Wednesday, July 28, 2004
The Accidental Addict
It’s been long enough.
I’m coming out of my closet now.
I’m an addict.
As imminent unemployment looms (for some reason, some part of me is insisting that the greater part of me wants to be a surgeon) and my days in accident and emergency gradually draw to a close, I can’t help but feel that I’m going to miss it.
I’m not going to miss my colleagues, like I did as a medical and surgical house officer - it isn’t going to be that beautiful ward pharmacist, or that lovely nursing student that I’m going to pine for, but rather the nature of the job. The nurses in A&E were nice enough, but there were just so many of them that I never really got to know them. And there wasn’t an Abby lookalike dammit.
I remember signing for two A&E jobs in a row. Everybody thought I was mad at the time, and I even wondered myself if perhaps I had masochistic tendancies. But after my first A&E job, I knew I wanted to do it again, to try and do it right this time. To learn how to be competent, and not just passable.
I reckon I am competent now. I’m not a terribly confident doctor. I believe that confidence takes years of experience to build, and any confidence I were to try to wear after a mere 1 year in the job would simply border on arrogance.
And I simply cannot imagine a career in A&E… becoming that craggy generalist consultant who subspecialises in administration would kill me.
But the SHO and registrar level work gives me a buzz that I’ve never felt in any other field of medicine.
I saw a young chap with severe left back pain last night that wasn’t tender to palpation, and wasn’t worsened on resisted arm movements.
I reckon most of the other SHOs would have let it go there and sent him home with a strong NSAID, but something in my head clicked and I noticed he was tall, and thin. And on closer examination, had a possibly high-arched palate (it’s never as easy as in the textbooks is it?) and a very long arm span. (1 inch greater than his height, to be precise.)
So suddenly I was ordering a flurry of “unnecessary” investigations (the nurses thought so, anyhow) including left and right arm b/ps which consistently showed differences - fortunately the differences alternated from left to right. good old nhs equipment.
and a chest X ray, and ECGs, and re-examination for radial-radial and radial-femoral delay, and close auscultation for any quiet murmurs I might have missed the first time around.
Granted everything came back normal after all that - no mediastinal widening on CXR - and his pain gradually settled to a tolerable level, and I did send him home in the end with a strong NSAID and advice for him to consult his GP for referral back to hospital ? Marfans, and for follow up cardiology (that’s how the NHS works. Mere casualty doctors aren’t allowed clinic access… we’re too incompetent, apparently.)
The point was, that something elusive clicked, eyeballing the patient. Somewhere along the way I’ve transcended the initial brainlessness of a new casualty officer and matured into a proper “Senior House Officer".
And, well, it’s a nice feeling.
So it wasn’t with quite the trepidation I expected, telephoning the locum agencies today and learning that they could secure me middle-grade or registrar grade locum positions in A&E in several of the london hospitals I always wanted to see the insides of…
Surgery can wait another six months, I guess. Or however long it takes for me to get a job.
Right now, I’m still an A&E addict.
*****
Senescence is a Strange Thing
Somedays it feels like life's on hold. When you don't get a single call or text message, or even an email, and everybody else's web page has gone into stasis. And nobody's left even a mark on yours.
It's days like this that make me think how much I miss home, and life from once upon a time, when there were always messages on my answering machine, and emails from close friends in my mailbox.
Senescence is a strange thing.
I’m coming out of my closet now.
I’m an addict.
As imminent unemployment looms (for some reason, some part of me is insisting that the greater part of me wants to be a surgeon) and my days in accident and emergency gradually draw to a close, I can’t help but feel that I’m going to miss it.
I’m not going to miss my colleagues, like I did as a medical and surgical house officer - it isn’t going to be that beautiful ward pharmacist, or that lovely nursing student that I’m going to pine for, but rather the nature of the job. The nurses in A&E were nice enough, but there were just so many of them that I never really got to know them. And there wasn’t an Abby lookalike dammit.
I remember signing for two A&E jobs in a row. Everybody thought I was mad at the time, and I even wondered myself if perhaps I had masochistic tendancies. But after my first A&E job, I knew I wanted to do it again, to try and do it right this time. To learn how to be competent, and not just passable.
I reckon I am competent now. I’m not a terribly confident doctor. I believe that confidence takes years of experience to build, and any confidence I were to try to wear after a mere 1 year in the job would simply border on arrogance.
And I simply cannot imagine a career in A&E… becoming that craggy generalist consultant who subspecialises in administration would kill me.
But the SHO and registrar level work gives me a buzz that I’ve never felt in any other field of medicine.
I saw a young chap with severe left back pain last night that wasn’t tender to palpation, and wasn’t worsened on resisted arm movements.
I reckon most of the other SHOs would have let it go there and sent him home with a strong NSAID, but something in my head clicked and I noticed he was tall, and thin. And on closer examination, had a possibly high-arched palate (it’s never as easy as in the textbooks is it?) and a very long arm span. (1 inch greater than his height, to be precise.)
So suddenly I was ordering a flurry of “unnecessary” investigations (the nurses thought so, anyhow) including left and right arm b/ps which consistently showed differences - fortunately the differences alternated from left to right. good old nhs equipment.
and a chest X ray, and ECGs, and re-examination for radial-radial and radial-femoral delay, and close auscultation for any quiet murmurs I might have missed the first time around.
Granted everything came back normal after all that - no mediastinal widening on CXR - and his pain gradually settled to a tolerable level, and I did send him home in the end with a strong NSAID and advice for him to consult his GP for referral back to hospital ? Marfans, and for follow up cardiology (that’s how the NHS works. Mere casualty doctors aren’t allowed clinic access… we’re too incompetent, apparently.)
The point was, that something elusive clicked, eyeballing the patient. Somewhere along the way I’ve transcended the initial brainlessness of a new casualty officer and matured into a proper “Senior House Officer".
And, well, it’s a nice feeling.
So it wasn’t with quite the trepidation I expected, telephoning the locum agencies today and learning that they could secure me middle-grade or registrar grade locum positions in A&E in several of the london hospitals I always wanted to see the insides of…
Surgery can wait another six months, I guess. Or however long it takes for me to get a job.
Right now, I’m still an A&E addict.
*****
Senescence is a Strange Thing
Somedays it feels like life's on hold. When you don't get a single call or text message, or even an email, and everybody else's web page has gone into stasis. And nobody's left even a mark on yours.
It's days like this that make me think how much I miss home, and life from once upon a time, when there were always messages on my answering machine, and emails from close friends in my mailbox.
Senescence is a strange thing.
