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!

#LondonAttacks

Once again, extremism has raised its ugly head and wiped away 7 lives, destroyed the hopes and aspirations of all those connected to them - and injured almost 50 others, at least a dozen of them critically. 

Three men, travelling in a large vehicle, first rammed this into a crowd of innocent pedestrians atop the London Bridge, then took the vehicle into a market area and, parking it, got off the vehicle and began to run around, randomly knifing people going about their usual lives. Within 8 minutes of the police receiving news of the attack, they were killed in an intense round of police fire. They were found to be wearing what seemed to be jackets rigged with explosives. However, the tin cans attached to their jackets proved to be fake ones. 

As I write this, the police investigation is ongoing. Patients are admitted to five hospitals in the vicinity, among them the King's College and the Guys and Thomas' Hospitals. Nearly a dozen of the injured victims are critical, while the rest are recuperating. 

Among those dead is a Canadian citizen, a New Zealander and two Frenchmen. 

A quick thought: this is the third attack by terrorists in three months in the U.K. The last attack was just 12 days ago in the Manchester Arena. What is happening? 

I was talking to a British lady today while walking in Stanley Park. We agreed that Britain was reaping the effects of what it was sowing all over the world, blindly following the United States of America. The picture of Theresa May being led by the hand by President Trump symbolises this more than anything else. 

May and Trump (click this link)

If only the U.K. government stops meddling in the affairs of the various countries it is engaged with, Islamic extremism will stop attacking it - at least this is my opinion. It has become almost impossible for terrorists to attack the U.S.A. That is why, they are now targetting the softer option - the United Kingdom. This is a war, and the U.K. should start protecting itself rather than try to "restore" peace, democracy etc. in other countries. 

The lady I was talking to is an ex-journalist who was shooting birds with her Canon camera. We both felt that the people of U.K. are becoming increasingly frustrated with the way things are going. Racism is making a comeback, she said. While she was putting this down to politics, I felt that people were basically relinquishing common sense and attacking anyone not their own without understanding that without immigrants, the U.K. would be finished as a world power. 

Back to the attacks: there will be a general election in the next four days' time. The Tories may well continue to be in power, and May will then have the power to negotiate hard with the European countries to retain its value in a post-Brexit world the way she wants to. Or, as a dark horse, the Labour Party may win and Jeremy Corbyn will be swept into power as the new Prime Minister.

Only time will tell - within a week, we will know the outcome.

The election comes at a time when the people will still be reflecting on the London Attacks. May the souls of those who died rest in Peace. Amen.

Medical Education and Practice - India vs England

One of my Facebook friends has asked me to pen a post on comparing the teaching system in the U.K. with that from India. Frankly, there is no comparison. Firstly, the kind of illnesses we see in India and the ones that we see in the U.K. are quite different. Secondly, our healthcare systems are completely different. In India, we work with limited budgets, whether in government/municipal hospitals or in private clinics/hospitals. 

In the U.K., too, there are some budgetary constraints, but the supplies are all top-class, and there is no shortage of essential as well as non-essential stuff, except for the items which are in the very expensive range. 

Thirdly, and this is the most important difference: the system is driven by evidence - the kind of evidence that comes from research and trials - and is completely based on protocols that are specific to each institution but framed from national and international data that is published by national-level agencies. Such evidence is periodically reviewed so as to be abreast of the current knowledge. This kind of evidence is completely lacking in India. Individual doctors may, from time to time, update their knowledge base and use this to help their own patients. Devising of hospital-wide uniformity of treatment never does occur, so that every doctor treats the same condition differently, based on their own learning, experience, and hearsay from their peers.

Coming to teaching: We have excellent teaching in India as well, but it is fragmented. Doctors learn from their seniors when they are students, but as soon as they start a private practice, they give secondary importance to continuing education. The Medical Council of India and state-level bodies like the Maharashtra Medical Council etc. have recently moved to enforce that every registered practitioner should have a certain number of points to be able to stay registered on the professional register. However, the points can easily be collected by sending the money to the organisers of teaching programs and then receiving the participation certificate in absentia. Many a times, doctors will attend a conference or learning seminar just to get the points, but not use the learning to improve their practice. Occasionally, doctors will, for reasons of expediency, join programs that are not even from their own speciality, just to gather the required points.  

In the U.K., learning is referred to as teaching! Thus, when a student says that they are going for teaching, they are actually going for learning. While I haven't done my formal medical training here and cannot, therefore, comment on how their teachers are, I can definitely say that medical students here are far more experienced than Indian medical students are, in practical, hands-on experience. This is because, from their third year onwards, when they attend the wards (just as we did or do in India), they begin to clerk patients in a proforma, taking the patient's history, examine them, etc. and they will, in their fourth and fifth years, be expected to give a differential diagnosis, and formulate a plan of management for that patient. This allows them to think like practicing doctors years before they actually will practice clinical medicine. 

What really makes the difference in their training, however, is the fact that they have to collect, and later produce, evidence of their learning. This has to be uploaded by them electronically, and I have often had students presenting a medical case to me and then coming back a few minutes later to take my digital signature on their mobile phones to collect the evidence that they did, in fact, present a case to me. They will also sometimes send us a link to give a feedback on how their performance went. This is a requirement for them and not an option. This enables them to advance professionally in a more structured, evidence-led method than the kind of haphazard learning that we have in India.

I hope this answers the question for my friend, and helps others too, to understand how the system works in the U.K.   

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. 

#ManchesterAttacks

On the night of the 22nd of this month, Ariana conducted a music concert at the Manchester Arena. Everything went well until the very end. She had done an encore and had exited the stage. People  - a lot of them youngsters and even children - were beginning to leave the venue when a large explosion occurred just outside the arena near the ticketing window. Set off by a man who died in the explosion himself, and subsequently identified as Salman Abedi - a native Mancunian who acted most likely on behalf of ISIS - this explosion killed 22 people, many of them children, and caused injuries in another 59, some of them critically injured - and changed the threat perception of the UK from level 4 to level 5 (critical).

This event is now officially the most sinister terrorist attack on Manchester, the third largest city in the U.K. Unlike other major cities, Manchester is one of the most diverse cities in the U.K. with people from different parts of the world and all the various religions of the world assimilating together for the common good. To have such a dastardly attack that shook the entire country was indeed very shocking and unbelievable. 

The country is on the cusp of a general election in less than 15 days, and yet, everyone is in no mood for electioneering or campaigning at this point of time.

The city has moved on, but the event shall linger on in the minds of every person in the city, in the country and, dare I say, in the world. 

May the souls of the dead rest in peace, and may quick recovery occur among those who are still under treatment. Amen.

Flashback to day 1 of my vacation: an interesting quartet

Blog entry: 27^th April 2017: Flight to India 

I must admit that I haven’t found the time to connect with you, dear readers, from the time I flew to my homeland from Manchester on the 27^th of April. The flight was interesting, as were my flight companions. On the first leg of my Air France flight, I flew in a smaller airplane run by AF’s partner Flybe. It would take us over England and then over the Channel to Paris’ Charles De Gaulle airport in just over an hour. I sat in a window seat. This flight had 2x2 seats, so I had just co-passenger. He was a giant of a man, around 40+ with a simple English name that I can’t remember now. He and I got to talking, mostly about a GPS app that he was constantly studying on his iPhone. It seemed to be like any Maps display, only, much more detailed and multi-coloured. It reminded me of my school day maps with physical contours of the land, etc.

He told me that this was an open app that one could get on both Apple and Android devices, but its accuracy was underpinned by the defense sector. It cost a huge amount of money as it was highly detailed. If I am not wrong, it costs nearly GBP 500-600 to buy the maps on this app! I was stunned. I wondered why he needed this app. He told me he was a trekker who climbed hills alone, and he needed to know exactly where he was if he ever got lost!

As we touched down at the Charles de Gaulle airport, we parted ways. My luggage would arrive in Mumbai directly. I was walking towards the right gate for my connecting flight. I met, quite by chance, a young woman who looked Asian/Indian. We began chatting. She was Jerlin. Born and brought up in Mumbai, Jerlin is a Keralan-descent trained nurse who had reached Paris from Ireland where she had begun work in the past year. We stuck together while awaiting our flight. She told me this was her first holiday to India after her joining the Nursing force in Ireland, and that she was going there to attend a family wedding. Jerlin was a bubbly young woman who kept laughing. She was a very good listener too. Her luggage was loaded with gifts and chocolates for her entire family.

Our flight to Mumbai departed on time, and it would take us over 7 hours to fly this distance. My seat companion was a Gujarati IT person called Mehul. We shook hands and spoke to each other. As the plane cut the distance, we chatted away. He has settled in Toronto, Canada. He told me he travels to India nearly once, sometimes, twice in a year. Happily married and with kids (I can’t remember how many), he was an extremely nice person.

Once the seat-belt sign went off, we both got up to stretch our legs. We met a young Bengali woman of Indian origin named Benazir who, like us, had got up to stretch.

The two of us and she struck a conversation near the steward’s service area (which is also where we had our seats – viz. Mehul and me). Our friendship, casual though it was, grew slowly, and we were chatting away for an hour or more while other passengers came and went past us. We then met Benazir, a Bengali woman who was based in Berlin, where she was pursuing a doctorate in English literature at the Free University of Berlin. She had a remarkable story to share, and both Mehul and I were engrossed in her telling it. Presently, who should come around to visit the loo (which was right ahead of our seats) but Jerlin. She and the three of us were now a quartet, and we continued to chat for another hour or so. It was a great thing. The stewards, one of them a smart Frenchman who was jovial and very helpful, gave us space to continue to stand in a tight group and continue to hold the conversation.

Eventually, we parted and returned to our seats when the stewards announced a snack service. Outside, the skies had turned dark as we were flying due east from Paris. We would arrive at half past eleven in the night at the Chhatrapati Shivaji International Airport. From here, Jerlin and I would go to our respective homes, Mehul would fly onward to his home in Gujarat, and Benazir, to her home in Hyderabad. We promised to stay in touch.

Our baggage safely retrieved, I then hired a cool cab and reached home at a little after half-past one in the morning. It was now the 28^th of the month. I would sleep after a bath and tea. The next day, after my 3-4 hour nap, I would begin my Indian vacation.

Hectic vacation in Mumbai - read a bit about everything I experienced and did

So far, it's been a very hectic vacation indeed. To top it all, coming to India when it is at its near hottest has been energy sapping and tiring. On the flip side, of course, it was my first opportunity in over five years to be in Mumbai at the height of the "hapoos" (alphonso) mango season. The alphonso mango is the king of mangos, and among the top in the tastiest fruit of the world. I was very fortunate to get to eat this fruit repeatedly. One of my medico friends Dr. Patankar actually enhanced my happiness by gifting me 2 boxes of the original, untreated variety of the fruit that is known as the "Devgad" alphonso, after its place of origin. He gave these to me when his family and ours met each other at Goa, where I had gone for a two-and-a-half day vacation.

I visited my mom for the first time after she was struck down with a paralytic stroke in January this year. She is now confined to bed, but is mentally alert and plods on with the help of a 24x7 maid by the name of Tehmina. I found her to be going through a kind of depression as she struggles to understand why she, among all, was afflicted with this life-limiting illness.

Among the other highlights of my brief vacation was my completing the formalities for renewal of my registration with the Maharashtra Medical Council for the next five years; my meeting most of my mom's side relatives at a function organised by my younger brother Murtuza to celebrate his son's misaaq; my visit to Nishrin's sister-in-law Balwinder's home with Inas; our entire family visiting Nishrin's cousin sister Dalvir Kaur's home; our family's outings to see Bahubali 2 (Inas and I went separately, while Nishrin went with Hannah); my gathering of the various foodstuffs I am going to carry back with me to the U.K. (including farsans, chapatis, dry fruit, etc.); our family's visit to a stand-up comedy show (a delight); our eating out at various restaurants, esp the "Lemon Leaf" restaurant behind the Taj at Colaba, and "Oh! Calcutta", where we had dinner on the 14th to celebrate Mother's Day AND Hannah's birthday. 

In addition, our family also went for dinner to other friend's places. And, on one happy occasion, I had lunch with a school friend Farhad Khursetjee. This was at Sassanian's - a Parsi Irani cafe located near the Metro Cinema. I must not forget the excellent dinner and experience my wife and I had when we went to attend a wedding reception of the son of Dr Shailesh Joshi - a visit to a hall in Hiranandani Powai property. This was remarkable!

I must say that we spent the best days of my vacation in Goa, where we went on the 2nd of May. We stayed at the Hotel Ibis styles at Calangute. This was a well-appointed resort. You can read my review of this on Tripadvisor HERE. We went to the beach at Calangute to participate in water-sports. Also, on all the two or three days we stayed in Goa, we had traditional Goan seafood on most of the occasions. The hotel's own meals were quite delicious. We also ate at Britto's at Baga beach. 

During my stay, there were unhappy events as well. Mrs. Sakina Palitanawala - the lady who minded and loved my girls when they were very young - passed away, as did Mr. Shabbir Disawala, a school friend who died from cancer.

How can I forget my meal with the Kedy doctors - Muhbeen, Arif and Ashfaq. As usual, we met at the Persian Darbar and had a goat raan biryani - this is so huge in size that we are never able to finish it. I took a large portion of the remnant as a parcel for Hannah, who loves it a lot and had asked me to bring some if any was left over. 

I returned to Blackpool on the 16th of May in the early part of the afternoon.