Imposter Syndrome

After more years as an SHO than I care to remember, it’s time to take the leap. Admittedly my step up in responsibility to the esteemed position of A&E registrar has come as part of the Jeremy Hunt-induced mass exodus to Australia, and is slightly tempered by the fact that I’m not actually an Emergency Medicine trainee, but I’m considering it a promotion nonetheless.

My first day doesn’t get off to the best of starts. It turns out scrubs aren’t provided in my new hospital, so facing the unenviable choice of introducing myself to my new bosses wearing either tattered jeans with a lasagne-stained t-shirt, or a pair of scrubs I found lying on the floor in the corner of the changing room, I opt for the latter. Unfortunately the scrub top has ‘theatre staff’ etched in large letters across the front, and is at least four sizes too large. I shuffle to the doctors office looking like an unfurled parasol, the equally ill-fitting trousers catching under my trainers with every step.
My new colleagues glance at me as I enter and introduce myself. They look suitably unimpressed.
‘Are you…a doctor?’ one of them asks, eying me up and down. Given my appearance, it’s a fair question.
‘Yes, I’m the new S.H…registrar…’ I say, my voice tailing off. I curse myself inwardly. Old habits, it seems, die hard.
There’s a gut-wrenchingly long pause.
‘Is that a pommie thing?’ asks the same doctor.
What the hell, I think, i’m going for it.
‘Yeah, it’s basically a registrar’ I say, sounding far from convincing. ‘It…it’s a first year registrar…’
The doctor smiles knowingly. He works in A&E; he can smell bullshit a mile away. He’s enjoying himself though, and is not going to let me off the hook quite yet.
‘You look old to be a first year reg’ he observes, displaying all the subtlety of a slap to the face. I’ve always loved the sensitive approach of the Australians.
This one stings. He’s clearly never worked an A&E rotation in the U.K; an experience guaranteed to age even the most youthful of dispositions.
Fortunately, the day gradually improves, and all my new colleagues are welcoming and happy to help. Throughout the whole shift though, and all the shifts I’ve worked since, I feel like a fish out of water. Sure, I’m working in an entirely different healthcare system, and in a specialty that is not my own, but I think the problem is more deep-rooted. I’m suffering from a severe case of impostor syndrome.
There’s no objective reason for it; I don’t seem to be letting anyone down, and everyone seems relatively happy with my performance, but I seem incapable of internalising these facts. At any moment I expect to be found out and identified as a fraud, and the Australian Medical Council to descend en masse at any minute and drag me kicking and screaming from the building. I look around the doctors office at others in my position and wonder whether anyone else feels like this. They all look so confident, and so self-assured. They project such a confident exterior, and look as though they’ve been registrars their whole lives. I feel as though I’ve regressed; transformed from a self-assured and thoroughly competent SHO to a bumbling registrar, barely able to speak on the phone without tripping over my words and botching my referrals. I’m the England football team of registrars – I’ve developed the yips.

Maybe this confidence, and the ability to appear comfortable in a role befitting your experience, is all an act. Perhaps it’s just something that takes a bit of time. Otherwise I’m doomed to spend the rest of my career crippled by self-doubt and insecurity; a doggy-paddler in an Olympic swimming event.
Only time will tell what will happen in the long run, but in the meantime in my role as an ’S.H registrar’, all I can do is keep on swimming.

#imonemergencycoverjeremy

To everyone picketing…well done.

I’m sure I wasn’t the only one who was nervous yesterday about the first Doctors’ strikes for decades, and all things considered, I thought it went just about as well as it could have. It sounds as though everyone approached picketing in a professional and calm manner, and by the sounds of it the response from the public was generally sympathetic. Whether this will continue if and when further strikes happen is another question entirely, and one for another day.

There’s not much left to say about the contract dispute: there have been so many articles written about it that even the most battle-hardened junior doctor must be beginning to tire of the subject. The contract forum’s initial value as a source of updates on progress has been lost, diluted with the inevitable stream of inane comments and opinions. Since unsubscribing from the endless updates and notifications my blood pressure has returned to (almost) normal levels.

I only have one additional point to add, and for what it’s worth, it’s a piece of advice:

I think that the BMA, and all the doctors commenting in the media, are doing themselves a massive disservice by continuing to claim that the NHS already is a 7-day service. Yes, doctors already work seven days a week, and no, hospitals do not close on the weekends, but almost everybody already knows this. He’s seemingly trying very hard to prove otherwise, but Jeremy Hunt is not a complete idiot. He knows that doctors already work every day of the week. He is very aware, as all of us in the medical profession are too, that his insistence on creating a fully functioning 7 day NHS has not developed from a belief that there is no service at the weekend, but that the service there is isn’t as comprehensive as it should be. Can any doctor who has worked ward cover at the weekend, be it medicine, surgery, paediatrics or whatever, honestly claim that the cover is sufficient and safe? Maybe the department of health have misinterpreted the data in attempt to prove increased weekend mortality, and perhaps there isn’t any increased risk associated with being admitted on a Saturday or a Sunday, but does anyone honestly believe that medical care is as comprehensive as it is during the week? Whether we need anything more than emergency care at weekends is another issue entirely, but coming out with the sound bite of ‘the NHS already is a 7 day service’ risks us sounding ill informed and stubborn.

The question we should repeatedly be asking is how the secretary of state plans to instigate this, to which he hasn’t yet provided a convincing response. This is the point we need to be emphasising. Hunt’s plans are poorly thought out and logistically unworkable, but his claim that the NHS is not a 7-day service is correct. The BMA needs to accept this, or risk losing support and credibility.

Monster Doctors

Firstly, a reminder. I am completely opposed to the idea of the new contract. I think it is both unfair and potentially unsafe, and will ultimately lead to the collapse of the NHS as we know it should it be successfully implemented. This contract dispute has united doctors all over the country, inspired unprecedented marches, and will almost certainly result in industrial action from doctors for the first time in decades.

Unfortunately, it has also awakened a monster.

The initial response from junior doctors everywhere was admirable, and trainees all over England stood together in a show of solidarity. Most of the original content on the 50,000-strong Facebook group expressed outrage at the contract changes, discussed the possibility of industrial action, or mused at the merits or otherwise of fleeing to an alternative career in Australasia.

Other contributors, though, veered away from the serious and depressing nature of the contract disputes, and soon amusing videos, memes and parodies saturated the wall. Some posts you felt must have been accidental; surely no one thought it was appropriate, or of interest to others, to post a recipe for chilli on a forum dedicated to contract implementation? Suddenly, too, we were seeing photos of contributors’ babies, with inspiring quotes pasted above them.

As inane as some of this was, it was just about manageable. It was good-natured, it was harmless, and it was in some ways a welcome break from the disheartening realisation of the impact of the impending contract. What was not acceptable, though, was some of what followed.

First there was the Gladiator parody film. Is comparing Junior Doctors’ contract disputes to the plight of slaves really appropriate? Yes, it was an attempt at humour, but you can’t help from reading some of the responses that some believe us to be martyrs to a cause of epic proportions.

Next came the music video (can we call it that?) outside an instantly recognisable hospital. Here are Doctors prancing with synchronised dance moves, singing a song about Jeremy Hunt. Is this the kind of attention-seeking behaviour we want to advertise to the public? It makes doctors look lazy, and it’s not hard to imagine the average Daily Mail reader’s reaction. Why are these doctors cavorting outside the hospital rather than treating patients inside, they may ask. To be fair, it’s not an unreasonable question.

This video appeared in the midst of endless tales of self-sacrifice and heroism. Doctors have been frantically documenting all of their wonderful altruisms for others to see. You’ve held the hand of someone who was dying? You’ve stayed 3 hours beyond your shift? Congratulations, you’ve done your job. The same way as pretty much everyone else who has ever worked as a junior doctor has done theirs. Perhaps you’re writing all this on a public forum because it provides some relief or catharsis. Reflect on it for your E-portfolio then! That’s what it’s there for! Sadly, the implicit point seems in many cases to be that being a doctor is somehow more worthwhile than any other career.

This brings me on to my next grievance. I’ve read more than once that doctors are the cream of the crop, and that ‘we could walk into any job in the private sector’. This comment smacks of both arrogance and ignorance towards any career other than our own, and quite frankly, makes me embarrassed to call myself a doctor.

Ok, so in all likelihood it is a small minority of doctors who feel this way, and these posts probably aren’t reflective of the views of the profession as a whole. This sanctimonious attitude worries me though. With it looking more likely every day that doctors will take industrial action, this contract dispute will be hugely influenced by public opinion. The medical community cares deeply about public perception, and attitudes that some doctors are demonstrating is only going to hinder any attempt at gaining support from the public.

I’m beginning to feel uneasy about striking, primarily as I don’t think it will have the slightest impact upon the government’s plan to push forward with the contract implementation. If we do strike though, we need to do so whilst retaining some semblance of class and perspective. Otherwise, I’m afraid, this new contract is all that we deserve.

An open letter to the Nurses of the NHS

I’m one of the thousands of Junior Doctors working in the NHS. We’re a group that includes not only the fresh-faced newbies that fill you with fear for a few weeks every August, but all your doctors up to the level of consultancy.

I’m sure many of you have read some of the multitude of articles and letters that have been shared over the last few weeks. I wonder whether you’ve been underwhelmed by the stories of empathy, of sacrifice, and of heartbreak. Why? Because you go through exactly the same every day. These scenarios are not unfamiliar to you. We work side by side on the wards, in clinic, and in the community, and work as a team to provide the best for our patients.

I feel privileged to have worked side by side with some of the most knowledgeable and compassionate nurses I could ever imagine, and I know that there are thousands of other doctors out there who are as eternally grateful for your support.

And so it is that once again, we need your help.

If the contract changes being implemented by health secretary come to fruition, we believe wholeheartedly as a profession that this could be the start of the dismantlement of the National Health Service as we know it. I’m not going to re-hash figures – they’re in most of the letters that have already been written – but as colleagues that know what it’s like to care for patients on the front line, I’m sure you’ll understand our concern that patients’ safety is at risk. Doctors will leave either the profession or the country, and their tired replacements will make mistakes in the 90^th hour of their working week.

Unfortunately, it’s likely that Mr Hunt has your profession in his crosshair too. Once he’s crossed the doctors off his list, would you bet against other health care professionals being next in line? These contract changes need to be stopped at source.

So how can you help? By raising awareness, primarily. You may have been surprised at the lack of media interest in the issue, and without public support our position is certainly weakened. Please tell your friends and tell your patients, or post a message of support on social media. Perhaps you’d like to join us when we protest in the streets? I know you’d be welcomed with open arms.

Teamwork is what allows us to work together to look after our patients, and right now teamwork might be what saves the NHS from Jeremy Hunt, and from irreparable damage.

Yours,

Dr Mike Forsythe

GP Trainee

Dear Mr Hunt

whistlingdixietalk's Blog

Dear Mr Hunt

This is not a letter about the ‘7 day service’ shaped political football which seems to be is perpetually in play. This is not a letter about the consultant opt-out clause. It is not a letter about the difference between elective and urgent care. This is a letter about the unjust and unsafe contract which the junior doctors of this country have been threatened with. I am by no means unique or particularly special among my profession, but as I stand aghast at the proposals being thrust upon us, I can only presume that you do not truly understand what they will mean for my colleagues and I. As Atticus Finch told us “You never really understand a person until you consider things from his point of view…until you climb into his skin and walk around in it.” This is a philosophy we often use in medicine…

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A storm is brewing

24 hours later, and I’m feeling marginally more positive. The impending Rugby World Cup may be a factor, but more likely it’s down to the unanimous reaction from doctors all around the country to the government’s announcement yesterday – let’s call it ‘Contractgate’ – and the passion that many of these posts or comments demonstrates.

Yesterday I voiced my worry that any complaints or objections would remain exactly that, and not lead to any concrete action or response, but judging from the overwhelming response from doctors and other healthcare professionals, a proactive response could be on the cards. The BMA’s press release wasn’t exactly the rallying response many were looking for. The sad expressions of two of their members, looking as though they’ve forgotten to set the record for the Great British Bake Off, and a promise to ‘urge’ the government to reconsider their stance, are unlikely to inspire an reassure an entire profession that their working in our best interests.

There were many wonderful responses though, most notably from Dr Aoife Abbey*, and a genuine sense that doctors are prepared to act, and stand up for their livelihood. Is industrial action the answer? It may be the case soon that there are few other viable options.

If that is a case, then here’s a warning.

I wonder if anyone else shared an initial bewilderment at the lack of press coverage dedicated to Contractgate, and to the fact that almost a quarter of a million people signed a petition to sack the Health Secretary? Have you, too, have come to suspect that this is far from a coincidence or an oversight? I realise that I might be sounding like a crackpot conspiracy theorist, but it would certainly be in the Government’s interest to limit the public’s involvement in the matter. Make no mistake though; should it come to a situation where doctors do strike, there will certainly be no shortage of press coverage then. We will made pariahs, be cast as uncaring and selfish, and held responsible for any medical misfortune the newspapers feel fit to report.

So here’s my rallying cry to all my fellow doctors, and anyone who cares about the future of the NHS. If we really believe that Contractgate is unjust, if we truly want to instigate change, and if we are serious about standing up for our profession and everything it represents, then we need to involve the public, and somehow raise awareness. It’s time to tell your patients, and talk to your non-medical friends, and try desperately to pre-empt this impending cataclysm.

A storm is coming, and we need all the allies we can get.

*https://whistlingdixietalk.wordpress.com/2015/09/16/dear-mr-hunt/

Resignation, not resignations

It pains me to say it, but Jeremy Hunt is a clever man. He may have the constant smug expression of man who’s just hit 21 three successive times on the Blackjack table, but he’s a canny operator. Faced with the task of cutting costs in the NHS, he’s set his crosshairs on an easy target. Perhaps playing on assumptions of many that doctors are privileged, overpaid and error-strewn, he’s also identified the nature of the workforce that’s he’s dealing with.

Probably aware, too, of the lack of truly viable alternatives available to doctors, the health secretary has realised that if he can cope with a short-term tirade of abuse on social media, and a longer-term resentment from the majority of NHS staff, he’ll soon have succeeded in his aim.

Doctors are stoical. There are very few who haven’t regularly stayed late at the end of their shift, often for many hours, for one reason or another. We’ve known we’re not going to get paid for this extra time in the majority of cases, but do it anyway, either through a sense of duty towards those we look after, or simply because if we didn’t, someone might die. We may get home and moan to our flatmates, partners, or family, but we return the following day and do exactly the same.

I fear that the new contract implementations will elicit a similar response. There will be indignation, there will be discontent, but ultimately there will be acceptance. Most doctors love their job, and care deeply for their patients and the concept of the NHS.

What other options do we have? Many are threatening to go abroad to work, enticed by financial incentives, and the promise of a better work/life balance. Uprooting and moving to the other side of the world is a drastic step though, and for many with families and ties in the UK, not one that is realistic. Besides, in many countries traditionally associated with accepting British doctors into jobs abroad, the emphasis is now on training home-grown medics, and it is they who will receive preference when it comes to filling jobs. Gone are the days of sending an enquiring email to a hospital in Melbourne or Sydney, and receiving a job offer the following day.

Striking is not an option, primarily due to the duty of care we have towards our patients rather than any trade union bill. There’s also no chance that the startling lack of media coverage dedicated to the contract implementations would be repeated should doctors plan a walkout.

I find scant consolation reading the vitriolic responses from doctors on social media. It’s admirable that people still seem to care, and still have the energy to summon a degree of outrage to this prolonged attack on our profession. There is talk of action, and of taking on the government with the full backing of the British Medical Association. There appears to be genuine hope, albeit tinged with desperation, that we can fight the injustice and apparent madness of these reforms, and come up with an alternative that will benefit both patients and healthcare professionals.

Sadly, but I can’t see a satisfactory way out of this dire situation. The future of the NHS is far from certain, but the Health Secretary will be happy to call its doctors bluff. He knows we will cling to it for as long as it lasts, like a captain loyally going down with his ship.

Many are threatening to quit their jobs in the light of the new contracts, but rather than resignations from doctors, expect widespread resignation, and a further fall in morale from a crumbling workforce.

Latte for Jeremy

A couple of months ago, I met the health secretary in a motorway services off the A3. Actually, to say I met him is somewhat of an overstatement. He was in the queue in front of me at a Starbucks, and after much debate and silent gesticulating, his identity was only confirmed when a barista yelled ‘latte for Jeremy!’ at the top of her voice.

There was much I wanted to ask Mr. Hunt. I wanted to challenge him about his plans for the future of the NHS, and tell him that I didn’t believe he cared about those who A work in this fantastic organisation.

I have to admit, I bottled it. I told myself at the time that it was because he was with his family, and I didn’t want to intrude, but it was worse than that. There was still part of me that wanted to believe that he was an intrinsically decent human being, and that some part of him still cared about the NHS and its staff.

Following the well-publicised activity of Mr. Hunt over the previous week, it has become obvious that I gave him far more credit than he deserves.

Responses in the press and on social media to Mr. Hunt’s attack on hospital consultants have been swift, and largely unanimous. Many have highlighted the lack of respect towards staff that sacrifice so much to care for the sick, whereas others have focused upon the financial ramifications of the government’s reported plans to rebrand the classification of ‘out of hours care’. Some of these articles have been beautifully written, well thought out, and truly inspiring. They’ve made me proud to work for the NHS.

Nowadays it seems that no outpouring of outrage or combined solidarity is complete these days without the obligatory Twitter hashtag. Whereas it’s been entertaining to see pictures of colleagues and friends working on the wards via the medium of #iminworkjeremy, I hope that this attempt at gallows humour doesn’t distract from the gravity of the situation. It seems ridiculous that we should have to emphasise the fact that health care professionals work weekends, as though this is something out of the ordinary.

We must continue to object in the strongest possible terms to the unprovoked attack on hospital consultants, a move clearly made to attract the greatest degree of public support. Attacking those in perceived positions of privilege is well-used tactic by politicians. The health secretary has made no mention of the fact that most in the NHS agree that the development of a seven-day service is a necessary step.

As many before me have correctly pointed out, the presence of consultants in hospital at the weekend will not back a shred of difference unless every other group of professionals, from porters to radiographers, are also in the hospital.

I do feel sorry for patients at the weekend; it can be a lonely and frustrating 48 hours without any new information, and no progression in their treatment. I’ve worked weekend on-calls and been desperate to check-in on my regular ward patients, only to find that the sheer weight of workload renders this completely out of the question.

If Mr Hunt is truly determined to instigate an effective 7-day service, rather than just provide headline grabbing sound bites, alienating the very people who could help him establish it is an act of pure stupidity. I fear he’s more interested in saving money than in optimising patient care.

The next time I’m in a coffee shop, or a motorway service station, I’ll look out for Mr Hunt. If I am ever unfortunate enough to run into him again, I promise I won’t miss the chance to give him a piece of my mind.

The Complaining Game

Originally published on the Guardian online. 

There’s a fact that’s common knowledge amongst those of us who work in the NHS.

We pretend it doesn’t exist, deny it to each other even, and would certainly never admit it to patients.

The dirty little secret is simple; if you are a patient who makes a complaint, or causes a fuss on the ward, you’ll probably receive better care from those employed to look after you.

Everyone would surely agree that this isn’t fair. Unfortunately it seems that as soon as a patient complains, or utters even a word of discontent, there is immediate commotion; a state of complete panic setting in amongst the ward staff. Suddenly consultants who haven’t been seen outside of their offices for months appear on the ward, stern faced and on the hunt for someone to blame. How dare one of their patients have cause for complaint! And who is the junior doctor responsible for this?

There are probably many reasons for this – no doubt the fear of potential media coverage being one – but even the smallest quibbles have to be dealt with with the utmost care and attention.

If you’ve ever had to write a formal response to a complaint, even if it is completely unsubstantiated, you will understand just how much effort this involves. A potential story appearing in the media is even more of a daunting prospect. The need to comply with patient confidentiality often leaves trusts unable to comment on stories reported by the press, their silence consequently seen as an admission of guilt.

The complaints procedure is entirely necessary; it prevents negligence and promotes transparency of care, and patients should always retain the right to make a complaint, and to highlight situations where something has gone wrong.

Some patients have become wise to this however. They can be obnoxious, attention seeking, or downright unpleasant, but we grit our teeth, and resist the urge to tell them so. Regardless of the veracity of their complaint though, they will receive more attentive and more efficient treatment. This is an age of patient-led care, and for all the benefits that this has provided, many patients have become empowered to make demands that are far beyond what the NHS can provide.

Spare a thought for the little old lady in the corner, the one who waits quietly by their bed, not wanting to cause a fuss. They don’t deserve to be overlooked in favour of the loud and demanding patient who threatens to contact the Daily Mail at every opportunity.

Often through little fault of their own, NHS staff are stalled by unavoidable hurdles, such as staffing levels, or lack of resources. Working under these extreme pressures inevitably means that we sometimes cannot always provide the instant answers and results that some expect from their healthcare system. With every other newspaper article bringing news of the latest failure of the health service, it’s easy to jump on the bandwagon and blame every discontent on the NHS.

Patients shouldn’t have to resort to making a fuss and criticizing to receive appropriate care, but equally doctors and nurses’ fear of repercussions should not result in preferential treatment over others.

The IMD Doctor

Originally published in the BMA News.

Working night shifts can lead to some questionable decision-making. As I stumbled bleary-eyed into the clubhouse after a precarious 45-minute drive straight from work, agreeing to play in a golf tournament didn’t seem like the most sensible of ideas.

I was to be paired against a local GP called Dr Hardy, so at least, I thought, he’d understand better than most my current combination of exhaustion and delirium.

It took all of one swing of the club to remember why it’d been so long since I’d ventured onto a course, and I was soon knee deep in the undergrowth trying in vain to fish my ball out of a gorse bush. My opponent helped me with nothing more than a perfunctory sweep of the surroundings, one eye no doubt on his own ball, sitting triumphantly in the middle of the fairway.

‘Sorry,’ I ventured, ‘I’ve just finished a weekend of night shifts, so I’m not expecting to give you much of a game today’

Dr Hardy raised his bushy greying eyebrows.

‘Do you just work the three night shifts in succession nowadays? That doesn’t seem particularly challenging’

So there it was. I’d suspected as much on first meeting him, but here was confirmation. My opponent was an ‘In My Day’ doctor.

Every junior knows at least one IMD doctor. They learnt their trade in a bygone era, and feel the need to remind you of how much tougher everything was for them when they were training. 48 hours a week? They worked three times more than that. An afternoon every month for undisturbed teaching? They were afforded no such luxuries, forced to study their medical textbooks only after finishing their shift.

A short while later, perhaps buoyed by the fact that he’d comfortable won all of the opening four holes, Dr Hardy began his onslaught.

‘We used to work for over 24 hours straight when we were on call,’ he muttered as we stood on the 5^th tee. It seemed a bit rich of him to be preaching about hard work, it occurred to me, given that it was a Monday morning and he was on the golf course.

‘It’s not surprising that you lot are not being trained properly,’ he continued, simultaneously admiring another arrow-straight drive.

This is another IMD doctor favourite. Working a rota that allows any time outside of the hospital is apparently not conducive to learning our trade, and leaves us hopelessly inept, incapable of providing even half-decent medical care. My post-nights euphoria was wearing off, replaced instead by a splitting headache, and a steady crescendo of frustration. Who was this man to criticise a whole generation of doctors without the slightest provocation?

I told myself that Dr Hardy was not someone worth getting worked up over, even if he had accompanied every successful putt with a fist pump in my direction. IMD doctors’ criticisms are based on flawed assumptions and over-simplifications. Yes, they worked longer hours and sometimes worked 24 hour on call shifts, but they were paid more as a consequence. And is an exhausted doctor not potentially more of a danger to patient safety than a well-rested one?

Rising tuition fees have left many of today’s junior doctors with crippling debts, and we don’t have the luxury of free accommodation that many before us benefited from. We spend our days at work buried under more and more paperwork, with many learning opportunities limited by the potential threat of litigation. The press label us as incompetent, and we’re shifted from department to department, often for no reason other than service provision.

And then there’s the E-portfolio. Every thought and action has to be written down, reflected upon, and validated by a senior. Hours upon wasted hours are spent persuading colleagues to fill in reports describing how wonderful we are, or reminding them that they once watched us change a patient’s dressing, and should recount the procedure in detail.

Maybe it was thinking about the E-portfolio, but suddenly I was filled with a steely determination. I was going to stand up for every other junior who’s job had been belittled, and for every colleague that’d had to sit silently as a senior complained about how much harder it was when they first started. There were only four holes left to play, but I was not going to lose to Dr Hardy.

I settled over my tee shot, embracing the challenge of being three shots behind, and of facing a hole with a far too conspicuous railway line snaking perilously close to the edge of the fairway. My body was relaxed and my mind focused as the ball flew off the middle of the club, high into the midday sky. This was a swing for disgruntled junior doctors everywhere.

Passengers on the 12.07 fast train from the local railway station would have at least remained oblivious to just how close a golf ball came to disrupting their journey, the trajectory of my hook meaning disaster was avoided by at least a couple of inches. I held out my hand to my opponent, resigned to defeat. Dr Hardy didn’t make much effort to hide the smug expression from his face.

I squeezed his hand weakly, wishing my night shift had lasted 12 hours longer.