Evening everyone. I don’t normally do this, but I’m handing over my beloved blog to my girlfriend, Sarah, who is a junior doctor working in Northern Ireland. She works unbelievably hard, and ridiculous hours to ensure the safety of her patients. And it’s not just her. Every junior doctor deals with tough working conditions and they are committed to the future of the NHS. This segment could become a thing, it really could. Something along the lines of Karōshi: The Life of a Junior Doctor. Karōshi is a Japanese word (because of course it is) that translates to “death from overwork”, and I believe many junior doctors feel close to karōshi more than you imagine. That’s all from me for now, I’ll let Sarah handle the rest.
Karōshi: The Life of a Junior Doctor by Sarah
I don’t use social media a lot, but I felt that today of all days, with the Junior Doctors’ strike in England, was the day to share with you all my past week of working as an F1 doctor. Thanks to Adam for letting me hi-jack his blog.
Last week I worked regular days, that’s 9am to 5pm, Monday to Wednesday. I got Thursday off because I was scheduled to work nights starting on Friday evening. So, at 7:30pm on Friday I set off from my apartment in Belfast on the 60 mile journey to work in Coleraine. I arrived just before 9pm, in time for handover. For those of you unfamiliar with the inner workings of the hospital, at handover day-staff who have been on-call let the incoming night team know about any patients waiting to be admitted from A&E, patients who have been sick during the day and may require review overnight, and any outstanding jobs, such as checking test results, prescribing pain relief and anti-nausea drugs etc. There are sometimes even discharges and transfer letters handed over at this time. After all this has been discussed, the oncoming F1 doctor collects the bleeps from their colleagues who are leaving. And yes, I carry several bleeps as the F1. There’s my own personal one, the medical on-call bleep (which cardiac arrests, stroke lysis calls, and routine jobs will all be called through to), and the on-call surgical bleep. I am the most junior member of the medical team on at night. There are two more senior doctors, who are higher than a first year, but not quite a consultant yet. They deal primarily with incoming admissions from A&E, but, thankfully, are also available to be contacted if there is anything on the ward that needs a senior review. There is also a surgical doctor on, again, higher than me, but not a consultant. And, as ever, the consultants are at the end of a phone if ever we need them.
This past weekend, the first two nights were fairly routine. I worked from my jobs list, finishing up jobs on the 6 medical wards, 2 surgical wards, and outliers in the gynaecology ward. This mostly involved writing up insulin and warfarin prescriptions, prescribing pain relief and assessing any minor ailments patients had reported since the day staff left. Of course, there are always a few more serious things, and there were several patients I had to discuss with my SHO (senior house officer). She came to review the ones I was worried about, and gave me advice for the ones she was too busy to see immediately or that I could attend to myself.
Throughout the night bleeps keep coming in, sometimes directly from the wards, but mostly from the hospital at night (H@N) co-ordinator. I don’t know how staff without a hospital at night team cope. All requests for jobs between the hours of 9pm and 8am are supposed to go through the co-ordinator. This marvellous person filters all the bleeps, giving advice to the nursing staff if that is all that is needed, and contacting the appropriate level of medical staff for everything else. In most cases, that means phoning me. For all but the most serious or specialised cases, the F1 is the first person on the scene. We carry out an initial assessment, request any investigations we think might be necessary and initiate treatment. Then we contact our senior if we need any further advice. On a typical night I work steadily until about 1 or 2am before taking my first break for, what I suppose you would call, lunch. Not that a meal eaten at 2am has a proper name. Post-midnight snack? This is inevitably interrupted by bleeps with more jobs to complete. Then it’s back to the wards. I usually fill up two sides of A4 paper with my list of jobs.
Then comes 8am when I can offload the surgical bleep to the oncoming day team. From then it’s just a matter of finishing up any last bits and pieces before the 8:45am handover. There usually isn’t a lot to do and I can get a bit of a sit down and a cup of tea.
This past weekend was much the same as any other. Except there had been no phlebotomist on during the day to take bloods, which meant the three F1’s covering the hospital had been too busy to complete all their jobs. More to handover to me. I finally got on top of things by about 2:30. I grabbed my microwave pasta meal, and headed to the doctors’ room. And was stopped in my tracks by two bleeps back to back. Two patients on different wards had passed away and I was needed to confirm the death. This is never pleasant. It’s sad to hear of the death of someone you have known, however briefly. And so far, it hasn’t gotten any easier with experience, even if you know that there was nothing more that could have been done.
So, this weekend I finished up the formal handover at 9am on Monday. I then spent the next half an hour going from ward to ward, passing on any outstanding jobs and making the incoming staff aware of any patients than had been unwell overnight. Then it was time for the hour and a half drive home and the battle against sleep until I was safely in my apartment. Sleeping during the day for any length of time is something I am still not quite used to. It’s almost like being jetlagged, but without the excitement of exotic travel. It does have the advantage that I’m on the same time zone as my friend living in New Zealand.
Then it was back to work on Tuesday at 9am, less than 24 hours after finishing night shifts. Difficult as that is, today was made slightly worse by a sudden shortage of staff. Late in the afternoon, the on-call F1 had to accompany a patient to a different hospital just under an hour away for investigation not available at our hospital. While he was away he left the on-call bleep with me, saying he should be back not long after 5pm, and if he wasn’t back, the SHO might be able to cover until he got back. So, after he left, myself and one other colleague were left to cover our own ward, and his. Plus medical outliers. 5 o’clock came and went, and a message filtered down from one of our consultants that one of the F1’s would have to stay to cover. Now, as a disclaimer, he did say he’d allow time off in lieu the next day. After asking around, none of the other F1’s were able to stay on, so I agreed to cover until the long day person returned. I picked up jobs, clerking patients in, putting in cannulas, writing up prescriptions and checking blood results until almost 7pm, when my colleague returned.
Please don’t get me wrong. I am not complaining about this. I should also point out that mine is not a one off case. Every doctor I know has worked an equally tiring rota, and has gone above and beyond at some point. We’re all in this together. Someone had to stay, and I will be allowed some time off in the morning to make up for it. But, it does mean that in the past 4 days, from 9pm Friday night to 9pm Tuesday night, I have worked 47 hours, and have a further 24 hours scheduled before I get a break at the weekend. I am still young, and aside from my boyfriend, there is no one relying on me to arrive home at a certain time. But this is not a sustainable pattern of work for the long term. I can feel myself burning out already. Seeing all the recent coverage of the junior doctors’ strike in England and the spin some of the less pleasant newspapers have been putting on it makes my heart sink. To suggest we are underworked, over paid and lack a sense of vocation is insulting. There are few careers in which it is acceptable to work four 12 and a half hour shifts back to back, with no protected breaks. To enforce a new contract that would remove the safeguards we currently have in place would endanger not only patients, but the physical and mental health of healthcare professionals. And I have no doubt that if the doctors fall, our wonderful nurses and allied healthcare professionals will not be far behind.
It’s not safe. It’s not fair.