The home straight

Time is flying here. Winter seemed to reach it's peak last week. We had a couple of weeks of really cold mornings - down to -25C on a couple of mornings and -30 with wind chill factored in. At that temperature the cycle to work becomes a race to get there before your nose and fingers drop off.

The snow is now melting, and it's warming up. We had a couple of feet of snow altogether. The boys are very disappointed we didn't get to build a snowman. It's too cold - When it's cold here there is no moisture in the air - and the snow seems really dry like powder, so the snow doesn't stick together. We had to buy a humidifier for the house - I was getting nosebleeds overnight because of the dry air. We'll miss the snow - it's been fun - sledding with the boys, cross country skiing, and skiing in Brighton - just 30 minutes drive North of Ann Arbor.

We also had a holiday in Breckenridge, Colorado. We hired a condo there via VRBO.com - a great website for finding private holiday lets. Breckenridge was awesome. We had a fantastic week, and we will definitely be heading back there. A lot of Brits skiing there said to us they would never go back to Europe after skiing in the USA. I highly recommend it for any skiers. Fly to Denver, hire a car. 2 hour drive from the airport. Rent a condo from VRBO.com or Homeaway.com. Rent ski's from Blueriversports.com. See Breckenridge.com for lessons, passes, etc.


It's unbelievable a whole year has nearly gone. They are planning the annual Rotator leaving party (aka "Go back to your own country" party). A year ago we were frantically making arrangements to come out, and we had already had our leaving party. We are less frantic about the move back to Britain. That's not to say we haven't got a lot to organise. At the time of writing we still do not have anywhere to live sorted out in the UK. The move back to the UK is exciting in some respects, and sad in many others. None of us really want this year to end because it's been such a great experience. It's been intense - like a couple of years worth of experiences squashed into one year. We've worked hard, played hard - it's a cliche, but it's true.

All the rotators here know it won't be the same when we go home. In our time here we've had holidays / breaks to Chicago twice, Las Vegas, Niagara, Washington DC, Colorado, North Carolina & Tennessee, 2 holidays in Northern Michigan and one long weekend on Lake Michigan. We're also having another holiday in Florida before we return to Blighty. As well as the frequent holidays, we've got a taste of the good life in general. Big house, big car, nice city to live in. We've got used to eating out 2-3 times a week, and have got used to big portions and service with a smile (and always having to tip..) . We've got used to beautiful parks and clean streets. Good coffee and crap chocolate. Most of all we've all made very good friends - who no doubt we will keep in touch with, but we will be sad to say goodbye.

In work we have got used to more responsibility, and also more respect. We are not treated like children, but like professionals. In return we're expected to act like professionals. It's not uncommon for us to be working later than our official hours here to make sure that all the lists get finished (Cases never ever get cancelled because we ran out of time). In return we are paid well for our extra hours, and we get fed (Usually 30 pizzas from the local takeaway). We get fed a lot here at work. Bagels or yoghurts from breakfast every day, Fruit and danish pastries every Thursday morning with the M&M meeting. There is often a free lunch, and pizza or mexican in the evenings if you're here late. And of course there is Starbucks filter coffee on tap all day long. We have a nice on-call room for our on-calls. The residents have on-call rooms too. They realise the importance here that even on a night shift, a short sleep and a break helps you function.

I'm worried that because we've had such a good year I will have to come back down to reality with a thump. It's not just me - it's a sentiment shared by all the rotators. A fear of going back to normality - back to "life before". Back to a small house, small car, eating out less, fewer holidays, nights shifts, no on-call rooms, less responsibility, less respect, less money, and all the latest pointless tick boxing exercises forced upon us by the government.

In a way I think the differences illustrate the difference in how the US and UK societies value their doctors and healthcare in general. In the US people pay a lot for healthcare. They pay huge insurance bills, then often have to pay co-payments on top of that. They know it is expensive. Perhaps because of that they value it more. The doctors earn a lot from healthcare. They justify this because of the amount of personal money and time they have had to invest to become doctors. The doctors here get a lot of respect from the public in general because people know they have worked hard to get to their position.

In the UK society has become used to free healthcare. Very few people understand the true costs of their treatments. Fewer and fewer people appreciate what they get from the NHS. Those that do value the NHS are often those old enough to remember the days before the NHS. Everything is expected to be provided for free. Perhaps because everything is free it is undervalued. Doctors have invested just as much time (although admittedly less money till now) to get to their position, but earn substantially less. Doctors in the UK are still relatively well paid, but when you compare doctors earnings in the UK with other professionals, and doctors earnings in other countries against other professionals it appears that in the UK we are relatively undervalued. I'm not just talking about doctors, but healthcare in general. And it's not just about the money either. We put up with worse and worse working conditions and are powerless to complain about it. We don't even get tea or coffee or milk provided anymore. No hot food after 8 in the evening. No on-call rooms. Over crowded office space. Small, cramped and dirty changing facilities.

Of course going home is not all that bad and every cloud has a silver lining - and I can't wait to go to a nice pub and drink a nice warm beer, eat a big roast dinner with yorkshire puddings, watch some rugby, go walking in the welsh mountains, see the sea, drive on proper roads. In work - I'm looking forward to doing my own cases again, and doing my own procedures rather than supervising most of them. I'm looking forward to doing my paediatric module, finishing my training and getting my CCT. And of course I'm looking forward to catching up with all my friends, family and work colleagues.

It's not over yet of course - and we're determined to make the most of our last 6 weeks or so. I'll be working for most of it - I've got my research project to finish off and write up. I'm hoping to present it at this years ASA conference in Chicago. We've got 10 days in Florida before we return to the UK though which will be a great way to end the year.

That's all for now - Keep checking in -

Drake.