My Last Day…s

On Tuesday 1st 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.



The Parental Reaction

I told my parents about my resignation today.

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I cheated. I chose this weekend because on Sunday they’re throwing me an engagement party, and are currently busy with preparations – I was hoping this would be enough to distract them from the magnitude of this revelation, hoping it wouldn’t make headline news. I suppose I also hoped that my engagement would provide something about me for them to be proud of – an oasis in this current desert of my achievement.

I couldn’t do it on my own. I came back to their house in the early afternoon, and several times when my parents asked me how I was, it was on the tip of my tongue, but I was too chicken to say a word. When my fiancé arrived later in the evening, I felt so guilty. My parents were laughing and joking with him, and behaving as one does with someone who is familiar, yet not quite close enough to be treated with the comfortable indifference of family.

They were enjoying a fascinating conversation about the interpretation of Buddhism by different Asian countries when I dropped the bomb. The smile on my mother’s face vanished in an instant, and I couldn’t even look at my father. I felt about an inch high as they expressed concern at my failure to finish FY2 – why couldn’t I stay till April? It’s only a few months away! I could have completed this stage of my training! People change, didn’t I know that? If and when I want to return to medicine, having FY2 would have been so much better. What was I doing leaving without a plan or another job to go to? Not a sensible thing to do. Should have talked to my dad about it first.

Perhaps it was beneath me to resign without consulting them, but genuinely, it was not out of any disrespect for their opinions. I feared telling them – that much is true – but this is a decision I had to make on my own. I can’t keep running to mummy and daddy every time something goes wrong, and then blaming them for giving me advice I don’t like. I am a grown woman and I need to start taking responsibility for my own decisions.

I could tell my dad was deeply affected by the news. He grew very quiet, and that was harder to deal with than spoken disapproval. He asked if I was really not enjoying the job, and when I said I was not, he said it was important that I was happy. He gave me a comforting smile later on, so I knew it was OK.

Still, I felt very emotional. It grieves me to grieve my parents, who have loved me so much and given me everything. While they were setting up the marquee for the party, I ran upstairs and find solace in Jane Austen’s Northanger Abbey for a few minutes. Jane Austen has saved me from many a personal crisis, and if anything she reminds me of the strength of the written word. She will never know how she has saved me, and who knows how many others she has and will continue to save with her wonderful, wonderful books. Though tears were rolling down my nose, I couldn’t help but giggle at her wit and laugh at myself:

“Miss Morland, no one can think more highly of the understanding of women than I do. In my opinion, nature has given them so much that they never find it necessary to use more than half.”

The problem is, I cannot answer any of my parents’ questions. I cannot reassure them at all. I was summoned to see the Dean on Thursday – the doctor in charge of foundation medical education in North East London. I was a bit nervous about seeing her, wondering if she was going to try to persuade me to stay, but she was actually very kind and understanding. She seemed genuinely worried about me, and had the same concerns as my parents. Some of my colleagues and seniors as well do not see this as the wisest move.

There are a lot of well-educated, older, more experienced people around me telling me that what I’m doing is effectively crazy.

Why am I not listening? What the hell is wrong with me?

I don’t know. I really don’t know what I’m doing and I’m not entirely clear on why I’m doing it, but there is a strange freedom in that. It’s almost cathartic to have this aspect of my life fall apart in front of my eyes, like a forest fire burning through the old scrub and making space for the new, green shoots that peep up through the soil when the blaze is over.

Oh dear, maybe I will live to regret this. Or maybe I will realise my true potential. I am good at medicine, but good isn’t enough. Improving my skills just to keep my head above water isn’t satisfying, being bored of learning is deplorable, signing up to tedious projects and audits just for the sake of going on to the next stage is intolerable.

I want to do something I’m brilliant at. I want to be hungry to learn more, I want to stay up till 3 am absorbed so deeply in my work that I don’t realise the time, to speak so passionately about it that I make people think I’m weird. I want to get back to the girl who asked for a French grammar and verb table for her 16th birthday because she was a total geek!

Was that Northanger Abbey quote strangely apt? Have I, for all this time, only been using half of my understanding? Maybe one day I’ll look back at this period of confusion and realise I was simply being ‘clever enough to be unintelligible…’ *

Till then, I live in hope.

*Jane Austen again, of course.