Wednesday, 17 November 2010

Of roles and expectations

I've just finished listening to another excellent episode of Pseudopod, a weekly podcast of horror short stories and this week's was particularly interesting for me. It focuses on a woman who comes to a village under the guise of helping when in fact she has a darker motive.

Alasdair, the host of the podcast, does a wonderful job (as always) of deconstructing the themes of the story. For anyone in healthcare they are juxtaposed between being an everyday part of the job and so very important that if you stop and think about it, our responsibilities are staggering.

The patient will see you as a caraciture
People put their lives in our hands and, more often than not, accept that whatever we do for them or ask them to do is in their best interests. When I push the drug trolley around people accept that because I am dressed like a nurse, seem quite comfortable and friendly, I must be giving them the right medication at the right time etc. etc.

Every nurse I know has made at least one drug error.

Every doctor I know has made at least one drug error/ misdiagnosis.

And yet they come to us. Because we look the part, because they believe in us, our uniforms, our stethescopes, our strange language. There is another component, I think. We have entered into a social contract. We have chosed our roles and promised to fulfull them to the best of our abilites. That, I would argue, is the reason people come to us.

It is both a privilege and a responsibility.

Runner's Hip


So nearly 4 weeks ago I was finishing up a 6 mile run and there was a sudden, sharp pain in superior lateral aspect of my thigh, which made walking so painful I figured I'd pushed myself a little too hard and I had a few days of hobbling.

Like I say, 4 weeks ago.

TFL to its friends
I carried on hobbling and stopped running and felt annoyed. It got slightly better after a couple of weeks, but one running session took me right back to square one. So, off I went to the GP, running through SOCRATES in my head:

S - Site - Superficial to the greater trochanter
O - Onset - 4 weeks ago
C - Characteristics - Hurts when I run, not much else
R - Radiation - Nope
A - Alleviation - Not running (!)
T - Timing - Uh, no
E - Exacerbating factors - Again, running/ not running
S - 2 normally, 8 running

My GP went through a range of motions with me, poked and prodded and said "You've damaged a muscle". Indeed. As it wasn't constant and didn't limit my range of motion, we could rule out any joint damage or ligament-related hilarity, thankfully. Nope, the culprit is Tensor fasciae latae. So now I'm taking a further 2 weeks off running and chowing down Naproxen 500mg BD in a bid to tell my body to calm the eff down with the immune response already. In general my GP was against the idea of running "Swimming, yes. Cycling, yes, Rowing, yes. Running? No, no, too much impact", but I think that was idealogical rather than lifestyle advice!

Tuesday, 9 November 2010

Creative Writing?

He lay in bed, staring at the ceiling and knew he had to go back to work.

It wasn't that his current life was easy or that he especially wanted to go back to the proving ground of the wards, but he knew that going back was important - both financially and because he felt himself getting soft.

As his wife lay with her head on his chest, gently twitching as her breathing became deeper and slower, he looked up at the ceiling, his eyes burning like coals. He ran through permutations, likely complications he had been schooled in: hyperkalemia, hyponatremia, common analgesics, IV fluid prescriptions, the contents of the drawers of the crash trolley, urine output, FBC, biochem, coag, CVC management, venepuncture - the list rolled on and on in his mind.

His wife moaned in her sleep and turned over, freeing his arm and allowing him to bring both hands across his chest. Still staring up at the ceiling in the dark of their bedroom, his mind wandered on. He knew that going back to the wards meant going back to the places where people went sick, where the job ground you down to a fine powder that could be, and often was, blown under the door at the end of a shift. MAU, HAU, Acute Elderly Care, Respiratory Medicine, these places wouldn't be easy and he would earn every penny, every shift.

He realised he hadn't exhaled for what felt like a lifetime. Lying there in the dark, he had held his breath as his mind raced and ran over the likely issues that would arise on a Saturday night shift on an elderly care ward. And he wasn't scared. He needed the money, he was good at the job and for better or for worse, he missed the satisfaction of handing over his patients at the end of the shift and feeling like he had done something useful with the last 12 hours of his life.

He knew it was time to go back.

Wednesday, 3 November 2010

One down, a few more to go

So last Friday was the first exam I have done in Med School. And it was "just" a formative. Being a formative is nice because it meant that we could use it as a way to test how appropriate our work in PBL has been.

Allow me to expand on this - PBL involves a lot of self-directed study and this provides an opportunity to decide how deep you want your own learning to go. This can go either way; you can study too little and not have the detail the exams expect you to have, or you can go too deep and learn way more than you need and consequently expend more time and effort than you need.

I felt the exam went okay. You never can tell before the results and I don't intend to jinx myself! It did demonstrate to me that although it was a formative and a learning experience, people were still quietly obsessing about doing well. The talk was all "I just want to pass", but I suspect otherwise.

Still we worked hard and then partied hard for Halloween. My costume was bloodied scrubs and a theate hat (the obvious choice?) and my drink of choice was Guiness until I was told it was time to go home. It felt very good to tie one on in a most cathartic way. And totally wasn't "using alcohol to relieve stress" like the questionnaires say ;)

Now we've moved on to the immune system and infectious disease which is pretty cool and definitely something I have more interest in than reproduction, so hopefully the revision for this bit will be easier!

Thursday, 14 October 2010

You are not a unique and beautiful snowflake

This is not you

Just a quickie, but I just thought I'd share an experience I had yesterday that has really helped me deal with the self-doubt and associated shit that this week has brought to the surface.

I have a very good friend with whom I go drinking and she has a good friend who has just taken his entry exams for the Royal College of Surgeons.

Apparently the night before his exams, he too was wracked with self-doubt, suggested it was all too much, how could a person remember all this, he should chuck it all in now etc. etc.

My friend, Hazel, opined that this was just how doctors (and by extension, med students) are, full of self-doubt, neurotic and constantly feeling overwhelmed by the volume of knowledge they are expected to have.

So, in one respect, yay! I'm not behaving in an abnormal way, my negative emotions are validated and guess what? It doesn't mean everything is doom and gloom, it's probably just a emotional survival strategy.

In another respect, boo! I am not a beautiful and unique snowflake and hey, guess what? My emotions really aren't anything special!

*sigh* I jest, I'm feeling a lot better and more capable. And maybe just a little bit apprehensive about the future ;)

Tuesday, 12 October 2010

Have you got what it takes?

So it feels like I need to work on my clinical self-confidence.

I'm finding the transition going from senior staff nurse to wet-behind-the-ears-med-student hard. It's hard going from being on top of your game, in a comfortable place - the go-to guy full of how-to and confidence - to being uncertain and feeling vulnerable. Before I started this course, I didn't realise how fragile my ego is.

It's compounded by being surrounded by a group who are effectively the top 10% of the class. Imagine the equivalent of a class filled with the girl who has a dozen different coloured highlighters and does extra reading for fun. I know I've earned my place here, but it doesn't make me feel any more comfortable. I know this is all in my head and I should just deal with it and crack on with the work...

It's pretty tragic that this is taking up so much of my run-time, as the course is full of work I need to do and is more than capable of giving me stuff to worry about. I think I just feel like the fact I'm an awkward nerd who tends to make friends on his own terms, is being thrown into sharp relief by the naturally gregarious and socially-engaged behaviours of med students in England. Why that is the norm, I don't know, but it's just helping me to relive a whole bunch of shit that I thought I'd dealt with in high school but apparently really haven't.

Good grief, this is a wee bit self-indulgent, isn't it? Hopefully telling the internet my deepest, darkest worries will help me get a handle on them. It would be really nice to be over all this kind of nonsense so I can really focus on worrying about how much I need to learn in four years!

Saturday, 9 October 2010

This medicine thing takes a lot of time

In space, no-one can hear you be a massive nerd
I can't believe it's taken this long to find the time to do another post. Even worse, I can't think of a cohesive topic for a Friday night, so I (and subsequently, you) will have to make do.

Here's some thoughts:

1) I'm pulling 8 hours a day, a couple of hours in the evening and I don't think this is going ever let up. I'm not complaining, just sayin' is all. I'm balancing it out by knowing that you have to make sacrifices to get what you want. And any time I feel I'm a bit stressed by it all, I watch a little Randy Pausch and get a bit of perspective and a renewed eagerness to work harder.

2) My uni seems to think that one lecture on pharmacology per quarter is acceptable, but we have 3 comms sessions a week. This is the kind of thing I'm just going to have to address with a "suck it up and walk it off" mentality. I can't change it - we've had an opportunity for feedback, but I don't feel like The Man really wants to address this kind of thing. Whatever, I'll play the game, pass the tests and try and do more individual learning to make up for this.

3) Channel 4 do a good line in getting Britons to show off their embarrassing bodies. (Apologies to people who 

4) This week was a good week. I felt like I was on top of things for the first time in a long while. With PBL it seems very easy to cover just the Learning Objectives your group agrees on and not go much deeper. Then you rock up to the next PBL session and realise that other people have pulled out the lead a bit more than you and have gone deeper. Then you feel stupid and lazy and it means you feel at a deficit for the next round.

This week, however, I went deep enough and really nailed the issues we discussed in group. I feel more comfortable with the menstrual cycle than I have done for aaaaages. I feel like learned a lot and had plenty of positive input in the group sessions. My group of friends is getting tighter, too, which is awesome. I'm hitting the gym with one of my PBL homies on a regular basis and really lifting weights, on top of my prep for the Hastings Half-Marathon - so that's all good.

5) I may have also reactivated my EveOnline account. I'm not going to apologise - I need to indulge my nerd a bit and if by playing at being a spaceman every now and then, so be it!

Monday, 27 September 2010

Another space filler

Urgh, I am having trouble finding the time for a proper post, but here's a little something for this evening: The Differential Diagnosis

There as many ways to do this as there diagnoses (PRO TIP: It's never Lupus, but it might be TB) but the one my PBL group has settled on for the next few weeks is the acronym, Investigations - a like so,

Idiopathic/ Iatrogenic
Neoplasm
Vascular
Endocrine
Structural/ Mechanical
Traumatic
Inflammatory
Genetic/ Congenital
Autoimmune
Toxic
Infective
Old age/ Degenerative
Nutritional
Spontaneous/ Social

And as for history taking, I'm yet to find a good one, so I just end up humming...

Sunday, 26 September 2010

Entertainment, journal style.

I have a proper post for this week, but I've just stumbled across A Good Poop and it reminded me that people write medical papers because sometimes life is just too bizarre.

It doesn't look like it's still being updated, but it does have a some intriguing papers and now I've got my BMA membership, I might well celebrate by hunting through the BMJ archives for more oddities...

Sunday, 19 September 2010

One thing I have in common with Don Draper

Last night was a night out at The Blues Kitchen in Camden which was pretty awesome. It's quite boutiquey and didn't get crazy busy which was nice. There was some great food, proper American Southern fare and some great drinks particularly the Old Fashioned that I spent most of the night drinking. And unsurprisingly the music was blues, which makes for good background noise when you're eating, drinking and chatting.

I'm quickly beginning to realise that this kind of thing will have to be a once in a blue moon event as I am now coming to the end of my last paycheque. From here on out it's student loans and whatever I can get from the occasional shift - although I'm still yet to actually get on the staff bank.

Saturday, 18 September 2010

The first of many

Another week down, first exam out of the way.

This week we covered a topic that I'm pretty familiar with, both from many years studying it and from having to care for patients who have had it. I hate being so cagey about the topic of the week, but our school teaches by PBL - problem-based learning and repeats the cases each year, so in the unlikely situation that someone from next year's group reads this they might get a feel for what cases they will see and I will get in trouble. Or something.

Gah.

Anyway, the PBL case was pretty cut and dried, compared to last week, so it was just a case of nose-to-book and sucking up as much information as possible. I think it's a little ironic that the course dresses up learning with so much back story, patient depth and the like, and it all just leads to going to the library and opening a book and IRL ctrl+c, crtrl+v. It's the self-directed aspect that I guess we do have the onus on us to work at learning, but still, I think my point stands.

Our exam this week was BSL (or CPR, depending on where you come from). It was a nice reminder for me that I still know it to a level considered competent. Inside a hospital CPR is a strange beast that doesn't involve "rescue breaths" and counting to 30 for the chest compressions, invariably because you're being led by an anaesthetist who is keeping track of everything for you. But for the sake of the exam I did my counting, I noted the lack of chest movement from Anatomical Annie and called for help in a suitably loud voice. I passed but was chastened for winking at the examiner on the way out. It wasn't a creepy finger-guns kind of wink, just a friendly gesture. The examiner didn't see it that way, but they didn't fail me either, so I'm not too bothered. Especially seeing as one of my course-mates failed AND got yellow-carded for swearing at the manikin.

And now the weekend, in which our intrepid hero tries to fix his bicycle so he can save a few pennies in train fare and lose a few pounds in excess body weight.

Sunday, 12 September 2010

That was the week that was

One week down, so very many more to go!

So it looks like my PBL case wasn't as straight-forward as it seemed - the presenting complaint didn't resolve into the most common differential diagnosis, but rather a <1% kind of thing. And at the end of the week we were treated to an expert forum with a specialist surgeon, to allow us to ask questions about aspects of the case we were not totally sorted with, only to have the surgeon say the diagnosis was "what you decided it was when you had ruled everything else out"!

To be honest, I'd suspected the straight-forward answer was unlikely to be it, if only because our learning around the topic is expanded 100% if we spend half the week chasing one diagnosis only to have it go lateral on us by thursday; leaving us to have to follow up on this new direction.

I've never worked this hard before, but it was fun and made the drink post-lectures on Friday night feel that bit more earned. However, on my walk home my iPhone made a brave leap for freedom and dashed itself on the pavement (this is my story and I'm sticking to it). This gave me ample opportunity to pick shards of glass out of my hand when I picked it up and admire the spiderweb pattern of cracks and fissures. Now the offending 'phone has an adhesive plastic cover on its back to cover the worst of the damage and a rubberised bumper around the edge; the net effect has converted a sleek piece of 21st century design into the cell phone Special Kid. It's not a great look, but it should avoid future damage.

I'm determined to keep as much of the weekend as I can for enjoying the company of my wife and my friends, a life away from medicine. Being suckers for a good film, we watched "The Crazies" last night and thoroughly enjoyed it - Timothy Olyphant does his best to survive escaping his midwest town after the populace go mental and start killing each other. Then this afternoon we went for dinner at Tortilla (easily the best Tex-Mex in London) and then went to see Inception at the BFI IMAX (allegedly the biggest screen in Britain, something I find easy to believe). Inception is a great, thoughtful, violent and engaging film that doesn't spoon feed you plot and expects you to keep up. The reward is another strong performance from Leonardo DiCaprio, incredible visuals (try and figure out what's CGI and what's just clever special effects) and a tight plot that keeps the pace up for the entirety of the film.

Oh, one last thing, a new resource I've just come across is http://www.keepingup.org/, a site dedicated to digesting the latest news in emergency medicine and putting out a weekly 25 minute podcast bringing you the more thought provoking stuff. This weeks was particularly relevant for me as they covered new research around the relative merits of chest compressions alone vs. standard CPR. It's free and a valuable learning resource, so it gets my vote.

Now a glass of whiskey, make my lunch for tomorrow and to bed.

Wednesday, 8 September 2010

Drinking from the fire hose of knowledge

So, Medical School.

It's been nearly two weeks since I got my ID card, locker and dissection room coat and I am so happy that I went down this particular trouser leg of time (sorry for borrowing your analogy, Mr Pratchett).

My course graduate-only and consequently it is a broad church; people from all walks of life (I'm not the only nurse!) and with lots of different reasons behind wanting to study medicine. I think for a lot of people it is a personal challenge, which is nice because I think it means they will be very engaged with the course.

The structure is very much oriented to Problem-Based Learning (PBL). We have a session for a few hours on a Monday morning where we are given our case, then we discuss the issues that arise from it and any learning objectives that we think are relevant to the case.

And then we turn on the fire hose.

I have never had such fun leafing through books in a library and learning. My knowledge-base from nursing has given me a bit of a leg up, I suspect, but this is just learning turned up to 11. I have spent every day this week buried in books and journal articles chasing learning objectives arising from the acute abdomen and I love it. And after the intro bumf of last week, it's nice to kick things into high gear and get learning.

Some of it however is covering old ground - a BLS session that I could have done with my eyes closed, even down to calling out "CAN I HAVE SOME HELP PLEASE?!" in a crowded room (something that always makes me feel stupid). But this is to be expected. One of the most exciting bits of the course for me is finding out where my knowledge ends and where the new material I am expected to learn begins.

The hospital my medical school is attached to has its own nursing bank so I have applied to work there, money being unsurprisingly tight and I want to keep my hand in, too. Nursing has given me a lot in terms of supporting knowledge for medical school and I hope it continues to do so for the next few years. As part of the application process I had to take an entrance exam - drug calculations and a scenario-based "answer of best fit" MCQ section. Happily I scored 100% on it, so I guess I've not got that rusty in the past couple of months I've been off work.

Perhaps the most surprising discovery for me is that I think I have found the soundtrack to my independent study - Trance. I am an indie kid at heart and wouldn't have listened to dance music if you paid me previous to this, but trance is the music I can study to surprisingly well. And it means if I get bored in the library I can, quite legitimately, start throwing shapes in the church of dance. Or something.

Tuesday, 10 August 2010

Transitions

An excellent and thought-provoking article on the Student BMJ detailing one nurse's experience of becoming a doctor and returning to her department with different workload and demands:

CCU sister to CCU junior doctor

I hope I keep writing long enough to produce something for a journal like the Student BMJ.

Monday, 9 August 2010

Show me where it hurts

"Doctor! Doctor!"

I sigh and without even turning 'round say loudly "I'm a nurse"

"Oh! Right! 'Course you are! Well, I mean, I'm in pain, is there anything I can have? I mean, doctors wouldn't know about that, would they?"

Charleen's unintentional Uriah Heep impression doesn't warm the cockles of my heart. She came to us ?Pancreatitis ?EtOH abuse, known ex-IVDU. Now I am not the kind to refuse analgesia to anyone - pain is pain, you can't judge another person's pain, period - but there is something frankly funny about someone who can sleep all morning after their a.m. methadone and then be unfortunate enough to wake with "terrible pain" in their abdomen and an accompanying limp that seems to have manifest itself. Luckily for Charleen, she IS able to have some Oxynorm. It is as much as I can do, not to roll my eyes to show my lack of surprise.

As I say, pain is pain. I do not tarry to get someone pain-killers, even the more suspect actors amongst our current crop of patients. I do, however, find it rather tiring when people make these grandiose shows of how they are in pain and can't I do something, please, and oh it must have been 2 hours/ 4 hours/ 6 hours since their last dose of oxynorm/ morphine/ diamorphine etc. etc. Just tell me you're in pain. We both know that you've been watching the clock, that you know *exactly* when your last dose was and, yes, that paracetamol will in no way improve the terrible and sudden pain you are in.

Pain is, as my lecturers might have said, a vital sign and the symptoms of which vary from person to person, aetiology to aetiology. Maybe you really are in pain, maybe that potent opioid is just a bit moreish, honestly, I don't care if it's the latter. It just means that I have to go hunt down the CD key, another RN and interrupt whatever it is that I'm doing, so you may have to wait a bit.

I don't want to come across as some cold-hearted bastard, I do really have a personal interest in pain - if I'd stayed in nursing it would be something I could see myself specialising in. Junior doctors don't really understand how to prescribe analgesia in my experience and more often than not don't understand that morphine is not going to solve all kinds of pain - and isn't without its side-effects. This often leads to people being left in pain, whilst I apologise profusely and bleep the doctor to get something more written up. I'd ask of all doctors, when writing the drug chart up, if you can please give me some diclofenac or codeine or dihydrocodeine or tramadol on the prn side, if only so I don't have to see one of my patients in pain and me helpless to do anything about it. I know that some people are not suitable candidates for more potent pain-killers (liver damage, head trauma, renal insufficiency, whatever) but that doesn't mean they have to run the risk of being left in pain.

 I hope I remember all this in years to come, if only so I don't (as has happened to me in the past) shuffle up to an RN and ask, plaintively, how tramadol should be prescribed.

Friday, 6 August 2010

Hobbyist Nursing

"Just when I thought I was out... they pull me back in." - Michael Corleone (Godfather III)


"Oh hey, you're back so soon?"
"Wow, guess you just couldn't stay away, huh?"


The 'phone rang at 7 o'clock, the number said "Blocked" and I knew it was the hospital. I'd been umming and ahhhing over booking a couple of shifts with NHS Professionals next week to get a bit of cash and to keep my hand in, but this was a pleasant(ish), surprise. One of my colleagues apologised for waking me and wondered if I could come in. I stared at the ceiling, counted to 3 and said "yes". Time enough to brush my teeth, grab a clean uniform, pack up my lunch and kiss my wife goodbye. She sensibly muttered something about "having fun" and went back to sleep. I ran to the bus.


Coming back to work felt nice. I'd been getting a little misty eye'd about nursing watching Nurse Jackie and it was great to take handover, plan my immediate to-do's and then start the drug round. I really enjoy going through the obs, the drain charts, looking the patient in the eye, saying "Good morning, my name is AbsentBabinski and I'll be looking after you today". Generally they smile back and say good morning and you get a sense of them.


My heaviest patient was a guy who had suffered a stroke intra-operatively and had been left with reduced strength throughout. I helped him with breakfast and it was nice to be doing this for another person, the simple, important stuff. I guess I'd forgotten in the run up to med school how satisfying and intimate this kind of thing is. We chatted as I spooned up porridge and I then I gave him a wash. My lecturers at nursing school had always waxed lyrical about how we were so lucky to be involved in such intimate aspects of care; I had always proposed the notion that they *really* needed to get back on the wards and find out how things worked. I'm not saying that I totally agree with them now, but pulling bank shifts, it feels like a lot of the pressure is gone and I can practice my nursing care in a different way. I feel like I'm doing it as a hobby which means I can take things to a level of detail that perhaps I couldn't when I was ward staff and dealing with the crap that goes with it.


And it was nice to see everyone again, see one of our junior staff take a shift in charge and, frankly, do okay at it. Probably better than my first time in charge!


THIS JUST IN: My med school have *finally* confirmed my place for this year. After so much jumping through hoops and form filling, I got an email from UCAS today saying the uni have confirmed my place, so watch this space!

Wednesday, 4 August 2010

My new Favourite Thing

I know I'm late to the party with this one, but I've finally started watching Nurse Jackie and I think it's wonderful.

If you suspend your disbelief about a few issues (certainly somethings would be impossible in the UK and they seem like the kinds of things that would be impossible in the US), it's a well-written and touching show. It's bleak, with dark comedy and a troubled protagonist. The titular Nurse Jackie is an RN with a drug problem, two men on the go (one is her husband, with whom she has two children) and dopey - if well-intentioned - student nurse in tow.

The  show really picks up on a lot of things, such as the peculiarities of the relationship between doctors and nurses, the way that nurses are important for making people "better" in a more complete way than the doctors, how shift work can make your real life seem like just something that happens when you're not at work and how you can't save them all.

If you've worked as an RN, you'll feel well represented here, and probably enjoy the dark humour that drives so much of this show. I certainly do.

Monday, 2 August 2010

Getting things done

If you are anything like me you can't remember any of the long list of the real life tasks that mount up when you're not in the hospital trying to remember any of the long list of demands that nursing/ medicine/ general serfdom generates.

To this extent I have spent the last year working with Remember the Milk to try and stay on top of things. It's a nice, spartan set-up with a decent enough iPhone app (yes I have an iPhone, no it is never more than 10 feet from me at any point in the day). It can be a little less than intuitive at times, but rarely is it difficult to use. The only real down side is the cost - $25 (convert that as you please) for a year's subscription. But that is only for a "Pro" account - mainly the reason I have one is for the iPhone app.

I realised I needed a system when I found myself using backs of envelopes to organise my life and when I lost one, I'd lose my plan for the week with inevitable consequences.

I'd also point you in the direction of Merlin Mann, a Californian who makes a living from telling businesses how to get things done better. He's not your usual cheap suit, bad tan, bright smile BS seller. And he does the very (occasionally painfully so) funny podcast You Look Nice Today, a self-proclaimed journal of emotional hygiene.

Statement of Intent

I was, until last Friday, a promising Staff Nurse at a London hospital. Now I am a promising Staff Nurse on Annual Leave and soon to be starting medical school.

Nursing is something I enjoyed and something I was good at. Presumably, I am still good at it - I don't imagine my skills have dropped that dramatically over a weekend (although my leaving do did kill a few brain cells). It was a rare opportunity to do a job that provided a great sense of achievement by just doing my job. You help people get better, you make a positive difference in their lives and you do something for them that they can't do for themselves. And you get paid pretty well for your time.

By no means is it the magical, beautiful, most wonderful experience in the world my lecturers tried to make me see it as, it has its own bug bears and BS. But leaving it to pursue medicine is something I decided to do with a heavy heart, it meant leaving a family and institution that I had come to know and (occasionally) love. I had to do it, though. I was faced with the choice between nursing for the rest of my working days or taking the plunge and finding out if I could succeed in a field that just fascinated me. I would lie in bed staring at the ceiling, wanting my chance to show I could be a doctor. My time as a nurse made me realise that (in the UK at least) so many of the nursing pathways of care would end with "and then I call the doctor" and that wasn't enough for me. Yes, I know that there are all kinds of roles that extend nursing into the junior doctor's role, but that wasn't what I wanted  - and that too would end with handing the job over to someone else when it got interesting. Medicine for me is the other part of the equation that gives you the answer of how people get better and it is something I hope to be good at.

I know that there are people who will understand why I wanted to make the shift as much as there are people who will never understand why I did, why nursing "wasn't enough" for me. This first post isn't an attempt to apologise for my choice. It was mine to make and I made it. This first post is a statement of intent:

- I will blog the things that stand out in my experiences
- I will use this as an opportunity for reflection when things go wrong
- I will try and make you laugh, cry and sigh with the stuff that I see and do
- I will not forget my nursing training or how important nurses and their knowledge are
- I will not break confidentiality (duh)
- I will occasionally, in times of whimsey, blog about past nursing experiences (It's my blog, so nyah)

And finally, I will go to bed at a reasonable time. Ooops.