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After graduating earlier last week, I applied online to finally become a pre-registered doctor with the General Medical Council (GMC).  The process was swift – fill in an online form, click send and then await the confirmation email.

The confirmation from the GMC came the morning after I submitted the form. The email was direct and plain – no flashy graphics or banners, just universal text format – with a brief but courteous acknowledgement of the occasion:

Dear Dr Alexander,

We are pleased to tell you that we’ve granted your application for provisional registration with a license to practice. Congratulations on becoming a doctor.

I was now provisionally on the medical register. It’s taken the bank holiday weekend for this feeling to fully settle in – one of both happiness and mourning. Happiness because, well, great, I’ve done it. It’s real now. Might not have been how I expected it to happen, but it’s a job done, and it’s been done well.

The sadness came because I hate saying goodbye. It felt like now I was really separating from Cambridge; from the university that has been an integral part of my life for nine years. I had had the full taste of Cambridge life, from college, to lecture hall, to lab and to town, and I had enjoyed pretty much every moment of it. But now it was time to move on. A moving video recorded by the Clinical School, together with a tweet of good wishes from Cambridge Neuroscience (the network I was part of as my PhD) set me off. It is comforting to remember that I may be back someday – plus, I’ll definitely visit on weekends!

Before ‘officially’ starting in August 2020 as FY1s, we’ve got the option of working as interim junior doctors – called FiY1s (strategically avoiding the acronym ‘iFY’) – at either a hospital within our medical school’s catchment (for me, this would be the West Suffolk Hospital) or at the trust we’re due to start our work at in August – in my case, Guy’s and St Thomas’ (GSTT). The FiY1 role shores up medical staffing and also provides us with an opportunity to continue developing our skills.

I was torn between the West Suffolk and GSTT – whilst I was more used to the West Suffolk, I also reasoned that these next few months could be a good opportunity to get settled in at my future place of work. Plus, I had heard from several friends who are working in London that the trust was offering accommodation in nearby hotels, which are of course vacant for the time being, making moving much easier. One of them is the posh Park Plaza hotel. I wouldn’t mind that!

Like most choices that aren’t on an exam paper, there was no obvious right or wrong. I rationalised both, but the ultimate decision came to a ‘gut feeling.’ Much in the way Antonio Damasio describes in his book Descartes’ Error, I figure it’s my brain’s way of trying to make this sort of dilemma a bit easier to manage. The gut feeling told me to go to London.

Moving to London is a big step for me. I have never lived there before, and despite being in Cambridge – a mere 45 minutes away by train – I seldom go to visit. Being from Manchester, I’ve both missed the ‘big city’ feeling whilst being in Cambridge. Manchester is home and whenever I go back I always feel comfortable there. There’s so much to do – parks, clubs, pubs –

Whilst Manchester is a big place, it is more ‘manageable’ than London. I’m worried that I will feel overwhelmed with the immensity of the urban sprawl; the masses of people; the streets, backstreets and alleys with shops upon shops upon shops. The buildings of austere institutions and embassies together with the rows of Georgian houses are beautiful to look at, but at the same time, can feel cold and impersonal. I can’t help but feel a little small when I wander around London. But sometimes the reaffirmation that you are a small cog in a much bigger wheel is a good grounding mechanism. It doesn’t help that I don’t have many friends there either, although those that are there I consider close.

I’ll get used to the city after a while, and adapt to a new normality. One with less cycling and more underground tunnels. Last summer I spent two months in New York for my elective, and the same feelings were pretty prominent at the start. But after a couple of weeks, I settled into a routine. I began to enjoy the unexpected feeling of anonymity you get being surrounded by thousands of strangers. Being one amongst many provides some privacy, important in an age of virtual intrusiveness.

The hospital will likely provide some accommodation for us as we start work as FiY1s. The ‘official’ hospital accommodation is full, so trusts are using nearby hotels to house staff.

The clinical school has been holding virtual lectures to prepare us for practice. These have been immensely useful, both in providing a reassuring sense of security (“ok, so I do vaguely know what I’m doing”) but also as something to do during these hours locked away at home.

I like to think I’m pretty book smart, and that I’m clued-up on most (ahem) of the material you’d want a new doctor to know. But I know that there won’t be a 1:1, linear translation of this knowledge to practice. I’m sure there are going to be moments, especially early on in the transition, where I freeze, struggling to recollect even one byte of information from the gigabytes I have imputed over the course medical school. Where I forget that key drug that’s been in hundreds of multiple choice questions for finals. Where I can’t put that lovely flow diagram I drew in my notes into practice.

Medical education is slightly dichotomous: there are two approaches juxtaposed during medical school. In the preclinical stages, you are rewarded for knowing the ins-and-outs of every little detail: whether through rote learning the Kreb’s cycle to understanding the mechanism of action of outmoded drugs. But when you enter clinical medicine, the real sign of a safe doctor is not knowing the minutiae; instead, it’s understanding the basics and appreciating when your lack of knowledge or experience means something is beyond your capabilities. I remember it took several months at the start of clinical school for me to appreciate this. I had been a stickler for detail, but that was less important on the wards: now the goal was to learn to become a doctor, not a walking pathology textbook.

Medicine is humbling in that respect. You soon realise that it is impossible to know everything. There is always going to be someone who knows more, and that’s comforting, because you know there is someone you can call on in times of need.

Outside of medical life, the bank holiday weekend weather has been sublime. I’ve set up a makeshift office space next to the window, perching on the edge of a recliner with a piano stool as a desk for my laptop. I don’t think it’s doing wonders for my posture, but it is comfortable enough. Adjacent to the window is a tree with Clematis growing up its trunk, and its flowers are in bloom. The petals are rose pink and crinkled like tissue paper. I can sit next to the window sill and inhale, and catch their sent, slightly diluted in the breeze but still noticeable. From inside, it feels like nature’s taunt.

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Clematis montana from my ‘office’ window.

A group of coal tits frequents the tree and their vocal register is quite impressive. Often I listen to relaxation tracks when I’m working, but I don’t need one now. The silence of the streets means the birds’ calls echo. You can hear them chattering back and forth amongst themselves. In the two years I have been here, I’ve never noticed them before.

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One of the coal tits. They are noisy!

The government have been worried that the warm weather over Easter bank holiday will bring people out of their homes. I for one have strictly kept to my once daily outdoor exercise (he says, sitting on his high horse). Whilst running around Cambridge, I have seen the police round up one or two sunbathers on Parker’s Piece – a big field in the centre of town. There are definitely more coppers around, and I do feel on edge when they drive past. I get that not-guilty/guilty feeling much like the one you get when you walk through airport security, or when a bouncer checks your ID.

The bank holiday has felt long, the days protracted and drawn out. My mind wanders and settles on things that I wouldn’t normally think about. I definitely have obsessive tendencies, which can work to my advantage or disadvantage depending on the situation. If my mind’s eye settles on something productive, something that I find interesting, I can exploit this aspect of my personality and use it to push myself. However, if it lands on something that to others would seem inconsequential, it can magnify a small problem into one that is all-encompassing.

That happened over the weekend, a risk with all the free-time one has when sitting indoors all day. In my living room, I had become distracted from reading and was thinking about the future, my move to London, what the first few shifts as a doctor will be like. It was my mind’s way of processing the week’s events of graduation and pre-registration. I treat the thoughts in my mind as autumn leaves on a river, and I’m standing on a bridge looking down. Most of them I allow to pass by, some I will fish out and cogitate over.

But one particular thought I focussed on meant I began to fall into a loop. A loop of ruminant, spiralling thinking that has happened three or four times over the course of the nine years I’ve been at university. It traps all your other thoughts in a vortex, like a whirlpool has formed in place of the leaf you plucked out of the river. I began to dwell on the fact that I might not be good enough – both technically, and empathically. I had seen all the saviours on social media, all the skilled and competent doctors bravely battling the virus in the midst of swathes of patients falling ill. They were unrelenting in a mire of illness.

I doubted I could do it. Emotionally, I didn’t feel ready. The reams and reams of bad news had left me feeling numb and blunted. The death tolls didn’t seem to phase me as much anymore. My own affective repertoire had become stunted after days indoors, with minimal human contact. Not to mention, the wards now seemed distant in my past. I hadn’t been in the hospital for several weeks, and despite my best efforts, I was frightfully afraid of becoming deskilled.

I was becoming a junior doctor and were these signs that I was already burning out?

My thoughts turned to Easter. I am not religious; I would describe myself as agnostic. Sunday is the day of resurrection; a new start. I placed the leaf back in the river, to block the vortex. The torrents were still there but gradually dissipated. It was time to think of something else.

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