My Air Ambulance Elective!

‘It was now night time and as we pitched up at scene, I noticed the debris scattered all over the road with signs of a potential fuel leak nearby, there was a massive ‘bulls-eye’ on the windscreen and there were sirens wailing and bright blue lights flashing as Police and Fire Service crews worked hard to secure the scene. Bystanders, including family members were crying out for help and screaming for something to be done as they witnessed their loved one go into traumatic cardiac arrest. This was the first job I attended with EHAAT and it was a motorbike vs van collision at high speed. ‘Welcome to pre-hospital medicine’, I briefly thought to myself’

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After returning from my trauma elective in South Africa, I had another SUPER exciting elective lined up. The day after returning from SA, I moved to Essex to start a 4-week attachment with the Essex and Herts Air Ambulance Trust (EHAAT).

I felt so grateful for this opportunity but also had major ‘imposter syndrome’ and up until my first day with EHAAT, I kept feeling like this was all a dream and that when I’d turn up for my first shift, they would be like ‘who the heck are you?!’

Thankfully, my worst fears weren’t confirmed and I was officially part of the student elective programme!

EHAAT

So for those who don’t know, Essex & Herts Air Ambulance Trust is a Charity Air Ambulance service providing a free, life-saving Helicopter Emergency Medical Service for the critically ill and injured of Essex, Hertfordshire and surrounding areas (around 3-4 million people). It is not funded by the NHS – only by charitable donations and it costs around £6 million a year to fund the service.

My Experience

As part of my elective, a typical week consisted of two clinical shifts, two shifts where I would focus on a project and a day of clinical governance/death & disability discussions. I really appreciated the variety on the timetable because it gave me a much more realistic insight into what life is like for a pre-hospital doctor.

The jobs we attended were quite mixed; from road traffic accidents and suicide attempts to medical cardiac arrests and paediatric choking incidents. One of the main decisions that need to be made in the pre-hospital environment is deciding which hospital the patient should go to. Essex/Herts is a large area and there are not many major trauma centres (MTC) within a small area like there is in London. For this reason, the decision to bypass a trauma unit for a MTC requires more clinical acumen. Moreover, for those with specific injuries such as head injury or conditions such as MI, they need to transferred to the appropriate hospitals based upon what the hospital specialises is. I vividly remember transferring a cardiac arrest (secondary to STEMI) patient to Harefield hospital and I was so impressed with how the cath lab team greeted us at the door for the handover and allowed us to watch the Primary PCI (procedure to restore the blood flow to the block coronary artery). Also, their staff room had Nutella which was an added bonus!

Although flying in a helicopter to jobs was very exciting, it was the actual ‘job’ itself that provided the most cognitive-stimulation and excitement. It was incredible to be a part of the team deployed to critical cases. My duties included exposing the patient fully with the help of shears, getting the monitoring equipment on and providing traction to fractures etc. Seeing a patient in the pre-hospital setting adds a whole different element to your decision-making process. You have to use all of your senses and experience to figure out the mechanism of injury and the most likely subsequent injuries. This allows you to preemptively treat, package and triage the patient. I found this whole process both incredibly challenging and enjoyable. I feel that the experience I had in the ED and during my trauma elective allowed me to keep a cool head when confronted with dying patients to ensure I was thinking through the clinical situation as clearly as possible. Being able to remain calm in critical situations is definitely a skill that can be learnt and practised and I hope to continue doing this.

Another case that was extremely critical was a motorbike collision which led to a catastrophic pelvic bleed. The patient’s blood pressure was very low and continued to be unstable and venous access was difficult. We were also the first on scene which meant we were starting from scratch. We had to move quickly because it was clear that this patient needed blood and blood products. We packaged him after getting a line in and reducing his fracture and flew him to the local MTC.

Then in the ED, I noticed a lot of human factors issues such as a lack of situational awareness from the trauma team leader, there was also a faff with the Belmont Rapid Infuser and there was no closed loop communication. Moreover, there also made a comment about there being only one venous access. This raise an important point. The ED teams who receive a patient from the pre-hospital team don’t always fully appreciate how difficult it is out on the road where resources and time are extremely limited. So although, patients may arrive via HEMS nicely packaged with all the monitoring on etc, it takes a lot of work to achieve this so I had renewed appreciation for the HEMS team.

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One of my favourite days of this elective was my shift with the Hazardous Area Response Team (HART). To me, HART is basically the SAS of paramedicine and they attend all the chemical incidences, difficult extrication jobs and jobs involving water, tunnels or even terrorism. They are highly-trained and highly-skilled paramedics and on my shift we attended a variety of jobs which I won’t go into for confidentiality reasons but I learnt a lot about their crucial role.

It was always an incredible privilege to be a part of the team in the pre-hospital environment and it was truly beautiful to see how well the emergency services worked together to ensure the best outcome for the patient

Clinical Governance Days (CGDs)

Pre-hospital teams take quality improvement and feedback from colleagues very seriously. I feel that to be a successful member of the pre-hospital team, you need to be somewhat of a perfectionist – someone who is constantly striving to improve their practice with the help of others.

Part of this learning is achieved with the help of monthly CGDs which involved auditing patient cases from the past month and seeing what went right and what could have been improved. There are also sessions on latest guidelines and important learning issues. All of this results in an enjoyable and interesting day of learning.

Alongside the CGDs, there are weekly D&D’s which is where cases from the previous week are discussed, particularly focusing on death or disability and if anything could have been improved or done differently. I always found it super humbling to be allowed to sit in on these conversations where doctors discuss their cases in an open and honest way, all in the hope of improving patient care going forward.

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Research Poster

As part of this elective, students undertake a project/audit alongside a doctor/paramedic in order to answer a question or improve practice. I looked at the drowning victims that were attended to by EHAAT and analysed outcomes to figure out what interventions were being used and to what effect. With the help of my EHAAT mentors, I managed to create a poster and presentation which I presented at the D&D and I hope to submit my poster to future pre-hospital conferences.

Increased passion

All in all, I had the most incredible month in the pre-hospital environment. This experience definitely confirmed for me that I want to pursue pre-hospital medicine as a career because of the variety in the cases, the incredible nature of the teamwork and the constant desire to improve. I feel really appreciative that I was able to have this opportunity as a medical student and feel so grateful to all the staff at EHAAT for guiding, helping and teaching me. I learnt an awful lot about what true teamwork is all about in addition to clinical decision-making and patient assessment.

Now I’m back at my normal medical school for my final year and life is definitely a lot more mundane now that I’m back on the wards –  I miss emergency and pre-hospital medicine a lot!!

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My trauma elective in Johannesburg

Women running aimlessly in the trauma department and wailing with deafening screams after being told their children are dead, patients with gunshot wounds to the head being carried in by horrified friends, other patients presenting with projectile arterial bleeding from their neck from knife wounds whilst in the background the smell of burnt flesh lingers in the air due to 95% total body surface area burns and fights are breaking out between patients/enemies. This was my experience of just a single shift on payday weekend at Bara hospital in Johannesburg in Aug-Sept 2018.


About three years ago during my first clinical year at medical school, I often heard UK doctors talk about their elective experiences in South Africa and in particular at ‘Bara’ hospital (Chris Hani Baragwanath Academic Hospital). I was immediately enthralled by their ‘war stories’ and vowed to myself that one day I will go to Bara for my own elective and create my own story that will live with me forever.

I organised my 4-week trauma elective at Bara about 18 months ago since it is notoriously difficult to get a place both due to the competitive nature of the elective and due to the administration process not being as streamlined as it should be. So in mid-August 2018, I travelled to Cape Town (CT) to enjoy a week of sightseeing (see previous post). This was one of the best weeks of my life due to the shear beauty of CT.

Next on the agenda was to travel to Johannesburg and start my elective. Johannesburg is very different to CT. The whole vibe is a lot more dog-eat-dog and you can definitely feel the presence of safety-issues as soon as you arrive, hence why people who can afford to do so live in houses with barb-wired fences, which resemble those of a prison.

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The security-controlled entrance/exit to Bara

On my first shift at Bara I was immediately aware of the resource limitations that plague this beautiful country. Pieces of equipment that I normally take for granted here in England were not always present at Bara such as scalpels, tourniquets, gloves, gauze, tegaderm, bandages, scissors, tape, sterile instruments etc and there was significant under-staffing too, made worse by the fact that a lot of the nurses were not… how do I put this in a diplomatic way… particularly helpful or engaged in patient care.

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There are 15 resuscitation bays in Bara’s trauma department

It’s difficult to summarise all of my experiences into one blog post. I am only just fully registering some of the things I saw and did at Bara and there are some incidents which I have not fully acknowledged yet but I’m sure I will further down the line. There are a lot of gory images that I have both in my memory and in my photo album but I won’t be sharing those in this post both due to confidentiality reasons and due to the fact that once they are seen, they cannot be unseen.

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‘The Medical Corridor’ – where I’d often sit and have my lunch if I had time

One of the most haunting aspects of my time in Soweto was witnessing how brutal and traumatic the violence against women is. On a daily basis I saw women who had been beaten by their partners, brothers and other male figures in their life. They were being beaten to a pulp with fists, sticks, bricks and sometimes even knives and what makes it worse is the fact that most of the men responsible will walk away scot-free. I have never seen such relentless and barbaric violence against women before and it pained me that I couldn’t do much other than to patch up the wounds, ensure there’s no life-changing/life-threatening injuries and then talk to the women about their experiences and their feelings. Most of these women brought police documents with them and asked us for help to build their case but I knew from speaking to the senior doctors that sadly justice would not be delivered to these poor survivors.

Hijackings are also very common in Johannesburg. I arrived at 7pm to start my night shift in the department during the final week of my elective. As soon as I arrived, a couple of off-duty paramedics walked in and said there’s someone who has been shot in the back of a car parked outside. We ran out after donning gloves and saw two people outside a car crying for help and there was a large male patient in the back. I’ll never forget the look of hope being wiped from their faces once we assessed the patient and found him to be cold and pulseless with no breath sounds or pupillary reflexes. The pure horror and tragedy in their response as they learned that their pastor of many years was now dead is something very vivid in my memory.

Another day that was extremely unique was the day of the strike. All the nurses in the entire hospital planned a day of protest against the hospital’s CEO due to allegations of corruption and pay disputes. Now, when nurses protest they like to have all the other hospital staff join them too including radiographers, lab workers, porters, security etc etc. So the only people left working were doctors, medical students and a couple of radiographers who would only scan life-threatening trauma patients. I was the only medical student on shift that day and suffice to say, my workload was pretty full as I worked with the doctors to ensure patient safety and patient care remained a priority. We had to put the hospital on divert and used the major incident protocol to issue patient files as the clerks were also out striking. Patients still filtered in either by walking in or via ambulances. We didn’t have access to the drugs cupboard so for nearly an entire shift, patients in resus did not have access to pain and sedation medication such as morphine and propofol. At certain points, due to the lack of staff, I was the most ‘senior’ person in the department and I had to co-ordinate the process. To sum up, this was a crazy day haha.

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Taking patients to the CT scanner was always very ‘interesting’. On one particular shift, I transferred a ventilated patient with one of the doctors and just as the scan finished the ventilator stopped working due to the battery suddenly dying without warning. We then had to quickly scoop the patient onto the trolley and make a rapid dash to the resus room and connect him to the mains all the while seeing his o2 sats slowly drop during the journey.

Due to the lack of staffing but massive workload, at Bara the ethos is very simple: ‘see one, do one, teach one’. After seeing certain procedures such as chest drains and central lines, we were taught to get stuck in and start doing them ourselves. Initially we’d do them supervised and once we were confident in our own competence, we could even do them ‘unsupervised’ (the doctor would have one eye on us instead of two). I still remember the gush of air from the first intercostal drain I inserted, the sound was like music to my ears as it confirmed I was in the pleural space and had released the pneumothorax.

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This comment by the radiologist regarding my chest drain made my day!
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My first central line. Photo used with consent from the patient.

I know so far I have made it seem like it was all doom and gloom but it really wasn’t. The doctors at Bara are absolutely incredible and I view them as heroes for being able to cope with such harsh situations on a daily basis. I learnt an incredible amount and I was doing procedures that are usually only reserved for middle-grade registrars and above here in the UK.

With the help of a very kind gentleman and doctor in Johannesburg called Dr V, I managed to organise an air ambulance shift with HALO who are based all over South Africa. We got to fly to a patient who had sustained an injury to her spine after a fall and had reduced power and sensation in her lower limbs as a result. The job involved packaging the patient safely and administering a higher-level of analgesia and transferring her to the appropriate hospital. This pre-hospital experience was absolutely incredible and the team at HALO are, in my opinion, second-to-none in south Africa in terms of pre-hospital critical care. That was a great day and one I will treasure for many a year to come.

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The views of Johannesburg from above were stunning!

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Other notable times/things I won’t forget from my time at Bara are:

  1. Taking a bullet out of a patient’s leg
  2. Scrubbing down the countless burn patients with the help of ketamine +/- propofol
  3. The mob assault patients who were patients brought in after being beaten to within an inch of their lives after committing a crime in their community
  4. Being in charge of the new interns for a couple of days as out of all the junior staff I had been there the longest (2 weeks!) hahaha
  5. Constantly living in fear of sustaining a needle-stick injury
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The bullet I removed from the very happy patient. Photo is being used with consent from the patient (he actually asked me to take it!).

Whilst in Johannesburg, I also had time to visit the beautiful mosques, the apartheid museum which was extremely eye-opening and emotional, Mandela Square (WOW, just WOW!) and Pilanesberg Game Reserve (where I saw the ‘big 5’, including lions eating a zebra, a leopard who had killed an impala and hung it up a tree and then I drove right behind a massive elephant for a while!).

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“To be free is not merely to case off one’s chains, but to live in a way that respects and enhances the freedom of others” – Mandela
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Find the Madiba in YOU

I had THE most incredible time in South Africa and since being back for a week now, I can’t stop thinking about it and I love talking about my experiences with others, especially if they themselves have been there. I’ll definitely be going back there at some point in the future (I also would love to travel to Swaziland, Mozambique and Botswana the next time I go SA) and it would be awesome to go back to Bara as a registrar and learn some more!

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Cape Town – An absolutely stunning city (Photos)

I recently spent 5-6 days in Cape Town (CT) prior to starting my Trauma elective at the world-renowned Bara hospital in Johannesburg. I fell in love with Cape Town and its beauty immediately. The mountains, the oceans, the beaches, the sunsets and the scenic drives are unparalleled. My close friend planned my itinerary for me.


Tuesday

District 6 Museum – museum about the Apartheid. Very eye-opening.

Truth coffee – ‘World’s Best Coffee shop according to the Telegraph’

Kirstenbosch botanical gardens

 

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Signal hill for the sunset

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Wednesday

Lion’s Head

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World’s first heart transplant museum

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90 mins before sunset do Chapman Peak drive. This was the most beautiful drive I’ve ever done in my life. Photos do not do it justice!

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Thursday

Get up early drive to Cape Point (coastal drive route on google maps) & Cape of Good Hope (most southwestern point of Africa and it’s where the Indian and Atlantic oceans meet!)

On the way we stopped in this really nice village and had breakfast at an amazing small outdoor café called Café Roux in Noordhoek

After breakfast/ brunch, still on the way to Cape Point there is an ostrich farm on the way aswell, stop off there to see some cool ostriches if you want

Simon’s Town and Boulder’s beach (penguins on the beach!!)

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Friday

Pray at Masjid al Auwal (first mosque in South Africa) and check out Bokaap. Bo kaap is Malay Muslim area of CT. It has cool houses and Malay food.


Camp’s Bay where there’s boat cruises to see seals.

I also visited the aquarium which was amazing

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Saturday

Table mountain (you could also see Robben Island from the top which is where Mandela was imprisoned for nearly 30 years).

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(Old Biscuit Mill and) VA Waterfront Mall- cool little market and Mall with entertainment

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Cape Town was a trip of a lifetime and its full of incredible views and astonishing history.  I highly recommend all to go visit it!

Stay tuned for my Johannesburg post which will include stories about my time at Bara!

 

The importance of paying it forward

As far as medical schools go, I belong to a relatively small one in terms of the cohort size. This comes with its own pros and cons but undoubtedly the biggest pro is the fact that a smaller cohort allows for all of us to get to know one another and rely on each other for help and support.

This massive benefit was made apparent to me during my first week of medical school when a motivated and extremely bright 4th year student arranged to deliver regular teaches to us ‘Freshers’. The contents of his teaches were mainly clinical and he aimed to teach us high-yield content (look up the Pareto Principle). Upon asking him why he decided to dedicate so much of his time and energy into teaching 1st year students, he explained that not only does he enjoy teaching but he also sees it as his duty to teach those in the years below him as when he was in his 1st year, senior medical students had taught him too. In essence, he was ‘paying it forward’.

This philosophy struck a chord with me and I too began to understand the importance of ‘paying it forward’. There were other medical students in the years above who also organised regular teaches for us. A significant component of being a doctor is being a teacher as we have to educate both our peers/students as well as our actual patients. Therefore, I realised I could hit two birds with one stone by delivering teaches to medical students who were more junior than me as this would not only allow me to ‘pay it forward’ but it would also allow me to improve and develop my ability to teach.

When I became a 2nd year medical student, I organised regular teaches to deliver to the new ‘Freshers’. I tried to make the teaches as relevant as possible whilst endeavouring to pitch at the right level. I realised early on that I enjoyed teaching and imparting whatever limited knowledge I had. Moreover, teaching others allowed me to fill my own gaps in knowledge and I often learnt a lot from the students I taught.

Most recently, I have been involved in teaching 1st, 2nd and 4th year medical students both at my own medical school and a medical school in London in order to prepare them for their upcoming OSCEs. I found this extremely gratifying as I felt I was actively involved in improving the quality of future doctors. Moreover, several weeks ago I also organised to go back to my old college to speak to a group of students who were aspiring to apply for healthcare degrees at university. I really enjoyed giving them an insight into the life of a medical student and answering their questions about various degrees including Nursing, Physiotherapy and Midwifery. I am a massive believer in widening access to Medicine, thus find it extremely important to try my best to inspire and motivate students from disadvantaged backgrounds to apply for Medicine. Finally, the biggest reason as to why I started this blog was to ‘pay it forward’ in whatever small way I could by sharing my experiences and learning points as a medical student in the hope that it may resonate with others and help fellow students in their own journeys.

If we now look beyond Medicine, ‘paying it forward’ is something we should strive to implement in our every-day lives.

Every day, we have countless opportunities to impact the people around us, either positively or negatively. Most of the time it’s easier to stay apathetic. If we’re not part of the solution however, we may actually find ourselves to be part of the problem.

Every day we have the opportunity to help make the world a better place for others and ourselves. We only need to seize the opportunity and act. One way is to pay it forward or, in other words, commit random acts of kindness.

Examples of random acts of kindness include giving someone way whilst driving, texting an old friend to check they’re okay, standing up for justice, smiling and greeting others more often when in public, holding the door open for others, giving money/food to the homeless etc etc.

Do not underestimate the value and power of small good deeds. As medics we are extremely privileged and we should try to share this privilege and blessing by helping others. Even before I got into medical school, I was helped massively by doctors and medical students with my application which is why it is my duty to do the same for others. I wouldn’t be a final year medical student without all the help I have achieved from medics who have been ‘paying it forward’.

Let’s inject more positivity into the world around us by lending a helping hand more often whether that be by helping fellow students or by random acts of kindness to the public at large. I truly believe doing so will lead to an increased level of personal and societal happiness.

5 books that drastically improved my life

I used to view reading as an unnecessary chore and until 2016, I hadn’t read a book since the compulsory reading I did for my GCSEs about 7-8 years ago. Whenever I’d observe someone reading a book on public transport, I’d often think: ‘oh, what a pompous arse! They’re just trying to act smart!’. *facepalm* – I feel so embarrassed about these ignorant views I held back then.

During my third year of medical school, I wanted to make better use of the time I spent commuting to and from the hospital for my placements. The commute was about half an hour each way and I felt it to be a terrible waste of time as I was not doing anything productive whilst sat on the bus.

Since then, I have completed a book every week on average. I mostly read self-help/productivity books or books written by medical doctors as I find these to be the most cognitively-stimulating, thought-provoking and actionable. Below are the 5 books that I feel have helped to improve my ability to live a more fulfilled life as well as helping me become a better medical student/future doctor. I would highly-recommend you all to read them regardless of what career you are in as the skills and knowledge gained from these books are extremely transferable.


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‘How to Win Friends and Influence People’ by Dale Carnegie

When I first wanted to get back into reading books, I enlisted the help of my twitter followers to ask for book recommendations. This was the first book recommended to me and it was advertised by my friend as a book that had ‘transformed many lives’. I wasn’t convinced it would help me much as I naively thought books couldn’t offer THAT much value. I was gladly proved very wrong.

Carnegie is widely-renowned as the ‘godfather’ of self-help books and this is the most cited self-help book of all time. It is filled with many actionable steps in improving your relationships with friends, family and colleagues in order to increase your influence and ability to connect with people.

For me personally, one of the biggest lessons from this book was to learn people’s names. It doesn’t matter what quirky tactics you have to use in order to achieve this – just do it! Think about how great and important you feel when someone remembers your name, despite only having met them once or twice. In a similar manner, doing this for others will be a great feeling for them. Throughout this academic year, I have been based in an entirely new hospital with an entirely new group of staff. I took it upon myself to learn everyone’s names to ensure whenever I approached them or greeted them, I would use their name to harness a more positive environment.

At times I would surreptitiously look at their ID badges or ask colleagues about what such and such’s name was before I approached them. By simply learning everyone’s name that I came across, I was able to build meaningful and positive relationships with my colleagues and supervisors. Not only do people feel incredibly happy when you remember their name, but they also remember you in good light so when you have to ask them for help or a favour, they’ll happily oblige ;). In short, research has shown that learning names improves a team’s togetherness and this is a highly-important aspect of human factors.

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The Happiness Equation’ by Neil Pasricha

Paricha goes through simple steps to live a more fulfilled and happy life, particularly focusing on an ‘ikigai’ or a purpose in life that makes it easy for you to wake up in the mornings. One of the big ideas that I took away from this amazing book was the importance of ‘being happy first’.

A lot of people believe the notion that you have to work extremely hard throughout your entire life to then get a great job and earn the house with the illustrious ‘white picket fence’ (!) so that you can one day retire and then somehow you’ll deserve some ever-elusive happiness. I was in the same boat. I used to wish that I could get through medical school quickly so that I can then start my specialty training so then I could become a consultant/attending as soon as possible. Only after ticking all these boxes did I think life would be good and i’ll be happy. This book made me realise that racing to achieve X-Y-Z or wishing to get through each stage in your life/career as soon as possible is a form of wishing your life away. It is important to enjoy the journey itself rather than solely focusing on the end destination.

It is therefore important to be happy first, rather than believing that attaining your goals will lead to happiness. Being alive means you’ve already won the lottery. You are among the wealthiest people in the entire world. The average world income is five thousand dollars. Are you higher than that? Then you’re in the top 50%. And if you’re higher than fifty thousand dollars you’re in the top 0.5%. Do you need much more than 99.5% of people alive? You either have the money to buy books or you have the time to read them. Either way, you have it good! You already have more than almost everybody on the planet. On your very worst days, you have to push your negative thoughts. You have to take a step back. You have to remember the lottery. Being ‘happy first’ ties in nicely with being grateful and studies have demonstrated the neural effects of gratitude on well-being. Happiness is when what you think, what you say, and what you do are in harmony.

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‘Being Mortal’ by Atul Gawande

Atul Gawande is a renowned surgeon and author who was born to write. He has written many books but this one for me is my favourite. I learnt about this book whilst on my palliative care placement in my fourth year of medical school as it was recommended by one of the consultants. I began reading the book and was immediately captivated by Gawande’s style of writing and his ability to talk about death in a very open way, a way that is often avoided in practice. According to Gawande, Medicine has become too focused on battling death and not appreciating life for what it is. Additionally, he discusses the fact that the closer people THINK they are to death, the more their priorities change whereby they begin to value their relationships with loved ones more as well as valuing their autonomy more.

This book taught me the importance of having these discussions with patients to ensure that they are treated as a person, rather than just as a disease. It’s vital to ask patients what their ‘ideal death’ looks like, what things they still want to achieve in their life and who they want to be around them in their final moments. Discussions like these are understandably very difficult to have with patients, especially when there are time and resource constraints. However, I will be taking this empathy and compassion for the dying person forward in my own practice to ensure that shared-decision making and plans are set in motion early with patients to allow them to have the death they want. This book coupled with my palliative care placements really improved my empathy skills and I am working hard to harness this even more as I progress through my career. I recommend this book to those in healthcare and those who aren’t as we are all inevitably going to come in contact with a loved one who is dying, if we haven’t already.

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The 7 Habits of Highly Effective People’ by Stephen Covey

Covey is another heavyweight in the field of self-help books and this book is filled with 7 gems on how to live a more successful life. The need to ‘seek first to understand then to be understood’ has helped me tremendously. Many of us, when conversing with others, only listen with the intention to reply but instead we should focus on what the person is actually saying so we can understand their views and feelings. This can be applied in Medicine when I am listening to a patient’s story. It can be easy to let my mind wander as the patient is speaking to think about what I will ask them next, but instead of this it’s a lot more fruitful if I listen to them actively so that I can treat them holistically as a person rather than just focusing on their symptoms. By listening empathetically instead of forcing our natural autobiographical responses onto each situation, we can get beyond a surface-level, transactional exchange and have a real impact.

Another key habit I took away from this book is the need to ‘sharpen the saw’. This refers to the fact that as humans we are fallible, but even more so when we are tired or burnt out. In healthcare, burnout rates are scarily high, especially amongst medical student and doctors. As such, it is vital we pay close attention to self-care. An easy way to do this is to use the acronym ‘HALT‘. This stands for ‘Hungry, Angry, Lonely or Tired’. When we are feeling less productive or feeling a bit ‘off’, we should question whether any or all of these 4 factors are to blame and we should then remedy them immediately. By ‘sharpening the saw’, we can re-energise ourselves and complete our remaining tasks with a lot more rigour and efficiency. It’s important to dedicate time in your busy schedules to take breaks, enjoy hobbies and spend time with positive people.

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‘Thinking Fast and Slow’ by Daniel Kahneman

This book was introduced to me by an Emergency Medicine consultant last year. Recently in Medicine, especially in Emergency Medicine, there has been a huge emphasis on decision-making and human factors. During life and death situations, when the pressure is on and judgement can be easily clouded, the human mind is prone to error-making which can ultimately cost lives. Kahneman brilliantly writes about how we think and make decisions and what biases we are at risk of when making every-day decisions.

The basic idea is simple – there are two modes of thinking:

  • System 1” thinking is intuitive thinking – fast, automatic and emotional – and based on simple mental rules of thumb (“heuristics”) and thinking biases (cognitive biases) that result in impressions, feelings and inclinations.
  • System 2” thinking is rational thinking – slow, deliberate and systematic – and based on considered evaluation that result in logical conclusions.

Meta-cognition is extremely important because once we’re aware of how we think, we can then put in place systems to mitigate the risks associated with cognitive biases. In Medicine, for example, ‘confirmation bias’ is common whereby once you think you know the diagnosis, you will interpret all the information in such a way that points towards this diagnosis rather than maintaining an open mindset. Such thinking can lead to premature closure and misdiagnosis. Another common bias is the ‘framing effect’ which refers to the fact that our thinking is biased by the way information is presented to us. Advertising companies are aware of all these biases we are prone to and use it against us when marketing their products in order to persuade us to spend our money.

This book will allow you to improve your critical thinking skills and enable you to understand your decision-making processes better, so that you can ensure you’re able to be more logical and systematic in your approach to every decision you make.


In summary, these 5 books have stood out amongst the dozens and dozens of books I have read and together they combine to form the ultimate summer reading list. I have no doubt that you too will gain as much as I have from reading them and irrespective of what your career or life is like, these books will give you tremendous value.

Thank you for reading.

The importance of just ‘showing up’

“Eighty percent of success is showing up” – Woody Allen


For many of us May is an incredibly busy month. Exams are imminent and summer plans are being carved out. For me, it’s been no different. This month has consisted of multiple university deadlines, intense emergency department shifts, organising a regional Emergency Medicine conference, arranging my medical electives, appointments and most recently Ramadan.

Suffice to say, it’s been quite an arduous and at times, overwhelming month. As such, I put my personal goal to post one blog per calendar month on the back burner and kept delaying it and delaying it until I got the more important tasks (view my previous blog post) out of the way. If I skipped this month’s post, literally no one would have realised but that’s not what is important. I made a commitment to myself to post at least once a month and having achieved that so far since starting this blog towards the latter end of 2017, I feel like I have built some momentum and it would be a shame to lose that. It would have been easy to skip this month and tell myself I’ll write two posts in June but that’s not how habits are formed. Consistency is crucial in habit formation. I would highly recommend ‘The Power of Habit’ by Charles Duhigg to learn more about habits.

For each of the tasks I mentioned above, it took an incredible amount of willpower to engage in them. For example, with my university deadlines, it was so difficult to get started with my assignments because I kept thinking about how much I had to do for them which put me off starting. Similarly, for this blog post, I kept postponing it because I feared that it would not be perfect. This characteristic of perfectionism can be quite paralysing at times and I watched a YouTube video today by Thomas Frank who mentioned this exact concept. This prompted me to get a move on with my blog!

So what do I do when I’m running out of willpower, have many tasks that need completing or simply get distracted with other things?

Just. Show. Up.

It’s at simple as that. Whether it be days when I’m feeling sluggish and cannot be bothered to go to the gym or days where I don’t want to write my essays, I tell myself:

‘Just do the first 10 minutes’.

This trick has worked wonders for me and can be applied to pretty much any task from doing the dishes or gardening to doing exam revision and a workout. Right now, it is Ramadan and I’m fasting for 18 hours a day, so energy levels can be quite low towards the end of the day when I would otherwise go to the gym. But, I am trying to avoid excuses and instead of expecting myself to have the same level of workouts as when I’m not fasting, I have reduced both the intensity and length of my workouts. I still feel productive and just by showing up I am getting closer to my fitness goals.

In terms of the fear of not producing perfect content, we can look at Gary Vaynerchuk as an example. For those who don’t know him, he is a well-known entrepreneur and social media guru who makes daily vlogs on pretty much every social media platform. His main focus and message to others is to churn out content every single day. Don’t get me wrong, the quality is still very high but neither he nor his audience expect it to be perfect. But by doing this every day and just showing up, he is in fact improving day in day out – I mean just compare his earlier vlogs to now. In the same vein as this, I aim to continue to produce at least one blog post per month, without letting myself be paralysed by fear of failure, in the hope that my creativity, ability to write and potential to help others improves.

It’s not just in our work lives where just showing up can lead to success. It helps in our relationships with others, in our health and in our leisure time. Just think, how many times have we made plans to do something out of our comfort zone like going travelling alone or speaking to a stranger but then only to flop on these plans last minute? Just bloody show up! You will feel much better for it because your mind will have been exposed to new stimuli and important learning experiences.

Today I went through many things on my to-do-list, quite menial things but things that had been bugging me for some time now as I had not been able to clear them off my list or more importantly off my mind. But I willed myself to just ‘show up’ and managed to tick about six items off my list. After posting this piece, I will only have one thing left to do (make a phone call to finalise plans for the opportunity to become a professional football club doctor after I graduate!) on my list. I cannot explain how this feels for my peace of mind!


I want to urge all of you to remember this post the next time you feel too lazy to get those important tasks done. We all have those days, I have more than I would care to admit, but when it comes to crunch time it’s important that we muster up all the energy and willpower we can to just ‘show up’. These little bouts of effort, done repeatedly, will compound into great amounts of success. To learn more about this concept, I would highly recommend ‘The Compound Effect’ by Darren Hardy.

Just Show Up

There’s more to life than our jobs

Never get so busy making a living that you forget to make a life.”


As it is currently exam/deadline season for many medical students, I thought it would be useful to write about the importance of maintaining a healthy work-life balance. In my earlier years at medical school, I was somebody who used the several weeks leading up to exams to strictly focus on studying. I would stop going to the gym and stop hanging out with friends as often as I normally would, all in the hope that I would have more time to work hard and hopefully pass my exams.

As the years progressed and I started my clinical years on the wards, I realised that (most) doctors had a much better work-life balance than me! How messed up was this? This was a significant epiphany whereby I realised that if a doctor can find time to chill and enjoy the good things in life – why the heck wasn’t I?! Was I perhaps putting too much emphasis on my degree and the uber-competitive rat race of medical school?!

Don’t get me wrong, when it wasn’t exam season I would enjoy my free time liberally (whilst trying not to feel guilty for not studying!). But this was a wake up call for me. At the time, I was on my Plastic Surgery rotation. So after my shift ended, I had a chat with the Consultant/Attending about life outside Medicine. I have repeated this story many times because it was genuinely very life-changing for me. This was a surgeon who was very experienced and extremely talented. I asked him, very frankly, about his earnings and lifestyle and I was grateful for his honest replies. He told me, in his younger days he used to do a lot of private work which paid extremely well. He continued this additional private work (outside his contracted NHS hours) even after he married his wife and had children. Then, at a certain point, he came to the following realisation:

No one ever says, “I wish that I’d spent more time at work” on their deathbed.

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He explained that since he realised that, he has been a lot happier as he cut down his working hours and started spending more time with his loved ones. This struck a chord with me – did I really want to dedicate every living/breathing moment to my career?

I vowed to make a change and live a more balanced lifestyle from now on. To achieve this, I pledged to continue with my extra-curricular activities and relaxation time even during exam season. I thought, if I can’t even maintain a healthy work-life balance now as a mere student then how on earth would I manage it once I am actually a doctor?


So what are some of the steps I took to ensure I had more free time and was getting more out of life than just a degree?

Find your Purpose

One method of keeping focused on what’s ultimately important to me is to regularly reflect on what people will say about me once I’m dead. This took a lot of introspection and Sufi levels of mysticism(!). But eventually I came to the conclusion that at the end of the day the things most important to me are my religion, my family and a few select friends. Above all, I want my future children to be proud that I was their father. To achieve this, I know that I need to do a heck of a lot more than just become a doctor. I need to work on my character and on being a good, honest and loving person. This is definitely still a work in progress but I’m trying to make this the focus of my existence.

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Work Smarter – Not Harder

I learnt this life lesson from someone who’s had a massive impact on me and who has inspired me throughout my life – I am of course talking about none other than The Best Ever – Floyd Money Mayweather (50-0) #TMT. For those living under a rock, Mayweather is the greatest boxer of our era, having recently knocked out that Irish crackhead who I shall not name.

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How does he inspire me you ask?

Mayweather works EXTREMELY hard, don’t get me wrong. He arguably works harder than any other athlete on the planet (except for CR7 maybe). However, what’s more is he works SMART. By ‘smart I don’t mean that lame acronym which we’re told to use when setting goals – I mean he works in a deliberate and focused manner so that he can do five hours worth of work in half the time. He carefully plans each and every training session and his drills so that once he is in the gym – he doesn’t waste a single second. Then boom. It’s done and he can leave the gym and enjoy himself with his family and friends.

I started using this philosophy whereby instead of spending hours and hours studying and not actually getting much done, I began to revise in a very efficient manner. I would have set revision targets for the day (usually 2 or 3 things) and get them done in short but intense bursts with zero distractions (the pomodoro technique is very handy for achieving this). I would use evidence-based methods of learning and retaining information such as ‘active recall‘ and ‘spaced repetition‘ to get into a state of ‘flow‘ and once my tasks were done, no matter how little time they take, I am done for the day – knowing that in the long-run I am on track for achieving my long-term goals.

Another way I used to do this was by saying to myself: ‘9am – 5pm’ are my dedicated working hours where I will stay focused and not get distracted, then after that it’s my time to chill.

Getting adequate sleep is an important factor in being able to work intensely. It’s important to ‘sharpen the saw‘, as famously stated by Stephen Covey, in order to maximise our productivity capacity.

Finally, do NOT fall into the trap of trying to ‘multi-task’. Humans cannot multi-task – it’s a myth. Just focus on one thing at a time, and just like Mayweather – get that shit done using hard work and dedication.

Prioritising

Stephen Covey also talked about time-management in his highly-acclaimed book called ‘7 Habits of Highly Effective People’. He writes about compartmentalising the tasks in your life into what’s truly important for your overall growth and well-being.

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Above is an example of how to prioritise daily/weekly tasks. What may be ‘urgent’ may not actually be ‘important’ thus it can be delayed or delegated to others, allowing you more time to get on with the important tasks so you can have more time to chill out afterwards.

Learning to say ‘no’ to things is important. I know first-hand how difficult this is but it gets easier the more you do it. It’s better to say no and succeed at what’s already on your plate, than to say yes and perform poorly or worse.

Conclusion

By using the above techniques, you will find that you are completing your work a lot more efficiently, thus leaving you more free time. What you do with this free time is just as important, if not more important as what you did with your studying time.

Use this ‘down-time’ to work on your hobbies and passion projects. Use it to discover new interests and strengthen ties with family and friends. Go travelling. Enjoy time in the sun (if you’re lucky enough to have the sun in your country). Read a book. Go to a show. Work on your character flaws. Do some de-cluttering. Construct a morning routine. Watch a film. Do some gardening. Go for a walk. Work on yourself as a person.

When I first started becoming more efficient with my learning, I realised that I had LOADS more free time than my peers. Whilst they were studying, I was chilling watching TV or going to the gym. At first I used to feel guilty – like damn, should I not be studying like them too? This tendency to compare ourselves with others is very damaging. It occurs so much at medical school because at the end of the day we’re competing against each other. Thankfully, I gradually became more relaxed and allowed myself to enjoy my free time – I earned it.

During my time at university so far, I have travelled to fifteen different countries – a lot of these were during term time! I took extended weekends here and there to go travel and explore the world and see what life is like for other people. Medics can become so focused on themselves and their career that it’s easy to lose perspective.

I just got back from Budapest the other day – beautiful city!


I guess my summarising point would be:

Enjoy the heck outta Medicine – it’s definitely the best career ever and we are so blessed to be in it.

But similarly – enjoy the heck outta life and don’t let it pass you by whilst you are caught up in exams and deadlines.

Balance is key.

Until next time, keep smiling 🙂

#KOD