Feb2000
I was starting my first job in the NHS. I had qualified as a doctor in 1995 in Chennai and completed a three year master's degree in General surgery by 1998. I then worked for a 6 month period in Plastic surgery and wanted to pursue this as my career. This is when the UK bug caught me and brought me to this wonderful country in Autumn 1999. After three months of trying to break into a job in surgery, I managed to get a senior house officer job in Emergency medicine in a leafy suburb of Birmingham. The department was run by 2 consultants from south Asia - one Indian and one Pakistani. It also had a middle grade tier which was made up of an Indian, a Pakistani and a Nigerian doctor. The senior house officer tier had a mixture of British graduates and overseas graduates. It felt like we were the commonwealth ED department. This was before I realised most of NHS was run by the citizens of the commonwealth. A commonwealth of subtle and unspoken inequalities. All the British graduates were on a standard training pathway(as part of surgical or general practise training) and the overseas doctors were on a stand alone job desperate to break into a rotation of some sort somewhere.
We lived in a hospital provided 2 bedroom flat within the hospital campus. I had a wonderful 6 months there with my wife. The most expensive thing we bought with my first salary was a panasonic music system which is still with us and working well, mostly. We were so happy, soon my wife became pregnant and the next thing we remember is a scan showing us the bundle of joy. Amidst the mood swings and hyperemesis of my wife, I was busy working the ridiculous shifts in a busy emergency department and applying for a job from August. The evil Home office would only give a short 6 month visa which barely covered my stay in UK till the end of the current job. I found my dealings with the Home office and visa the most stressful. You were somehow made to feel like an unwanted criminal even though you were adding so much value to one of the spines of this beautiful country, the National Health Service.
The first thing I had to learn in UK was to understand what a surname and christian name meant. Coming from Tamilnadu, where we had done away with surnames two generations back it was a little confusing and there were many occasions where I would mix up the names like " Hello Mr. Smith James" and the patient would correct me that it is "Mr. James Smith". Even today my passport says I am Ganesan Arunkumar, whilst I go around calling myself Arunkumar Ganesan! The second thing I learnt was that the British have a passion for breaking their 5th metacarpal(a bone in the hand). I learnt that no matter what reason they give "I slipped and fell" "I accidentally knocked it on the wall", they are almost always due to a punch. Later in the day we probably will see another man with a facial injury who will also claim he slipped or that he accidentally knocked on the wall. I learnt that this is not an in frequent British past time on a Friday or Saturday night.
My most impressive colleague was a really cool medical senior house officer who had many years experience and could literally manage anything medical that came into the resuscitation room. Coming from a surgical background I probably learnt most of my medicine from this wonderful doctor. Unfortunately NHS hospital medicine had killed his spirit and I was told he was moving onto the world of Primary care to work as a General Practitioner. I could never understand this craze for becoming a General practitioner in UK. Coming from India in the 90's I always thought doctors practised General Practise mainly because they could not get into a 'proper specialty'. I was ignorant then and did not realise the amazing work done in Primary care in UK. I think it still remains one of the under recognised 'proper specialty' all over the world.
My most memorable nurse was one of the shift co-rdinators in ED. She was a fat( or should I say high BMI) middle aged nurse with the most amazing multi tasking ability. Sat on a chair at the nursing station she knew what was happening with every single patient in the department just by looking at a big paper chart in front of her. This was before the era of computerisation and I am yet to see a slicker co-ordinator and in some ways computers have probably slowed down the flow of decision making in emergency departments over the years. These computers have also reduced the time people actually look at the face of the person they are working with because most of the time we are like zombies looking at one screen or the other. I will not be surprised if psychologists come up with research to prove that these screens have increased human stress levels many times and has made us less human and humane.
My most memorable patient was a cardiac arrest. We were alerted about a young man who was in cardiac arrest as a result of injuries sustained because of an alleged assault by a group of drunken youth. He came in asystole (no electrical activity in the heart)and did not survive. Post mortem revealed traumatic brain injury, bilateral lung contusions, the liver lacerated into two pieces and ruptured bowel. A few months later I had to attend a court to give medical evidence in a case where the group of young men were facing murder charges. I still remember the shock I felt when the defence lawyer asked me if the liver and lung injuries could have happened due to the CPR(chest compressions) done by paramedics and emergency medical staff. I later came to know that the group of young misguided youth were convicted of the murder. I hope they went on to regret the day they thought it was ok to jump on a poor homeless guy on the street. I hope they came out reformed and better individuals.
The 6 months flew by very quickly and soon it was time to say good bye to the wonderful team I was working with in Birmingham. Somehow I managed to get a job in Cardio thoracic surgery from August. It was not my first choice specialty and I would have much preferred Plastic surgery but given the difficult job situation for overseas doctors in NHS I felt I cannot be too fussy. More importantly I could not believe I was getting to work in one of the Premier University cities of UK in a equally prestigious cardio thoracic department. Unfortunately my wife could no longer cope with our life in UK because of her homesickness aggravated by some serious hyperemesis. So she went away to India to provide the right atmosphere for herself whilst she grew our bundle of joy. I was off to Oxford for the next stage of my life in UK.
Pause.
Picture below taken through the window of a Boeing flying over the skies of Arabian sea
