Reflections: how long do I have left?

Part of being a medical student, and doctor, is the ability to reflect and learn from situations you find yourself in. I have come to realise how important it is to actually sit down and do this. I used to think it was such bullshit the time I would have to spend filling out my Reflective Diary. I looked at the task as such a chore. But I was wrong.

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Recently, I was in a situation with a patient who had just been told that their previously localised liver cancer had now in fact spread to their brain. In the chaos of the morning ward round, the doctor explained to her the extent of the metastases and then left to continue seeing patients, asking myself and my fellow medical student colleague to stay behind with the patient. We sat with the patient in silence for what felt like ages. I didn’t know what to say. What could I say? The patient broke the silence first.

How long do I have left?”

It was the question that no doctor can answer with any real certainty, and one that a medical student dreads.

I found out later upon discussion with the doctors that the ball park figure at best was a year; at worst, a few months. Of course at the time my response was, “I’m sorry, I just don’t know“.

We then sat with the patient for maybe twenty minutes, mostly in silence. I got her a glass of water; I knelt down next to her and held her hand. She cried. As a medical student, you learn how to break bad news. You get taught a structure in which you give the patient “warning shots” before you hit them with the bad bit. However, no one teaches you what to do after it’s done. No one tells you how how to react in that moment where someone finds out they will die. I felt helpless. There was nothing in that moment that I could’ve said or done to make the patient feel better. So I didn’t. We continued to sit in silence and I let her take in the news. It was at this moment that one of the doctors came back into the bay. She offered to call her husband and ask if he would come in. The patient agreed and we left the bedside to let her take the call privately.

After we had left the patient, we went for a coffee with the doctor and debriefed on the whole situation. We talked it out. Discussed our feelings and all that so-called “bullshit”. It’s not bullshit of course, it’s actually really important to talk about these things. To know that it’s okay to feel utterly helpless, to know you don’t have to say anything. The doctor told us that after we had left, the patient actually wanted to pass on her thanks to us for sitting with her. Turns out us sitting there, holding her hand and saying nothing, was just what she wanted.

This day was one of the heaviest days I had had in a while. I was still thinking about the patient when I got home that evening. I told the boyfriend about it that night and cried. But I felt much better for doing so. It turns out all that reflecting they tell you do both at medical school and as a post-graduate isn’t just to waste your time. It’s to get you to learn from that situation, and know what you will or won’t do the next time it happens.

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Hello, my name is Lisa and I’m a final year medical student

It’s been nearly a year since I posted here, which probably means I had a very busy fourth year, but I am happy to say that I am officially into my final year of medical school! I’m actually one rotation down already in my fifth and final year, which means I only have two more rotations left before finals ..which is actually only five months away, eek! 

What is nice is that I can finally see the light at the end of the tunnel, and I cannot wait to be done with this degree. A lot of my friends graduated a few weeks ago and today they start their first ever job as a doctor. Today is the ominously named “Black Wednesday”, which is the day in which all the new baby doctors across the country rotate into their new jobs. As excited I am for my friends who are embarking on this new chapter of their life, I am also terrified that that will be me in a year’s time. It’s hard to imagine myself as an actual qualified doctor and whenever I think too hard about it, it makes me feel incredibly anxious. I think for now, I will be taking it one day at a time. There are still finals to get through first, and they are rapidly approaching…!

Anyway, I have the next three weeks off over the summer to relax a little, recharge and get ready for the onslaught that will be next several months. I not only have finals but job applications and the dreaded Situational Judgement Test to look forward to before my last exams of medical school. I recently had a lovely break to Malta with the boyfriend as well as a weekend away to Wales with some gal pals so am feeling suitably chilled out. I think over the next few weeks off I am going to blog a little about those trips to keep my mind off medicine, and also to get back into the swing of writing again. I forgot the reason I started this blog and now that I’m heading into the busiest couple months, I remembered why I began writing for myself – to use this as an outlet for my anxiety over medicine and hopefully get myself excited about it all again. 

Big pharma & beignets

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I was lucky enough to get the chance to attend the American Diabetes Association’s (ADA) Scientific Sessions in New Orleans this summer. It’s the largest conference on diabetes in the world and there were over 16,000 people in attendance.

I had actually never been to a medical conference before and to attend one that was as huge as ADA was pretty cool. Work had me attending as many of the presentations and sessions as possible, which was both interesing and dull. It was all a bit hectic as the venue was massive and going from one end to the other took 10-15mins walking..!

The experience of it all was great – and being on the industry side of it all was definitely different. Being from the UK, where medications are all paid for by the NHS, it was weird to be in America, where the promotion of medications is so liberal everywhere you look. The conference centre had booths set up by different pharma companies, each marketing and promoting their drug. It was a big eye-opener on how much money gets put into the pharmaceutical industry. Despite working in the field for 7 months now, it only really occurred to me when I was in New Orleans how much of it is about sales. Probably a little naive of me, really. But that’s not to say the work done by the pharma industry hasn’t helped those who need it.

I did make me think that I’d be better suited to be on the flipside of things. Being a clinician and collaborating with big pharma, as opposed to being immersed in the industry completely. I don’t know if healthcare marketing is something I’m totally ready for right now!

New Orleans itself was a blast, though. Great city with great food (I totally recommend an iced coffee + beignets at Cafe du Monde and a po’boy from NOLA Poboys) and people. The weather was hot and humid (along with thunderstorms and torrential rain) but I was lucky that the sun was shining on my days off from work to go out and enjoy it. Even got to see some ‘gators…

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My leave of absence

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When I tell people I’m on a leave of absence because I don’t know if I want to be a doctor anymore, I get a number of different responses:

  1. ‘Enjoy your time off – make the most of it!’
  2. ‘I wish I could do the same’
  3. ‘Don’t be silly, this feeling will pass’
  4. ‘Are you quitting medical school?!!’

Telling my parents was the most daunting thing. I had received a job offer as a junior medical writer and was trying to weigh up my options. I was torn between wanting to take the leap and try something new because I was fed up of medicine, or powering through in the hopes that it would get better. I think I’m lucky in that my parents are pretty understanding people. Whilst telling them I wanted time off wasn’t without tears, they seemed to understand that I had thought hard about it, and I wasn’t walking away from it forever.

The reason I was getting fed up was because I didn’t particularly like the job that I was seeing before me. The science side of it is fascinating to me, and always will be. However, the bureaucracy of it all was really putting me off. I didn’t really want a job where time off was potentially scheduled in for me, where there was no guarantee I would finish work at a certain time, or even know my rota far enough in advance.

People might argue that I should have known all this when I considered medicine as a career and I should have been prepared to make that sacrifice. But I disagree. I don’t think any 16/17 year old, myself included, would fully understand what the job would entail. With the recent uproar and public attention drawn to what working as an NHS doctor is really like in the UK, I think any young person considering medicine is thinking hard about it and (hopefully) making the most informed decision they can.

For me, taking this time out has been a great decision. It’s removed the tunnel vision that can take over when you are so focused on just one goal, i.e. becoming a doctor. I’ve had my horizons broadened and know that there is more beyond practicing as a doctor and several paths available to me once I’ve graduated.

I don’t regret choosing medicine. Without it I wouldn’t have had the experiences I’ve had and met the awesome people I know now.  Even if I don’t practice as a doctor when I graduate, I know that with those four letters after my name comes a certain level of skill and knowledge that can be transferable to any job I choose to pursue in the future. I don’t worry about what will happen after medical school because to me, making the leap into the working world was the biggest decision I’ve had to make, and it wasn’t as terrifying as I thought. I do plan to come back and finish my degree (although the thought of it does make me anxious), and I hope that I will return with a new attitude and outlook.