10 years

I wasn’t sure how it would go. I was a little anxious.

Today I spent a few hours working as the medical registrar.

This was part of my pay-back for J helping me a few months ago.

I didn’t know what to expect.

I didn’t know whether I’d be up for the job.

It was funny.

In medicine, we spend years working through different phases of training – acquiring skills, talents and techniques that are useful at the time. Some of these we carry with us – how to listen, communicate, think outside the diagnostic box; others, which fade with time.

It is these latter skills that had me most worried.

I knew I’d be OK if I had to lead a cardiac arrest – I did this a few months ago, although not with the finesse of my registrar years…

For those of you unfamiliar with the chronology of a doctor – here is a template:

1998 to 1999 house officer*

1999 to 2002 senior house officer*

2002 to 2007 registrar*

2007 to date consultant

*We get told-off for using these old-fashioned designations; as this is my blog, I don’t care.

That is the run-through. Some people take a different path; for me, I didn’t know what I wanted to do when I finished medical school & as the lines of the song go, I still don’t.

The skills you lose when you become a consultant – in my case, one who spends his time listening-to and supporting older people are the practical procedures – taking blood, siting cannulas, central lines, temporary pacemakers and chest drains.

I know if it came to it and I had to do any of these procedures I could muddle through; perhaps not with the same aplomb as 10 years ago, but I’d be good-enough (which in UK – the Bolam* Test, is all you need).

Over a few hours I encountered a stunning array of patients and diseases; old and young; meningococcal septicaemia, leukaemia, renal failure, pneumonia, delirium, dementia, overdose, heart, lung and liver failure, arthritis, migraine… the list goes on. We sometimes forget how broad is the panoply of human disease, how many dimensions there are to suffering.

Different to the role of a consultant, as a transient registrar, I could spend time talking with patients – time that in my usual life is so squeezed. In this job, with my trusty bleeper, I was adrift in the system, no longer solely responsible for my actions.

Sure, there was prioritisation, ordering and organising, but different to my day-job.

Crap. I found it fun.

I remember struggling with the transition from senior house officer to registrar – not because of the increase in workload or other challenges, but because of the loss of intimacy, the loss of me and the patient, us, together, within the ranks.

I know it was just for a few hours and I was lucky that nothing went wrong and I suspect none of the patients realised they were being supported by a much older version of a doctor than would normally have spoken with them.

As with my day-job, it was an honour. It was a pleasure. It was fun.

This is what we need to hold-on to when the bastards are getting us down. When the system is upturning our values, when the resources are finite and the demand overwhelming.

Could there be a better job than one in which we can connect with people during their time of need, of vulnerability and fear, and offer a solution or a support?

I have spent so long recently crying over our beloved system, this was more like a time to celebrate.

*The Bolam Test – suggests that doctors need to be as good as the standard set by a ‘responsible body of medical opinion’ – they don’t have to be the best. (Although we all aspire to be the best – that is ego; a separate principle)