Emma Ladds: Keeping a sense of perspective

photo (5)Getting through the key safe is often a major accomplishment on home visits. Once you’ve achieved that, you can be pretty sure you can manage what lies beyond. Today I was going to see a lady with a palliative brain tumour*. I’d been part of her admitting hospital team and had remarkably come across her again during my primary care placement almost 10 months later. She remained overwhelmingly positive and visits were always full of a joke or two. A new carer had started today, and had called to say that she thought Mrs B had slurred speech and could do with a medical review. I had sighed. Mrs B’s speech had been slurred for days now, thanks to her cortical invader. She was hemiplegic too. Not long now. I had agreed to go and visit though. I wanted to say goodbye.

It’s that time of year again when hundreds, if not thousands, of junior doctors have to pick up their lives and move on. More senior, settled colleagues dread the impending weeks of chaos, while those responsible for organising rotas and placements frantically work to ensure everything is finalised before the big reshuffle.

Perhaps the move is along a training pathway towards a long held goal, or maybe it’s a sideways step into something new—a clinical fellow’s post, teaching, research, or another degree; maybe out of medicine altogether. Some opt to stay in the UK in the comfortable, well known battleground of politics, media coverage, and patient expectation that envelops the NHS. Others, beguiled by the promise of third world challenges or first world training opportunities, head overseas.

While it is a time of excitement—a time to look forward—it is also a time of immense stress and insecurity. The entirety of a life must be transported—often in just a couple of days. Rotas are rarely confirmed beforehand, contracts seem non-existent, and salaries are only ever vaguely outlined, making the process of buying or renting a house a monumental struggle. For those with relationships and families there are the added concerns of juggling a home life, schools, and another career, while for those without such trappings it is a lonely, stressful enterprise. Adding insult to injury is the overwhelming mass of HR bureaucracy and paperwork that must somehow be negotiated while working full time. All the while our patients look on, uncomprehending and slightly bemused—who would ever design such a perplexing, inhumane system?

As I left Mrs B that day, I paused. “I may not see you again,” I said.

“I’m not giving up yet, dear,” she replied.

“No, no,” I smiled, “I’m afraid I move to a new job in a couple of weeks.”

“Oh,” she said sadly, lifting her paralysed right arm with the left, “Oh dear doctor. How sad. Well good luck. I’ll miss you.” A moment’s hesitation, a lopsided grin, then, “Well my left side will anyway.”

It’s good to keep a sense of perspective.

*Patient consent obtained.

Emma Ladds is an academic F2 in Severn Deanery about to commence plastic surgery themed core surgical training in the Oxford Deanery.

Competing interests: None declared.