There is a female bay on one of the surgical wards in our hospital. 6 beds, 6 women. Usually this is fine, people get on well, they chat, they eat, they sleep, they get better and, eventually, they go home. Sometimes, however, there can be problems.

2 nights ago, one of the patients, Doris, an elderly lady with dementia, spent the night shrieking, and making a fuss. This has an impact on everyone in the bay; no one had much sleep that night.

In the bed opposite was Jean, a retired lady with all her wits about her. Sadly, she had hardly had any sleep, and spent the whole day miserable and exhausted. When we saw her on the ward round, she was very unhappy. We apologised and everyone hoped for a better night following.

The next day, we went to see Jean. She looked much brighter, and said that the night had been much better – Doris had been noisy at first, then relatively quiet. All seemed normal, until one of the nurses had a word with me…

“Last night,” she said, “We noticed the curtains around Doris’ bed were shut. We thought that was a bit odd, as none of us had done it. So we went to see why.”

“Why? What happened,” I said, with mild trepidatation, hoping that Doris hadn’t passed away in the night without any of us noticing on the ward round.

“About 10pm, Jean got up, walked across the bay, closed the curtains, and thrown a full jug of cold water over Doris!”

I walked back over to Jean’s bed. “Jean, err… was there an *ahem* incident, with a jug of water last night?” It was quite funny to see Jean’s reaction – she went bright red, like a guilty schoolgirl caught flicking elastic bands in class.

“I don’t know what came over me!”, she exclaimed. “I just couldn’t stand it anymore, it was so unfair, and I was so angry, and… I just had to do it!”

It was hard to maintain a stern manner, especially since all three doctors (myself included) started gaffawing. The shame of having to own up seemed to do the trick anyway, as she cringed and said “I was really hoping no one would ask me about it!”

With a promise from her that she wouldn’t do it again, we left her to the rest of her day. As Aristotle said, “The virtue of justice consists in moderation, as regulated by wisdom“. Fairly sure, in the circumstances, a single jug is still classed as moderation.

NB. I am thoroughly committed to being a great doctor, which includes respecting patient confidentiality. All information about patients on my website is anonymised, and often altered drastically so that whilst it still makes a good anecdote, it is unrelated in sex, time, location, age and/or ailment from the original facts.

This weekend, I worked the Freudianly named “graveyard shift” at Chesterfield hospital. Three nights, 9pm until 9am, Friday, Saturday, Sunday.

Whilst a great time to get some real hands-on experience, there is a key problem in working nights. It goes thus:

1. Most of us are not naturally nocturnal.
2. Most of us have jobs in the day time.
3. Night shifts usually only have a day’s grace between day shift and night shift.
4. It takes more than one day to completely upend your circadian rhythm.
5. Therefore, you always feel completely, exhaustedly, hungover-jetlagged-coma-after-a-trainwreck tired.

There are two methods for attempting this changover. One is to try and stay up as late as possible the night before, sleep all day, and go to work (hopefully) refreshed. I tried this. The result was that I was so tired on the first shift that I started having visual hallucinations about 4am, attempted to wear a commode around 5, and woke up the next morning completely naked in the middle of the M45.

The other method is to sleep normally the night before, stay up all day, and have a two hour nap before the start of the shift. My SHO used this method. The result was that he became so tired that he began to have paranoid delusional beliefs around 3am, attempted to order the demolition of the hospital library about 6, and woke up the next morning on a ferry to Bergen, with a new tattoo. Of the Queen. On his face.

Obviously there’s a bit of exaggeration there, and neither of us actually developed first rank symptoms of schizophrenia, but we were very tired. Aside from this, the weekend was actually fairly enjoyable. There’s a bit less red tape and paperwork on the night shift, and less distractions.

One highlight was a tired A&E clerking on Friday night from another doctor, who had written “Patient is a resident in a residential home” twice in three paragraphs. Some would say that this is not particularly useful information, even when written twice. The doctor had failed to mention that the woman was profoundly deaf, and severely demented. Which would you rather know?

My most memorable event of the weekend came at about 5:30am Monday morning. I was hungry, so I went to the vending machine to get a packet of crisps.

5:30 I put in my 45p, and selected some Prawn Cocktail Walkers. They fell out of the holder, and got stuck halfway down the machine.

5:31 I got annoyed, and tried to shake the machine. A lot. It didn’t work, the crisps remained stuck.

5:32 Rammed the machine again, and another packet of crisps fell out, Cheese and Onion this time. It also got lodged. Right next to my other packet. Nudged it again, to no avail.

5:34 Tried ringing the vending machine company, asking for a refund of my 45p. Oddly enough, no one there when its barely dawn.

5:36 Decided I *needed* crisps, so used my might again. This time a Capri-Sun fell out.

5:39 Having drained the last drop of the Capri-Sun in a contemplative manner, I hit upon an rational plan of action – purchasing the chocolate bar directly above the crisps will cause it to fall, thereby dislodging my crisps!

5:40 The Kit Kat chunky holder turned, and then the chocolate bar twisted out, began to fall and then… got stuck in the mechanism.

5:42 I finished screaming, and decided to whack the machine again.

5:43 Still whacking.

5:44 Another Capri-Sun fell out, but still neither crisp packet nor chocolate bar is released from the vending machine’s iron grip…

5:45 After a final heave, the Kit Kat fell, dislodging both packets, and I left the machine clutching half a newsagent’s in triumph. (Feeling a little guilty at my windfall, I later went to the reception desk in the hospital, who congratulated me on my honesty, but told me to keep the food!)

There ends my summation. At 9:15am Monday I left the hospital after 36 hours of attendance, with mild tooth decay and a mite more experience as recompense. Plus I think I’ll get paid at some point too, but right now I’m more excited about the Capri-Sun.

NB. I am thoroughly committed to being a great doctor, which includes respecting patient confidentiality. All information about patients on my website is anonymised, and often altered drastically so that whilst it still makes a good anecdote, it is unrelated in sex, time, location, age and/or ailment from the original facts.

On Wednesday, after five years apparently spent preparing for the experience, I started work as a doctor in Chesterfield hospital. A real doctor. With a stethoscope and everything!

My first job is a four month stint in Cardiology, and my first ever day as a doctor was a 12 hour emergency on call. It was a sharp learning curve, with little prior explanation of even the simplest proceedings.

My first hurdle was the “bleep”. Your bleep is your electronic dog lead; anyone can use it to make you heed to their beck and call. Obviously that’s good if someone has a heart attack, and you are needed for resus. It’s less good if a secretary the other end of the hospital wants your signature on some mildly unnecessary form, whilst you are trying to finish a ward round.

This combined with my non understanding of the system on the Emergency Admissions unit to make me look an absolute idiot in my end of day handover. Day rating: 7/10.

On Thursday, I wasn’t on call, but I did have to conduct the ward round and all the ward jobs all on my own, with my SHO, Registrar and Consultant all on leave or busy. Whilst this was mega intense, and frankly not a lot of fun, I did manage to get everything done, and went home (nearly) on time. My Consultant seemed happy enough, so I’m not too worried, although I would like to have lunch at lunch time more often, rather than eating a sandwich on the toilet at 3:30pm, combining two time occupying jobs into one. During the last hour of my shift, I turned on the CD player in the nurses station: the only CD we had was one of Christmas hits. The tacky music alone made this an 8/10 day.

Friday started out very well. By lunch time – and it says a lot that I was even having lunch – we had finished the ward round, and started on the patient care endless paperwork. And then I discovered I had to attend a compulsory 2 hour introduction, hand washing and blood taking lecture. I got back to the ward, and almost immediately got bleeped to go write a TTO for a patient I’d never met, who needed a slightly complicated bit of warfarin prescribing. I was also approached by rather a large man, looming over me as he asked:

Large man: Are you a doctor then?
Me: Well, yes, just about.
Large man: Can you write me a prescription then?
Me: Err… are you a patient here?
Large man: Yes.
Me: In that case, what for?
Large man: Can you prescribe me a hug?

Needless to say, both of us ended up with a hug. Unfortunately, by the time I had finished on that ward, returned to my own, and finished seeing all the patients, reviewing all the drugs, and filling out all the bits of paper, it was 6:45. I only get paid until 5, but I suspect the NHS aren’t too bothered about that. Despite the lateness, I got a hug off a somewhat threatening man, so the day has to get a 9/10.

So far, the best thing about the ward is all the wonderful nurses, pharmacists, receptionists and porters. Without them, I would actually still be in the hospital, probably gibbering quietly, and completely naked except for drug charts sellotaped all over my body.

Stay safe kids, and remember – don’t get sick in Chesterfield!

It happened. I have graduated. View some more pictures over in my facebook photo album.

I’m going to listen to the Slackers now, and drink some coffee. See you soon!

As a doctor in the NHS, we have to use official Nhs.net email accounts – as in dr.lowry@nhs.net. Unfortunately, the NHS has caught on the the fact that email accounts allow a level of anonymity that could cause opportunity for abuse. So they have increased the security.

A lot.

Here are some examples of how it’s an ugly mess, totally inconsiderate of users:

1. Your password must contain uppercase and lowercase letters, and numbers, and be more than 8 digits. This makes it extra fun trying to remember your password.
2. The first three digits must be typed on an on screen keyboard with a mouse, then the rest by physical keyboard (see picture). This makes it inaccessible for phones, or those who are visually impaired. The latter is, of course, illegal.
3. The password must be changed every month. And you can’t repeat passwords until you have used 4 others.
4. There are no contact details online, no “forgot your password?” links, and no contact numbers.
5. In fact, it’s surprisingly hard to find who to contact at all. It took me 6 calls to get through to the right department (you need to call 01422 222600), and then I was put on hold for 20 minutes with a song that suddenly cut, and restarted, every 30 seconds! As you can imagine, that was very annoying.
6. When I finally got my password changed, I was told I needed to be on an NHS computer to log in for the first time. I work at a hospital 16 miles away. Is this a good use of my time and money?!

In a health service that is striving to be evidence led, surely we should apply this to wasting employee’s time as well? There is a reasonable amount of argument that the trade off that increased computer security entails is not cost effective, that password content is often irrelevant, and that changing passwords frequently has little security value. Some security experts even recommend writing down passwords – but this clearly harms security; I know someone who accessed the Hallamshire computers for two years, using a user and password account they read on a wall!

What’s more, we were told that we must use the NHS accounts over personal email accounts for the reason that “sometimes it can be difficult to get hold of people if they change them“.

Since I have not been able to access my email, and will not until I go to work, I think that’s a pretty shoddy reason.

Since if I have an issue with my password, I will never be able to access my account from home without first visiting the hospital, I would even say that it is quite a bad reason.

Since there is a compulsory need to frequently change my password, the stringent conditions for each password mean there is a a high likelihood that I will frequently forget my password and need to have it reset. The fact that this dramatically increases the risk that I will not have access to my NHS email account on frequent and inconvenient occasions, thus being impossible to get hold of, means that I would go as far as saying that the above is a terrible, irrational reason. If we aren’t going to pay for homeopathy, we need to stop wasting everyone’s time with misguided, discriminatory, out of date security nonsense.

Eventually I rang the hospital directly to obtain my rota. They emailed it to my personal email account.

Once again spent the whole night dreaming, which meant I woke up knackered. Last night I dreamt about having to fly back through Africa, try to get home, and I didn’t have a passport, and no tickets, but I just kept blagging it onto planes, then somehow landing in the wrong place again. I don’t remember much except seemingly spending the entire night pleading with airline officials. Odd.

Today we went to a meeting with the Ministry of health, where they outlined what funding they are going to provide, and the very specific, long-winded way we will need to claim it. Interestingly, its all part of a new EU partnership; they are getting ideas on how to run their health system from our pathetics attempts – if the NHS had to deal with 7 million HIV positive people, it would utterly and completely collapse.

Anyway, that took much of the day, plus we had another meeting with a separate charity, that want to give us funding in exactly the same area; Home Based Care. Needless to say, my days for the next week will be spent with registration documents and funding proposals. Fun!

This afternoon, we got to play with some guns. First I fired a 9mm handgun, followed by a .38 revolver. Then I had a go with a .22 rifle, which I was much more comfortable with, since I have a .22 air rifle at home; I was pretty good with it, got all my shots pretty much with 3 inches of each other, from 25 metres.

I then got a go with the big mahoona! A double barrelled shotgun! Shamole! From 100 metres, I hit a man sized target 7 times in one shot (Each shot contains 16 pellets). It kicked like a horse, but it was worth it lol.

This evening, I finished our EP, and mostly polished off the Tshwaranang website. Bed at 12 was late, but needed.

“God answered Solomon, “Because this was in your heart, and you have not asked possessions, wealth, honor, or the life of those who hate you, and have not even asked long life, but have asked wisdom and knowledge for yourself that you may govern my people over whom I have made you king, wisdom and knowledge are granted to you. I will also give you riches, possessions, and honor, such as none of the kings had who were before you, and none after you shall have the like.”

2 Chronicles 1:11-12

I want to be wise.
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