H. Hospital (2)

In this same hospital, I encountered consultants I either really liked or really disliked. To set the scene, there were quite a few consultant obstetricians and gynaecologists who met regularly at meetings, and around half of them were female, half male. Dr Ergometrine, Dr Embryo, Dr CTG and Dr Foetus were the male consultants; Dr Syntometrine, Dr Anti-D, Dr Suck-up, Dr No-back-bone were the female consultants. And leading the group, or at least trying to, was Dr Brash.

Dr Brash was a small gaunt lady with dark boy-cut hair. Now, drug companies regularly send representatives to give very short presentations or explanations to doctors at their meetings. It is commonly accepted that they organise five to ten minutes in a meeting that doctors will attend anyway, and they usually bring abundant food for the doctors to have. Sometimes they are deemed obnoxious, but most of the time, doctors (and medical students) greatly look forward to sitting down with no pressure and eating the food. I’m not saying they are brilliant people–nothing in this world is for free, and I am sure there is huge element of capitalist give-and-take here: they clearly want to buy the time for them to advertise and market their products, sure. Still, I do not agree with Dr Brash’s behaviour. She came into the meeting room–packed with thirty or more people–a few minutes late, and proudly received the smiles from Drs Suck-up and No-back-bone, and even a coffee that Dr No-back-bone had personally bought, personally saved for her and tackled through the packed room to personally present. She then looked up and blinked a few times at the drug company representatives who were presenting. She turned around to her wide-eyed fans and mouthed a question, asking who had invited these reps. “Oh, I don’t know!” the two female doctors replied, leaning forward with overly bewildered expressions to eagerly present their grovelling answer. Dr Brash, still looking dramatically confused, crept over with her coffee to Dr Syntometrine, who was clearly aware of what Dr Brash was approaching for, and was ready as soon as Dr Brash opened her mouth to stop her by saying, “I don’t know.” Dr Brash, brushing off the interruption, rose from the floor and said to the reps, “Excuse me!” The reps, mid-presentation, stopped at the second or third “excuse me” and looked at Dr Brash. “I’m sorry, but who invited you?” Dr Brash questioned. The reps were silent for a second and then replied that a “Roy” had done so. “Our registrar, I see. Well, we don’t usually have drug reps in this meeting, you see. Now… it seems a bit childish to ask you to leave when you have come all this way. May I ask how long the presentation will be?” The drug reps, poor things, gave a hearty reply that it wouldn’t last long–perhaps five to ten minutes. “Right,” Dr Brash replied, “then I will return in ten minutes.” And with that, she left.

With this story, I hope I have been successful in planting in your heads the characters of a few of these doctors. Dr Brash was most definitely not one of the my favourite consultants. She proudly relished vainglory for herself, and how ungraceful her character seemed to me! She was the very example of a doctor I did not want to become–how pitiful it would be to have the best intellect when you cannot gain the true love and respect of fellow comrades and patients. Now, perhaps you gained some insight into Dr Syntometrine–the woman who did not humour petty nonsense. She was the consultant I was allocated under and a doctor I admired. She never complained about her patients, never joked crudely about anyone, and she treated everyone with respect–this all done with a solemn face that easily broke out into a kind smile. When a 16-year-old patient came in from the ward to her clinic, the patient pointed at me and asked, “Who is that?” “This is my medical student, Emily.” “Why is she so young?” the patient cried. “Yes,” Dr Syntometrine replied, eyeing me, who had a rather serious look on my face, “they get younger every year.” You may have noticed she called me Emily. Hahaha. She called me that for a good week or more, and I had not the heart to tell her she was calling me by the wrong name. She had remembered it began with an E and I suppose that was good enough for me. I really didn’t mind–we medical students come and go, and I was soon to leave. If she wanted to call me Emily, then say hello to Emily! But later, when I introduced myself to a patient, she continued the consultation and as soon as the patient left, she held her head and cried, “I was calling you Emily and you didn’t correct me!” I laughed and replied, “It doesn’t matter.” She slammed the desk and exclaimed, “Yes, it does!” That was quite sweet. But really, it didn’t matter to me. I remember when one slightly worried patient came in for a consultation and trans-vaginal ultrasound, the patient said she was getting pains in her abdomen and wandered if something was wrong with her gall bladder. Dr Syntometrine, with her deadpan face, looked at her abdomen and said, “Well. This isn’t really my area…” But as she spoke, she picked up the broader ultrasound head, gelled it, and started scanning the upper abdomen. I don’t know why, but that image gave me a strange feeling. I had been with so many consultants who were snide and who didn’t go much out of the way for their patients. But this consultant, regardless of not being a gastroenterologist and unlike the others who would have brushed it away or straight away told the patient to ask their GP for a new gastroenterology referral, quietly tried to see if she could find anything and in doing so, comforted the patient.

From one end to the other. Dr Suck-up. Again, I’ll tell you one story of this doctor. As Dr Syntometrine did not deliver babies, I had to go on a search to find a birth to observe. I found out that Dr Suck-up was delivering and so I entered her theatre. I didn’t know anything about Dr Suck-up, and had I talked to my friend Reginald, I would have found out that he had had a bad experience with this consultant. We went around in the theatre introducing ourselves–something most theatres do–and I remember saying that I was Esther, the fourth year medical student, and I remember glancing at Dr Suck-up to see her nod at me. She left the delivering to her registrar and she stayed at the back, gossiping with the female anaesthetist. I even remember them looking at me whilst talking and my eyes meeting with Dr Suck-up’s, to which she had hastily looked away. I had the patient’s history saved in my head to present to a consultant. When Dr Suck-up reached the door to leave after the delivery, I stopped her, saying, “Sorry to disturb you, Dr. I was wondering if I could get signed off?” I thought it, and still do, best to word such a request like that, as different consultants have different styles: some want you to present the history, some want to just sign you off so they have less of a hassle, etc, so it is best to ask like so and then the consultant can reply with what they desire from you. Dr Suck-up was clearly different. She stared back at me, looked down at my log book and spat, “Sign you off? For what?” I kept my ground. “For observing the birth.” She looked at the log book. “This is not a presentation! You must present the patient!” I was getting bewildered, but kept still. “Yes, I can present if you’d like.” She clearly did not want to let me present, and she did not want to give in to what I can only call a tantrum. She was incredibly snide and was acting like I was asking for her to be a surrogate mother for my babies. “No, for a presentation you must have looked at the notes and you must know the history! This is not a presentation!” It was quite a sad sight, thinking back. She was trying to look at me with a confident air of superiority and right, but her gaze kept wavering; the poor woman was trying to act hard, but all I could see was a pathetic stubbornness. I gave up on her. Regardless of the fact I had a presentation ready for her, I stepped away with a brisk nod and disbelief within. Angered, but trying to keep my cool, I approached the consultant anaesthetist (not the one who was gossiping with Dr Suck-up) and asked him to sign me off instead. He was a tall man with an accent and was new to being a consultant; he very keenly signed my book after hearing my presentation. I took my book and very boldly walked through the ward, past Dr Suck-up, and home. I won’t lie; I was really annoyed at the way I was spoken to. I heard later that my friend Reginald had been shouted at in the theatre in front of all the staff by Dr Suck-up to leave at once as he had no right to be there. She is one doctor I do not want to be like, thank you very much. The utter disrespect she showed us medical students, and then the utterly spineless grovelling at Dr Brash’s feet, really put me off her.

I seem to have a lot to write about H. Hospital. I must write a Part 3.

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H. Hospital (1)

I had my Dermatology, Neurology, and Obstetrics and Gynaecology placements at H Hospital, at different times of the academic year but at the same hospital.

There isn’t much to write about my Dermatology placement. I was with a female Chinese consultant, young, fashionable and chic, who was the object of many medical students’ admiration, especially the male medical students. She was passionate and keen in her specialty, and also did some hip hop dancing outside Medicine. She involved us in the clinics, telling us to make incisions for her, and asking us lots of questions. Now here’s something: if you ask a medical student a question and they don’t reply in the first five seconds, it most probably means they don’t know the answer so you should either move on or give a hint to help. This consultant would ask a question, stare for a good few minutes, go back to seeing patients and then return for the answer. Now, I don’t know what her theory is–whether she thinks my brain is capable of brewing answers that weren’t there before–but her technique doesn’t work. I can’t speak for all medical students, but it most certainly does not work with me. You will end up with an awkward silence, and me pursing my lips as I look up at the ceiling to avoid eye contact and pretend I am engaged in educational guesswork. She then got a bit annoyed at me and my clinical partner as we both sat still, looking away, and said, “You can’t just look up at the ceiling like that in the exams. Come on, you should know this.” Firstly, yes, she hit the nail on the head, the tricksy little hobbit, and secondly, the questions she was asking were really not for our level. She then started to grill me until I felt like some Korean barbeque–I mean, I just wanted to flee, waving a white flag and screaming “I surrender!”

Let’s move on to Obstetrics and Gynaecology. My word. I saw things I cannot unsee.

Wandering about the labour ward with my clinical partner, Vaughan, I ended up going into a labour room alone as the family was Muslim and did not want Vaughan to be present. I smiled as I entered, introduced myself to the patient, gave a friendly nod to her mother, her husband, and the two midwives–well one midwife and one student midwife. It was a normal vaginal delivery so there were no doctors present. A normal delivery with gas only to aid. I won’t go into detail, but let me just say that as soon as the baby was out–after all the screaming and tearing of rather delicate parts, can I say–the midwives turned to me with broad smiles and said, “That was so beautiful. So beautiful! What did you think, Esther?” What did I think? I think, my dear woman, that beauty is clearly in the eye of the beholder. Right, let me just wipe this blood off my face. It looks like you have everything under control–I shall be gone. Move aside!

I don’t know what I had been expecting. Some crying, some desperate pushing, and ‘plop’–a baby! It’s really not like that. It takes such a long time for the head to come out. One push doesn’t visibly seem to progress the head. It was long and painful.

After the birth of the baby, the patient was asked to move over to a seat with a rope to pull on–something the labour ward has to aid in pushing–to try and push the placenta out. The seat basically looked like a toilet seat, and the patient stood up to move over. Now, she had to get up from the bed, which was literally pooling with blood, the umbilical cord hanging out of her vagina with two clamps pulling it down, and waddle over to the seat, dripping blood as she went and the cord with the clamps swinging like a pendulum. She perched herself on the end of the seat, started pulling down at the rope and tried to push the placenta out. The two midwives and I were crouched on the floor, surrounding her, and all intently staring at the vagina. We then heard a huge release of air–I don’t know from which hole–and then a sudden explosion of blood, which splashed onto our feet. There was utter silence. And the silence was broken by the husband saying, “Oh no.” It got sorted out–the blood worried the midwife into leading the patient back to the bed and administering Syntocinon to prevent blood loss. The husband was so keen to make me hold the baby afterwards–I politely declined, saying with a smile, “No, you should hold her, you’re the father”, but he stood up, saying, “No, I’ve held her for a long time! You can hold her!” and started to push the newborn baby into my arms. So there I was, shaken after seeing my first normal birth and holding a newborn baby that I had not much of a desire to hold in the first place. After giving the obligatory compliments for babies’ parents, such as “how adorable”, etc etc, I was then asked by the midwife how my first experience of observing and aiding in a birth was, the answer to which every single person in the room stopped and stared with smiles and small nods to listen to–even the nearly unconscious patient. The patient did actually lose consciousness after I left the room, from overuse of the gas.

I don’t mean to scare anyone into giving birth. I mean, that was my first ever experience of a birth and it was very au naturale. Another normal birth I saw–much smoother–was that of a young black woman who gave birth alone. Her mother had left the ward, and only returned after the birth. It was quite a sight. The mother, an old black lady, swept into the room, cried out in joy at the birth, gave praise and danced about on her own, gave the newborn baby one stroke on the cheek, and waltzed into the bathroom to call her family. The patient had been trying to breastfeed the approximately ten-minutes-old baby, but then she started to grimace and push the baby aside. The midwife was taken aback slightly, but she took the little girl from her and placed her on the resuscitation trolley for the while. The patient’s face then lit up as she took out her phone and started calling relatives also. She started celebrating on the phone the birth of her baby with her family. So there was this patient crying out in joy with the phone to her ear, the mother’s cries of joys from the bathroom as she called relatives also, and then the newborn baby not held for more than ten minutes, lying on its own.

The same evening, a patient in her forties came into the labour ward to give birth to a premature baby, and I must mention her waters had broken a week ago. Offensive liquor had come out the week before, and she had been in hospital since. Now, she was very calm and collected. She was a small black lady, with her sister and niece, and waiting for her partner to arrive. The family was joking about and having a good laugh. She would fall silent with each contraction, and then start laughing again. The partner, an incredibly young-looking black man, came in with a chicken burger takeaway, and started to eat away in the corner, filling the room with the smell of fast food. He was very quiet and deadpan; he would look at us waiting for the birth and say to his partner, “You’re taking your time. Look at them; they’re falling asleep waiting for you.” The registrar was yet to arrive as the patient was not dilated much. The midwives were moving about, getting things ready, when the patient suddenly shared her desire to “pee”. The midwife left the room to get a bedpan for the patient, but as soon as she left, the patient shouted, “I’m gonna push!” Everyone stood up, shocked. She repeated herself, “I’m gonna push!” I sprinted out of the room and down the corridor, in search for the midwife who had just left. “She’s going to push!” I cried, and the midwife, aghast, started to hastily move back towards the room, waving the bedpan. Back in the room, I could see the niece beside the patient, telling her she should not push yet. The midwife cried out, “Don’t push! Don’t push; the doctor’s not here!” The patient’s eyes were tightly shut. She positioned herself into a crouch and screamed again, “I’m gonna push!” Everyone started to move about in haste, and the registrar entered in the midst of the tumult. She came in confidently, saying things like “it’s okay”, and perched herself on the bed; she reached out her hand for the delivery kit to be handed to her by the midwife. “I’m gonna PUSH!” Splat. There was dead silence as everyone stopped to stare at the bed; there was a newborn baby kicking and crying between her legs. The silence broke. Everyone started shouting and moving quickly. The registrar vigorously shook her outstretched hand for any kit quickly, the midwives were bustling about and just then, the neonatologist swooped into the room, pulling along a resuscitation kit. He hurriedly turned on the resuscitation trolley, opened up his case, started taking equipment out, took the baby from the midwife, and started examining him.

There had been no vaginal tears. The patient was back to laughing with her family in a few minutes, and even whipped out her phone to tap away. The baby smelt tangy and sour–the result of infected amniotic fluid–and had six fingers on each hand. Apparently the father was born like that too, and he touched the hands of his son proudly.

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P.A. Hospital

Looking out the hospital window at some cars honking at cyclists, I remarked, “Oh, I hate cyclists.” The consultant’s voice suddenly boomed behind me: “I’m a cyclist.”

I do not hate cyclists–not anymore. At the time I was frustrated by some cyclists not stopping at traffic lights or pedaling away at high speed on pavements.

Whilst I was on firms in P.A. Hospital, I was with a Consultant Rheumatologist who happened to think me incredibly keen to learn–I had never been accused of such a thing–and took to me warmly, showering me with teaching and opportunities. During this time, I was sitting in on her clinic, Rheumatology being a specialty heavily clinic-based, when an incredibly pretty young patient walked in. She had flowing hair bouncing about and her features were very well moulded–and alas, she let it be known that she was a model. She went straight to telling the doctor of her problems, but the doctor told her that she would listen in good time and asked that she do an examination first. The patient grabbed the clothes to change into for the examination–the consultant led her into the examination room and told her to let her know when she was ready. The doctor closed the door and returned to her desk. A minute later, from the examination room came a shrill “come in! Come in now!” You could see the shock on the face of the consultant; it read “I beg your pardon?”

She was not working at the moment and was bringing up her toddler at home as a housewife, but her rheumatoid arthritis was not controlled. Picking up her child was painful and she was scared, she said, of dropping the child. She spoke with no expression; it was like she was standing on the catwalk. Yet with her emotionless face, she kept pushing at her desire for the biological medication Infliximab to be started, for she was finding no benefit on being on Methotrexate, she said. The consultant told her she did not fit the criteria. Her catwalk face was not amused. “Well, then,” she replied, “that’s fine, I shall just have to risk the life of my baby.” An awkward silence veiled us all.

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Quo Vadis

I have literally just finished reading the book ‘QUO VADIS’ by Henryk Sienkiewicz, translated by Jeremiah Curtin, and I have to say I really loved it.

I wanted to write this post to not only remind myself of the brilliance of the book, but also to raise awareness for it. It is a book that is not well known these days, but it greatly contributed to the author’s receiving his Nobel Prize in Literature in 1905, and led to a fantastic film on its story in 1951 (This is the best interpretation).

How did I find out about this book? My mum watched the film as a teenager and read the book. She could not recommend it enough to me, joking that the main character Marcus Vinicius was her first love. I watched the film with her a year or so ago, and then started reading the book.

What on earth does ‘Quo Vadis’ mean? It is Latin for ‘Where are you going?’ and are the words spoken by one of the main characters Peter as he flees from Rome to a safe place where he can preach on Jesus Christ. Rome had just carried out a mass murder of Christians in an amphitheatre and Peter was trying to leave. “Quo Vadis, Domine?” he asks Jesus (Domine being Lord) when he sees Him on the road before him facing Rome, and Jesus replies that if Peter does indeed flee, He Himself is going back to Rome to be crucified again. Peter upon seeing Jesus returns to Rome to continue preaching.

It is not a history book. It is not a Bible. It is in fact a novel based on many historical truths.

The novel has such a brilliant diversity of characters: the self-loving Emperor Nero who is an absolute buffoon, the witty and cunning Petronius, the handsome and brave Marcus, the beautiful and pious Lygia, the strong and childlike Ursus, the pretty but jealous Poppaea, the loving and wise Peter and Paul, the disgustingly greedy and lying but later pitiful Chilo… the list goes on.

The story starts in the Roman times under Nero’s rule. The victorious general Marcus is seeking the advice of his uncle, Petronius; he had dislocated his arm and was taken into a lordly house to recover and fallen in love with a girl called Lygia there. He is not sure of the background of the girl. He knows she was adopted into the family, but is of blood the daughter of a tribal king. Marcus and Petronius find out that she is technically being held a post-war “hostage” in that house after her country was defeated in battle, but that she was adopted into the family’s hearts and loved like a daughter. We learn that Lygia has a giant bodyguard called Ursus who loves her as his queen and she is, alike most people in her house, is a Christian. Marcus just wants to possess her as soon as he can, and so with the fast thinking of his uncle, they devise a plan to let Emperor Nero give the hostage Lygia as a present to Marcus to thank him for his efforts on the battlefield. Lygia is torn away from her adoptive family whom she loves, and kept in the palace of Nero. Nero eyes her up, as does his wife Poppaea, and likes what he sees. Lygia is a beauty: more beautiful that Poppaea who deems herself the beauty of all the lands. But Petronius is cunning. He puts words in Nero’s mouth, and he is so good at it, you end up marvelling at his skill. When Nero shows interest in Lygia at a feast, Petronius says quickly,

“I am ready to lay a wager with Tullius Senecio concerning his mistress, that, although at a feast, when all are reclining, it is difficult to judge the whole form, thou hast said in thy mind already, ‘Too narrow in the hips.'”

“Too narrow in the hips,” answered Nero, blinking.

But don’t get me wrong: Petronius is always on the ball and uses a lot of his skill to achieve a good outcome for himself. Nero may be an idiot, but he is indeed a dangerous beast too. He killed his mother, wife and brother before marrying the twice-divorced Poppaea.

Unlike his plan to possess Lygia and give her everything and make her happy, Lygia is far from happy. At first when she thought she was being taken for Nero, she is distraught that she will be condemned to a life of a defiled and bought concubine of an evil king. She liked Marcus, and when she finds out that it was actually him that planned all the arresting and taking away, she feels betrayed that he did not approach her as a woman, but as a slave. And not to mention, as a Christian she cannot let herself freely give her heart to him as he is a Roman lord who has a history of enjoying gluttony, greed and many women. She flees. This leaves Marcus tormented as by following his uncle’s advice, he has lost his love and cannot find her. He begins a long journey to research into where she has got to and recounting his time at Lygia’s adoptive house, which was a time of peace and love he had not known before, he remembers that she had drawn a fish in the sand. Here enters a character who has left quite the impression in my head: Chilo. He is a most disgusting old man with greed and worm-like manners, you can describe him in the modern tongue as “a bloody selfish suck-arse”. He helps Petronius and Marcus find Lygia, for as much money as he can get, of course. (However I must say, his ridiculousness does make you chuckle). We follow the story as Marcus finds out the fish is the Christians’ symbol and Marcus, who does not even know what a Christian is, and can faintly recall rumours of them being evildoers that poison water, kidnap children and enemies of society, ends up entering the magnificent world of the Christians.

I will not spoil anymore. However I cannot urge you enough to pick up a copy and start reading. The language is not difficult; anyone can read it who can read. And the descriptions are so vivid that you can feel what the characters feel, and see and hear what they do. You laugh, gasp, swoon and cry as you read the happenings. It is full of crazy and huge happenings. Trust me. Things really HAPPEN. And yes, it does have the theme of Christianity in it, and it shows the love, faith and hope that the Christians feel, which made the book to me all the more interesting and brilliant to read.

Let me know if you do decide to read it. :) It’s free on Kindle.

READ IT. Thank you. Goodbye.

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As a fourth year

I realised I had forgotten to write a lot of things in my previous post. Can I take this opportunity to tell you about how things have changed being a fourth year medical student? As a third year, all the doctors were so friendly and asked you simple questions, not expecting you to know the answers. Third years go around with a label on them that reads, “This is my first year on the wards so be gentle on me please. Kthanksbye.” Fourth years go around with a label on them that reads, “This is my second clinical year. I don’t really know all that much, but you will ask me more difficult questions because I’m nearly a doctor now. Be gentle? No? Ok, fine then.” I do enjoy being a fourth year medical student – you’re no longer treated as, and you no longer feel like the baby on the wards.

I had a GP trainee doctor on my ward who turned out to be dating a famous singer and sings herself. My friend Rita madly texted me when she found out from her FY1 friends, and later she turned on one of the singer’s music videos in which our doctor came out as the singer’s lover. I could not finish watching it. It felt so weird watching her sway to the music and softly sing when I see her on the ward being all professional and even slightly cold at times. I never told her I knew about her being famous. I highly doubt it, but if you are reading this, Doctor, well… I knew. I just didn’t want to make you feel uncomfortable on the wards.

One of the male patients on the Geriatrics ward kept looking at me during the ward round when I was helping the F1 by calling out the obs. He mumbled something and the consultant asked, “What did you say?” The patient pointed towards me and replied to the consultant, “No, I was talking to my wife.” He clearly thought I was his wife and was wondering why I was ignoring him. The consultant froze and then said, “That’s not your wife; that’s our medical student.” The patient replied, “WHAT? I thought that was my wife!” The consultant replied, “Does your wife look like her? You lucky man!” (This was one of the only nice things the consultant actually said about me, so I want to savour it… Thank you, savour finished.)

I clerked a patient at the end of the female bay, so I had to pass four or five other patients’ beds to get to hers. During the clerking, one of the other patients kept shouting, “Help me. Help me!” At first I went to try and help her, but soon realised that she had dementia and just continually said that. After finishing the clerking with my really friendly patient who was one of the few patients who didn’t have dementia, I stood up to leave and started walking toward the exit. As I walked, I got shouted at by all the patients with dementia who were crying out random incomprehensible things. I was taken aback and as I was wondering what to do, the patient I had just finished clerking shouted out to me, “Just keep going onwards! You’re going to be late!”

The consultant asked me, “Do you know the pain ladder?” I slowly nodded and he whispered to the nurse next to him, “Does that sound like a Yes to you?” I replied, “Isn’t that when you start with weak opioids and move onto stronger ones?” He replied, “So that’s a No.”

He then asked to borrow my stethoscope to examine a patient. After using it, he cleaned it with an alcohol wipe and said to the nurse, “Look at this. This is brand new.” I said, “I’ve had that for five years now.” He replied, “Yes, but it’s still new. You never use it.” I said, “Yes, I’ve used it a lot!” He asked, “On who?” I just whispered after giving up, “On myself…” to which he looked at me in a funny way.

There was a new nurse on the ward when I was there. She was from Texas so she had a thick American accent. Mistaking me for a doctor, she approached me, calling in her American accent, “Doctor!” And I had the sudden urge to dramatically stand up and shout, “We can’t lose him! We need an EKG… STAT!” Don’t worry, I didn’t.

Dr. Akinesia told us there are two types of doctors in the world: a tickbox doctor and a doctor who uses their initiative. He told us that these days the hospitals and GMC just want tickbox doctors who just do things because they have to and they do it without much thought. He said we should be curious like a five year old who keeps asking “Why?” He said we should always look at patients and ask ‘Why does he have this? Why did it happen? Why does this cause this?’ Hopefully I will become a curious physician and just a curious human being.

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