Endings

I had passed my two AMKs, passed the SJT and passed the prescribing skills assessment.  I had been matched with my 6th choice on the FPAS list and had a job lined up waiting for me which would send me far from home to a DGH in The North  starting with a rotation in Emergency Medicine.  There was just one small hurdle to overcome.  I knew I couldn't do anything and what would be would be so I tried to keep busy for the three weeks of the holiday.leading up to results day  I spent a lot of time with Mum as I knew it was potentially the last summer holiday I would have at home, and I wanted her to really enjoy it as she would miss me if I was leaving.  We went shopping, we had crafty afternoons and we had lovely days together.  She wanted for nothing and I was determined she would have lots of happy memories from our last summer holiday together.  Mum was hopeful and she'd planned a celebration meal that family from all over the country were coming to.  It would be the first time she would meet Mr's parents.  She'd picked out a present of a new stethoscope she wanted to get me.  She had more faith in things working out than I did, after all, this is what I excel at.  I get so close, within touching distance and then fail at the final minute.

When the 2nd of July came around, the results would be released by an email at 12.  I was sick to my stomach with nerves and time went so slowly.  At 11:37 my phone binged:

RE: Outcome of Year 5 Progress and Award Board

         

Further to the meeting of the Year 5 Progress and Award Board, which was held on Monday 29^th June 2015, we can confirm that the decision of the Board was as follows:

Award of BMBS

Kind regards

Registry Services

I did it..... I passed! After all the stress, getting a standard email like that was a bit of an anti-climax, but I wasn't fussy, it had the magical words in it.  I could not believe that the thing I had worked so hard for for so many years had actually, finally happened.  I was now a Junior Doctor.  I would be moving in three weeks to start my new job as the only F1 in Emergency Medicine in a hospital on the other side of the country.

Mum had done a good job of inadvertently distracting me on that day as she'd woken up with a bit of a chest infection and so I'd spent the morning looking after her.  She was feeling a bit drained so I got the GP out who gave her antibiotics and I tried my best to keep her drinking and eating.  Within 10 minutes of the email coming she'd started vomiting.  It was getting to the stage where she couldn't keep anything down and her blood sugars were rising so I eventually persuaded her to go into hospital.  She detested hospitals and doctors and was refusing but I told her if she didn't she's be too poorly for my meal and graduation the following week.  Dad and I left her comfortable and looking tons better on AMU getting fluids and antibiotics.  We promised her we'd be back in the morning to visit.

At 0415 I got a phonecall from the ward asking if we could go back in.  Dad and I set off chuckling that she was being awkward.  We expected to find her sat up in bed refusing treatment and demanding to see us.  I knew something was wrong when they took us into a quiet room instead of straight to her sideroom.  They all looked so worried.  The Med Reg came to tell us that she'd gone into respiratory and then cardiac arrest after coming back from her chest X-ray at 0400.  She had been proudly telling anyone she came into contact with that her daughter was now a Doctor and so they thought I might like to watch the resuscitation attempt.  I couldn't believe it, she was fine, so I had to see for myself.  There were so many people in her little sideroom there was barely room for Dad and I to get in.  She was in PEA.  They were up to the 6th round of adrenaline and were discussing why the transcutaneous pacing wasn't working.  Someone was being sent to fetch and ultrasound machine.  She had access both sides and IOs in her shins.  The CPR they were performing was so effective at perfusing her brain, she was moaning and trying to climb off the bed.  Every time they stopped for a rhythm check she lay lifeless on the bed again.  I had a brief moment of surreal panic as I couldn't see where I fit into the team and what job I needed to do to help.  There was already access, there was already fluids being squeezed in, what could I do to help?  One thing was clear, they were doing everything.

The consultant anaesthetist who was leading the arrest call lead Dad and I outside and talked us through what was happening.  He asked if we knew Mum's wishes and if they got an output back would she want to be put on a ventilator?  Was there any reason we wanted her on one?  At that point I dissolved.  Of course I wanted her on one.  In 14 days time she needed to be sat smiling in the audience watching me walk across a stage at graduation.  She needed to go wedding dress shopping with me when the time came.  She needed to meet her grandchildren.  She needed to celebrate me becoming a consultant.  What sort of a question was that to ask?  Dad and I looked at each other and we knew.  No.  She'd hate that.  She always said it was the worst thing having make the decision to turn off Grandad's ventilator.  We knew what she'd want.  The anaesthetist was told the ultrasound was negative, no fluid.  All the H's and T's were sorted.  There was nothing more to be done.  The people quietly filed out and Dad and I went in to sit with her as she peacefully passed away.  In the space of 24 hours I'd had the happiest news and the most devastating news of my life.  What was I supposed to do next?

Rest in peace Mum, sweet dreams.

5th Year

I had been really looking forward to relaxing in fifth year and just enjoying it.  There were only two AMKs to sit and supposedly the only real way to fail 5th year is on professionalism.  Given my track record, do you think it was that easy? Ha! No.....

My first block was GP.  I was apprehensive as I hadn't enjoyed GP before but I was pleased to get the block over and done with.  As it turned out, I had a great rural practice, 20 mins drive away and I was working with a lovely bunch of people.  My GP facilitator was very clear that the reason he chose GP was so he could surf in his lunch breaks and he was keen I made the most of mine by going for walks or to the beach.  I had my own patients booked in to see me, I had one protected two hour teach a week with my facilitator and in the afternoons I was free to go home or pick from the emergency list of same day appointments.  It was great!  Not enough to convince me to be a GP, but I enjoyed it more than I thought.  It was a very friendly practice and I got on really well with everyone.  Picking off the emergency list let me see some more acute things as well, which appealed to me.  One day a week I was scheduled to follow the on call GP so we did home visits in the lunch break.  With one GP this meant sharing a car ride with his soppy dog, and with another it meant bacon baps on the beach.  It was wonderful.

Second block was where it began to fall apart.  I had GUM and I had been looking forward to it because I enjoyed my GUM block in Plymouth.  I found the staff to be very friendly and because it was mostly nurse led it had the same sort of team feeling that I find in ED, where everyone mucks in together.  Here, not so much.  I was given a timetable that had me at another site on a Monday and then only in for 2-3 sessions for the rest of the week.  If I tried to come in at other times when I wasn't scheduled I was told they had no room for me and the nurses looked at me like I was being awkward.  Once a week I had a scheduled clinic with my facilitator where I would see alternate patients on their list and present to them.  This invariably made them run late and a bit stressy.  This was the only time I saw my facilitator during the week.  Half way through my block just before the Christmas break I was told that complaints had been made against me by some of the staff.  They said I was cold and not approachable and they were worried about me.  What was I going to do to fix it?  I assured my facilitator I had never heard any feedback like that before and I couldn't see what I had done, but I'd work on it.

After the break I baked cakes, I went out of my way to be friendly and talk to everyone.  I went the long way around the building to leave at night so I could say goodnight to more people.  One of the nurses gave me positive feedback from a patient while standing right next to my facilitator... who wasn't listening.  I handed out 360 feedback forms to everyone.  I'd been told at my initial meeting I didn't need them because my facilitator would collect their own feedback but I wanted some evidence for my portfolio.  I only got 3 back and when I went to chase more they said they'd asked my facilitator who told them not to hand them back to me.  At my final meeting my facilitator told me people hadn't handed them back because they didn't want to write mean things about me.  I was failed on my professionalism and was told I hadn't done enough to improve my behaviour.  I was competent to be a Doctor as I had the knowledge, just not capable to be one.  I was handed a clinical skills assessment form which had been completed about a male genital exam I had done in front of my facilitator on which they had failed the professionalism judgement section saying I made the patient feel uncomfortable.  My facilitator said it wasn't slick and although I had done all the right things I hesitated.  I also hadn't given the patient enough eye contact.  They had put the date as the first week of my block, so it pre-dated the successful form I'd already completed with another supervisor and handed in and therefore superseded it.  In one fell swoop I was teetering on the edge of failing. We are only allowed two negative professionalisms so everything for the rest of the year had to be perfect.  I was furious as it felt like nothing I could have done would have changed the situation.  My facilitator had made up their mind and that was that.

My next two blocks passed without a hitch.  I did gastro surgery which allowed me the freedom to come and go when I pleased.  I did ward rounds, went to surgery and clinic.  I spent a lot of time on surgical assessment unit clerking and I did a lot of night shifts.  The juniors I worked with were great and I really enjoyed it.  I didn't enjoy block 4 as much.  It was respiratory and I found it quite boring and repetitive.  Every day was the same, patients stayed in for weeks and I did nothing but bloods and cannulas.  I passed both blocks and was home free to my favourite and final block - Emergency Medicine.

I had the best time in A&E.  I could come and go when I pleased, I was encouraged to see patients and present them and I was treated like a real member of the team.  I had amazing support and a fantastic facilitator.  It was perfect, I didn't want to leave.  In the final week of my block I was called to see my academic tutor.  I expected it to be a pat on the back, well-done-you-got-through-it meeting but it turned out my tutor wanted to see how I was feeling.  We have one wild card professionalism judgement that is the locality judgement.  If you get an on-the-spot positive or negative which is usually formative, the locality judgement makes it summative and so count towards your final grade.  It is decided on by a panel lead by.... the facilitator from my GUM block.  I hadn't had any on the spots and not everyone gets a locality judgement so I hadn't thought anything of it.  The school office hadn't told me told me but my GUM facilitator had given me a negative locality judgement.  My tutor broke the news and assumed someone had already informed me.

That was it, I was done.  I had failed medical school.  I had come to the end of my money, I couldn't afford to resit the year.  All my friends were celebrating finishing and I had to call my parents and tell them I'd failed.  I was utterly broken.  I had worked so hard, for so long and it all came down to one person not liking me.  I threw my all into that last week at placement.  I figured if it was the last time I was going to be able to work in A&E I was going to make the most of it.  My facilitator took me and my partner out for lunch on our last day and I told her then.  She was outraged and submitted an on the spot excellent judgement for me, hoping to negate the locality judgement somewhat.  I had one final chance to pass.  Because I had failed the year, my case would have to be discussed at the Progress and Awards Board.  I would have to wait three weeks to find out their decision.