I've started to learn to drive.
Not a particularly big deal, something that most adults in the UK seem to do and take for granted, but it's a big deal to me. I didn't learn at 17 when my friends did for many reasons - environmental, health, time, terror and lack of need living as I did in an area with amazing public transport provision.
Things have changed though - I'm now a 23 year-old who can't walk without pain and can't wheel herself on cambered pavement (pretty much all pavement) for any distance, who spends money she doesn't have on buses for distances most could walk, or taxis for places that are too far to walk/wheel from the bus stop. This includes most hospitals, even some of those which have a bus stop in the grounds. That's not to mention that getting a bus as a wheelie generally means leaving 3 buses before the one you need to get to get there on time to allow for inaccessible vehicles, broken ramps/bad backs/drivers not stopping - annoying but do-able for routes that run every 10 minutes, but impractical when it would mean leaving the house 3 hours before a 9am ward round.
So I'm learning to drive. In an automatic, because my shoulders/elbows/wrists would give before the gear stick. Luckily my parents are paying (a belated 17th birthday present) because it's anything from £3-5 pounds more expensive per hour to learn.
I thought it would be a disaster. My lack of proprioception makes me ridiculously clumsy, and when I panic I curl up in a ball and put my hands over my ears - not the most useful of defence mechanisms.
But it's going ok. I've had 2 lessons, and the 2nd I was driving for 40 minutes out of the hour, tackling traffic lights, mini roundabouts, turning corners and other bits and pieces. My instructor is lovely - endearingly eccentric - and very encouraging. And I'm really, really enjoying it. Unexpectedly. By the end of today's lesson, my self-confidence which has taken such a knocking again of late was practically singing a little song.
There's a lot more to learn, and then there's decisions to be made over a car, and working out who gets the car when because the mrs is hoping to work in places that need a car to get to so that she's not essentially penalised for staying here with me when all the local hospitals are crap and horribly unsupportive places to start work.
But for now I'm smiling at the memories of the lovely little noise the indicator makes when it clicks off after you turn a corner, and turning on the windscreen wipers, and the way putting the hand brake on at traffic lights makes me feel really grown up.
There's something really soothing about pootling along the road at 25 miles per hour and taking your part in the little dance that is a mini roundabout.
I'm sure I'll get bored of it soon, or come up against all the stressful bits, but for now it's nice, and I feel really good about it.
At Both Ends of the Stethoscope.
Showing posts with label clinical placements. Show all posts
Showing posts with label clinical placements. Show all posts
Thursday, 24 November 2011
Tuesday, 22 November 2011
Tiny losses, tiny let-downs
I find making new friends and meeting new colleagues quite tricky. Partly I think because I'm an introvert, and most people aren't, so it takes a lot of energy for me to do sociable-type things like going to lunch with the whole gang every day rather than curling up in a quiet corner with a book.
I also don't feel like I have a lot in common with other students - my life looks very different in significant ways like disability, or longtermlivein relationship, or queerness - but it's generally the seemingly less significant bits that actually make me feel like an alien - being vegan, doing activism, being Christian but not the kind of Christian the majority of Christian students seem to be. And things that shouldn't matter, but still hurt, like everyone else taking the shortcut to the canteen down the back stairs while I have to go round via the lift, with a merry "see you there". Lunch with a group of people I don't know is my idea of hell. I end up feeling weird, feeling 'other', feeling inferior and fatlazystupidhorrible.
I have friends in medical school, close friends, friends I would eat lunch with every day, it's not that I'm a social outcast. It's just that when you're in a year group of 300, the chance of being placed with someone you're close to is slim. Even when you're in the same hospital as a friend, meeting for lunch is a challenge when each of you is at the whim of whichever consultant you're stalking that day.
A big consideration for me when I chose to intercalate (take a year away from med school to get a BSc) was that I would end up in a different year group. The way things worked out meant that most of my close friends (although not my best friend) intercalated, so I had plenty of familiar faces in the new year group, but it was still quite hard. Now I'm taking this year out, it will happen all over again, except without the scattering of familiar faces to make it easier.
I've come to realise that this is going to happen every year now, for at least the next ten. Working less than fulltime will mean that those I start the foundation programme with will finish in half the time, leaving me with a new batch, and the same will happen in specialist training.
In a lot of ways this doesn't worry me - I have friends and a support network that is not dependent on who I'm working with. I don't feel the urge to socialise a lot out of work with my colleagues in big groups - and I often can't manage the activities anyway - clubbing, late nights, lots of drinking don't go well with my wonky bod (although this is another part of introversion that people don't really understand and I don't think it helps me in terms of fitting in).
But I'm worried about constantly meeting new people (and along with that constantly fielding 'what's wrong with you?' or 'you don't eat cheese?' or 'so what does your partner do, is he a doctor?'). I'm worried about resenting friends who can chug through life at 'normal' place, or being told that I have no right to be stressed/tired during FY1 when I work less than fulltime or don't do certain shifts.
I was talking to the mrs about this yesterday. It's not easy to let myself work through all these little bits of conceptual sadness, these little losses of stuff that isn't yet. I feel so angry, so sad, so let down. I can't think about it, because if I let it overwhelm me, they'll be so much more to grieve for. I'm finding it hard to be at church at the moment, and I think that this is why. It's the only time in the week that I can't control the direction my mind wanders. That wouldn't be a bad thing - I want to work through this stuff, want to name it, to feel it, to put it aside or act on it as appropriate - but I don't get the whole way through the process. I just go to church, get upset/angry, and then come home feeling like shit. I don't know how to make it better. I know it's hard for the mrs that I don't go, but I can't face it. I don't want to keep going to church and leaving in tears.
And you know, I'm actually really happy. I have a beautiful mrs, and lovely family/friends, and a daft cat. There's just this bit of me that's hurting, that hurts more every time I have to fight with my GP to provide the healthcare I need, or listen to the med school's bullshit about why they can't make adaptations. Every time people's words and actions seem to scream that I'm a lazy, inconvenient liar who they wish would disappear.
I also don't feel like I have a lot in common with other students - my life looks very different in significant ways like disability, or longtermlivein relationship, or queerness - but it's generally the seemingly less significant bits that actually make me feel like an alien - being vegan, doing activism, being Christian but not the kind of Christian the majority of Christian students seem to be. And things that shouldn't matter, but still hurt, like everyone else taking the shortcut to the canteen down the back stairs while I have to go round via the lift, with a merry "see you there". Lunch with a group of people I don't know is my idea of hell. I end up feeling weird, feeling 'other', feeling inferior and fatlazystupidhorrible.
I have friends in medical school, close friends, friends I would eat lunch with every day, it's not that I'm a social outcast. It's just that when you're in a year group of 300, the chance of being placed with someone you're close to is slim. Even when you're in the same hospital as a friend, meeting for lunch is a challenge when each of you is at the whim of whichever consultant you're stalking that day.
A big consideration for me when I chose to intercalate (take a year away from med school to get a BSc) was that I would end up in a different year group. The way things worked out meant that most of my close friends (although not my best friend) intercalated, so I had plenty of familiar faces in the new year group, but it was still quite hard. Now I'm taking this year out, it will happen all over again, except without the scattering of familiar faces to make it easier.
I've come to realise that this is going to happen every year now, for at least the next ten. Working less than fulltime will mean that those I start the foundation programme with will finish in half the time, leaving me with a new batch, and the same will happen in specialist training.
In a lot of ways this doesn't worry me - I have friends and a support network that is not dependent on who I'm working with. I don't feel the urge to socialise a lot out of work with my colleagues in big groups - and I often can't manage the activities anyway - clubbing, late nights, lots of drinking don't go well with my wonky bod (although this is another part of introversion that people don't really understand and I don't think it helps me in terms of fitting in).
But I'm worried about constantly meeting new people (and along with that constantly fielding 'what's wrong with you?' or 'you don't eat cheese?' or 'so what does your partner do, is he a doctor?'). I'm worried about resenting friends who can chug through life at 'normal' place, or being told that I have no right to be stressed/tired during FY1 when I work less than fulltime or don't do certain shifts.
I was talking to the mrs about this yesterday. It's not easy to let myself work through all these little bits of conceptual sadness, these little losses of stuff that isn't yet. I feel so angry, so sad, so let down. I can't think about it, because if I let it overwhelm me, they'll be so much more to grieve for. I'm finding it hard to be at church at the moment, and I think that this is why. It's the only time in the week that I can't control the direction my mind wanders. That wouldn't be a bad thing - I want to work through this stuff, want to name it, to feel it, to put it aside or act on it as appropriate - but I don't get the whole way through the process. I just go to church, get upset/angry, and then come home feeling like shit. I don't know how to make it better. I know it's hard for the mrs that I don't go, but I can't face it. I don't want to keep going to church and leaving in tears.
And you know, I'm actually really happy. I have a beautiful mrs, and lovely family/friends, and a daft cat. There's just this bit of me that's hurting, that hurts more every time I have to fight with my GP to provide the healthcare I need, or listen to the med school's bullshit about why they can't make adaptations. Every time people's words and actions seem to scream that I'm a lazy, inconvenient liar who they wish would disappear.
Wednesday, 14 September 2011
One wasted journey too many
Today’s post comes saturated with brain fog. (To illustrate, that sentence took 14 attempts) It's also rather long.
This afternoon I had a 2.5 hour round trip to placement in order to go to a clinic which when I arrived (and found it – having been told it was in the clinic area it moved from 3 years ago) was cancelled. No-one was expecting me (despite me being timetabled to be there), so they had no chance to warn me even if they would have thought to.
This was incredibly frustrating, and noone’s fault in particular – some kind of mix up meant that only one patient had been invited.
Obviously this was no big deal, I strolled up to my placement ward and saw a few patients.
Oh no wait.
The building that the clinics are in is a 30 minute walk from the building my placement ward is in (for me). Even if I could have managed that today, it would have meant taking a £10 taxi home, because it would have stolen my spoons* allocated for wobbling back to the bus stop. If I’d have got to the ward (after taking another 30 minutes to recover – that’s assuming I could find a free room to lie flat on the floor of) I’d have been a bit stuck. I had to leave my wheelchair at home, because I thought I was going to the clinic building and so would have no room to leave it in, and it’s too bloody heavy for me to take on the bus at evening rush hour when the driver won’t put the ramp down. Even if I had taken it, I wouldn’t have been able to get it from the clinic building to the ward, because I can barely use it outside. So, I’d have been on the ward without the wheelchair, which, while I’m aware was the situation until before the summer, is now not possible (for many reasons bouncing off each other to create one giant one).
Hence 2.5 hour round trip for no teaching.
I use this to illustrate the one point that I keep trying to raise with the medical school : the level of chaos surrounding our course - new placements every few weeks, no idea of timetable until the first day of placement (and that’s if we’re lucky), never being expected anywhere (despite ‘timetable’), rotating series of placement supervisors who are only interested in completing the paperwork – is frustrating and demoralising for everyone. Those of us who are disabled and/or living with chronic illness have far fewer reserves to allow for this. These 2.5 hours of travel time are not just a waste of 2.5 hours work – they waste more, because travelling takes a lot of energy (especially when everyone turns Atosesque and questions my right to a seat over the right of pretty much anyone else, because young=well).
When Beanie can’t plan her time, has her time wasted, isn’t properly supported on placement it causes her a lot of stress and I am not trying to deny that. When these things happen to me they make me ill by encouraging a ‘boom-bust’ cycle of work, it means that my needs are not fully met on placement because noone knows me and therefore again puts my health at risk, it eats up energy that I don’t have meaning that I can’t do other stuff like shower, or y’know stand up all evening.
This is not something that I can afford in the run up to my finals, and a lot of it would be so easy to fix, but every time I, or other disabled students, make these simple suggestions they either say yes and do nothing, or tell us that we’re wrong – that there is no problem in the first place (or in their ultimate divide and conquer tactic, tell us that ‘the other disabled students are fine with it’). It. Is. Exhausting. And I’ve had enough.
Tomorrow I plan to talk about some of those simple suggestions, and how I plan to make them listen.
*See here for the full version, in short : spoons = units of energy, everyone has a finite limit and disabled people / those living with chronic illness have a lower, and more strictly policed limit than others.
This afternoon I had a 2.5 hour round trip to placement in order to go to a clinic which when I arrived (and found it – having been told it was in the clinic area it moved from 3 years ago) was cancelled. No-one was expecting me (despite me being timetabled to be there), so they had no chance to warn me even if they would have thought to.
This was incredibly frustrating, and noone’s fault in particular – some kind of mix up meant that only one patient had been invited.
Obviously this was no big deal, I strolled up to my placement ward and saw a few patients.
Oh no wait.
The building that the clinics are in is a 30 minute walk from the building my placement ward is in (for me). Even if I could have managed that today, it would have meant taking a £10 taxi home, because it would have stolen my spoons* allocated for wobbling back to the bus stop. If I’d have got to the ward (after taking another 30 minutes to recover – that’s assuming I could find a free room to lie flat on the floor of) I’d have been a bit stuck. I had to leave my wheelchair at home, because I thought I was going to the clinic building and so would have no room to leave it in, and it’s too bloody heavy for me to take on the bus at evening rush hour when the driver won’t put the ramp down. Even if I had taken it, I wouldn’t have been able to get it from the clinic building to the ward, because I can barely use it outside. So, I’d have been on the ward without the wheelchair, which, while I’m aware was the situation until before the summer, is now not possible (for many reasons bouncing off each other to create one giant one).
Hence 2.5 hour round trip for no teaching.
I use this to illustrate the one point that I keep trying to raise with the medical school : the level of chaos surrounding our course - new placements every few weeks, no idea of timetable until the first day of placement (and that’s if we’re lucky), never being expected anywhere (despite ‘timetable’), rotating series of placement supervisors who are only interested in completing the paperwork – is frustrating and demoralising for everyone. Those of us who are disabled and/or living with chronic illness have far fewer reserves to allow for this. These 2.5 hours of travel time are not just a waste of 2.5 hours work – they waste more, because travelling takes a lot of energy (especially when everyone turns Atosesque and questions my right to a seat over the right of pretty much anyone else, because young=well).
When Beanie can’t plan her time, has her time wasted, isn’t properly supported on placement it causes her a lot of stress and I am not trying to deny that. When these things happen to me they make me ill by encouraging a ‘boom-bust’ cycle of work, it means that my needs are not fully met on placement because noone knows me and therefore again puts my health at risk, it eats up energy that I don’t have meaning that I can’t do other stuff like shower, or y’know stand up all evening.
This is not something that I can afford in the run up to my finals, and a lot of it would be so easy to fix, but every time I, or other disabled students, make these simple suggestions they either say yes and do nothing, or tell us that we’re wrong – that there is no problem in the first place (or in their ultimate divide and conquer tactic, tell us that ‘the other disabled students are fine with it’). It. Is. Exhausting. And I’ve had enough.
Tomorrow I plan to talk about some of those simple suggestions, and how I plan to make them listen.
*See here for the full version, in short : spoons = units of energy, everyone has a finite limit and disabled people / those living with chronic illness have a lower, and more strictly policed limit than others.
Monday, 12 September 2011
On sex and disability
This one's about sex. If you don't want to read it for whatever reason, then look away now!
I was chatting with a friend yesterday about sex. Now, those of you who know me offline will find nothing unusual in that, being as I talk about sex all the time, but I don't know how many of you know why. I am very open about my sex life, because I have needed others to be open with me in order to navigate my various impairments.
A lot of information that is available about sex and disability is very cis-heteronormative*, and focuses on one specific impairment - which for those like me who don't fall into these neat groupings can get quite frustrating.
I have found some resources very useful - most online, which is normally the case when you're trying to find stuff for 3+ intersecting identities - but it's very hit and miss. There are loads of sites about sex and disability and a lot of them serve to undo the hard work of the few, through cis/heteronormativity, through questioning whether disabled people should be allowed to have sex or preaching involuntary sterilisation, through reducing the issue to the mechanics of overcoming 'wrong' anatomy and physiology.
I have never been asked how my impairment affects my sex life or my relationship. (The fact that I have never been asked how Beanie copes with being my carer, and if she needs any support should also be noted.) Most medics will have seen folk presenting with quite advanced disease or pathology involving their genitals, because they have been too embarrassed to come before. This should never happen.
It is not all the fault of the NHS - when sex education at school is little more than a lecture on puberty and how to use a condom is it any surprise that people have so much shame surrounding sex? There is more to sexual health than avoiding STDs, more to sex than what fits in where, more to sexuality than heternormativity and gender binaries, more to sexuality than sex.
I understand that doctors are embarrassed to ask, and that they don't want to be seen as prying, but I (gently, and sensitively) ask all of my patients with long-term conditions if it affects their relationship and/or sex life, and none have been offended. Obviously it's not a question to ask in the middle of a bustling ward round, and sometimes it is not possible to ensure adequate privacy, but I believe that it is important to try and find time to ask (just as I always ask if patient's have religious beliefs and/or a faith community, and how that has an impact on their experience).
When I consider the biopsychosocial model - a way of considering the holistic effects of a conditon physically, mentally and socially, I add in sexually and spiritually, because although some argue that those fall somewhere under the others, they are not treated as though they are.
The answer to a lack of good sex ed, and consequent embarrassment and shame is not to ignore the issue because it's all a bit awkward (nor is it to be gratuitous and crude - obviously). Giving medical students and doctors some sex-positive sex ed, and outlining the issues that patients may face would be a good start I think.
What are some good resouces you have found about sex and disability?
*Is written from a perspective that cis-gendered hetersexuality is the norm, and therefore that anything else is abnormal (and thus not worth considering / writing about)
I was chatting with a friend yesterday about sex. Now, those of you who know me offline will find nothing unusual in that, being as I talk about sex all the time, but I don't know how many of you know why. I am very open about my sex life, because I have needed others to be open with me in order to navigate my various impairments.
A lot of information that is available about sex and disability is very cis-heteronormative*, and focuses on one specific impairment - which for those like me who don't fall into these neat groupings can get quite frustrating.
I have found some resources very useful - most online, which is normally the case when you're trying to find stuff for 3+ intersecting identities - but it's very hit and miss. There are loads of sites about sex and disability and a lot of them serve to undo the hard work of the few, through cis/heteronormativity, through questioning whether disabled people should be allowed to have sex or preaching involuntary sterilisation, through reducing the issue to the mechanics of overcoming 'wrong' anatomy and physiology.
I have never been asked how my impairment affects my sex life or my relationship. (The fact that I have never been asked how Beanie copes with being my carer, and if she needs any support should also be noted.) Most medics will have seen folk presenting with quite advanced disease or pathology involving their genitals, because they have been too embarrassed to come before. This should never happen.
It is not all the fault of the NHS - when sex education at school is little more than a lecture on puberty and how to use a condom is it any surprise that people have so much shame surrounding sex? There is more to sexual health than avoiding STDs, more to sex than what fits in where, more to sexuality than heternormativity and gender binaries, more to sexuality than sex.
I understand that doctors are embarrassed to ask, and that they don't want to be seen as prying, but I (gently, and sensitively) ask all of my patients with long-term conditions if it affects their relationship and/or sex life, and none have been offended. Obviously it's not a question to ask in the middle of a bustling ward round, and sometimes it is not possible to ensure adequate privacy, but I believe that it is important to try and find time to ask (just as I always ask if patient's have religious beliefs and/or a faith community, and how that has an impact on their experience).
When I consider the biopsychosocial model - a way of considering the holistic effects of a conditon physically, mentally and socially, I add in sexually and spiritually, because although some argue that those fall somewhere under the others, they are not treated as though they are.
The answer to a lack of good sex ed, and consequent embarrassment and shame is not to ignore the issue because it's all a bit awkward (nor is it to be gratuitous and crude - obviously). Giving medical students and doctors some sex-positive sex ed, and outlining the issues that patients may face would be a good start I think.
What are some good resouces you have found about sex and disability?
*Is written from a perspective that cis-gendered hetersexuality is the norm, and therefore that anything else is abnormal (and thus not worth considering / writing about)
Thursday, 8 September 2011
I wish that you could change their minds.
I tell myself that if I brought them to you - the people who suggested these dangerous bills, those who supported them blindly, or with conviction, or against their better judgement, those who had the chance to stand up and say "no", and didn't even show - I tell myself that if I brought them to you, they would change their minds.
You would invite us into your cubicle, and I would draw the NHS-special-issue sound-proof curtains around us. When we were sitting around your bed, I would help you to lift the oxygen mask, and you would tell them what they're doing.
I tell myself that we could explain it to them, and that they would get it, and it would all be alright. But they know. They know exactly what they are doing, and they don't care. Either that or they're in such Westminster denial that they actually believe the stories they spin themselves. Why would they listen to your story when they've ignored everyone else's?
With tears in your eyes you would repeat the stories you've told me - about your care hours being reduced (because the cuts aren't looming in the distance - they're already happening). I will hold your hand as you tell them that your husband can't cope, that he is grey with worry and not able to sleep.
They will say "what about a nursing home?", "how would I pay?" you reply, "and tell me one in my area that would have space for me". (It would have to be close to home, or else you would be trapped there, with no visitors.) They make it sound so easy - they have no idea of the paperwork, and the pleading, and the postcode lottery that can be involved in accessing appropriate care. And being in residential care in your 30s is no easy solution, especially given the standards of 'care' so many receive.
You tell them about the neurologist who diagnosed you, finally, after you were messed around and ignored by so many doctors. She listens to you, she has known you for years, and she has become an expert in your condition and the ways it affects you. One of your biggest fears is that you won't be able to see her any more, that instead you will become a patient of T*sco's own brand neurology. I wish that I could tell you that this would never happen, but it doesn't sound so far-fetched these days.
Your voice steady, you tell them that if your benefits are cut you will kill yourself, that you are both in debt, barely scraping by, and that you would have no other option. You ask them not to take away the little dignity they have left you with - the ability to (barely) feed and clothe yourselves, to keep a roof over your heads.
They will tell you that you'll be fine - that you have "nothing to fear". If I brought them to you, and you told them your story they would say "No, you've got it wrong - it's not you the cuts target, it's the others. We're making the benefits system easier to navigate for you, we're sending the fakers, the manipulators, the scroungers back to work so we have more money to spend on you. We're making healthcare competitive so that they have more incentive to treat you well."
Before we can even process how deluded these people are by their own rhetoric, a camera flashes in your face (the photos will appear on the news websites later - you surrounded by smiling politicians) and they are gone.
[The 'patient' is an anonymised composite, but the stories and fears are very real. The HofL's 2nd reading of the welfare reform bill is very soon. Use this template to write to them, and/or keep an eye out for a Hardest Hit action near you if you're able to participate.]
You would invite us into your cubicle, and I would draw the NHS-special-issue sound-proof curtains around us. When we were sitting around your bed, I would help you to lift the oxygen mask, and you would tell them what they're doing.
I tell myself that we could explain it to them, and that they would get it, and it would all be alright. But they know. They know exactly what they are doing, and they don't care. Either that or they're in such Westminster denial that they actually believe the stories they spin themselves. Why would they listen to your story when they've ignored everyone else's?
With tears in your eyes you would repeat the stories you've told me - about your care hours being reduced (because the cuts aren't looming in the distance - they're already happening). I will hold your hand as you tell them that your husband can't cope, that he is grey with worry and not able to sleep.
They will say "what about a nursing home?", "how would I pay?" you reply, "and tell me one in my area that would have space for me". (It would have to be close to home, or else you would be trapped there, with no visitors.) They make it sound so easy - they have no idea of the paperwork, and the pleading, and the postcode lottery that can be involved in accessing appropriate care. And being in residential care in your 30s is no easy solution, especially given the standards of 'care' so many receive.
You tell them about the neurologist who diagnosed you, finally, after you were messed around and ignored by so many doctors. She listens to you, she has known you for years, and she has become an expert in your condition and the ways it affects you. One of your biggest fears is that you won't be able to see her any more, that instead you will become a patient of T*sco's own brand neurology. I wish that I could tell you that this would never happen, but it doesn't sound so far-fetched these days.
Your voice steady, you tell them that if your benefits are cut you will kill yourself, that you are both in debt, barely scraping by, and that you would have no other option. You ask them not to take away the little dignity they have left you with - the ability to (barely) feed and clothe yourselves, to keep a roof over your heads.
They will tell you that you'll be fine - that you have "nothing to fear". If I brought them to you, and you told them your story they would say "No, you've got it wrong - it's not you the cuts target, it's the others. We're making the benefits system easier to navigate for you, we're sending the fakers, the manipulators, the scroungers back to work so we have more money to spend on you. We're making healthcare competitive so that they have more incentive to treat you well."
Before we can even process how deluded these people are by their own rhetoric, a camera flashes in your face (the photos will appear on the news websites later - you surrounded by smiling politicians) and they are gone.
[The 'patient' is an anonymised composite, but the stories and fears are very real. The HofL's 2nd reading of the welfare reform bill is very soon. Use this template to write to them, and/or keep an eye out for a Hardest Hit action near you if you're able to participate.]
Tuesday, 6 September 2011
On fuckwittery, and paperwork.
This is a really long post, which is in essence two joined together, but I'm too tired/fogged to figure out a more sensible arrangement.
I promised myself that I wouldn't let this blog make this look easier than it is. Every time someone tells me to 'just' apply for DSA or 'just' take a year out to sort stuff out or 'just' apply for less-than-fulltime work, it cuts a little deeper. I promised myself that I wouldn't gloss it into 10 simple tips to deal with being the 'problem' in the system.
The truth is chaps, within the current system, it's bloody difficult. There will be a lot of fuckwittery and a lot of paperwork. You will have to overcome the urge to punch each person who says "but that's 'just' the way we do things (so deal with it)" and can't understand why that's not justification for not changing something. Med school will make you find your physical and mental limits, and struggle like mad to defend those limits. And a lot of the time, when the training programme looks like it's just going to be a shitload more of the same nonsense you will wonder why you couldn't do something else with your life (before you remember that you'd probably just revisit the same issues in a different form).
The only advice that I, or anyone else can truly offer is this : always keep in mind why it is you're doing this (and recognise that this will change over time), and know what you are willing to sacrifice to get there, and what you are not.
Things are really rough at the minute, and I offer the reasons why as an example of 'just' how difficult it can be to play this particular game. This is a pretty bog-standard worry list.
1) My SI joints are out and my back is in spasm. I have considered phoning the GP to ask for some drug-related assistance on that front, but being as he thinks that the tramadol is far more than a 23 year old should be taking, that seemed pointless.
I still haven't found a way to sort things out with my GP, and now whenever I think about trying to talk to him about anything I cry. [now is not the time to suggest that I 'just' switch GPs] Advice from any fellow medics on this score would be appreciated. I fear that most other GPs would present similar problems.
2) Placement is a 40 minute bus journey away, which is tiring and sore. I can't take the current wheelchair on the bus, because it's too heavy for me to push outside, and to lift (rush-hour buses "don't do" ramps), so that means a £10 taxi journey, which I can't afford because I still don't have DSA (because no matter how easy it is once you've actually applied, my very best efforts are not enough to persuade my mother to sign a form and send it to me so I am as yet un-funded for the year, thus have no funding body to claim from). There are several closer hospitals, but I am in the current one for most of the year. In many ways it's better in terms of input, but that's useless if I'm too much of a zombie to take it all in.
3) Job applications. We have decided (almost) not to apply for special circumstances after I spent the best part of 2 days sobbing every time I thought about it. Not because of me, but because of the stupid, agressive questions that Beanie (which is now the mrs's's's pseudonym, bien sur?) would have to answer. (I just opened the form to find an example am now crying again - see the end of the post for these questions)
BUT we're not quite sure of one thing - if special circs can dictate more than ending up in a specific part of the country we might need them, because I'm having serious concerns about slotting into part of a regular rota (I think that 13 hour long days would end with fainty, vommy junior doctor, and that's not really what you want as a patient...). The deadline is coming up soon, and we have no idea what to do / if it's possible for part-time foundation years not on a pro-rata basis. We can't meet with the person who might know until a couple of days before the deadline (and not for want of trying to bring it up earlier...)
4) And in the middle of this, I'm pretty sure that depression has slipped in without me noticing again. Of course, it's hard to tell amidst fatigue and big'n'scary decisions. I am so scared of getting ill in this particular direction again, because services screwed up pretty dramatically last time, and I'm pretty sure that this fear clouds the waters still further.
--
And you know what? I am so keenly aware that I'm one of the privileged ones - I'm one of the ones who made it to medical school in the first place - other disabled people, other folk from less-privileged backgrounds (especially now with the tuition fee hikes), other women in some parts of the world - so many folks don't get to this point of being on the inside and bitching about it. That's the part of this I don't talk about often, but it doesn't mean that I'm not thinking about it. I know that the system's not only broken for me.
I'm so tired of fighting fires distracting me from trying to make the course that I love truly and joyfully accessible. That is one of the reasons that I started this blog, and that I'm exploring the possibility of forming a support and campaign group for disabled students within my med school. I have to leave it that bit easier for the next person.
So, here are some of the questions necessary to answer should Beanie wish to apply for Special Circumstances in FPAS as my carer :
"What happened (or will happen) to the person you care for while you were (or will be) on your elective? Who cared (or will care) for them during this time?"
- answer : So many assumptions in one little question! It assumes that everyone can travel for their elective, it assumes that the care-ee isn't doing their own elective...
"What other services does the person you care for utilise e.g. social services, private carers...primary health care team? Have all local support resources been fully considered?"
- answer : Once again, I am also a medical student. I cannot consider "local support resources" until I know where I'll be living. Secondly, non-professional carers often take on that role because outside help does not fall out of the sky. (Remind me to tell you about trying to access a Social Work assessment during another rant...)
"How do you plan to combine these responsibilities with a full time F1 post, which involves irregular shifts, nights and weekends? (Foundation doctors cannot necessarily guarantee to leave exactly at the end of their shift every day.)"
"What arrangements will you have in place for unexpected or planned periods when you will be unavailable? What will happen, for example, if you have a week of nights, you are unwell, or you go on holiday?"
- answer : We don't know, for several reasons. Firstly we don't know if we'll be living here, in which case there is always someone I can call for help if I really need it. Secondly, we don't know how accessible the housing we will be living in is.
However, the main thrust of the answer is that when Beanie is working odd shifts, unless I manage to get a level of DLA/PIP that means I can pay for some help, I will be severely limited in some activities (those that involve leaving the house), and other things will have to work around her schedule (like showering). I will also be at risk when I'm in the house on my own (for example during the night I often fall down and need help to get back up).
It should be pointed out at this point that medical school is anything but a regular schedule or commitment, so anyone applying for special circs as a carer will already have been dealing with these issues to some extent.
--
If you think that I'm being unreasonable, please note that parents do not get asked any of these questions, or any like them (nor should they). These questions are designed to catch out people who are claiming carer-dom for the convenience of staying put, but surely getting a GP / Social Work to certify that someone is a primary carer would be as effective a way to deal with that (being as if someone was determined to lie their way into this, they could do it anyway...). Although even with that suggestion there are problems, for those who do not have supportive professionals around them to confirm their caring role (this is a big problem when applying for benefits etc).
They also require a copy of a 'care plan'. When will people realise that not all of us who need input from professional services get it? What is the point of Beanie preparing a written care plan, just adding to the work she has to do for me? And plus, the variable nature of my condition would make that bloody difficult anyway.
I'm sure that if I brought these points up with whoever decided on these questions they would say "Oh, we didn't think about the fact that the care-ee could be another medic" or "We need to make sure that people aren't trying to play the system". To me, and others like me, the intent doesn't matter - what matters is that my partner is being made to prove herself yet again to a bunch of strangers, that once again noone has considered our situation as a possibility, that this is just another way to make the application process harder and more complicated for those who don't tick the right boxes.
I promised myself that I wouldn't let this blog make this look easier than it is. Every time someone tells me to 'just' apply for DSA or 'just' take a year out to sort stuff out or 'just' apply for less-than-fulltime work, it cuts a little deeper. I promised myself that I wouldn't gloss it into 10 simple tips to deal with being the 'problem' in the system.
The truth is chaps, within the current system, it's bloody difficult. There will be a lot of fuckwittery and a lot of paperwork. You will have to overcome the urge to punch each person who says "but that's 'just' the way we do things (so deal with it)" and can't understand why that's not justification for not changing something. Med school will make you find your physical and mental limits, and struggle like mad to defend those limits. And a lot of the time, when the training programme looks like it's just going to be a shitload more of the same nonsense you will wonder why you couldn't do something else with your life (before you remember that you'd probably just revisit the same issues in a different form).
The only advice that I, or anyone else can truly offer is this : always keep in mind why it is you're doing this (and recognise that this will change over time), and know what you are willing to sacrifice to get there, and what you are not.
Things are really rough at the minute, and I offer the reasons why as an example of 'just' how difficult it can be to play this particular game. This is a pretty bog-standard worry list.
1) My SI joints are out and my back is in spasm. I have considered phoning the GP to ask for some drug-related assistance on that front, but being as he thinks that the tramadol is far more than a 23 year old should be taking, that seemed pointless.
I still haven't found a way to sort things out with my GP, and now whenever I think about trying to talk to him about anything I cry. [now is not the time to suggest that I 'just' switch GPs] Advice from any fellow medics on this score would be appreciated. I fear that most other GPs would present similar problems.
2) Placement is a 40 minute bus journey away, which is tiring and sore. I can't take the current wheelchair on the bus, because it's too heavy for me to push outside, and to lift (rush-hour buses "don't do" ramps), so that means a £10 taxi journey, which I can't afford because I still don't have DSA (because no matter how easy it is once you've actually applied, my very best efforts are not enough to persuade my mother to sign a form and send it to me so I am as yet un-funded for the year, thus have no funding body to claim from). There are several closer hospitals, but I am in the current one for most of the year. In many ways it's better in terms of input, but that's useless if I'm too much of a zombie to take it all in.
3) Job applications. We have decided (almost) not to apply for special circumstances after I spent the best part of 2 days sobbing every time I thought about it. Not because of me, but because of the stupid, agressive questions that Beanie (which is now the mrs's's's pseudonym, bien sur?) would have to answer. (I just opened the form to find an example am now crying again - see the end of the post for these questions)
BUT we're not quite sure of one thing - if special circs can dictate more than ending up in a specific part of the country we might need them, because I'm having serious concerns about slotting into part of a regular rota (I think that 13 hour long days would end with fainty, vommy junior doctor, and that's not really what you want as a patient...). The deadline is coming up soon, and we have no idea what to do / if it's possible for part-time foundation years not on a pro-rata basis. We can't meet with the person who might know until a couple of days before the deadline (and not for want of trying to bring it up earlier...)
4) And in the middle of this, I'm pretty sure that depression has slipped in without me noticing again. Of course, it's hard to tell amidst fatigue and big'n'scary decisions. I am so scared of getting ill in this particular direction again, because services screwed up pretty dramatically last time, and I'm pretty sure that this fear clouds the waters still further.
--
And you know what? I am so keenly aware that I'm one of the privileged ones - I'm one of the ones who made it to medical school in the first place - other disabled people, other folk from less-privileged backgrounds (especially now with the tuition fee hikes), other women in some parts of the world - so many folks don't get to this point of being on the inside and bitching about it. That's the part of this I don't talk about often, but it doesn't mean that I'm not thinking about it. I know that the system's not only broken for me.
I'm so tired of fighting fires distracting me from trying to make the course that I love truly and joyfully accessible. That is one of the reasons that I started this blog, and that I'm exploring the possibility of forming a support and campaign group for disabled students within my med school. I have to leave it that bit easier for the next person.
So, here are some of the questions necessary to answer should Beanie wish to apply for Special Circumstances in FPAS as my carer :
"What happened (or will happen) to the person you care for while you were (or will be) on your elective? Who cared (or will care) for them during this time?"
- answer : So many assumptions in one little question! It assumes that everyone can travel for their elective, it assumes that the care-ee isn't doing their own elective...
"What other services does the person you care for utilise e.g. social services, private carers...primary health care team? Have all local support resources been fully considered?"
- answer : Once again, I am also a medical student. I cannot consider "local support resources" until I know where I'll be living. Secondly, non-professional carers often take on that role because outside help does not fall out of the sky. (Remind me to tell you about trying to access a Social Work assessment during another rant...)
"How do you plan to combine these responsibilities with a full time F1 post, which involves irregular shifts, nights and weekends? (Foundation doctors cannot necessarily guarantee to leave exactly at the end of their shift every day.)"
"What arrangements will you have in place for unexpected or planned periods when you will be unavailable? What will happen, for example, if you have a week of nights, you are unwell, or you go on holiday?"
- answer : We don't know, for several reasons. Firstly we don't know if we'll be living here, in which case there is always someone I can call for help if I really need it. Secondly, we don't know how accessible the housing we will be living in is.
However, the main thrust of the answer is that when Beanie is working odd shifts, unless I manage to get a level of DLA/PIP that means I can pay for some help, I will be severely limited in some activities (those that involve leaving the house), and other things will have to work around her schedule (like showering). I will also be at risk when I'm in the house on my own (for example during the night I often fall down and need help to get back up).
It should be pointed out at this point that medical school is anything but a regular schedule or commitment, so anyone applying for special circs as a carer will already have been dealing with these issues to some extent.
--
If you think that I'm being unreasonable, please note that parents do not get asked any of these questions, or any like them (nor should they). These questions are designed to catch out people who are claiming carer-dom for the convenience of staying put, but surely getting a GP / Social Work to certify that someone is a primary carer would be as effective a way to deal with that (being as if someone was determined to lie their way into this, they could do it anyway...). Although even with that suggestion there are problems, for those who do not have supportive professionals around them to confirm their caring role (this is a big problem when applying for benefits etc).
They also require a copy of a 'care plan'. When will people realise that not all of us who need input from professional services get it? What is the point of Beanie preparing a written care plan, just adding to the work she has to do for me? And plus, the variable nature of my condition would make that bloody difficult anyway.
I'm sure that if I brought these points up with whoever decided on these questions they would say "Oh, we didn't think about the fact that the care-ee could be another medic" or "We need to make sure that people aren't trying to play the system". To me, and others like me, the intent doesn't matter - what matters is that my partner is being made to prove herself yet again to a bunch of strangers, that once again noone has considered our situation as a possibility, that this is just another way to make the application process harder and more complicated for those who don't tick the right boxes.
Wednesday, 31 August 2011
They're just words.
I keep trying to write. I have boxes full of scribbled half thoughts on the back of bus tickets. Pages and pages of getting It out. Pulling it out of my head, cajoling it out, and trapping it down on paper so I can look at it this way, and that. My mind works on paper, captured thoughts revisited. I'm steeped in other people's words - book on book of ideas and stories - trying to see through all this paper to the few grains of truth that connect it all together.
There is so much that I want to share, but I can't cut through all of these words to communicate.
I am frustrated. I'm having problems articulating (and swallowing). Brain fog regularly robs me of words, but this is different. My voice is drunk and slurring, stumbling and uncertain, especially when I'm tired. I have been particularly conscious of it back at placement - communication is so much a part of what I do.
It's another aspect of control that has fallen away. Fainting, throwing up, giving way. Jerking, shaking, grunting. My body insists on making its presence known, its difference apparent. Now you will lie down, no you can't eat that, I want to jump and bounce and twist. One long lesson in going with the flow.
I feel vulnerable when I can't hide behind words. I am afraid to speak in case the sounds that come out aren't right, aren't acceptable. My control and my mask are being shredded. God, it's scary. I can't 'pass' anymore as non-disabled. Not invisible anymore, for all the good and bad of that.
I'm doing some studying, some reading. I'm listening more. I can't help but wonder if it's not some cosmic lesson telling me to shut up because I talk too much.
I play with communication on placement. Written information, diagrams, trying to get the most infomation from the least questions. Using silence and touch, when appropriate. Studying how my presence interupts or enhances the doctor-patient conversation, how formality and professionalism blend with the personality of both parties. What do I hold back behind my professional distance, and does that limit how patient-centred my approach can be? How do I vocalise the 'elephants in the room' when someone insists they've come because they "can't sleep", but they seem to be saying that the sleeping tablets help their anxiety? Which words build barriers, and which break them? Is it ever appropriate to say "me too", or would showing true compassion render that unecessary?
This feels like just another experiment in communication, not having the words to make them see past the stick or the random movements, or the chair. Letting people see me, react to me, and not feel the need to explain. Working out when it is really important for me to open my mouth, and when it's just noise.
There is so much that I want to share, but I can't cut through all of these words to communicate.
I am frustrated. I'm having problems articulating (and swallowing). Brain fog regularly robs me of words, but this is different. My voice is drunk and slurring, stumbling and uncertain, especially when I'm tired. I have been particularly conscious of it back at placement - communication is so much a part of what I do.
It's another aspect of control that has fallen away. Fainting, throwing up, giving way. Jerking, shaking, grunting. My body insists on making its presence known, its difference apparent. Now you will lie down, no you can't eat that, I want to jump and bounce and twist. One long lesson in going with the flow.
I feel vulnerable when I can't hide behind words. I am afraid to speak in case the sounds that come out aren't right, aren't acceptable. My control and my mask are being shredded. God, it's scary. I can't 'pass' anymore as non-disabled. Not invisible anymore, for all the good and bad of that.
I'm doing some studying, some reading. I'm listening more. I can't help but wonder if it's not some cosmic lesson telling me to shut up because I talk too much.
I play with communication on placement. Written information, diagrams, trying to get the most infomation from the least questions. Using silence and touch, when appropriate. Studying how my presence interupts or enhances the doctor-patient conversation, how formality and professionalism blend with the personality of both parties. What do I hold back behind my professional distance, and does that limit how patient-centred my approach can be? How do I vocalise the 'elephants in the room' when someone insists they've come because they "can't sleep", but they seem to be saying that the sleeping tablets help their anxiety? Which words build barriers, and which break them? Is it ever appropriate to say "me too", or would showing true compassion render that unecessary?
This feels like just another experiment in communication, not having the words to make them see past the stick or the random movements, or the chair. Letting people see me, react to me, and not feel the need to explain. Working out when it is really important for me to open my mouth, and when it's just noise.
Tuesday, 30 August 2011
First day back =)
A quick post, but a happy one!
I hadn't realised just how terrified I'd been about starting this placement until I got home today and noticed that the sick feeling I've been carrying around for weeks had gone. So far the placement seems well-organised, the building is new and pretty easy to navigate (although the doors are on the heavy side) and there's a room I can leave my wheelchair overnight which also has air-conditioning, which will be a godsend (I get really overheated on the wards, and it makes me sound and feel like I'm drunk). Simple things make such a difference.
[I have a big brute of an NHS bog standard manual which I can self-propel on polished, flat, indoor surfaces for short periods of time (think browsing in a shop, or moving between beds on a ward round). I can take it in and leave it in the hospital (I can't manage it outside on my own and I can't afford to get a taxi every day until I get my DSA) so that I will have the option for parts of the day that normally involve a lot of standing around, such as ward rounds and bedside teaching. When my lightweight chair arrives I will hopefully be able to use it for the whole working day and I'll be able to manage short distances outside on the flat as well.]
I'm a bit nervous about how people will react, but I'm in a small unit with only a few other students, so I'll be a bit sheltered until I get used to it. It's totally worth it if it makes placement easier to manage.
I hadn't realised just how terrified I'd been about starting this placement until I got home today and noticed that the sick feeling I've been carrying around for weeks had gone. So far the placement seems well-organised, the building is new and pretty easy to navigate (although the doors are on the heavy side) and there's a room I can leave my wheelchair overnight which also has air-conditioning, which will be a godsend (I get really overheated on the wards, and it makes me sound and feel like I'm drunk). Simple things make such a difference.
[I have a big brute of an NHS bog standard manual which I can self-propel on polished, flat, indoor surfaces for short periods of time (think browsing in a shop, or moving between beds on a ward round). I can take it in and leave it in the hospital (I can't manage it outside on my own and I can't afford to get a taxi every day until I get my DSA) so that I will have the option for parts of the day that normally involve a lot of standing around, such as ward rounds and bedside teaching. When my lightweight chair arrives I will hopefully be able to use it for the whole working day and I'll be able to manage short distances outside on the flat as well.]
I'm a bit nervous about how people will react, but I'm in a small unit with only a few other students, so I'll be a bit sheltered until I get used to it. It's totally worth it if it makes placement easier to manage.
Saturday, 16 July 2011
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.
Wednesday, 6 July 2011
Tea, biscuits and psychiatry
1) For me, the best bit of psychiatry was that ward rounds involved sitting in a room with tea and biscuits while the patient comes to you. (OK, maybe not the best bit, but it makes a nice change!) They can be very long though, because they tend to be once-weekly, and multidisciplinary.
2) Some wards, especially forensic or intensive care psych wards won't let you work in them if you have mobility problems. There are two main reasons for this - not being able to make a quick enough getaway if somethings kicks off, and the potential for a stick or crutches to be used as a weapon.
Noone mentioned this to me before my placement, but I suppose the people to talk to would be whoever decides which student goes to which ward (to ask them to avoid placing you on secure wards), occie health for the hospital, or your supervisor for the placement to ask if they do any work on a secure ward, and what the local policy is on this.
3) It is worth spending some time with CPNs, to get an idea of how community psychiatric services are organised. House visits may not be possible, depending on issues of accessibility, but CPNs will often run clinics at the CMHT base. If nothing else, ask a CPN to describe their job, and ask a few patients what their experiences are with CPNs.
4) This isn't actually psych-specific, but this is just where it came up for me. My partner would have been placed with one of the doctors who I saw when I was under the CMHT if she hadn't happened to be on holiday. It hadn't occured to me before that I could end up placed with one of my doctors. There is not really any facility to deal with this at my med school, because allocation of supervisors is handled at the hospitals rather than centrally.
If you do end up in that situation, I suppose there are two options : either get in touch with the med school / teaching administrators and ask to be transferred to somewhere else, or sit down with the doctor in quesion and talk about any issues that might come up. It might even be helpful for your consultant to see exactly how you're managing on placement.
5) During my A and E placement, I found it really difficult how certain doctors talked about / to patients who had self-harmed or overdosed. I reported one particular incident to a consultant because it was so inappropriate. I understand the frustration that doctors feel when they feel like they're getting taken away from people who didn't "choose" to be there, but this frustration should not be taken out on patients.
People will not think of the possibility that you, or members of your close family/friends may have been affected by similar issues. There is an 'us' and 'them' mentality, which feels very awkward as someone who is both.
6) If you are likely to be at all triggered by anything that comes up during placement, make sure your 'support network' - partner, friends, family, minister, disability advisor, CPN etc - know that you are starting the placement, and that it may be difficult for you. Make suggestions about how they can best help and care for you, if you know.
7) I have done two psych placements now, and both times I have told my supervisor that "I have a history of mental health problems" so that they knew in case I was struggling. If this feels too personal, or for whatever reason, you could say that a close family member / friend has mental health problems instead. This will hopefully stop them saying stupid things in front of you, will give you a chance to raise any suggestions e.g. "can you give me a brief run down of each patient before they come in so I don't get surprised by anything difficult?",and will explain away your freak-ish knowledge of little-used anti-depressants.
8) I don't normally journal regularly, but I wrote in a journal every day during my two psych blocks, so I could explore anything that had triggered me, and any emotions that the placement had brought up. Having said that, neither I nor any of my friends with MH problems have found the psych block particularly bad. I still think it's a good idea to prepare for the worst, just in case. Have a think about what you can do to cope if you have a tough time of it.
9) Prioritise your own health. Don't put yourself in any situations that you know are bound to cause problems, such as patients with a similar condition or history to you, or those who are aggressive and intimidating. Focussing on some of the theory (side effects of psych meds seem to make for popular exam questions) can help to take out some of the 'sting' of it
10) That being said, you will have to face some psychiatry in both final exams, and as a junior doctor (and, obviously, you will always find patients with mental health problems popping up in other specialities), so you need to find a way to, for example, assess a suicidal patient, and do it well and thoroughly, without damaging your own health. There are no easy answers to this, but I suspect that, as with many things, the key may lie in practice.
2) Some wards, especially forensic or intensive care psych wards won't let you work in them if you have mobility problems. There are two main reasons for this - not being able to make a quick enough getaway if somethings kicks off, and the potential for a stick or crutches to be used as a weapon.
Noone mentioned this to me before my placement, but I suppose the people to talk to would be whoever decides which student goes to which ward (to ask them to avoid placing you on secure wards), occie health for the hospital, or your supervisor for the placement to ask if they do any work on a secure ward, and what the local policy is on this.
3) It is worth spending some time with CPNs, to get an idea of how community psychiatric services are organised. House visits may not be possible, depending on issues of accessibility, but CPNs will often run clinics at the CMHT base. If nothing else, ask a CPN to describe their job, and ask a few patients what their experiences are with CPNs.
4) This isn't actually psych-specific, but this is just where it came up for me. My partner would have been placed with one of the doctors who I saw when I was under the CMHT if she hadn't happened to be on holiday. It hadn't occured to me before that I could end up placed with one of my doctors. There is not really any facility to deal with this at my med school, because allocation of supervisors is handled at the hospitals rather than centrally.
If you do end up in that situation, I suppose there are two options : either get in touch with the med school / teaching administrators and ask to be transferred to somewhere else, or sit down with the doctor in quesion and talk about any issues that might come up. It might even be helpful for your consultant to see exactly how you're managing on placement.
5) During my A and E placement, I found it really difficult how certain doctors talked about / to patients who had self-harmed or overdosed. I reported one particular incident to a consultant because it was so inappropriate. I understand the frustration that doctors feel when they feel like they're getting taken away from people who didn't "choose" to be there, but this frustration should not be taken out on patients.
People will not think of the possibility that you, or members of your close family/friends may have been affected by similar issues. There is an 'us' and 'them' mentality, which feels very awkward as someone who is both.
6) If you are likely to be at all triggered by anything that comes up during placement, make sure your 'support network' - partner, friends, family, minister, disability advisor, CPN etc - know that you are starting the placement, and that it may be difficult for you. Make suggestions about how they can best help and care for you, if you know.
7) I have done two psych placements now, and both times I have told my supervisor that "I have a history of mental health problems" so that they knew in case I was struggling. If this feels too personal, or for whatever reason, you could say that a close family member / friend has mental health problems instead. This will hopefully stop them saying stupid things in front of you, will give you a chance to raise any suggestions e.g. "can you give me a brief run down of each patient before they come in so I don't get surprised by anything difficult?",
8) I don't normally journal regularly, but I wrote in a journal every day during my two psych blocks, so I could explore anything that had triggered me, and any emotions that the placement had brought up. Having said that, neither I nor any of my friends with MH problems have found the psych block particularly bad. I still think it's a good idea to prepare for the worst, just in case. Have a think about what you can do to cope if you have a tough time of it.
9) Prioritise your own health. Don't put yourself in any situations that you know are bound to cause problems, such as patients with a similar condition or history to you, or those who are aggressive and intimidating. Focussing on some of the theory (side effects of psych meds seem to make for popular exam questions) can help to take out some of the 'sting' of it
10) That being said, you will have to face some psychiatry in both final exams, and as a junior doctor (and, obviously, you will always find patients with mental health problems popping up in other specialities), so you need to find a way to, for example, assess a suicidal patient, and do it well and thoroughly, without damaging your own health. There are no easy answers to this, but I suspect that, as with many things, the key may lie in practice.
Monday, 4 July 2011
Children are not mini adults...
...A survival guide for paediatrics.
1) If you look "different" in any way, children will ask questions about it, and parents will (for the most part) get embarrassed. You've probably come up against it at the supermarket already, but if you haven't, have a think about what to say to "why is that lady using a stick / chair? etc". Something simple such as "my legs don't work the same way as yours" works for younger children, and simply "I am disabled" for older.
Decide to what extent you will answer follow-up questions as well. To non-medics I tend to say that "I have a problem with my joints", and this seems to work fine with children. (Medics, I tend to tell what I have, purely because it's not well-known and I want more people to have at least heard of it!)
2) I try to be welcoming to questions and curiosity from kids, because I think that's it's a really good opportunity to de-mystify disability. If kids are staring, or parents get embarrassed, I tend to ask the wee ones what colour my stick is. It seems to open up some good conversations.
3) I did talk to a couple of parents who said it was really good for their disabled child to see a disabled medical student. I didn't know what to say to that, but it made me a bit happy. This isn't really a tip so much as something to bear in mind.
6) I found it really frustrating how much better coordinated childrens services are than adult. There's no easy answer to this, but it's not just you. Don't be afraid to voice these frustrations, because most paediatricians share it, because they see the anxiety that surrounds the transition between.
7) If you've not spent much time with babies before, and you're nervous around them, get the nurses to teach you how to change nappies / give bottle feeds. If you muck in, you'll get plenty of experience, and the nurses / auxillaries will love you. (If you like cuddles, barter one nappy change for one bottle feed like me!)
8) Spend time in the play room or with play therapists to hang out with some toddlers. Being able to make a child smile will make clinical exams so much easier - a relaxed child is way easier to examine, and a relaxed parent gives a better history. The easiest way to get a child on side is to say "who is that on your Tshirt? / what is your teddy's name? / what colour are your shoes? is that your favourite colour?". Always ask the child their name and age before (if they can't answer) asking the parent (unless they're very obviously 8 weeks old!).
9) But, if you choose to take this kind of hands on approach, remember : have a change of top around in case you get peed or puked on. (Or know where the scrubs live!)
10) Also, know your limits in terms of lifting babies / children. Don't hurt yourself (by lifting a particularly weighty, but tiny-looking 2y/o like me...) and really try not to drop them!
1) If you look "different" in any way, children will ask questions about it, and parents will (for the most part) get embarrassed. You've probably come up against it at the supermarket already, but if you haven't, have a think about what to say to "why is that lady using a stick / chair? etc". Something simple such as "my legs don't work the same way as yours" works for younger children, and simply "I am disabled" for older.
Decide to what extent you will answer follow-up questions as well. To non-medics I tend to say that "I have a problem with my joints", and this seems to work fine with children. (Medics, I tend to tell what I have, purely because it's not well-known and I want more people to have at least heard of it!)
2) I try to be welcoming to questions and curiosity from kids, because I think that's it's a really good opportunity to de-mystify disability. If kids are staring, or parents get embarrassed, I tend to ask the wee ones what colour my stick is. It seems to open up some good conversations.
3) I did talk to a couple of parents who said it was really good for their disabled child to see a disabled medical student. I didn't know what to say to that, but it made me a bit happy. This isn't really a tip so much as something to bear in mind.
4) Depending on your life experiences, some of the issues that are raised in paediatrics may raise some difficult feelings. Recognising non-accidental injury, for example, will almost certainly be raised.
The pictures shows a young girl of about 3, dressed in red, kneeling over
a baby, dressed in white, who is lying on the floor. The girl is playing
with a syringe (no needle though, don't worry!), and mum is watching
over them, her left wrist loosely bandaged by the wee doctor.
Picture by uncoolbob on flickr.
5) The MDT is highly valued within paediatrics, and specialist community nurses are the back bone of chronic disease management in kids. Depending on access issues, home visits may not be possible for you, but nurses often also run clinics from a hospital base, or are part of consultant-led clinics (e.g. diabetes clinic).
The pictures shows a young girl of about 3, dressed in red, kneeling overa baby, dressed in white, who is lying on the floor. The girl is playing
with a syringe (no needle though, don't worry!), and mum is watching
over them, her left wrist loosely bandaged by the wee doctor.
Picture by uncoolbob on flickr.
6) I found it really frustrating how much better coordinated childrens services are than adult. There's no easy answer to this, but it's not just you. Don't be afraid to voice these frustrations, because most paediatricians share it, because they see the anxiety that surrounds the transition between.
7) If you've not spent much time with babies before, and you're nervous around them, get the nurses to teach you how to change nappies / give bottle feeds. If you muck in, you'll get plenty of experience, and the nurses / auxillaries will love you. (If you like cuddles, barter one nappy change for one bottle feed like me!)
8) Spend time in the play room or with play therapists to hang out with some toddlers. Being able to make a child smile will make clinical exams so much easier - a relaxed child is way easier to examine, and a relaxed parent gives a better history. The easiest way to get a child on side is to say "who is that on your Tshirt? / what is your teddy's name? / what colour are your shoes? is that your favourite colour?". Always ask the child their name and age before (if they can't answer) asking the parent (unless they're very obviously 8 weeks old!).
9) But, if you choose to take this kind of hands on approach, remember : have a change of top around in case you get peed or puked on. (Or know where the scrubs live!)
10) Also, know your limits in terms of lifting babies / children. Don't hurt yourself (by lifting a particularly weighty, but tiny-looking 2y/o like me...) and really try not to drop them!
Sunday, 3 July 2011
Ready? Get set... Surgery
I am not one of life's surgeons. It's medicine all the way for me. Having said that, I came out of my surgical placement this year feeling smarter, more confident and able to present patients a lot more succintly. And I really enjoyed myself. If I can do it, anyone can. Here are some hard won lessons that I will definitely be bearing in mind next year.
On the wards
1) Surgical ward rounds are fast-paced, which makes it hard to sit down at each patient. Consider sitting out alternate patients, or bays in the doctors room. Alternatively, do your own WR over a day. See each patient and review their notes at your own pace. This is very good for learning, especially if you don't peek at the diagnosis before seeing them (except if the patient answers your opening "what was it that brought you to the hospital?" with "I had a massive heart attack"...)
In clinic
2) Surgical clnics are as speedy as the WRs, and doctors tend to walk from room to room as the nurses shuffle the patients so there's not much chance for sitting. Again try seeing alternate patients, or taking regular breaks (starting before you get tired, not after). In certain clinics, for example one-stop breast clinic, it's really useful to shadow one patient through the entire process. This is naturally paced by the queues for each procedure!
Don't always feel the need to stay for a whole clinic. Go to the ward, or the library to read up on what you've seen.
Looking the part
3) Wear clothes that are easy to get in and out of, and compression stockings if you are prone to fainting or getting all oedema-y in the feet when you stand. If you need particularly large, or particularly small scrubs, it's worthsnaffling a pair from the hospital buying your own pair (you can get fairtrade ones here).
4) Buy your own clogs if you have musculoskeletal issues. I'm coming to my 6th month of achilles tendinitis and plantar fasciitis after wearing a pair that didn't fit out of the spares bin (even though I was sitting down almost the whole time!). In most places closed toe crocs are fine. You can (at least in my trust) also just wear shoe covers over your normal comfy shoes.
Pictured are a pair of wooden clogs, painted bright orange, against a
grey background that looks like concrete. These would not be practical
for theatre but at all! Picture by garyknight on flickr.
5) I didn't take my stick into theatre, but if I had, I would have made a cover from a pair of old-and-falling-apart scrubs bottoms, or something. I plan to ask a friendly scrub nurse for something suitable next time.
[Update : When I took my stick into theatre, I was just asked to clean it with hard surface wipes. Obviously, I couldn't use it while scrubbed in. When I started using the wheelchair, one hospital let me bring my chair through the changing rooms and just leave it to scrub in, but another made me leave it in the changing room. I talked to theatre sister in advance about when I was going to be where and she helped me sort out a stool to sit on.]
In theatre
6) Scrub in at least once, even if you can't assist. It's a good skill to learn, and it's all kinds of fun. Ask a scrub nurse to show you how to do it properly. If you do assist, don't for more than 10 minutes the first time (even if non-disabled and/or not holding on to a fat flap / retractor). It's harder work than it might look.
[Update : You can sit down while scrubbed in. During my gynaecology placement I assisted for full lists while sitting down.]
7) Ask a scrub nurse or technician for a spare stool if you can't find one (or ask the anaethetist to borrow theirs if they're not using it). Theatre stools don't usually have back support, so it might be worth talking to you supervisor / disability advisor to try and sort something out if that's a problem. [Update : one hospital I had placement in also had higher stools (think barstool height) which are normally used for optho surgery - these were great for being able to see the field while seated. It's always best to chat to the surgeon about where is best or you to sit so you won't be in the way]
If you can't stand at all, or for long periods, then laparoscopic or opthalmic procedures are great because you can sit and watch what's going on on the screen. Most urology surgeries and some breast surgery (axillary node clearance) are carried out seated so you can see the field sitting down. [Update : I was primary assistant on full gynae lists while seated, without any issues.]
8) Pace yourself. Seeing 3 of the same procedure back to back is not the best use of your time. Sit often, for short periods - don't wait until breaking point to have a rest, and between patients go and sit in a more supportive chair in the break room, and have a drink and snack.
9) Drink plenty of water, don't skip breakfast, and don't be embarassed to sit down or leave if you feel dizzy. It's much less embarassing that fainting into the surgical field (luckily I didn't learn that one by experience!)
10) If you don't have a specific anaesthetics placement, spend some time with anaesthetists during your surgical placements. They are very good at explaining physiology (but be warned, they also ask really tough questions about it...), and there are plenty of chances for procedures (venflons, airways etc). Plus there's lots of sitting. Next time I also plan to shadow a scrub nurse for a list.
On the wards
1) Surgical ward rounds are fast-paced, which makes it hard to sit down at each patient. Consider sitting out alternate patients, or bays in the doctors room. Alternatively, do your own WR over a day. See each patient and review their notes at your own pace. This is very good for learning, especially if you don't peek at the diagnosis before seeing them (except if the patient answers your opening "what was it that brought you to the hospital?" with "I had a massive heart attack"...)
In clinic
2) Surgical clnics are as speedy as the WRs, and doctors tend to walk from room to room as the nurses shuffle the patients so there's not much chance for sitting. Again try seeing alternate patients, or taking regular breaks (starting before you get tired, not after). In certain clinics, for example one-stop breast clinic, it's really useful to shadow one patient through the entire process. This is naturally paced by the queues for each procedure!
Don't always feel the need to stay for a whole clinic. Go to the ward, or the library to read up on what you've seen.
Looking the part
3) Wear clothes that are easy to get in and out of, and compression stockings if you are prone to fainting or getting all oedema-y in the feet when you stand. If you need particularly large, or particularly small scrubs, it's worth
4) Buy your own clogs if you have musculoskeletal issues. I'm coming to my 6th month of achilles tendinitis and plantar fasciitis after wearing a pair that didn't fit out of the spares bin (even though I was sitting down almost the whole time!). In most places closed toe crocs are fine. You can (at least in my trust) also just wear shoe covers over your normal comfy shoes.
Pictured are a pair of wooden clogs, painted bright orange, against agrey background that looks like concrete. These would not be practical
for theatre but at all! Picture by garyknight on flickr.
5) I didn't take my stick into theatre, but if I had, I would have made a cover from a pair of old-and-falling-apart scrubs bottoms, or something. I plan to ask a friendly scrub nurse for something suitable next time.
[Update : When I took my stick into theatre, I was just asked to clean it with hard surface wipes. Obviously, I couldn't use it while scrubbed in. When I started using the wheelchair, one hospital let me bring my chair through the changing rooms and just leave it to scrub in, but another made me leave it in the changing room. I talked to theatre sister in advance about when I was going to be where and she helped me sort out a stool to sit on.]
In theatre
6) Scrub in at least once, even if you can't assist. It's a good skill to learn, and it's all kinds of fun. Ask a scrub nurse to show you how to do it properly. If you do assist, don't for more than 10 minutes the first time (even if non-disabled and/or not holding on to a fat flap / retractor). It's harder work than it might look.
[Update : You can sit down while scrubbed in. During my gynaecology placement I assisted for full lists while sitting down.]
7) Ask a scrub nurse or technician for a spare stool if you can't find one (or ask the anaethetist to borrow theirs if they're not using it). Theatre stools don't usually have back support, so it might be worth talking to you supervisor / disability advisor to try and sort something out if that's a problem. [Update : one hospital I had placement in also had higher stools (think barstool height) which are normally used for optho surgery - these were great for being able to see the field while seated. It's always best to chat to the surgeon about where is best or you to sit so you won't be in the way]
If you can't stand at all, or for long periods, then laparoscopic or opthalmic procedures are great because you can sit and watch what's going on on the screen. Most urology surgeries and some breast surgery (axillary node clearance) are carried out seated so you can see the field sitting down. [Update : I was primary assistant on full gynae lists while seated, without any issues.]
8) Pace yourself. Seeing 3 of the same procedure back to back is not the best use of your time. Sit often, for short periods - don't wait until breaking point to have a rest, and between patients go and sit in a more supportive chair in the break room, and have a drink and snack.
9) Drink plenty of water, don't skip breakfast, and don't be embarassed to sit down or leave if you feel dizzy. It's much less embarassing that fainting into the surgical field (luckily I didn't learn that one by experience!)
10) If you don't have a specific anaesthetics placement, spend some time with anaesthetists during your surgical placements. They are very good at explaining physiology (but be warned, they also ask really tough questions about it...), and there are plenty of chances for procedures (venflons, airways etc). Plus there's lots of sitting. Next time I also plan to shadow a scrub nurse for a list.
Wednesday, 1 June 2011
Bitterness is not my most attractive quality...
On days like today it takes a good 99% of my combined strength, self-control, fears of repercussion and compassion not to beat certain patients with my stick (with disability comes handy weaponry).
Most patients I see are having a really crappy time - and if they weren't before spending 3h59 on an A/E trolley being target practice for hapless med students, they certainly are after. They are frightened, confused and in pain (and if they weren't before...) and most do their best toget away asap help you find out what's wrong with them. [No, no medical problems. Diabetic, hypertensive, COPD-ish, triple bypass recipient - oh, yes, I was forgetting]
I enjoy placements. I enjoy them because of friendly colleagues, conspiratorial old ladies, dazed men who sing to me, and 30 somethings who share the skittles their kids brought them with said hapless med student.
But on days like today, it takes everything in me not to tell the guy with "11 out of 10" abdo pain that radiates everywhere, and comes with the most impressivevoluntary guarding I've ever seen - who has just tackled the 8 flights of stairs back to the ward from a cig break with ease - that I am in pain every day, so I'm maybe not the person to try it on with.
I bite my tongue, of course, because just sometimes there's a massive gunky appendix, or a scarred and sorry liver lurking in that guy's abdomen. And if not that, there must be something else going on. Because who but a hapless med student would spend 3 days hanging around surgical receiving without getting paid for the privilege - unless they hurt, or they need a bed, or some company, or a fix.
Even if they can saunter up the 8 flights, while I wait 15 minutes for the 1 lift in 4 that is cooperating today.
Most patients I see are having a really crappy time - and if they weren't before spending 3h59 on an A/E trolley being target practice for hapless med students, they certainly are after. They are frightened, confused and in pain (and if they weren't before...) and most do their best to
I enjoy placements. I enjoy them because of friendly colleagues, conspiratorial old ladies, dazed men who sing to me, and 30 somethings who share the skittles their kids brought them with said hapless med student.
But on days like today, it takes everything in me not to tell the guy with "11 out of 10" abdo pain that radiates everywhere, and comes with the most impressive
I bite my tongue, of course, because just sometimes there's a massive gunky appendix, or a scarred and sorry liver lurking in that guy's abdomen. And if not that, there must be something else going on. Because who but a hapless med student would spend 3 days hanging around surgical receiving without getting paid for the privilege - unless they hurt, or they need a bed, or some company, or a fix.
Even if they can saunter up the 8 flights, while I wait 15 minutes for the 1 lift in 4 that is cooperating today.
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