Tailing off

I haven't posted in a few days. Twould be easy enough not to, and to let this project end before it's even started. The thing is - I'm really tired. I don't have anything clever / useful to say. I've been reading back through the Broken of Britain blog, and I remembered this post the "We're fine" update.

I just got an email from one of my best friends who's just got out of the hospital, another has just moved away from home to start work, because the MTAS system is crap. I feel helpless here, so far away. But, let's face it - I've been lying on the sofa for 3 hours, desperate for a pee, not quite able to stand up, let alone find the energy to negotiate the stairs up to the loo - so I'd be as much use as a chocolate teapot even if I was at home.

I'm not really ok. I've had rather an onslaught of symptoms the last few weeks / couple of months, and here I am, exhausted. I'm worried that my mood's not quite behaving, but it's kind of hard to tell, because nothing else is behaving either. I wish I had got signed off sick for my elective as was offered, I can't afford to keep feeling like this.

I'm so happy. Really, deeply happy. This isn't either/or, it's some weird and. I don't understand how deep happiness and deep sorrow can go together, but they do.

I might not post for a few days, unless I type up a few of the posts I've got scribbled in my notebook (so much for modern technology, right...)

In the meantime if you have anything you'd like me to post about, or if you want to write a post about your experience of the NHS - good or bad, as patient, carer, medic or other professional who works in or with the NHS - please send them to my brand new email disabledmedic[funnyAthing]hotmail[dotcodotuk] . Thanks for all of your comments and encouragement so far =)

p.s. I wrote this post some hours ago now, and have since been rescued, had a wee and a cuddle (not at the same time), and am feeling a bit less woebegone.

What's all the fuss about?

When I had a meeting with the head of my year in the medical school this year, he kept saying things like "I think you're being over-cautious, you won't run in to any problems" or "doctors deal with patients with disabilities so they're good at dealing with colleagues with disabilities". I couldn't get through to him that it wasn't that I was worried in case their would be problems at some point in the future, I was there because these problems were part of my daily experience.

So I decided to keep a list of all of the accessibility issues I encountered during one day of placement this week. Obviously things change between hospitals, but this is a fairly average representation.

1) There are 3 steps up from the front door to the entrance hall. There is a level entrance door, but it's not right at the front where I can get dropped off, and it's the other end of the hospital from the paeds ward.

2) The lift buttons are incredibly stiff, so I either sublux my fingers or don't manage to register that I've pressed them every time. I eventually ask a stranger for help.

3) The ward has a keypad entry system, and push button to exit system. If I have one hand on the stick, and one on the keypad, then there's no hands for the door. And the period the door is open is very short so I keep missing it. A nurse takes pity on me and comes to open the door.

4) Once inside the ward, the doors are big, old, fire doors. I can only open the push ones, because when I try to pull them open, my joints give before they do. Again, a nurse helps me out. I would not manage at all in a chair. I'd tip over.

5) The doctors room is not on the ward, but is as often happens, at the other end of the building. This means longer walks backwards and forwards, which add up really quickly to increase pain and fatigue. It also means getting through a tonne of the above heavy doors of evil.

6) The ward has very small cubicles. Each has a bed / cot in for the patient, and an armchair bed for a parent to stay. When there are two doctors, a nurse, and a parent in, there is barely room for me, let alone for me to bring a chair in. By the end of ward round at the start of the week, my seated heart rate was 150.

7) There are very rarely (if ever) staff disabled toilets in hospitals, and this is no exception. I use disabled loos because it saves me getting stuck not able to stand up (as nearly happened in the cinema yesterday). This is an infection control and privacy issue, and often means having to leave the ward and going to the ground floor to find the only appropriate one, especially in a small old building.

8) The toilet door is heavy. The lock is stiff. I nearly can't get out, and there is no alarm cord with which to summon help (not that they're generally heeded anyway).

9) The shortcut from the ward to the dining room involves going down 2 flights of stairs and back up 1, then the same in reverse. This is how the others go to lunch, but I have to go to the lift, and people ask why, and it ends up being a really obvious difference. Consultants also tend to not think before run down 5 flights with a teaching group, too quickly for me to ask where it is they're heading.

10) The canteen is self-service. I asked if someone could carry my tray to the table, because my wrists are prone to giving way, even when one of them isn't taken up with stick. The staff refuse, because it's busy and they "don't do that". The consultant comes over and takes my tray for me, and goes off into a reel of "you're so brave to deal with this" nonsense. I'm not brave. I just get up in the morning and live my life.

11) The consultant was late for clinic, so I had to stand around and wait for him, because the few chairs in the waiting room were full. There aren't enough chairs in the world in general, I've decided.

12) Spent the whole afternoon in clinic during which the consultant took no rest breaks, so as a consequence I didn't either. 4 hours of near constant sitting in a chair without arms means that I have a wicked headache / neck spasm by the end from trying to hold my head up. It's increasingly hard to concentrate.

13) In the clinic, the examination couches were fixed height, so it was not possible to sit down to examine the patients.

14) At the end of clinic we were taking a pile of case notes up to the secretaries. Case files are heavy, even in paeds, and the fastening are stiff and awkward to use, causing more hand trouble. (The delay in getting paper letters out really disadvantages coordinated care, especially for kids with complex conditions. They're currently typing up letters from January clinics). Junior doctors spend a lot of time acting as postmen for Xray requests, and case files.

14) I get a lift home, as I got a lift in, for which I'm very grateful. The bus stop isn't within my walking capacity from the house, and the bus stop outside the hospital is at the bottom of a steep hill leading up to the entrance (as seems to often be the case).

15) In the middle of this I am trying to keep to a good routine for my meds, and food, because my tummy's been so sad recently. This is really hard when you're not in control of your own timetable.

This is one day of placement, not including what happened before or after at home. It gets very tiring.

Intercalating : A year off the treadmill

Here is my 3rd in the series of alliterative posts this week (small minds, small pleasures...). I took an intercalated degree (BMedSci Honours degree) between 3rd and 4th year, and I'm really pleased that I did. That said, it was far from easy, and I think a lot of people jumped into it without thinking about what it would involve. So, here's the latest addition to the top 10s - some are tips, some more "thinking points". As always comments are welcome, especially if you chose not to intercalate, and can explain the reasons behind it.

1) Think carefully. Intercalating means another year at medical school, with all the costs - financial and otherwise - which that entails. Talk to other students who chose to do one, or not, and ask them their reasoning, and whether they agree with their decision in hindsight. Do your homework about what is actually involved.

2) My opinion would be that if there's a particular subject that you're interested in, want to learn more about, or may need later in your career, then it may well be worth it. Equally if you're interested in the more general aspects of research you can consider it. Don't do one just for the sake of it.

3) Intercal is a year off the treadmill, a year to step back from the inevitability of the medic conveyor belt. It's a great chance for some head space, for re-focussing, and for trying something a bit different. This was invaluable for me.

4) But it is not a year off. For example, my year was composed of a stats course with a final exam, research lectures (e.g. how to run a clinical trial, research ethics) with a final exam, journal club involving presentation and research, writing a research review on a given subject, 3 specialist courses with final exam, and a research project with a final presentation, paper and poster. It's the equivalent of the honours year of a degree. It is a lot of work, and especially towards the end was incredibly busy and stressful.

5) If what you want is a year off, to do some rehab / sort your life out / think about whether medicine's for you, intercal may not be what you need. It's less physical, and it's a change of scene, and you don't have the pressure of ward work, but if a year out is what you need, apply to take one. Most med schools are happy to accommodate this if you have good reason.

6) Intercal will make your brain work. You will encounter more complex ideas that in the normal run of med school. It takes time to remember how to do quality-not-quantity brain work. I really enjoyed this, but I know not everyone enjoys brain ache. It's also very self-motivated (speaking as a PBL student) and that can be very difficult if you are having a bad patch.

7) You will learn a lot. I now feel confident to read and properly interpret papers (a vital skill in an evidence-based service), and I could make a good stab at planning a trial or study. I've also got a good grasp of my specialist area.

8) Myth busting : you will not forget all of your medicine. I was a bit rusty when I came back - I had forgotten some details. But I feel like stepping back for a year allowed my brain to organise and consolidate information. I came back with a better overview of medicine than I'd ever had before. I also grew more confident, and you can notice a big difference in maturity? poise? between those who intercalated and the year below that we have joined.

9) Your access needs may be dramatically different depending on how much clinical work is involved in the early years of your course. Talk to the disability service, and the course organisers early. If you need something to persuade you that access in hospitals is really quite good, do an intercal in a department based over 3 stories, with no lift. See the top 10s tabs for advice on days of lectures and [pending] coping with dissection and lab work for ideas.

10) Before intercal, read Bad Science by Ben Goldacre. Read it again before intercal exams. After intercal run through the main 4 examinations (CV, resp, GI, neuro) and basic principles of history taking. Don't freak out and study all summer!

Anything to add?

Infection Control or "oh, I hadn't thought of that"

Would you believe me if I told you that infection control issues are some of the most challenging that I have to face in terms of access?

It's true, dear readers.

You see, at some point before I started medical school, the NHS decided to promote the use of alcohol hand gel before and after patient contact to reduce the spread of infectious disease. I'm sure someone has proved its effectiveness, and that can only be good, the fact that it has left a generation of staff with allergic dermatitis and that it is not effective against C.diff (which doesn't need any help to spread around) notwithstanding. Personally, I would rather there were more sinks, so that I could properly wash my hands around, but apparently people weren't using them or something.

I think it's good common sense to wash your hands between patients. Folk should wash their hands anyway. It's just nice, and not icky. But, here is my problem, as I explained to the last infection control nurse to teach me to wash my hands (I've been taught 11 times since I started med school...) :

I see a patient, I pick up my stick, I wash my hands, I pick up my stick, thus all the patient germies hang around.

She gave me a look that said "this is not on my algorithm", and then said that I should wipe my stick with a Tuffie wipe between each patient. This makes sense, except that Tuffie wipes all seem to come in tubs of 5 million (and with my stick I already have one less hand to carry stuff), that this means I take longer between patients than everyone else, and the ward round waits for no student, and that I would have to buy them out of my own pocket.

I explained what I had been doing - that is putting a surgical glove (which are all over the wards) over the stick handle each time I wash my hands. This seems an imperfect solution - it's really wasteful, the gloves aren't sterile (people will stick their hands in to the box to get a glove without washing first), and it makes me look silly...

She didn't like this idea (but couldn't explain why) and thought I should use Tuffie wipes. Which hasn't happened for aforementioned reasons.

The other option is to put gloves on every time I see a patient, taking them off before I pick up my stick. This combines two of the earlier problems - gloves not being sterile, and carrying something else around in my one free hand - plus the fact that I don't like making patients feel like lepers from the Bible. I found a newspaper article in the depths of the internet that said that this was the approach taken by a wheelie medic - but on wheels you have more capacity for carrying stuff around.

It's confusing and horrible to feel like I'm not perfectly conforming with a policy that people are so obsessed with. People also comment on it left, right and centre - either telling me off, or telling me I've found an ingenius solution.

That's the major IC issue, but there are others. "Bare below the elbows", brought in in Scotland in 2006, means that I can't wear splints, supports or bandages on fingers, hands or wrists. It's also caused problems for colleagues because of scarring.

I've shown here that I don't have simple answers to these problems, and I don't expect anyone else to - it's just that noone's thought about it. It seems assessing the equality and diversity impact of a policy only relates to patients and not staff. Noone has considered wheelies, or stick users, or splints etc. It's a really isolating feeling when everyone you ask double takes, and says "oh, I hadn't thought of that".

Identity

I know the title "disabled medic" sounds as though I have myself totally boxed off. As with most things in life, it's a little more complicated than that. The reason the blog is titled as it is, is because this is the search I plugged into google on the first day of 4th year after a conversation with my supervisor.

I had mentioned mental health problems to a supervisor before, but not the joint pain, fatigue and fainting that had gradually come to the fore over my intercal year as the worst effects of my 3rd year breakdown faded. It was a bit of an afterthought to mention anything, and so I said something along the lines of "oh, er, um - and I guess that I should tell you that I'm disabled, or something". I can be so articulate...

That night I went home and googled "disabled medic". A lot of what I found that was useful ended up in my "Disability and Medicine" links. The majority seemed to be condition/impairment-specific support organisations, fluffy-but-without-real-answers pages from the GMC/BMA/med schools, a smattering of "wheelchair boy banned from med school" headlines, and forum threads about whether disabled people should be allowed to apply.

The only site that offered any kind of real overview was HOPE for disabled doctors which is definitely worth a read, but I have found very little written from a personal perspective, and very little that specifically relates to mobility impairments, or fatigue.

In offering this blog, I'm not claiming to have all of the answers. For medical students who acquire an impairment, or for disabled folk who become medical students, the learning curve is incredibly steep. My hope is to provide a resource to help people find their feet a little bit. There is a lot that I haven't figured out yet, and all I can write about is my own experience (and no-one will have the exact same experience as me), but here it is, for what it's worth.

There are so many other words that describe me other than disabled and medic - but there are resources out there to address losing weight on a vegan diet, planning a big gay wedding, training cats to bring chocolate when summoned and learning to play the ukelele. So here is a resource about the being-a-disabled-medic bit, so that you can get back to being a vegan, pacifist, crafty, tea-loving, gay, closet-nudist who enjoys reading - or whatever all those other bits of your identity are, that make up the lovely you. Enjoy =)

Elective, wk 1

To update on my week, I managed 2 days of placement out of 5, threw up 3 evenings out of 5, gained 1 ukele, learned to make 5 different kinds of origami flower, passed out 0 times (considerable acheivement) and made 1 banana loaf.

It's been fun, really. I've had a lot of time to rest, enough sunshine that I don't have Rickett's but not enough that I've melted, and plenty of good food. I miss home,  but I've got the mrs, and daft cat, and the 3 of us are taking on the world together.

I had interesting chat about journalling and mental health yesterday, and also a bit about PTSD after major health crises, so remind me to post about those at some point. Also about an article I read in the sBMJ.

I hope you're all enjoying your weekends, and that your week to come involves more origami than vomit... (now there's a blessing for you!)

Posts coming up this week :

- Identity

- Intercal top 10

- Infection control

Confessions of a TV addict

All being well, this should appear when I'm eating lunch at placement tomorrow! Hooray for feeling a bit better =)

I've enjoyed the chat on the tops 10s post (thanks guys for all your suggestions - very helpful for me, and I hope for other folk - keep the comments coming!). I've enjoyed it so much in fact that I think it's time for a new series. This one is slightly less serious, but I think it will be amazing (and the rest of you will just have to humour me!).

I'm sick of being compared to Dr House. Yes, we both have awesome walking sticks, but that is pretty much where the similarities end. Except that I am, also, an excellent diagnostician. In fact, I always beat him to the diagnoses the second time of watching.

I'm especially tired of the comparisons because there is no shortage of disabled doctor-ness with which to compare me. At least one lady at church had the imagination to compare me to Kerry Weaver, who is at least female and gay...

It got me to thinking about disabled doctors in TV dramas. And then I got to compiling a list. So, how about a little content analysis of my favourite TV (read : ER, Holby City, House, Grey's Anatomy, Scrubs and Casualty)? As I said, humour me =)

And if you don't think I'll have much to work with (depending on definitions of disability) :

-Dr Carter, ER, substance misuse

- Dr Stevens, Grey's, metastatic melanoma

- Dr "Thirteen" Hadley, House, Huntington's

- Dr Turk, Scrubs, diabetes

- Dr Hunt, Grey's, PTSD

- Dr Casey (Michael J Fox), Scrubs, OCD

- Dr Winters, Casualty, "breakdown"

- Paul Nathan (medical student), ER, Parkinson's

- Dr Burke, Grey's Anatomy, hand issues

- Dr Howard (doesn't get a surname), ER, OCD

- Dr Lockhart, ER, alcohol misuse

- Dr Adams, Holby, Parkinson's

- Dr Romano, ER, upper limb amputee

- Dr Griffin, Holby, (colorectal / liver) cancer

And, of course, Dr Weaver and Dr House.

And that's only the ones I could think of off the top of my head without bothering to go upstairs and look at the list me and the mrs made on the train on Sunday.

I don't quite know what form it will take, but there are definitely themes (such as the miraculous lack of after effects in all but a vanishing minority following hugely traumatic happenings). It'll be a good excuse for me to watch some boxsets if nothing else ;)

Challenge : who can think of more for the list?