Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh

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As a medical student, I find myself naturally drawn to books relating to the subject. Whether it’s Max Pemberton’s Trust Me, I’m A (Junior) Doctor or Paul Kalanithi’s When Breath Becomes Air, I have a real penchant for reading about the medical profession. I sometimes wonder if its the twisted sense of love/hate I have towards medicine that draws me in. But needless to say, each of these books have made me feel strong emotions in many ways.

I first read Do No Harm at a time in my life when I was personally struggling with my career choice. I was a month into having taken some time out of my medical degree. I had made the somewhat bold/stupid/mature decision to take a break from medicine for nine months. It was a decision I didn’t take lightly but one that I wholeheartedly do not regret.

I mention this significant time in my life because Henry Marsh’s book recounts his own cases or patients who have made a mark in his memory. Whether it’s because they defied the odds, or because things took an unexpected turn of events, Marsh writes about them with such eloquence and respect. Littered throughout the book however, are side quips in regards to the slowly changing face of medicine throughout his career. The changing structure of medical training is apparent as Marsh laments the lack of camaraderie because of the constant rotating of the younger trainees.

The stories Marsh tells are touching and bittersweet. They reveal the difficult decisions that face doctors on a day to day basis. Alongside this is the constant interjection from government forces that are stripping away the doctor’s autonomy and slowly chipping away at the core of the NHS. To me, it reflects what has been going on with the state of our national health service over the last couple of years, and the precise reason why I felt like I needed some time off myself.

Medical degrees are one of the longest degrees to undertake. They are also one of the most competitive courses to get into. The somewhat grueling process of applying and surviving medical school can take it’s toll on so many students, myself included. This book made me reflect a little more on why I chose to do this degree in the first place. It made me look for reasons to come back and to finish my degree. And books in similar veins (pun not intended, ha), like the ones I mentioned earlier, always seem to pull me back to medicine when I am starting to pull away slightly.

For an insightful and thought-provoking look into not just one man’s successful surgical career but also an account of how the NHS and medical training has changed over the years, I couldn’t recommend this book enough.

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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.

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. 

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.

Junior Doctors Walkout

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The BMA confirmed that the second of the two planned strikes would be a full strike. This means that all juniors will be on strike, even those in A&E and critical care wards.

My views on this are simple: this should have happened sooner. I get that there are concerns regarding patient safety but in all honesty, with enough preparation, things should run without any major problems. Yes, there will be disruptions to routine services but patient safety will not be compromised. Patients will be seen and treated by consultants from start to finish and receive the best care available by the most experienced staff.

I believe that this should have happened sooner because the BMA have already given the government enough chances to listen. And each time they spout the same soundbites they always do. Hindsight is a wonderful thing, but I honestly think that if action had been more drastic earlier on, maybe the negotiations would have got somewhere faster. It’s almost April; there are less than five months until this contract gets imposed and we are nowhere nearer to a resolution. I feel that if this contract goes through, it will be much harder to fight. And it paves the way for the government to start moving in on other healthcare professionals within the NHS (they’ve already started with nursing).

I could rant about this forever but it’s probably better for my stress levels if I don’t. It frustrates me that this whole issue even has the medical profession divided because I feel that that is exactly what the government wants. And that is how we, as a medical profession both present and future, lose.

 

Doctors’ Strike 2.0

imageThe second round of the Junior Doctors strike started yesterday. There will be in total three lots of 48 hour emergency care-only strikes over the next month, and I am completely behind each and every one of them. As a member of the public, I’m in full support of these strikes, as everyone should be.

I recently wrote a blog post for a medic who has left medicine and pursued a different career path. I totally admire thedisillisionedmedic for having done what she has because it takes a lot of courage to do it. As doctors, you are selfless by nature but there are times when you have to look after yourself first.

Below is the post I wrote for her really interesting blog. It comes from the point of view of medical students who are in a sort of limbo about the future of their training. It was both sad and anger-provoking for to write as it really drove home how important the issue is not just for the medical profession but everyone who uses the National Health Service.

Last year, a post on Reddit went viral and this heartbreakingly candid photo of a doctor grieving over one of his patients was shown to the world.

Evidently, the reality of being a doctor is tough. It’s draining, both emotionally and physically. They sacrifice so much of their time and self to help others. The reward can be great; doctors make a huge difference in people’s lives. However, if it goes wrong, they have to pick themselves up and do it all again for the next patient that comes through their door.

The junior doctor contract debate that has come to light over the last several months has angered and frustrated thousands of doctors around the country. The changes to the contract have been widely rejected and deemed unsafe for both doctors and patients. Yet, despite the strikes and protests, news broke recently that the contract was going to be imposed anyway.

The whole medical profession is up in arms yet again, and rightly so. The definition of the word ‘contract’ is: “A written or spoken agreement, especially one concerning employment, sales, or tenancy, that is intended to be enforceable by law.” The key word here is agreement. At no point has anyone agreed and accepted this contract. So why has the government suddenly decided they are going to force it on thousands of employees?

Besides the 50-odd thousand junior doctors in England, there is a significant cohort of people who were never really considered or consulted on the matter of a contract that would dictate their future – they are the 6,000 medical students in England whose voices were overlooked by the government. Six thousand people who will leave medical school and have a job contract enforced upon them that they didn’t agree to.

Amongst my friends and fellow medical students, the general consensus is one of outrage, disappointment, and uncertainty. Outrage at the audacity of the government to go ahead and impose a contract widely condemned as unsafe and unfair; disappointment at the lack of meaningful responses from the government; and uncertainty over what this means for the future of training.

I asked some of my friends for their personal views on the matter and what it would mean for them. Will they complete their foundation training in the UK then leave? Will they apply to do foundation in Wales/Scotland? Would they leave medicine altogether after graduation/somewhere down the line? Or will they stay in the NHS and fight this thing until the bitter end?

The responses were mixed. Some are considering and preparing for alternatives: Wales and Scotland; taking an F3 abroad and playing it by ear; taking the USLMEs. Some are looking for ways out of medicine altogether (I only have to look down my Facebook feed to see events pop up for ‘Alternative Careers in Medicine’ and the like, to know people are considering their options). Some don’t have much choice in the matter of whether to stay or go – the financial investment and ties to family and friends are too strong to consider leaving. And why should they have to?

One common thread amongst medical students is a desire to fight this contract for a better future for themselves, every other medical student that will follow them, and the patients of the NHS. A friend made a good point about how governments will always change and politicians are always attempting to make big reforms; we just have to fight them and stick it out. It took a lot of brave people to keep the NHS running thus far, and it will need a lot more brave people to do the same now.

However, I know for me personally, I don’t know if I could do it. Prior to this contract saga, I had my own personal doubts over a career in medicine anyway and it is looking even more unlikely that I will practice as a doctor. I actually find it quite sad to say because at one point that was what I wanted to do. Unfortunately somewhere along the way, I lost that desire and am currently on a leave of absence to work out what I want to do next. The thing is, it doesn’t surprise me to know that I am not the only medical student who feels this way.

We are incredibly lucky to have, in my opinion, the greatest healthcare system in the world. Sadly, the current government are hell bent on destroying it. The NHS probably won’t be sustainable forever, and it has its flaws, but there are so many more positives about it that we, as medical students, doctors, and members of the public, have to fight for. Medical trainees from all over the world aspire to work in the UK health system, but with the changes this contract will bring, all those highly sought after trainees will go elsewhere. And those that are in the UK already will leave. If practising doctors are considering their alternatives, and medical school graduates like myself are looking at other options, where does that leave the NHS?

It’s easy for the government to sit back and make whatever decisions they want to extend working times, reduce overtime pay, and remove safeguards for doctors. They are not the ones who will have to deal with the fall out. They won’t be the ones who will end up being treated by doctors who are tired, overworked, and damn right miserable about the conditions they work in. That will fall on the general public and all the people who rely on the NHS for their health care.

And it’s just not fair.

Is medicine toxic?

I read an interesting article today on the need for change in the culture of medicine.

The idea that one learns best through humiliation is bizarre to me. I’m sure there are fellow students who thrive on that feeling of being challenged and pushed, but there is a certain way of encouraging someone to think outside the box without making them feel like they’re being hung out to dry.

In the past, I’ve had experiences with doctors where if I don’t provide a spot on answer within a second of being asked the question, I’m accused of being a rubbish medical student. I’ve had seemingly funny quips about whether I even attended medical school, which I’ve awkwardly laughed off. Truthfully, in that moment I probably wanted the ground to open up and swallow me whole.

I wish I could say I only speak from personal experience of being on the receiving end of an old school doctor’s grilling, but I’ve seen it happen far too many times to my fellow students. And it’s not a nice experience to watch, let alone go through. Some say that it’s all part of being a medical student. Apparently getting grilled by your seniors is viewed as some sort of twisted rite of passage. One that we all go through to reach the end goal of being able to inflict that pain on some poor soul beneath us.

I exaggarate of course, but reading this article on just how toxic medicine can be made me realise one of the reasons why I felt so demoralised by the profession.

This post is a bit of rant after a discussion over how medical school can quite frankly, be a bitch. But it doesn’t have to be. There are certain stresses to the job that you can’t change: dealing with life and death is part and parcel of being a doctor. However, medics can help make the learning and training less awful by not humilating students and making them feel even smaller than they already feel.

We already know we’re the bottom of the food chain. There’s no need to keep reminding us of how little we are.

Disclaimer: I have actually also had good experiences, despite my moaning. Some doctors know exactly how to push you as a student and at the same time make you feel like you matter to the team. Those are the doctors that are I personally have responded best to. They are the ones who I have walked away from with positive vibes about that specialty. Which is probably why I most definitely do not want to do surgery.