Not literally, but that's about what my afternoon on call feels like, looking back over it. It's been mad busy and I finished late, and now I'm going to get to bed.
Not literally, but that's about what my afternoon on call feels like, looking back over it. It's been mad busy and I finished late, and now I'm going to get to bed.
Whew - far too tired to come up with any sort of coherent post. Staying up late two nights in a row was not exactly my smartest move.
Tuesdays are theoretically easier than Mondays because I only work mornings, but it never seems to work out that way. For one thing, they're at the branch surgery, which is a few miles farther away and along twistier roads. Not a huge difference in travel time, but unfortunately by the time I have the kids ready to leave for Christine's I barely make it out the door on time to get to the main surgery I work for, so that small difference in travel time is the difference between being on time and starting a few minutes late. When your morning is divided into ten-minute slots, starting even a few minutes late can really get things off on the wrong foot. Then, GP days don't divide evenly - visits and paperwork after the morning surgery mean that mornings always seem to be longer than half a day. Then there's the shopping to do in the afternoon, and the bins to empty, and somehow there never seems to be any real time before going to pick the kids up, after which there's the scramble to get dinner ready/lunches made for the next day while Katie demands that I play with her non-stop, and then to get them to bed.
Tonight I did at least manage to persuade Katie (who loves pretending to be a baby and talking in baby talk) that babies sit in seats while their mummies work and chat to them, so she fetched her toy pushchair and sat in that outside the kitchen while I got stuff done. Then there was the usual complicated juggle of getting two small children ready for bed simultaneously while making sure the one I'm not currently washing/brushing teeth of/getting into pyjamas isn't wandering off to find something noisy and exciting to play with. Jamie got into one of his excited forceful monologues about Super Mario brothers, but in the end I managed to get Katie into bed and Jamie outside the room to lie on the hall floor next to me and talk to his heart's content; I was expecting Katie to appear through the door and the juggling to start anew, but, fortunately, she seems to have been too tired to get up again and I had the chance to lie there next to Jamie and listen to him while his words slowed to brief jerky spurts interspersed with long pauses, like a battery running down. Another day successfully managed - just need to log into the work computer to finish off some stuff, find the energy from somewhere to exercise and shower, and then I can get to bed.
Anyone have anything in particular they either want to know about me or want my opinion on? I wouldn't mind some ideas to keep me in material at this point.
It's World Breastfeeding Week, and the theme is 'Communication'. (More accurately, the theme is the rather peculiarly worded 'Breastfeeding - A 3D Experience', with communication being the 'third dimension' we're meant to write about, and time and place of breastfeeding support being the other two. Which makes for an odd slogan, but you get the point.) I started writing a long and detailed post that I've now had on my 'really need to blog about this one' list for more years than I care to think about, and I'm still hoping to get that one up fairly soon, though I may or may not manage it in time for the end of the week. But, as I wrote, I found part of it needed to be a blog post of its own. Here it is.
It's fair to say that, despite my strong opinions on breastfeeding promotion and how it should be done, I've had minimal direct experience. This is because I work in a healthcare system where maternity care is midwife-led, and so I don't do the routine prenatal appointments that are where, in my view, it's best discussed. However, in sixteen years as a doctor, I've had a whole lot of experience with health promotion in other areas. I've had to start a lot of conversations on smoking and alcohol and diet and exercise. I've had a lot of occasions of seeing my patient's eyes glaze over as I start to speak, which has given me plenty of opportunity to think about what kinds of approaches make that happen and how to avoid it. Over the years, I've found my experience gradually formulating into a rule in my own mind: Start from where people are.
Start from where their minds already are on a particular topic, because, otherwise, anything I have to say won't touch them. When I've started talking out of my own viewpoint on a topic without acknowledging the very different viewpoint of the person sitting across from me, the mental image that has come to me has been of me sitting on one side of an abyss and yelling across to the person on the other side to climb over and join me. Why on earth should they want to? When I've found a way to climb across, meet them where they are, and see if I can look from their perspective to find a route I can point out to them, I can feel the difference in how well the consultation is going. Of course, they may well still choose not to take this route - but they're thinking about it. They're tuned in. They're listening.
A more formal term for the concept would, of course, be 'connection'. In reading about discipline and how to reach children, I've learned the importance of forming a connection with them to get the message across - which is, of course, a subject for another post, but I've realised that it works with people of any age and that this is precisely what I've been doing in my more successful consultations. Or, to phrase it the way it was always phrased for us as trainees, find out the patient's ideas-concerns-and-expectations (and, yes, we did indeed use that phrase so often it turned into one word). But the wording I still find myself repeating silently to myself when I hear myself rushing in with a generic health promotion speech to someone who isn't disposed to listen to it, is 'Start from where people are. Don't start from where people aren't - start from where they are.'
How do you do that? You find out where they are on the subject (and it may not be where you were expecting to find them). You acknowledge where they are, and the life experience that led them to that point. You think about how your advice might look through their eyes. And you see if, moving to their spot and looking at the route from their perspective, you can figure out that route from there to where you want them to be. Or to even a little bit closer to where you want them to be.
So, let's say you're a midwife or doctor seeing a woman for one of her prenatal appointments, and it's time to start talking about breastfeeding. You have your spiel on the benefits and the how-to of breastfeeding prepared, all ready to launch into. Now, let's say this woman comes from an area where just about everybody formula feeds. She herself was formula-fed, all her friends have formula-fed their babies, and she doesn't know anybody who's breastfed. She's distantly aware of breastfeeding as something that mothers in some other group that she doesn't belong to or identify with (middle-class women, maybe, or tree-hugging hippies, or just some undefined group in the Not Us category) sometimes do, but that no more impacts on her own life plans than the knowledge that some people go off and live on boats. What's going to happen when you launch into your generic spiel? It won't touch her, because there isn't any point of experience in her life that it can stick on. It'll whistle past or over her and leave her unaffected.
But if you explore her feelings with a few questions - such as "How were you planning on feeding your baby?" "How did you make that decision?" "How much do you know about breastfeeding?" or whatever else seems appropriate, then you find out where she is. You start from there. You acknowledge it, without judgement: "So, it sounds like you've never really thought about breastfeeding," and then see if you can find a way to move a few steps closer to where she is - "What would you think of finding out a bit more about it, seeing if it's something you might be interested in? After all, it's a lot more convenient when it works well, and it can cut down the chances of a lot of different illnesses for baby and you." You test the waters, you see how much she's willing to take in then, and whether she might be willing to revisit the issue. You do all this while trying to stay where she is, moving at most a step or two ahead so that you can see whether she'll move that much too.
Maybe she's somewhere worse than that as far as breastfeeding's concerned - maybe she's had a previous lousy experience and she isn't just indifferent to breastfeeding but actively hostile. Then, you can sympathise - "Oh, boy, that sounds awful! I can understand you not being too thrilled with the thought of trying again" and see if you can move forward at all from there in terms of opening up the possibility that her experience with feeding a different child might be different again. Or maybe she's someone who's potentially interested in breastfeeding, but has some specific reason for not wanting to do it. If you take the time to find out what that reason is and to acknowledge its validity, maybe you can figure out a compromise she'll be willing to try - breastfeeding for X amount of time, mixed feeding, breastfeeding with occasional supplements.
But always, always, aim to start from where she is. Because, if you do that... you've got a hell of a lot more chance that she'll be willing to move over to where you are.
"What jobs are there in the universe?" my son enquired from the bathtub.
"The universe? Oh, do you mean the university?" Jamie's explanation to my visiting mother-in-law over dinner of the different years of his primary school ("...and then there's Year 3 and then Year 4 and Year 5 and Year 6. So you're at [schoolname] for a long time") had led on to my mention that secondary school happened after that, and thence to Jamie asking, once we were upstairs for bathtime, about whether there was any more school after that and my explanation of the various options available post-school. "University isn't a job - you do jobs after you finish. Or you can do jobs instead of going to university."
"No, but what jobs are there in the university?" Jamie struggled to get his point across.
"Do you mean, what jobs do you need university to do?" Interpreting a Jamie conversation can require a certain degree of lateral thinking. "Well, lots of different ones. For example, I learnt about how to be a doctor. That's called medical school"
"What did you recognise at medical school?"
"Do you mean, what did I learn?" This translation appeared to be correct. "Lots of things. I had to learn about all the different parts of the human body - do you remember that anatomy book I showed you this morning?" (I do not, I should probably point out, make a habit of showing my son anatomy books. This had been in response to last night's bathtime query, which was about what the thing on his back was. Since it was in fact a prominent shoulder blade, I thought he might be interested in looking at some pictures, and had hauled my good old Grant's Anatomy out to look up pictures of scapulae to show him.) "I had to learn about all the bits in that. All the bones in the body, all the muscles, all the..." (I realised he wouldn't know the word 'organs') "...all the different bits. And..."
"Did you learn about these bits?" Jamie indicated the bits in question.
"Testicles? Yes, I had to learn about those as well."
"What colour are they?"
"Um, pink, I think." Testicular colour had not, in fact, been on the curriculum at medical school, as far as I could recall. I wished he'd asked me about possible causes of testicular pain or swelling, which I'd have felt much better equipped to answer.
"I want to know," Jamie explained, "so that if anyone asks me what colour my, um, tentacles are, I can tell them."
I am all in favour of being prepared for all possible conversational as well as other eventualities, but did feel able to reassure him that I was 99.999999% sure that nobody was ever going to ask him what colour his testicles were. However, out of interest, I did ask about it on the urology forum of the medical website where I ask all my medical questions and in reply got three rather good jokes, one related Amusing Child Anecdote, one photo, one groan from a doctor who'd been looking at the photo when his daughter came in and demanded to know what those were, some interesting information on the different colours they turn in pathological situations, and the actual answer. Which is, just in case anyone ever asks you what colour your testicles are, grey and white with a white membrane round the outside. So glad to have been able to help; I always wanted to contribute to increasing the world's store of general knowledge, although it is fair to say that this is not quite what I had in mind.
One 'Now that I've taken up all of the appointment time with other matters could I just mention this potentially serious eye problem that you are not going to be able to ignore and will have to spend extra time dealing with', one late arrival (not her fault, in all fairness - she got caught in a traffic jam), two referrals, and one please-expedite-this-patient's-appointment letter. It could have been a hell of a lot worse. I finished surgery at 5.35 and finished off everything else shortly after six. I've had later departures than that on normal days. I loaded my last few things into a bag, took the sunflower picture off the wall, took one last long look at the room I'd worked in for almost five years, said my last goodbyes to the other people in the building, and left. And I'm done.
On Wednesday, I can start dealing with the learning curve I've got ahead of me - new patients, new computer system, new referral procedures, new hospitals to refer to, all in a building so large I should probably take a map, a compass, and three days rations with me every time I try to navigate it. I can do all of that. The great thing about tidying your desk, apart of course from having a tidy desk, is that after that you know you can do anything.
Somewhere in the middle of all this, I'm about to turn forty. I haven't actually had time to think about this very much what with all the other change going on, but it seemed worthy of passing mention. It's odd to think that this time ten years ago I was still a trainee GP commuting back and forth to a long-distance boyfriend who I hoped would turn out to be the one for me. Ten years, two postgraduate qualifications, two jobs, one wedding and two children later, I can say that it's been a darned good decade.
Well, despite the whole business with the computer going down over the weekend when I was trying to catch up, and despite me getting in to work to discover that the head receptionist and the health care assistant were both off sick, and despite the failing fluorescent light in my room that has been flickering on and off all day in seizure-inducing fashion... I have, in fact, had a very reasonable day. And, by 2.36 p.m. this afternoon, I printed off the last prescription, completed the last pending comment in a patient's notes, and pronounced myself caught up. I went for a walk to celebrate.
(One item that I missed from the list of things that were personal and important enough to me to leave on my desk right through to the end was my Edward Monkton desk calendar, an endearingly quirky set of cartoons and comments about life. June's comment is "The little bags of magic say there is NOTHING that they cannot do." It has been my inspiration for the past few days, and I am now beginning to believe it.)
I have eleven patients left to see today (one of them has a double appointment booked), and I am not underestimating the potential of the afternoon surgery to wreak utter havoc on the day. But I have the satisfaction of knowing that, for once in my life, I enter the fray with a clean slate, fully caught up.
For some weeks now, people have been asking me when I'm due to start the new job and then drawing in their breath on hearing that the answer is two days after I finish the old job. So soon! they exclaim. No time off in between? I have to admit to being a bit baffled by this viewpoint; if I didn't have this job and was simply turning up for my current one as usual on Wednesday, would anyone be amazed that I hadn't taken some arbitrary break to recuperate?
It's not time off after this job ends that I've been feeling in need of, but time off to catch up before it ends. I had this whole grand plan as to how the final weeks would go - spare moments during days in work would be spent catching up on the things requiring my physical presence (my inbox, my desk, phone calls), and evenings would be spent catching up on letters (we have the GettomyPC programme, which lets us log in in the evenings), thus bringing me to this weekend with only a couple of days' worth of letters to do, which I would then catch up on over the weekend, leaving me able to walk in on Monday with a clean slate and only having to do whatever came up on Monday before leaving. Which might, of course, still be enough to keep me working late, but at least hopefully not too late. I'm closer to that plan than I'd expected, but it's been darned hard work.
One hitch has been work's computer system crashing over the Bank Holiday weekend, putting a severe crimp in my plans to catch up on the long list of letters that had built up over the previous two days. I shrugged at Fate's vagaries, did as much as I could from memory and from Docman (the system for storing the hospital letters, fortunately separate from the one we use for consultations and not subject to its many nosedives), and determinedly fought the to-do list back down to nothing on the Tuesday and Wednesday evenings. The other hitch was our drastic current state of understaffedness. On Thursday, I had about twenty minutes to work on clearing my inbox before having to deal with a pile of prescriptions that took over an hour to work through, a morning surgery that went on until almost two in the afternoon, and two visits and multiple phone calls before having to drive over to our branch surgery and start afternoon surgery there almost an hour late. Things then calmed down enough that I did just barely manage to at least get the results and incoming letters looked at before leaving, but I was further from getting everything else cleared than I had been when I started the day.
(This may be an apt moment to mention that it occurred to me recently that I hadn't actually seen any prospective candidates for my job being shown round or introduced to me at any point, and that the evidence appeared to point to the conclusion that the practice wasn't actually replacing me. I inquired about this when I ran across the practice manager and assistant manager on the Thursday, and they exchanged somewhat blank glances, apparently trying to remember whether they had at any time in the past three months gone through the process of advertising the job, interviewing prospective applicants, and appointing one to start next week and whether this might simply have temporarily slipped their minds. I think we can take it that this is a 'no', so it looks as though my already overworked colleagues are going to have to somehow struggle on with one more full-time member of staff gone, and how in blue bloody blazes the manager and assistant manager imagine that's going to happen given the current state of affairs I can't begin to imagine. I'm deeply glad that it will no longer be my problem, but I don't half feel sorry for the people still there who are somehow going to have to deal with it all.)
On Thursday evening, I logged on and caught up on as many more referral letters as I could (they had built up again during the day. Considerably.) On Friday I got in shortly after seven in the morning, left at almost six in the evening, and spent almost every minute I could squeeze around consultation time in the intervening near-eleven hours on clearing the things I had to clear. And I did it. Just before leaving I made the final phone call that let me drop a message into the pile for shredding, cleared the last few extraneous pieces of paper from the last pile on my desk, and left with five years worth of random bits and pieces in my car and a (relatively) tidy desk. The last was what really brought it home to me; this is it, for real, for good. When I next make that journey home, it'll be the last time. I logged on again that evening to work through more of the referrals, spent Saturday in a comfortable glow of achievement/haze of sleep deprivation, and logged on on Saturday evening to find the system had crashed again. Of course. I tried to get through to the practice manager several times today, but with no luck, and the assistant manager is on holiday, so the last few referrals remain undone. It's only twenty or thirty minutes worth of work, but that's going to be enough to be somewhat annoying if I end up having to do it after work when I'm supposed to be leaving. So be it; quantum in me fuit.
I've left the essentials at work, plus the few things that were enough of me that I wanted them to stay right up until the end. The electronic doodad with the photos of the kids on that Barry gave me for my birthday a year or two back; the belatedly hung sunflower picture; my Edward Monkton desk calendar; the miniature globe that I spin to distract fractious babies for the few minutes it takes to listen to their chests; the tube of bubble mixture I used to use for the same purpose (one of the things I've stopped doing in recent years, as my life got busier and more rushed); my portable blood pressure cuff, my box of Kleenex, the soap substitute I use to spare my skin, my Vaseline bottle. In a lifetime ruled by extraneous junk I never seem able to clear, it's good to have a moment in which part of my life is boiled down to its essentials.
I've left jobs before; plenty of them. In SHO years, it's the way things work - a standard training post lasts six months, occasionally a year if you're really up for commitment. I was an SHO longer than most, rambling around the different specialties to gain experience in as many as I could before settling into GP-dom, and so for years of my life I was starting jobs with the end date already fixed for the not-so-distant future. Then there was my first GP job, where I effectively only found out in retrospect that I'd left. (I went on maternity leave, interviewed successfully for my current job while I was away, got offered the job just before I was due back at the one I had at the time, and went back only to work out my three months' notice. Since I was working for a PCT and not for an actual practice, they decided not to bother sending me back to the practice I was at just for three months, and sent me to a different one instead, so I found my departure on maternity leave rather unexpectedly converted into a permanent one. I always felt sorry for the many regular patients of mine whom I'd assured in all good faith that I'd be back.) Then there was the three-month post at an understaffed, overworked practice that the PCT had me do to work out my notice and that I left with no regrets whatsoever, and then, of course, there was this one. At a few weeks short of five years, it is (albeit only by a few months) my current record time spent in employment at one place, and the first long-term job I've ever left in the foreknowledge that I was going to do so. It has been, for all its faults, a damn good job, and I've enjoyed doing it. And now, I'm ready - bar a few remaining referral letters - to leave it and move on to life's next adventure.
All of a sudden, I seem to have an alarmingly small number of days left to work in my current job. Not only is June 7th approaching with haste, but I also had a bunch of annual leave owing that I was going to have to use now or lose, so I've ended up just booking it wherever it could be fitted in. This means I've been off last week and the beginning of this week, I'll be back for Thursday and Friday, then off for five days (Bank Holiday weekend plus my usual Tuesday off plus annual leave on Wednesday), then back for Thursday, Friday, and Monday... and then finito. (Technically, Tuesday 8th will be my last day, but since I don't work on that day it's a bit of a moot point.) It was something of a shock to realise, at the end of the week before last, that although I still had just over three weeks to go in my job by the calendar (which, of course, is an eternity and nothing to get too worked up about) I only had five days of actual work during that time. Gulp.
I can't actually remember the last time I took this much annual leave in one go. My usual practice is to try to spread it out as much as possible, partly through inclination and partly as a response to the practicalities of having two different lots of family in two different distant locations to visit - we can do that more often if I take a lot of long weekends. I have to say, there is something particularly relaxing about knowing that not only do I have the whole week off but I also have an extra few days after that. Instead of spending last week knowing that all this relaxation was all very well but next week it would be back to business as usual with a full working week, I got to spend it knowing that I would still be off for the first three days of the week, and that I'd then only have two days back before being off again for several more days. This is a near-unheard of luxury in my life, and I cherished it.
So, with all this time off, what I've been doing with it has been going back into work. Only on a couple of days, of course. The rest of the time I've been toilet-training Katie (a project that I was putting off until after the wedding and thus now have to actually get on and do), and alternately catching up on other stuff I've been meaning to do and relaxing. But I have the usual enormous stack of things in the general category of Put Aside To Deal With Later, and, now that I'm rapidly running out of later, I need to catch up. Hence, last Friday and this Monday, after dropping Jamie off at school, I went in to work and devoted a few hours to clearing both my virtual and physical inboxes. This is not nearly as bad a way to spend your holiday as it sounds, because it's darned good just to have the chance to sit down in the knowledge that you will remain absolutely uninterrupted by other responsibilities for the next few hours and actually crack on with all that stuff that is, admittedly, hellishly boring to deal with but isn't all that great to have looming over your head as undone work either. Being able to focus on clearing a load of it out of the way was damned good.
This has worked pretty effectively. While there are still a few items that for various reasons didn't get sorted out on those days, not to mention just over two years' worth of clutter on my desk awaiting clearing (I can date the duration with precision, since I last cleared my desk just before going off on maternity leave and hence do at least know that the current clutter has all accumulated since I returned), it is now looking at least somewhat feasible that I will have everything done and dusted by June 7th and be able to walk out at a not-desperately-unreasonable hour that evening with a clear desk, inbox, and conscience. Whereupon, of course, I will start my new job with a new leaf thoroughly turned over and spend the rest of my life being super-organised and getting everything done when I'm supposed to (pausing only to dodge the flying pigs).
So, the goal of getting caught up on work is going fairly successfully. So indeed is the goal of getting Katie toilet-trained (without wishing to burden you with too much detail, I am pleased to say that just over a week into the process we are getting more successes than failures and she clearly has a good general grasp of the whole issue). So is the goal of relaxing. Last Wednesday, Jamie's school were offering parents of children in the Reception classes the chance to come in and join the children for lunch, so I did that and stayed for the rest of the lunch break. Which meant that, after a quick flashback to the school dinner halls of my childhood, I got to spend a glorious half-hour running around with three five-year-olds, practicing handstands, rolling down a hill, and jumping into a former sandpit. I didn't have nearly this much fun when I was five.
I have also been ordering research articles. And ordering research articles and ordering research articles and ordering research articles. What, you thought all those articles I report back on in my efforts to provide evidence-based posts on parenting controversies were just lying around waiting for me to pick them up? They are obtained for me by the wonderful staff at the library of our local hospital, who have, over the past five years, ordered dozens of articles on breastfeeding and sleep training and cortisol levels in children and all sorts of things of equally limited relevance to general practice, all without batting an eyelid at my requests. I'll technically have the option of doing the same in my new job, but, of course, there's no guarantee that the librarians I'll be dealing with will be quite as happy as the ones at this hospital to order large numbers of articles on whatever I might happen to be arguing about on the Internet with no questions asked as to what all of this actually has to do with my clinical practice. I'm working on the basis that if there are any studies I really want to read, I'd better order them now. Since the number of studies that could potentially fit that description is almost unbelievably vast, I have been spending whatever spare minutes I can get on poring over review papers and meta-analyses and scribbling out request forms by the score. Give it another few years, and I may even get around to reading them all.
The other thing I've done is something I've been meaning to do for the entire almost-five years I've been working in my current job; I finally got round to hanging the sunflower picture in my room at work. I am not kidding about this. Five years of meaning to get a job done, and, with only five days to go, I finally do it. I bring new levels of meaning to the term 'better late than never'. Well, either that or to the term 'completely bloody mental'. I'm not oblivious to the fact that the sensible thing to have done at this stage would have been to leave it and save myself the trouble, and for a while I planned to do just that. But that little room has been my domain for the past five years and, while it may be small and crowded and awkward and a complete nightmare to get a wheelchair or pushchair into, it's still mine, and I've been feeling sad at the realisation of how little I ever did to mark it out as my individual little bit of space. This was my last chance to do so, and, in the end, I didn't want to miss it. So I took down the Edwardian-style picture of children playing blind man's buff that I never ever liked, and hung my giant framed Anne Worthington sunflower print in its place. For the five final days that I work in that room, the patients will have something to look at that's beautiful, eye-catching, and a statement of my individuality. For my five final days in that room, I'll know that it's properly marked as mine.
I do realise that my new initiative of getting myself to blog more by following the inspirations of the writing workshops and breastfeeding carnivals is, unfortunately, proving to have the drawback that I never seem to find time to blog about anything but writing workshops and breastfeeding carnivals, and thus am now not only neglecting my children for my blog, I'm even neglecting to blog about them for my blog. So, really, the decent thing to do would be to give the Writing Workshop a miss this week. However, twelve years ago I had a six-month live-in SHO job at St George's Hospital in Morpeth, and living there was the kind of experience that I've always felt deserved its very own blog post despite being nothing whatsoever to do with my life today, and hence I've been just waiting for Josie to have 'Tell us about an interesting place you used to live' as one of her workshop prompts so that I have an excuse. She hasn't, but her second one this week is 'Tell me about somewhere you used to work', which is just as good a lead-in for this topic, and I could not resist the opportunity. The kids can wait to be blogged about. What the hell - they'll still be cute next week.
St George's is a large psychiatric hospital in a very small town in Northumberland. It was built back in the Victorian era, isolated on the top of a hill, a throwback to the days when people with mental illnesses were shipped off to the asylum and never seen again. (I understand that 'going up the hill' was the local colloquialism for 'losing your mind'. One inpatient told me ruefully of his moment of doing something absent-minded and automatically thinking to himself "You'll be going up the hill at this rate!" before it hit him that he was in fact already there.) I arrived there very late on a Tuesday night, four days after the last-minute interview at which I'd seen the hospital for the first time and nine and a half hours before I was due to start my six-month stint as a junior doctor there. The grounds were dark and deserted, the beautiful place I'd seen in bright sunshine at my interview a mere memory to augment the shadowy building I could see. I presented myself at the main reception just inside the front door and the receptionist/switchboard operator called for the caretaker, who set off in his van with me following and drove half a mile past half-seen outbuildings before pulling up outside a door and leading me through it, through a huge hall with rooms either side, and up two very long flights of stairs to the door at the top. I wondered how long it would take me to find my way back to the main building in the morning; it was only in the morning that I realised I was still in the main building and had simply been taken round to a handy parking space at the back of it.
It had been a busy few days. This was at the time when junior doctors with too much wanderlust to sign up for a three-year training scheme in one place could take matters into their own hands and apply for each of their six-month posts individually as they went along; a far more exciting way of doing things, as long as you could live with the constant interviews, with the uncertainty as to where or when or whether you'd be working at the end of whatever post you were currently doing, with the chance that you'd one day find yourself moving almost two hundred miles on four days notice. For me, all those things ultimately just added to the fun of it; but it had been an anxious and confidence-rocking few months of scouring the BMJ careers supplements and being turned down at interview after interview, followed by a mad whirl of activity after St George gave me the last minute job; packing all my stuff, taking back library books, arranging for my mail to be forwarded, all on top of 8 - 4 shifts on the Monday and Tuesday at the A&E department where I worked in Liverpool. I did get away from my Tuesday shift early, got back to the house where I rented a room, nibbled rapidly at the sandwich I'd been too excited and busy to eat at lunchtime, and spent an hour heading up and down stairs loading everything into my car that would fit. (I'd given the landlord a month's notice on my room - everything I couldn't take with me would stay locked in there for as much of that month as it would take me to arrange to get back with a van.) It wasn't until seven o'clock that I'd said goodbye to my housemates and got into the car for my journey away from the city where I'd learned my trade and lived for almost eight years. I remember that 'We Built This City On Rock And Roll' was playing on Liverpool's local channel as I drove down the M62 for the last time, and I kept it tuned to the channel for as long as I could, until the last of the song faded into indistinguishable static. And then I drove on into my new life. That was where I was coming from when I got to St George's.
In the days that followed, I got to know the hospital. The main building was a huge, sprawling, red brick creation, surrounded by outbuildings holding various wards and a handful of sheltered accommodation-type places for patients with long-term mental health problems, all set in grounds so beautiful they could have been a famous park or the garden of a stately home. The whole lot was magnificent. It was like living in a mansion; I used to stand outside and admire it and marvel at the fact that I lived here.
And it was mostly empty, a relic of a bygone age. The two acute wards were in a much newer outbuilding, as was the higher-security unit; there were also innumerable long-stay wards for people with various shades of long-term mental health problems or dementia. (When I say 'innumerable', I mean it fairly literally. We had, of course, a list of what wards were where and what variety of patients they were meant to contain, but on one on-call I had a bleep to come and see a patient on a ward that I'd never heard of before. I followed their directions and found them buried in the main building, their existence hitherto entirely unsuspected by myself and by, apparently, whoever had the job of compiling the complete list of wards at the hospital. The ward appeared to be thriving and entirely unbothered by having their existence generally ignored. I daresay someone more official than me must have been aware of them, but that didn't stop me coming up with mental images of them surviving by growing their own food in window boxes and on bathroom flannels and simply never dealing with the outside world at all. Well, except when they had to call the on-call doctor for something.) But most of the wards were in the outbuildings. Apart from one long-stay ward that I covered, the Mystery Secret Ward that I saw just that once, and, I suppose theoretically, any other Mystery Secret Wards that were similarly hidden away and that I never did get bleeped to (in that building, anything was possible), the main building stood empty.
It was huge. It was Gothic. It rambled and sprawled. Late at night I would wander around it, unlocking doors with the master key to explore the hidden corners, feeling like the prison warder walking the corridors in the opening credits of 'Prisoner: Cell Block H'. (Just to relieve any misunderstandings caused by that last, I would like to clarify that I didn't watch 'Prisoner: Cell Block H', or at least not deliberately - I just had a boyfriend who did.) It reminded me (to switch comparisons completely) of the girls' comic story I used to read as a child about the orphan who lived hidden away in the basement of a huge theatre, using her knowledge of all its secrets to spy on and help the performers who worked there. Admittedly I never actually found much in the way of secrets other than the Mystery Hidden Ward, but, then again, I always felt like one of the secrets. In that huge building of wards and empty rooms, few people knew about the doctors' flat hidden up at the top, where I lived and from whence I crept out in the evenings to explore. It was like being the mad person hidden away in the attic in Victorian novels, only in reverse.
I would unlock the door of the hospital library on the ground floor and look round there. Not that there was anything very exciting there unless you happen to enjoy poking through a few years' worth of back issues of a few journals and a motley handful of books about psychiatry (and don't knock it - it filled in a few slow evenings), but it was the principle of the thing; how cool is it to know that you live in a place that has its own personal library? I checked out the gym, although unfortunately it had been shut due to health and safety issues and so I never actually used it, but ditto the above comment. (Health and safety issues, by the way, do become more of an issue when you live in a hospital. One Friday afternoon, I received a call telling me that my freezer had failed the routine safety testing and had to be switched off immediately. If I'd lived in a house I'd probably have kept on using it for years, quite unsuspectingly; as it was, I had to make a hasty trip to the nearest Comet to buy another freezer, while meanwhile the hospital staff helpfully allowed me to keep my frozen food in the occupational therapy department's freezer so that it didn't go off over the weekend, and I just had to do without ice cream that weekend, to my extreme chagrin. My father was quite tickled by the thought of my food spending the weekend in occupational therapy. "So will your frozen peas come back knowing how to weave baskets?" he inquired.)
I loved my little flat, but, looking back, it was pretty obviously originally designed for people to spend on-calls in rather than live in; the three bedrooms were large and comfortable, but there was no living room, the kitchen was a tiny slip of a room, the bathroom was standard-issue institution, and there was no washing machine. The first three weren't a problem to me but the last was; Morpeth didn't have a launderette, and I had no intention of spending six months schlepping all my dirty laundry to another town to wash it or washing it by hand. I brought the problem up with the hospital administrators and they agreed I could use the washing machine on the acute ward - the one the patients used for their own laundry. Carrying an open box of washing powder over there without spilling it was a minor nuisance, so, as there was a locked walk-in cupboard in the laundry room that could be opened with the master key, I kept my washing powder over there. On one occasion, I put the washing powder back and walked out of the cupboard to see one of my patients coming into the room; we exchanged nods and hellos and I headed off. "I've just seen Dr W__ coming out of a cupboard in the laundry room," he commented to a staff member. The staff were most relieved when I confirmed the next day that this had indeed been the case; they'd been worried the man was hallucinating.
By the way, one other benefit of the flat worthy of mention was that no-one ever seemed to charge me anything to live there. It was initially agreed that I'd have it at a fairly nominal rate, but nobody ever asked me for any money and, as far as I could see from looking at my pay slips, nobody ever seemed to remember to dock the rent from my pay either. I spent six months living in a Gothic mansion in stunningly beautiful settings absolutely free of charge. Life does not come much better than that.
I recognise that I'm not saying much about the actual job in the midst of all this raving about what a great place it was to live, but I did love the job as well. The life of a trainee GP doing hospital posts is one of forever being the lowest on the totem pole, forever moving on just as you get the hang of one specialty and one hospital, forever being a learner. On top of that, I'd mostly done acute posts up till then - obstetrics and gynaecology, A&E, the usual house officer jobs - the kind of jobs that involve a lot of rushing around and quick decisions, which is not a pace that comes naturally to me. Psychiatry works at a whole different speed ('urgent' means 'try to make it later on today'; taking a basic history can take a full hour without anyone thinking you're taking too long), and the specialty suited my temperament much better. I liked having the time to spend to listen to people, and liked doing something that I actually seemed to be good at for once, and liked not feeling so darned rushed the whole time. On top of that, I'd picked up enough general knowledge along the way that I was finally starting to feel like a useful doctor. It was a good six months.
I was there for New Year's Eve, 1997. I spent the evening stitching together the sweater I'd been knitting over the past couple of months, finished it a little while before midnight, and strolled over to the ward to see the New Year in with the patients. They were trying to switch the TV on - it was a fairly old one that took several minutes to warm up and for a few minutes it was touch and go whether we'd get a transmission in time to hear the chimes at midnight, but the TV just managed it and my patients and I watched Big Ben together and wished each other heartfelt Happy New Years and I exchanged celebratory hugs and smiles with a personality-disordered self-harmer, the two of us finding a contented moment of common ground. My all-time favourite New Year's Eve celebration was the one in 1999; 1997 is a close second.
I left St George's on a Tuesday evening. This time, I'd succeeded in getting my next job - a palliative care post at a hospice in Nottinghamshire - in plenty of time to find a flat and move the bulk of my stuff into it. I packed my last few things up after work while talking to the new SHO who'd turned up at the flat ready for her job the next day, got into my car, and drove away. I stopped off at the Metro, Newcastle's giant shopping centre; I wanted to take my last chance to ride the funfair rides there. Then I drove south, onward to the hills of the Peak District, to the town of Mansfield, to life's next set of adventures.
A few days ago, faced with the imminent end of the year and the impetus to rush to get things organised that that usually triggers (Hurry! Hurry! Time running out for anything you want to feel you've achieved in 2009!), I thought it over and concluded that the three things I really wanted to get done before the year ended were:
1. Catch up on my accounts
2. Catch up on my letters and other paperwork at work
3. Get a blog post up for this month.
Which was, of course, like saying that what I'd really like to do right now would be to travel around the world - very nice to daydream about, but not actually anything that's going to happen in real life.
However, I then spent the past few days turning into a whirlwind of speed and efficiency. Intermittently. Between long periods of child-watching, website-reading, or just plain torpor. But I spent my evenings logging on to the work computer (it's set up so that we can log in by remote control) trying to get letters done a few at a time. On Tuesday, while Katie napped and Jamie went down to the shops with Barry, I blasted through I'm-not-even-going-to-tell-you-how-many-months of bank statement reconciling and ticked no. 1 off my list. On Wednesday, I spent the day catching up on as much paperwork as possible. By this morning, I had three letters and half an insurance form left to do. By 7.30, I was at my desk typing, interrupted only by the need to sign the usual stack of prescriptions and see someone who turned up before surgery as an urgent extra. Six hours later, after seeing a million patients (OK, we had a couple of no-shows, it was actually only nine hundred and ninety-nine thousand nine hundred and ninety-eight) and phoning five more about various things and checking results and scribbling madly on forms in every spare minute between patients (or while waiting for patients to get undressed, or for the automated cuff to take their blood pressure...), I was done. Apart from the two visits, which took an extra hour. And the time to log them onto the computer from home afterwards (we closed at 1.00 for the New Year's holiday. Theoretically, anyway, though with the number of patients that had been booked and the number who booked in as urgent extras it was in fact somewhat after that, not even counting the extra hours for visits.) And one incoming letter that I hadn't had a chance to summarise in the notes and had to do from home as well. But apart from that? Done. The pending letters, the extra couple that arose from the day's work, even the darned insurance form. Done done done. I drove home for my afternoon off with a light heart.
So, there you have it. Nos 1 and 2 satisfactorily crossed off my to-do shortlist, and if I can manage to hit 'Post' on this any time within the next twenty-four minutes it'll be three for three. I can end the year, highly unlike the way I spent almost all of it, bathed in a warmly satisfied glow of achievement.