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The Daily Rhino
Sunday, November 05, 2006

Pretend doctor
THE crappy articles I write for the fine, fine Medical Student Newspaper have somehow won 3 nominations for the Guardian Student Media Awards 2006 (best columnist, best features writer and best diversity writer). Don't tell anyone there's been an error until after the ceremony.

With my worrying graduation, the newspaper now has two in-house doctors with my column on F1 (the first year of work) alongside the celebrated Dr Crippen's column.

Below are my first offerings for the new academic year, first published in the October 2006 issue.



F1. It's fun.

Merely a few weeks ago I was one of you. I loved being a student. Now, dragged kicking and screaming into the world of work, I realise I know far less than I did before finals.

Medicine is one of those degrees where you are essentially the same impotent apprentice for four/five/six years and within the space of one exam result, suddenly you can prescribe morphine and cardiovert people.

The summer after finals is a glorious time - all the perks of being a doctor (i.e. telling people you are a doctor, and are thus superior to them) but none of the responsibilities. Even when starting work, you're eased into things and you have helpful SHOs and registrars to guide you away from negligence suits. But after a few beers on Saturday night, it's quite another story.

I was out with two non-medical mates, buying a pitcher. As I was paying, some bastard grabbed my pitcher and started glugging my beer. Drunk rapscallion's best defence was "I wanted a drink". I figured it wasn't the best day to get stabbed in a drunken altercation, so I walked away. Note - no cowardice was involved, only good sense. GOOD SENSE.

The story met with resounding condemnation when recounted to my two friends, Arthur and Froy, but we continued our drinking. Hours later we were leaving the pub. I saw the same thieving miscreant mounting his scooter. I said "look, there's the blighter!"

Arthur and Froy expressed yet more disgust at the beer-burglar and Froy shook his fist in the air and said "I hope he gets run down!" We had totally mislaid the fact that the chap was blind drunk.

As we walked onto the road, a sudden and almighty crash spun us around. All I could see was a helmet rolling slowly down the main road.

My first instinct was, obviously, to check to see if a head was inside. Secretly, we remembered our beer and its heinous theft.

As I was calling an ambulance I walked around the corner to see a pretty horrific sight. The rider had been thrown clear over a wall and onto a pedestrian island by a mini-van, his scooter was in quite another part of town and his left shoe was in Monsoon. A pool of blood was collecting around his head, as was a huge group of Saturday night revellers.

"I know what to do!" "Put him in the recovery position!" "Press on his cut!" They thronged.

I walked closer and then I said it. The line that I'd been dreaming about saying since I got into George's. A fortnight or so into the job and here I was with a chance to say it to a captive audience.

"Guys, guys, it's OK. I'm a doctor."

If you've read any previous Rohinplastys (so...just you Mum), you'll know nauseating arrogance is something I positively enjoy, but this may have been my apogee. That one moment made six years of debt worth it. I'm told that the rewards of helping people and saving lives make medicine worthwhile, but until I actually do any of that, the smug-factor of that one line will be the highlight of my life as an F1.

The huddle parted for me. I was Moses. Get out of my way, I'm a doctor, a doctor I tell you! Let me bask in your admiration for a bit.

Oh yeah, guy on floor. Fuck.

The glory was quickly replaced with deep, deep regret. Why did I step forward? What the hell can I do? I'm about as useful as rhubarb. Right, right…primary survey, ABC. Good, he's breathing OK and stuff. Err… "Don't move his neck" someone shouts. No help, I knew THAT one. Umm…D, disability. Shit, bugger, err…

He did turn out OK, despite a woman asking if I really was a doctor. But two vital lessons were learnt.

First, I'm not a REAL doctor yet. Further testament to my pretend-doctor status is plentiful at work, I can't prescribe drugs outside the hospital, all my clerkings are reviewed and I need to be supervised doing anything mildly fuck-upable. If you are a drunk beer-stealing scooter-driver, you better hope a passing doctor isn't a new house officer. You REALLY better hope it's not me.

The other lesson was far more important and learned not by myself, but by the lad on the floor. Deep down he knows, yes he knows, that if you steal beer, bad things happen. And karma sure is instant these days.



Relating to the dead

Ash cash. The sixty two pounds a doctor pockets every time a patient they have certified pops their clogs and is burnt to a crisp is nothing short of infamous. Known as the house officer’s privilege, it is the fund for Thursday night drinks all over the country.

A colleague working on care of the elderly has effectively gone up a banding due to the vast amounts of ash cash he rakes in. No comment on his quality as a doctor, of course. Ahem.

Yet when we are filling in the form, we all answer ‘no’ to the question ‘Do you have any pecuniary interest in the patient’s death?’

Despite some noble souls donating their cheques to charity, the rest of us catch ourselves secretly hoping that families opt for cremation.

If a terminal patient is known to several doctors, we also hope they survive just until we’re on call and then we’ll be the one called to confirm, see the body after death and head down to patient affairs before anyone else beats us to that cheque. Well, perhaps that’s just me.

Irrespective, one such patient passed away recently. Every doctor knew her because she was afflicted with something juniors encounter on a frequent basis, the family from hell.

On each occasion I was on ward cover, I would spend a good portion of my evening engaged in fruitless and frustrating conversations with her children. They were in complete denial that their young mother had extensive breast cancer with massive brain, lung and liver mets.

The nursing staff were no less bullied by the family and as a result the responsibility of placating them was always shifted to the on-call docs, who would be summoned repeatedly.

After a month or so of the daughter demanding to see a doctor at all hours of the night because she wanted all analgesia stopped or DNAR forms reversed, I became fairly rude and grew to intensely dislike being asked to review the patient.

I could only be disappointed with myself for coming to loathe a patient’s family, but as long as they made my life difficult by wasting my time as the bleeps piled up, I didn’t care. It is a horrible thing to hate someone just for loving their Mum.

Finally, she died.

Confirming the death of a warm, just-expired body, late at night, is an unusual experience for some.

You will find that when you confirm your first death, you convince yourself you can hear something as one rarely hears silence through a stethoscope. The embarrassing thought that a patient will reach the mortuary and suddenly perk up ensures you are extra-thorough.

As soon as I found out this poor lady was to be buried and not cremated, I lost all interest. I was genuinely sad that this mother-of-two had died a slow death aged 42, but relieved I would never have to meet her insane family again.

Life continued for me as normal and I did not give her another thought for several days. Until five days after her mother had expired, the problem daughter was leaving my ward at midnight.

I asked the staff nurse why she was here and she explained she had come to pray in the room in which her mother died. With a shrug of my shoulders I dismissed this as yet more odd behaviour from an odd person.

I finished my always-horrific ward cover on-call soon afterwards and went back to my digs. Out of the window I heard two foxes fighting, but when I looked out I instead saw the daughter howling with sorrow outside the hospital.

She had lost her Mum. Her Mum was younger than mine is now. It was almost 1 a.m. and she was alone. I felt overwhelmed with guilt for hating this unlucky girl and I went outside to talk to her. In yet another example of my complete inadequacy, I sat there for some time, not knowing what to say.

Maybe it helped; it probably didn’t. It would be overtly corny to suggest that now every time I write a death certificate, I do so with a sombre disposition and rueful melancholy. It is necessary to be somewhat hardened to death and dying as a doctor or medical student. But I sincerely try to put myself in the shoes of a patient’s family member.

Having said all of that, I still curse when I am asked to see an unpleasant family. Relatives can stonewall and flummox you, but corpses don’t ask awkward questions.

I treat the dead the same way I always have, but I’m slowly learning to deal with the living.

"A grave is a place where the dead are laid to await the coming of the medical student"

- Ambrose Bierce

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Comments:
Oh dear Rhino.

Enjoy it while you can. But the stress and damage is buiding up underneath.


John


http://nhsblogdoc.blogspot.com/2008/04/dead-bodies-and-ash-cash.html
 
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