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. 

About how I am getting along at work

In my previous post, I wrote about my efforts to get fit. Today, I am going to share with you what I am doing at work. When I last wrote about this, I did share with you that I was still on a steep learning curve, and that it sometimes got overwhelming. Well, as I write this today, I will confirm that as far as those view-points are concerned, nothing much has altered. However, my acceptance of them has enabled me to try that much harder to overcome the obstacles that I thought initially to be insurmountable.

Yesterday, I was successful in cannulating the vein of a child for the sake of blood collection; today, I was able to do a test known as a lumbar puncture - something that one does to collect the fluid around our brain and spinal cord to check if there is neural infection.This is one test that relatives in India often do not give consent to, but here, in the UK, they are already aware that it is a necessary test to confirm or rule out infection in the coverings of the brain, or the meninges. This is a potentially serious form of neural infection, which can even be lethal if it occurs in a weak or small child.

Then, today afternoon, I trained with one of the advanced neonatal nurse practitioners, Ms. Liz Morrison, in examining well babies on the post-natal ward (where they keep mothers with recently delivered normal babies).

Now, to be honest, it isn't that I have not cannulated veins or done lumbar punctures or examined healthy babies. I have done all those things during my residency training nearly 32 years ago! And, during my years as a consultant, I kept doing those things off and on - but rarely on a daily basis. That led me to being less confident that I could pick up those skills again. Thus far, I have had difficulties in drawing blood samples from children, or in doing their lumbar punctures,  both of which I had done countless numbers of times during my training in the nineteen-eighties. Lack of continuous practice has blunted my experienced hands. There is another aspect to this as well. Techniques and the tools we use to do these collections have also changed. Needles are sharper too. In the UK, parents are allowed, nay, encouraged, to stay in the room with the child during blood collections and cannulations. All these things are unfamiliar to me, and cause me disturbance that comes in the way of my efficient performance. 

Thus, the last few days have really helped me to become a lot more confident and comfortable with the tasks I am expected to perform, May this confidence help me to convince the others on the clinical team, both, my juniors, and my seniors, to have faith and to believe in my capabilities. Amen.

On the positive side, I am very comfortable when I am asked to see patients in the Paediatric Clinic. This is because most of the consultations are of patients who are "cold", i.e., they have no acute emergency requirements. When the consultants are good to me, I get immense opportunity to learn from them. Usually, they are always good, but, at times, especially when there are many patients, the consultants do get a little impatient and flustered. I can understand where that is coming from, so it's fine. I remain patient and abide my chance to go into the consultants' examining rooms and listen to them and their conversations with the patients and their carers. They will also go over the cases I have seen and make course corrections where they find my plan to be in-consonant with the needs of the patient, or, in some way, not in line with what they think is correct. This is an immense learning opportunity and I am quite happy with it.

Any threats to me? Well, if I don't ship up in the next few months, I might get into trouble, but I sure don't think so, as I am an eager learner, and I guess the more I stay on the wards and do my work, the better I will get at my skills.

Arrival in the UK

The preparations to come to this country took well over 2 months. First, I had to complete my medical council registration; then, the UK visa; and finally, do shopping and accumulate stuff that one should compulsorily have with them when they wish to immigrate to the UK - but especially important stuff like utensils, a pressure cooker, clothes to ward off the cold and wet climate with, money to carry along, and a host of other stuff. 

During the past few months, I also hosted a few get-togethers; the first one was with my Nagpada friends, Drs. Muhbeen, Arif Shaikh and Ashfaq; at this get-together, which I had in the month of September, we had Raan Biryani, the favourite dish of Persian Durbar- the place we ate at. The next one was a family get-together with Murtuza's family. This was hosted by Murtuza, and was also at Persian Durbar, with all of us again having the same main dish that my friends and I had gorged on previously. 

The final big get-together was the one we organised about 3 days before my departure from India. At this meet, we invited the entire families of my dear friends - the Jolly club members, my own family and my wife's closest family members - a brother's family and a cousin sister's family (Pappu being the brother and her cousin Lovely being the sister). This get-together was organised by us at the Kolsa Mohalla jamatkhana. Will post pictures of this one day in this blog.

On the 14th morning, I finally caught a flight from Terminal 2 of the Mumbai Chatrapati Shivaji International Airport (Gate 73, Turkish Airlines) to Manchester. My flight took off at 6.50 a.m. IST. I had a layoff for about 2 1/2 hours at the airport in Istanbul, which I reached after a journey of 7 hours and where I changed planes to continue my onward journey to Manchester. This second leg of my journey took over 4.5 hours. Thus, my entire journey took over 14 hours, and I arrived in Manchester at around 3.30 p.m. GMT.

En route, Turkish Airlines served great food; during the first flight, they served a Turkish meal consisting of cheesy salted items, spinach and smoked salmon with sides of salad and a strawbetty yogurt, On the second leg, they served snacks, which were equally delicious. All in all, the flights were good. Istanbul airport is a very, very busy airport. They have so many departure gates! Mine was gate 304! The population at the airport was completely cosmopolitan. My first flight was running full. The second was nearly full, too.

On arriving at Manchester, the immigration formalities and retrieval of luggage took over an hour, I got a local train from Manchester Airport to Poulton le Fylde. My bags were really heavy and I had a tough time transferring them from the airport to the rail station, and from the station on to the train itself. However, I got an empty train and got settled in into the second compartment from the rear. Disaster struck when the announcer said that only the first three compartments of the train would travel to Blackpool, while the rear 3 were slated to be disconnected and would be going to another place - with a new locomotive engine. I managed to disembark at Preston, and boarded the front compartments with some difficulty. I reached Poulton at 6.30 p.m. Took a cab from there and arrived at Blackpool Victoria Hospital around 7:00 p.m. 

That's all for now. More in my next post.