Friday, July 21, 2006

NHS returns

A lot has happened since I last wrote an entry as the flippantly-entitled “regular Colonist”. For a start, I have not been a regular, rather an ex- or suspended-from-active-service Colonist. A lot has happened in the world, too.

In fact, it has been over a year.

In this year I have been once again an active medical relative, or medi-relly. This merged seamlessly with becoming a medical patient (there is probably a term for this so rude it cannot be printed or even thought) as my hips fell apart. Well, my pelvic girdle did less girdling and more grinding of its component parts against each other under crazed hormonal instructions.

Next, it was a mini education that every surgeon should undertake: being operated on. My, doesn’t it hurt? Amazing, it is, that one could have made so many easy slits with scalpel in skin that immediately parts and then the blood comes in little points you swab before getting down to the job. And never once known how much that little or long wound would hurt as the ensuing hours un-numb it and the days and nights slowly pass before you can hope for anything other than severe pain. And how unsympathetic doctors of all shades are, whatever they say.

Then, fairly instantaneously, I became a mother again. (Give me endorphins every time – cannot remember the pain of natural childbirth at all. In retrospect it gains a halo of ennobling effort. Especially in contrast with a caesarean section.)

A long while after, we took all of us to the States for half a year.

And now I am back, walking without crutches and taking up colonoscopy again as if it all had never happened at all.

Yet the NHS has changed. Where before we were a happy-go-lucky department, admittedly the least busy of any I’d ever seen – now I walk in and the tension is crackling on all sides. I am immediately appraised of this redundancy here, cuts there, job threats and, disconnected as I am, floaty still on my little cloud of happy baby-gazing, I am dragged into the argument first one side then the other. I reel home shocked less at my predictable failure in confidence and technique that allows me to get stuck at the hepatic flexure on 3 cases than on the steamy atmosphere of accusation and overt rowing. This is what causes me to back off and hand over the colonoscopies to the boss - I am trying hard not to get any flak directed at me. Dodging the cross-fire is enough to deal with. I don’t want the grievous sin of holding up the list as well.

The second list, second week – it is the same. No one is even pretending to ask about the baby now. I’d had a preview trip with baby in tow before starting, but had not really got a handle on the situation, not met the key players before she was awake and needing feeding and, worse, wanting to crawl. Not in an endoscopy unit, I don’t think so dear.

But I was worse this time – couldn’t even get a venflon in to one poor guy with veins like ropes. I know how much that hurts, too, now. Can’t look him in the eye. Call the boss over after 3 failures. There is nothing odd about his motorway-veins. The kind you give to beginner medical students before sending the cocky ones to stick the lady on Warfarin. (My own mother now the Lady on Warfarin. It was me who was sent, not cocky just practical joker of a houseman, to take my first blood ever from a lady on warfarin. I am sorry, Lady, wherever you are. I wish I’d told you you were my first. You had a right to refuse.) The boss’s venflon slides in and rocks around inside. Has to be taped down to stop the whole tiny thing being swallowed up by the great vein it is a tap into, like a mosquito. The boss does not deign to be triumphant – it is only a venflon. First day back. Still, I expect to be watched a little more carefully now. I talk to the guy, tell him everything to expect before giving me first his signature and then his colon to inspect – fully acquainting him with the expected side effects of sedation and the risks of the procedure. My two bosses differ slightly in how rigorous they expect this chat to be.

Any how, there he is undergoing the first part of it – up to the splenic flexure, which we do routinely with no sedation as a limited procedure. But in this guy, we have to get all the way round. He jumps. I apologise, and as I do, I suddenly realise that I never gave him the sedation. I resist the temptation to tell him. My boss could give it but misinterprets my pained looks as merely my being stuck in the colon and offers advice. As the patient is fully awake, I can’t communicate as clearly as I want to shout argh help I've forgotten something! As I try to assess how serious this mistake is and how best to get out of it, my realisation I am going to have to fess up leads me to flush to the roots of my hair. I turn to the boss – “haven’t.. sedation” I stutter then just grab the waiting drugs (one hand on the ‘scope) and give him it via the disputed venflon muttering honestly (yet it is not quite the whole truth), “I’m just going to give you a bit more painkiller”. Alice’s offended answer to the March Hare’s offer of more tea comes into my head: “I’ve had nothing I can’t take more”"You mean you can't take less" says the Mad Hatter. "It is very easy to take more than nothing".

I am suddenly glad that after a year off, I am not back doing a list of anterior resections and trauma surgery. It is like riding a bike, the physical cerebellar-controlled actions of the skill you have learnt by practising. It really does come back. But other components to doing the job are not so easily recalled. Perhaps I should have warned him that I’d been away for a year. Would you want to be the first patient of such an operator?

Afterwards they laugh at me. You’ve been away from the NHS for too long, they say. You are being too nice to the patients. No time for that! That’s not what we do...

And it is true.


Anjali said...

Dearest Tz,

I have to admit this is the first time i have read one of your blogs. I am a mere Final Year medical student, hoping to be a Doctor this time next year!

Your blog made me laugh and cry. Literally! My life has been stressful but as a single young woman I can't imagine juggling a newborn and a job!

I may have assissted in 10 deliveries but until I'm a mother I will not be able to empathise with you fully! (we've been taught A LOT of communication skills!)

However as a medical student and a woman i can sympathise with you. I may not be a Psychiatrist but Imperial College have ingrained communcation skills into my system since Year 1 and i had the glorious pleasure to be in the first cohort of 'Medical Humanities' which is where this blog began!!

So I completely comprehend why writing your blog and reflecting upon your year and the different roles you've played is clearly therapeutic!

Hence I am posting a response! This is the start of my Final Year. Since my 9 weeks of psychiatry i understnad myself a million times better. now that i have understood myself i feel i can sympathise and empathise with my patients better!!

So i know that typing this post is therapeutic for me. I cope with stress by talking ( I am the Queen of verbal diarrhoea!) and i like to relax with a bit of banter with colleagues as well as, more importantly, my non-medical friends!!

So thank you for putting a smile on my face so early on a Saturday morning (I'm still a student so 10am is shockingly early!)

I hope you have a lovely weekend!

aj said...

Welcome back Tz! Its nice to know the Docs have the same experiences as us... although I had rather hoped that side of things would magically disappear at some point! Oh well.

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