"Writing about music is like dancing about architecture"
In a largely successful bid to annoy myself, I've been reading various publications' "Top Albums of 2009" lists. The main difference this year is that Spotify puts much of this music instantly at my fingertips, and so I'm in more of a position to form my own opinion.
Opinion? I think you'll find here that objectively, Merriweather Post Pavilion by Animal Collective was the best album of 2009. It's certainly been a recurring theme in all of these definitive lists. Which makes me wonder how many people heard a number of albums last year, and thought, "Yes, that is my favourite album of all those that I have heard this year." It seems a theme that often these albums will get a "pretty good" review when they are released, only to be heralded as better than all those albums that got 5 hundred stars come the end of the year.
Elbow are a good case. I love Elbow, and think that their third album "Leaders of the Free World" is possibly my favourite album ever. It didn't fair too well in end of the year lists back in 2005. "Seldom Seen Kid" is also wonderful, but fairly similar and by no means a grand leap forward. But for some reason (Mercury Music Prize?) it featured in almost every critic's top 10 list last year... A lot of it seems to be whoever is new, and whoever is vogue at the time. Do you remember Arctic Monkeys? They released an album this year, pretty much on a par with all their previous work whilst trying out new ideas. I haven't found it on any lists as yet...
Anyway, no-one really cares which my favourite albums of 2009 were, but it's my blog so I'm going to tell you anyway. So, in no particular order:
Mumford & Sons - Sigh No More
Possibly my favourite - to be fair I haven't been listening to it for as long as some of the others. For a list like that to be fair, I think you'd have to wait 5 years before creating it. That's an interesting idea actually... Anyway, this is sublime folk, consistently memorable, melodic songs performed with passion. And they're from West London, although appear to have accomplished a bit more than me...
The Decemberists - The Hazards of Love
It sounds a bit pretentious, with a "prelude" and everything, but then I have a real weakness for this Americana/Alternative Country sound.
Jamie T - Kings & Queens
Didn't like him first time around, but when I read a good review of this album I decided to give it a try and was quickly hooked by the milk-bottle percussion and atmospheric guitar sounds of the first track "368". The vocal delivery stops grating once you get used to it, and really there isn't anyone else that sounds like this, is there?
Animal Collective - Merriweather Post Pavillion
Not entirely sure how I feel about this record. I love "Summertime Clothes", and always love bands that use a lot of harmonies. But, a bit like TV on the Radio, I can see that they're good and understand why they're praised, but I admire them more than love them.
The Yeah Yeah Yeahs - It's Blitz
In my snobbish ways, I tend to like bands like this before or after they're popular, which could explain why I like them again now. But these songs are so catchy, with the kind of energy that makes you strut around the room when you listen to them.
The Mummers - Tale to Tell
I loved this album first time around - it's melodic and orchestral so very much to my taste. I still like it a lot, but it's a bit lacking in depth to keep bringing me back to it again and again. Still, the singer has a strong voice, and the songs are strong. If I was being a critic, I'd say something like "Tindersticks meets Bjork". Yeah.
Wilco - Wilco
Wilco are a band I should love - I adore Lambchop, and Wilco come up as "similar artists". But I don't, and my main problem is the dude's voice. Other than that they have good sound, and this album is my favourite of theirs so far. Good songwriting usually wins the day.
Florence & The Machine - Lungs
Tipped for great things, people had mostly got bored of her by the end of the year - or at least that was my perception of things surrounding Florence. She tends to over sing, but you can't really argue with songs like "Dog Days Are Over."
Kasabian - West Ryder Pauper Lunatic Asylum
A band that I never particularly liked before, but I decided to give them another chance after hearing "Where Did All The Love Go", which I still think is my favourite song of the year. Particularly impressive when I saw them at Big Day Out festival.
Sweet Billy Pilgrim - Twice Born Men
A very subdued, mordant affair so you have to be in the right mood for it, but when you are then it's very pretty, very enjoyable misery.
Noah & The Whale - The First Days of Spring
Possibly the least subtle break up album ever, but holds together nicely with some very nice orchestral touches.
Boxer Rebellion - Union
Another possible favourite. The only album I was surprised to see so completely unacknowledged in the lists. They sound like a far better version of The Editors, but with an excellent singer with an incredible range and real emotion in his voice. There was even a "success" against the odds story, when they had to release it themselves with no budget after their old label collapsed. Anyway, a very atmospheric sound, with soaring lead-guitar lines and fantastic mix of the melodic with crunching, heavy guitars. Love it.
Hockey - Mind Chaos
There's a real charm to this band, and a real energy to their songs. Check out "Too Fake" and "Song Away" and dance happily around your room.
God Help The Girl - God Help The Girl
I was initially unimpressed by this vanity project from a personal hero, Stuart Murdoch of Belle and Sebastian. But then I was drawn in by the quality of the songs. If you start listening from "If you could speak", you'll see that it's as strong as anything B&S have done.
The Invisible - The Invisible
When I listen to stuff like this, I think that it's a shame that R&B is dominated by the slick production and slimy superstars of today's charts. It has soul, it's funky, and it's all sung by a singer with real richness in his voice.
White Lies - To Lose My Life
iTunes says this was released in 2009, but Spotify says 2008. So not sure if it's a valid choice, but this band has a great sound and some great songs.
Emmy the Great - First Love
Occasionally seems like she's being quirky for the sake of being quirky, but she keeps it interesting and clearly puts a lot of thought into her songwriting. Which is what it's all about...
Gomez - A New Tide
I saw Gomez live this year, and loved every moment of it. This is a band that have been playing together for years, and it shows. What a amazing singer Ben Ottewell is! And they harmonise so perfectly. So yeah, I love Gomez. This album is solid rather than spectacular, but it's Gomez, so I'm happy.
Eels - Hombre Lobo
Again, Eels aren't new or fashionable, so why should this superb album be mentioned on end of the year lists? But it's brilliant - simple songs with clear attention to how the album hangs together as a whole. There can't be many bands with as strong a back catalogue as Eels.
The Horrors - Primary Colours
I was aware of the Horrors without really knowing what they sounded like. Then I made a playlist of all the Mercury Music albums available on Spotify, and this was the one that really surprised me. It glories in its discordance in that arty way, but the end result is a real success.
So that's that. I feel slightly empty now, in that way you do when you've spent the best part of an hour and a half doing something really pointless...
9.2.10
6.2.10
Woke Up This Morning
"I just want to be friends. Plus a bit more. Plus I love you."
So, new dream life plan. I live in San Francisco, where all my family and friends have also moved, writing for American TV in the cool cafe that I also own and run and bake cheesecake for.
Joy! Of course, a close second dream life plan is the one where I live in New Zealand, and work in a local ED. And eat cheesecake. I think I might bake cheesecake later...
Fairly average night last night. Many highlights - most involved verifying random claims on Wikipedia. I saw one guy who had been dropped on his head by a friend at an AC/DC concert. This led K to ask me if the lead singer of AC/DC was a serial killer. When R the nurse didn't know, I looked it up on Wikipedia. There was no mention of it in the band's biography, which I think means K might have been right...
I see a lot of head injuries, and hardly any of the patients are knocked out by them. That's real life people - that film you saw where someone was knocked out because a leaf fell on their head is not quite accurate. I'm sure Wikipedia will verify that for me. Hang on...
Anyhoo. I also saw broken clavicle guy, who had a lot of questions. "Should I take my sling off when I put my shirt on." Um... I'm going to go with yes. Common sense in an confident, knowledgable tone. That's what I go for when Wikipedia can't give me the answer. Or when D doesn't come along and tell my patient that 95% of collar bone fractures heal perfectly.
"Well, pretty well. Well, you'll probably have a lump there."
"What stops the 5% from healing?" Again with the questions.
"They almost all heal. Yours will almost definitely heal. Probably."
D's ok. Someone told me not to learn people skills from him. I like K too - he gave me a very enthusiastic greeting last night which made me glad to have made the decision to go to work last night. (It was a close one.) There was a good moment yesterday when D and I were talking yesterday about books. I think it started when a nurse told us about a book called, "The only way to quit smoking" which I thought was a genius title for a book - instant bestseller. Which somehow led to us talking about Harry Potter, and me checking with...um... some website or other to see if J.K. Rowling used to be a teacher. And then D said, "I wonder what I could write a book about." And for some reason I found that absolutely hilarious.
What else did I see yesterday? Not much really. It started so so busy, but the department was pretty much empty by 4am. Such is nights. A man who's soft toys talk to him and tell him to take overdoses of Neurofen Plus. Only he often takes 60 tablets a day, so really 24 tablets yesterday was an under-dose for him. And then he asked me if he should be on methadone to help with his addiction to Neurofen Plus? I went with no. Didn't need to look that one up. I did once like psychiatry, but it will take me many more rejection emails before I think that way again.
Anyway, I must sleep now. Don't think that this regular updating thing is going to last. I usually find that I write about all the funniest stuff when I email my mother, and can't be bothered to type it out again. Which leaves me with various rants about medical careers and stuff, so look forward to that.
So, new dream life plan. I live in San Francisco, where all my family and friends have also moved, writing for American TV in the cool cafe that I also own and run and bake cheesecake for.
Joy! Of course, a close second dream life plan is the one where I live in New Zealand, and work in a local ED. And eat cheesecake. I think I might bake cheesecake later...
Fairly average night last night. Many highlights - most involved verifying random claims on Wikipedia. I saw one guy who had been dropped on his head by a friend at an AC/DC concert. This led K to ask me if the lead singer of AC/DC was a serial killer. When R the nurse didn't know, I looked it up on Wikipedia. There was no mention of it in the band's biography, which I think means K might have been right...
I see a lot of head injuries, and hardly any of the patients are knocked out by them. That's real life people - that film you saw where someone was knocked out because a leaf fell on their head is not quite accurate. I'm sure Wikipedia will verify that for me. Hang on...
Anyhoo. I also saw broken clavicle guy, who had a lot of questions. "Should I take my sling off when I put my shirt on." Um... I'm going to go with yes. Common sense in an confident, knowledgable tone. That's what I go for when Wikipedia can't give me the answer. Or when D doesn't come along and tell my patient that 95% of collar bone fractures heal perfectly.
"Well, pretty well. Well, you'll probably have a lump there."
"What stops the 5% from healing?" Again with the questions.
"They almost all heal. Yours will almost definitely heal. Probably."
D's ok. Someone told me not to learn people skills from him. I like K too - he gave me a very enthusiastic greeting last night which made me glad to have made the decision to go to work last night. (It was a close one.) There was a good moment yesterday when D and I were talking yesterday about books. I think it started when a nurse told us about a book called, "The only way to quit smoking" which I thought was a genius title for a book - instant bestseller. Which somehow led to us talking about Harry Potter, and me checking with...um... some website or other to see if J.K. Rowling used to be a teacher. And then D said, "I wonder what I could write a book about." And for some reason I found that absolutely hilarious.
What else did I see yesterday? Not much really. It started so so busy, but the department was pretty much empty by 4am. Such is nights. A man who's soft toys talk to him and tell him to take overdoses of Neurofen Plus. Only he often takes 60 tablets a day, so really 24 tablets yesterday was an under-dose for him. And then he asked me if he should be on methadone to help with his addiction to Neurofen Plus? I went with no. Didn't need to look that one up. I did once like psychiatry, but it will take me many more rejection emails before I think that way again.
Anyway, I must sleep now. Don't think that this regular updating thing is going to last. I usually find that I write about all the funniest stuff when I email my mother, and can't be bothered to type it out again. Which leaves me with various rants about medical careers and stuff, so look forward to that.
5.2.10
Time of Times
"If a man speaks, and no woman is around to here him, is he still wrong?"
So, a couple of dilemmas today. Firstly, what should I do about sleeping? I flew back to NZ yesterday - at least I think it was yesterday. I'm a bit confused about days at the moment, what with leaving on Tuesday and arriving on Thursday. And now it's still Thursday in the UK, but Friday where I am, which kind of leads me to the dilemma, because I start work at 11pm today, and only slept for about 5 hours on the plane, despite sleeping tablets. Which 5 hours those were in which time zone is completely beyond me - what with navigating 3 different departure gates over 28 hours, I got a bit disorientated.
Well, of course, the moment I felt most tired was the moment I was trying to make it through passport control and smuggle polo mints through customs. I made it home, and cooked frozen pizza which had the word "gourmet" on the box but square, cardboard chicken pieces on the base. Then I slept from 9pm to 4am NZ time, and now I'm not really sure when I will be able to sleep again, or when I should.
The second dilemma is mostly my own making, a result of my naivity and blase attitude to specialty recruitment this year. 7 applications, 2 interviews and no job. When I sat around discussing my back up choices with my housemate in early January, it seemed completely hypothetical. As if I wouldn't have a job! My plan for my return to the UK was already beautifully complete in my mind.
Bother. What now? The nominal back-up plan was to get a registrar job in ED in NZ. I did enjoy being back in the UK a lot, and I'm not sure I want another year here. I missed Christmas, and birthdays, and my best friend is getting married in November.
There is a round 2 of recruitment, but with it costing £1000 each time a pop home, I'm not sure that that is feasible. So if I do apply again next year, being in the UK would be easier. Score one for trying to find any UK based job. But what would I do in the UK? Being in NZ would mean a training job which would look a lot hotter on the CV and could make job seeking next year a little easier.
Well, at least even though I'm single and jobless, I have no regrets about coming to NZ. In a cliched way, I have found myself. I have discovered that I prefer coffee to tea, and that I love watching DVDs of U.S TV shows. Ha ha! I think I might be American...
Half and half could be the way forward. By which I mean 6 months in NZ and 6 months in the UK. And I still haven't decided if I should give up on round 2 yet. Hopefully my housemates will be back soon and can plan my life for me. Part of coming to NZ was to stick 2 fingers up at the inflexible UK training system, get more experience and enjoy the ride. It was also a way to indulge my lack of ambition and self-drive, which is a worry when I think about applying next year.
Friends are getting engaged and buying houses, and I'm getting left behind and trying to be a child for as long as possible.
I'm also half watching "Definitely Maybe", which is a bit too complicated to be half watched. I've got the subtitles on, so that I can understand more as I half watch it, and amuse myself when it says (Indistinct Chattering) or (Birds Fluttering). Ryan Reynolds seems to have three choices, all of whom are beautiful, although based on looks alone I think Rachel Weisz wins.
Speaking of my American TV addiction, Jenna Fischer is also beautiful. And I'm sure you've noticed that QPR have fired 2 managers this year, and are doing pretty badly. Plus, you will have noticed that I haven't unpacked yet, so I'd better stop doing this and do that...
So, a couple of dilemmas today. Firstly, what should I do about sleeping? I flew back to NZ yesterday - at least I think it was yesterday. I'm a bit confused about days at the moment, what with leaving on Tuesday and arriving on Thursday. And now it's still Thursday in the UK, but Friday where I am, which kind of leads me to the dilemma, because I start work at 11pm today, and only slept for about 5 hours on the plane, despite sleeping tablets. Which 5 hours those were in which time zone is completely beyond me - what with navigating 3 different departure gates over 28 hours, I got a bit disorientated.
Well, of course, the moment I felt most tired was the moment I was trying to make it through passport control and smuggle polo mints through customs. I made it home, and cooked frozen pizza which had the word "gourmet" on the box but square, cardboard chicken pieces on the base. Then I slept from 9pm to 4am NZ time, and now I'm not really sure when I will be able to sleep again, or when I should.
The second dilemma is mostly my own making, a result of my naivity and blase attitude to specialty recruitment this year. 7 applications, 2 interviews and no job. When I sat around discussing my back up choices with my housemate in early January, it seemed completely hypothetical. As if I wouldn't have a job! My plan for my return to the UK was already beautifully complete in my mind.
Bother. What now? The nominal back-up plan was to get a registrar job in ED in NZ. I did enjoy being back in the UK a lot, and I'm not sure I want another year here. I missed Christmas, and birthdays, and my best friend is getting married in November.
There is a round 2 of recruitment, but with it costing £1000 each time a pop home, I'm not sure that that is feasible. So if I do apply again next year, being in the UK would be easier. Score one for trying to find any UK based job. But what would I do in the UK? Being in NZ would mean a training job which would look a lot hotter on the CV and could make job seeking next year a little easier.
Well, at least even though I'm single and jobless, I have no regrets about coming to NZ. In a cliched way, I have found myself. I have discovered that I prefer coffee to tea, and that I love watching DVDs of U.S TV shows. Ha ha! I think I might be American...
Half and half could be the way forward. By which I mean 6 months in NZ and 6 months in the UK. And I still haven't decided if I should give up on round 2 yet. Hopefully my housemates will be back soon and can plan my life for me. Part of coming to NZ was to stick 2 fingers up at the inflexible UK training system, get more experience and enjoy the ride. It was also a way to indulge my lack of ambition and self-drive, which is a worry when I think about applying next year.
Friends are getting engaged and buying houses, and I'm getting left behind and trying to be a child for as long as possible.
I'm also half watching "Definitely Maybe", which is a bit too complicated to be half watched. I've got the subtitles on, so that I can understand more as I half watch it, and amuse myself when it says (Indistinct Chattering) or (Birds Fluttering). Ryan Reynolds seems to have three choices, all of whom are beautiful, although based on looks alone I think Rachel Weisz wins.
Speaking of my American TV addiction, Jenna Fischer is also beautiful. And I'm sure you've noticed that QPR have fired 2 managers this year, and are doing pretty badly. Plus, you will have noticed that I haven't unpacked yet, so I'd better stop doing this and do that...
31.1.10
Do or Die
"It all depends on what happens afterwards as to how people regard your behaviour at the time."
The past 3 months of my life have been taken up with applying to "Core Training" posts in the UK. The whole process has been unspeakably horrible, and I'm feeling apprehensive just at the thought of typing about it. Overall, I feel more down than angry about it all. Perhaps the anger will come later as I start to recover from the mental exhaustion. Perhaps not.
Perhaps there's not even that much more to say. I've already done my best to give a fair and balanced description of the dire hoop-jumping horrors we have to go through to carve out any sort of career for ourselves. Probably best not to read the unfair, one-sided version. And though I can quite clearly see how difficult it is for the powers that be to navigate the maze of intractable conflicts that make up junior doctor training in the UK (made all the more difficult by the messy mis-firing of MTAS and MMC) it is small comfort when it could well be my life and career that is messed up.
Sitting here, with no job offers, and only two interviews that I felt went badly it is probably not surprising that I feel rubbish about the whole thing. Perhaps it will all seem worth it if I get an offer in the next couple of days. But what is particularly unpleasant is that I can't help but wonder if working in New Zealand has had a negative impact on my employability in this country. One of the jobs I applied for this year was the same job that I had an interview with last year. No such luck this year, and yet I put so much more effort into the application form. My CV has improved! I promise, really it has! Perhaps more tangibly, one of the deaneries had jobs of the sort I was applying for left in the second round last year. I couldn't apply to that deanery, because I could only be in the country for 2 and a half weeks.
I don't regret going abroad - it has been a fantastic experience all round. But human nature is what it is, and that's where my mind goes. Perhaps I was naive, but I really felt upbeat about my prospects for this year. I had that interview without really trying last year, and now I had what I thought was an impressive year in a different healthcare system gaining experience relevant to the job that I was applying for. I had even hoped that there would be fewer people applying this year because more people would go abroad like I did. My back up plan to stay another year and try again seemed like needless prudence.
Which brings me neatly onto perspective. It has been lovely to be home for these two weeks, catching up with friends and family, and remembering that these are ultimately more important. My back up plan is a pretty good option, tarnished only by the thought of going through this nightmare again next year, although the system is likely to have improved by then according to the BMJ, and I would be better prepared. And it is my sincere and rational belief that the God of the Bible is real, and that he in all things... works for the good of those who love him.
So, not much else medically to say. One of the problems that I had with the interviews was the "clinical scenarios" stations. In one interview, I was presented with the scenario of a 30 year old woman fitting, and I was asked what I would do. Obediently I rattled off that I would check her airway, breathing and circulation (easy as A,B,C...) and call for help. What could I do whilst help is on the way, I was asked. What were my differential diagnoses in this situation?
I don't know why, but I find it so, so difficult to put myself into the scenario and think the way I would think if I was actually confronted with this problem in real life. I knew that there was something I could give her, and I knew that it wasn't an anti-epileptic as such, and I knew that my interviewer was willing me to say this simple word, and yet that word had completely left my brain. Perhaps because of this, I found myself unable to think of many differentials. "I know that you know this," encouraged my lovely interviewer, whilst my heart sank lower and lower and my brain unhelpfully reminded me that this interview was actually quite important.
But so much of my clinical knowledge is wrapped up in the different cues you get from the clinical setting, which were absent in the hotel function room that I was being interviewed in. Sat outside, awaiting the next station, the answer finally came to me. I knocked on the door I'd just left. "I would have given her diazepam!" I exclaimed at my bewildered interviewers. "Yes, well done, thank you," came the solemn reply, and I sheepishly shut the door again.
Just before leaving New Zealand, I met up with a couple of friends who were also applying for jobs back at home. One had had to leave early, leaving two of us to reflect on how good she was, and better prepared than both of us. I related this to my housemate the next day.
"But I'd far rather work with you or R, than with H!" she replied, kindly and honestly. But it was no comfort, I thought as I tried to revise the seven pillars of clinical governance, wondering if knowing the difference between a guideline and a standard (a classic interview question) made me a better doctor.
The past 3 months of my life have been taken up with applying to "Core Training" posts in the UK. The whole process has been unspeakably horrible, and I'm feeling apprehensive just at the thought of typing about it. Overall, I feel more down than angry about it all. Perhaps the anger will come later as I start to recover from the mental exhaustion. Perhaps not.
Perhaps there's not even that much more to say. I've already done my best to give a fair and balanced description of the dire hoop-jumping horrors we have to go through to carve out any sort of career for ourselves. Probably best not to read the unfair, one-sided version. And though I can quite clearly see how difficult it is for the powers that be to navigate the maze of intractable conflicts that make up junior doctor training in the UK (made all the more difficult by the messy mis-firing of MTAS and MMC) it is small comfort when it could well be my life and career that is messed up.
Sitting here, with no job offers, and only two interviews that I felt went badly it is probably not surprising that I feel rubbish about the whole thing. Perhaps it will all seem worth it if I get an offer in the next couple of days. But what is particularly unpleasant is that I can't help but wonder if working in New Zealand has had a negative impact on my employability in this country. One of the jobs I applied for this year was the same job that I had an interview with last year. No such luck this year, and yet I put so much more effort into the application form. My CV has improved! I promise, really it has! Perhaps more tangibly, one of the deaneries had jobs of the sort I was applying for left in the second round last year. I couldn't apply to that deanery, because I could only be in the country for 2 and a half weeks.
I don't regret going abroad - it has been a fantastic experience all round. But human nature is what it is, and that's where my mind goes. Perhaps I was naive, but I really felt upbeat about my prospects for this year. I had that interview without really trying last year, and now I had what I thought was an impressive year in a different healthcare system gaining experience relevant to the job that I was applying for. I had even hoped that there would be fewer people applying this year because more people would go abroad like I did. My back up plan to stay another year and try again seemed like needless prudence.
Which brings me neatly onto perspective. It has been lovely to be home for these two weeks, catching up with friends and family, and remembering that these are ultimately more important. My back up plan is a pretty good option, tarnished only by the thought of going through this nightmare again next year, although the system is likely to have improved by then according to the BMJ, and I would be better prepared. And it is my sincere and rational belief that the God of the Bible is real, and that he in all things... works for the good of those who love him.
So, not much else medically to say. One of the problems that I had with the interviews was the "clinical scenarios" stations. In one interview, I was presented with the scenario of a 30 year old woman fitting, and I was asked what I would do. Obediently I rattled off that I would check her airway, breathing and circulation (easy as A,B,C...) and call for help. What could I do whilst help is on the way, I was asked. What were my differential diagnoses in this situation?
I don't know why, but I find it so, so difficult to put myself into the scenario and think the way I would think if I was actually confronted with this problem in real life. I knew that there was something I could give her, and I knew that it wasn't an anti-epileptic as such, and I knew that my interviewer was willing me to say this simple word, and yet that word had completely left my brain. Perhaps because of this, I found myself unable to think of many differentials. "I know that you know this," encouraged my lovely interviewer, whilst my heart sank lower and lower and my brain unhelpfully reminded me that this interview was actually quite important.
But so much of my clinical knowledge is wrapped up in the different cues you get from the clinical setting, which were absent in the hotel function room that I was being interviewed in. Sat outside, awaiting the next station, the answer finally came to me. I knocked on the door I'd just left. "I would have given her diazepam!" I exclaimed at my bewildered interviewers. "Yes, well done, thank you," came the solemn reply, and I sheepishly shut the door again.
Just before leaving New Zealand, I met up with a couple of friends who were also applying for jobs back at home. One had had to leave early, leaving two of us to reflect on how good she was, and better prepared than both of us. I related this to my housemate the next day.
"But I'd far rather work with you or R, than with H!" she replied, kindly and honestly. But it was no comfort, I thought as I tried to revise the seven pillars of clinical governance, wondering if knowing the difference between a guideline and a standard (a classic interview question) made me a better doctor.
23.12.09
If You Could Speak
"Mrs Plornish was particularly ingenious in this art; and attained so much celebrity for saying 'Me ope you leg well soon' that it was considered in the Yard but a very short remove indeed from speaking Italian."
Isn't that wonderful? A man is able to make me laugh out loud with words that he wrote 150 years ago on the other side of the world. Here I am, looking in on London in the 1820s, whilst being burnt by the Kiwi sunshine of January 2010.
So job applications, broken laptops, sorry for not posting as regularly recently blah, blah, blah. Let's say it's my new year's resolution or something. Spend more time writing nonsense on the internet that no-one reads - actually that sounds like one I could keep. The jogging every day one has been less successful.
ED then. "Emergency Department" seems to be the latest shift in nomenclature for the casualties and accident and emergency departments of the UK and New Zealand. Perhaps it's so that you can laden your opening, "What brings you to the emergency department today?" with extra sarcasm, making the girl with an insect bite smaller the one on your own arm blush and vow not to waste your time further. Perhaps it's because ED sounds cooler, closer to ER, which I suspect American TV owns the rights to.
Whatever, I've taken to calling it ED fairly quickly. "A+E" now sounds clumsy and arcane. I've also taken to enjoying it very much fairly quickly. A good thing, of course, but one which complicates my career planning considerably.
On the surface the two seem quite disperate, but fundamentally they aren't far apart at all. These are the inbetween specialties - halfway between the elegant puzzle solving and slow burning cures of medicine, and the hands on, life and limb saving decision making of surgery. Specialties with less ego, happy to let the glory go to others. Specialties without ward rounds, clinics, and in which you can wear scrubs and trainers all the time.
All arguable, and just the impressions of a small, third year post grad, but I have met similar personality types in both. So, I must decide: Do I enjoy the excitement of resuscitation, the variety of knowing that anything can walk through the door, the practical, seeing and treating that comes with pulling fractures and closing wounds. Remember how people used to ask "How many stitches did he have to have?" when somone had been to Casualty or A+E? Well now it's me sewing those stitches! The 10 stitches holding the skin on that man's arm together- my handiwork. He broke a glass on his arm. I cleaned it up, checked for remaining shards on an x-ray and then fixed him. Clearly I do enjoy it. My question is, do I enjoy it enough to work shifts for the next 8 years, and stay patient with the abusive drunks and attention seeking overdosers.
It's a while since I did anaesthetics properly, and I have applied for anaesthetics training jobs again this year. However, the ACCS programme is designed to produce acute medics, emergency physicians and anaesthetists, so in theory switching shouldn't be too hard. My main concern with commiting wholeheartedly to anaesthetics is that I will get bored after a couple of years putting people to sleep and sitting listening to surgeons swearing at nurses and juniors. The amateur transplants summed it up quite well:
"Everyone wonders what anaesthetists do whilst the patient's asleep.
Everybody wonders what we do for three hours while that machine goes beep.
Everybody reckons we drink coffee and we gossip and we're generally subversive.
Everybody reckons we do crosswords and sudoku's and we chat up all the nurses.
But do you really think that's all we do?
Well let me tell you now it isn't true.
Cause we sometimes check the screen,
and every now and then we write stuff.
And if we have to intervene,
we inject a bit of white stuff.
And we offer to alter the light,
or the height of the bed.
Or fiddle with the radio, change the CD,
we even check the patient occasionally.
And if they move, we turn op the vapor,
and then we go back, to reading a paper."
Well, there is a grain of truth to that. But then, as I explained my dilemma to my current, and very enthusiastic and lovely boss, her subversive colleague kept asking people in the office why they went into emergency medicine. "It was so you could go to the bank on a Wednesday wasn't it?" she demanded, before each witness nodded sheepishly.
Ok, that's it. I'm talking no more about my career dilemmas. Next time I'm going to talk much more about NZ. Although I'm going home for interview next Sunday. Woo.
Isn't that wonderful? A man is able to make me laugh out loud with words that he wrote 150 years ago on the other side of the world. Here I am, looking in on London in the 1820s, whilst being burnt by the Kiwi sunshine of January 2010.
So job applications, broken laptops, sorry for not posting as regularly recently blah, blah, blah. Let's say it's my new year's resolution or something. Spend more time writing nonsense on the internet that no-one reads - actually that sounds like one I could keep. The jogging every day one has been less successful.
ED then. "Emergency Department" seems to be the latest shift in nomenclature for the casualties and accident and emergency departments of the UK and New Zealand. Perhaps it's so that you can laden your opening, "What brings you to the emergency department today?" with extra sarcasm, making the girl with an insect bite smaller the one on your own arm blush and vow not to waste your time further. Perhaps it's because ED sounds cooler, closer to ER, which I suspect American TV owns the rights to.
Whatever, I've taken to calling it ED fairly quickly. "A+E" now sounds clumsy and arcane. I've also taken to enjoying it very much fairly quickly. A good thing, of course, but one which complicates my career planning considerably.
On the surface the two seem quite disperate, but fundamentally they aren't far apart at all. These are the inbetween specialties - halfway between the elegant puzzle solving and slow burning cures of medicine, and the hands on, life and limb saving decision making of surgery. Specialties with less ego, happy to let the glory go to others. Specialties without ward rounds, clinics, and in which you can wear scrubs and trainers all the time.
All arguable, and just the impressions of a small, third year post grad, but I have met similar personality types in both. So, I must decide: Do I enjoy the excitement of resuscitation, the variety of knowing that anything can walk through the door, the practical, seeing and treating that comes with pulling fractures and closing wounds. Remember how people used to ask "How many stitches did he have to have?" when somone had been to Casualty or A+E? Well now it's me sewing those stitches! The 10 stitches holding the skin on that man's arm together- my handiwork. He broke a glass on his arm. I cleaned it up, checked for remaining shards on an x-ray and then fixed him. Clearly I do enjoy it. My question is, do I enjoy it enough to work shifts for the next 8 years, and stay patient with the abusive drunks and attention seeking overdosers.
It's a while since I did anaesthetics properly, and I have applied for anaesthetics training jobs again this year. However, the ACCS programme is designed to produce acute medics, emergency physicians and anaesthetists, so in theory switching shouldn't be too hard. My main concern with commiting wholeheartedly to anaesthetics is that I will get bored after a couple of years putting people to sleep and sitting listening to surgeons swearing at nurses and juniors. The amateur transplants summed it up quite well:
"Everyone wonders what anaesthetists do whilst the patient's asleep.
Everybody wonders what we do for three hours while that machine goes beep.
Everybody reckons we drink coffee and we gossip and we're generally subversive.
Everybody reckons we do crosswords and sudoku's and we chat up all the nurses.
But do you really think that's all we do?
Well let me tell you now it isn't true.
Cause we sometimes check the screen,
and every now and then we write stuff.
And if we have to intervene,
we inject a bit of white stuff.
And we offer to alter the light,
or the height of the bed.
Or fiddle with the radio, change the CD,
we even check the patient occasionally.
And if they move, we turn op the vapor,
and then we go back, to reading a paper."
Well, there is a grain of truth to that. But then, as I explained my dilemma to my current, and very enthusiastic and lovely boss, her subversive colleague kept asking people in the office why they went into emergency medicine. "It was so you could go to the bank on a Wednesday wasn't it?" she demanded, before each witness nodded sheepishly.
Ok, that's it. I'm talking no more about my career dilemmas. Next time I'm going to talk much more about NZ. Although I'm going home for interview next Sunday. Woo.
6.12.09
Place for Us
"She says I always criticise her, which is another flaw of hers."
Hello, hello. So, I've started emergency medicine, which was a pretty major reason for me coming out here. I enjoyed my shifts in paeds ED, and thought I'd give it a quick try before committing to anaesthetics. The main questions are, did I like paeds ED for the paeds or for the ED, and will I love or hate shift working? I started on nights, so I'm collating my answer to the second question straight away.
There is a part of me that thinks shift work should be, well, fun. Finishing work as everyone else comes in, going against the traffic, days off during the week, empty shopping streets and not being at work when post offices are open. The camaraderie of the night shifts, and the way it makes you feel you're doing a job where every day is different because, amongst other things, you're working different hours each day! Afternoon shifts allow you to lie in on a work day! I'm easily pleased.
Perhaps it's just me who thinks like this. I'm worried that the reality will be work hanging over me before late starts, so I feel like I can't get anything done, and the death of my social life. But that's the idea of testing it out first, right?
On the plus side, it means that I can score 1-2 points on my application form, under the section "any experience in the ACCS specialties (excluding foundation training)". Oh yes, it's already here. Application form grief. Why can't they just give me the job that I want? Why do they have to make it such an unpleasant hoop-jumping exercise?
"It's a game, you've just got to play it," says my flatmate K.
"If it's a game, then why isn't it fun?" I reply, whilst between us we try to make it sound like organising a hospital touch rugby team shows leadership skills.
It's not a nice experience to confront a question, "Please provide details of outstanding achievements outside the field of medicine.(250 words max)" and to draw a blank. Why can't I just be good at and enjoy things without seeking international accolade? Is grade 6 piano outstanding?
Ugh. It's just my nature to downplay everything I've achieved in life, and so to have to sell myself so shamelessly really grates. And it's to a committee of people ticking boxes en masse, trying to decide if I've shown enough of an interest in anaesthetics to get to interview and the next part of the game. And they do so by reading about which of my audits was the most boring, and the fact that by some fluke I managed to do an interesting project at med school which was presented to the national conference of a royal college. Both of which prove my excellent bedside manner, diagnostic skills and medical knowledge.
The thing that makes me really angry, is that they have made such little progress on the application forms. I am applying for a specialty that is recruiting at a local level. If I want to apply to lots of different parts of the country, because I want the job more than I want any locality, then the application forms are different. Couldn't they have just got together and made one standard application form for the whole country?
The other area in which they have made no progress is giving offers. I have a preference 1, and a preference 2. Preference 2 will be interviewing and giving out job offers 2 weeks before preference 1. Suppose I am successful and get an interview from preference 2, and then they offer me a job straight away. I have 48 hours to say yes or no, not knowing at all how the interview will go with preference 1. I have to either stick with my second choice, which I have, or take a gamble on my first choice and potentially end up with nothing.
It is a horrible way to be treated, and it is a problem that has been highlighted for 3 years running. I appreciate that it is difficult from the deaneries point of view - if everyone holds on to the jobs only to turn them down later then they could potentially end up with no-one to do the work when August arrives. But I feel sure that by now a third path could have been found. The Royal College of Physicians has managed to make applications to core medical training national. Everyone fills out one application form, and chooses their top two deaneries (geographic areas) to apply to. They also list all the areas in order of preference so that there can be a clearing system for those unlucky enough to not get either of their top choices. In one fail swoop the amount of work for both applicant and deanery is slashed, and the system allows people to hold a job until they have heard from both of their top two choices.
The Medical Training Application System was a pretty massive disaster. However this was because of the application form, and the sudden bottle-necking that came about by suddenly offering a limited number of golden tickets and ruining the careers of anyone who tried but didn't get one at the time. The idea of a national recruitment scheme is a sound one, and I wish that people would get their act together.
I also wish that medical bloggers wouldn't moan so much. I mean, grief, we have well paid, fulfilling jobs! So, to stop myself moaning, I'm not going to write anything until the 18th December, which also happens to be when applications close. Fingers crossed.
Hello, hello. So, I've started emergency medicine, which was a pretty major reason for me coming out here. I enjoyed my shifts in paeds ED, and thought I'd give it a quick try before committing to anaesthetics. The main questions are, did I like paeds ED for the paeds or for the ED, and will I love or hate shift working? I started on nights, so I'm collating my answer to the second question straight away.
There is a part of me that thinks shift work should be, well, fun. Finishing work as everyone else comes in, going against the traffic, days off during the week, empty shopping streets and not being at work when post offices are open. The camaraderie of the night shifts, and the way it makes you feel you're doing a job where every day is different because, amongst other things, you're working different hours each day! Afternoon shifts allow you to lie in on a work day! I'm easily pleased.
Perhaps it's just me who thinks like this. I'm worried that the reality will be work hanging over me before late starts, so I feel like I can't get anything done, and the death of my social life. But that's the idea of testing it out first, right?
On the plus side, it means that I can score 1-2 points on my application form, under the section "any experience in the ACCS specialties (excluding foundation training)". Oh yes, it's already here. Application form grief. Why can't they just give me the job that I want? Why do they have to make it such an unpleasant hoop-jumping exercise?
"It's a game, you've just got to play it," says my flatmate K.
"If it's a game, then why isn't it fun?" I reply, whilst between us we try to make it sound like organising a hospital touch rugby team shows leadership skills.
It's not a nice experience to confront a question, "Please provide details of outstanding achievements outside the field of medicine.(250 words max)" and to draw a blank. Why can't I just be good at and enjoy things without seeking international accolade? Is grade 6 piano outstanding?
Ugh. It's just my nature to downplay everything I've achieved in life, and so to have to sell myself so shamelessly really grates. And it's to a committee of people ticking boxes en masse, trying to decide if I've shown enough of an interest in anaesthetics to get to interview and the next part of the game. And they do so by reading about which of my audits was the most boring, and the fact that by some fluke I managed to do an interesting project at med school which was presented to the national conference of a royal college. Both of which prove my excellent bedside manner, diagnostic skills and medical knowledge.
The thing that makes me really angry, is that they have made such little progress on the application forms. I am applying for a specialty that is recruiting at a local level. If I want to apply to lots of different parts of the country, because I want the job more than I want any locality, then the application forms are different. Couldn't they have just got together and made one standard application form for the whole country?
The other area in which they have made no progress is giving offers. I have a preference 1, and a preference 2. Preference 2 will be interviewing and giving out job offers 2 weeks before preference 1. Suppose I am successful and get an interview from preference 2, and then they offer me a job straight away. I have 48 hours to say yes or no, not knowing at all how the interview will go with preference 1. I have to either stick with my second choice, which I have, or take a gamble on my first choice and potentially end up with nothing.
It is a horrible way to be treated, and it is a problem that has been highlighted for 3 years running. I appreciate that it is difficult from the deaneries point of view - if everyone holds on to the jobs only to turn them down later then they could potentially end up with no-one to do the work when August arrives. But I feel sure that by now a third path could have been found. The Royal College of Physicians has managed to make applications to core medical training national. Everyone fills out one application form, and chooses their top two deaneries (geographic areas) to apply to. They also list all the areas in order of preference so that there can be a clearing system for those unlucky enough to not get either of their top choices. In one fail swoop the amount of work for both applicant and deanery is slashed, and the system allows people to hold a job until they have heard from both of their top two choices.
The Medical Training Application System was a pretty massive disaster. However this was because of the application form, and the sudden bottle-necking that came about by suddenly offering a limited number of golden tickets and ruining the careers of anyone who tried but didn't get one at the time. The idea of a national recruitment scheme is a sound one, and I wish that people would get their act together.
I also wish that medical bloggers wouldn't moan so much. I mean, grief, we have well paid, fulfilling jobs! So, to stop myself moaning, I'm not going to write anything until the 18th December, which also happens to be when applications close. Fingers crossed.
17.11.09
Today
"Choice"
I feel that I should clarify a couple of things from my last post. Firstly, when I talk about medicine, I mean general medicine as a specialty rather than medicine as a profession. Secondly, I have nothing against Dermatology and CER will make a great dermatologist. It's just that I have a lot more contact with acute/general medics and I know the value of a good one.
CER is still back and providing good entertainment. On the downside is the moustache he is growing for charity. "Movember" is massive in NZ, but that is no excuse for the mo-nstrosity that's currently staining his top lip. It needs peroxide to match his hair. Exactly.
On the upside, he's still as needy as ever. "I'm having lunch in the RMO lounge for a change of scenery." Well worth a page. Not sure I need to know your every move. And we've been team clerking this week, which is what we do when there aren't enough patients for us to see so we take it in turns to see a patient with the other person writing the notes. It's quite a good exercise - useful to see someone else take a history and examine, and then have someone watch and critique your own assessment of a patient.
We were team clerking a slightly reticent lady last week, when I got to the background questions and asked her what she used to do when she worked.
"I was a nurse," she replied.
"Oh," I said, in my throwaway manner, "perhaps that's where you got your mistrust of doctors from?!"
"No," she explained, "I developed my mistrust of doctors when my husband was in hospital, and they ignored my concerns about him, and then he died suddenly."
I don't think you can say anything to that. I paused, half mumbled regrets and "sorry", paused again and asked her if she had ever smoked.
The next night I saw her again, now with a diagnosis of a brain tumour, possibly not even a primary. (i.e. she has cancer somewhere else, and it's advanced enough to have built colonies.) She wanted to go home overnight, and I wanted to let her. So I said yes, and then spent the rest of the evening picturing her having a seizure alone in her house, choking on her tongue and not being able to phone for an ambulance... Which is not normal for me - I'm usually pretty good at switching off once I leave the hospital, and distancing myself from patients. I saw her walking around the ward the next morning and breathed a sigh of relief. I had the temptation to embellish her unreasonable demands and threats to walk out if I refused her wish to spend the night in her own bed, but saw it pass because writing lies in a patients notes is a far worse crime than making a mistake and a patient coming to harm from it.
Today we were group clerking again. An English patient - giving us the chance to pine for the old country whilst congratulating each other for leaving and coming to sweet as New Zealand. A 92 year old lady whose legs didn't work when she tried to get up this morning. "I think people should get to 85, and then just press a button to stop," she told us. And then no-one for ages, until I saw a Tongan man who had been to the GP for a refill of his medications. The GP had done a blood test (why not?) and found that he had a pretty massive anaemia.
But then, the story the GP told us on the phone was a bit different. Yes, this man had a drop in his blood count, but the test hadn't been done for over 6 months, so the drop is from before May, and he hasn't had any symptoms. And the "recent hemi-colectomy" turned out to over a year ago.
CER took the call. Low haemoglobin after an operation - surely the surgeons need to see him first? I pointed this out to him once he was off the GP phone. "Well, the surgeons refused him," CER replied, whilst I made various incredulous faces. "We'll see him and triage him to the apporpriate service." "But," I insisted, "couldn't the GP give you an idea where his bleeding is coming from?" Blood doesn't tend to drop as quickly as the GP implied without an escape route, be it in bowel motions or vomit or whatever. CER shrugged, "GPs can't tell you anything here."
I do not wish to slander all Kiwi GPs. I have had some excellent referral letters from very switched on GPs. But I have experienced an overall lower standard. The one that really annoys me is the letter that says:
"Dear collegue,
Many thanks for assessing the above patient.
Yours sincerely,
Dr Cantbearsed"
And there follows a print out of the last 5 consultation notes like a good little computer programme. Well, I do not need to know that you gave him Ceclor for a cold 5 months ago. I do not find consultation notes as helpful as a GP writing specifically to me, the admitting doctor, and telling me what he or she has found and why he or she has been concerned enough to seek admission for HIS/HER patient. And since many GPs here seem to send people to hospital for a second opinion, to resolve themselves of any responsibility, independent thought or the need to examine the patient, I feel the least they could do is write a proper referral letter.
I feel that I should clarify a couple of things from my last post. Firstly, when I talk about medicine, I mean general medicine as a specialty rather than medicine as a profession. Secondly, I have nothing against Dermatology and CER will make a great dermatologist. It's just that I have a lot more contact with acute/general medics and I know the value of a good one.
CER is still back and providing good entertainment. On the downside is the moustache he is growing for charity. "Movember" is massive in NZ, but that is no excuse for the mo-nstrosity that's currently staining his top lip. It needs peroxide to match his hair. Exactly.
On the upside, he's still as needy as ever. "I'm having lunch in the RMO lounge for a change of scenery." Well worth a page. Not sure I need to know your every move. And we've been team clerking this week, which is what we do when there aren't enough patients for us to see so we take it in turns to see a patient with the other person writing the notes. It's quite a good exercise - useful to see someone else take a history and examine, and then have someone watch and critique your own assessment of a patient.
We were team clerking a slightly reticent lady last week, when I got to the background questions and asked her what she used to do when she worked.
"I was a nurse," she replied.
"Oh," I said, in my throwaway manner, "perhaps that's where you got your mistrust of doctors from?!"
"No," she explained, "I developed my mistrust of doctors when my husband was in hospital, and they ignored my concerns about him, and then he died suddenly."
I don't think you can say anything to that. I paused, half mumbled regrets and "sorry", paused again and asked her if she had ever smoked.
The next night I saw her again, now with a diagnosis of a brain tumour, possibly not even a primary. (i.e. she has cancer somewhere else, and it's advanced enough to have built colonies.) She wanted to go home overnight, and I wanted to let her. So I said yes, and then spent the rest of the evening picturing her having a seizure alone in her house, choking on her tongue and not being able to phone for an ambulance... Which is not normal for me - I'm usually pretty good at switching off once I leave the hospital, and distancing myself from patients. I saw her walking around the ward the next morning and breathed a sigh of relief. I had the temptation to embellish her unreasonable demands and threats to walk out if I refused her wish to spend the night in her own bed, but saw it pass because writing lies in a patients notes is a far worse crime than making a mistake and a patient coming to harm from it.
Today we were group clerking again. An English patient - giving us the chance to pine for the old country whilst congratulating each other for leaving and coming to sweet as New Zealand. A 92 year old lady whose legs didn't work when she tried to get up this morning. "I think people should get to 85, and then just press a button to stop," she told us. And then no-one for ages, until I saw a Tongan man who had been to the GP for a refill of his medications. The GP had done a blood test (why not?) and found that he had a pretty massive anaemia.
But then, the story the GP told us on the phone was a bit different. Yes, this man had a drop in his blood count, but the test hadn't been done for over 6 months, so the drop is from before May, and he hasn't had any symptoms. And the "recent hemi-colectomy" turned out to over a year ago.
CER took the call. Low haemoglobin after an operation - surely the surgeons need to see him first? I pointed this out to him once he was off the GP phone. "Well, the surgeons refused him," CER replied, whilst I made various incredulous faces. "We'll see him and triage him to the apporpriate service." "But," I insisted, "couldn't the GP give you an idea where his bleeding is coming from?" Blood doesn't tend to drop as quickly as the GP implied without an escape route, be it in bowel motions or vomit or whatever. CER shrugged, "GPs can't tell you anything here."
I do not wish to slander all Kiwi GPs. I have had some excellent referral letters from very switched on GPs. But I have experienced an overall lower standard. The one that really annoys me is the letter that says:
"Dear collegue,
Many thanks for assessing the above patient.
Yours sincerely,
Dr Cantbearsed"
And there follows a print out of the last 5 consultation notes like a good little computer programme. Well, I do not need to know that you gave him Ceclor for a cold 5 months ago. I do not find consultation notes as helpful as a GP writing specifically to me, the admitting doctor, and telling me what he or she has found and why he or she has been concerned enough to seek admission for HIS/HER patient. And since many GPs here seem to send people to hospital for a second opinion, to resolve themselves of any responsibility, independent thought or the need to examine the patient, I feel the least they could do is write a proper referral letter.
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