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The Dean Bridge - Edinburgh, UK

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We have the future.

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Epping Forest - Essex, UK

Whilst I continue to spend time in a clinical role, developing my skills and accruing experience, I am spending more time dedicated to the study of the political, economic and social conditions in which health is shaped.

As I celebrate my 100th post and take a moment to acknowledge my progress and the journey so far, I can begin to see the way in which both my interests and responsibilities might manifest. Whilst it feels inevitable that I’ll be both trying to mop up the floor (treating patients in healthcare settings) and turning off the tap (preventing health inequities from arising), it remains to be seen how exactly this comes to be.

I’ll continue to explore where I might be able to have a positive and meaningful impact and contribute as part of broader groups and collectives. There are plenty of paths and a great deal more to be done.

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Cholsey - Oxfordshire, UK

Helping to manage a critically unwell child is undoubtedly stressful, especially so at this very early stage of my career. ‘Do I want to have to go through that day in, day out, for the next few decades?’ I thought to myself, as I recollected my thoughts in a vein effort to decompress and process what had just happened. It was tricky to focus for the hour after I had removed myself from the bay, which when I last glanced in, had about 15 health workers competing for space within it, each playing a role and racing against time to stabilise and package the patient for a transfer to a specialist unit 15 minutes away. I made a contribution and helped move things along, but on taking stock of the patient’s progression and specialist interventions from the intensivists and anaesthetists, removed myself to allow precious space around the bed. We were alarmingly close to having to start chest compressions; a damning indicator of a child so unwell that from such a point, the prospect of a fatality can become the expected trajectory for them.

No, in those moments, I’d rather not have to do that day in day out as a career. But this is a career that is still fledgling and should note that I was stood shoulder to shoulder with those with decades of experience, plenty stressed and still unsure of how things might have panned out for this child. 

I’ll be in this situation hundreds of times over. And with each one I’ll hope to get slightly better each time and will learn to manage the stress more effectively.

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Calton Hill - Edinburgh, UK

I gave it my best shot, and I passed.

After the sustained and demanding effort, I’m delighted to have a small but significant milestone under my belt. Of course, there is a long way to go, but a good result bestows confidence that was found lacking and will look to use this inertia to take me further on my journey.

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Malham Cove - Yorkshire, UK

And so, the inevitable has arrived. It’s time to start revising for an exam. There was only so long I could delay the process for. Like a wall, it looms in front of me and the onus is on me to devise a way to get over it.

Like many, previous experiences with exams have been unpleasant and I never got into the swing of things at medical school. I’d not cracked a method that would enable me to absorb inordinate amounts of factual knowledge all the while others made it look so easy. 

I have a fresh opportunity to revisit this challenge and I’ll give it my best shot.

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Derwent Edge - Derbyshire, UK

This week I’m taking positives from small wins with larger significance having had an opportunity to undertake two challenging procedures with some success.

While the first did not bring about the desired outcome, it was an unmissable opportunity to attempt a highly technical procedure under close supervision. Having given it my best shot, mental barriers that often lead to me finding excuses to not have an attempt have subsided and I’m fired up to seize the next opportunity to put into practice learning points and build my confidence.

Thankfully the second was a success, and while the process could’ve been smoother, we got the job done and helped progress the care of a 6 month old. I was on the cusp on aborting the procedure, knowing in the back of my mind the chances of success were slim. As I was beginning, the anxious parent mentioned a consultant had tried a month prior with no success. What was so rewarding, was that this was a procedure that I’d spent many months gaining experience in watching seniors undertake so effortlessly. Ever since, I’ve been trying to emulate them despite the hit and miss success rate on older children on whom precision procedures are usually more straight forward.

It’s a good feeling. As I look over my shoulder and see where my journey has taken me so far, I’m counting them as little victories on the arc of my overall progress. 

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Bankside - London, UK

Storms brew within storms. As hospitals and the health system once again find themselves systemically overwhelmed, heading into the new year we are pulled into the orbit of maladaptive circumstance that threatens to break the final straw for the most vulnerable individuals, households and communities.

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Padley Gorge - Derbyshire, UK

Working with, caring for and supporting children and young people is proving rewarding and joyful. There are no doubt new and exciting challenges and experience will count for so much, but right now it’s a wonderful specialty to be working in.

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Beverley - Yorkshire, UK

My third year has started strongly; the train has very much left the station. I only wish I could have more time to enjoy each day and to be more present within so many moments. The pandemic continues to distort my sense of time, both on the day to day, and within the wider context of how society is changing or returning to a faux status quo. For those who’ve been fortunate to reclaim sentiments of relative ‘normal’, that so many others continue to go through hardships, both directly relating to the pandemic, or the wider economic disarray, means that no one truly is back to baseline. We are all inter-connected. All change.

I’m grateful to have more autonomy over my working hours, permitting space to develop in other ways both professionally and personally. Central to this is the simple joy of reading - something I’ve neglected during the last two years. I’m discovering so many new stories and wonderfully descriptive perceptions of the worlds surrounding writers and authors. I’ve been inspired by much of what I’ve come across, reinforcing the role of words and literature in capturing emotion and painting intricate and ornate canvases of lived experiences far removed from my own.

Regardless of what the year ahead throws at me, both in regards to my own career who’s next chapter focuses on children’s medicine as well as the rapidly changing world around me, reading is something I very much hope to keep up.

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Newcastle upon Tyne - Northumberland, UK

My second year practising has come to an end. The months have once again seemingly flown past in a colourful blur, punctuated by unforgettable moments, stories and connections. While my confidence rose to new heights this year, I’m aware I have so much more learning and growing to do. 

Over three quarters of my training has taken place within the sub-text of the pandemic, installing so many new challenges for junior trainees whilst warranting an adaptability taken to whole new levels.

The pandemic continues to exert an unrelenting pressure on every corner of the health system, though how this manifests is more visible in some areas than others. My time in the A&E department as an example, offers an anecdotal insight into the heavy toll on resources and staff in the wake of the contemporary under-resourced pandemic society. I hear the same from the world of general practice. The firefighting of the disease is exhausting on so many different fronts.

Yet, discourses on how the pandemic has and will continue to affect health can overlook a more contextual view of how social, economic and political forces shape population health.

Attention must be drawn towards distinguishing how the pandemic itself and pandemic responses shape health and wellbeing - for better or worse. This is perhaps most obvious when it comes to the health and wellbeing of children and young people, a group that are biologically most insulated from the risks of COVID-19 infection, but at the mercy of harmful reactive policies in which children seem to have become an after-thought in the emergency response.

On myriad occasions during the last year and a half, political decisions have augmented the dangerous effects of the pandemic, a phenomenon itself without a master or game-plan, enabling spread, compounding disease and, looking more broadly to the wider disease burden, limiting the social, economic and ecological circumstances in which people can attain and secure better health. The focus on COVID-19 related mortality, has eclipsed important scrutiny on morbidity, and all cause morbidity and mortality.

In doing so, this has stalled discourses on addressing health inequities, ones that stand to make enormous positive change for societies and the health of the most vulnerable. Narrative devices such as vaccine development, production and uptake, while important, have been used to strategically distract away from important root cause issues including the drivers of poverty, soaring cost of living, asymmetry of the economy and its winners and losers, collapse of political accountability and more.

There is a lot to reflect on. An early career dominated by the pandemic has provided a rich and complex background to my interest in the broader determinants of health and wellbeing. I am now entering a new phase of my career where I hope to explore them further.

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Kilnsea - Yorkshire, UK

The final night shift of the rotation awaits me. I am days away from completing the second year of my training and this most valuable and unforgettable chapter is drawing closer to an end.

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Bamburgh Castle - Northumberland, UK

My time in children’s medicine has, as expected, flown by. The learning has been relentless and all consuming. The impact of the pandemic has created an unusual composition of burden of childhood disease on the ward. I’ve been thinking a lot about the relationship between the conditions shaping young people’s health and wellbeing out in the community and how it manifests as children arrive to the ward and assessment unit. There’s a going on, and a lot to keep pace with. I hope to make to the time to come back to this soon - what we’re seeing in children today, is shaping the health of adults tomorrow.

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Roseberry Topping - Yorkshire, UK

It’s been a busy start to paediatrics but what an amazing learning opportunity it has been. It’s surreal to be back in the hospital full time having spent the last 8 months in the community - they are worlds apart.

Children are not small adults. Their physiology, capacities to rebuff illness and responses to treatment are almost entirely different. Beyond this, in the medical setting, the interaction with the child patient is a different challenge altogether.

Every day has been littered with learning opportunities, both big and small, clinical and professional. I’m so excited to make the most of the remaining time and am grateful to have so many positive and inspiring colleagues as I approach the peak of this stage of my training.

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Sandsend - Yorkshire, UK

In many ways it’s been a successful month, a steady accumulation of small but formative wins, despite the protracted challenge in the backdrop. Successive positive experiences are opening up a space to explore the role and impact of motivation; where it comes from, how it can be used most effectively, and how to adapt when it vanishes.

As ever, my competing interests within and outside of my role as a clinician and the duty of care to patients and my colleagues, remains a fine balancing act, requiring a concerted effort to find the right balance in order to do the both to the best of my ability.

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Cayton Bay - Yorkshire, UK

It’s already time for a new rotation; inpatient psychiatry. I’m looking forward to the opportunity to learn and develop over the next four months in a specialty I have relatively little experience in.

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Blackfriars - London, UK

I’m lucky to meet so many people as part of my job. Often I get to know a patient for the first time but it is of course not uncommon in primary care, to meet patients for the second or third time. Then there are the myriad staff members and colleagues, without whom, the work I do would simply not happen.

Meeting such a rich variety of people, social circumstances, backgrounds, personal dilemmas and stories, is one of the most captivating parts of the job and they have a prominent role in shaping my insights and understanding of people and place.

There will always be a handful of patients that one never forgets. Those who have a profound impact on one’s own perceptions of the world around them and the people that occupy it. They are unforgettable often because of their situation or predicament when you first meet, or their attitude, disposition, or state of being, sometimes in the most trying and dreadful of circumstances.

Yesterday I met a young man in his mid-thirties who attempted to end his own life after his personal circumstances and mental health took him to the brink. There was something so striking about his manner, a coalescence of steely intellect and an aura of worldliness that I rarely come across, especially in someone so young. His understanding of the biochemical intricacies of the psychotropic medications he was using, was second to none and would put the knowledge of many doctors, including myself, to shame. I was, and remain, taken aback for reasons I can’t quite put my finger on. He sat there, peacefully reading Homer’s ‘Odyssey’, his lips stained black from the charcoal used to prevent ingested drugs and poisons from being absorbed from the gut straight into the bloodstream.

I’m still processing what this encounter meant to me, but there’s no doubt I’ll remember this case for some time to come.

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Praia São Tiago - Funchal, Maderia

One of the most embattling aspects of working in healthcare, is a feeling of paralysis when unable to help patients, particularly when in desperate and vulnerable circumstances.

This feeling shouldn’t be news to any new doctor who paid attention during their time as a student, reconciling that our capabilities to live life to the fullest and most meaningfully are often ensnared by the broader social circumstances that determine our health and wellbeing. 

For many, a visit to the GP can resemble a lost battle after a hard fought fight, an acquiescence to the overwhelming myriad forces of life that shape our wellbeing. For some, it resembles the point at which a problem can no longer be ignored, after drawing out a period of protracted personal conflict, doing one’s utmost to close their eyes firmly shut and hope the lingering menace evaporates away.

Walking into the clinic can therefore, seemingly draw odd comparisons to the embattled finding refuge in a place of faith or sanctuary, seeking redemption as uncomfortable truths are reluctantly confronted.

So I should expect to condition myself for these encounters; desperate, tragic and crushing.

I always want to try my absolute best, but on one occasion this week, I felt totally stuck and incapacitated, feeling like I was doing a disservice to a grieving child and a grieving family. My words of reassurance felt empty, my sentiments inconsequential.

When all was said and done, colleagues assured me nothing else could be done for them. It still doesn’t take the sting out.