Confessions of a Junior Doctor

A&E was packed.  Doctors and nurses were running around all over the place.  This must be in London, Birmingham or Manchester.  One of the great cities of the British Isles that are groaning at their seams.  But no.  This hospital was in Northampton.  It was full to bursting and severely understaffed.

None of this is the fault of the staff.  Nor is it the fault of the patients.  The NHS is a victim of its own success by pushing the boundaries of medical care.  We are living longer than ever before.  Something that our politicians are finally recognising. The problem is that the other vital infrastructure needed to support this, hasn’t caught up.

Governments think of everything in the short term.  This way of thinking has slowly dripped down into all aspects of life.  This short term thinking is in direct conflict with the long term planning that the NHS is crying out for.  It operates by using targets to prove efficiency.  A hospital or a school isn’t a machine.  You don’t pump one thing in one end and get a product at the end.  People aren’t commodities.  Yet the management strategies being adopted fail to recognise or question this.

Healthcare, as well as education and to some degree, law enforcement, involves dealing with the whole individual rather than the illness, the exam or the crime.  The only place where this is really done in society is when someone wants you to buy something.  Go to any car dealership and they are trying to find out every aspect about you to find a car suitable to your needs.  The same goes with property and estate agents.  You are even asked for your name when you buy a coffee which puts in perspective one of the junior doctors who had been so busy, she didn’t have time to remember her patients’ names.

This is something the junior doctors in Confessions of a Junior Doctor know all about.  We saw an oncology junior doctor being brave enough to tell her consultant that she wouldn’t be hurrying her rounds.  Her superior was informed that if she didn’t take the time to reassure and listen to one particular patient, he would get extremely anxious and possibly talk of suicide.

On another ward, another junior took the time to find out why a relatively healthy twenty year old man was only weighing four stone.  What he discovered by just listening, was that the patient was using cannabis heavily.  Although cannabis is famous to inducing the munchies, if overused, like alcohol, it can suppress appetite.  I thought the consultant was going to kiss the junior doctor for discovering this.  The man had often been in and out of hospital and he was a bit of a mystery. Yet the junior doctor found out the root cause of the problem just by listening.

Such stories give you hope that all is not lost.  But these are doctors who are going against the system.  They are doing what they think is right, not what some of their superiors want them to do.  Now they can just about get away with it.  Whether they could get away with this in five years’ time, no one knows.

Emmerdale

I feel a fraud writing about Emmerdale.  I’ve not watched it in years.  The last time I watched it, Amos and Mr Wilkes were pulling pints in the Woolpack and Andy Sugden was an obnoxious ten-year-old.   Now Andy has left with many wives and kids in tow but I think the Dingles are still knocking about.

Anyway, it turns out that a Dingle in Emmerdale has been diagnosed with cancer.  Faith Dingle was diagnosed a while back.  There has been praise in the media on how the soap has treated this.  Much lessons have obviously been learnt since Pat Butcher.

At last it seemed that a soap would now involve a character that was living with cancer.  However, the writers baulked at this.  She’s now been “cured” apparently.  Or more accurately “in remission.” Being in remission is not the same as being cured.  I used to think it was.  Remission basically means a break.  A break from cancer.  This break can be long or short.  For me, my first remission was for two months, if that.  My second remission was a bit longer at a year.  I’ve meet people who have been in remission for twenty or even thirty years.  They all know that the cancer will probably come back at some point in their lives.

Many advancements are being made to either make remissions longer or to stall the cancer when it reoccurs.  New treatments are being developed all the time.  I know many people who switch and change treatment quite often and can just get on with it really.  They are the lucky ones. What is scary about cancer, is when it takes hold, the downfall is quick.  Although Pat Butcher’s demise was a bit too quick that it almost was laughable, you can’t underestimate how powerful cancer can be.

Yet it’s not all depressing.  More and more of us are now in the grey area.  We are not in the brilliant white of remission and we are not in the deepest blackness of death.  We are in a pale grey.  We have cancer, but are having treatment to keep it at bay.  Every year there are more and more people in our ranks.  It’s something that TV is slowly recognising.  In Sons of Anarchy, the sheriff, who is trying to turn a blind eye to the biker gang’s illegal exploits, is suffering from cancer.  This is touched upon, but it’s a side issue and doesn’t dominate his sheriffing activities.  Emmerdale were very nearly there but faulted at the last.  Why? Maybe it wasn’t dramatic enough for a soap to deal with.  That’s the problem with illnesses.  It all starts with the high drama of the initial diagnosis and treatment.  Then the boredom kicks in and it all gets a bit tedious.  However, this tedium is a God send.  This gives you time to savour and value life.  You work out what is good for you and what isn’t.  Tedium is something that would kill a soap dead.  What would Emmerdale be like if everyone was happily married and nothing was going wrong? No one would be watching that’s for sure. And maybe that would be a good thing?

Supervet

Our family have never been big on animals.  Although both my parents had dogs when they were younger, full time jobs and living next door to a main road put a scupper on me and my sister having such luck.  Goldfish and that was the limit we were told.

When the C bomb dropped, I decided to reduce my teaching hours.  Part of this was health related and part because I wanted to do what I wanted to do. After much umm-ing and ahh-ing we decided to get a dog. What dog was the next question. I didn’t want a small yappy terrier type dog.  We had lived next to one when I was a child and it scared the bejesus out of me and my sister.  I didn’t want a puppy either.  I wanted a fully developed, mature hound.  I’m not sure how we chanced upon greyhounds, but we did.

A visit to a retired greyhound sanctuary was booked just to have a look.  Word to the wise.  You never visit an animal shelter for a look.  Sookie was the first and only greyhound we walked.  My husband, who had owned two rescue dogs previously and therefore an expert, decreed that she was the one.

Papers were signed, home visits conducted and in a couple of weeks we had a fully formed greyhound snoozing on our sofa.  They don’t really warn you, but it’s a life changer.  I can’t image what life was like before.  She is so much part of our lives now.  It would feel strange not to open a packet of cheese and not feel a nose by your elbow.

A programme that documents this love so well is Supervet.  The Supervet in question is Mr Neil Fitzpatrick. There is no alter ego or costume change. It is just Neil Fitzpatrick.  But he can do remarkable things.  He can make legs where there are none in a whole range of animals.  He screws, welds and hammers all manner of stuff together. He does all this in the wee small hours, after his surgery closes. It’s clear to see that it’s his passion.  His life is the animals in his care.  He lives and breathes them.  It’s hard to say if he gets this passion from the animals or the owners.  Possibly a mixture of the two.

Before I had Sookie, I never watched Supervet.  I couldn’t see what the fuss was about.  A dog is a dog at the end of the day.  Since getting our hound, I watch now with enthusiasm and awe on what can be done.  It makes you think that if such possibilities are available to our best friend, what wonders are there for all of us.

Melissa had used her organisational skills to the max and had arranged an appointment for me with Dr B and Mr Q, a plastic surgeon.  My eye issue could now be sorted for once and for all.  The allotted day and hour rolled around.  Back in the lovely ENT waiting room and they were running late.  My appointment was at four and we were well into Flog It.  I wasn’t feeling optimistic.

At quarter to five, I was called through.  Dr B and I exchanged niceties, twiddling our thumbs for the man of the moment to make his appearance.  When he did arrive, it was a bit of a let-down.  He snuck in without much fanfare.

What I’ve noticed during my cancer “journey” is that most health care professionals match their job descriptions. GP’s are often quite “general” because they know a little bit about everything.  This means that they can be vague in certain scenarios.  Junior doctors are eager to please.  They don’t want to mess up.  They take detailed histories and agonise over any decision.  Registrars are smug.  They know it all.  What they don’t need are patients cluttering up their day. Consultants are a mixture of junior doctors and registrars, but in a milder form.  Nurses are the glue that hold everything together.  They are the warriors at the frontline implementing the various plans that are devised to make everything OK.  As for surgeons, they are clear and precise.  They are like the surgery that they perform.  They don’t sugar coat anything.  It’s a bit like talking to a scalpel, if that makes sense.

Mr Q was no exception.  He was scanning my face and thinking of all manner of things.  I explained that I wanted the left side of my face hoiking up.

“Oh yes… we can definitely do some hoiking…”

He outlined a whole range of possible procedures.  I wasn’t really listening.  They seemed to involve cuts on my smile line, cuts to the back of my head and at one point thigh muscles were mentioned.  When he finished, he took out his phone.

“OK.  I can see you in my clinic on 2nd May. Is that OK?”

I nodded feeling cock-a-hoop.  Who cared that the 2nd May was the Tuesday after the May Day Bank Holiday when I would have had to rush back from North Wales from celebrating my Auntie Claire’s 80th birthday?  Who cared that I also had a full day of teaching that day which would be a nightmare to cover, especially with exams in the offing? The man had a plan and that was all I cared about.

Man Vs Food

Could he, do it?  Could he really eat a burger the size of his head?  After half an hour of build-up, we had to find out.  Welcome to the world of Man Vs Food.

Man Vs Food is one man’s odyssey around the US of A sampling the delights that American cuisine has to offer through the various eating challenges some restaurants have to draw in the punters.  This man goes by the name of Adam Richman.  He is charm personified.  His enthusiasm for food, kitchens, America and life in general has a magnetic draw. You can’t help but cheer him on in his quest.  It’s a great programme showing the diversity of American food.  It’s easy to dismiss American food as all burgers, fries, terrible chocolate and enough sweet stuff to fire a power station.  Yet America is a huge country.  I remember being told once that the distance from New York to LA is the same as from London to Baghdad.  A country so vast must have a lot of diversity within it.

In Man Vs Food, you see amazing seafood from the north-eastern states, Mexican inspired food from the south west, Texan steaks and a never-ending supply of hot wings and other barbecue food matter.  One of the best Man Vs Food came from Puerto Rico, which is part of the States, but somehow isn’t.  Yet Adam and all of us viewers, were bowled over by how amazing the cuisine was as well as the warmth of its people.

America gets a hard rap from most people.  Sometimes this is wholly justified especially where foreign affairs are concerned.  But it is an amazing country.  It has deserts, mountains, swamps and glorious beaches.  It’s quite understandable that two thirds of Americans don’t possess a passport.  They don’t need to go anyway, they have everything they need.

Food is a contentious issue in cancer.  Don’t eat sugar. Don’t eat bacon. Don’t drink caffeine. Every week there seems to be a different bit of advice. It’s a tough call as food is a very personal thing.  We live in a time now where eating is something to feel guilty about.

My cancer has affected my eating.  Thanks to the surgery on my mouth, I can’t open my mouth very wide.  I feel a pang of jealousy every time I see Adam deliver a huge bite into a burger, sandwich or burrito.  My big biting days are sadly over.  It also takes me longer to eat food. This can be a bit awkward, especially in restaurants.  On the plus side, as I’m chewing my food more, the portions I have, have reduced drastically.  Whether this is good or not, time will tell.

I am now a messy eater.  This is something I relish.  I see some people that I eat with recoil sometimes when I am eating.  Rather than be ashamed by this, I get a perverse enjoyment from their discomfort.  This is because, like Adam, I think that food should be enjoyed.  How can you enjoy food without getting a bit messy in a while? Adam often has hot sauce smeared over his face, which he wipes off with the back of his hand, before taking another chunk out of whatever it is he’s eating.  It’s pure enjoyment, plain and simple.

We are lucky to live in a country where food is in abundance.  You could say that programmes like Man Vs Food seems to show the dark side of this where gluttony is celebrated.  Yet food makes people happy.  If you feel like a piece of cake, have that piece of cake.  Just don’t eat the whole cake…

Murder She Wrote

Murder She Wrote is a staple of daytime TV all over the world.  It’s the one programme I’ve seen in both Thai and Czech, which was an interesting experience.  It seems odd that most crime shows involve people solving the crime, who aren’t qualified to do so.  I blame Sherlock Holmes.  He started it.  He went about his investigations in such an arrogant and original way, that he became the go to blue print for modern detectives today.

Now there’s a whole army of these vigilantes going around, sticking their oar in.  Image if that happened in real life?  The Met are investigating a brutal murder when up pops Father Brown to save the day.

There are some parallels with this and healthcare. When you go for an appointment, quite often you a met by Jessica Fletcher rather than DCI Tennyson.  On the surface, there is nothing wrong with Jessica Fletcher.  She solves the crime and everyone is happy.  Yet something is missing.  Police work is often quite boring.  Trawling through phone records and CCTV to get the evidence to prove your case.  But Jessica glosses over that.  Instead it’s all a big adventure.

This is why encountering a Jessica Fletcher in your appointment can be annoying.  They don’t know the detail.  Details are everything in healthcare.  When was your last scan?  What medication are you on?  When was your last blood test? Jessica Fletcher ignores all this.  She wants you out of that room as quickly as possible.  Yet she’s not horrible.  She wants you to feel better.  She is a doctor after all.  Yet when you are spat out at the other end, you are still left with your questions unanswered, bewildered in the waiting room.

That was exactly how I was feeling after all my to-ing and fro-ing in the eye clinic.  No one really knew or cared about the nitty gritty.  Just keep dolling out the eye drops and all was good.  Frustrated I phoned Melissa, my cancer care nurse in ENT.  She was sympathetic.   Within a week, she arranged an appointment for me to see my oncologist and a plastic surgeon at the end of the month.  Simples.  Hopefully now DCI Tennyson would be on the case…

Columbo

Columbo is like Marmite.  You either love it or hate it. Columbo always reminds me of rainy Sundays with my mum concentrating intently, while knitting away.  My mum loved Columbo.  I think this was because you found out who did the murder in the first half an hour of the programme.  With other whodunits, mum would usually fall asleep half way through.  It would be annoying explaining to her the next day who did what.

My favourite Columbo episode involved William Shatner of Star Trek fame.  In it he played a wine buff.  The two of them had a wine tasting face off in the last scene where you were unsure which wine was poisoned.  Seeing two such experienced actors play off against each other was great for a Sunday afternoon.  Of course, Columbo knew exactly what was going on and off went Shatner, hand cuffs and all.

I like William Shatner.  He seems a man who doesn’t take himself too seriously.  I read his autobiography a couple of years ago.  It’s a good insight into the temporary nature of the acting business.  Shatner’s coping mechanism of dealing with rejections that came his way was to shrug it off and keep on plugging away. Our family have a slight claim to fame involving Mr Shatner.  My mum’s cousin shared a room with him while at uni in Canada.  This was a while ago but in his autobiography, Shatner describes his time at uni by “hanging around with cool guys with red sports cars”.  Whether this was cousin Brian or not, is unknown.

My mum also has a quite amazing claim to fame which stunned my husband into silence.  While she was at teacher training college in Loughborough, she popped down to the student union to watch the film that would be playing at their weekly cinema club.  Once she got there, she saw that the film had been cancelled and that a young guitarist would be playing instead.  My mum decided to hang around and see if he was any good.  That guitarist was Jimi Hendrix.  I don’t which fact is more surprising.  The fact that my mum saw Jimi Hendrix in his prime, before he hit the big time or the fact that Jimi Hendrix was in Loughborough.  I wonder what he thought of the East Midlands…

I was once again at another marvellous institution of the East Midlands awaiting my follow up appointment in the eye clinic to see what on earth would be happening. On arriving at the Queen’s Medical Centre, a harassed sounding tram driver told us that unfortunately the lift wasn’t working at the tram stop.  Not a good start. I checked in at the eye clinic, did the usual eye test on arrival and settled down in the waiting area in time for Doctors.

After about half an hour I was beckoned into a room.  I had decided that this time I would use a different strategy.  She had probably already decided what she wanted to say, so I stayed silent.

“How are we today?”

“Fine…” (even though I have half my left eye sewed up, I felt like saying, but didn’t.)

“Right let me look at it then.”

She examined my eye and reported back that it was fine.

“I’d like to see you in three months’ time.  What medication are you on?”

This put me on the spot. I could remember my painkillers and the cancer stuff.  But now I was expected to remember the eye stuff too.

“Urm… something beginning with “L”?”

She frowned.  Surely it must be in my notes! I felt like screaming at her but I kept up the silent treatment.  She scribbled on a prescription pad.  It was barely legible.

“OK.  Here you are and see you in three months.”

“So, I guess the stitches are a permanent thing then.”

“Yes, until you…”

She didn’t need to finish the sentence.  We both know how it ended.

I nodded and left the room.  I smiled one my way to pharmacy.  I had a plan…a very good plan…

How to handle people with cancer

Cancer is a terrible, terrible illness. I have found out those around you have very varied reactions to it.  These reactions are in response to when you say the word cancer, people think of death.  When you tell someone, you have cancer, you are telling that person you are going to die.  This means that the person you are speaking to is forced to acknowledge your mortality.   The awkwardness comes because they are also forced to acknowledge their own morality too which, unsurprisingly, is not an easy thing to do.  So, there are a whole load of hidden demons lurking there.

People with cancer sometimes give others quite a hard time in their response to it.  Whatever they do, it always seems to be the wrong thing.  It’s either far too suffocating or they aren’t doing enough to help.  This is because cancer and any other life limiting illness, changes you.  You have no idea what is going to happen and ultimately, you are going to die.  For this reason, your own life becomes much sharper.  You can see through the fog of nicety and social conformity. You know exactly what you want.  For once it isn’t about others, it’s all about you.

For me, to widely generalise common reactions, most people fall into the following categories:

The “I’m here not matter what” person

Every cancer patient has encountered one of these.  I encountered one just last week.  I was at the cancer support centre I go to and there she was, nursing a green tea.  I said hello and  got the full story.  Her friend was upstairs in the breast cancer support group.  She had been diagnosed with breast cancer about six months ago.  This woman had been to every single appointment with her friend.  She had been to every scan, every blood test, every chemo session, every radiotherapy session.  She had cooked breakfast, lunch and dinner for her.  She had cleaned her house from top to bottom.  She had walked her dog.  She had accompanied her taking and collecting her children from school.  She had been at her friend’s side ever since she had been diagnosed.  I smiled.  I was thinking what was going on upstairs.  I bet that now she had finally gotten rid of her, at last she could now finally tell the others in the breast cancer support group what exactly she thought of her!

But she has been soooo supportive! I hear you cry.  Well yes… but to a point.  What you need to ask is how much of all this is to help her rather than her friend?  I got the impression that her friend with breast cancer had no say at all.  It seemed to make her feel better about the cancer diagnosis rather than her friend.

Her friend with breast cancer is partially to blame as well.  When I started my various treatments, I was quick to say to all of my loved ones that I wanted to go through them either with just my husband or alone.  I didn’t want to have the pressure of having to “entertain” people, especially through chemo.  That was my choice. I was always struck by how while during chemo, you would have the cancer patient slumped on the chair.  Next to them a chirpy friend would be asking everyone in the unit if they fancied a cup of tea.  Although I guess this chirpiness is a coping strategy, it can be very annoying.  Be honest with the person who has the illness.  Just have a frank, straight forward conversation where you tell the person what you can do.  Then ask the person if that’s acceptable to them for you to do it.  A person with cancer is finding life hard, but they do have a brain.  In fact they are pretty much the same person you were friends with before the diagnosis, so treat them as so.

The “Just Tell Me What To Do” Person

This person is freaking out.  Maybe you are the same age as this person.  You telling them that you have cancer is like the grim reaper telling them they are going to die.  Obviously you can understand people being shocked that you have cancer.  That is a perfectly natural response.  What is annoying is the response to it.  “If there’s anything I can do, just let me know…”

What’s wrong with that?  Well it’s the ultimate non-committal response.  It relies on the person who has the illness to conjure up a task for their friend to do.  When you have a life limiting illness, your needs vary from day to day and sometimes from minute to minute.  The “If there’s anything I can do, just let me know…” I think weirdly, takes power away from the cancer patient and gives it to their friend.

And all the while they are no closer to accepting the change in circumstances.

This response is more difficult to counter. I have been guilty of saying this when someone I know is going through a crisis.  I guess the best thing is to tell you friend that if you are doing something, ask them if they want to come too.  For example if you are going shopping, ask your friend if they want to come along as well.  If they are too ill ask if there is anything they can get you.  Be specific not vague.  The key is to ask and to remember that you friend is still your friend.  They just have cancer as well that’s all.

The “Do Nothing” Person

I actually don’t mind the “do nothing” person.  To me the “do nothing” person is respecting your space and giving you the time that you need to accept the diagnosis.  This is a completely different story if the “do nothing” person is your husband, your wife or your parents.  If your support network shows no support whatsoever and expects you to carry on regardless of all the poisons and radiation that you are being exposed to then this is a bad thing.

Part of this reaction is denial.  It’s no surprise that quite a lot of marriages break up when one partner gets a life limiting illness.

You must accept that your partner, son, daughter, brother, sister, friend has changed.  They can do most things but there are some things they can’t do.  If they ask for help, provide it.  Don’t tut, sigh, moan and groan.  This is also true for social arrangements.  If they can’t come to your wedding, birthday party, christening, barbecue or whatever, accept it.  Although it does look a little selfish, for the person with the illness, knowing that you have accepted their decision and are having a fantastic day, more that makes up for them being there in person.

It’s hard knowing what to say or do around people who have serious illnesses and there is no one correct answer.  However the key thing to remember is that your friend, husband, wife, brother, sister’s needs come first.  If they are not in a position to articulate these then use your noggin.  You know what they are like.  If they like milk in their tea and there’s no milk in the fridge, buy a pint of milk for them.  If they are fretting about the washing up, do the washing up.  You don’t need to ask permission, just do it.  As the saying goes, actions speak louder than words.  Don’t make a song and dance about it, just do it.  Also give your friend, husband, wife, brother, sister a hug.  They will more than likely need that too.