“Doctor, Mr M has just passed away. Can you come and verify please?”

I see a lot of dead people. Verifying a death is famously part of a doctor’s job (and it’s not quite as easy as that first episode of Scrubs, where JD takes one look at the body and says ‘time of death…’).

During induction I remember some other more experienced junior advising us to ‘let the dead get cold’, because it makes the job easier if Mrs P is definitely dead when you enter the room. Every horror or comedy film you’ve ever seen will tell you you don’t want to get that one wrong.

But it’s not quite that simple, is it? Even though most people can recognise a dead body, in hospital it’s the doctor’s role to perform a set of examinations to confirm a death. I try not to wait around because doing it promptly means families are kept informed and the death certificate can be written.   

What does it involve for me? I enter the room where the patient is lying, perhaps with curtains drawn if they’re in a bay. I talk to them as if they’re awake, in case they are. “I’m just going to listen to your chest”. I listen for two minutes for heart sounds or breath sounds, and feel for a carotid pulse. I look in their eyes. I check for a response to a painful stimulus. I check for a pacemaker. That’s the medical part. Sometimes I can hear my own heartbeat in my stethoscope, feel my own pulse in my fingertips, and wait a little longer in case I’m missing something. I think of my mother, whose worst fear is of being buried alive. I always think of this. I always wonder what are the chances. I place a hand on their shoulder and try to imagine what they looked like as a child, as a person full of life. Not in hospital, not in a hospital gown. I turn away and write in the notes. Time of death…

I see a lot of dead people, so now it doesn’t shock or surprise or scare me. Of course not, it’s part of my job. But I worry about the consequences of so much exposure to mortality. Everyone dies, everyone dies, so will life lose its importance and meaning for me? Some argue that exposure to death makes you value life more. But often I feel it’s just too inconsequential, like a candle burning briefly and then being blown out. What is it that really matters, in the end?

Dear Baby Doctors

So I will start my first job as a doctor this week, amid mingled excitement, terror, and fear of doing something that is purely embarrassing. Here is some very welcome wisdom from the lovely wandering medic. I particularly like this one:

“For your patients, a hospital is almost never going to be something as benign as the place where they go to work. It isn’t a big deal for you to go into hospital in the morning. It is a huge deal and usually a really scary thing for them, and that shouldn’t be minimised.”

Amen to that.

The Road Less Travelled

Dear Nearly New FY1s,

I remember my shadowing as a blur of paperwork and an urgent sense that I needed to assimilate all the knowledge in the week I had before someone handed me a pager and left me with actual responsibility for actual patients. I kept thinking that eventually I’d be escorted from the building when someone realised that I’d graduated medical school by mistake. I felt a little bit as if Sputnik had landed on my head.

You can’t have missed what’s been going on in the the last fortnight: take that seriously, by all means, we’re being disrespected and disenfranchised and lied about, and, yes, be furious and be engaged and get involved, but don’t let that ruin this for you and don’t think for a minute that it means we love our jobs any less. The political bullshit: yes. The job, the being doctors, the looking after people: no. The…

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Front line

Sometimes, after a day spent touching so many other people’s bodies, I want to keep washing my hands, as if one time, five times isn’t enough, as if the grime and germs and sweat will come off into my dinner. And then, later, I realise it probably will, but stop caring.

I love A&E. The controlled chaos of it, the camaraderie, and the way it has steadily demystified, like a crime novel solved by the new medical version of myself.

The mechanic

Sitting back after dinner, I listen to you describing the details of your latest legal case, and watch him explaining his new political campaign. And I think of yesterday, when I put my finger in that woman’s rectum.

And I wonder, not for the first time: am I saving lives? Or am I holding the fort: lifting the bonnet and carrying out essential repairs, so that people like you can save them?

The other the same

It seems as though I’ve seen a lot of people dying recently. Dying as a verb – breath gasping, limbs seizing, guts retching; dying as a noun – interrupted, ventilated, brain dead. After all this time in hospitals – the medical student in the corner witnessing silentlyish the tragicomic human mess – I wonder what I’ll feel when it’s me or my loved ones. Will I feel it for real, or will it seem second-hand, as if I’m remembering something I saw once in a film?

Why do we become doctors?


Another blogger wrote a lovely post recently about some of the challenges of being a medical student, and about her motivations for doing what she does. It reminded me of all the times I’ve wondered the same question.

Medicine is hard. Really, you say? Didn’t we tell you that before you started? Well yes of course, and I knew that and yes, I heard all those doctors who told me not to do it. I’m not deaf. I’m not stupid.

Medicine has been hard in ways I didn’t expect. The work is pretty full on, yes, but not really harder than another degree. Worse has been learning to be a student again, summoning up motivation to study, and exchanging friends for textbooks. And while medical school is one thing, I suspect working life will bring additional…issues. I’ve recently applied for my first Foundation doctor job, a national process that gives final year medical students a vague illusion of choice and autonomy before corralling them into random hospital posts across the country. That’s how it feels anyway. I find myself resenting this process heavily, given that as a… mature… student I would quite like some say in where I settle down for the next few years.

And of course it will continue to be hard. More exams, more job applications, more relocations, less time with partners, friends, children…and of course the sheer hardness of being a doctor at all. Of remembering all the blood results of every patient on your ward in case the consultant asks. Of knowing what to do when you’re the doctor on call and someone stops breathing. Of working out the real reason Mrs Singh has come to your GP clinic and managing her 26 differing needs in a way that is sensitive and appropriate and evidence based.

And to think I used to have jobs where all I needed to do was turn up at 9:30 (9:30!) and switch the computer on.

So why do we do it then? Is it because we “want to help people”? It’s the obvious med school interview answer, but you can help people as a plumber, teacher, hairdresser, kid’s party entertainer, politician – and have more time for your family. Is it to get rich? Better to choose banker, oil company executive, footballer’s wife. Is it because we love science? The thing is, medicine isn’t science, not really – you’d be better off in a lab.

For me, well I’m still not sure and the answer will probably keep evolving. But it probably involves needing some kind of job due to not being an heiress, being nosy about other people’s lives, the rush of a busy shift on call, the amazement of seeing a brand-new baby or someone’s insides, the daily ethical dilemmas, the joy of getting a thank-you kiss from an old lady, the satisfaction of making a diagnosis, the sheer daily variety and, yes, knowing that – even if it was just for an instant, I definitely did make a difference to someone’s day. (It could have been a net negative difference mind, but hopefully not).

It’s interesting, isn’t it, that at the end of the day we often make emotional rather than rational decisions about the most important things in our lives. I didn’t make a rational checklist when choosing my boyfriend – most people would agree that to be weird.

I know that as a medical student I still have a somewhat unsullied view of the daily grind. If you quote this post to me one 6am when I’m about to start my hour-long commute to work having been up all night feeding the baby, you can expect to get a slap. But I will try to thank you afterwards for reminding me.

I’m a GPeeee!

Yep, I’ll admit it. Part of the reason I’d been looking forward to my GP placement is that GPs sit down all day, right? And they start late and finish about 4 o’clock, right? And they drink loads and loads of tea.


I’m halfway through the placement now, and the day goes something like this.

Wake up, jump on bike, arrive at GP, weave through epic crowd of patients, walking sticks, pushchairs etc in waiting room, hoping that none of them are already on the lookout for me. Find consulting room, log onto computer, find GP supervisor, scan first patient’s records, call in first patient, listen to description of sore back/palpitations/cough/noisy neighbours/insomnia/incontinence/unemployment/divorce/pregnancy/itchy toe, ask semi-informed questions relating to symptoms, rack brains to check for obvious missed things, smile, examine back/chest/abdomen/toe, write in notes, ask about ideas concerns and expectations, check BNF, discuss options, ask questions, explain medications, call doctor, present history, write in notes.  See next patient, do neurological exam, explain difference between tension headache and migraine, try to allay anxieties about medication side effects, calculate BMI, check appointment list, apologise to next patient for lateness, listen to chest, look at tonsils, take temperature, print diet advice, call the doctor, breathe. Feel a pulse, take patient for ECG, diagnose atrial fibrillation, discuss management with doctor, explain different anticoagulants to patient while doctor writes referral, pass tissues, make small talk about patient’s son who is training to be a doctor. Think about that cup of coffee. Join doctor on home visit, take blood pressure, write in notes, play with the dog. Drive back to surgery, grab lunch, mainline coffee just because I finally can. Return to consulting room, call in next patient, repeat.

The thing is, I was looking forward to this placement a lot; I always thought I’d like GP and I was interested to see how the days would be. I like people’s stories. I like that every patient has a social or psychological side to their presentation, and that that stuff matters to the GP. I like that I have responsibility here – my own list of patients each day who I see on my own. I like that when I say I’m the student doctor people actually nod and stay in the room, and even listen to what I say. I didn’t realise how crazy busy it would be though. I take my hat off to GPs. The job is phenomenally grinding and complex and they work their socks off. I don’t know if I could do it forever, I don’t know if I have it in me to care enough, in ten-minute slots, about every sore foot and infected finger and sleepless night that walks through the door, and then to be on-the-ball enough to pick out the cardiac arrhythmia, the sick baby, the case of cancer and do something in time. It remains to be seen if I can do that.

The thing is though… here’s the thing: when I get home each night, and stop to think about it, I have had an awesome day.

In praise of geriatrics

“Is that physio coming back today?”, asks Mrs Jones in bed three. “The dishy one? Oooh, he was so tall and dark. The most handsome young man you’ve ever seen.”

Mrs Jones is 91. “This is one of the many great things about geriatrics”, laughs the consultant. “You don’t hear this stuff anywhere else.”

I’m doing a three-week ‘career experience’ in geriatrics, and it’s great. It’s one of the fairly few specialities where you have to be a real generalist – old people come into hospital for lots of different, often interconnected, reasons. Perhaps they come to A&E because they’ve fallen over at home and broken their hip, but the geriatrician’s job is to work out why they fell and try to treat the cause. Did they have an arrhythmia, an abnormal heart rhythm? Does their blood pressure drop too much when they stand up? Are they unsteady on their feet because of cerebrovascular disease or Parkinson’s or arthritis? Do their medications need adjusting? Or is it just that they can’t see properly and their house is a bit cluttered? I love detective stories, so this kind of medical sleuthing really appeals.

It also takes more than just doctors to do the job. There’s no point in fixing Mrs Jones’s broken hip if there isn’t also a dishy physio to help her learn to walk again, an occupational therapist to make sure she can manage at home and a social services team to arrange carers to come and see her. And you have to care about people’s whole lives, not just their illness. What kind of house does Mrs Jones live in? Are there stairs? How many? Where? Who is at home with her? Does she have a husband who can help, or is she the one looking after him?

People say geriatrics must be depressing because your patients are old and so many of them will die. I don’t really see it like that though. We will all die, but these are people to whom small things make a huge and immediate difference. Like Mrs O, age 89, who cried with happiness the first time she walked again after her hip operation. Or Mr H who didn’t mind being in a residential home as long as it was close to his friends. We seem to fail so often in this country, in the way we treat our elderly. We need to get these things right – our parents and grandparents deserve this.

Of course there are sad things. My constant lament – that people come into hospital with some minor ailment and end up diagnosed with something worse – is ever present here. Like Mrs B, who complained of constipation and ended up with metastatic cancer.

And it is ethically fascinating. As my consultant says, “You can’t get as far as breakfast in our society without having to make dozens of ethical decisions.” And geriatrics is the same. Geriatricians decide on a daily basis whether patients can give informed consent for a treatment; when a procedure is in someone’s best interests; when it’s ethically right to withdraw active treatment and allow someone to die.

Mrs Brown is 95. She came in several weeks ago after a fall in her nursing home, and then developed pneumonia. She is frail and sick, and has dementia, and her family want her to be allowed to die peacefully without any more aggressive treatment. My consultant agrees, but for some reason she has been started on antibiotics anyway.

Mrs Brown has fallen to one side in her hospital bed, tiny against the pillows. A bag of antibiotics hangs from a drip stand by her bed, snaking into a cannula in her hand. My consultant tries to rouse her but she doesn’t speak, just grips his hand in both of hers and doesn’t let go. “It’s frustrating”, he says. “What benefit are we giving her with these antibiotics? Take them down. Take the cannula out.” He turns back to Mrs Brown and squeezes her hands. “Are you alright? Is there anything I can get you?” She opens her eyes for the first time and smiles. “Can I have a nice cup of tea?”





On travelling alone

Travelling alone can be exciting, freeing, lonely and boring in equal measure. On one hand you can do whatever you like. No-one will know if you spend whole evenings watching The Apprentice on YouTube rather than doing something cultural or sociable. On the other hand, you’re at risk of spending whole evenings watching The Apprentice rather than doing something cultural or sociable. This is probably ok.

Travelling alone requires that you deal with certain potentially uncomfortable situations, such as going out to dinner alone. Many people have strategies for this, such as arming themselves with a book or a phone so they feel less awkward and block out the horror of the situation. Some write blog posts about being alone, thus convincing themselves that they’ve sidestepped the issue. Other people revel in the moment, gazing around confident and prop free as if to say, “Yes, I’m dining alone. I’m a free and competent human being”. I’ve never met any of this latter group.Image

Travelling alone also means you have fewer cool photos to impress people with on Facebook. Endless photos of scenery or temples with no-one in them quickly become boring, and so you start taking photos of food, which are worse.Image However, being alone provides the opportunity to use the timer function on your camera to set up arty selfies, so you can look cool and pretend to have friends.

A less fun part of travelling alone is when you get ill, which invariably happens. This lone traveller heartily recommends stockpiling plenty of bottled water to avert death due to dehydration, then resigning oneself to 36 hours of gazing at the ceiling fan.Image

Finally, an important part of travelling alone is meeting other people, which can make things more fun. Some people are good at this and manage to strike up easy conversations in bars or on buses. However, there is the risk of looking desperate or – worse still – ending up with a new companion who you find even more boring than your own company. For this reason it’s sometimes better to stick to travelling alone.

How to ride your moto


Today being a day off, I decided to cycle up the road to the wonderful Angkor temples. They’re beautiful, as is the tropical forest around them. More about that in the guidebooks.

Road travel in Cambodia is great fun.* There are surprisingly few cars; most people travel by the cheaper motorbike – or motodop – and there are also a lot of bicycles. The way it works is like this: starting from a side street, join the main road with speed and aplomb. Looking back is for wimps. Follow everyone else’s lead in riding along on the right hand side as fast as you can. If that’s the wrong direction just turn round and ride against the flow instead. When overtaking, beep your horn or bell as loudly as possible, then race up the middle and hope for the best.Image

Transport is a sociable affair. A moto with less than three people on board is a moto wasted. Standing, sitting on your dad’s shoulders and riding side saddle are all ok. imageAcceptable activities whilst riding your moto include drinking iced tea, chatting on your mobile phone and breastfeeding. Sometimes, if there are police around, you should consider wearing a helmet.Image

A moto is an all-round family vehicle, perfect for driving your mates to school, taking your girlfriend on a romantic sunset drive, and it’s still good three kids later. More than three kids and you need a cart. Happy riding!

*Cambodia also has the highest rate of traffic fatalities in Asia. But it’s my day off.Image