Archive for the 'work' Category

You talk way too much

Sorry for all the quotes but they really are crackers.

From the journal of the college to which i belong – reasons why i find my job stressful and why i don’t sleep so well at night:

The emergency department (ED) is a complex and difficult environment in which to provide medical care and differs substantially from more traditional settings in healthcare organisations. Care is “unbounded” in the sense that the ED is the only part of the hospital where any number of patients can be admitted and held. It is the only “infinitely expansible” part of the hospital. Emergency caregivers typically treat many patients simultaneously and in a much greater variety than do caregivers in other settings; there are no limits on the type of complaint or condition that patients may present with; there are severe time constraints and often a paucity of information.

…This Government-set performance indicator target aims to increase the speed with which the patient moves through the emergency admission system, with 98% of patients being seen, treated and either admitted or discharged within 4 h. This has created huge pressures, not only on the ED but also on our support services and diagnostic services to increase their efficiency.

…Communication and decision-making are arguably the principal activities of emergency staff. In one study, 89% of emergency physicians’ time involved communication

…Observational studies have revealed that staff members working in the ED are dealing with up to 42 communication events per hour, with a third of these being classified as interruptions. Moreover, senior clinicians and nurses have been shown to be subject to the highest levels of communications and interruptions

I don’t even like people. I am so in the wrong job…

The cost

Blogging while sleep deprived and a bit pissed off makes for good reading I expect but perhaps you say more than you meant to. I imagine this is the type of thing I’ll re tell on a comfy leather couch in about 20 years (or months depending on how it goes…)

The problem with medicine (says he, with finger pointed and all eyes watching the figure with the air of authority as he gets ready to put the world to rights…) is not neccessairily the medico-legal responsibilty.

Say that I cock up and kill someone, or miss something big or whatever – then there is a certain medico-legal responsibility that I have been negligent or incompetent and should (though not always and occasionally too often) face some kind of disciplinary action.

I figure I get paid for that kind of responsibility. That seems to be the way things work in the world, the more responsibility and education and learning you have the more you get paid. Like a top class economy crippling banker – you bring the world as we know it to an end and you still get your golden handshake…

[Although that is probably a tad unfair on the old bankers – no doubt they were unscrupulous and greedy but they were merely in the position to be so. Yes they’re bastards but I’m pretty sure we all are. Anyhow the dodgy millions they made are what paid the taxes that fund the whole NHS and now that their incomes (and tax revenues) are falling then the NHS will suffer. Anyhow it’s all a tad more complicated than a quick “bastards are bankers” “bankers are bastards” joke allows…]

Legal responsibility is one thing. Moral responsibility is a whole other kettle of fish.

You see that’s were the problem lies. I don’t give too much of a stuff about whether I’m legally responsible for a patient – fine sue me, see if i care. What I do care about is my moral responsibilty to the patient in front of me. Yes I am that self-righteously pious. It has taken years of practice believe me…

They turn up with their woes and sicknesses and it is to me they come. And me with my mythical diagnostic and healing powers, foisted upon me by a legacy of TV shows, movies and dishonest doctors, is the one that that has to give them some kind of answer and dare i say it – final solution to the whole mess. (No nazi killing reference intended…)

Do not get me wrong. I am not grumpy and moaning. I am not saying “why can’t you blood sucking parasites leave me alone and sort your own lives out and crawl into a corner and die as you best see fit”.

I enjoy the job. I enjoy that position. It is one of the highest honour and priviledges to face and speak to these people who are part scared, part hopeful, part accepting of what may lie before them.

It is the moral responsibility that I carry around with me. The simple notion that these people need sorted and that in essence is my job.

It is also what keeps me up till 3am worrying about all these little broken, sickly creatures wandering around out there in the community. It is what makes me come home and be grumpy with my house mates and my family. When you see me staring into space and grumpy and  uncommunicative I’ll either be thinking about Da or about all the patients I carry around with me in my head.

Without a doubt this is part of what makes me (i think) good at my job. It is also a large part of what makes me walk across the car park each day swearing inwardly at myself, the patients and the way we serve them.

While trying not to be too melodramatic – oh why the hell not… –  they come to me like ghosts, or apparitions, their faces, their names, their x-rays their CT scans, their veins and arteries and wounds all their weeping, worried relatives.

I have this uncanny knack of remembering every patient I’ve ever seen. Well not everyone but a scarily high proportion. I go in the cubicle and ask have i met them before then i’ll remember – you were in cubicle 4 two and a half years ago and you’d hurt your wrist and there was no fracture on the x-ray. Which is all very impressive till the patient says “oh yes but i came back a week later and the consultant said it was broken…” Which always takes me down a peg or two but I could do with that.

But i remember them all, the things we got right, the things we got wrong. Each one tells me a story.

I’m not entirely sure if all this psychotic craziness is since Da died or not. Certainly watching one of your own go through it makes you painfully aware of how important all this is. But I think I was like this to start with. Only now more so.

I sometimes I think I have a shelf-life, a period of time that I can pull this off for before it all comes crashing down around me and I end up pulling an into the wild and doing private practice as a dermatologist (awww that’s unfair on dermatologists, sorry…). I hope not.

“a man who has no memory has nothing left to hide… nothing and i like it…”

Thank you for saving me

I got my first bottle of wine off a patient today. Not that I think patient’s should encourage their doctor’s to alcohol or anything, though there could be worse things.

Some people’s office’s and pigeon holes are coming down with thank you cards and pressies from patients – there is a certain speciality bias to that.

People who deliver babies get lots of gifts cause it’s generally a happy event and there’s lots of pressies being bought anyhow.

Surgeon’s get lots cause what they do to the patients is fairly dramatic and occasionally it even works (sorry, no surgeon bashing, sorry…) and you generally see lots of them over a month or two so there’s a certain relationship that develops there.

Anywhere, where you get to develop a relationship with a patient (not in any dodgy “let’s meet for dinner and a movie” type way) then there’ll be opportunities for free stuff.

Unfortunately given the nature of A&E we generally don’t develop too much of a relationship – the majority of what we do is basic management and diagnosis and then referral on for appropriate definitve care. The bit of the job that is truly ours and ours alone is the critically ill and resuscitation. Unfortunately most of our target demographic is nearly dead or technically dead and therefore not big into relationship building.

[Anaesthetists suffer a simiar problem in that they put all their patient’s to sleep and do the cross word till the butcher surgeon is all done.]

So we suffer a somewhat unfortunate lack of biccies and pressies relative the 70000 or so we see a year.

There are exceptions to this. Almost every patient of Gilly’s I review will have “a little something” for Dr Carson. But then he is truly exception as medic, Christian and human being. And he doesn’t even drink the whisky…

5 years I’ve been working now and not one pressie have I got (I once got given 20 quid which I put into the ward fund) – now I’ve got boxes of celebrations dedicated to the ward staff but nothing to me personally. Yes I’m that self-absorbed.

Till today. A young fella who I had blind luck to pick up sarcoid on got me a bottle of vino – even though it was the respiratory team who did all the real work of scopes and scans and biopsies. Seems unfair. But hey I’ll take what I can get –  deserved or not.

I’ve been working

I’m back. I suppose. Whatever that means. I’m back in work. I’m back in my own house. I’m back, for the first time for two years, to what counts for stability and doing the same thing for perhaps slightly longer than a few months at a time. Not exactly the circumstances i would have wished for but it is what it is.

I’m now a fully paid up full-time, permanent contract member of staff in the chaos of the emergency department (as the kids are calling it these days…). It is chaos. It is horrible, it is wonderful. It is what i do.

I’ve made a list of about 20 or 30 things to change in the department, from knocking down walls to bits of equipment i’d like on order. The sisters told me to write a letter to Medical executive Satan Santa and see how i got on.

I’ve come up with a list of new rules i need to follow. I’m one of those people who likes rules. I like these little self-imposed commands that seem to represent some ethic or moral that goes with the conduct of each shift. I’m better at obeying some more than others.

– Be thorough in all aspects of history, examination, notation, treatment and disposal [though this would be supposed to be elementary, the temptation to be slack is constant…]

– Work slower [I work manically and far too quickly, i see a lot of patients. I’m not convinced this is a good thing]

– Fight for the patient [in the sense of annoying and if necessary pissing off other doctors if it’s in the patients interest – how not to make friends or influence them…]

– Always go and see the patient you’re asked about [when you’ve been woken at 4am for advice over the phone, you will almost inevitably say something stupid]

– Pee [15 hour shifts no problem…]

– Eat [easy to forget]

– Do not be afraid to follow up patients on the phone

– Keep a list of all the interesting patients

– Copy x-rays/CTs/ECGs [useful for teaching and remembering the interesting ones]

– Remember dual pathology on X-rays [just cause you’ve seen the broken clavicle on the x-ray doesn’t mean that’s the only break]

– Think laterally, always reconsider the differential despite what may seem obvious [just because the patient, GP and nursing staff are telling you they have appendicitis, does not always mean they have appendicitis]

– Ignore any pressure that is not in the patient’s best interests [4 hour target nonsense etc…]

All very noble and honourable ideals. We’ll see how long it lasts.

Here comes the anxiety

I have come home to roost. Back to the world of emergency medicine and waitng times and drunks and crazys and the worried well. With the odd bit of emergency medicine thrown in for good measure.

I love working there. I’m not entirely sure why when I think about it but I do. I tend to work late evening shifts and come home with my head buzzing from all the different patients and spend ages searching uptodate for better diagnoses than I could come up with. And going through all the resuscitations in depth, like little movies on repeat, with all the different things I could’ve done highlighted.

I’ve been doing lots of studying of late and realising that perhaps ignorance was bliss. When my medical knowledge was particularly limited then I had less to worry about. Now that I know a few things, I have a better idea of what can go wrong.

Don’t worry, honestly. I can do all that for you…

Fat Freddy’s Drop

Footy tournaments are wonderful distraction therapy. Watching terrible games twice a day, just in case you miss a cracker (yes I missed Holland-Italy…).

Though in work this has the added advantage of giving me something to do while waiting for the “magic cream” to cook on the kiddies.

Your child, safe in my…oops I dropped him…

Better do Better

epa0966l.jpgI’ve got myself all worked up now into an angry irate blog against the NHS. Well maybe not against the NHS, more of a passionate defence of what we hold dear.

Since arriving back (I’m thinking of dividing my life into BNZ – Before New Zealand and ANZ – After New Zealand) I have become increasingly frustrated with my beloved hospital. Though I suspect none of this is peculiar to me alone.

To be perfectly frank I think all the poor dying, sick people we’re meant to care for are getting a pretty raw deal. I think all the poor kids pulled from car wrecks are getting a raw deal, all the wee grannies dumped to our care get a rough time of it. Even the kiddies, the babies, and the mums are getting a raw deal. Health service has a kind of hollow ring to it.

Now this is of course not universal, lots of people get a great deal from the NHS and will tell of wonderful experiences. But then that’s the whole point – we’re not succeeding on a universal level, we’re  not even succeeding on a passable level.

Basic principles of medicine (these are more mine than Hippocrates, thought up while waiting for the pizza on a Friday night) could go as follows:

1) relieve suffering – because we’re generally crap at actually fixing things. People die, we’re crap at stopping that. We can make the process of human existence slightly more palatable. This is a long way from euthanasia.

2) we occasionally fix people – see note above.

3) deal with people with grace and dignity and kindness

4) understand something of what it means to be in their shoes.

5) ensure patient safety – in other words that it should be the disease that kills the patient, not us.

And we’re not doing great, we’re working in a system, that’s akin to a recently departed horse getting the beating of it’s life.

The NHS is full of people who hate their jobs, at least that’s how they talk. At tea breaks, all people do is complain about how busy their department, how they’re pushed to breaking point, how they’re frustrated with their jobs, their wards and their patients. Everyone sounds like they’re one crisis away from quitting.

I feel sorry for the students, the guys coming through in every discipline. They’re exposed to nothing but stress, pressure and frustration with a system that seems to have no answer.

The depressing tea break conversation is coming from smart, committed, dedicated people. With a desire to do the job right, but seeing no way to do it in the system they’re in.

I love my job, I believe I’m the luckiest guy in the world to have it. I feel it’s nothing but an honour and a privilege to be a part of people’s lives at some of their most significant moments. It kills me to see those around me struggling to feel anything positive about the place. It pisses me off to see patients getting treated like shit all the time.

They get sorted eventually, but they get neither the time, respect nor treatment they deserve.

The NHS will continue to survive on people busting their ass for their patients. But simply surviving doesn’t really count for much.

The dear, brilliant, hard working people (though not everyone in the NHS is up for a sainthood, there’s lazy gits here too) I work with will continue to work in a system that is being continually squeezed in successive efficiency drives to meet targets to fulfill a politicians mandate. No one ever stopped to think whether an efficient NHS is good for the patient. Maybe a hospital works better (for the patient) at 80% capacity (though clearly less efficient)

But anyway, I’m not going anywhere (what else would I do), I continue to love the job, we’ll all keep trucking along to a mediocre standard till a few more people die unneccessairily, and a few thousand more get sub-standard treatment and maybe we’ll start thinking about properly funding the place…

Proudest Monkey

Night shifts are quite good for snatching a wee moment, a wee moment of clarity when the whole ward’s asleep, when you’re dandering the corridors on your tod (whatever that means) and the whole world may as well be empty. Those moments when you remember something you just said or did, and you realise – “you know what – you can be a real asshole sometimes.”

Yes, this will be one of those rather self-depricating blogs.

My biggest problem with work (and I suppose with life in general) is my pride and my arrogance. A little green monster inside me that has proclaimed the greatest hot-shit medic to grace the corridor of Craigavon (or indeed Hawke’s Bay) hospital. That I can do it all, and that I know it all.

Work brings out many positive and good and healthy things in me. It also gives me almost unlimited license to indulge my own ego. The struggle is to magnify the former and flee from the latter. I’m pretty sure I am actually quite good at my job, just not as good as I think I am. I suspect no one is as good as I think I am.

I’ll be your baby tonight

baby.jpgAt 4.45 am on Sunday morning I’m sitting in a back room on the ward, fiddling with songs on Logic Pro, buzzing from too much coffee and waiting for the bleep to go off.

Yet it doesn’t. I kind of like this job. I’ve had two very civilized nights so far. I’m most impressed.

I am now back in the world of full time employment. And while I’m in no way busting a gut, I do at least have to turn up every day as opposed to when I want to like my recent locums.

I am also now a little person doctor (which is different from being a little doctor…). Smaller, sightly less hairy versions of the homo sapiens I’m more accustomed to dealing with.

This has advantages and disadvantages. There is a distinct lack of drunken violence and suicidal ideation. This is what I would normally spend my Saturday nights in work dealing with. I suppose I consider this an advantage.

Of course being smaller, it means the veins are a tad harder to hit. So I have to use the wee tiny needles all the time and try to maintain an even steadier hand than usual – which the coffee earlier on wasn’t helping. I suppose this would be a disadvantage but I kind of like the challenge.

The neonates (ie newborns) are the biggest novelty to me. They are, completely and unsurprisingly – tiny. With tiny hands, and tiny feet and tiny toes and tiny noses. I know this sounds elementary but they are especially cute and I get to play with them as part of my job.

One of my jobs is to do routine ‘baby checks’, screening for heart conditions, hip problems and cataracts mostly. Mainly it’s a simple head to toe and a “your baby’s normal” and onto the next one. The idea of assessing normality needs a completely different mindset from that which I’ve practiced for the last three years – ie that most patients I saw would be at immediate risk of serious illness and possibly death (whether they were or not I was to presume the worst and hope for the best).

The concept of normality and routine health checks are a tad foreign to me. I’ve surprised myself at how much I’ve actually enjoyed it.

Though the wee buggers do try to piss or vomit on you when you’re examining them, especially the boys with their multi-directional apparatus. Surprising the height of the fountain a 36 hour old can generate. I had one this morning who was doing his very best to pee in my eye while I checked the pulses in his legs. It kind of backfired and and he ended up peeing in his own face. Is it wrong to feel smug bout getting one over on someone barely a day old?

When you realize how much can possibly go wrong with the process then the fact that any of us make it (never mind how many of us make it in perfect normality and working order) at all is stunning.

Neonates are a bundle of peeing, pooing crying reflexes that somehow end up with personalities we come to love and hate and people who learn to be happy and sad and bring joy and pain into the world.

The whole concept of human development from embryo to person is simply mind boggling and a beautiful process. Though I admit it tends to take a bit of a downturn once we learn to talk and think and invade Poland the like

Not that I don’t think it’s good we move on from being bundles of pissing, pooing, crying reflexes (with such cute little noses…)  it’s just that it all seems to get a lot more messy, and I’m not talking of poo or pee…

Did ye get healed?

Today was one of those nice days in work. Normal hours for starters. So much nicer to start and end work when most of the people you know do as well. This is a rarity but all the nicer because of it. You get civilised things like lunch and even a coffee break. I was wearing my navy scrubs. I like them better than my blue ones, better pockets.

T’was also a nice day cause I only had a very few patients who I didn’t know what was wrong with them. Being bewildered in diagnosis is an all too frequent problem. The human body plays up in so many spectacularly different ways that it’s hard to get on top of them all. Telling people what’s not wrong with them is much easier than telling people what is wrong with them.

It’s (relatively) easy to spot big things, like broken legs and heart attacks but what about all those niggly pains that don’t really seem to fit into any diagnostic category. Something is causing it (something is always causing it), it may not be serious but something is definitely causing it.

It didn’t used to annoy me. As long as I could rule out the big things then I wouldn’t concern myself over the ‘minutiae’ of diagnosis. But (sigh…) no longer, as I slowly mature from baby doc to toddler doc, I’ve developed this annoying desire to actually know what’s wrong and how to fix it. This leads to many a night, reading medical books at 2am trying to work things out.

But anyhow, I will endeavour to remain positive on todays events. Along with generally knowing what was wrong with the patients I even got to do some wonderful hands on stuff like slicing open juicy abscesses and squeezing out the pus. If you tihnk I’m mad then that’s OK, I see the pus squeezing as therapy…

Indeed I even got to do one of my favorite things – sticking needles in people’s backs. Now back in the old days (I mean when I lived in NZ), I got to lots of this, central lines, chest drains, LPs, if you could stick a needle or a tube in it then I was your man.

I miss the needlework (not the cross stitch kind…). I miss the ligamentum flavum and the little give when you get into the epidural space (however rarely I felt it…), I miss the joy of the flashback of CSF, the quiet smug satisfaction of getting a needle tip into a tiny space. Ahhh. Good times.

I think I’m a frustrated surgeon at heart.

And remember… your life safe in my hands…

[Yes it’s late and I’m tired…]

Long Time Coming

Walking home in the fog and on the ice tonight I thought again about how long it’s been since I wrote anything. And i got all nostalgic about a month ago and thought “you know I should write something when I get home”. And so I am.

I’ve been so used to having lots of time and stuff to write about that being on the blog was a normal routine part of my life, like my room or work or the Volvo. I’ve come to miss the blog, even though it’s only been two weeks.

Obviously the sheer volume of comment and mail I’ve been getting demanding more blogs has also prompted me somewhat.

img_2282.jpg

img_01212.jpgI (and a large part of the Portadown massive – well 10 or so…) spent new years in a wee cottage in Donegal, staying up till 5am watching Die Hard and prolnged games of Trivial Pursuit. It was of course simply wonderful. My desire, some would say itch, for travelling has left me. I have no desire left in me to see many of the great sights of the world. I have a desire to go and live and work overseas, but mere travel seems unattractive to me now. My current ambition is Donegal for a few days with a fire and a few books. Weird.img_2277.jpg

And though I meant to I never really go round to a proper Dongal blog and now it seems a bit distant.

I have upped my intense work schedule to 3 days a week in the past month, and though this seems kind of minuscule it has really seemed quite busy to me. My main problem with work is that it leaves me sleepless. I generally get home late, with my mind buzzing, clearly set for “thinking” mode and not “sleeping mode”. There have been a number of 3ams seen as I run through resuscitations in my head and look up rare syndromes on UpToDate on my phone.

Work itself is generally 8 or 9 hrs of not sitting, eating or peeing while I run around like a mad eejit, my head stressing and buzzing. And the weird thing is I love it. I love the stress and I love the buzz. Will be the end of me no doubt.

Outside of work I’ve spent hours with the headphones on fiddling with GarageBand, recording and mixing a few songs for a mate. They’re really good songs, which is nice for a change from playing with the miserabilist dirges I tend to write. I have vague notions towards doing more music stuff, but it would mean selling a kidney (or even my soul…) and buying Logic Pro and a MacBook Pro and getting all excited about compressors. I’d love to be that person, just not quite sure whether I should.

My reading has gone to pot, somehow just not getting the time to wade through books the way I used to. All these darn people getting in the way.

I have a job interview next week. For a proper job, instead of my current Mickey-Mouse (but wonderful) current position of “work when I want”. I’m not sure I want a proper job.

That about brings us up to date. Not sure you missed out on much really.

Never leave a job half done

I applied for a job yesterday. One I’m feeling rather less confident than usual that I’ll get, and one that I’m not entirely sure I want. I feel confident the interview panel will not be reading of my doubts regarding the position.

My job is largely delaying the inevitable – keeping the old ticker ticking along, maintaining the vitality of the vital signs and endeavouring to maintain oxidative metabolism at the cellular level. Eventually this all stops, this is pretty much universal. And personally I know I’ll look back and see it as no bad thing. I’m keenly awaiting Human Mk II – to see if they get round to fixing the current bugs (total system failure, usually occurring between year 0 and 100) and possibly reconsidering the idea of putting the reproductive and waste disposal systems so close together.

No doubt they’ll just make the bum a bit curvier, add a spoiler and double the price…

Occasionally I am lucky enough to be involved in actually improving someone’s quality of life or return them after their brief tango with the grim reaper to a relatively normal (and more importantly dignified, satisfied and even enjoyable) level of function. An awful lot of us do seem to enjoy being alive, no matter how much we complain about the weather or X-Factor.

Since qualifying I’ve largely been soothing my ego running around resuscitation rooms wearing scrubs and shouting STAT and such. Well not really but I do tend to slip into the adrenaline junkie type of doctor (you could actually try being a literal adrenaline junkie and see how long you last – heroin is much more of a long term career move…) Medicine is both good and bad for me. It does indeed feed my ego. It also gives me opportunities to practise (definitely practise!) such good old fashioned concepts as humanity, compassion and a job done well for the sake of it being well done. I have a complex relationship with my work, it’s not the work’s fault, I manage to form complex relationships with everything.

Since Da got sick I’ve not been working and have filled my time with writing meandering self-deprecating blogs and and even the odd depressing fairy tale. Throw in a very occasional shift as a locum in A&E and a couple of hours cutting up dead bodies and it seems my week is filled.

I’m fairly under confident about the job, seeing as it specifies experience in a speciality I have no experience in. It also states that the successful applicant will have (I’ve never understood the use of the future tense in job applications) a firm commitment to a career in such and such a speciality. Which I also don’t have.

In my favour, I am the only doctor I know personally who is currently unemployed (I’m sure there are others floating about somewhere given last years fiasco) and as a result am immediately available whereas everyone else will have to wait another 2 months to get out of their contracts.

What worries me is not so much not getting the job but what if I do actually get it? It’ll mean getting up every morning (though to be fair I’m up at 0730 most days), only getting 3 cups of coffee in a day, having to stop cutting up dead bodies and start piecing together live ones, having to wear a shirt and tie to work (possibly one of the most daunting prospects), not having time for people and receding into my little self protective shell which I seem to have been coming out of of late, because of boredom if nothing else.

If nothing else it might save you from quite so much poetic disintegrated psychobablehicoughup that makes fascinating reading as my former boss described what I write.

Homeward bound

The ferry back to the north island is again, a spectacular experience. As cold as it is, we still brave it just to stand and marvel at Marlborough Sounds and the blueness of the water and the brightness of the sun. We attempt the old ‘arms length group photo’ for a while in the hope that someone will come and offer to take one. We’ve been at so long that it’s getting a bit silly before a kindly American lady offers to do the needful.

People are nice. Exceptionally nice. I’ve said this before, but I’ve met fewer more congenial people. Even people working in petrol stations or supermarkets (the hive of the rude and ignorant), make the effort to wish you a good day or insult your national rugby team.

I tell them that they’ve got a good country and try not to mess it up too much the way we’ve done with ours. I worry one day that they’ll take this to heart and build a big wall round it to keep everyone else out.

By the time we get to Wellington it’s raining. Good to see it’s keeping to form. And we have  a lovely (if slightly chilly and damp) afternoon in Wellington, wandering the streets in search of a café called Fidel’s and second hand bookshops. I like Wellington now. Not that I didn’t before, just that I now realise that it’s the only place with decent bookshops and a music scene.

The next day I’m back in work and time shifts up a gear or two. I’m working long days and all of a sudden the boys are gone. Despite sitting up till 2am chatting they’re still gone too soon.

The worm hole

Time flies. Usually with the addition, ‘when you’re having fun’. I find it generally always flies. Maybe I’m always having fun. It was always more as a kid that I thought time dragged. Like in the back of a car travelling to Cork with the endless ‘are we there yet?’ I must have been (past tense naturally) an annoying wee twerp.

The worst job I ever worked in, not that there have been that many, was in a garlic bread factory. Not pleasant as you can imagine. It was just after I finished my A-levels and there were threats of laundry not being done and food not being served if I didn’t get off my bum. Kind of justified.

So I ended up in this place through the wonders of a recruitment agency. I had a glowing CV and I’m sure it was my beating heart and lack of criminal record that landed me the job. And there was me naively thinking they might take brain surgeons just after their A-levels.

The place sucked. It was a noisy, conveyor belt thing, where little slices of frozen garlic bread came through a window from some other room (in fact I never found out where they came from, maybe they just appeared in the room through some worm-hole from another, more galricky universe, I doubt it though…) and my task was to put 5 (not 6 mind you) slices in a little plastic tray before it entered from cellophane wrapping machine.

I remember the same summer one of my mates, who worked in Moy Park, told me that he’d seen a guy lose a finger in one of their machines. I felt bad for the guy’s finger, but worse for the fact that I didn’t have any cool stories to tell. Except that guy who fell in the worm-hole but no one believed me…

You had to wear lovely white overalls, a hair net and lovely shiny gloves that didn’t fit. It was freezing so generally you had to wear a few layers even under the overalls. It was so noisy that you couldn’t even speak to folk beside you. Given the boredom of the job, a conversation would have been a pleasant way to pass the time.  But no joy, you could try shouting above the conveyor belt, but you would have to repeat yourself so many times that you’d lose concentration on your slices, and all of a sudden there’s be 7 slices in a tray and the cellophane machine would jam and then you’d have scary, facially challenged, Margaret (I’ve no idea if she was called Margaret, I had that little contact with her on a human level that she left no impact on my life) shouting at you.

At your precious, 15min break times, you’d sit alone in a changing room, eating garlic flavoured sandwhiches (everything tasted of garlic) while everyone else went to smoke in a dingy smoke room. Maybe that was the only way to get away from the smell of garlic.

After my first day, I knew things would have to change. I brought a book (Sophie’s World – brief, narritive history of philosophy, great book) of my brothers and sat in the car, eating my lunch and listening to the same Delirious tape over and over and again (King of fools incidentally, now always brings back bad memories. Unfortunate, not a bad album).

There’d be occasional brilliant moments when the supervisor would send you on some task, like to bring the pallet truck into the cold store. A job like that was a joy, freedom, in whatever limited capacity, for a few minutes. The coldness of the cold store would take your breath away. I would wonder how long I could stay there before anyone noticed, or indeed, before I would freeze to death. Guilt always got the better of me and i’d go back to the worm-hole.

I had planned to blog about how time has flown since I’ve arrived but I’ve digressed so far that it’s now quicker to go on than go back. Sorry. Though not sure what for.

Where the garlic bread thing leads is this. Because I was reading Sophie’s World, I would philosophise my time away between each break, musing over what I’d just read. Is the garlic bread really there, or is it all an illusion. Are these people a figment of my imagination. If a tree falls in a forest and no one hears it, does it make a noise? Real Phd type stuff.

But I got thinking about memory and came up with this – which would be worse:

a) to have to work a full 12 hr (6am to 6pm, that job sucked) shift packing garlic bread, and experience the fullness of the cold, garlic and boredom of it all BUT at the end of the shift the memory would be wiped from your head, as if the previous 12 hrs of your life did not exist.

b)To spend a day at home, doing lots of fun stuff, having a great time, getting paid for it BUT come 6pm to have 12 hrs of the full garlic bread experience implanted into your head as a memory.

I never decided either way. I edged towards b) cause I didn’t actually have any work to do in that one. But then in philosophy the answer is hardly the point. Kind of the whole problem with philosophy isn’t it.

Four weeks later I spilled my bottle of juice over Sophie’s World while I was eating my lunch in the car listening to ‘King or Cripple’ and that was the end of that. Well that and I quit work and spent the next week in the shower with various industrial agents (cleaning agents, not the ‘hi I’m agent Smith of the association of industrialists’ type agent) trying to get rid of the smell of garlic.

Playground politics

I have only vague memories of my first day at school. I remember being scared and not wanting to leave mum and I remember Anna Wilson’s bubble gum shoes – I have no idea why I must say. It wasn’t what I would call a significant event in the scheme of things.

I had my first day at work today. And I make the comparison to first day at school cause all the fears and insecurities I have about things like this (and many others) are garbled, grown-up versions of playground ‘politics’.

And no, I didn’t have my lunch money stolen, in school or today. Nor my head flushed down the toilet or even ‘wedgeed’ (tricky spelling, sorry).

But it’s the fear when you don’t know anyone, that no body will eat their lunch with you or share their toys. Which is why teachers make you share your toys with new kids. And yes, Jonny Lockhart I still remember (and harbour much bitterness) that mrs wallace made me share my lego with you in P2 simply because you were new.

And so I lay awake last night worrying about such things. Actually I didn’t lie awake all night at all, that such sounds dramatic but I did wake quite early and think that I should have worried about it.

The unknown can be daunting when you have to face up to it. Whereas the unknown from the far side of the world isn’t nearly as daunting cause you don’t have to practically deal with it.

I’ve only ever worked in one hospital, and that for 6 years in a row. So I knew everyone, I knew the way everything worked, I knew where to find the forms and how to work the phones – which is 90% of the work of a junior doc. As your man in Shawshank says, I was a man who knew how to get things. Some people may want to add a ‘wrong’ at the end of the previous sentence.

Like going from P7 to 1st year in junior high, I am no longer a big fish in a small pool. Or at least a pool where I knew where all the best algae was, and all the cool bridges to swim under were. Or something like that. Not good with those metaphor/similie thingys.

But sorry, this doesn’t really tell you anything of what happened. I turned up at 8am as requested and met Craig, the guy who organised the job and who i’ve been emailing for the past 4 months or something. Good lad. There was me and an english fella called Tafique starting on the same day, so we spent the first hour filling in various forms and signing various statements that will no doubt all come back to haunt me.

And then occupational health. Now they’re the folk who ensure you’ve not got some terrible contagious disease when you start work, and that you don’t give it to the patients. They’re also the same folk who advise you how not to catch some terrible contagious disease from the patients you’re supposed to treat.

This was more than the usual box-ticking session it usually is, I was swabbed, jabbed and prodded and probed to ensure I wasn’t smuggling so much as the common cold into the country.

MRSA, which I suspect you are all aware of, is much less of an issue here than it is back home. To the point that there was the ludicrous question on the occ. health questionnaire – have you ever come into contact with MRSA positve patients in your job. Those who work in the health service will realise that this is a ridiculous question as working with hospital patients is working with MRSA. Sorry that’s enough MRSA talk.

Had to listen to a crazy women telling me how not to poke needles into myself for 15mins. Though I thought this was all rather elementary and that if I stuck to the simple principle of not sticking needles in myself then I would probably be fine.

From there we had a wondeful computer training session. Which in most places is a 2 min chat on your password and not looking up porn on the net. But this was something else entirely.

In hawke’s bay (where I work, cool name eh?) they have tried to do what seems incredibly obvious to most people and computerise lots of the stuff. You would think this might simplify matters but the software itself is a mystery. Saving lives and raising the dead will be easy in comparison.

Got a brief tour of the hosptial from Craig. Confirming the fact that hospitals are the same the world over. That each ward needs a room to place the drugs, rooms for the patients, a room for paper work, a room for the linen and a room for all the poo-related issues. These rooms must be placed in no particular order and decorated in classic 19-whatever tat.

And it was then that I got scared. Not by the wards, but by all the people working there. Busy, focused-looking people who seemed to know where the forms where and how the phones worked. For all I knew they could have been doing the job for years. All I could see was them not understanding that I didn’t know how to page someone or get a CT done. I’m sure they’re all lovely folk really, folk generally are, but in my head I was going to be shown up as a big useless doc who couldn’t find a blood result.

And this is a fraction, a glimpse of the neurotic, self-consciousness that fills my waking hours every day. If it wasn’t for reason, common sense and a sense of humour i’d be a gonner.

And all of it was needless anyhow. The medical council of new zealand have decided they need to see me face to face to make sure i’m not the next Shipman (note to self – lose the beard) before they let me practice (got to love the truthful accuracy of the term) in NZ. Unfortunately they want to see me in Wellington (the city not the boots) which is a 7hr round trip from here. Not so good. I start work on wednesday instead now, if I can get rid of the beard and the criminal record that is.

But it’ll not be too bad. I like driving and NZ is a cool place to drive in. I bought a tool kit today (enough to build the next A-bomb, and all for 3quid), all men need tool kits. I took apart the CD player in the car, broke a few bits at the back, taped them back together with some medical tape stuck to my stethscope and managed to wire in a jack socket so I can plug in my MP3 player. There have been few things that have brought such a self-satisfied grin to my face since I arrived.


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July 2020
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