Working as a middle-grade

The last fortnight has got me into the middle-grade rota, and I am learning so many new things. The most important thing, though, is the realisation that I am now responsible for all the patients everywhere in the department when I am on night duties or on long weekends and that the consultant may not be present on site. It is also humbling to know that the SHOs, who were, until the middle of February 2018, my "colleagues", are now, sort of, "under me", and come up to me to take the responsibility off their shoulders and leave it to me to make decisions. To be honest, some of them have been beacons of information that have helped me take cogent and medically sound decisions. So, a humble thanks to all my colleagues, young and old, junior and senior.

Coming to the actual decision-making process, it can either be a trifling matter and something quite easy to decide on, or can cause me to give it a lot of thought before answering! The matter, in itself, could still be a minor one, but the fact that what I say will be the final word can be quite a stressful thing to digest.

I am sure that with the passage of time, I will learn to take these kinds of things in stride. It's just that, with the new responsibility of managing these things day in and day out, I sometimes do get worried as to whether I took the right decision or not.

It helps that the new band of registrars who have come in since the end of the first week of March 2018 are a bright lot and very supportive. I may as well add that the consultants themselves are kind too. This was especially apparent during the first tranche of night duties  that I did the previous weekend. It has helped that my line-manager is the head of Paediatric services too, and he has been keeping a benevolent eye on me.

In the end, I must say that this is a new area of the vast sea of experience that I am sailing in, and I know that if I keep my eye steady and my sails in the right direction, I should be able to sail smoothly and with the least possible difficulty. I request my readers to write in what they feel about this in the comments section. Thank you.

Back in Blackpool after a great holiday back in India

After spending a fortnight and a bit more, I reached Blackpool on the afternoon of the 6th of March 2018 and resumed work today, viz., on the seventh of the month. I have, as I stated in my previous post, been accepted as a registrar with a full rota. It was pleasant to hear this from my line manager when I went to meet him. Dr Curtis welcomed me back to the department and exhorted me to stay calm and perform well. I also had a chat with my educational supervisor, and this, too, was a meeting that put things in the right perspective.

Now, I am all agog and ready to meet the challenge head-on. Let us see what the future brings for me. That's it for now. 

Pausing for a breather. Then, moving on.

Returning to this blog after quite a pause. It has been a hectic month, what with planning for a vacation back in India in mid-February. I write this while counting down the hours left for my flight to India via Frankfurt on Lufthansa this time ... I hope to be amidst the living sometime in the early hours of the 17th  ... in Mumbai. 

Work-wise, a few great things happened, and a few things went wrong too. On the wrong side first: I participated in a course that goes beyond life-saving resuscitation of a newborn to learn advanced resuscitation techniques. For this course, I went to Manchester in end-January. The course turned out to be a little tough. However, it did help me to understand a lot of things and will make my treatment and management skills more accurate, specific and well-rounded. 

I went back to my educational supervisor and explained what had happened. I then offered to not be a full-rota registrar that I was slated to become from the 7th of the coming month. This is what then transpired. My supervisor had a lengthy chat with the departmental head and they agreed that it might be a good idea to let me work as a registrar on every occasion except on night calls since that is when there is no support for a registrar and they are pretty much alone with no consultant to cover.

However, here, then, follows the good news. Over the last fortnight, I have been closely scrutinised by the paediatric nurses and the consultants, and they must have felt that I am otherwise quite capable - so they put me back on the night as a registrar in the last two days. I performed quite well, and therefore, am hopeful that I may continue to be on a full rota once the 7th of March comes around. 

In other news, I did perform a few extra practical procedures on neonates and have now gained much more confidence that I can perform well even with this precious category of patients. 

Moving away from the professional to the more personal stuff: in preparation for the vacation that starts tonight, I have been on a buying spree on Amazon as well as offline to meet the demands of my women. I have ended up buying so much stuff! This includes frozen fruit, novelties, items specifically requested by my daughters, and so on. Valentine's day went by yesterday, and this, I believe, will be the best way to fill their hearts with my love for them!

And with these hopeful words, I will end this post. I hope you found it interesting. Thanks. 

UK Life, Two years on.

I completed two years of my work/stay in the UK on the 16th of November last year. Nearly two more months have elapsed. It is time to take stock of where I am, what I am doing, and what my future plans will likely be.

Let me begin with the good news. I am moving on to become a full registrar at Blackpool from coming March. The progress my consultants have seen in me and my work have finally convinced them that I am safe to be a full-time registrar and manage the department on my own. Thus, instead of working 40 hours per week, I will be on the full rota. This will mean that my locuming days will probably get reduced drastically. However, it will also mean that I WON'T need to work elsewhere, as my emergency hours work will get me extra income from within my own trust. 

This has been a very satisfying bit of news. I have the most extensive experience as a Paediatrician - even more in the number of years I have worked as a children's doctor than most of the consultants I am working under. However, thanks to my complete inexperience with the working requirements of the NHS, I was unable to inspire, so far, the confidence that I can manage patients on my own - until now. Come March, things will change, I hope.

How has life been? I could have had better life had I seized all the opportunities at my disposal and used them optimally. However, to be fair, I have tried to live a balanced life; this has meant that while I have worked very hard to earn the maximum possible money and experience, I have also enjoyed on those weekends when I haven't worked but roamed around the countryside, or within Blackpool, or even visited more distant landmarks within the country. The farthest I have ever been on my own is the Peak District National Park, the nearest, the Marton Mere Nature Reserve. I have undertaken many different railway-bus-car-on-foot journeys, some of which are definitely worth repeating.

I have taken up new hobbies such as learning to play the keyboard and learning how to colour pictures with a pencil colour set. I have persisted with my old hobbies such as cooking, travelling, birding and bird photography and a bit of writing and a lot of reading. 

The arrival of Sky TV/Telephone and Network changed a lot in my life. I now record a lot of programs, look up things I have missed and catch up with those, rewatch a few programs that I recorded earlier, and so on. I also purchased the mid-range New Amazon Echo, and with it, I am now able to listen to old, golden songs from the super singing sensations of the yesteryears, such as Mohammed Rafi, Kishore Kumar, Lata Mangeshikar, Asha Bhosale, and many others. 

In the UK, I have also made a lot of new friends. More about this in my next post. 

Thanks for reading. 

Dr Taher

An update

It has been a long time since I entered a post here. Just to update everyone, here is a simple synopsis of things that have happened in my life:
1. I rushed home to make peace with my dying mother in the third week of August.
2. I completed my first month in the new home
3. I went back to Mumbai on my planned fortnight-long holiday from the 17th of September to the 20th. In between, my mum passed away to meet her Maker.
4. Upon returning, within a week, I took my study break to visit the United States of America on my first ever visit. The purpose was to participate in the World Congress of Gastroenterology - where I was to mount, display and answer questions on my scientific poster at the Orange County Convention Center, West Concourse, in Florida, USA. I stayed in a budget hotel for 5 nights and used some of the free days to roam around and visit some of the major city-wide attractions, including Universal Studios and Seaworld.
5. Life has gone back to a relaxation mode and I have resumed my work in the hospital.

And that's pretty much it, insofar as a synopsis goes.  

Writing after a long time

It is true that I have been very busy the entire last month. Just last week, I had to rush home to India to help my family look after my mum who took suddenly and critically ill and was admitted to the ICU. She came down with sepsis secondary to infection in a bed-sore. With treatment, during the three or four days that I was there, she managed to pull out of the critical stage and has gradually improved over the last 10-12 days that have elapsed since. 

In other news, I am trying to get a visa to visit the U.S. to present a paper (a poster, actually) in Orlando, Florida, in mid-October. This would be at the World Congress of Gastroenterology. Towards this end, I went for an interview at the US Embassy in London. The interview went off well, I think, and I should be granted a visa to go there. 

Now, I am shifting to new rented premises outside the hospital. It's bye-bye to the rooms I resided in for the last over 20 months. It will be a bitter-sweet parting, as these 1 1/2 years have taught me a lot ... and not just about my work, but also about living alone in a developed country, where one can have anything one wants by ordering it online or buying it in a store. I have hoarded so much stuff that when the van-renter came to pick up my things to transport it to my new premises, he simply gawked and said he had never seen as much luggage with a bro! Well, my luggage was phenomenal in volume - stretching to over 300 kg by his estimate. It consisted of several cardboard boxes and literally dozens upon dozens of plastic bags. As I write this, I have shifted all my luggage to the new premises, but a lot is still to be unpacked and put away in its proper place. 

In the afternoon, I visited the Furniture shop of the British Heart Foundation and bought several used pieces of furniture that will be delivered to my new place tomorrow. These include a dining table, two chairs, a glass display case, a computer table, and several other smaller items. Once they are all set-up, I should be ready to live in my new place.

So, where is it? It is a mere 5 minutes' walk away from the hospital in what is known as Victoria Mansions. Hopefully, I will complete my move within the next 36 hours. HERE is a map showing my new place. It is only 300 meters away from my current location (and the hospital) as the crow flies, but translates to about half a km if you follow the roads.

In quite other news, I went to the Blackpool Livewire 2017 event at the Promenade yesterday. The event organisers had offered free passes to the concert as well as to the after-dinner party for the first two days of the event, viz. on Friday and Saturday. I had requested passes for two people only for the Saturday, and the passes were waiting for me in my inbox when I returned from India. They had upgraded my pass to a VIP pass. This pass enabled me to access the VIP area on the promenade. This was an elevated shamiana facing the large stage where singers and performers came, traipsing in a line, to entertain the crowds. 

Is anything else happening? Yes. I did a few registrar locums now. One was at Whiston last month and the second was just a few nights ago at Oldham. Both of them were in Paediatrics and I guess they went reasonably well. 

At my own trust, I am now a person that is increasingly entrusted with tasks done by middle-grade doctors, and I guess my progression is just about at par with my expectations. I should be looking at better prospects once my current tenure expires in February 2018. Whether it will mean a proper middle-grade job in Blackpool, or whether I will have to look elsewhere, I do not know. We will have to wait and see. 

And that brings me to the end of the post. Do let me know your reactions to this post and comment on what you think. Thank you.

Working Registrar shifts this weekend

Yes, that happened this weekend. I had originally a 2-day off, but I had booked a locum shift in Bolton NHS hospital in Neonates. I received a request to work as a registrar within my own trust as they had no one to cover the shifts. I agreed and worked these two days with Dr. Mohammed Ahmed as my consultant. I think it went well. 

The result of my accepting these two shifts will, of course, be good for my wallet, as I will get paid for them. For my work-life balance, though, these two shifts were poorly placed. In fact, I have been doing continuous duties from the 10th of this month. In the week from last Monday to this Sunday, I did nearly 80 hours of work! That is at least 11 hours per day! I feel fatigued. 

However, professionally speaking, the two duties I did will count towards improving my confidence of working as a middle-grade doctor, so I have no regrets. All credit to my head of the department for allowing me this as it is only thanks to him and his other colleagues that I was allowed to work in the capacity of a registrar. 

The best thing about working as a middle grade, though, was the fact that I was working with my own colleagues who were filling in as SHOs while I worked as a middle grade. Their inputs were precious and very useful in making my job look much easier than it probably is. It also helped that the nursing staff was very supportive. There were a few quibbles with my writing down the doses that they thought were "unconventional", but Dr. Ahmed was supportive and helped clear such hurdles.

All in all - a very good pair of days indeed. 

Thank you for reading!

Weekend update

I have been quite irregular of late - in updating this blog. My apologies to the regular readers. If you are stumbling upon this blog for the first time, welcome. I am an Indian-origin Paediatrician who writes about his life in the U.K. here. My name is Taher. It has been over 18 months since I moved to Blackpool. This is a coastal vacation town on the Irish Sea coast and geographically belongs to North-West England, and to Cumbria, and even more specifically, to Lancashire. 

I am working as a junior doctor in the NHS-run Blackpool Victoria Hospital. I am gradually learning a lot of practical skills and am able to navigate the system almost 100% now. 

Last week, a few positive things happened. I inserted a peripheral long line into a newborn baby for the first time - and it was quite easy. I was supervised by the consultant who is in charge of neonatal services at our hospital, and who is also MY educational supervisor. The baby was the second of twins and was born, like his sibling, 9 weeks earlier than term. I had observed this procedure 2-3 times but had never done it myself. Hence, doing it accurately and correctly the first time was extremely satisfying. To understand what this procedure is all about, see THIS YT video. 

On Saturday and Sunday, I went to Whiston Hospital to do locum duties. They had arranged for my accommodation within the Neonatal unit by allocating to me one of the rooms reserved for relatives of babies who are admitted to the unit. Hence, it was a breeze to work. The Paediatric department of the hospital has two wards - one each on the third and the fourth floors. This can mean a bit of running around between two floors. Their A & E is located on the bottom floor, and one keeps getting called there to see new patients who have been referred to them through the G,P, or the community walk-in centre. While Saturday was a relatively quiet day, I had several calls from the A&E on Sunday. I did, however, find the time to go for lunch in the hospital's top floor restaurant on both the days. They had a lamb rogan josh with rice on Saturday. It was very good. On Sunday, I had their lamb hot pot with pastry. This was so-so, but wholesome, to say the least. 

On both the days, I had dinner from my own supplies that I had brought with me from Blackpool. This was mostly a collection of samosas and lamb pattice with chappatis. In addition to the meals, I had a lot of tea and some coffee - machines with free tea and coffee are installed in every clinical area. Overall, it was a good experience. 

That's it for now. See you around. Do follow me if you wish by adding your email ID to the Follower's list. And, if you feel like it - do comment in the space below this post to tell me what you thought about this post. 

And hey, do view that video ... Thanks. 

Nearly three months on the rota

I am quite happy to share with you the ongoing rota of a senior house officer that I am currently a part of since the beginning of February 2017. I have learned so much and am continuing to do so. Yes, it is much longer work hours, but, also, it gives me a shot at improving my clinical skills and decision making. Too, I get paid an extra amount for doing what is called duty in unsocial hours such as weekends and nights. 

The rota is quite different from week to week. On some weeks, I do just about 48 hours, whereas, on others, I do over 56 hours of work per week. In the past few weeks, I have had an off only on weekends, with long work hours on all the weekdays. On Tuesday, although I wasn't working, I travelled to Manchester to attend a study workshop on Communication skills. It was quite rewarding. 

Cooking-wise, I do get a chance to experiment on the lighter weeks. On the heavier ones, I get by with what I have in my refrigerator or eat in the hospital restaurant if that is possible. Occasionally, I have skipped meals at the end of the day because I was too tired to cook something. I then end up having tea and biscuits or just fried eggs with bread. 

On my Manchester trip, I went to the Asian foods supermarket (Worldwide Foods) and bought some stuff to have over the coming week. Not much, though, as I am preparing to go to Mumbai for vacation. However, I did parcel a lamb biryani from a Pakistani restaurant called Spicy Mint and it is located just across the road from Worldwide Foods at Rusholme (which is just over the signal from the Central Manchester Hospitals where I attended the workshop.

I also visited Chennai Dosa with the intention to take away some cooked stuff from there as well as have some south Indian delicacies. It disappointed me completely. The onion utappa that I ordered was undercooked from inside but crispy brown from the outside. I decided to just have it rather than argue over it as I had limited time at my disposal. When I tried to order a lamb biryani from there (Spicy Mint was a second option that I went to as I couldn't get the biryani at Chennai Dosa), they told me they did not have it at that point of time. 

In any case, to return to the main subject: it was a very good workshop and I met with quite a few interesting people, including some consultants from the hospital. Food at the workshop was quite basic with sandwiches, tea, coffee and orange juice. 

I returned to Blackpool by half past nine. A very exhausting day indeed. 

Truly, knackered.

Working 4 successive nights is something I have just completed for the first time in hospital. It has been a mixed experience. This is because I worked as a registrar for the first two nights and as a senior house officer the next two. During the nights as a registrar, I was carrying the bleeps meant for a middle-grade doctor. This means that I was the doctor responsible for whatever happened those nights - on the hospital campus. One of my colleagues worked as a SHO "under" me. On the next two nights, I held the bleeps for SHO, and another colleague worked "over" me as a registrar.

This allowed me to see the work from both points of view. And, I hope, it made me a better doctor. I think I managed the ward reasonably well, considering that this was my first time as a registrar, albeit as a stand-in.

Working nights means you need to sleep well the day prior to your first night, and then, every day following. In that respect, I guess I am a poor sleeper. I tried to sleep longer hours, but couldn't manage more than five and a half tops. On my third morning, I even took a herbal sleeping pill - but it did not lengthen my sleep time by even a few minutes. All I am saying is - I can get by with a lesser amount of sleep compared to an average bloke.

The other thing that doctors (or other healthcare workers) do when they do night shifts is that they carry with them a lot of food. This can either be a healthy mix of, say, sandwiches, fruit juice or fruit, and some healthy snacks, or, as is more usual, a mix of some healthy stuff and also some unhealthy stuff like potato chips, carbonated beverages, chocolate, and so on. I can admit candidly that my diet goes for a toss when I am on a night shift. My food bag resembles the second type of mix. For example, on my first night, I took rice, paya masala, a bag of low-salt, hand roasted chips and a caffeine-free Pepsi. On the fourth night, I had a white bread chicken mayo sandwich, a Pepsi (the same as before) and orange juice. Thus it goes.

Finally, when the night is full of work, as it was on the last of the four days, one can get really tired. Even so, I managed well, I think, thanks to the 3-4 cups of tea that I had in between running around doing the chores.

And that's about it for now. Thanks for reading. Do share your comments below.

Nearly a fortnight on the new rota as a Trust Grade SHO

Gradually, I am beginning to live the life of the title of this blog! It has been nearly a fortnight since I started on the full rota with holding the crash bleep. It has been a great experience so far. The consultants who work with me are also observing my progress with interest. I have to do this until mid-April, after which I should probably go back to my earlier routine. 

So, how has it been? Well, to tell you the truth, I am no longer doing registrar duties. I should add the word "almost" here since I did get called to do a clinic on one of my long days. As a SHO, I now carry the crash bleep, attend emergency calls, take referrals, and so on. It has begun to show me the correct way to handle cases. Well, I should qualify the word "correct". By this, I mean the way things are done in my hospital, and broadly speaking, the way it is done in NHS England. These guys do everything by looking at the evidence or by looking at protocols. It is not exactly similar to the way we did things back in India. I must admit, though, that following rules and protocols does make up for better practice of medicine. 

So, what duties have I done? I started off with a couple of night duties, then went on to do four long days (which simply means 12 1/2 hours of continuous work from 08:45 to 21:15 hours), and three other assorted duties ranging from between six to eight hours. In addition, I also got 2 mornings and three full days off. 

This change of duties has also thrown my life a bit out of gear. Before the start of February, my life was simpler: I worked eight hours a day, fixed timings, from Monday to Friday. On the weekend, I had the option of going elsewhere to do locum shifts and augment my usual income.  Additionally, I have also begun to mostly eat home-cooked food and avoid eating at the hospital's Oliver restaurant. My food has, therefore, become a lot healthier, although I still nibble at junk food from time to time. The other change that has happened is that, because I am now "first on", I have to walk a lot more. I am now averaging nearly 4 to 4.5 km of walking every duty day! 

The flip side of all this is that I do get a lot more tired at the end of a long duty; I eat at odd hours; I don't get the time to call my family much, and I miss my old routine. Be that as it may, I do enjoy this change in my routine and look forward to this work. The day after I write this, I am scheduled to do a duty from 13:00 to 21:15 hours ...

Do leave your comments below. Thanks for reading. 

Big change coming up

I have already described the road my journey in the U.K. has taken from the professional point of view. Click HERE to go to that post. I have also discussed with you, dear readers, what is currently on. Things are going to be a bit different from the first of February. What is happening is that while I will continue to work at the Blackpool Victoria Hospital, I will now be working as a full-rota SHO. This means that I will now be carrying a first-on-call bleep and will be working shift duties including weekends and nights. 

How will this change my journey? If I am able to perform as a capable SHO, it might motivate some of my consultants to begin to think whether I would be, at some stage, be ready to become a registrar. Secondly, it will augment my paycheck, and make it a little less necessary for me to work in other hospitals, doing locums. I am a bit nervous from the first outcome point of view, and a little happier from the second outcome point of view.

What it also means is that I will be working 48 hours a week instead of the 40 that I do now, and as some of these will be night duties or what is called "unsocial hours", I will be paid additional money for these. 

It seems that this will be an opportunity for me to shape up and show the seniors that I am ready to take on additional responsibilities. What I need from you all is encouragement, which I am sure you will all offer me, and a prayer - if you believe it its power. 

Thank you. 

Locum work at Bassetlaw District General Hospital

For the Christmas holidays, I chose to work this year. I secured a rather good hourly rate and so went to work at the BDGH located in British midlands area of Doncaster. I would do 2 long days - on the 24th and the 25th of December, and a night duty on the 26th night. I reached only around 11 a.m. on the 24th, as Bassetlaw, located in Worksop town, is over three and a half hours by train from my place in Blackpool. I caught the first train from Blackpool to Manchester Victoria at 06.38 a.m. From there to Man Piccadilly, and from Picadilly to Sheffield took nearly one and a half hours. The final leg was a train to Lincoln, which took me to Worksop. There, a short walk later, I was at the bus stand where I caught a 22 no bus to the hospital, a mere mile away. Arriving at the main reception, I was asked to contact the security for my accommodation keys and directions. I found my way to Cochran lodge for accommodation. There are three security gates with number pads to reach the floor where rooms are located. You then open your room with a traditional key.

My first impression of the accommodation was very positive. The room was large, with an attached bathroom. There was a tea-maker, a mini-fridge, and not one, but two almirahs -albeit without any hangars! The study table and chair were utilitarian and the bed was quite comfortable. Additionally, the room had a full-length wall mirror, a wall bookcase, an easy chair and good illumination. Outside, there was access to a large common kitchen, a TV viewing area (lounge) and a pool table as well. Impressive.

I returned to the hospital and went to the Paediatric department to commence my first shift. The ward is quite spacious and attractive. I would learn later that the department itself is in a process of shutting down its admission services from February next year and will continue to function only as an out-patient assessment unit from then onwards. Currently, it is sanctioned to accept no more than 6 patients on the admission roster. It takes patients for assessment only from around 8 a.m. until 7 p.m. Outside these hours, it compulsorily refers all patients to Doncaster Royal Infirmary, its parent organisation. The DRI and the BDGH are part of the Doncaster and Bassetlaw NHS Foundation Trust.

There was minimal work as most work is now shifted to DRI. However, the staff was very friendly and cooperative with me. All in all, I had a good time. In fact, on Christmas day, they even served a free Christmas lunch; the Indian-origin registrar made a unique Tamilian gravy from pre-assembled ingredients and I had that with rice. It was very delicious.

During my night duty, I even had time to doze off in one of the empty rooms at the back. To summarise, therefore, no issues. I had a good time. 

A Year in the U.K. Looking back on my professional life

I would be fooling myself if I said I am at the top of the world. Well, yes, I am in a much-coveted place, that is true. However, when it comes to defining where I am on a professional level, I must say that I have a way to go, indeed. The reason I am writing thus is that it has been a challenge for me to adjust to the way the NHS works and the way the British people communicate with each other. 

Of course, I have "improved", which means I am now doing things the way they should be done in the U.K. (which is not always the right way of doing things) and the process of unlearning what I previously knew about Pediatrics has been more than a little difficult. To make light of it, I am now practising "Paediatrics" and not Pediatrics. What this means is that the British method of healthcare is different not just in the spelling, but also in the details. I have often wondered how it is that medical care can vary so much in the details even though both systems of medicine across the Atlantic rely on much the same sources of knowledge and the same sources of research. Then I realised the difference lies in the basic way of approaching illness. Whereas the American system of medicine relies heavily on acute care, the British method is all about hanging in while the patient roughs it out through the ups and downs of his/her illness. Also, the NHS is a government-facilitated system where the citizen pays nothing. Hence, a cash crunch causes a very difficult problem of not being able to deliver healthcare where it is needed most. On the other hand, the American system is mostly based on private enterprise. 

But beyond all this, at the root of it all, is the way the healthcare is tailored in consonance with the wishes of the patient. In this most important respect, the NHS is completely different from medical care anywhere else I have worked. The patient has the right to agree to, disagree with, question, and critique any care they may be receiving or be about to receive. They can, if they are mentally competent, reject treatment of any kind, no matter how strong the evidence for the use of that modality of treatment may be. The only exception is when the patient has lost their mental faculties or where a certain treatment is life-saving. This act of "putting the patient first" and keeping them in the "centre" of care makes the NHS so different. A woman may not want to breastfeed her baby even if she has a lot of milk coming in, and that is her right. In the same way, if a patient chooses not to have chemo for his malignancy, that is his right. The fear of medico-legal issues is very strong too, so if you as a healthcare giver goes against the patient's wishes, you can be penalised or even prosecuted. 

On a more personal level, how has it been for me. It has been a year of mixed fortunes, but I am, as I said previously, slowly inching towards professional competence. I still have some issues that need sorting out, but I am hopeful I will be able to cross those hurdles over the next several months. At some point, I should be able to return to my middle-grade level. I am hoping this does not take more than six months more, or else, it will be difficult to sustain myself at a junior level. It will also make future promotions and move to any other country that much more difficult. So, let's see how that goes. 

And that's it for this post. Do share your views and comments if you wish. Thank you for reading this and for your encouragement that I will constantly need. 

Back on the job, and advent of winter

It has been over a fortnight now since my family vacation ended. And yet, it seems as if it was only yesterday! What a time I had. We had never taken such a long vacation and it was definitely worth it. And the funny part is that we never realised how time flew. We saw over 15 different places, and some of them were unplanned route diversions where we saw and did amazing things. Above all, this hugely enjoyable vacation did not even cost a big amount of money. I must have spent about 6500 GBP in all, a very reasonable sum indeed. 

And now, it's back to work. The autumnal fall of leaves is now done with, and trees are almost barren. There is a cold nip in the air, the more so in the past few days. In fact, it has rained quite a bit in the past 48 hours or so. Darkness descends upon the firmament as early as, say, 5 o'clock in the evening. When you wake up in the morning, you just don't feel like shrugging off the duvet and rising and shining! What keeps you going, though, is the awareness that if you don't wake up and start soon, you will most likely be late to reach your place of work. This can be a tricky situation, especially if your bosses are aware that you pretty much stay on the hospital campus - and are still late, even if by a few minutes. 

It has been a busy week or two, with the Paediatric ward filling up with infants and children experiencing breathing problems right, left and centre. The best thing that happened to me was that I was placed as the only junior doctor looking after the neonates in the special care newborn unit. Of course, there was a consultant who took the rounds with me, but on a couple of days, no consultant was available, and I took the entire round by myself. On that particular day, I felt as if I had stepped up a bit. I continued doing the neonatal rounds until the end of the week, which was earlier today. 

And that is how it goes. I will probably not be gainfully employed over the weekend, but, as they say, tomorrow is another day. 

Ten thousand views... and growing

Thank you, dear readers. Your support has allowed my blog to reach an amazing figure of 10K views. Yes, sharing my posts with social media helps. What I want is for you all to read my posts and to take away what you think is beneficial to you. Some of you are inspired by my writing skills; yet others are searching for some help before they, too, take a plunge to come to the U.K. for work; some simply want to keep a brotherly/sisterly/friendly eye on their friend/colleague; yet others are looking to see how a lone person can enjoy himself in spite of the many challenges that he faces day in and day out. Be whatever it may - I am here to inform, entertain and inspire you all. 

Through my earlier blog on my life in Saudi Arabia, I have definitely inspired many of my Paediatric colleagues to work in the Middle East. One of them is now in Saudi Arabia; another, in Bahrain. A third is making plans even as I write this. With this new blog - the one you are reading - I hope to inspire a whole new bunch of doctors. These doctors have the knowledge to work anywhere in the world. Some are hesitant because it is unlike their own culture; others are worried that their incomes will fall; still others are scared about the racist undertones of British society. I am always available to help you understand. However, the final decision must be yours. 

Earlier today evening, a Muslim Egyptian doctor who has now cleared his MRCPCH called me to tell me that he has a job offer from a hospital in Wales. His dilemma is very clear: he wants the freedom to work in an advanced country like the U.K. (currently he is in Dammam, KSA), but he is worried about the cultural differences between the Islamic culture that he and his family are used to, and the permissive, Christian culture that prevails in the U.K. While I did explain to him the shortcomings of this advanced country to give his family the shield that he so desires. He is not sure if he will find a mosque; if he will be able to access Halal food; if his wife will be able to adjust in an open society; if his children can stay away from the harmful influence of a disruptive, over-permissive society; and so on.

These are valid questions, and there are no easy answers. I tried to explain whatever I knew to the best of my ability. However, I could not answer all his questions because there are some areas I am myself unaware about. I request you, dear reader, to help me with your input wherever you can. Thank you so much.

Please leave your comments and enter your insight. I need your answer to just one question. How does my blog affect you: does it entertain? inform? educate? inspire? Are you someone who is my friend/relative/colleague in real life? Are you here to make sure I am all right? Do my words comfort you? Do they make you anxious? Worried? Thanks in advance for your input.

Completed a year since leaving Saudi Arabia ... and why NHS is so admirable.

This is a reminder to me that I left the Kingdom of Saudi Arabia on the 3rd of September 2015. Hopefully, it would be my first and only stint of working in the Kingdom. The major takeaways of that stint of nearly 4 years were  the fact that I was able to perform Umrahs and Hajj; that I was able to save some money; that I was able to emancipate my family from being dependent on me; and that I completed the exams that would serve as my stepping stone to enter the United Kingdom (I am talking about the M.R.C.P.C.H.). 

I am unable to say which of these four achievements have led to the maximum benefit to me and my family. I would probably say each of them had their own merits. Spiritually, I came closer to Allah with my Umrahs and Hajj. Mentally, I was able to study further and get qualified with an additional, U.K. approved, post-graduate qualification. My family's "independence" served to liberate me as well. Today, my wife Nishrin and my children, Inas and Hannah have become largely independent and only occasionally have to consult me. Finally, the bank balance has permitted me to take positions in some investments within my country, something that I could not have done earlier.

Since my arrival here in the U.K., I have learned to adjust with the entirely new and unfamiliar system of medical practice. I have realised that I have a long way to go before I will get accepted by my bosses. I am currently learning a lot of skills by working at different trusts in the North Western part of England (and occasionally at other trusts in the U.K.). These skills include communication skills, cannulations, lumbar punctures, planning therapy, child protection, and a lot more.

Over and above this, I am beginning to understand how the English health system (the NHS) functions below the belt. Its underbelly, if you understand what I mean. Initially, I struggled to work, especially when it came to managing the out-patient clinics. Now, don't get me wrong. I have had a clinic for nearly 25 years in India before I went to Saudi Arabia. Nothing prepared me, however, for the kind of patients you see in the U.K. There is acute paediatrics, of course. In the clinics, however, it is all about chronic stuff. Things that can stay in a child's life for years, if not decades. Until 16 years of their life, they are ours to see. In some cases, especially with children having chronic, incurable illnesses, we continue to manage them even when they cross that age. After this, however, they transition to adult medicine. In India, the most we could do was to see them until they turned 13. I did have a few of my old loyal parents who came to me with their 15 and 18-year-olds to have them treated by me, but it was legally untenable. 

However, it is not just about age, or the chronicity of problems. It is about the range of diseases and problems that are totally different from a tropical country like India. Additionally, it is the inherent knowledge patients have about their own illnesses and about their own biological stuff. Finally, it is about how to communicate with them. British sensibilities are completely different from ours. What we discuss with patients openly in India has to be said privately and with much more empathy, for example. The risk of being sued in courts always hangs upon you wherever you work, but it is definitely much more in the U.K. compared to India. 

There is yet another, very crucial difference. In the U.K.. there is a huge infrastructure of community and outreach services that have no comparable example in India. A child with cerebral palsy, for example, has to spend huge amounts to even reach a level of mediocre care in an advanced city like Delhi or Mumbai. Even then, when it comes to successfully rehabilitating that child and integrating him with society, we can hardly do anything. In the U.K.. the system is so advanced that the child gets automatically eligible for a range of rehabilitative services. For example. even his home can be modified at government expense to get him to have a ramp to ride his wheelchair on. If a child with excessive illness related to pollution applies, he and his family can be given an entirely new place to stay by the government. Of course, the family will pay off whatever they can over years and years, but care to the child will not stop because the family does not have the means to fund it.

Child protection is a big thing and abuse of a child sets off a chain of governmental remedial actions that include but are not limited to removing the child from the influence of his abusive relatives, handing him over to an appropriate foster parent, or hand him over to court, which will then place him appropriately, police action that is swift and commensurate with the degree of the abuse, and so on. Social care services will then continue to monitor the whole thing ... until the child can be, if feasible, returned to the family - or be kept away for as long as is needed. 

With such services spread nationally, it is not difficult to understand why the U.K.'s NHS is considered to be one of the best health services in the world. And the services are 90% free to the people - not just British or English citizens, but also legal residents and immigrants after their stay has been legally sanctioned. 

This is all I will be writing about in this post. Do leave your comments below. 

Thanks for visiting, reading and interacting with me.

Weekends doing locum work

As the weeks roll by, so does my routine of working outside Blackpool in other NHS trusts. While it is always professionally profitable to work as an on-call doctor with a bleep (which sort of trains me to work with deadlines and take a few decisions rather than just be around), it is also financially rewarding. This is because the NHS suffers from shortage of doctors across all categories and almost everywhere in England. 

This weekend being a Bank Holiday one (the holiday is on Monday, and probably because banks need a day off every 6 months to reconcile their accounts), I ended up working three instead of two nights. While my Friday night was at Tameside General Hospital, located east of Manchester near Ashton-under-Lyne and part of Greater Manchester, I travelled to Birmingham to work at the Birmingham Children's Hospital for the next two nights. I am writing this from within the BCH as I await patients in the Emergency Department of the hospital where I am posted. 

The ED is quite a busy place staffed with doctors dedicated to the ED. In addition, they have a clinical decision unit or the CDU where the Paediatric SHO (that's me) and Registrar work to see patients referred by the ED staff to us. Last night was actually very busy, and my registrar and I were busy seeing one patient after another as the night melted into a new morning. Today, it has been a gentler start, with 2 infants born within a day of each other at the same hospital but unknown to each other coming with different but insignificant complaints. Both of them have now left the hospital as their problems were not suggestive of any major form of trouble. 

The work area is divided into the actual ED with 12 cubicles, 5-6 observation bays and a treatment area, the CDU with 3 beds, a General Observations Bay where patients can be kept for up to six hours, and a Paediatric Admissions Unit (the PAU) where children who need longer hospitalisations can be shifted. There is a quiet, efficient hustle-bustle as children come in, are seen by the nurses, then the doctors and then sorted out to either go home, be transferred to the observations bay, or admitted into the PAU. Every one working here takes a break at around half past two or three a.m. when the work is lightest, but this is not always possible, so things can get rough and people can miss their break. There is a small room with a wall-mounted TV, a refrigerator, a toaster, a tea-pot and a microwave oven where people can go to relax. It all adds up to a fairly interesting shift of duty indeed. 

While I worked with a ST 5 (a middle-grade middle level registrar) yesterday, a Greek man by the name Vas, today, I am working with a Bangalorean ST 8 registrar Ratna. Working with both of them (so far) has been enjoyable. 

I have been granted accommodation within the hospital. I had some excitement yesterday when I first came in. My access card that opens doors within the hospital (which I was given by the hospital security within an envelope marked with my name) was not working; then, the room I was allocated was really the worst of the rooms within the multi-room flat that I was allocated to stay in; and, finally, I could not find my way to reach the reporting area. One by one, each of these problems got sorted out. Hence, today, it has been smooth work with no hassles. 

Earlier in the evening, I woke up from my post-on-call slumber around half past four in the evening, and decided to walk around the area. I noted a few interesting things. One of them was a no-vehicle, pedestrians only zone built BELOW the level of the roads where there was a large open space, trees, lawns and various pathways that led to the different roads around the area. There was a large group of local youth that sat under a big tree. I was really impressed with this level of infrastructure. 

I then stepped into a Jamaican restaurant (Aunt Sally's Caribbean Food) and had my first ever Caribbean meal. It was delicious and I was forced to buy some more meals to carry back to Blackpool for later consumption.

Will post photos later ... thanks for reading this. Do post your comments, as I really appreciate it!

Easing into the second innings of my old job

My readers - I am grateful to all of you for your good wishes. I am aware that many among you have been disturbed by the recent posts where I have hinted at emerging problems with my work here in the U.K. I had given news that I was going to have to shift to a new job from August. I am happy to tell you that I won't be shifting after all. The recent months have seen my skills go up significantly. I am now able to understand the complexity of working with the UK's NHS system much better than where I was, say, in May 2016. 

As a result, I have been re-offered a new contract with the Blackpool Hospital. I will not be working as a registrar until I can prove my talent. However, I will stay on, and continue to work Mondays to Fridays as a senior house officer (with a reduced annual salary, of course), until I am adjudged to be skilled enough to re-take the registrar posting. This will allow me to grow professionally with the same team with whom I have begun my first innings in the U.K. I am hoping that I will continue to do locum jobs on weekends, and thereby augment my knowledge and income as I am doing currently. 

This is the news as of now. Do watch this space for more details and new happenings. Thanks once again for reading and for your good wishes. If you like - do leave your comments.

Medical Professionalism Matters

On the evening of the 12th of July, I had the unique opportunity to attend a workshop on the captioned topic. The venue was the Museum of Science and Industry at Deansgate, Manchester.

This was a joint programme of many organisations led by the UK's top regulating body, the General Medical Council. Other organisers included the British Medical Association, the RCGP, the RCP, and others. The thrust of this event was to interact and formulate a blueprint of what professionalism means to doctors and other healthcare workers in modern times. There were discussions related to several aspects of this; they included talking about proper communication, having compassion in care, being ethical and responsible, being concerned about self-development (professionally and otherwise), being safe and having a paramount concern for safety in healthcare, being a team-worker and being resilient. 

There was a keynote speaker, Prof. Jacky Hayden (@Hayden.Jacky), who spoke on several aspects of qualities of being a good health professional. Her talk was brief but it highlighted all the important issues and set the tone for the next programme - a series of group discussions. During these group discussions, a moderator from the GMC collected thoughts from the participants at each table on a specific aspect of the main theme. Thus, there were tables where, for example, communication was discussed; or, where the discussion related to patient safety, or, to doctors' advancement as scholars and innovators in their field. I enjoyed these group discussions tremendously. There were professionals from all walks of the medical field, right from junior doctors like me, to stalwarts like Pali Hungin, the president of the BMA, sharing ideas freely on all these topics. Each table sat for 20minutes, then we changed to another table, with another topic for brainstorming. 

Supper was served after these discussions, and this was then followed by a panel discussion where the panellists took questions sent by participants. The entire discussion was very illuminating. One of the speakers was Dr Umesh Prabhu, (@DrUmeshPrabhu), a Paediatrician from Wigan. He is a highly innovative person who has made a mark on NHS through his work related to Patient Safety in Healthcare. Do look him up on Twitter.

To read more about this event, and the issues raised therein, do visit www.gooddoctors.co.uk.

Thank you.

P.S. For non-medicos, who are not interested in this post, I apologise sincerely.