Home

Today was the big day. 4 months since seeing the last result. I remember it was a Friday morning. I was hiding in a clinic room, finishing the jobs from the week. Also hiding, in case the results came out. Sure enough, there it was… Fail, by 1 mark. After a few minutes of feeling the gravity of the moment, I sent my Education Supervisor a message, and a few minutes more, he was there to show support whilst I was feeling pathetic and useless.

Failing an exam as a doctor is the worst. This is also relative – in the US, failing an exam is completely unacceptable. Medical training in the UK is a bit more forgiving, you have several attempts at an exam. For the FRCR Part 1, you have 6 attempts. This was my fourth.

For the last 4 months, although I can’t say that I’ve put my head down with blinders 100% of the time, I can say that I have put in a lot of effort – listening to lectures in the car to Southampton and back, reading lecture slides, meeting with Radiographers and Dosimetrists, done maybe over 1000 Raphex questions, learning and re-learning calculations. Re-watching all the lectures these past 7 days. Still, it feels like it is not enough. Still doubtful. All that for a 50 question over 2 and a half hours exam. I accept that I will never understand Radiation Physics completely (let’s face it, who does?).

Walking back into the Royal College of Radiologists, although I felt a bit more relaxed – I’ve been here before, I’ve done this before, it still brings back memories of the last times. But I do feel a little less clueless compared with the last times.

The biggest kicker today was Proton Beam Radiotherapy questions. 4-5 of them (10% of the exam). Yes, it’s the section that I’ve looked over once or twice as it is never on our daily treatment menu. Heck, there are only 2 centres in the UK that deliver PBT.

Other things – I remember flagging up 11 questions and went back through them (surely I’ve not gotten all 11 wrong). All calculation questions were doable – half life, tenth value layer, activity, monitor units of a palliative plan with a single beam.

Like the last few 100 metres of a marathon, when the Finish Line is in sight, I watched the timer count backwards in minutes then in seconds, then it was over. Exam Finished (the screen said). 50 questions in 2 and a half hours. After the exam, I cannot help but be filled with dread. What if it was still not good enough?! Silly Proton Beam questions! Unlike a marathon, I won’t find out how well/poorly I did until 3 weeks from now!

Well, I suppose I could go back and do a bit of running again whilst waiting. And sleep.

…is how I answer bleeps when on-call.

Registrar of the Week (Pre-Game)

Two weekends ago, I did my first weekend On-Call at Southampton. The big event was getting a patient with lung cancer who got caught in the middle of a perfect storm of recently having a cycle of chemo-immunotherapy, then becoming neutropenic and ending up with Norovirus. The result being a woman with septic shock and terrible electrolyte imbalance, needing intensive care support. Any instance wherein the ICU team accepts any of our patients (appropriately of course) is always a big win.

Last week, whilst in clinic, a patient walks in looking awful, has been vomiting at home. Her son showed me her most recent blood sugar readings, these were off the charts. The machine couldn’t read the high numbers. I managed to get her accepted by Medics for assessment as I suspected Hyperosmolar Hyperglycaemic State – a diabetic emergency. Any instance wherein Medics accept any of our patients is always a big win.

I also looked after a patient who had immediate suprapubic pain after antegrade stents being inserted. The stents failed shortly after insertion. Kidney function worsened – bladder not filling, Cr 500, eGFR 9 overnight. With good advise and logistics working on my side, the CTKUB confirmed stents were in place and can’t see blockage. Bilateral nephrostomies were inserted at 4 pm. Any instance wherein procedures for our patients get done on the same day they were requested is always a big win.

I felt pretty chuffed about myself. Then Reg of the Week happened.

Registrar of the Week

More commonly known as ‘Reg of the Week’ or ‘ROTW’ or being ‘On-Call.’ To me, it is ‘my most favourite week.’ Alternatively, it could also escalate to ‘the shittiest week ever.’

This week was my first full Reg of the Week in Southampton. What is quite different is that as a Clinical Oncology Reg here, you only deal with the Clinical Oncology patients, the Medical Oncologists look after their own. This is different from Portsmouth wherein you look after both.

In Medicine, the word ‘Quiet’ is like ‘Voldemort’ in Harry Potter. Nobody likes saying it, nobody likes hearing it. Monday to Wednesday were Quiet (I can say that now). It was very odd. It was just not what I was used to, as in Portsmouth. I found myself wandering the halls, desperately looking for jobs to do. One of my other Reg colleagues said ‘Monica, you look like your adrenaline is not being pumped enough.’

If it’s adrenaline you want, it’s adrenaline you get. Thursday came around and it started with planning for a patient transfer for emergency radiotherapy for cauda equina syndrome. Then a patient who desaturated and deteriorated pretty quickly, who I suspect had a massive pulmonary embolism (sadly passed away), then neutropenic sepsis, then frequent vasovagal episodes that initially looked like seizures, then someone with a blood pressure of 200/70 (wide pulse pressure), then someone who had purple finger tips (Buerger’s disease) with low blood pressure then plain old sepsis. All in a day.

I was anticipating that Friday would be a ‘when shit hits the fan’ kinda day. Conventionally, all the cord compressions get referred on Friday at 4 pm. But there was none of that. Instead, it was a ‘when shit hits the fan’ kinda morning. Five new admissions to review (handed one to another Reg) – luckily, two I already knew about, one was waiting for a procedure then home, left me with one – post-radiotherapy odynophagia. Phew.

But wait there’s more. The hardest one was a patient sent from another hospital for emergency radiotherapy but it turns out, he had deteriorated further overnight. By the time he got to us, he was already dying. But no one alerted us. So as Reg of the Week, I had to break bad news to the patient and his family (who I only met 15 minutes before) that the radiotherapy will now be futile in his current state. I made the decision of not sending him back to other hospital, we will now start end of life care. Yea, that one’s gonna linger for a while. Throughout the day, I kept thinking on how I could have made that situation better. (Of course, all was discussed with Consultants).

And just like that, it was 1700 on Friday afternoon. Reg of the Week was over (til the next one). Time for the Post-ROTW PTSD to take over.

The biggest lesson this week yet…

On Tuesday morning, I attended a virtual Wessex Exam Skills course, in hopes that I can improve my exam technique – given 3 failures of the Physics exam. One of the advice was that download the syllabus (which I have) and compare the feedback report to see if you identify weak topics. I keenly did this during one of the breaks and lo behold…

I was actually okay in the first few topics. Then about 50% in the middle and just dropped off towards the end. 2 possible reasons, I most likely don’t focus on the last topics enough and perhaps I am more tired towards the end of a 2.5 hour exam. A perfect storm of poor performance.

Now I can’t help but relate this to the way I run marathons, positive splits is not part of my vocabulary. I always start out strong, then compromise around the middle and then just slow down towards the end.

So after this discovery, I am changing gears. I am going to read up on the last topics and focus building knowledge around that.

Facepalm moment: I should have analysed the exam feedback a while back.

Also, I should also view my previous race metrics in more detail. Maybe I am not as serious about races as others and don’t really go beyond looking at my Finish Time. But hey, I can only improve if I engage and learn with my previous shortfalls. Otherwise, I’ll just be doing the same thing over and over again.

Rest assured… I have started zero-ing in on Quality Assurance, Radiation Protection, and Radiotherapy sources.

Project Pass Physics update. Chunking. During marathons, I set smaller milestones like run til the next mile or run to the next lamp post or 3 miles to the next drink of water. This week I finished all of the Intro topics – what is an atom? basic radiation Physics, electromagnetic wave spectrum, photons and particles. Next up is starting radiotherapy planning, a big chunk but could also be broken down a bit more.

Project Declutter update. I managed to tidy up one cupboard in our bedroom. In the 5 years of living here, we’ve just been shoving things in it ‘to sort later.’ Finally, it’s been sorted.

Out with the old…

After 4 years at the Queen Alexandra Hospital, it was time to move on. I had spent my Internal Medicine Training and the first 2 years of Clinical Oncology Specialty Registrar Training there. I had chosen to stay within the QAH when transitioning from IMT to SpR here so I didn’t have to struggle with learning new hospital systems etc., I could just focus on learning how to be a Registrar. I think I made a good decision there. Also I didn’t want to be too far from home as the kids were also just starting school.

Of course, one thing I couldn’t help naturally is getting attached to the place and the people. The QAH is a challenging place to work in, it is chaotic and more often than not, you can feel that things could be a lot better. However, I enjoyed my time at there, especially at the Oncology department. I was greatly supported by my Consultants and fellow Registrars. The nursing team and support staff were all amazing. On reflection, I did develop quite well in that environment and I’ve established really good relationships. I had thoroughly enjoyed my time at the QAH.

However, one must never get too attached, according to the Buddhist philosophy of impermanence. Attachments (to people, desires, expectations, thoughts, self) can lead to suffering. One must let go.

I should learn from past lessons, moving from Asia to America, now to Europe, leaving things and people behind, that despite the reluctance to go, the anxieties of fitting in, it is all one big adventure, one new chapter, and another opportunity to experience new things and grow. There is beauty in that.

In with the new…

Thursday came around and I set foot at the University Hospital Southampton for the very first time. The first few days (and the few weeks to follow) in a new hospital system are always about induction and finding your feet again. New computer system, new policies, new people, new corridors. Know where the coffee and the toilets are. A lot of “Hi. I’m Monica, one of the new Regs.” I had more anxieties than excitement last week. However, I also know I need to be patient with myself and just ride this new wave. Try not to set a lot of expectations apart from trying to do a good job. Who knows… I might even enjoy it. So, Southampton and Uro-Oncology, here I am.

Some running… back to basics.

Stick to 15 miles a week for now just to maintain some level of sanity. After not really been running for training, I’ve set some acceptable standards over the weekend for Project Don’t Stop. It can only get better from here.

I’ve also realised that the only way I can really have a running mindset is I am training for a race. No, I have not signed up for anything. In fact, I am not running a the Portsmouth Marathon in December as I am just not ready. However I am keeping in the back of my mind that post-exams, if entries are still available and I am feeling good, then maybe the Southampton Marathon in early May may be an appropriate and timely option.