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Friday, June 01, 2007


I have just had 10 days off on ‘zero hours’ or annual leave. It was bliss, not having planned anything, not having to do anything. Usually, if I had more than a week off, I would have planned way in advance to go away, to go somewhere and get out of London, my house. But I guess, with this year and all that has been happening, I am really tired, mentally. I have been working hard, at doing well in my job, showing that I can be the best I know how, and understanding more about myself and pushing myself to the limits. Each time I get used to the job and can enjoy it for what it is worth and do it to the best of my ability be comfortable with it, I have to change placement again. And therein lies a cycle of getting to learn new things and getting used to the new environment again. Change happens, again.

The first thing I noticed about A+E is that it is never-ending. Always continuous. That is a downside of it. Another is that although there is majors and minors sections, which are full of patients as it is, there is no paediatric bits to the job (as it is handled by the Paediatricians on the Heliers side). Thank goodness I have undergone Paediatrics and had the benefit of working in a Level 3 Neonatal Unit with brilliant colleagues, whom I have learnt a lot from during that period of time.

On the other hand, it’s a great thing not having a bleep. Every time I was on-call and had a bleep, I was excited on one hand, but at the same time, the moment the bleep keeps on going off, I had the vision of just throwing the bleep into the toilet bowl or against the wall many times. But now that I do not have a bleep, I am savouring every minute of it. Also, I am thankful of the fact that I am still managing to see some patients who have surgical problems. I am also at Heliers, which was what I wanted and which I managed to arranged. Thank goodness for the swap, coz I think it is a blessing in disguise!

I have now gone through almost 2 months of A+E, and I love every moment of it. I am learning lots. Learning how to deal with minors patients, re-learning medicine for majors patients, and even learning how to deal with resus calls. In the first 2-3 weeks, I was terrified of taking any resus calls, as it seems that all the middle grades are busy with everything and everyone else. So I didn’t volunteer, and it was like I was trying to cover up my fright by being busy with the majors patients. But now, I am not scared anymore, and am learning how to deal with such situations and taking it one step at a time.

My colleagues too, both medical and administrative, are wonderful. My supervisors and regs are good and willing to teach, if we are willing to learn. I realise that we can learn a lot from one another, and I am talking about SHOs/F2s. Each of us has done different placements, or maybe we have done similar placements, but we each have different experiences. And although we are all very different people, we have similar mindsets, and that is, to recognise an ill patient, and to treat every patient to the best of our ability.


I have just attended the Advanced Trauma and Life Support (ATLS) course at St Helier Hospital at the beginning of May 2007. It is a great course to go through, and the instructors were very hands-on, and built on a basic foundation. It helps that Mr Churchill and Dr Stevens, both my educational supervisors who are brilliant, are the course directors. I hold high regard for them as they have taught me a lot by example. Pre-course, I needed to read a humongous ATLS book for preparation of the course. Those 3 days of the course itself was amazing. It was very informative. Although one would have read the book beforehand, it never beats having the basic concepts drilled in to you and reiterated every so often, be it in lectures or in practical sessions.

Not to mention, one does not realise that they are constantly under scrutiny by the course instructors, because they are not obvious at all. But it stands to hold that they observe you all the time, as the course is essential. One can be book-smart, and can pass the course easily at the written test or the moulage, but I feel that it is more of the consistency of throughout the whole course itself.

Having said that, we went through the 2 mock test stations before having the actual moulage/test itself. During the mock stations, I feel that even though you know the basic concepts behind it, one is never totally prepared for the actual situation itself. Although I knew what I was supposed to do and look out for, it is so different despite speaking out loud during the exercise itself. It turned out to be so fast and so slow. Anyway, to sum it all, even though I passed the moulage and thought I did well in the written paper, I was wrong. I failed in the written paper, and got the lowest. Which even surprised my mentor (in the course) and myself. I lost a bit of confidence there, and just let it be for a couple of days. Then I re-sat the written paper a week and a half later, after reading the whole book again. And I passed, with a score of 36 out of 40! A great relief, that was for me.

What I have Learnt

I have just finished a week of nights now. Altogether, I have done 2 sets of nights under A+E, and during these times, I wonder at the intelligence of the population which we are treating. I understand that people want to be seen by a doctor, and they have to wait. Some just can’t seem to comprehend that there are some others who are more ill than they are. Especially those in minors, where they complain that they are waiting so long to see someone, and that their problems are the most urgent. Compared with someone who has had a heart attack or an epileptic fit, in priority/resus, they don’t seem to comprehend that that is more urgent. That just irks me. Irritates and annoys me tremendously. I’ve learnt that, given a hard enough push, especially if it is unreasonable, I can lose my temper. I’ve come close to that a time or two through the week of nights, but I never have lost it. After a while, I just resign myself to the fact that some people are more selfish than others, and I just have to deal with it. And exercise my patience, something which I don't have a lot of.

I have learnt lots in this rotation alone. A+E is never-ending, and I enjoy the variety of cases that come in. I relish the adrenaline rush with the priority and resus cases which come in as well, but I admit, I get scared at times of not being able to cope during the immediate management itself. Or getting access. Or not giving the right treatment. But I manage. And I know that there is always someone to ask, somewhere around in the department. But I’m also afraid of being seen as incompetent at times. I don’t want to be known as the ‘doctor who is useless’, or my colleagues just shaking their heads when they hear my name, as I have seen with some other doctors. I want them to be able to trust in me, that I am safe, reliable, and good enough for my level, if not better.

Moreover, I have learnt that I work too hard at times, even continuously, and initially, forgetting to take my breaks. Until my regs order me to. And I think that is good. Those breaks are life-saving, if not, I feel so burnt out after a shift that I do not have the energy to do anything after that, and just crash at home. Then go back into work the next day. It is not healthy. And I have changed that. It is good that I have really good SHOs in the departments, who have done a variety of placements, and that vast experience pooled together, has helped in discussion of cases, and learning more about the management, and interacting with other colleagues, and having fun at the same time! This is with the nurses as well, and I get along well with most of them, even having a laugh at times!