My Last Day…s

On Tuesday 1^st December 2015, we all thought it was the last day. Every four months, foundation doctors rotate round into their next specialty, meaning a new team, new patients, new rules and sometimes even a new hospital or town. Tuesday was to be that day, but then the unprecedented industrial action was called over the junior doctor contract row. The first strike was planned to take place on our rotation day, and with the government being so continuously unreasonable, the strike seemed imminent. We all said our goodbyes on Monday – to our favourite patients, the nurses, the ward clerks and our senior doctors, knowing how our day to day closeness would fade into brief smiles in the corridors and occasional chats in the coffee shop queue.

For me, there was another goodbye to make: to medicine. It was a very busy day and we were short-staffed, but for once I was grateful for this. It was a distraction from the enormity of what I was about to do: walk out on my profession and my security, into the unknown. My colleagues reassured me with reminders that I can always come back if I change my mind in the future. I know they’re right and I appreciate them trying to make me feel better, but right at this moment, I do not think I will ever come back. Unless financially I am forced to locum to support myself, I think this is it for me.

With this in mind, I found myself becoming very emotional as the day went by. “Is this last time I will write a drug chart? Is this the last time I will order an x-ray?” I even felt sad doing a discharge summary! Grappling with hopeless IT systems and pointless tick boxes has been the bane of my life for the last 3 years, and yet I seem to have become strangely attached to it.

The hardest reality to face was that of blood taking… I remember how nervous I used to feel when I first started doing bloods and cannulas on real people back in medical school. I remember the venepuncture failures when I first started working, and sidling up to my seniors, looking sheepish, to ask for help after two unsuccessful attempts. Then I did a Geriatric job – thin, faded arms with sagging skin and veins as thin as paper, which collapsed into bruises at the touch of a needle. My Paediatric job was the most challenging of all – tiny, premature, newborn hands with miniature vessels made visible only by a transilluminator, and the harsh, yet irrepressible guilt as their innocent screams ring through your ears at 3 in the morning while you stab at the skin they have owned for barely ten minutes.

Thanks to these experiences, I am now rather good at taking blood, and over the last four months, patients have told me often that my technique is painless. It is a skill that I can’t really take elsewhere with me, and it does feel like a waste. I cried after cannulating a patient yesterday.

As I walked around the hospital doing various jobs, I got a sense of how privileged I have been to have occupied this world for a time. I scoop up a set of back-breakingly heavy patient notes, and the unattached bits of paper inside all slide out unpityingly onto the floor. As I sigh and pick them up, I realise I am looking at someone’s cancer records. If I wanted to, I could log into the system and look at their bloods, or pull up their scans and see the tumour myself. I could read their clinic letter and find out what their prognosis was. I am privy to some of the darkest moments of people’s lives every day. How odd to lose that suddenly.

I wander over to theatres to find a consultant, and peer into the operating room to see if he’s nearly finished. There’s an anaesthetised patient on the table, half naked with a long bloody slash down one leg. Hip replacement. Isn’t it weird that I get to see this? It’s so normalised for me now that I don’t even think about it, but other people – non-medical people – would find it overwhelming. Inspiring. Fascinating. Gross.

As the day came to an end, I said my goodbyes, took a deep breath and went home. I didn’t have time to be emotional, as my mind was pre-occupied by the plans I had that evening with some colleagues: we were planning to go into central London in our scrubs and stethoscopes to talk to the public about the junior contract row – a ‘meet the doctors’ initiative. I thought it fitting that the last thing I would do as a junior doctor would be standing up for the profession.

Just as my train pulled into Liverpool Street, however, the news came through that the strike had been called off! And agreement had been reached at the eleventh hour! I messaged my colleagues and there was a lot of confusion over why this had happened and what it meant for us, so our meet the doctors plan sort of disintegrated. I had to laugh because I’d just spent the whole day mourning the loss of my daily grind, and here I was going in the very next day to do it all again!

It did feel very strange that this political storm was going on during my notice period. I’ve been vigorously defending my fellow junior doctors whilst knowing that I’m going to be jumping ship very soon. It does feel like I’m abandoning them, but then perhaps they can use me to their advantage and tell the newspapers that Jeremy Hunt’s schemes forced me to quit!

My actual last day was again very busy, as several patients were unwell. Two patients had post-op bleeding and needed blood transfusions. One developed an awful looking wound infection and another was found to have cellulitis. One was paralysed from the waist down, but had the attitude of an angel and the patience of a saint, while another walked cheerfully around the ward for most of the day, but then would crawl back into bed whenever the doctors came in, complaining of ‘unbearable’ pain and not being able to move at all. I had referrals to make, letters to other hospitals to send, rehab units to call, discharge summaries to do, drug charts to re-write, bloods, x-rays, cannulas, and of course, a tour of the hospital and a patient hand-over to do for the person taking over my job. At about 4pm, I sat down to have lunch. Then one of my patients developed signs and symptoms of a heart attack! Nightmare day! I sorted everything out for him and was just about to leave when the emergency buzzer went off in one of the side rooms. I smiled at my colleague as we ran over – it seemed as if Fate did not want me to leave! Luckily it was just a false alarm.

I finally left the hospital at about 6.30 pm. I expected to feel upset, relieved, overcome by the significance of the moment, but I did not. This long, drawn out goodbye has only left me feeling incredibly anxious, and when I got home, I cried for nearly an hour. My worries about locuming, the future and financial stability got the better of me, and I suddenly felt very scared and alone.

What am I going to do now? How am I going to employ my time? How do I make a living? I try to believe I can do anything I want to, but it’s hard to do that at the moment. My nails are bitten to pieces with the stress of it all, and I can’t shut my worrying brain off. Deep down, I know that resigning was the right thing to do, but right now, it feels awful. This is the culmination of my ‘break-up’ analogy. Divorce papers signed, possessions split, paths diverged – bring on the wine and the ice-cream, because I just need to feel my way through this.