Guest Blog: Dr Joanna Poole, Post Mortem of a Career

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Dr Joanna Poole is an Anaesthetic trainee and a DAUK member. After sharing a blog on Twitter about wanting to quit medicine which went viral, Joanna has also been inundated with messages from fellow doctors who have found themselves in a similar situation. Now, Joanna has been invited to share her experiences with multiple Royal Colleges and Joanna is collating the responses she has received anonymously in the hope this will inspire a kinder NHS for our doctors. Joanna is a force for change and is a real example for what grassroots doctors can achieve when they speak up. We look forward to working with Joanna at DAUK. You can follow Joanna on Twitter @jopo899.

 


From the age of 9 I remember my dad sitting down on a summer day whilst I was on the swing on the apple tree and communicating in one of those poignant father-child ways that one of his greatest wishes in life if I could go to Oxbridge. He himself was from a working class family and had apprenticed during university holidays, and had gone to a grammar school, after doing well on the 11+ which his parents were thrilled by. My mum was first a nurse then a midwife then finally a band 8 (although I am biased she is both smart and lovely), even though her family was also poor and the neighbour paid for her school uniform.

Then I, always keen to make people (and my dad) proud of me, was a super geek at school and applied to Oxford (for my partner at the time). To my absolute surprise I got in; albeit to the college so academic it was called where fun goes to die and they shut the games room during exam time. I was told off for coming 7th in my year because that wasn’t the way of my college.

Half way through I went to London for clinical training. Having had no hospital experience and still fairly shy of people I did very badly in the practicals, though written was still easy but they didn’t contribute to the year. My parents were paying a lot to support me through London rents and catching the tube between zones 1-6 for med school. (As in £1500/month), so I thought I better buck up. Finally I left with distinction and started off an academic job in Oxford deanery (academic was wonderful) but like all new juniors it was hard work. It turned out the years above us however were taking bets on which F1s they could sleep with, lovely. Suddenly the offers of help and advice from seniors became quite sinister! Accommodation nearby was expensive so I stayed somewhere rather rough until I called the police for a women being attacked in the house next door and then came home to find all my windows broken the day after. Though nearly all consultants are helpful they were rather busy, and so the odd ones who threw ringbinders at you or told you to go back to med school, or you were going to fail at at medicine because your supervisor had gone on a month cruise and things wouldn’t be signed in time, occasionally made you think twice. But medicine is rewarding and satisfies your curiosity.

Fast forward to anaesthetic training. I moved up north for two years for a partner I broke up within a month of the move. I knew very few people but got to, worked hard, decided to focus on exams, travelled back 3-4 hours each way to see friends and my mum when she was poorly , dealt with some of the casualties from the terror attack. signed everything off, passed my exams, focused on getting a clinical fellow job because I didn’t feel ready for reg posts. Then when the Rotas were one in two weekends with a lot of single days off , but a six hour round trip to see anyone new, I turned that down (feeling absolutely guilty – who was I to turn down an opportunity in medicine for boring family reasons?) luckily got a reg job where people were suddenly jumping off the hospital and slitting their throat which was wildly out of my comfort zone but you get on with the job.

I find it interesting people rarely ask how your first shifts/night shifts are even though they are often absolutely far beyond the scope of a normal person’s entire life experience. We ask about first days of school, a new job, but rarely about first day in a new hospital. I got engaged (but no one knew because there are hundreds of anaesthetic consultants and you are only there for three months at a time/on nights/see people either never or max three times and you can’t wear a ring at work). Only my peers knew as well, when my dad fell down a twenty foot concrete trench. We don’t really ask each other about our weekends between consultant/trainees which I think is partly lack of familiarity and partly an opaque hierarchy.

I worked over Xmas, mostly on lists unrelated to my training. Meanwhile my aunt had a large heart op and had a spell in icu but I couldn’t go see her. Then a colleague let me know I’d been missed on an email regarding us all starting at a completely new trust in two months. Suddenly that annual leave I had been collecting could not be debited, because too many other people were off over January.

Then on my last weeks I was coming in between night shifts (despite also living an hour away) to get things signed off. But it comes with the territory. Then on my next block I had to go to induction on my annual leave days. I was paying £25/shift to park initially until I figured out cheaper places because despite living forty miles away they’ve run out of permits. Expenses will cost be the same as my mortgage payments for petrol, parking and the four new tyres I’ve needed in eight months of motorway driving.

My grandad passed away (my aunt rang me saying the carers had found his body what should she do). I was at work so I mentioned the ambulance and called the gym where my mum was to get reception to go and get her so we could tell her that her father had passed away. I then worked the twelve hour shift, with only the midwives being sweet. I didn’t feel compassionate leave would be acceptable so I tried to swap shifts to go to his funeral 250miles away.

Some of the anonymous feedback from UK doctors that Jo has been collating

Some of the anonymous feedback from UK doctors that Jo has been collating

Once I had an incredibly traumatic death of a young person.  Even the consultant was distraught at 2am. No one had cleaned the body even though the family were in the room. I did it, and it was incredibly frightening and gory even though I am pretty inured to the frights of trauma and death. Three months later I was having nightmares about it, and for a two day spell would be speaking to people, and seeing their eyes dilating and then passing away, even though we were just sat in clinic and it was a complete illusion. Luckily that was short lived and i still went to work, driving the hour and back from shifts, leaving the house at 06:30 and returning at 9pm, or vice versus on nights. Twice I slept in the car at services, once I tried to but a kindly traveller had knocked on the window thinking I was dead. I was so guilt ridden about a journey one day in the snow, I walked forty mins to a station, caught two trains and a taxi to work (which took about three hours), felt horrific I was late, but then all the patients had cancelled.

I love medicine and my colleagues are smart, funny, caring and inspiring. But none of my seniors, who I get on well with, knew about my engagement, my dad, my grandad, either because of the rota pattern, busy shifts or we aren’t designed to ask. We all get asked how our shifts were but not the viscera of our lives.

I am not depressed, I wouldn’t give it up, but I am tired that medicine in the UK at the moment has created a system that is systematically designed to separate us from our real lives, erode the mentor/trainee relationship, move us round hundreds of miles and perform a constant circus of acid rain on our self esteem,deep rooted desire to please, and ability to conduct ourselves as a daughter, partner or parent. Medicine is unfortunately one of those careers you have to prostate yourself before/marry. I’m not sure I understood completely what I was sacrificing at 18. I accept that For healthcare you do just have to sacrifice, but realistically there is a fleet of small, inconsequential things, like the omission of small talk, missing people off emails and registers, coming up with complex and circuitous methods of claiming annual leave, that would transform my world were they to undergo a humane metamorphosis.

There is that remnant shard of infant inside me that is still curious, enjoys exams, feels comforted that with the world in catastrophe I still have a job that is pleasurable and well remunerated, and sets goals that I will chase as avidly and enthusiastically as a spaniel with its ball. My colleague, more business-like than me negotiated kinder working conditions. He wryly observed that after honing myself writing essay after essay on things such as whether and how memories last forever, the evolutionary bioengineering of the knee (the locking mechanism is a highly efficient way of maintaining a standing position in terms of energy) and whether pain was “all in the head” in med school, I was fully able to communicate the minute, vague and petty tortures of a colossal machine like the NHS, and why goodwill matters. I myself still feel a little confused that I felt compassionate leave was cheeky. Why?? If the NHS wants to employ people in a lifetime career then it needs to make it that career sustainable. That includes allowing for precious moments in the lives of staff. I find emails about resilience galling because they seem to say that it’s our fault we find it hard sometimes, and the environment can not be altered. It’s not that I feel burned out, it’s that despite exchanging some of the most pivotal events in my life to work, I am continually missed off emails about my own life (eg rotas, the hospital I will actually be working at); and clearly so anonymous no one would actually realise you were gone until the first time you didn’t turn up for a shift.

Why are we treating professionals who have cost thousands to train, dreamed of the career often since a child, work at the expense of their health and personal life, in such a disposable way?