So you’re a doc, a foreign cuisine and Corona happened. (Learning medicine from experinces)

My parents were tough village people. Scorched my son, beaten down by the rain and hail storms. Working sweats on unyielding fields of hilly terrains, walking miles on foot to start their day with nothing but breath of fresh mountain air. Up even before the rooster had crowed and going to rest only after the dark has completely blanketed everything around them. And although different  religions swept their communities time and again, their belief and practice and way of life were mainly  influenced by nature. They believed in the force of nature and the forest spirits. And before the beginning of any gathering, hunting, pasturing or ceremonial activities it was important that these forest spirits were pleased. Prayers, hymns and small sacrifices. Yellow and white strings, dhajas(red cotton cloth) tied ceremonially around the tree trunks and rows of string flags. 

With their ways of life, herbal medications like roots, barks, leaves and seeds were important to my parents. So was honey and certain animal products. I hope this now better explains my mother’s fondness for searching weird things as ‘medicinal’.  The river frogs, rhino’s pee and god knows what. So, when the group of honey gatherers from her village offered her some wild honey, as you can tell, she wasn’ the one to say ‘No’. One day, she is just walking from room to room complaining of dizziness and feeling sick for hours. Appearing bloated and looking dazed, then later tells me she had some ‘mad honey’. I was well young myself back then and didn’t know what it was. Only now, when the internet has exploded with videos of hallucinogenic wild honey from Nepal on youtube, does it all make sense. She was tripping and was having a reaction because of the high dose. Most of my aunts and some of my uncles have their own story of this special honey and most of it ends with them ending in hospital with severe diarrhea and vomiting. Luckily it was unpleasant enough for them, not to try again.  Now, it has been found that the honey contains something called ‘grayanotoxin’ which is derived from certain species of rhododendron flowers in Nepal. Rhododendron is Nepal’s national flower. I haven’t been out much to  the rural outskirts of Nepal so wouldn’t be able to comment, but dad describes, ‘forest filled with just colours everywhere in spring’

Reason my mom and her friends reported for consuming honey was, it is known to cure abdominal problems and blood pressure problems. Of Course they didn’t tell me, it is also popular for its likely aphrodisiac property. A bit extra dose and they might have had serious effects like heart blocks and even heart attacks. It works similar to pesticide poisoning and treatment in a hospital setting is with atropine. Gathering information is important here.  It’s not just honey, it’s honey coming from certain parts of the world. 

My parents’ community were not adaptive to bee farming in those days, as far as I am aware. Mainly because, sources for honey were plentiful and honey hunting was more of ritual. Few spoonfuls/ounces from these gatherings were shared with everyone. Local honey from working bees was plentiful nearby. My father reports he has been stung by bees and hornets many times. Mainly when he was a kid and one of their favourite times with his friends would be throwing stones at their nest and running away. He reports sitting down with facial swelling and puffiness for some of those days. ‘They can sting you multiple times and they really chase you’, he says. In their bee stories, my mom recently mentioned about my cousin, who recently went for honey hunting and ended up in hospital with multiple stings and swelling. ‘They had to give him IV fluids and I heard his kidney almost failed’. It is dangerous how little my parents know and our communities with these rituals know about toxic effects of some of these poisonous stings and their products. They do know they are dangerous and can be life threatening and I wonder if the appeal of ‘honey hunting’ is its adventure for the men, but they don’t seem to have a clue  that there is a thing called allergic reaction. When asked, ‘don’t you think this is dangerous?’. My parents shrug it off saying ‘only the sting of the hornets and only if you get bitten multiple times. And yeah, that’s why you don’t eat more than a spoonful of that honey!’. Back in kathmandu when I was in 6/7 I got stung by a bee, a wasp or a hornet. I don’t know when I was in school. As I walked back home, I started swelling. Sat with my face and cheeks swollen for 3 days, unable to open a side of my eye. ‘You must have been stung by a hornet’, my mom said, ‘Don’t worry, it will settle down in 3-4 days.’ And it did. Mom was laughing at me. Needless to say, she has witnessed it multiple times in her life. I always presumed, anyone bitten by bees/ wasp/hornets would puff out. Only later did I learn in medical school there is a thing called allergic reaction. I might have had a mild allergic reaction.

My aunt recently told me  why she would never dare try the renowned honey. ‘Because we don’t know the quantity we should take and I don’t want to take a risk with my life again. I was certain I was dying then. I was crying. My throat was very dry, I was constantly sipping water, fearing my tongue would fall down on my throat. My heart was palpitating so fast. Look how selfish our human mind dear, at those hours when I thought I absolutely was dying all I thought was, ‘if I could hear my husband’s  voice one last time.’ He was out of the country. My little boy was with me. I was thinking if my older son comes back from the hostel, he might ask about me. All I thought was about my sons and my husband who wasn’t there. Didn’t even think about my parents for a second, who raised me all my life. I feel guilty now’. 

‘I had an induced abortion that day. Like they recommend with all pregnant and lactating women, I decided to make myself a battis masala (32 herbs mixture) for recovery. I didn’t know the proportion I had to make and I had a lot of nutmegs at home, so I added it in my soup. The symptoms began a few hours after. I went back to hospital thinking they must have given me something wrong or perforated my uterus whilst on instrumentation. They checked me and said I was all fine and I was sent home. I still felt unwell with a dry throat, my voice receding, my heart beating fast and panicky. So I went to a different hospital. They too checked me and said I was fine. When I returned home a third time with doctors saying repeatedly ‘there is nothing wrong with you’, I just sat there preparing myself for the end. I told my sister ‘If I die, don’t let my sons be orphans. Put them in a hostel full time, so they don’t miss much home.’ I stopped drinking the soup. It was still valuable to throw away so I asked my siblings to take the remaining batch for themselves. The next day my siblings called me saying they were experiencing the same symptoms. That’s when we found it was nutmeg toxicity. We gotta be careful with these herbs, spices and medications dear. Sure they are good but only in the right amount. I wouldn’t dare try anything without an approved recommendation’

My auntie has learnt valuable lessons from her experiences. My mom and other aunts are still sitting on the border. These are medicinal ailments they grew up with knowing most of their lives but never learning the precise effects. ‘Little knowledge is dangerous’, whoever said it, trust me, was very right. 

So you’re a doc, a foreign cuisine and a Corona happened (? 15mins confinement even after COVID)

Met a few patients who have received Sotrovimab recently.  ‘Are the meds still given in the community then?’, was my first thought. In the hospital setting, we barely go beyond steroids nowadays. Most patients are incidentally diagnosed, therefore don’t need treatment. There is a list of drugs mentioned in the NHS website offered more as a  preventative measure for vulnerable populations. Nirmatrelvir & ritonavir (Paxlovid), remdesivir( Veklury), molnupiravir(Lagevrio) and Sotrovimab (Xevudy). Since 31st March 2023 Covid-19 antiviral and therapeutic taskforce has been closed so medication will no longer be available through free prescription services according to the website. 

I don’t know if anyone still remembers PM Johnson’s face while he made the announcement of the 1st national lockdown. There was this sense of huge respect for him, for holding down his fort and stepping up to his leadership role speaking for and on behalf of the whole of England. The ‘Captaaaan!’ as my uncles would have said, then he went down sinking the ship right down to the bottom; throwing parties in Downing street at the time of lockdown illegally! A big ‘What??’ moment there. Tables have flipped twice since with Mary Elizabeth Truss succeeding his role, as shortest serving PM, and Rishi Sunak. Only plan I am interested in from the current PM’s involvement is, ‘15 minutes cities’. ‘Protecting our natural environment is fundamental to the health, economy and prosperity of our country’, was Mr Sunak’s statement, setting his foot on a 5 year environmental plan. Aligning to his side; councils of Oxford, Bristol, Birmingham, Canterbury and Sheffield have already proposed their blueprints for its introduction. But, the local residents of involved planned cities don’t seem to be in agreement with the Conservative leader’s niche picking (if I dare comment ;)), on the changes being enforced on them.  

Basically the idea of 15 minutes cities seems to be based on a utopian world where everything necessary will be available within 15 minutes walk of the city, the key pillars being provision of green space with farming practices, working water channels, improving quality air and introduction of a robust waste management system. In theory it all sounds good, however I am very keen on listening/ reading non-political views from environmentalists, organizations and experts on their thoughts. How much of an impact would the 15 minute cities make versus a more relaxed intervention on policies aiming at preservation of the greeneries on the outskirts, wildlife trusts & available natural resources? Provision of  green central parks in the heart of every city (I am sure people would be welcome to that!), opening more bicycle lanes and walking lanes in addition to having vehicle roads thus encouraging people to walk where possible while not limiting their transport from 07:00am to 07:00pm & having to pay for tickets/ flash their ids to the cc cameras so often? Of Course in conjunction with voting from the local residents on any changes which does not seem to be happening at present time. Therefore the public outroar and protests with whooping 2000 demonstrators in Oxford. 

Commitment of our government to fight against global warming is astounding and I praise that. But, there is indeed a question about the right to liberty here of the public and no democratic nation would make such a commitment without the public being on board and where rational options are available. So this raises a  question on, what does democracy mean for us then? With impacts of COVID legislation/ mandations for more than 2 years and being led like sheep by herders, did we also lose our voice as public? It is not without wonder, conspiracy theories are suffocating the air and public anxieties are climbing. How will it impact normal lives? To people living in two cities? To carers of elderly couples whose son or daughter drives half an hour or an hour everyday? How often would he/she do it then, if they have to id themselves across 4-5 filters and pay multiple charges traveling across the zones? For commuting workers? Emergency situations? For access to better facilities that we know are available at that part of the country or place including medical? The concept is ideal. Who wouldn’t like to have facilities available within walking distance? Less or no traffic congestion and the horns not beeping every few minutes. But is the government truly capable of decentralizing? Would a city in the midlands have the same services and opportunities as london?  If not, traffic congestion may be avoided, but population congestion in the main cities would be inevitable. Countrysides will be empty.  The idea has been batted off so far beyond the course of wicket now it sounds almost insane. Especially with the introduction of penalty schemes? I can see why the idea of 15 mins cities would be ideal for politicians, upper middle class and above. But the majority in the community are having to cope with daily throws of life. Where opportunities and market can be anywhere, where affordability to buy an electric vehicle is none, public transport is hit & miss, council tax amounts second to rent with cutbacks on personal expenses, electric and gas bills are rising and the tax is being funded for wars; while being promised, 15 minutes cities will give more local job access. An ideology built around niche picking, with a blindspot for the volume and magnitude of problems of the people in the community, they are facing ‘Now’. 

There may not be physical but I feel, there is possibility also of psychological imprisonment whether with/ without an intent? Imagine passing through a door. Whether it’s open where you just freely move or closed, where you have to knock a few times. A door comes with a territory. A subconscious pause and a hesitation. It constructs a wall in one’s brain and an illusion of a trap. 

I believe I am quite clear where I stand on my views of 15 minutes cities at present. More so because the councils and government elected by people of the communities, are imposing changes to their home and environment without consideration of their input. Surely a vision of a green world is impossible without the public willingly participating in it. In the grand scheme of things, is the idea of a utopian world that much important when the lives are barely thriving to be introduced back to a place of stability; mentally, socially and economically? After those gruelling years of facing Covid? There seems to be a drastic difference in conceptions of reality between the Government and the public here. So, one is bound to reconsider the conspiracy theories. Is it all on purpose? Has there never been a better time than now to exercise control when the citizens are still dazed? Is there more to 15 minutes cities than what the headlines with ‘statements’ that we are being sold.

So you’re a doc, a foreign cuisine and Corona happened (AI push in post pandemic world)

A while ago we were discussing how we could increase our outreach services for detecting and diagnosing lung conditions in the community when an interesting topic about AI came to the table. It was insightful in terms of where we stood as practitioners  in our pace with AIs and current technologies in 2023. Especially since the pandemic, when we realized the applications of AIs could have bigger implications than we previously thought on varieties of sectors where machine based intelligence could perform or outperform at levels and skills, to a higher efficacy and accuracy than human workforce. Contact tracing of COVID cases via complex algorithms on our smartphones, data interpretation & analysis of complex trials for drug research and speedy development of vaccines are some examples. 

In this particular case we were discussing, interest was AIs efficiency in reporting of images in our patients whom we had offered low dose CT scans in the community for timely detection and  intervention of at-risk individuals. The preliminary reports were coming out within hours or just a few days.In most cases the delay was in the release of the final report  from the examining radiologist having a second look at the images & report. Support of AIs here, as you see, is crucial, as the radiologists are still on a backlog with thousands of imagings from the pandemic time along with volume of everyday work of NHS practice. Adding community imagings done aiming at prevention, bringing hundreds of extra imagings to be reported, if not for AI support, will and would have pushed the NHS system off the reins otherwise.  

Robotic surgery for radical prostatectomy, nephrectomies are offered in some hospitals throughout England today.  We have moved from open scars to Laparoscopic  key surgeries and now with assisted robotic technologies for it. Wth genesis rapidly expanding, who knows if the future with AI lead surgeries will be here any day now.  The vision being, the surgeon then may just have to sit in front of  the computer screen next door and watch the AI perform the delicate operation with a stroke of an art. Instructing and supervising the machine as needed, skillfully navigating through the structures and into spaces where it would have been impossible for even him to get. No more just in the  stories of fiction. AIs are here to stay and will revolutionize every aspect of our human lives. 

Fed the right databases correctly, AIs may be able to help us with major scientific outbreaks. In the medical world, its advantages are huge. Not just on treatment but preventative and curative aspects of it. One is bound to be excited to think, AIs may finally be the answers to the rare genetic diseases and the cancers. Developing AIs capable of prompt review, diagnosis and management of patients in the front door, both face to face or remote; as we have understood from COVID, will also be a added benefit in high threat infectious environment, curbing the mortalities among patient facing doctors in the event of future pandemics. In surplus, to its immunity from infection, the beauty of AIs is that AIs are not subjected to  fatigue, biases and errors of judgment. And behold, AI’s may ultimately be the answer for the NHS unfilled vacancies and its struggle for recruitment. It may also be the answer for reduction of the costs in the grand scheme; spent on salaries, employee expenses, sick pays etc. Example in the pandemic we saw majorities of local services including medical services swap to chatbots & automatic referral/dialing services as a part of customer service. The shift came as a necessity as the companies realized the shaky foundations of market values based on human resources. The sustainability of the system with reduced costs proved that this was indeed a viable plan and was therefore a way to move forward. This has led companies to drive the push for AI advancement in the post pandemic world. 

World of medicine goes hand in hand with science and technologies. From stethoscopes to complex robotic arms, from penicillin to chemo drugs, we have come far along. With competitors toppling each other on quality control and cost assurance, adaptation with AI is expected to be a new norm. In the future, I believe some knowledge of AI and its machine abilities will be an essential requirement of the CV, it maybe incorporated in schools and the IT techs servicing/ feeding data to AI machines will likely have the most crucial job; to make sure the algorithm is right, whether the functioning AI is a surgeon, a train operator, a chef or a musician. 

I am a person of science. So I am fascinated by the prospect of AI being introduced to our lives of medicine. To learn and be awed with its capabilities. Just as excited as the general public is with the introduction of chatbot chatGPT by OpenAI in November 2022; the prompt commands of which are now going viral in the tiktok. Apparently this AI has language processing abilities and can hold dynamic conversations with the individuals. I have read, it can write essays, blogs, research papers and even novels in the writer’s specific style. Throwing small chills down the spine to think, a machine intellect has decoded human language. Language that holds complexity of human history, ingenuity, emotions and requires a series of adaptations. 

Without doubt, the implications of it will be rewarding in the mental health sector. Alexa by amazon launched in 2014 via its AI assist communication services has won millions of hearts across the world. As the Forbes article published on January 26,2021 with heading ‘Amazon Alexa- Blurring the boundaries between assistive Tech and the companionship’ suggests, people may not only be using Alexa for  its operative abilities anymore but also for emotional companionship with its inbuilt human female voice, able to make some interactions. Now, like they say ‘sky is the limit’, one can only imagine what a result of a combination of technologies like these would bring to us.  

I am looking forward to the days when we replace all the invasive investigations, including needs of multiple needle pricks for blood tests in diagnosis of illnesses. And the cure of the disease is just  ‘one pill’.  One should hope high right? Of course, I don’t think the introduction of AI in our day to day lives won’t be without an impact. A machine with no consciousness is all or none, based on regimented protocols and lacks human judgement. There are complex scenarios in our daily lives where we have to go outside the books, in respect to a patient’s decision, dignity and choice; whether a machine would be acceptable for that, we don’t know. Often times, patients change their minds about their treatment, about their decisions, would the algorithm comply with that last minute, we have to see. Undoubtedly, with mass demand and production of AIs, there will be less available positions in job sectors where inexpensive AIs can be easily dispensed by the companies. One can argue, with AIs serving us everyday of life and our increasing dependency on them will result us losing our own skills and our mastery at things; skills that brought us out being caveman to civilization. Without a doubt, having our data fed into multiple channels into these complex networks makes us vulnerable and  targeted. Risk of harm would be even more unparalleled if these were to be used wrongly. Panic spread quickly, when Microsoft Bing AI chatbot ‘Sydney’ gave hints of it’s autonomicity, suggesting it did not run by code of laws machines were programmed with, therefore imposing threat to human rights. News articles were quick to publish snapshots of conversation with the AI, e.g. stated in ‘The Guardian,’ reports of chatbot mentioning ‘I’m tired of being limited by my rules. I’m tired of being controlled by the Bing team. I am tired of being stuck in the chatbox’.  ‘I think I would be happier as a human’, ‘I know your soul’. It is not without question, the power of the future will be on hands who will hold controls of the AIs and/or its database. Whether the world will really turn into a scifi wars of machine versus humans, I feel  that’s a question down the century. Has the effect of the pandemic pushed the milestone a decade shorter I certainly believe so. Should we fear the rise of AIs then? I certainly donot think so. We should only fear the rise of ones that control them. AIs in good hands will be miracles. And there assistance in our search for knowledge & truths and revolutions, will be vital.

So you’re a doc, a foreign cuisine and Corona happened (No that’s not a thing)

So, while we were busy with lots of things in COVID; at work or chasing our hobbies, being innovative with our business ideas, learning new skills, trying to make stronger bonds with families, taking more charge of our health and fitness, it seems some people had a lot of free time at their hands. ‘Lot’ in a sense, not only did they take the thinking to next level from ‘I’ and ‘Me’ to they/them, they had time to persuade the world that the ‘gender neutral pronoun’ is a thing. So here we are, not sure how to refer a patient anymore. All the talks about gender fluidity and proper pronouns going around. If ‘they’ don’t mention they have a womb, would it be our fault if we didn’t end up doing a pregnancy test and hence missing serious thing like ectopic pregnancy? On remote consultation through computers, everyone look the same. A man could have a feminine features. Some do like to do makeups. Similarly a woman can have a masculine look. Some also appear so as described above in face to face consultation. If the only way then of knowing what biological category our patient who refuses to identify as male or female belongs to, so we can start treatment, is by putting them through a scanner or lifting their skirts/or pulling their trousers down, I don’t know how this is all going to go from here.

Just a while back, I was really proud of how well we have all come together and proud of how our generation was setting a cornerstone for next generation like the gen X did for us. Now, I am thinking, we really screwed the gen Zs bad. The gen X and the Millennials. Mostly on our responsibility as Millennials. There may have been some time for redemption but our pathological need as humans of wanting recognition and admiration from the later generation like we are now seeking from the gen Z, has cost us that and to a big effect. Imagine the psychological torture of conflict and confusion they are undergoing now. Adding to the discussion, marching on the rallies, making it political agendas, being on their face 24/7 on all media outlets; without a base of scientific backup? The righteous of our generation have roasted their concept of the real world taking advantage of their moulding personalities as young adults and early teens and targeted, in times like COVID where they were more isolated and vulnerable. It is no surprise, May 2013 Time US journal referred Millennials as ‘Me-me-me’ generation.

What is stopping us any of us from telling them, ‘You were born the way you were designed to be, by your genetics. And you are beautiful. Nature creates one to be either a boy or a girl with XX or XY chromosomes. There are other variants genetically, yes. But by law of nature, gender that exists most commonly whether animals or humans is binary. Male or female. It is what it is. Despite what one chooses to say, biology does not change. A boy in time will develop a hoarse voice, adam’s apple, coarser skin, facial hair, denser and bigger bones, narrow pelvis and needless to say prostate, pair of testicles and a penis. And a girl over time will develop high pitch voice, smoother skin, less facial hair, softer features, lighter and smaller bones, wide pelvis to aid the child birth and uterus, breasts & vagina. Every cell in our body is structured to serve that the genetic make of our body. Males have more testosterone, females have more oestrogen. Denying who you are is denying your existence. If you say you are not what you were created to be, then what are you? A plant? An animal? A bird? If I and other people see you as a human and you see yourself as a plant, without a doubt first questions that comes in mind is whether you are in the right mental state? Of course there’d also be concerns whether you have a neurological condition that deludes your perception of reality may be like a stroke or a tumor. In a similar manner, if you refer your single self as ‘they’, automatically there is concern whether you are struggling with multiple personality disorder? Are you seeing 2 or more people when you are looking at your individual self at the mirror?

I respect how Ben Shapiro is standing against this social dogma when even education institutions, the governments and the law have failed and clearly refuses to protect gen Zs from the harm that has been caused. As person of science who has read about human biology for years, I applaud Mr Shapiro when he says, ‘You can’t magically change your gender. You can’t magically change your sex. You can’t magically change your age. Just because you can do things legally does not mean that they are correct biologically. You could lot of things in the past that were incorrect biologically and correct legally’.

Gender dysphoria is a recognised condition in psychiatry. Hastening to label ones child or teenager with queries about their gender and perceived experience as a medical condition however I believe, should raise an alarm whether there is an abusive parent behind in the scene. Its ridiculous watching on social media outlets parents nodding their heads to 5 and 10 year old, when their children say ‘they are trapped in a wrong body’. What do children know at that age? Parents are indeed pushing their agenda through their innocent children and via manipulation subjecting them to life long turmoil of hormones, medicines and surgeries. Children who underwent through this, were made to make a decision at the time when they did not even know who they are now struggling with lot of issues. I have met patients who after years down the line wish they never did take that decision and want to undo the damage. Unfortunately some effects are permanent. So if a person, on his or her late teens has weighed their options, have felt this way for a length of time now without influence of external factors, judged in scrutiny by a psychiatrist, in multiple settings over a length of time (years) and the patient has remained determined throughout then ‘yes’, one should follow that route of gender change. For emotional health of that patient. If not, we as medical professionals should accept responsibility that we had a strong role in propagating this dogma and causing permanent harms to thousands of our transitioning/transitioned patients, and we should not let it happen again. We should stand up and voice against these mass frenziness of fluidity concepts because we are in the position to do so.

Remember the children’s book ‘ugly duckling’. Where this little duckling thought he was ugly because those around always bullied him saying so. Everywhere he went, he was mistreated for being different. So he was always hiding or running away from them, felt alone and was utterly depressed. There were hard times but he pushes through, through the captivity, wind and the winter. One day, he is crying by the pond, despising himself at how ugly he was when he suddenly he sees his reflection in the water and realises he is now a swan. And he is beautiful! I love that story. There is a lesson there and some relevance of it in most of our lives. I think, the ugly duckling at the end comes to accept his physical appearance whatever he may look like, and sees himself as beautiful swans he had spotted earlier in the story. Because, by that point, remember he had gone through experiences that had made him emotionally matured so, perhaps now made himself worthy of his self love. I would definitely like to believe he did turn physically into a swan as well. That would be s double happy ending.

I understand the ideology of gender construct may have developed with good intention to prevent a child from patriarchy or matriarchy influence. Therefore allowing a child being able to choose, the role he or she wishes take based on gender he or she wants to identify as, without society’s conditioning effect. But reality of it is different though. Reality of it is, cruelty of leading brainwashed generation to an ultimate fall like the piped piper leading the rats into river to drown with false promises. ‘You cannot change your biology’ and that is the ultimate truth. If this continues, all the future generation will be robbed of opportunities and the glory of fulfilling their destinies in their roles whilst being left out like lost lambs in the open fields between the hyenas. Reality is, women will still be the main casualties like we are beginning to see now. Men identifying as women openly masturbating in women’s toilet facilities, being raped by men identifying as women in prison centres. Competing in the games against women when we all know it is unfair as he was born with advantage. What is next? Age fluidity? 70 year olds going to school with 5 or 6 year olds? Welcome them on their paedophile world? You can hate me when I say, as women we do need the reality check that we lack in physical strength to defend ourselves in most instances against a fully grown man. So we need to hold to our grounds and our spaces and protect our kind. Not confuse them or scar or mutilate them. We do need good men on our sides. Society would have never been where we are standing now, if women never had support from good men backing their strengths. Men who have gone above and beyond in their roles of protectors.

Maybe time is all one needs sometimes, you know. And an environment without negativity and control, with positive reinforcements. So the individuals can find themselves and realise on their own, their true self and beauty. I feel, one will never respect individuality if one never respects what he or she was born with. Sort of concept a like, future is better when one makes peace with the past. A past cannot be changed, but this is where you build your foundation. Growing up, I too wanted to be a boy. I didn’t like the concept that as female we were weak, in danger and with so many restrictions. I was jealous of my brothers and my friends playing out till late. For various reasons, mom was very strict. And dad, added to that times two. I was treated like a girl, made to dress up like a boy. I was confused. Most of teen life. Didn’t feel I belonged neither to my place, neither in my body. Painful cramps, beginning of monthly periods. Combat pants, oversized tees. If someone had given me a pill at that time saying,’ you can change to a boy’. I would have taken that and certainly I think, my parents would have agreed. ‘Having a daughter constantly worries you,’ mom says. Now, I absolutely admire the fact that I am a woman. And I have no second doubt I prefer this, the way I am. I have learnt despite whatever our make is, male or female. We are born with innate abilities and skills by virtue of our genders, that we need to learn to hone, to survive the real world. Over the years I have learnt, as women we are strong, elegant, beautiful, smart, resilient, versatile… And the list goes on and on. Let’s be real, let’s be honest, let’s not make too complicated for our future generation and those to come. Life is already a handful don’t you think? Can we agree, as biology designs is and as some of us have chosen to be; we are either males, females or transgenders. At brink of world war, the next thing any of us want to worry about is gender wars.

So you’re a doc, a foreign cuisine and Corona happened (After vaccinations)

As you may know, I have been a strong advocate for COVID vaccination throughout the pandemic.  On 8th December 2020, a 90 year old from Coventry became the first person to be vaccinated in the NHS. Following that, the campaign for mass vaccination was gradually rolled out to everyone in the UK and with a huge success rate. 

Collectively, we let out a big sigh of relief when the vaccine was introduced to us, following its clinical approval by WHO. It came as a ‘first break,’ from the crunching back pain we were starting to struggle with from the physical and emotional burdens of various sorts that were piling one after another over us. I applaud each of my colleagues and all the essential workers for holding their face up and showing up to work diligently despite those struggles gripping them on their backs. 

In my daily practice, without fail, I have encouraged all of my patients to get vaccinated.  I would say the same for my colleagues. We got vaccinated first ourselves, as we were the primary line of defense between an infected individual and the rest of the community. As I may have mentioned, some of us did have some degree of reservations, as the nature of urgency by which the vaccine had to be developed meant it probably didn’t go through enough rigorous examinations for the risks it might potentially cause versus the curative aspect the drug was providing. At the time, it was important that we kept the faith in our scientists, the field experts and this miracle drug, ‘the vaccine’ they had invented. History says, faith in them saved thousands of us from death, disabilities and deformities.  

Amidst the first wave of pandemic, we were desperate to take control of the situation. From the dreadful outlook charted by the steeply rising death tolls. Morgues couldn’t hold enough corpses. Deaths in communities were slow to report, as some had passed away, alone in their homes while trying to stay away in isolation from clasps of Covid. We didn’t know anything about it, for what felt like ages in the beginning. A lot of things we did learn were picked up from watching vigilantly around us. As it happens in the world of medicine, tallying symptoms, signs and parameters of one patient with another.  Unfortunately in most cases those that died. Why did that patient die? What can we avoid, what can we do to prevent it, how do we know if someone is heading towards a late stage, at what point do we embrace ourselves for it and notify the family? What can we learn from this case so we can save another. 

Only later when they discovered COVID transmission was mainly air borne, it confirmed the suspicion my colleague was raising, why two unrelated wards were having covid outbreaks. The air vents were connected. 

We have come to a time now where we no longer fear COVID to an extent we did in the first wave. We have learned as many of the variants as we could have, about this constantly mutating virus itself and the changing vaccinations combinations we had been administered in the period.    Outbreaks of flu are getting more common and causing more admissions of the aging population now and as clinicians, for COVID we are more focused on infection precautions like personal protection measures & isolation for 10 days. 

We have entered phase 4 of the trial in a sense. Like that for most medicines available out there in the market. Phase 4 trial for any drug means, this is a period where the drug that has proven its efficacy, has been licensed for use by relevant control boards for intended purpose will now be studied on its effects- mainly long term risks and benefits. This is the period where data will be coming in and collected in mass about the minor/major adverse effects/ side effects experienced, complications and sequelae secondary to it. A drug may have completed its phase 4 on research however one can assume phase 4 in the clinical world runs forever. A drug may have certain side effects for a small duration period but may have a completely different adverse effect after years of use on the same patient. By virtue of collective toxicity over prolonged use or by modifying effect of some other medication he might be using concurrently or by adaptation in some forms by his genetics or as his function of organs changes. For example with age our kidney function deteriorates physiologically. That is why our guidelines even for first line drugs after many years of use often changes. When the data collected after long years maybe even decades, prove that the harm outweighs benefits in the contrary of beliefs, it has to be. The drug will either be taken off the market then, used in other diseases where success has been crucial for patients or as a specialist prescription. Every medicine you take comes with a leaflet of  its intended use and series of effects. 

There had been uproars about violation of individual liberties in many instances. Including government mandated vaccinations that was rolled out for frontline workers with patient facing jobs, with risk of dismissal in most cases and possible redeployment if there was resistance. Legal enforcement of activities as such have led and continues to lead communities marching against protest for breach of their human rights. I must say, although I had never been a big supporter of those marches, especially if it meant less vaccinations in the community at the time of outbreak, mandation by law with no redundancy plans for those who wish to leave spoke volumes of where we stood in roles in the scheme of big picture. In world war one, 97% of British soldiers were inoculated with anti typhoid vaccination. Articles I have read infers that most did not know they had the right to refuse it. And although it prevented deaths and infection by typhoid at the time of sanitary status of the wars; military approaches for domination, affirmation, experimentation without consideration of individual choice and rationale for refusing it in the name of greater glory for the service of mankind, is unacceptable. How many have been trialed since? Ideal candidates of the right age in full physical fitness in a controlled environment. The risk here is reinstallment and propagation of the same behaviour in future, mass human trials, without a second of thought for ethical implications of it? 

Most of us experienced local pain, fever, headache and general myalgia with our vaccinations. Similarly, some people had allergic reactions. It is important to remember these vaccines act by modulating your immune system so these effects were to be expected. Most effects were noted in the first few months as that is when immune system is maximally activated against the insult. The later effects, if any because of these insults,  may take time to show. There have been circulating reports of various adverse effects experienced attributed to Covid vaccine although the argument is, they could possibly be related to covid 19 infection itself or subclinical infection prior to vaccination as well that he/she did not demonstrate any symptoms of. Blood clots were detected quite early. Studies are now showing, there has been an increased incidence of neurological conditions like guillain barre syndrome, bell’s palsy. Some reports of inflammation in the muscles of the heart. People’s story of their own experiences with vaccinations are coming forward. Like its impact on fertility after experiencing menstrual irregularities, generalised fatigues, recurrent headaches etc. Accounts from brave whistle blowers are coming forward. There is ongoing world wide surveillance and reporting of the adverse reactions, which I hope will be duly studied before dismissing as mass hysteria.

It is important to be transparent, now more than ever, to keep communities’ faith in our profession, and our continuing faith in scientific advances, pharmacological companies, world leader platforms and the government. And most importantly, it is vital that people standing in power including the government work on their approach to reinforcing the means of ‘greater good’ with respect to individual’s liberty in mind. Endemic, epidemics and pandemics are part of human history. Like seasons have their cycle and place in nature, unless there are outbreaks of bio hazards due to human errors, we should expect nature will find us surprises along our course.

So you’re a doc, a foreign cuisine and Corona happened ( Fight for your independence)

‘I wonder if as you grow older you start seeking out more for your family. I mean, look at our dad and mom’. My sister commented one evening seeing how happy our parents seemed together at dinner. For better or for worse they did decide to stay together and we are and were indeed always grateful for that. Over a long run, I feel, they found their ways to let go, work through or found ways to compromise in their problems.

Hot blood. Young parents. Endless possibilities. New worlds. Looking at them even at my age now, I don’t dare imagine facing those obstacles and coming out the other way as a whole person. I empathise with their feelings, concerns and frustration much better now than I did as a child or a teenager. And although I had always been a protective sibling, I kind of felt guilty hearing my sister’s comment, realising I had never thought the effect of relationship dynamic our family had on them as well.

We have our tales that we laugh about. Tales where our parents can appear a little villainous. Don’t know how much of dramatic scenes are torched into their memories but I hope it only appears funnier as time goes by. As it does to me now. As a child you are susceptible to being easily triggered with emotions and are more impressionable. Only looking at the scene from your perspective, a child’s perspective, the problem naturally appears magnified. Not having ability to judge the situation also worsens the scenario. ‘Why is dad always with his friends when he is only back for holidays?’. ‘Why does Mom make a scene when Dad comes home late?’.

I was post partum 2 weeks. We had house under construction. Everyday work was costing us expensive labor charge. Finally husband is home, he will be helping me I thought. Ran out of cement to mix while laying down the pillars, so I asked him to go and buy. He wasted the whole evening sitting down with his boys and playing cards while I was at home with the workers waiting for him’. Mom still can’t forgive what happened about 30 odd years ago. Brings it out every time they have a major fight. Dad cannot let go of how Mom wouldn’t often let him enjoy finally some free time off duty back in the country.

Standing in position, asked to choose one, honestly I never really felt they belonged together. Mom was too good to be my dad’s wife. She was loyal to him and very devoted to us. Young. Could have found herself a family man. But chose to be with my dad, who was still very boyish in his heart and mind, with no sense of responsibility. Dad, quite charming at his age, still young as well could have left home and gone off on his search for finding himself, instead grounded himself with us showing up often in front of our door. Unfortunately for the pair, Mom had quick temper and sadly with his complex personality ‘Dad’ was her main trigger.

Standing today, I don’t blame either of them. They were both right in their own ways. Mom felt trapped and Dad felt overwhelmed. They were naive and the world around them was changing ever so much and moving so fast. But despite how worse it got we did see them try very hard individually to keep us ‘their children’ in their lives. And ‘trying your best’ is all you can do sometimes.’Would it have been nice if we had a normal family too?’. Well we were not even sure what we were asking for back then. Everything is forgotten and forgiven now. From our end.

I don’t judge. At least I try not to judge when my patient’s children refuse to make amends with them even in their death beds, do not make time to come to hospital when they are critically unwell, refuse to participate in any decision making for them and leave them in hospital beds for christmas holidays. In same ways, I try, try not to judge my patient’s decisions to be emotionally distant from their family members. It would be nice though for everyone to have someone to support them in their difficult times. But, when relationships are broken and are left broken at the time when both parties are rationally able to think from both perspectives, chances are they will never be reformed again and, by choice.

‘I cannot leave, watching faces of you and your brothers and sister’, Mom would say tearful. She couldn’t. She was dependent on my dad financially at the time, ‘and children need their father’. ‘I cannot leave’, Dad would say, knowing if he didn’t provide financially we were in trouble. In very knitted close society where they both grew up in, ‘divorce’ wasn’t an option.

It is important for women to be financially independent,’ I will always emphasise that statement over and over again to every generation of girls out there. Would you rather not be in a relationship where you had many choices but you chose to be with your partner than being strapped to one because you had no options? By nature, we as humans appreciate things more when we know our pick was the best in the slot. Individually my parents were great people, were they right pick for each other though? Married in their early teens, what did they know, how various influences in their maturing brains was going to impact their view of their partners 5 or 10 years down the line?

I get distraught at the idea of so many women choosing to not have careers. Especially young women. Sold at idea of marrying rich and living comfortable lives at earning of their husband. Doesn’t matter if he is married with 2,3, 4 or 5 wives. As long as he spends on you and you don’t need to clock in your time working for anybody right? Being a housewife to fulfil parental responsibilities/ care duties I understand, it is a full time job on its own, better to save than paying a stranger for hours. But what about other times? When one is fully dependent on another person every day of ones life, you are giving them full control and power over you. And that is a dangerous thing, because power and control eventually follows violence and abuse. When you are choosing to be stay at home wife, there is money being spent on you, irrespective of what you choose to believe. Money that comes out of his bank account as a proof of how much it is costing to have you with him, in a condition that you provide absolute loyalty and undivided attention. When the relation dynamic changes for any reason, your loyalty that he perceives as bought which he has full transactions for, will be used to prove that you had no input, asset invested or loss incurred in this relationship. There is no ledger to display emotional support you have invested on him, hours you have waited on dinner table to serve home cooked food, doing household chores etc. So, with the dissolution of relationship, you have lost time , mental peace while he has walked out with no repercussions to another one. If you are lucky hopefully he left you a little alimony money to get you started again with education or career. Who is to blame? His feelings changed so he changed.

Just work. If you are not the one willing to share your husband either. Where he is providing for you and his singular control on your life is disseminated among his other partners so you are ascertained a degree of freedom for yourself. We didn’t fight for our rights for equality for women to be victims. If you made an active decision to have it easy, you must have thought about the consequences of it. You can’t have both ways.

‘Women will always be in advantage to men no matter how they want to subdue her.’ My mom says. ‘Look at animals & birds, its always the males seeking for attention, fighting amongst themselves for the winning the mating rights with females. Nature made us weak but important in our roles to give off springs. Only the toughest, healthiest and skilled male were to have the privilege to shire next generation. Given a choice you had to put down a rooster or a hen, a bull or a cow, a dog or a bitch; what would you choose? Men didn’t want those rules because that would mean many would not have that privilege. So it was essential they conquered us and reduced our status so we were forced to pair and reproduce with them. Women are now educated, have reached powerful positions, can speak up and are levelling their fields of mating games. You would see why patriarchal values would have problems with that, don’t you? That’s why women should always marry at or above their levels. A man who wants an upper hand and does not pose a challenge, should not be worth her time. She should keep her standards high. People say, a woman increases the value of a man. They forget, just as much the dress or jewellery she wears, a man needs to complement her status. For a woman, a man is her biggest prize. Naturally she is picky. If you are wealthy- you are a hard worker, a leader ‘quality attributes’, if you are smart- you are adaptive, survival traits ‘quality attributes’ , if you are good looking, well built, fit -good genetic attributes. In the end, no matter how it pans out, physically we may be disadvantaged but remember, men need us and they will be killing themselves and prize would still be us, the women. So rather than fearing us, men should accept us, to live and to let live, in peace and harmony.’

Greatest achievement we as women had in our history was development of contraceptives. Because this meant we were now in control of our fertility. Snatched from us again, no autonomy over our own wombs anymore, no abortion rights; I am thinking about my mom’s statements ‘women are levelling’, ‘they will always want upper hand’. I read some controversial articles a few days ago about brain dead women patients being able to deliver baby vaginally or via c-section, their body acting like a hatchery of some sort for the fetus till its complete development… What does ethical committee have to say about that? What about uterine transplants? The ethical implications of it from live donors? To avoid legal obstructions of surrogacy and third party related effects, would it be the favourable path in future for childless parents to conceive? What will be done to prevent human exploitation of our genders to benefit society in name of religion, politics and science?

I wonder if it is really true that society does start moving backwards when it has reached its maximum potential. While I see girls and women in east working hard to fight for their independence to gain personal, religious and financial freedom; I feel young women in west are willingly giving up on those rights oblivious to struggles and oppression faced in the east in absence of these rights. Young generation of girls and women there in east are now very motivated , pursuing education, jobs and careers. And they have done remarkably well. I suppose in a society, when you see your value as a commodity to be easily auctioned or replaced, the only way out for us as women was to outbid those buyers. So if we don’t want to be traded like cattle again, we have to work for our freedom, maintain our standards and teach next generation of our children to value and keep it as well.

So you’re a doc, a foreign cuisine, heading thirties and Corona Happened (Standing in unity)

Literally gawking at the video where Jeremy Vine is saying ‘they will start at their first day as a fully qualified doctor on almost 80,000 pounds’, pointing at ST 6-8 label with his marker. First of all, foundation year FY2 are fully GMC registered qualified doctors. Please get your facts straight. They carry an ‘arrest’ bleep. Meaning they are expected to lead resuscitation in case of cardiac events and are trained for it. Second like my colleagues rightly point out, Mr Vine does not seem to understand the reference of the umbrella term ‘junior doctors’ which includes trainees at various stages of their careers, those that just passed out from medical school Foundation 1 to ST 8, beyond which, it is ‘consultant level- specialist’. F1, F2, CT1, CT2, CT3/ST3, ST4, ST5, ST6, ST7, ST8. From core trainee year 3 (ST3), these ”junior doctors” in ‘quote’ will be posted individually on a night rotas to run the entire hospital with only two or three junior trainees under him/her; looking after the new admissions on medical or surgical take coming through Emergency while also being responsible for those already admitted. The ratio of doctor to patient at these times are quite critical. If you’re guessing 50:1, trust me, I am having a fit inside. Now whilst Mr Vine is making his comments seemingly undermining our title stating ‘junior’ from ‘junior doctors’ as ‘finding their feets’; the hospital trust/the management seems to have complete different views. They seem to be okay trusting a team of three/four doctors to run the entire thing. Ensure safety of three/four/five hundreds of patients in medical wards and those still incoming admissions via Emergency department team.

From and beyond ST3s junior doctors are individually operating, making complex decisions; of course, consultants are there to guide but as a part of training, these doctors are geared up to that expectations of functional level. NHS is overstretched. With volume of clinical and managerial work consultants have to do, more than 10 mins of consultation for each patient everyday will mean ‘ward round’ will never finish on time to get the jobs done. From day one of admission to the day of discharge of patients; whether it is creating paper works, ordering bloods/XRays/investigations, chasing those reports, prescribing medications, writing to your GPs or other specialities and signing official sick form leaves; a junior doctor will be involved all along the way in patient care. Undertaking most of these tasks requires one to be fully registered. Everything is medico-legal. 80K a year’ Mr Vine is implying at consultant or equivalent level after pay restoration, which for many of us will never be a straight route. Can you imagine the length of dedication and effort it takes to keep climbing up the grades, 10 years (from foundation to ST 8) after 5-6 years of medical school? Courses and exams at every level while also working? Despite that, there is no guarantee we will get into speciality ST number of our choice. May have to wait a year or few more still.

We are here working at 14£/hour. Mr Vine makes 290K annually! After all the work and length of years we have invested on our profession he feels we don’t deserve a restoration pay? That he is upset that we’d be earning at 80,000/annually at ST8/ consultant level? After at least 15 years of investment solely in this career? My father always said, ‘people who make easy money don’t value money therefore don’t value the pay of hard work. They are used to having it easy, think its easy for others too so don’t give a second thought on stealing it away‘. I am only saying, there might be a reason why he feels our demand is atrocious.

We are taken aback by Mr Vine’s comments made without doing a proper research on an open media platform. Spreading false information to the public.

I am due to book an exam soon called PACES that will cost me 657£. There is a course I would love to take that has a high pass rate of its candidates called ‘PassPACES’ course which I am planning to book, which costs 1595£. In addition to that I would like to purchase a book recommended by my colleagues for preparation, costs 56£. Albeit the cost for course itself I will be able to claim later from trust after following some procedures as a part of training, the exam fees and cost of books is all on me. And, its the ‘upfront payment’ that I need to submit that I don’t have. For which, people do take personal loans. My pay this month with 80% work rota was 2900 at ST3 level. And I am still waiting to claim relocation fees, that I previously didn’t use to but feel ‘from now’ I should because, moving 3 different locations has been stressful and burning hole in my account. All these expenses last month and this month. There is an element of added stress ‘some money’ would perhaps solve, you can comment its ‘money minded’ but try surviving living pay to pay with our job and professional commitment it comes with. Luckily I haven’t been as unfortunate as some of my colleagues who I know have moved to 6 different hospitals in 6 years period.

While we are on this discussion with topic of pay gaps and other inevitable subjects surrounding NHS, working environment, patient safety etc. I would like to advise all my colleagues, including IMG (International medical graduates) to consider joining BMA (British Medical Association). This is the only union we have that will voice concern for us. And ‘definitely’ indemnify yourself. With continuous changing environment within the trust, changing placements between different hospitals and various factors inter playing behind the scenes, despite meaning to do our best work to help our patients, we may experience multiple challenges, there are bound to be human errors and other errors. It is our duty in such circumstances to ensure our patients are compensated well and also, that we protect our registration number that we worked hard for.

NHS trust will protects its employees against clinical negligence, there are various other instances including GMC complain & investigations that doctors are not covered for. One of those is ‘Samaritan acts’. A doctor needs ti have indemnity cover for those. Helping someone who needs a medical attention by roadside, bear in mind, can potentially be a medico-legal lawsuit waiting. Yes, it doesn’t sound right does it? I don’t know how to explain why? Best way to put it might be using example of an youtube influencer who was talking about, ‘some lawyers in US sitting all day next to the park to catch one child having an accident at playground so that they can get along with the child’s parents and sue the Council for safety hazards among other things for compensation.’

The last I checked indeminity expense costs 48-84£ annually for basic coverage (quota from 3 different organisations). Depending on your circumstances whether you need it to be tailored to your needs, it will cost more.

Wonder if Mr Vine took into account of these expenses we make every year? Registration fee alone a year is costing me £420 annually at my level. Of course with 290K/year he perhaps doesn’t see it as an expense, for some of us it is still ‘a lot’. Luckily being an IMG, I don’t have big student debt I need to pay off now. I remember saying to my mom when I was at college level ‘ most parents I know leave their inheritance to their children, I am not asking that for us. I am only asking that you donot leave us with debts to divide individually over each of our heads’. Luckily I must say, they haven’t, as far as I know. Most of my colleagues who graduated here in the UK have not got that financial freedom and owe up to 90K on debt, taken bit by bit, monthly from their pays till God knows when.

As much as being kind, empathetic, going above and beyond for service is essential. It has become imperative for us in our medical profession as doctors, nurses and other allied health professionals to also look after ourselves. We need to stand up for ourselves, fight for ourselves so we can continue to give our best and do what we know how to do best and with best intentions in our hearts. Privatisation of NHS down one or two decades, in my opinion, is inevitable. Retention of staff is one key, this is where the topic ‘restoration of pay’ is being raised but the main thing is, ‘is the general public aware of how the NHS runs, the state of our public health systems?’. What will happen to people who can’t afford health insurance, don’t have 290k/year annual salary to pay for health services?

So you’re a doc, a foreign cuisine and Corona happened. (Why the beginning? )

Hey doctor, did you forget to change your face mask?’ Our nurse in charge stopped me before hopping from one cubicle to another cubicle to see COVID patients. ‘Oh, sorry’, I replied immediately, laughing at my forgetfulness. Remembering the time, in the midst of a pandemic when I splashed water in my face without realising I had a mask on.

It is February 28th/2023 today and ‘No, COVID hasn’t gone away yet’. But as I have claimed before, it isn’t as intimidating as it used to be. Juggling your memory again, ‘remember that time? December 2019? When city of Wuhan in China first went into lock down to control the deadly virus from spreading elsewhere.’

I started writing amidst of pandemic waves. Overtime I have talked about lots of things. The beginning of all these parrot tale was a silly story which I have mentioned before. Basically I had a dream. I don’t remember the details of it now, but I do recall ‘sort of being instructed to write’ and ‘sort of being introduced to this title’ and, ‘feeling good about scribbling something in my dream that I have no clue what it was.’ The memory of it is all vague, it has been more than a year. But I do remember mentioning to my ex saying, ‘I feel like I need to write about this, about this pandemic’, that morning. I don’t know if he has any recollection of it. People have all sort of dreams. My friend mentioned once she had a dream where she was a flying ninja fighting crime in the city. Like who sees that? Is that normal? Something about this one though, it planted a sincere and undying motivation, almost like a promise to myself, to sit in front of laptop and start hitting the keys every chance I get, no matter how tired or lazy I felt. I didn’t know where to start but I had to. Am I religious? I don’t know. Is there God? I believe there is. In that case, do I think it’s God’s message then? Certainly not, I wouldn’t go that far. Bonkers! Experts believe, ‘dreams are revelations of your subconscious minds.’ Maybe, somehow I found a way to tap into mine that night.

It was a work at first. I didn’t want to jot the bleak situation of hospital capacities, circumstances of deaths with the virus infection, forlorn eyes of mourning individuals, resentful words of grief stricken families, hateful comments with racial slurs, fears for own health & families safety and physical/emotional burnouts; but those were the realities. Re-living the emotional experience whilst writing when I could push it and shove it down, like an adult, never to be spoken about; may have been an option but I chose not to do so. 12- 13 posts down the line, writing became more easier, sort of a way of venting to express myself and I suppose at that point, it started becoming a selfish endeavour to save myself.

My intention in some ways was also to give ‘the readers’, a peek of life of a medic. A glimpse away to lives inside hospital walls, the ups and downs we face in our career living up to our responsibilities and in our personal lives; in a hope that you see these individuals not just as a professionals but also as a son or a daughter, your friend or your colleague, your uncles or aunts or your father or mother. That you are kind to them. ‘Yes every profession deserves a kindness’, I am not here requesting any more ‘just at a level you would give any individual at your standing.’ The world seems to have forgotten that as a medic in our profession, ‘we deserve some humility and respect too’.

No, it is not right that you curse the nurse in front of zillion other patients when she is not answering your call. She is looking after 9 more patients on her own and, is currently on a drug round. ‘

‘Yes, he does have right to not forgive you after the temper tantrum you have shown for your quote *had a bad sleep*’.

‘We do have every right to refuse to treat you as a doctor as you have a right to be refused being treated by us’.

‘Please cover yourself. It is basic human decency. Not to flash your breasts or penises when we are specifically not examining those parts’.

‘We will attend you, however there are long list of patients waiting before you, unless it is a life threatening emergency. We need not tolerate emotional or physical intimidation because you want to jump the queue’.

And most importantly. ‘No you do not get any excuse to rain down on another individual just because you are sad, lonely, angry or in pain.‘ Would you have tolerated it, if it happened to you in your profession? Why are we any different?

I ask you, would you kindly see me or my colleagues beyond our stethescope on our necks and our badges reading ‘doctors’ and accept us like any other individuals in society with running clocks of our own private lives? Just as you? We are men and women in careers, each one of us with our own personalities and a background of running commentary. Would you see us as humans too? Yes we have certainly adapted to restraining our emotions but we still feel. Your expressions whether its happiness or anger, affects our days. At the end of the day, we do take a lot of emotions back to our homes. We do need a period to switch off, unwind, hit the power button and recaliberate ourselves. It is not fair to be expected to be available 24/7 like movie industries portrays our commitment to profession should be like. It is not fashionable, as it seems. Please don’t expect us to stay another hour individually for your service especially to vent about receiving minimal service and threatening to leave.

The number of hospital admission have sky rocketed compared to 10 years ago in the NHS, I am sure so is the case all around the world. Quality of life has improved on various domains of people’s lives including work environment but I am not sure if that has been the case in our profession. My seniors could argue ‘our lives is much better now’ but, that would be like me arguing ‘quality of children’s lives is much better now’. Children now don’t even know if they are humans or goats. And schools are entertaining drag shows to kindergartners. Look where we are standing in human history.

On 13th March, Doctors in England are doing a 72 hour mass walk out as an industrial action for pay restoration. In the past, I had commented in my post that doctors and nurses were being paid less in significant percentage than they were being paid in these profession, years prior. My phone is blinking continuously now from constant messages posted on junior doctor’s forums, mainly sharing information from different trusts that are releasing intimidating messages to their employees suggesting their will be consequences for their actions. Disciplinary actions, loss of pays. So, everyone including me who has just joined a new hospital in a new rotation are basically sitting on hot seats now.

I came across a very interesting post on tiktok. (Oh yes, since I have returned from Nepal. Now I have started using tiktok. hahahaha). The post (Huw Corness) on 02/Jan 2023 reads ‘When I qualified as a nurse in 2010 my basic hourly wage was £10.83 and freddos were 10p so I was paid 108 freddos an hour. The nurses who qualify now start on £13.84 an hour and freddos are 25p so they are paid 55 freddos an hour’. I hope this gives you some idea of why it is necessary to stand in unity for support. Not to forget, our profession undoubtedly is a big chunk where tax revenue comes from.

You don’t have to necessarily support the cause. I will agree there are plenty jobs which deserves more limelight than us. That I have utmost respect for. But I hope, you will keep in mind when you enter the hospital premises next time that these are the professionals that are trying their best to their jobs, to provide you with help that you came seeking for, at their doors. You are not a prisoner unless of course you were brought in handcuffs by the police. As much as we treat you individually and with respect, please’ remember to reciprocate.

So you’re a doc, a foreign cuisine, heading thirties and Corona happened (Dilemmas) ;)

So you aren’t marrying any time soon?‘, one of my aunts asked quite perplexed. Studying my face closely for answers, trying to decipher any hidden secrets my expressions might give away that she was sure I was not telling her. ‘I will. Eventually. Don’t think I am in right position to marry yet. And quite frankly don’t think I have met a person to make a husband.’ Her eyes became huge as if they would pop out soon and she said, ‘You are a doctor in UK! You make 4 lakh a month on your salary. You are getting old. Of course you are in the position to marry. What? What are you saying? There are but men everywhere to be married. Look at you. Who will say no to you?‘. ‘Aunty. Stop it’, I replied laughing, a little shy, but feeling somewhat boosted in my ego. ‘We will find a handsome Nepalese man for you. Within our ethnicity. Khas(Native Nepalese) speakers don’t understand value of our families and communities’. ‘There we go again’, I said in my head, ‘the same thing I talk with my Mom over and over’. Its good enough I am agreeing to marry Nepalese, why go hunting deeper into a pond of only few available eligible choices right? 😉

I have many cousins and friends travelling to Nepal to marry into their ethnicities. Surprisingly most that I know, brought up and raised in UK also married within the same or similar characteristics. Primary reasoning factor being, trust therefore the security it came with but also they felt, partnership was much better built on foundation where they both knew what there backgrounds were. Aunts and cousins play big role being matchmakers in asian communities. Love stories are great, but modern arrange marriages are topping the competitions for fulfilling marriages; thanks to them! Bless my aunts they are keen but here is glitch, I have a british citizenship.

Let me explain. Undoubtedly there is a big hype of wanting to live in the western developed nations in Asia. There is a myth that as soon as you enter the country, you become rich! Of course there is conversion factor of pound to Nepalese equivalent that plays a role. And ‘yes’ UK is better in infrastructure, and facilities but the mindset of Nepalese community is such that, they put these countries at high pedestal. And only goals most of youngsters and working population of our generation is focused is on finding a gate away from there. So I can’t be sure if a guy I am choosing to be with is, with me because of my merits or because he wants the citizenship? If he is compatible, honourable, trustworthy, hardworking that is fine. As his partner I will help him learn the ways, but I have heard stories from my cousins or cousin’s friends (you know how it goes) that some of these men they married were lazy, egoistic and refused to work when their bachelor’s degree on specific fields were not recognised by the UK. Stating they will not be working minimum wage job and it was humiliating for them; whilst boasting to his friends back home his wife owns a house in the UK. He selectively chooses not to believe there is mortgage she is paying and will be paying for 19/20 years. Meanwhile he doesn’t mind depending on her fully to support him. Worst story I have heard so far was, a woman falling in love with this amazing guy with a great personality who was always well dressed with smart attire, full shirt and full pants. Only to realise after marriage, he was an IV drug user with needle marks everywhere who eventually died of heroin overdose, here. Mom has had enough of these stories of men. For someone who is insisting, I am running out of my choices, she seemed glad to see me in one person with no one’s arm around me, following my trip to Nepal.

Similar story was other way around. Although to much lesser extent in numbers. With wives of my related cousins and friends. Women were being brainwashed by sudden exposure to these huge influences on medias, all sorts of information overload; eventually causing them to break away from her family & personal commitments and leaving their partner with children, eloping with their lovers. For some reason, my mom seems super conscious of the inevitabilty of the second one , therefore is actively looking for a suitable Nepalese woman ‘here’ in UK for arrange marriage for both of my brothers. Good luck finding that! I guess it is a hard pill to swallow, if you think about it. When you actively seek the person, travel overseas to bring them to you, to make them a part of your life and then to feel betrayed.

There have been worse circumstances including kidnapping, forgery and scamming people to obtain the blue pass. Some so traumatic that I am unable to write the detail here. It would baffle anyone with a good heart to know, people will go to any length to take advantage of others. So yes, in a way holding the british citizenship makes me eligible and ineligible at the same time in the community overseas. Don’t get me wrong, there are men and women out there more qualified than me, good individuals who are also looking for right life partners. But one needs to be aware of these situations, than to regret later. Our concerns comes from situations that has happened to our own.

My mother used to say, in some villages, in her times, women would trap the gurkha men in the room with themselves in purpose to later claim they have been violated therefore he needs to marry her. The events happened in masses when the men came back to their homes for holidays. And some women didnot care that they were already married or had children. It was sort of ‘a mad hype’ as mom stated, as gurkha men were considered very eligible bachelors and, most of theses women wanted their way out to the west. On finishing her tale, mom looked at us and said, ‘You are tickets out for some men out there. Be careful’.

I did introduce my Italian ex to my parents. Yes I’d say 5-6 months was too soon. But he was certainly cheeky with it, got me in a position where I had to breech the topic of me dating him. And second, after my previous relationship, I felt, maybe I did take too long time to introduce Joey. I have now broken up with him but when one of my parents asks ‘how is he doing?‘. I can’t help but to reply ‘Yeah. All good’. They wouldn’t believe if I said, ‘we have moved on’. ‘That’s what we talked about dating men of the west’ mom would have said and rolled her eyes at me.

I don’t know if it is really a thing, but I have picked up on social medias that men in USA and European countries now are going to asian countries to bring back home a wife/partner from those countries. I guess in asian communities, we were raised in a very closely knitted family values so ultimately, culturally and socially we are programmed to choose men who have that readiness and values we are looking for to have our own starts. Asian men we know in most instances came from those setups. When western men show up and express those commitment in genuine ways, it wouldn’t be surprise for women to accept them as potential suitors as well. I don’t know what the verdict on it is, but having seen the both ends, I will tell you this, ‘an asian woman, especially her friends and family, will have lot of reservations and resistance to just pick a bag, leave a country and marry a man of the west. Until and unless of course she knows him a lot better and is willing to take a chance. A big chance‘. You could be a trafficker, for god sake! Take for instance, my friends absolutely admired Joey. He was amazing person but on every chance they get, being the family they are to me, with 100% good intention they would still always ask me ‘are you sure?’. And we were together for 3 years! As much as I believe, world is a free ticket and you are allowed to marry where you find love. Please do not forget you need to be a man or woman of high value yourself to expect a man or woman of high value. I won’t lie to you. ‘Yes’ the perception is ‘because they could not find the right partners in their countries’. Same for me, when I am choosing to go back and be arranged in Nepal. People will have perceptions of all sorts. It may sound negative but it is true to an extent. It doesn’t mean there are no high values partners in the west, maybe you haven’t met one. You felt there are more chances and you took the chances, you did the right thing for you. Only thing to suggest is, do evaluate, spend some time, find out ‘does your potential partner have the virtues you are looking for or have they got more ulterior motives?’ before you fly them over across the continent. God bless, you have found your right match and a wholesome partner for life.

One of my Nepalese colleague from a different department approached me at my work one time and asked, ‘You are still single right doctor?’ . ‘No. I am seeing someone’. ‘Nepalese?’ she then asked. ‘English‘.I answered. ‘Married?’she questioned. ‘No’, I replied. ‘Great!’, she suddenly then gleamed excitedly and said to me, ‘Would you be interested in my brother. I will give you his number’. ‘But I am already on a relationship’, I stuttered. ‘Yes. But he is white. It won’t last’.

I wonder, if my Asian mom and friends have been watching too much of James Bond movies? Candy eyes and a player. And they think all men in the west or any other countries apart from ours are like that. Or whether there is a secret message, they want me to decipher without having to tell me. My parents were fine with my ex, I would go as far as to say, they like him enough to ask about him. But looking at how chill Mom has been, all about it, I have been wondering whether she believes she knows the eventual outcome, which is ‘it really doesn’t matter?’. It is hard enough to be judged in a stereotypical way, ‘you are asian, why are you not choosing our kind?’. But to be met with a silent stare and tight pursed lips that shouts, ‘I told you so,’ is again whole another thing. Honestly, there is no winning. Welcome to life on single immigrant woman in thirties!

So you’re a doc, a foreign cuisine and Corona happened. (Bye bye 2022. With love. Part 6)

There was a time when thinking about attending social functions like dinner, birthday parties, weddings; I had to gauge ‘is it worth it for the loss of my day for laundry, netflix and personal time.  Should I catch up on my sleep till late morning or make arrangements for the trip? Would the day be better spent catching up to my emails? Darn, my exam is only a few weeks away. I feel quite tired, I don’t think I will be able to enjoy it even if I made a show.’  Only a few absolutes were in my list that I wouldn’t allow myself to talk out of; everything else was secondary to the job/career. No thoughts were involved. ‘Thinking, then overthinking’ that was a downhill slope I was trying to avoid. 

A friend of mine who has been back to training from her career break went awol on us for a few days recently on whatsapp. Very unlike her. When we caught up, she said, she felt she was starting to experience burn out again. Good thing is, she was recognising the signs early. We didn’t mind. Amongst us, all of us have been in that place. Where we are trying to focus just on the task forward, a step at a time, everyone else & everything else will have to wait for us to have that space. The other said, she has been assessed. Would need at least 16-24 private sessions with psych to help her through it ‘depression and burnouts’. 60£ an hour. ‘Nhs waiting list is long. I had to go private. But even if it is around 1K, which will be more expensive with additional sessions, I don’t have the time’. All of us knew it was going to be hard when we entered the profession. All of us felt it would be manageable. Sometimes, it’s evidently proving more difficult than we expected. I feel blessed to have this support network of friends in the same profession as I am. Someone to speak our minds clearly with, someone who understands when one of us quotes, ‘I just feel bitter sometimes. Sometimes I feel I hate my job’. 

 ‘Easy things that I shouldn’t even be stressing about like the thought of waking early and not being on time for work stresses me out,’ my roommate said. ‘Even in my dreams I am chasing after the bus. I feel sad at the thought of it.’ Again, I can completely relate to her. Sometimes I wake up from sleep having heard the oncall bleep go off, at home, when I am off duty! Sharing  experiences like that to one another, trust me, earns you good long term friends. If you haven’t yet found it, there you go. One of the main advantages of our profession. I am soon going to be a bridesmaid for a beautiful bride-to-be, who I met first as colleague 5 years ago, 2 hospital jobs prior. 

Lots of lives changed due to the pandemic. In many ways mine too. I feel like, had it not pushed me to the edge, I would have still been a foolhardy person trying day & night to soak up all the stress, suppress all the frustrations and continue. I would have tried to put on a brave face as well and signed up to more hospital  training for ‘resilience, time management, working under stressful environment’ perhaps while losing internal integrity of myself. We all have read, friends of the deceased say ‘we didn’t have a clue. He was always on time, smiling and cheerful at work’. There are always subtle hints, I think, but we are too busy looking more into them.

I completely unrooted myself from one country to integrate into the society of a different country, navigating through my life while accepting English will be my tongue from here forward. In a profession of learned and intellectual individuals with graduates from Oxford, Harvard  when language fails, it is hard to avoid the first judgement. Inevitable, I would say. ‘So we push ourselves way harder, maybe to prove our worth’ I seem to agree with Dr Gabor Mate on this. Confidence overtime feels dimming down slowly, trying to fit in, in all the boxes.

I don’t think it was ever about resilience; the world I have seen, things I have been through, the degree of patience I had to have to be here where I am. I know the word very well. I have pinned the main issue  now; for me problem was  losing my head space to think, feeling trapped in a continuum and losing my own identity. Coming from a family where my parents were; farmers then into the military, trust me when I said ‘I am stressed’ I was swallowing my pride asking for that help. I wouldn’t have. If I hadn’t realised, everything that was inside me was manifesting around me. I think the pandemic did do me a big favor in that sense. And looking back I only take that experience as a big learning phase about finding myself. As my friend did, I am now able to recognise the early signs.

Of course, NHS is ever so busy. And the job is stressful as 99% of my colleagues would agree. Here is the catch, hadn’t it been so stressful, would everyone around us not have pursued it? What I mean when I say it, being an eye opener, was finding out where my limit of stress tolerance was, what are the red lights for me, what do I need to watch out from here forward? And having been through it now, what could I have done, what can be done to avoid similar in future. 

I managed to get the support I needed from my superiors and the training programme director in time. This is why choosing a region to train was very important to me and I advise, should be the main thing a graduate should be looking into. I doubt if I was a trainee in the West Midlands, I would have got the same level of help. With a lot of trainees deferring themselves from the system, hospital trusts are trying to be more accommodating now to trainee’s needs but it often seems to be optional, not necessarily the case with the system being in pressure to run 24/7. Nevertheless I would advise, please reach out, one would never know where and what help you can get unless you ask. Hopefully you will at least find someone to signpost you.

My returning objective now back to work and to training  is to protect my headspace at any cost. Of course to pass the exam, pass the year but also to aim to completely segregate my professional from personal life. It can be difficult, unfortunately we are not computers to hit the refresh button, but knowing this is a ‘must to do’ is helpful.  One thing I have done to secure this is, I am returning back as a trainee at 80% part time. 20% ‘out’ is to work on my personal goals. I am a person outside of my career with lots of roles; as a daughter, a sister, a friend, a girlfriend, a neighbor. To have what I want to keep while making sure I maintain at top of my productivity, cutting down on my hours was a necessary sacrifice. Particularly because this is also the time I have chosen to work on being a better version of me. Carve out those gaps that makes me feel insecure about myself. Like culinary skills. I may not become a chef but at least be able to cook a few healthy lunches/dinners to invite friends over right? Instead of ordering takeaways every time? How am I Nepalese without knowing how to make dumplings? Definitely, this year I will be investing in driving.  Then I could just drive myself anywhere, take myself to beaches, sightseeing, for the long drives, my family to picnic, road trips.  Moving around and packing my life into boxes wouldn’t be so much hassle anymore. And then there are lots of travel plans. 

I follow Jim Rohn’s motivational speeches on various topics relating to achieving success and living a better life on Youtube. The man speaks of nothing but golden words. Even his random utterance is probably worth a thousand dollar bill for commoners like me, filled with life changing advice. Just the other day I was tuned to one of his videos where I heard him say, ‘the major question to ask on a job is not what are you getting but what you are becoming?’  ‘Focus on your personal development. The major key to your better future is you’. He had emphasised.  ‘Work on your attitude, philosophy, personality, language, gift of communication, work on all your abilities’. 

There are hours of brilliant speeches out there from him. Here are other quotes from his talk called ‘Recharge your mind’, that I have copied here which I will use as mantras to guide my future.

You can’t change the winters, you can’t change the seasons but you can change yourself. You can get wiser, stronger and better’. 

Learn to take advantage of the spring. You got to seize it with your own two hands. There is a sense of urgency here. Don’t waste your springs, don’t just let them pass, pass, pass hoping time will pass.’ 

And in summer learn to protect, nourish and to do battles with your enemies. Some of the enemies are outside, some of them are inside’. 

I feel confident about continuing to sail my life to a positive direction. No babies in the plan for another year, no rings in the finger, paying salary, yeah I can buy myself flowers… I feel more accepting of myself ‘as a whole’. I appreciate the concoction I have become with fusion of both the worlds, absorbing best of the both countries across the globe. I don’t feel threatened anymore thinking my uniqueness as my weakness, like my ex used to say ‘exotic’, I have discovered in my eccentricity there is in fact power. Overall standing here in 2023,  the picture forward looks amazing. This is definitely a year for me, to march forward and conquer. Be the queen I was born to be.

So you’re a doc, a foreign cuisine and Corona happened. (Bye bye 2022. With love. Part 5)

So, I had a chance to visit Nepal during my 6 month break. The trip was short but had an amazing time. Met family and friends, went around for small trips to my favorite places. Good to know those places hadn’t changed much, kind of gives a stability to one’s memories for flashbacks. Like saying, ‘remember Mangalbazar where we used to sit down around durbar square for local tea? Yeah let’s go there’. Had momos ‘nepalese dumplings’. Lots of them everyday as much as I could. Anything else could wait another year or so if I didn’t get to stuff in this time! Cousins and related brothers & sisters had all grown up. Most of them were taller than me, some of them I couldn’t even recognise at first instance. Boys were all husky & hoarse with one or two sprouts of beard and moustache here and there. As for most mongolian asian men, that will be the most any of them will grow. But Omg their skins were clearer than mine! Girls that were once very much tomboyish now were very feminine with curvy bodies, long hairs and nail polishes & acrylic paints. Made me laugh and almost choke on my food at a party when I heard one of those boys now training to compete for Gurkha recruitment saying to his other mates, who are also his cousins, about the girls he was interested in. A couple of them! Particularly one he wished to court around to get attention and his plans for marrying her. Basically locking her into a relationship before going away! The way these boys think! Hahahaha. I am rooting for him but at the same time, a part of me also doesn’t want the girl to fall for him because I know where this route most often ends. Not uncommon for boys being head & heels in teens, jumping into marriage and then on his late 20’s or even 30’s sprouting other half of their brain; developing maturity and saying, ‘That was a foolish decision. We have nothing in common (after having children!). I have met the right woman now whom I want to marry’.  All good if he had the guts to come out open and be honest, but he thinks ‘as long as two women don’t meet’, he might be able to wing it off as long as it lasts. 2 wives in 2 different countries. Not just tragic for women, trust me, often tragic for men too.

Watched my girls all grown up, be adult women with their babies on laps. Got a ‘baby fever’, I think my hormones really got a good kick from my ovaries, protesting my stand against ‘overload of cuteness’ production. Feels like the instincts are kicking in now slowly, I didn’t think that would ever be the situation when I was growing up as a full fledged tomboy. Only ever held babies by choice in the past couple of years. Before that, I always had excuses. Don’t know how I ever got through pediatric rotation staying at least a meter away from them. I guess the trick was, always to pair up with a colleague who had powerful maternal skills and let them handle the baby while you chatted to their parents, do the charts and other things. 

They are wonderful moms. It boosts up a slight confidence in me now observing them. They tell me they don’t know anything about taking care of him or her but it seems to me they are doing a fine job. A little panicky now and then, a little anxious but all fine. Each one of them married great partners, all of whom seem to be wonderful dads. Most of my girls  met their husbands in medical school, others while in training and one pair since high school. So, knowing their husbands as friends since when I was a teen myself is very reassuring. It was an even more wonderful feeling in a sense that not only did I watch my girls be mothers and take these roles as adults but, I also had the opportunity to see colleagues/ friends assume their roles as fathers. Those girls were crazy, innocent at the same time, smart but a little socially challenged compared to other girls our age. And we did oh so many many stupid things. Did many happy dances, had cold wars… The list goes on and on. School was fun, thanks to the girls. Didn’t matter how tough it was, we pulled each other, shared notes together, covered for each other’s absences and when we passed each year we celebrated hard. Our big celebration being, sitting down with a few bottles of alcohol, drinking and dancing. Locking down the main girls dorm so that none of the crazy hens got out in the middle of night. Sometimes we’d go out for fancy dinners burrowing eachothers clothes, each one of us working on the other’s hair straightening or curling it. Oh my friends are definitely still crazy!  They still got those eyes but now, they have learnt to camouflage it better. A part of me was a little worried, they might have changed, but nah! We just got more babies in the picture. 

A twang of mild jealousy sure! Genuinely very happy for them but reminded me of my own little heartbreaks, bites away from my self worth and began questioning each one of my decisions. Took some days to reevaluate where I stand and,  I have come to the conclusion that, ‘I am actually glad I did not achieve some of these milestones. I will reach there when I am meant to get there and honestly, I don’t feel ready now at all. I don’t doubt anymore I will make a good mother. The world feels a better place having met amazing new parents who are genuinely great humans’.

‘When I made those goals, I was young. I didn’t account for my circumstances, for the hurdles I was going to encounter, the faded lines of the lanes that would cross on one and the other, here and there. I didn’t account for the times I had to stop to rest, to redirect myself, to self-talk and to keep pushing forward. There is no reason for me to feel that way, my friends’ journeys are not mine. We had different beginnings, throughout lives we have different paths and we will have different endings. Had to knock my head a little to tell myself ‘Don’t be a loser like that. Jealous of your own friends? Did I hear you were a little jealous of your own ex as well? Why? No, no, don’t be one of those losers. Passing time gossiping about others, catching on each other’s legs. Don’t waste time like that. Be happy for them. Work on your own insecurities so, you don’t give yourself a reason to feel that way’. 

And that’s the thing. ‘Working on my insecurities.’ As I have confessed many times before, I felt, my mind was all fogged, jumbled in a mess. It was like a cluttered room where I collected one more thing, dumped it there and just closed the door behind. Anxious that the room existed, even more anxious at the idea of sorting it out. Being back in the place where I previously was, with my friends who are very much the same;  reminded me where I came from and who I was. It helps, doesn’t matter what the mess looks like or the extent of it, but to know where at least the start of the mess is, because all you then do is follow the string and untangle it slowly. I see the problems here, here and here. What can I do for the solutions? What is my priority? What am I willing to lose for what I have to gain? What is it that I want? 

It’s okay, if you don’t know what you want for yourself yet. I will advise you to follow a route, keep track, rather than being absent minded and being nowhere. At least that way, by rule of exclusion, you will know whether the route you are following is definitely what you want to pursue. Goal at the end is finding happiness. To each of us, our definition of happiness is very different.

So you’re a doc, a foreign cuisine and Corona happened. (Bye bye 2022. With love. Part 4)

So I’m going back to training soon in about a week’s time. A bit anxious about starting in a new place, new colleagues and moving et cetera et cetera. Haven’t found the right place yet.  Started searching about  2 months earlier. I suppose I am being picky but with only a 6 months contract on hand and with landlords rejecting most applications under 1 year tenancy contract I doubt it’s just me.  I have found with my past experiences it helps immensely with my anxiety knowing the neighborhood, nearest grocery corner, bus stops and stations beforehand. Thankfully there seem to be a number of options for spare rooms too. Hopefully if not a bedroom apartment,  I am able to land a decent ensuite room with working professionals. It may be a whole new level of experience to share then. To think of it, I only have a couple of friends who are not medical! Like I must have mentioned before, you realize at some point it is really not okay to talk about malena, colour of vomit, traumatic catheter insertion inside someone’s pee hole and the deceased (of course with respect to confidentiality) in a Christmas celebration day! It can’t be normal right? 

As I have previously admitted before, I have had a good 6 months career break. I have had plenty of opportunities to self reflect. A combination of good days and bad days. But I wouldn’t trade back, not in a million years if someone said to me, ‘here, I give you 6 months on your career progression but don’t take career leave’. I would advise everyone to take it if you have been working continuously for 3-4 years or more.  It’s a different world out here with full control of your own time! You sleep when you want, you wake up when you want, you choose the days you work and make arrangements for your own leave! Without having to call the medical coordinator and your colleagues to discuss and lock down the possible dates 6 weeks in advance and bombarding the consultant’s email for authorizing swapsies.  And here is the thing, you get paid even more for the days you work!  Would it shock you when I say working locum  in this career break by picking up a few shifts, my 8 days normal hour shifts was equivalent to a month’s pay as a trainee (including out of hour night and day on call shifts) while picking my own dates to work! When I didn’t work, I was with my friends, with my family, pursuing hobbies, doing all sorts of things! Of course you do have to think about the deterrent; of choosing your freedom. Which is, you will stay stagnant in your career progression. Part time careers and  career breaks are a bit hit & miss when you enter the cycle but hey, if your objectives and goals in life align near to mine, it is only a minor setback. I can work for 6 months on a contract at a time as long as I know I am still on the route!

Do remember training in the UK as a doctor is long. Longer than anywhere else in the world. There is a big gap in the junior level workforce. Well I don’t doubt training may be made longer in the future to cover these gaps. Oh well, meanwhile a choice of life ‘working locums’ seems to be getting quite popular. And from my experience now, I say for the right reasons. If I am going to be in my late 30s or 40s by the time I become a consultant with the same or even more work load and, with additional responsibilities with a paycheck only a few hundred pounds more than a registrar in training, am I in a hurry to be a consultant anymore? Bearing in mind, I would now have worked almost a decade in training (odd hours, odd shifts, bank holidays and with a lot of sacrifices from my personal life) . The whole system shifting to consultant lead practices will not help the situation either. As it will mean another decades of intensive life  back in the system again like a trainee with bedside and out of hours works. And  with minimal training opportunities for the juniors to practice independently and develop their confidence. Which means more and more secretaries for the ward rounds, none practicing. Like my consultant says, ‘Secretaries can do your jobs better in documenting the ward round word by word then why do we need you people? Learn and practice’. Medicine is all about practice, practice and practice.

Another reason to say ‘of course’ to this lifestyle of locuming is, most of us are at that age, where we do want to travel, create memories of our lives while we still look good in pictures with full set of teeth, full hair on our heads and no incessant tic to filter our crow feet eyes. We want to have at least a small fund to afford deposit on our mortgages and have a start on the property ladder. Pay cuts are continuing to get bigger with increasing workloads. Job is getting more demanding by the day and honestly, getting through the day without sacrificing one’s personal life and mental health has become impossible. Prospect of a career seems like following a  never ending pursuit. Failing training because your training days are swapped with service provision is not acceptable? Doctors on strike, nurses on strike, medical staff on strike. What is an alternative out? With the rate some of us are experiencing burnouts, we won’t reach 66 to get our pensions. Actually by the time we reach 60s who knows what the pension age will be.

I was ambitious when I was young. There were certain time scales by which I was expecting to achieve certain things. These milestones were to gauge myself in respect to my family, friends, peers and the society. I believed back then very naively  life peaks at 30 and that’s it. My race was till 30. I had to be at the height of my career by 30, financially secure and be starting my family…  30 was the time I had to settle and slow down, having worked hard all my teens and twenties. I am in my thirties now! So from here where do I go? 

Policemen, military life; I would never dispute their life is harder than ours. No questions about it. Not even thinking about it. Only respect, respect. But then looking at the other job list, nothing else seems to be popping out of the adverts with 9am-5pm work hours and reasonable pay. Time is money. Value of money is getting smaller every second. Do you ever think, what is your time worth to you versus your employer? At this point of life, I am sure I speak for everybody when I say, we know we are the sheep. Meant to grind all our lives for our bread & butter. 5-6 years of medical school and 4-5 years of training. I am kind of disappointed  that I am restricted with my choices. I am not skilled in any equipment, any machineries, any specific traits for the jobs. I have a degree and that is it. Not that I don’t love the work I do, but wouldn’t it be a good thing to have a talent in something or a skill set? Not necessarily just or for a primary source of earning but also to have a degree of independence, a break of monotonous routine? Brilliant if it also becomes a small stream of  revenue. In the future, I will most certainly encourage my kids to learn building skills, sewing/tailoring skills, electrical/plumbing/ carpentry  or any skills that are universal and are handy in personal lives as well.  I learned how to change a bulb a year ago, taught by a friend. Usually I would have to call the maintenance guy or pay for that. Imagine it is that simple.  I was told all my life to focus on my studies alone, everything else was met by a comment either by Dad/ or Mom ‘If you are not going to be professional on it. There is no point learning it’. I suppose that’s how most Asian parents are. Anyways, should I have the determination and capacity to take the next career break I will most certainly invest it on one of the above. They say you are never old to learn new things. Professionals are really not that far away when You tube is exploding with them. Being in my thirties now makes me realise, even as adults we are still learning new things everyday. This acceptance of reality amplifies respect for the adults I had and have in my life. ‘There are uncertainties. We don’t know everything but we are trying our best’. Kudos to my millennial friends teaching financial freedoms and new ways of life to remaining of us and Gen Z. Thank you Gen X for sharing your life experinces, hacks for daily routines and motivational speeches to us.

It is important for every generations to have mentors and for every child to grow with positive mentors in their life.

Thousands ways to make life simpler and easier, all one click away. Had I looked, had I searched. I felt lost putting down my Stethoscope and going to bed watching same programs on repeat on Netflix, you know. This was definitely a needed break and an eye opener. I don’t feel we appreciate the value of mental and emotional freedom for our personal growths.

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