed across my forehead. It was also very well populated with very lovely trainees who were keen to chat about training and careers between the main sessions.

A lot of the day was education on acute medical topics. The philosophy went something like: “We are going to expect you to engage in acute neurology teaching first thing on a Saturday morning, but we are going to make sure that you are very well caffeinated for it.” That’s basically what I mean when I call them my people.

I would not dare to speak for everyone on this, as training experiences vary across the UK and everyone’s experience of their own training is different anyway, but the topics covered are ones that in my experience are covered badly, not enough, or not at all. To take an example from one of the earlier national conferences, in 2015, a session on “The Pregnant Patient on AMU”. It is not a thing that I’ve ever been taught and yet is a patient demographic that I happen upon all the time. It is incredibly exciting to me to spend a day being taught useful things by people who understand what happens at the front door of the hospital and want to help make it happen better, and that was what that day felt like. The presentations from the Bristol conference are all available online for those of an acute medical inclination, and a Storify, which includes video of a hundred people doing the dermatome dance, still first thing on a Saturday morning, has been put together of the day as told via social media.

It didn’t convince me that I want to be an acute physician; I knew that already. I think it reinforced for me that I’ve made the right decision.

I apply for a job in a month. For those of you who have been on this particualr merry-go-round with me for the last five years: Yes. Again. It’s a bit scary, this time. I remember when I was an FY1 that I definitely thought the registrars were the Proper Grown Ups. If you need me, I’ll be taking deep breaths with my head between my knees.

Have We All Survived Changeover?

*clears throat*

Doctors.

How are you all doing?

It’s just about a month now since changeover. I hope that’s time enough for you to have figured out where the toilets are, and how to get hold of psych on call in the middle of the night, and which of your seventeen computer passwords is the correct one to make a CT scan happen. It’s not quite enough time yet to have unlearned the learned response for the way to do things in your old hospital, though; your hospital, where you knew everyone’s name and you knew the protocol for prescribing vancomycin without asking a pharmacist, two nurses, and an FY1. It’s not quite enough time for your new hospital to feel quite like your hospital yet, or for you to not still feel just a little bit at sea.

FY1s, have you stopped needing to suppress giggles yet when you tell people that you’re a doctor? Are your seniors being reasonable and helpful? Are you getting to teaching? Are you remembering to eat and drink? Are you okay? If you are not okay, have you found someone to talk to about that?

I am sort of aware, FY1s, that it would be comforting if I let you believe that the confusion and weirdness of August changeover is inversely proportional to seniority and that it gets less weird and confusing after you’ve done it a couple of times, but, for many many reasons, that would be a lie.

In August, there are new medical registrars who have never had to be the med reg before. FY2s have just completed their first month of being the SHO, and that’s a big step up. All over the NHS, junior doctors have started new training programmes and been given new responsibilities and some are doing it in new Trusts or Deaneries that are entirely foreign to them and where their support networks are not. August is scary as hell. This is why we all walk around the whole month looking like Sputnik just landed on our heads. And for the record, I’ve been working in my Trust for four years and I’ve been working mostly at an SHO-equivalent level for those same four years, and August is still scary as hell. I’m a quarter of the way through this rotation, and I still have not learned everyone’s names or the intricacies of my very specialty-specific and very new-to-me computer system or how a kidney, you know, works.

FY1s, let your comfort if you need it be that every year from now until the end of time we are all in this particular period of weirdness together.

So, therefore, how are the rest of you doing? Are your seniors being reasonable and supportive? Have you found your educational supervisor yet? Have you worked out who exactly it is that you’re on call for? Are you even as we speak lost in the rabbit warren of interventional radiology in a hospital whose layout you still do not quite understand and need one of us to come let you out? (Is that one just me?) Do you need a hug?

Welcome. Pull up a patch of floor. We’ve got cookies and coffee and mutual terror and spare copies of Cheese and Onion.

A Requiem for PACES, and Alleluia

In my third year of medical school, I volunteered to help with the running of the PACES exam at one of the big Glasgow teaching hospitals. It was an opportunity to spend all day dinging a bell, to eat an heroic quantity of Quality Street, and to, between circuits, be shown some clinical findings more complex than those we were usually given in our medical school OSCEs.

In June, I sat PACES.

You may recall that the last time I wrote, I had put myself into some kind of fugue state refreshing the results website.

I passed.

And, you know, saying that, it still doesn’t feel quite real, even two weeks later.

I passed.

And — well, let me explain this, a little bit.

In the UK, one of the criterion for progressing in a medical career is to complete the necessary postgraduate qualifications to become a member of the relevant specialist “College”. There is a Royal College of Surgeons, and a Royal College of Emergency Medicine, and a Royal College of General Practitioners, and so on. The membership qualifications for the Royal College of Physicians come in three parts, of which PACES is the final part. In all, they have taken three years, untold hours, and a significant amount of actual money spent on exam fees, revision materials, and all the caffeine in Glasgow. I also have less hair than when I started.

The first two parts are multiple choice. The first part is six hours long (with a break in the middle), and I have previously described it as being not unlike spending six hours having one’s brains kicked in by a rugby team. I took it four times. The last time was in the Newcastle United football stadium, one of the stranger places I’ve ever been in the name of my medical education. The second part is nine hours long, and I sat that only once but in a room that contained no air during the hottest two days there have ever been in the west of Scotland. After 27 hours worth of multiple choice exam, I had lost the will to live but had grown very comfortable with colouring in boxes in 2B pencil.

The third part is not like that.

I think the thing that will perhaps best describe PACES is for me to say that even while in the middle of actually taking it, I was aware that I was muttering frantic karmic apologies to every single doctor at whom I had dinged that bell back when I was a third year medical student.

“You will be fine,” my consultants had been saying to me in the week leading up to it. “You’re a good doctor.” This was kind of them, but I kept reminding them that being competent at my job and appearing competent in this exam were two very different kinds of competent.

You wake up too early in the morning. You try to eat breakfast. You travel to a hospital that is not your own, and may not be exactly in the back of beyond but certainly feels like it. I went off to the conference suite of a hotel that is attached to the national specialist cardiology centre — a place that I have spent a lot of time on the phone to, but, despite nine years of living in Scotland, had never seen for myself. “This is Dalmuir, where this train will terminate,” said the Scotrail tannoy, which felt ominous. You sit in a room where time stops, making nervous small talk with the other four people who are taking the exam with you, filling in your name and candidate number on sixteen separate pieces of paper and flicking frantically through Cases for PACES as you try to remember the indications for liver transplant.

The next two hours pass at warp speed.

The basic structure is the same for everyone: assessments of communication skills and ethics, examinations in the four major body systems, and a final station two-case grab-bag of can-be-absolutely-anything. The patients are sometimes actors, but are mostly real patients who have been recruited in for the day. In my version of the exam, I was asked to take a history from a woman who I promptly blanked on half of her presenting complaint, I was asked to counsel a young man who was angry with my boss, I struggled to find anything at all wrong with the patient whose abdomen I was examining, and trying to listen for heart sounds I briefly wondered if my stethoscope had turned itself off. In the middle of telling me about his syncope, one patient, who had also mentioned that he was on a blood-thinning medication, said that he had hit his head on the ground when he had fainted. “I haven’t really,” he said when I started trying to look for a head injury. “I’m allowed to tell you that I haven’t really.” The whole time, there were two examiners, watching, scribbling things on those pieces of paper that I had painstakingly filled in back in the room-where-time-stopped.

As each of my examinations was completed, I turned to them, tried for a winning smile, and began, “Mr Jones is a fifty seven year old gentleman. He is comfortable at rest…”

In this exam, stage fright is a real thing.

A week earlier, in Edinburgh, I had sat down after making a speech to the great and the good of the Scottish Episcopal Church and said that if failing my exam was the price I had to pay for being there, it would have been worth it. (I could, after all, have sat it again in the autumn, which would have been a pain but hardly the end of the world.) Now, on the other side of it, it’s not that I’d necessarily recommend spending three days at General Synod as a revision strategy for PACES, but the experience does throw a person’s whole idea of what counts as an intimidating room into rather harsh perspective.

They go on to ask questions. I said things like, “I would want to get an abdominal ultrasound,” and, “I would expect the left hemidiaphragm to be raised on chest x-ray,” and, “Oh, hell, I’m sorry, I totally forgot to ask him about that,” and, at one point, “Well, on a SPECT scan you’d normally see, uh — ” and, screwing my nose up as I tried and failed to articulate it, drew a picture of what you’d normally see on a SPECT scan with my fingers in the air.

And then that bloody bell dings and you get the hell out of there while shouting through the door, “I’d do an ESR and a CRP, too!”

Forget having your brains kicked in by a rugby team.

“I think I’ve been smacked in the face with a baseball bat,” I said, collapsing in the car.

It wouldn’t have been the end of the world, of course, to take it again, but am I ever glad that I haven’t got to.

(Im)patiently Waiting

My job is all wait and hurry up.

It’s about waiting for the patients to roll in the door from ED and waiting for the urgent labs to come back and waiting the two minutes for the next rhythm check.

Once, waiting for the gas machine to finish an uninterruptible calibration cycle so that I could process the blood gas that I’d run across from a different building at 2am. The clock said it took about fifteen minutes. I still think it took about three hours.

And then it’s about the hurry up and the spaces between the waiting: the three patients needing sorted out all at once, the electrolytes with numbers that trigger a very particular on switch in the brain, the flurry of activity that happens at metronomic two minute intervals during a cardiac arrest.

The last two weeks, I’ve been suffering through a different kind of waiting.

It is two weeks ago today that I sat PACES, the clinical and final part of the exams for Membership of the Royal College of Physicians.

First, there was the waiting around before the exam. The waking up far too early and pacing the kitchen. The nervous twitching on the train out to the hospital in Dalmuir. They ask you to arrive an hour early, so obviously you arrive two hours early and have nothing to do but sit, looking at the walls, trying and largely failing to recall the causes of cerebellar syndrome and making desultory small talk with four strangers whose faces are all different shades of green.

And, then, finally, the hurry up: the two hours that ended before I’d properly registered that they’d started.

I beg of you, do not ask me how it went.

My colleagues mostly think that it will have been fine.

I mostly agree, but the reason I mostly agree is because I think I’ll be fine either way. I’ve taken this exam comparatively early, and I have plenty of time to take it again.

This incredibly sensible way of looking at things has not stopped my hairline slowly receding every day that passes with no result, or, for the last thirteen days — and, remembering how patient I was with the gas machine and its calibration cycle, you will be unsurprised to learn that this is a time period that I have come to perceive as my entire life — my main extracurricular activity being the act of hitting refresh on the MRCP website.

A person can go a bit mad. “I’m sure I sat it,” I said to a colleague today. “I don’t think it was a delusion.”

I am not good at this part.

Is That Even A Word?

You know, there are the days when I ask for specialist advice, and I nod and I ask at least vaguely intelligent follow ups and I write down all the investigations that they want me to arrange and I say thank you and I hang up the phone.

There are days when that comes with a side of nerding that’s based in never having seen That Really Cool Thing before in real life.

And then there are days when I ask for specialist advice and they know things that are so weird that I nod and I ask follow ups about spelling and I write down all the investigations that they want me to arrange and I say thank you and then the conversation is over.

And then I say, “Soooooo, just for my own education. WTF?”

Entirely Bonkers (But All The Best People Are)

It was quarter to eleven on a Sunday evening, a year or so ago. I had spent the weekend in one of the busiest of the old hospitals in Glasgow, and a half hour earlier had finally handed over the medical receiving bleep to my nightshift colleague. I talked to one of the nursing staff, checking on the management plan for a patient who hadn’t yet come over from the emergency department with their notes.

I’d come back to my department to document a few things that existed in my head but not yet on paper. I looked over a few blood results. My post-work plans were to attend with all due urgency to the food that was waiting a mile down the road for me and my FY1 before seeking horizontalness.

And standing at the nurses’ station at the end of the thirteenth hour of my Sunday, I blinked.

“I could do this forever,” I thought. And then: I can do this for a job!

And then: “I’ve gone mad.”

I was mentally and physically exhausted, bursting with joie de vivre and exultation at the sense of a job done to the best of one’s ability. I was flying high and obviously preparing to crash. It was clearly not the moment to make life-altering decisions about my career path, and so I fetched my coat and went off to my pizza and my bed.

But over the next few weeks that thought kept coming back to me and I kept poking at it, like a bruise that won’t go away.

The remit of acute medicine is (and here I’ll paraphrase from the JRCPTB website) that it concerns the first 72 hours of assessment, diagnosis, and management of adults who are admitted to hospital with a medical illness — the definition of “medical illness” being a very broad church but essentially meaning anything that couldn’t, in theory, be fixed with a scalpel. The idea of being a person who is trained in acute medicine with a view to that being the thing they have expertise in and then does it as their whole job is a very new one. Indeed, it wouldn’t have been possible when I started medical school in 2007. In the autumn of that year, I was given a tour of the recently opened acute medical unit in one of the local DGHs and the fact that that existed was considered hugely innovative. It didn’t become a specialty in its own right until the mid-2009.

I did an acute medical job in FY1, and loved it. I did an acute medical job in FY2, and loved it. In the year I took out of training last year, I spent 80% of my working hours in a really lovely job that I honestly enjoyed and for the rest of the time did locum shifts in my old receiving unit where I bounced around like the Energiser Bunny on steroids before ending up in my car at midnight marvelling that people were actually paying me to do something that I loved so much. All the career options that I’d mulled over and not been able to settle on during FY1 and FY2 had one thing in common: the part where I’d kept saying, out loud, even, that my priority was to be able to keep doing acute medicine. My favourite thing in the world (other than chocolate, maybe) is the part of my job where I start with a completely white piece of paper. And then from various sources there’s a whole muddle of information that doesn’t make sense, may not all be relevant, and more often than I’d like contradicts itself, and I get to try to organise it into a coherent narrative and work out what to do next and, on the very best days, actually fix it. And to a certain extent all of medicine is about that, but acute medicine is about that.

And a part of the reason that that was my priority was that I couldn’t choose an organ. My internal narrative went along the lines of: “I like the idea of endocrinology but haematology is still super interesting and the lungs and heart are kind of important and do things that I’d like to know more about but the liver is cool too and the kidneys work by magic which is amazing.” My personality is best described as Definitely An Adult Physician, But Eternally Indecisive About What Kind Because The Medical Specialties Are All Brilliant.

I like getting to start at the beginning. I like unpredictability. I like that even the things that are about pattern recognition aren’t the same, because people aren’t the same. I like listening to peoples’ stories. I like talking to patients and their families, and trying to demystify things for them. I like doing simple things that make big differences. I like doing practical things. I like being busy and useful. I like lists of problems and complicated things that I can start to unravel. I like teaching. I am fond of the occasional shot of adrenaline in my coffee.

Just before Christmas, I was involved in a Twitter conversation organised by the Society of Acute Medicine. A consultant who evidently has more poetry in his soul than the JRCPTB described the specialty as, “It feels like you’re standing in the hospital’s engine room every day.”

That’s it. That’s what I want.

As someone who is not yet in specialist training, the most frustrating thing about it is the number of people who look at you as if you’re having a psychotic break when you tell them that it’s what you want to do. I get why it isn’t for everyone, I do, but it’s for me, I think. In retrospect, the most surprising thing about my epiphany at the nurses’ station on that Sunday evening was only that it had taken me so long to have it. And if I am a little bit mad, I think that’s okay. As the Cat said to Alice, we’re all mad here.

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?”