Four Easy Pieces

The dentist offered to extract the offending wisdom tooth. I decided I could live with one gum infection a year - give me a course of augmentin over the risk of facial nerve injury anytime.

Walking home from the dental surgery, I realised I had just seen the 'other side' of the consultation. Less than 24 hours earlier, I had been trying to convince a 13 year-old and her mother that she should get part of her brain removed (that is, emphasising that they must attend the neurosurgery appointment this time), and then wondered why they were so reluctant about it.

*************************************

We've had a run of patients with "severe seizure disorder, global developmental delay, recurrent respiratory tract infections" discharged back to us from the paediatric intensive care unit (PICU) recently. Despite the fact that they do very little (mostly sit or lie motionless waiting for the next Physio session, or for the sats monitor to go off and a nurse to come running with a suction catheter) they make pretty demanding inpatients. A combination of repeated PICU admissions and limb disuse and spasticity means their veins are almost impossible to cannulate - and they always seem to be on a cocktail of intravenous antibiotics. They don't eat - they are fed by gastrostomy, and may also be on the ketogenic diet for seizure control. Some don't pee - requiring intermittent bladder catheterisation. The weekly consultant ward round (it is only weekly because most of the other inpatients are either undergoing neuro-rehabilitation or are under other paediatric teams) begins to resemble a ward round in Geriatrics.

******************************************

I left work at nearly 11pm yesterday. My sunday shift ended at around 9, but because it had been a busy week (9 sick/fitting inpatients instead of the usual 3 neuro-rehabs, 2 lumbar punctures under GA and all the usual clinics) I hadn't yet dictated my clinic letters. I knew that my week of leave would be guilt-tinged if I left them, so I deposited my cycling stuff in the office and went across the road to get a biriyani. (bit of a dilemma choosing between the 4 Bangladeshi takeways on the junction) So I've faxed off my EEG requests and my Opthalmology referrals, and all my patients' GPs shall soon be updated on their headache/seizure/etc management.

*********************************************

It is ironic that just as I am in a specialty that really interests me, and working with a great team who make me feel valued, I may soon be out of a job. I've not fared at all well in the MTAS lottery, and have been crying myself to sleep every night. I decided at the age of 11 that I wanted to be a doctor, and have worked extremely hard at it since. I have a first-class intercalated degree, and am published in two international medical journals, though I only graduated in 2004. I am coming to the end of a clincal rotation that has given me a rich experience in paediatrics in a colourful part of London, and have only one remaining postgraduate exam to pass. Please give me a chance. I have so much to offer paediatrics, to offer medicine, to offer the world (maybe) - if only I could get some proper specialist training.

*********************************************