Ishan Jain's Thoughts

Getting closer to knowing myself, day by day.

recent posts

about

  • It’s all about the people

    I heard several stories today from people. Each one led me to reflect. They all gave me one lesson to remember. It’s all about the people.

    These stories were from several family friends detailing their struggles, their experiences with their skin. They all came about after they asked me what I wanted to do, and I told them about my recent ambition to do dermatology. They were all eye opening. I knew from my own experiences that skin conditions are horrible, can knock your confidence and that’s why I wanted to do dermatology in the first place – to help those who had that happen to them. But, today reaffirmed that for me. To an extent I did not expect.

    I think I used to think it was just me. It was me who suffered more than everyone else. It was me who had the worst acne. Me whose acne needed 2 lots of roaccutane and still isn’t perfect. Me who cried all the time at the skin. Me me me. I didn’t really think about anyone else and how they were suffering too. I always knew others suffered too, but it didn’t occur to self-centred teenage me.

    Today just reminded me that actually it was lots of people that suffered. Not just as teenagers too. Into their twenties and even into adulthood. It was something you know consciously and makes perfect sense, but for some reason, you need to hear it just once again, at the right time, for you to fully process and realise and reflect on it, and think ‘wow people really do have similar or worse experiences after all with their skin’.

    The long lasting, almost traumatic, effects are evident from their stories. Their eyes. Their emotion. Their passion. Their crazy detailed knowledge about the topic. And it’s because they’ve suffered with it that they’ve done the research, they know what they need, but they don’t have the resources or contacts to necessarily get what they need. And it sounds extremely frustrating. They weren’t listened to, they were sent away, they were dismissed, they were told they were overreacting. It is tough in a Google age to tell your patients they’re actually incorrect about their own health, and it is tough to hear that from the patients they feel dismissed as a result. It’s a fine balance. It’s tough. It’s interesting.

    At the end of the day, it’s all about the people behind the stories. The struggles. I want to give people that power. I want to listen. I want to help. I want to really help. I want people to feel confident in their own skin. I want to find out just why people get these skin conditions that debilitate people. It drives some people to severe depression and anxiety, and these conditions ruin and takeover lives. There are many other conditions that do too, of course. I could go on and on about each and every system, and how they all have conditions which just halt people in their life tracks. It is incredibly really, just how important health is, just how it can genuinely ruin lives in a way that is just so personal, yet universal.

    I hope I can one day truly help people with their lives, with their skin, with their confidence, with them feeling themselves, feeling empowered and feeling listened to. I do care. I want to have the knowledge, the resources, the credibility to show that tangibly.

  • Anger: The Butterfly Effect

    I had to try and deal with an incident today.

    A family had been treated terribly by another hospital. With disdain. Disrespect. Rushed. Suboptimal care at best. It wasn’t their first time either.

    It becomes more difficult when you’ve seen both sides. I’ve been in that hospital, and know how shortly staffed, how intense the management expectations are and just how busy that department is. Things do fly under the radar. Guidelines are in place to make quicker decisions that are more clear cut. And they were followed. But what was maybe missed was the human aspect. The kindness. The patience. The listening. The calmness.

    And maybe then that person would have been treated better. That family would have been treated better. That family wouldn’t have lost faith in the system then. They’d be nicer to others then. They’d feel less angry themselves. Everything would be better then, right?

    It was interesting to see this play into each and every step of the way. Initially, that person was transferred overnight to another hospital. They’d fallen and were bleeding badly at a psychiatric hospital. Sent to A&E overnight. Somewhere along the way, notes were lost. Staff were switched over. Handover was lacking. Information was lacking. Angry people got angrier. They let their feelings known to people around them.

    Our patient was over-sedated due to their anger. Zombified. It’s one way of dealing with it. Maybe the quickest. Maybe even followed the guidelines. But maybe wasn’t the most human. Wasn’t the kindest. Maybe could have been avoided. Overworked staff there got angry at our staff. For nothing that was their fault. For something that should have been dealt with by someone else. But I guess if everyone things it’ll be dealt with by someone else, nothing gets done but everyone gets angry about it. Volumes go up. Veins start bulging in foreheads. Tensions rise. Hearts race. But none of these things make anything go quicker, better or help at all really.

    It’s an incredible domino effect as soon as one person acts this way for everyone else down the chain to feel the same way. Could have been something unrelated to work – something at home, with your own family, something on your commute, anything at all – that just raised your anger levels. Brought the threshold to lose it down. It’s amazing to witness. It’s really interesting. And I’d love to know how many people are aware of it. Or actually do something about it. One person getting angry guarantees their surrounding people to be closer to getting angry or upset. It can heighten emotions in various directions. And it either overwhelms or comes out to avoid overwhelming oneself.

    Our staff came back crying. I assumed it was to do with the angry staff they later told me about. But it was actually the taxi driver on the way back who’d given them a piece of their mind. They’d had a drunken person vomit in their taxi that morning, so when they heard they were next getting a psychiatric patient, their mind conjured up the worst possible image. Despite being over-sedated and not causing harm to anyone at all, they kicked up a fuss. Their mind found something to be angry about. Their mind hadn’t reset from the morning drunkard. The threshold was lowered.

    When I saw our staff come back crying, I then noticed everyone else get increasingly annoyed. For them. With them. Voiced their annoyances. I was looking around hearing everyone voice their angers. And someone looked at me, asking if I was angry too. I was in disbelief. I wanted to lecture them on to control themselves and chill out, but I chose to just empathise instead. I understood why people were angry, but I didn’t agree with it. It wasn’t helpful to the situation. It actually did make the situation worse.

    Next up were the family. They then came in, fuming. Literal steam came out of ears. It was a sight. I then was the person, of course, asked to see this person’s broken nose which apparently A&E had not dealt with. Having never actually assessed someone’s broken nose, in med school or in my entire first year as a doctor, I was a bit lost. I was thrust in the deep end, with family members and nurses looking at me expectantly while I shone my phone torch at this person’s nose, and after a bit of pondering thinking ‘it doesn’t look too bad but the family don’t think that, so don’t say that’, I ended up being honest. And that was received surprisingly well. I was expecting an offhand comment of ‘well what was 6 years training for then?’, or ‘aren’t you supposed to be the doctor?’. I empathised with their situation, listened, and simply said I would ask for help and I didn’t know much about what to do about their nose. I wasn’t the right person for that job.

    I talked calmly. I had open body language, hands up in the air surrendering. I spent a bit of time with them. I then stayed a bit after work researching what the right thing to do is, and spoke to the angry nurses. When I say spoke to, I really just stood there and nodded politely while they unilaterally vented at me. It is powerful. But everyone seemed to defuse after my presence. I was happy. It felt like I’d managed the situation, even though I didn’t really do anything. I stopped the butterfly effect of anger in its place. I felt like I’d stopped a tsunami. And it was actually really easy.

  • How sleep is looked at in hospital

    Sleep has been increasingly seen as important in health. More so than anything else. More so than good food, exercise, social connections, environment, everything. Everyone knows sleep is important, but is it even considered in hospitals?

    When I was in the physical health hospital, sleep was essentially not considered. Night time medications were scheduled for 10pm. Observations were done 4 hourly, often throughout the night for most patients. Occasionally, this is necessary, but for those who have been stable and healthy, is it better to interrupt their sleep, or is it better to take observations? Things like blood pressure cuffs can be uncomfortable, the observations machines can be noisy, they have bright lights too sometimes. This wakes up not only the patient, but can wake up people around them.

    Imagine having a blood pressure cuff squeeze your arm at 2/3/4am. We wouldn’t be well rested or happy in the morning either. If this did happen to us one time, we could forgive it, we could sleep well the next night and things would be okay. But, imagine this happening every night during your entire hospital stay? Sometimes weeks, months. Imagine on top of this, having injections into your belly every day, sometimes twice a day. People get bruises, they say the injections are painful. Some of these people are mobile, some of these people don’t really need the injections to prevent a blood clot.

    It’s all a painful process. It’s tiring. It’s not always the kindest. Hospitals are the worst places to sleep. Most don’t have side rooms. Most hospital wards are quite noisy places. I remember once going to a ward on a night shift at 3am, and the staff were playing the radio on full blast to keep them awake. I thought it was mad. I understand the need to stay awake is tough, especially on a night shift, but I think the benefits and importance of sleep are simply overlooked.

    And then, when you get to 6am, the incredibly bright hospital lights are all turned on, and the day starts. But, the lights aren’t turned off until at least 10pm, at least after the final night medications round are done. People think 10pm to 6am is enough time, they should sleep 8 hours. But, we all know that’s not true. Going to bed at 10pm means actually going to sleep at maybe 10:15-10:30pm, at best. That’s in the sanctuary of home. That’s when you don’t have extra thoughts or stresses keeping you up. That’s when you’re not in hospital and ill! I know ill people are more sleepy, as their bodies need more rest, but they still have thoughts and stresses, which they can’t necessarily deal with in the same way they would do at home.

    Then, you get woken up at 6am with the lights, the observations, the medications round. Interrupted sleep isn’t the same as continuous sleep. It is not as good. It does negatively impact your health. I just think patients are not getting 8 hours of sleep in the hospital, there is no way. Most of them are not, I guarantee it if you put a sleep tracker on them. It is maybe 5-6 hours at most. And the effects of this compound with each night. Continuously sleeping 5-6 hours is horrendous for your health, puts you at risk for a whole host of health conditions.

    People who have an extended hospital admission must have an increased incidence of health conditions in the future. I don’t have the evidence myself, I admit. But, after working in the hospital, especially on the adult wards, it just did not seem like as much of a place of healing, as I initially thought hospitals were. Seeing patients over an extended hospital stay was what made me realise this. Seeing them towards the end of their weeks-months long stay was difficult. They couldn’t wait to go home, to actually rest. To be themselves again.

    I know we do lots of incredibly good things in hospital for people’s health, we do save lives, I’ve seen that first-hand. We do it through complicated medications and methods sometimes. But, I do think the simple things need looking at in the NHS. Sleep, better meals (who loves hospital meals? Nobody!), more exercise and activities to keep them engaged, more time outdoors, etc. The simple things. The ‘non-medical’ things. The preventative things.

    Once, a patient on a night shift begged me for an eye mask and ear plugs. It was my first night shift, so I thought it was a perfectly reasonable ask, and when I asked one of the staff for this, they snorted at me, and said it wasn’t a hotel. I think eye masks and ear plugs in hospital would be incredibly beneficial. On every ward, for every patient. People will sleep more, and get better sooner! I don’t have the evidence, I don’t have a study, I haven’t yet run a quality improvement project, but maybe I will try.

    Now, in the mental health hospital however, things are different. Sleep is considered. Sleep charts are kept for some patients. They each have their own bedrooms. It’s private, it’s more like a proper bed. They have curtains, they aren’t awoken at 6am for medications. They have a ‘normal’ start to the day at 8-9am. Their morning routines are attempted to be recreated, whatever habits that may entail. They have a ‘normal’ wind down at the end of the day after having dinner at 6pm. It feels like a weird luxury to be here. To see this happen. It does feel more like a hotel in that sense. The patients have more freedom, more activities to keep them engaged, an outdoor area they can access at any time if they wish. People to talk to them.

    Overall, sleep is considered as an actual important factor in the mental health hospital. Medications are optimised for this and their environments are too. If they didn’t sleep well one night, that is taken into account. Whereas, it was never really considered in the physical health hospital. Sleep is good for mental health, but it is also good for physical health. Sleep is healing.

  • Being born in the UK

    One healthcare assistant was asking me for a signature to sign them off on performing venepuncture. Taking blood. A simple skill. One that I was trained in. They’d been given one training day. And then told to practice ten, get ten signatures, gotta be doctors, and then they get a certificate. The incredible reward of gaining this skill, allowing you to apply for higher band jobs, which have higher chances of gaining sponsorship for an all-encompassing visa. They were running out of time. I had many patients that needed bloods. So, we went on a round to get these patient’s bloods. With me looking over their shoulder, supervising, teaching.

    They were struggling to take blood, their technique needed some tweaks. And after my first time suggesting an adjustment, they panicked, they ran off. I went after them and said it’s okay, they can take my blood. I wanted to help. I noticed they were sweating, trembling, and they stabbed me, but panicked and withdrew, stabbing themselves too in the finger. I thought to myself, ‘how can I sign this person off honestly?’.

    I didn’t initially realise the stakes for them.

    I knew that being born in the UK was incredibly lucky. But, I never fully appreciated or realised just why that is. Until today.

    I met someone else at work who had recently moved here from India. They have a degree, an MBA, but are still struggling to find a job. They’re working as a healthcare assistant on a mental health ward. They didn’t really know what that was. They didn’t know what they were signing themselves up for. They felt like they had little choice. I learned a lot from a five minute conversation with them.

    They were telling me about working in the NHS. About how the barrier to entry appears to be lower. About how there are higher chances of getting a sponsorship for their visa. About the salary thresholds that exist to get this coveted visa sponsor. About the fact that their current salaries were just £63 below this threshold. And the roles they were eligible for, they were all like this. It feels like a game, except it’s people’s lives. And the people who set these very specific salaries know the rules. But the ones applying don’t get told them. The people who decide these numbers are finding loopholes, finding ways to maximise benefits for them. The numbers, they seem to lack kindness, empathy, and just don’t seem to help people. They’d applied for a role that they were eligible for. They weren’t eligible for many. Not being clinically trained. Not being from the UK. Admin and healthcare assistant aside, there wasn’t many. But it was a foot in the door. It was something.

    Despite having an MBA and being the same age as me, they were struggling. Struggling not because of the job itself. But the stress outside the job. The uncertainty. The bureaucracy. The paperwork. The constant feeling that it could all be snatched away at one slip up. The lack of security. The feeling that the law could be changing soon. Hearing the news about deportation threats. It must be just so hard.

    Now, I don’t know much about this topic. Maybe there’s another reason for these very specific numbers. Maybe there’s a reason that it’s so difficult to gain visa sponsorship. Maybe there’s just limited resources. Maybe there’s overpopulation. Maybe the country is struggling. Maybe. I don’t know much about this. But I do know that there’s a lot of inequality.

    That person wasn’t just stressing about getting my blood. They were stressing about whether they could stay in the country. Whether they’d be fired. Whether they’d be in this job next week, let alone next year. And if that happened, how could they feed their kids? Uphold a livelihood? The list goes on.

    And so, I later, after calming them down, and listening to them, I learned a lot of things. I saw much more than a trembling healthcare assistant struggling to take blood. I saw how much they needed this to work; need not want. I signed whatever they needed after seeing them do it again successfully. The relieved look on their face from my signature was something I never thought I’d see. It was powerful. It made me realise a lot. I can make a difference. Kindness can make a difference. Everyone’s story is so so unique. Everyone’s path to meeting you that day at that time is also unique. It’s amazing really.

  • What I realised working on a Geriatrics Ward

    I have just finished my Geriatrics rotation as an F1 Doctor. Wow, what a 4 months. A perfect representation of what the NHS is really like – chaos, pressures on ‘patient flow’, valuable learning experiences and some beautiful moments I’ll never forget.

    The biggest realisations I had that will stick with me are surrounding looking after your own health. Seeing these people in hospital at this stage in their lives made me scared. All of these people had lived rich lives. Had fulfilling careers, some with successful businesses, some had travelled the world, some were doctors in the NHS. Had families, kids, grandkids. Families that were all over the UK, all over the world. And they’d found themselves on this Geriatrics Ward. Probably never imagined they’d be there, never planned for it, never thought it would be them.

    A lot of them had come in with dementia – a horrible condition that gets worse over time. Dementia destroys families. I’ve seen it firsthand now create such difficult situations for families, tearing them apart. Sucking up their finances, their willpower and their mental energy to figure out how to handle it. Some distanced themselves, barely visited hospital, didn’t really get involved. Some might say they gave up. Some might call them heartless. I heard people say ‘I hope my family visit me in hospital’. I was thinking ‘I never want to be in hospital for them to visit’.

    So, I’d try and research in my free time how to prevent this. What can I do in my control to maximise my chances of staying out of hospital? The obvious things come up. Sleeping, exercising, eating well. Utilising your brain, keeping it active. Always learning. Keeping family and friends close. Connection. But, as I dived deeper into this, thinking there must be something else, there must. All these people would have known this, right? It doesn’t sound revolutionary. It’s not a magic pill, but surely they knew! Is what I kept thinking. Why them? Maybe they were dealt unlucky hands. Maybe they had other tough things happen to them they didn’t share. Maybe they were focussing on all the good times. Anything could be the case.

    So, I’d try and listen. The more I worked there, the more I tried to simply spend time with people and their families at the bedside. I’d spend more than half the time giving updates to families, answering questions, chatting to them, letting them share their difficulties, their struggles, their concerns. I’d enjoy it. I’d seen it as a privilege that I, a first year doctor, can be the person that provides them all their answers, their reassurance. It was something I felt good at. It was something that made them feel heard, and made me feel seen and appreciated. And I learned so much about the difficulties of having an ill family member. A loved one. I am fortunate that I haven’t had that in my own life. And I am doubly fortunate that I got to help these families through these times. And even if I didn’t feel as though I was helping sometimes, they seemed to appreciate that someone else got it. Someone else was there with them. Some of those faces, those names and most of all, their stories, will really stick with me. I can picture them now as I’m writing this.

    It made me feel incredibly lucky and grateful about my own life, my own parents, my own upbringing. And become increasingly grateful for my health, my independence, my mobility, my job, my freedom.

    It was here I was told to always remember that patients are people. And people have stories. Experiences. Lives. With many factors. Hospital was not one of those factors they had planned or envisioned for themselves. They are scared. They are hopeful. They are expectant. They want to be treated well. They want to be listened to. They want the best. Who doesn’t?

    And I wish I could have given them my best everyday. I tried to. But, some days, the politics of it all, the pressures of patient flow, the unlimited jobs list, the chronic understaffing, the frustrations voiced constantly, the stress that emanated from every senior in charge… It would get to me. It would make me freeze sometimes. I couldn’t think straight some mornings. I was overwhelmed. I was multitasking. I was making occasional errors. I missed things sometimes. I simply didn’t know what to do sometimes. I disagreed with senior decisions often, but had to be the one to explain to families what had happened, what the rationale was. I had to agree with the families when they rebutted, when they weren’t happy with the care. I had to make up reasons for delays sometimes, because sometimes there just wasn’t a good reason. It’s just ‘the system’. But what does that even mean? They’d stay in hospital longer for no particular reason other than ‘the system’ being rubbish, being overly bureaucratic and full of paperwork upon paperwork. They’d get ill from being in hospital too long, and the delay clock would reset. And it’d frustrate families, it’d frustrate staff, it’d frustrate people. And a frustrated environment is not a fruitful one.

    It’s a relentless task to get patients out of hospital to suitable places. It’s non stop. There’s a million people waiting for a bed, they’re practically knocking on the door. They’d put them in the corridors even when they anticipate a bed might free up in the next couple days, the next week sometimes. You’d put up part of a screen around that bed to examine them. It was putting a sticker over their dignity.

    Sometimes, you’d get a management person come in and ask why people haven’t left hospital in so long. And you just want to tell them to sit in your shoes for just half a day, just to understand a bit about what goes on, to understand the frustrations, to truly understand.

    There was one person whose blood was notoriously difficult to take. I’d failed a couple times. They teased me. They were fed up of me. They were fed up of hospital. Barely spoke to me. Then on my last day, I was suddenly successful. They looked at me. Smiled. Started speaking to me. Telling me stories. I had a lot to do that day. But, I just stood there, blood bottles in hand, and listened. I stood, in awe, at this person’s rich life. Must have been there an hour. I just kept looking around, thinking, but how? How did you go from that to this? What actually happened? But, part of you feels that you don’t want to pop their balloon. You want them to relish in the good times and feel nostalgic. They told me to enjoy life. Whatever I do, just enjoy it. They kept saying it. Since then, I have to say I’ve felt happier. Just enjoy it.

  • Working on your own

    Today, I was working on my own for most of the day. Only doctor in the office; on the shop floor. Senior contactable, upstairs, if I need them. My colleague is off. It’s just me. The nursing staff are there, ever-present, doing what they do best, putting out fires before they happen. But, I’m the one managing our side of things. The one they’ll go if things go out of control. It’s not the first time I’ve done it. But, I think I prefer it, secretly.

    I used to think that working on your own was not the way forward. Working in a nice team, full of friends, jokes, chatter, laughter – that was the goal. But, soon after starting work, I found that wasn’t for me. My mind felt more cluttered with people around. I couldn’t multitask. I couldn’t do my job well as well as make friends. I could do one or the other. Others seemed to thrive in this environment. But I wasn’t thriving. Was I the problem?’

    Recently, I was told a beautiful thing – that we need both kinds of people in the world. We need teams and we need individuals. They have different strengths. Can do different things. I suddenly felt more affirmed in what I was feeling. It is okay to prefer working alone. You read about the rise of loneliness, especially in men. You read that people, relationships, connections – that’s the answer. That’s how to be healthy. That’s how to be happy. How to live the longest. But, you don’t hear that working alone is optimal. Nobody wants someone who ‘can work alone’, right?

    It’s not that I can’t work in a team. It’s just that the teams so far I get put with. I don’t choose them. Handpick them. Who do I think I am? I’m very junior in my career. But I’m already dreaming of the day I get to cherrypick my own team. Find those that care. Those that really challenge me, improve me, take our team forwards. They have fun, they smile, but they also get the job done. They don’t complain about a couple extra tasks, staying late, they do what they feel is needed, what they feel is right. Because they care. Because they have the same mission. They understand what’s going on. They fight. That’s what I’m looking for. I want to be inspired, constantly, by the people I surround myself by. I want to learn. I want to be taught. I want to be corrected. I feel like I’m chasing my tail trying to collect unlimited knowledge about the world. But, I can’t stop either. It’s fun.

  • Caring

    Today, I noticed a stark difference between my old team and my new team. This team care. This team care so much about the patients, and it is refreshing and inspiring. This is why I wanted to be a doctor. I care. I care about people. And having a team around you that care really is infectious; it motivates everyone. It was so nice being in the family meetings, where everyone’s focus seems to shift towards the patient and their family so automatically. It is really nice to see. The families leave feeling a sense of trust and confidence, and always a huge sigh of relief that the stress is off them to look after their loved ones who are unwell. It makes me so happy and feel lucky that I am in these meetings, and that they really feel like we are doing the best by them.

    Psychiatry seems to be a true multidisciplinary team experience. Psychiatrists, doctors, nursing associates, psychologists, occupational therapists, mental health advocates, social workers and care homes are all involved in these meetings. Our sheer presence in the room makes them feel like they’re in good hands – which is really nice to experience. You can’t please every one of course. But, the ones that benefit from our help are in the majority. The short debrief after each meeting really consolidates things, and hopefully I can become more and more integrated as the weeks go by. I want to learn about each of their roles more and see them at work. Seeing passionate people at work really inspires me. Makes me believe in humanity again. Gives me a sense of community. I’m not sure I’ve really had that in the past year.

    I’ve worked with some incredible people. Some really caring people. But what seems to spoil it is gossip. I don’t like gossiping about colleagues behind their back about what they’re wearing, their hair, their attitudes or their knowledge. You should tell them to their face. In a nice way of course. But openness helps bring the team closer together. I find myself sometimes chiming in when people are talking about others; I don’t think I’ve had the maturity or the confidence to speak up against the gossip or what I see. I want to fit in. It’s human nature. I want to gain their approval. I don’t want to be a party pooper. The boring one who won’t join in the gossip. The quiet one.

    Showing my true nature of caring is also something I’ve struggled with. I haven’t always shown it. At work and at home. It makes me sad when it’s not clear that I do care. But, I think what’s happened is that if you don’t care for yourself, it does become tough to care for others. You can’t pour from an empty glass. So many times this past year, I haven’t really treated myself as a priority. I have been irritable, tired, hungry, thirsty, overwhelmed, anxious, frustrated. And I haven’t asked for help. I’ve taken out my frustrations at people I love. I’ve told myself off. I’ve blamed others for the way I feel. I’ve not taken accountability. I’ve not had as much self-awareness as I thought I had. I’ve tried to build healthy habits, I’ve tried to take care of myself. Through sleep, exercise and good foods. Through drinking water, taking my time, going outside, in nature, journalling, cleaning, cooking, meditating, breath work, yoga. I’ve tried a lot of things. I continue to sit here with pathologically bitten nails, skin that has been itched to death and a mind that is rarely clutter-free. Some days I feel like I’ve regained clarity. Like when I started writing these posts. But most days, I’ve been snowed under. With thoughts. Not meeting personal expectations. Not meeting personal deadlines. Scheduling a million things in my calendar, and not ticking off anything of note off my to-do list.

  • Day 3: Psychiatry

    Today was a day of being a beginner, a learner. New systems, new staff, new way of doing things, first Monday of my Psychiatry block. Learning the tricks of the trade, meeting family members, meeting new people. Ensuring current people can safely leave the place after being here for months, managing high risk aggressive people and most important of all, staying safe and sane amongst all this chaos.

    The most memorable incident of today was putting a plaster on someone. Over the last year, this would have been a very simple task taking seconds. But, on this ward, with this particular person, it was an ordeal; an event, something they called a Planned Intervention. It involved staff from all over the hospital, one from each ward, to come and help. I was tasked with cleaning the wound and dressing it. They were actively bleeding, streaking across the floor, oblivious. All we wanted to do was clean it up and dress the wound. It was quite the sight. With all the legal powers in place, and in their best interests, they were restrained. Because of their size and power, this took quite a few people. Trained in a way I had never seen or experienced before, it was quite impressive to watch. But there was no time to admire their skills, as I had to quickly clean and dress their ankle without getting kicked or punched. It was a remarkably smooth operation, and everyone else walked off afterwards as if not much had happened, including the person I put the plaster on. I was shocked.

    I learned that everyone has their skillsets, everyone has their own training, their own experiences, their own expertise. Everyone brings something to the table. If you listen to your team, you learn so much about what they can and can’t do, about different ways of thinking about things. It opened my eyes to all the different things you have to consider before doing something as simple as putting a plaster on someone. It’s not always as straightforward as you might think.

  • First Impression of Psychiatric Ward

    I had a scary encounter the first time I entered my Psychiatric Ward. I went there to find my supervisor, only to be greeted by an elderly person jumping in front of me and shouting at me. It scared me and sent my heart racing. I had never been on a ward like this before, even as a student. As I stood there, unable to move, that person grabbed me by the collar with both hands and just spoke gibberish at me as I made intense eye contact with them. It wasn’t like anything I’d experienced before. I really didn’t know what to do. But I tried to stay calm and just stand there silently, hoping for them to let go. They eventually did and my whole body breathed a sigh of relief. The nursing staff smiled at me and laughed, welcoming me to their ward. My heart hadn’t slowed down. My face must have looked terrified as they reassured me everything would be okay and led me to the office.

    It was a stark reminder of what illness can do to the mind. I had seen a lot of dementia on my previous rotation on a Geriatrics Ward. I had seen how it had torn apart and frustrated many families. I had heard lots of stories about how their parents used to be. I had seen people wait hand and foot on their relatives with dementia, and I had seen people walk away, not wanting to be involved. I had seen people with dementia be pleasant and unpleasant to their families. I had seen people wither away over days, weeks and months. It was heartbreaking. It was everywhere. I didn’t realise this illness could put you in a psychiatric hospital for months too. I didn’t realise people could become as aggressive as I had read about in their notes. I didn’t realise just how devastating it was for families. I still don’t, I can only see glimpses. They’re the ones with them all the time. They’re the ones who have the memories of what they were like pre-disease. That must be the hard part.

    It used to get to me quite often, especially families I would speak to multiple times, who were finding it especially difficult, and had other things going on as well as their family member with dementia. It really used to stay with me. I can picture their faces even now. Tired, frustrated, angry faces. Not at you, just at the situation. At the helplessness of it all. At the inevitability of it. At the lack of control they had.

    Meeting people like this made me want to hold onto my parents. It made me want to help do everything I can to prevent dementia in myself, in them and in the people around me. Some of the diseases within dementia sounded like just bad luck though. And that scares me. I can’t imagine the feeling of seeing your loved ones go through the battle that is dementia.

    Hopefully, this experience will help me learn more about these people, their lives, the staff, how they are impacted and how they deal with these thoughts that they must have had too. How do I not become consumed by these worries about the future? About what I’m gonna do if my parents get dementia? About how I could support friends and their parents if they get dementia? About how I can manage myself if that happens too.

  • Why do I want to be a dermatologist?

    I have spent so much time over the past year stressing about which specialty to choose, which path to go down, what to do with my life? It really was something that was keeping me up at night. Which is crazy to say, because it is something completely in my control. It is something I can choose. And with the unlimited choice, I was stressed. I told myself I had to get it right. I had to make the perfect choice. I had to make the one that made sense to me, and made sense for future me too. It felt like this choice had a million criteria to fulfil. And I only had one shot at getting it right.

    Obviously, this was the narrative I told myself. It wasn’t completely true. We are in a world full of choices. Unlimited options. The choice paradox tells us that more choices aren’t better. And I need to remember how incredibly lucky I am to be in a position fortunate enough to make these choices in the first place. Because I’m so lucky, so fortunate, I also put this added pressure on myself to get it right, because I am so lucky. I don’t have to worry about so many things. I have had an incredibly lucky upbringing. I have been put in this position of having the world be my oyster. And now, for the first time in my life where my life isn’t set out for me, I was panicking.

    Eventually, towards the end of the year, there was something that clicked inside me. Like yesterday, where an old memory made a magic neural connection to my current state, it happened again. And it was enlightening. It made me think that the answer was there the whole time. Under my nose. In my head.

    I remember as a kid thinking I wanted to cure myself, to fix myself. To fix my skin. It felt like no treatment was working, and I remember thinking I wanted to create my own, and fix myself. Purely selfish. But why? Why my skin?

    It was every dinner party, every new family we visited, every year visiting my family back home, every new friendship group at school, every new family friend that came to the house. They’d point out my skin. I only had acne. But I guess it was quite bad. I made it worse. I didn’t listen to the doctors, my parents or anyone else. I ‘tried’ treatments, creams, face washes, antibiotics like there was no tomorrow. I tried physically picking and itching and taking off layers off my face in hope that it would somehow help. It didn’t.

    All these things just made me feel shit. I had no confidence. No self belief. Couldn’t make eye contact with people. Couldn’t smile or laugh without thinking about it. Couldn’t meet new people. Couldn’t even meet people sometimes. Without feeling intense shame and shyness. Eyes were on my skin, words were said, some kind and well-meaning, and some less kind and less well-meaning. It crippled me to be honest. But I didn’t even know it. Didn’t really make the conscious connection. Until maybe first year of uni. I finally trialled what I was told was the gold standard treatment – Roaccutane. It was terrible timing, before the summer before uni. Got told to not drink alcohol with it, not go out in the sun. And yet if I delayed it, I would have this same shameful feeling at uni. I had no choice.

    That appointment was a pivotal moment in my life. There was an old dermatologist, on the edge of retirement, with ear hair and bad jokes. He was sat, while his young assistant stood next to him, behind him, smiling unknowingly. I was sat, barely looking up at him, while my mum did all the talking. All the advocating. Lying to him about how I’d tried everything, when in reality I probably tried each cream or antibiotic for 2 weeks if that, and didn’t really apply them or take them properly. I remember him telling me that this was the last treatment possible. It’s the best, but also the last, he said. He said if this doesn’t work, there’s no more options. He said it increased your risk of suicide and depression. With that, we reluctantly agreed to trying it. I remember walking out of his clinic, holding tears, straight into the dingy, underground car park at maybe 7pm in the dark. I sat in the car, and just cried.

    My mum was amazing that day. She hugged me, she supported me. She acted as if she’d seen me cry a million times before. I guess she had. But she’d never seen me cry over my skin. As far as I knew anyway. She probably did. I just didn’t know it.

    I always envisioned reinventing myself at uni. I would somehow gain a load of confidence and self belief, and just go out there smiling, making loads of friends and being popular. I think that’s what I thought I wanted. I thought that the only way to do that was clear skin. I thought that’s what the secret was. I’d look around and see all these people who’d probably never thought about their skin have perfectly clear skin, and I’d be envious. I’d stare. At their skin. It was somehow equivalent to prestige for me.

    My mum told me about how it was probably genetic, since she gets acne, even as an adult. I was surprised. I’d never even noticed. She pointed out one measly spot on her face. I remember googling Roaccutane and stumbling across Reddit threads. I think the first time I used Reddit was then. I didn’t know so many people had taken this drug. I thought it was just me. How naive. I thought I was the only one. But, here there were people with worse skin than me and they got infinitely better with Roaccutane. People on Reddit were saying you could drink, you could go out in the sun, and you could have a ‘good’ time at uni with Roaccutane. Back then, I always envisioned a ‘good’ time at uni equalling drinking, because that’s what I thought people did at uni to have fun. I’ve changed a lot since then.

    I had some promise going into my first term at uni, and I remember coming to the end of my course of Roaccutane, looking in the mirror and seeing acne still there. I remember feeling disheartened, lied to by the dermatologist, the internet, Reddit. I was back where I was. Except I never left. Nothing had changed. I felt guilt because I probably didn’t help Roaccutane by drinking, not taking it regularly. I was angry. At myself more than anything. I thought I had no hope. I was frantically googling what the next steps were.

    I remember the same dermatologist sighing when I next saw him. I know, I thought, it’s my fault it didn’t work. It works for all these people online, except me. But, he surprisingly just said to try again with an increased dose. I felt a glimmer of hope again. I told myself I’d drink less and be more careful with taking it everyday.

    I remember coming to the end of the 2nd course, and I remember feeling like things had worked. Not perfectly, but significantly. I couldn’t believe it. I felt a new lease of life. And my confidence went from 0 to 1. People telling me my skin looked good after I complained to them also helped to be honest. It was the first time I’d ever been told that. That felt good too. Having slightly imperfect skin didn’t seem to limit me socially either. Things were good…

    Later in my uni years, I confided in more people that I’d taken Roaccutane twice. Look at me, my skin was so bad. I used to pity myself with it. I must have been annoying to be around when I said that. And people around me with perfect, glassy skin used to say ‘I was on it too’, ‘me too’, and suddenly a whole host of people, friends had gone through it too. It was eye opening. They’d had incredible results, way better than mine. They had literally perfect skin. I remember being shocked, being in awe at their skin, and it really made me think wow. The power of Roaccutane. Imagine if I took it properly. Imagine if I didn’t drink during. Imagine if I’d never picked my skin back then. Or took the initial treatments properly. Wow, things could have been so different.

    To my dismay, scars, according to google, took years, many of them, to heal after picking. There wasn’t loads to do except take care of my skin and wait. I have them to this day. A reminder. I get told I have good skin a lot nowadays. It still shocks me to hear that from people with perfect skin, but it’s a nice boost. It’s needed too. I still touch my face way too much, I still am not perfect with my skin care routine. You’d think I might be by now after going through all that.

    And so, after wanting to choose something that didn’t require me to be in the hospital overnight, dermatology seemed like it made perfect sense. I want to help people feel good about themselves. I want to give people like me that boost. That bit of self confidence. That feeling of hope. That feeling of control. That feeling that the doctor is on their side. That feeling that things will be okay. I know how you feel. I have been through it. I have learned a lot. I have learned it perhaps a bit later than I should have. I didn’t listen. Wonderful things can happen. And confidence can come from many areas, not just skin.